phenylephrine-hydrochloride and Osteonecrosis

Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications. Because codeine has been the most commonly prescribed narcotic, this has shifted the standard practice.

Topics: Analgesics, Opioid; Codeine; Drug Overdose; Humans; Illicit Drugs; Narcotics; Nasal Septal Perforation; Nose; Osteonecrosis; Otolaryngology; Substance-Related Disorders

The trichorhinophalangeal syndrome is a rare genetic syndrome with characteristic craniofacial and skeletal abnormalities including hip pathology in variable manifestation. We describe hip involvement with Perthes-like changes and a novel mutation of the TRPSI gene in a family with 4 affected individuals. This case series underlines the clinical significance of rare genetic disorders such as TRPS that among other differential diagnoses should be kept in mind when children present with Perthes-like changes of the hip joint.

Topics: Abnormalities, Multiple; Child, Preschool; Diagnosis, Differential; DNA-Binding Proteins; Fingers; Genetic Testing; Hair Diseases; Hip Joint; Humans; Langer-Giedion Syndrome; Legg-Calve-Perthes Disease; Male; Mutation; Nose; Osteonecrosis; Pedigree; Radiography; Repressor Proteins; Transcription Factors

From July 1998 to December 2002, 42 patients (including 29 patients who had undergone radiation therapy) underwent a newly designed lateral nasal wall mucoperiosteal flap pedicled anteriorly on the lateral nasal artery of the angular artery to resurface a translocated facial bone segment during a facial translocation approach to the skull base to prevent its avascular necrosis. Of the 42 patients studied, 1 patient had full-thickness flap loss that resulted in bone graft necrosis. Another patient had marginal necrosis. The average length, width, and surface area of the flap was 30 mm, 45 mm, and 1350 mm measured on 5 patients. The mucoperiosteal flap tolerated radiation therapy well. The lateral nasal wall mucoperiosteal flap is a simple, reliable flap that provides ample vascularized tissue to resurface the nude translocated facial bone segment during a facial translocation approach to the skull base. It thus prevents its avascular necrosis even after radiation therapy.

Topics: Facial Bones; Humans; Nasal Mucosa; Nose; Osteonecrosis; Osteotomy; Paranasal Sinus Neoplasms; Plastic Surgery Procedures; Radiotherapy; Skull Base Neoplasms; Surgical Flaps; Tissue and Organ Harvesting

Topics: Child; Ecthyma; Female; Gangrene; Humans; Leukemia, Myeloid, Acute; Necrosis; Nose; Opportunistic Infections; Osteonecrosis; Pseudomonas Infections; Skin