Early diagnosis and aggressive surgical resection matters to cure rhinocerebral mucormycosis: Six case reports.

Rhino-cerebral mucormycosis (RM) is a rare and opportunistic fungal infection observed in immune-compromised patients and metabolic imbalances such as Diabetes Mellitus. RM rapidly infiltrates blood vessels, leading to vascular thrombosis, subsequent tissue necrosis, and high mortality rates (23.6-60%). Due to its fast advancement, RM is a life-threatening condition requiring accurate clinical decisions by the medical and surgical teams. Based on the report of six cases, we emphasize the need for an early diagnosis and starting antifungal pharmacological therapy at the slightest suspicion of RM. Moreover, the restitution of metabolic balance and aggressive surgical debridement are vital steps to control RM, reducing the possibility of fatal outcomes.

C-arm as intraoperative control in reduction of isolated zygomatic arch fractures: a randomized clinical trial.

PURPOSE: Isolated zygomatic arch fractures (IZAFs) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. METHODS: Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009 and 2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into two groups: 25 patients were in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm, and 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. RESULTS: The results did not reveal significant differences between both groups (p = 0.5). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. CONCLUSIONS: Despite the fact that the results are not statistically significant (p = 0.5), the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.

Use of onabotulinumtoxinA in post-traumatic oromandibular dystonia.

PURPOSE: Post-traumatic oromandibular dystonia (PTOD) is a disorder whose symptoms can include bruxism, muscle pain, and involuntary muscle contraction, among others. The use of onabotulinumtoxinA (ObT-A) is helpful in controlling the symptoms of patients with PTOD. The aim of this study was to evaluate the use of ObT-A in the treatment of PTOD. MATERIALS AND METHODS: In this prospective case-series study, the population consisted exclusively of patients diagnosed with PTOD, without distinction by age or gender, from January 2007 to December 2010. The patients were diagnosed with PTOD and treated with ObT-A infiltration (primary predictor) at the Department of Maxillofacial Surgery at the Hospital Clínico Mutual de Seguridad (Santiago, Chile). The primary outcome variables were bruxism, muscle pain, and involuntary muscle contraction. The data were obtained through questionnaires registered in tables at each control. Systat 13.1 was used for statistical analysis. The statistical test used to compare patients' evolution over time was the test of signs. RESULTS: Thirty male patients 18 to 65 years old diagnosed with PTOD were treated with ObT-A infiltrations. The signs and symptoms associated with oromandibular dystonia (bruxism, muscle pain, and involuntary muscle contraction) were decreased in all patients after ObT-A infiltrations. CONCLUSIONS: The positive results and the absence of complications recommend the use of the infiltration protocol presented in this study for the treatment of PTOD.