phenylephrine-hydrochloride and Wounds--Penetrating

Penetrating cranionasal injuries are relatively rare, usually occur in young children, and can be caused by a variety of unusual objects. The mortality and disability rates are high without appropriate treatment. We report a penetrating cranionasal injury caused by a bicycle spoke. Some fundamental principles in the diagnosis and treatment of penetration injuries are emphasized from this case and the surrounding literature reviewed.

Topics: Anti-Bacterial Agents; Bed Rest; Bicycling; Ceftriaxone; Child, Preschool; Craniocerebral Trauma; Female; GABA Agents; Humans; Nose; Tomography, X-Ray Computed; Valproic Acid; Wounds, Penetrating

Topics: Amputation, Traumatic; Bites and Stings; Facial Injuries; Humans; Nose; Rhinoplasty; Skin Transplantation; Wounds, Penetrating

Traumatic wounds are one of the most common problems encountered in the practice of emergency medicine. The literature is replete with articles concerning the evaluation and care of life threatening wounds, but many common non-life threatening injuries have received very little attention. This article focuses on nail bed injuries, plantar puncture wounds, and cartilaginous wounds. Although not immediately life threatening, these injuries may be associated with significant long-term morbidity and, rarely, life threatening sequelae.

Topics: Cartilage; Ear, External; Foot Injuries; Humans; Nails; Nose; Wound Infection; Wounds and Injuries; Wounds, Penetrating

Topics: Athletic Injuries; Child; Ear; Ear Diseases; Fractures, Bone; Humans; Larynx; Nasal Bone; Neck Injuries; Nose; Wounds, Nonpenetrating; Wounds, Penetrating

We describe the case of a child with an isolated penetrating trauma to the mastoid tip. Nasal blowing consequently induced air bubbles coming through the mastoid cutaneous fistula and causing extensive subcutaneous neck emphysema. A computed tomography (CT) demonstrated a right mastoid tip bone fracture with extensive cervical subcutaneous emphysema. The patient was treated conservatively with antibiotics and did not require operative intervention. His subsequent course was uncomplicated. This case emphasizes the importance of taking seriously even what seems to be a minor skin laceration.

Topics: Air Pressure; Child; Humans; Male; Mastoid; Neck; Nose; Skull Fractures; Subcutaneous Emphysema; Tomography, X-Ray Computed; Wounds, Penetrating

Reconstruction of the nasal lining has traditionally been performed using the folded radial forearm free flap, given its reliable blood supply, pliability, and familiarity to surgeons with respect to its harvest. More recently, the free ulnar forearm flap has been proposed as an alternative reconstructive option for the nasal lining, with safe and reliable outcomes, and improved donor-site morbidity compared with its radial counterpart. In this article, the authors provide educational video footage with accompanying text description of the senior author's (E.D.R) approach to design and elevation of the free ulnar forearm flap for the purpose of reconstructing a composite nasal defect. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

Topics: Adult; Anatomic Landmarks; Composite Tissue Allografts; Facial Injuries; Forearm; Free Tissue Flaps; Humans; Male; Nasal Mucosa; Nose; Postoperative Care; Transplant Donor Site; Vascularized Composite Allotransplantation; Wounds, Penetrating

Foreign bodies (FBs) in the paranasal sinuses are rare, whether iatrogenic or traumatic. One of the most common causes of such traumatic injuries is gunshot wounds from the bullets. Removing FBs from the paranasal sinuses usually needs endoscopic or open surgery. We present the case of a 22-year-old male soldier who sustained a penetrating injury of his nose and maxillary sinus with an iron rod that was a part of his gun, which was removed without either endoscopic or open paranasal sinus surgery.

Topics: Facial Injuries; Foreign Bodies; Humans; Male; Maxillary Sinus; Military Personnel; Nose; Tomography, X-Ray Computed; Wounds, Penetrating; Young Adult

Management of penetrating trauma to the paranasal sinuses with retained foreign bodies represents a challenge due to the proximity to vital neurovascular structures. The authors report the successful treatment of a patient with a work-related nail gun injury, carried out by means of a combined endoscopic endonasal external assisted procedure.A transnasal endoscopic approach was planned to minimize inadvertent movements of the nail during surgery and in case necessary to repair the orbit or skull base. No major bleeding or neurovascular complication was observed after surgery and a computed tomography scan was performed after surgery confirming the complete removal of the nail and with no damage of the orbit nor the skull base.

Topics: Adult; Foreign Bodies; Humans; Male; Nails; Natural Orifice Endoscopic Surgery; Nose; Paranasal Sinuses; Tomography, X-Ray Computed; Wounds, Penetrating

Topics: Forehead; Humans; Male; Myocutaneous Flap; Nose; Rhinoplasty; Skin Transplantation; Treatment Outcome; Wounds, Penetrating

We report the first case of a transnasal penetrating intracranial injury in Hong Kong by a chopstick. A 49-year-old man attempted suicide by inserting a wooden chopstick into his left nose and then pulled it out. The chopstick caused a transnasal penetrating brain injury, confirmed by contrast magnetic resonance imaging of the brain. He was managed conservatively. Later he developed meningitis without a brain abscess and was prescribed antibiotics for 6 weeks. He enjoyed a good neurological recovery. This case illustrates that clinician should have a high index of suspicion for penetrating intracranial injury due to a nasally inserted foreign body, even though it had already been removed. In such cases moreover, brain magnetic resonance imaging is the imaging modality of choice, as it can delineate the path of penetration far better than plain computed tomography.

Topics: Brain Abscess; Brain Injuries; Cooking and Eating Utensils; Foreign Bodies; Humans; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Nose; Wounds, Penetrating

Foreign body (FB) in the nose is a frequent situation seen generally among children. A variety of objects left in different sites of the nose has been reported in the literature. Insertion of a FB to the nose is generally via the anterior nares. In this report, an unusual entry site for a nasal FB in a neglected trauma patient is presented. FB should be suspected and investigated in children after penetrating facial injury.

Topics: Child; Female; Foreign Bodies; Humans; Nose; Radiography; Wounds, Penetrating

Topics: Accidents, Occupational; Adult; Foreign Bodies; Humans; Male; Middle Aged; Nose; Wounds, Penetrating

To determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) detections identified by nasal swabbing using agar culture in comparison with multiple body site testing using agar and nutrient broth culture.. Cross-sectional study.. Adult patients admitted to 36 general specialty wards of 2 large hospitals in Scotland.. Patients were screened for MRSA via multiple body site swabs (nasal, throat, axillary, perineal, and wound/invasive device sites) cultured individually on chromogenic agar and pooled in nutrient broth. Combined results from all sites and cultures provided a gold-standard estimate of true MRSA prevalence.. This study found that nasal screening performed better than throat, axillary, or perineal screening but at best identified only 66% of true MRSA carriers against the gold standard at an overall prevalence of 2.9%. Axillary screening performed least well. Combining nasal and perineal swabs gave the best 2-site combination (82%). When combined with realistic screening compliance rates of 80%-90%, nasal swabbing alone probably detects just over half of true colonization in practice. Swabbing of clinically relevant sites (wounds, indwelling devices, etc) is important for a small but high-prevalence group.. Nasal swabbing is the standard method in many locations for MRSA screening. Its diagnostic efficiency in practice appears to be limited, however, and the resource implications of multiple body site screening have to be balanced against a potential clinical benefit whose magnitude and nature remains unclear.

Topics: Aged; Aged, 80 and over; Axilla; Bacteriological Techniques; Carrier State; Cross Infection; Cross-Sectional Studies; Culture Media; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Perineum; Pharynx; Staphylococcal Infections; Wounds, Penetrating

Transnasal intracranial penetrating injury is rare. We report a case of transnasal intracranial penetrating metallic chopstick, which was removed successfully by endoscopic approach, and management of transnasal intracranial penetrating injuries.

Topics: Brain Injuries; Endoscopy; Foreign Bodies; Humans; Male; Middle Aged; Nose; Sphenoid Sinus; Wounds, Penetrating

Topics: Accidents, Occupational; Adult; Construction Industry; Humans; Male; Nose; Wounds, Penetrating

Central-facial mutilations, located within the nose lips and chin triangle, require great quality repairs regarding morphology and function. Plastic surgery history affords the ideas evolution in this field crossing over nose and lips reconstructions, which were the subject of successive reports within our society, in 1994 (nose reconstruction) and 2002 (lips reconstruction). Now a day, following this progress, the plastic surgeon has a large choice of reliable techniques. His choice is dictated by a precise evaluation of the limits of the substance loss to repair, according to a (mapping) classification of the nose-lip and chin triangle. This classification defines three units (nose-labial, bilabial and chin-labial) as reflexion bases to the therapeutic indications. This anatomical and surgical approach was built starting from a retrospective study of 195 central-facial mutilations caused by ballistic damage and dog bites. The results evaluation makes possible to carry out a reflexion on the potential indications regarding allograft as a therapeutic alternative to the traditional reconstructions of this territory.

Topics: Animals; Bites and Stings; Chin; Dogs; Evidence-Based Medicine; Face; Humans; Lip; Nose; Plastic Surgery Procedures; Rhinoplasty; Surgical Flaps; Transplantation, Homologous; Treatment Outcome; Wounds, Gunshot; Wounds, Penetrating

Topics: Accidents, Traffic; Brain Injuries; Cranial Fossa, Anterior; Craniotomy; Endoscopy; Foreign Bodies; Humans; Male; Nose; Tomography, X-Ray Computed; Wounds, Penetrating; Young Adult

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians.. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals.. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries.. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

Topics: Adult; Cohort Studies; Hospital Mortality; Hospitalization; Hospitals, General; Humans; Incidence; Injury Severity Score; Israel; Lebanon; Length of Stay; Male; Maxilla; Maxillofacial Injuries; Military Personnel; Multiple Trauma; Nose; Orbit; Registries; Retrospective Studies; Survival Rate; Warfare; Wounds, Gunshot; Wounds, Penetrating

Topics: Child; Female; Humans; Nose; Paranasal Sinuses; Wounds, Gunshot; Wounds, Penetrating

Intracranial penetrating injury through the nose is uncommon. We present the case of a four-year-old girl who sustained a transnasal, intracranial penetrating injury with a sharp wooden object. We performed endoscopic removal of the foreign body and repair of the associated cerebrospinal fluid fistula.

Topics: Brain; Brain Injuries; Child, Preschool; Endoscopy; Ethmoid Bone; Female; Foreign Bodies; Humans; Magnetic Resonance Imaging; Nose; Skull Fractures; Wounds, Penetrating

Topics: Female; Foreign Bodies; Humans; Middle Aged; Nasal Septum; Nose; Self-Injurious Behavior; Violence; Wounds, Penetrating

Topics: Accidents, Occupational; Adult; Angiography; Device Removal; Ethmoid Sinus; Facial Bones; Follow-Up Studies; Foreign Bodies; Humans; Male; Maxillary Sinus; Metals; Nose; Postoperative Complications; Skull Fractures; Temporal Bone; Wounds, Penetrating

Topics: Adolescent; Adult; Biological Factors; Female; Humans; Iontophoresis; Lip; Male; Middle Aged; Nitric Oxide; Nose; Nose Deformities, Acquired; Skin Transplantation; Surgery, Plastic; Surgical Flaps; Wound Healing; Wounds, Penetrating

Topics: Adult; Cooking and Eating Utensils; Foreign Bodies; Humans; Male; Nose; Tomography, X-Ray Computed; Wounds, Penetrating

Topics: Adult; Cellulitis; Cosmetic Techniques; Ear, External; Female; Granuloma; Humans; Impetigo; Keloid; Male; Nose; Wounds, Penetrating

Topics: Adult; Beauty Culture; Cricoid Cartilage; Ear; Ear Cartilage; Female; Glottis; Humans; Immunosuppressive Agents; Inflammation; Methotrexate; Needles; Nose; Polychondritis, Relapsing; Prednisone; Treatment Outcome; Wounds, Penetrating

Blast injuries involving the frontobasilar region and orbit can present difficult evaluation and treatment challenges. This article presents the surgical treatment of four patients presenting with blast-type injuries involving the central periorbital region and anterior skull base. Three of these were the result of close-range gunshot wounds, and one was caused by an avulsive penetrating tree branch injury during a motor vehicle accident. All four patients underwent frontal craniotomy for exposure to repair significant intracranial injuries. Following intracranial repair of dural and brain injuries, anterior cranial fossa reconstruction was performed. In two of these patients, elective supraorbital osteotomies were performed to allow improved access to the posterior aspect of the anterior skull base. The healing period of all four patients has been without complications relative to the anterior fossa injuries.

Topics: Adult; Blast Injuries; Bone Transplantation; Brain Injuries; Cerebrospinal Fluid Rhinorrhea; Craniotomy; Dura Mater; Eye Injuries, Penetrating; Female; Follow-Up Studies; Frontal Bone; Humans; Male; Nose; Orbital Fractures; Osteotomy; Skull Base; Skull Fractures; Surgical Flaps; Surgical Mesh; Wound Healing; Wounds, Gunshot; Wounds, Penetrating

A case of cowpox infection presenting as a necrotising cellulitis of the nasal tip and vestibule is reported. Diagnosis was established by identification of the pox virus particles from tissue culture of the nasal biopsy using electronic microscopy and the characteristic lesions on chorio-allantoic membrane produced by the virus. Cowpox of the external nose and transmission of the infection from a dog have not to our knowledge been reported previously.

Topics: Adult; Animals; Cowpox; Cowpox virus; Dogs; Female; Humans; Microscopy, Electron; Nose; Wound Infection; Wounds, Penetrating

We report an unusual injury of the face caused by the spoke of an automatic telescoping umbrella that come loose when the umbrella was opened. Due to the shot-like force of the spoke, the left nostril, septum and right wall of the nasal cavity were pierced. The part with the joint penetrated into the maxillary antrum. In order to remove the spoke, wire scissors had to be used to cuff off the spoke's joint inside the surgically opened maxillary sinus.

Topics: Female; Foreign Bodies; Humans; Maxillary Sinus; Middle Aged; Nose; Radiography; Surgical Instruments; Wounds, Penetrating

A method of surgical elimination of postoperative great defects of the hard palate is described. The method is based on using a nasolabial flap. The method was successfully used in 15 patients with this pathology.

Topics: Humans; Lip; Nose; Palate; Skin Transplantation; Surgical Flaps; Suture Techniques; Wounds, Penetrating

Both ears from 494 wild nine-banded armadillos (Dasypus novemcinctus) and nose specimens from 224 animals were collected and histopathologically studied. Lepromatous granulomas were present in the ear specimens of ten of 494 animals. There were thorns in the ears of 22.5% of animals, and in 36.6% of the nose specimens. In one armadillo, there was evidence to suggest that Mycobacterium leprae entered the tissue through the thorn pricks. In the normal habitat of the armadillo in Louisiana there are thorny bushes consisting mostly of the green briar and the southern dewberry. Thorn pricks as a means of transmission of leprosy in the wild armadillos is suggested.

Topics: Animals; Armadillos; Ear; Granuloma; Leprosy; Mycobacterium leprae; Nose; Plants; Wounds, Penetrating; Xenarthra

Topics: Accidents; Adult; Aged; Facial Injuries; Female; Hand Injuries; Humans; Male; Mouth; Nose; Thumb; Wounds, Penetrating

Nasal problems in children are very common. The factors that affect the embryologic development have been discussed. Injuries that occur in prenatal, natal, and postnatal periods affect normal development. Prompt treatment of minor injuries is necessary to prevent airway problems later. The "wait and see" attitude toward nasal deformity is ill advised. X-ray findings are not conclusive, as the nasal pyramid in a child is largely cartilaginous. Obstructive nasal breathing can result in facial asymmetry, malocclusion, and cardiopulmonary problems. Allergy and sinusitis are frequently causes of obstruction.

Topics: Acute Disease; Adolescent; Airway Obstruction; Birth Injuries; Cartilage; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Infant, Newborn; Male; Malocclusion; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Pregnancy; Sinusitis; Skull Fractures; Wounds, Nonpenetrating; Wounds, Penetrating

Topics: Brain; Brain Injuries; Craniocerebral Trauma; Humans; Nose; Skull; Spinal Cord Injuries; Wounds, Penetrating