Hyperbaric oxygen therapy as adjuvant therapy in necrotizing fasciitis of the face: case report.

Facial necrotizing fasciitis is a rare bacterial infectious disease. Rapid necrosis of the tissues and suppurative fasciitis is pathognomonic. It can be seen following odontogenic infection. Early aggressive debridements and wide-spectrum antibiotic therapy are currently accepted treatments. A 60-year-old man was admitted to the otolaryngology clinic for facial pain and swelling after odontogenic infection. Inflamed left maxilla and orbit were seen, and abscess contents spontaneously drained into the mouth. It was determined that infectious markers were increased in the blood. On MRI, a broad abscess with edema and gas formation was seen. Debridement of the necrotic tissue was performed immediately and wide-spectrum antibiotic therapy was started. Infection was stopped and wound was closed, with four weeks of antibiotic therapy, three sessions of debridement, and 30 sessions of hyperbaric oxygen (HBO2) therapy. HBO2 therapy must not replace the combination of early aggressive debridements and wide-spectrum antibiotic therapy, but rather must be considered as an important adjuvant treatment.

Radiographic and morphologic studies of multiple miliary osteomas of cadaver skin.

OBJECTIVES: The purpose of this study was to examine the frequency, chemical composition, and radiographic and morphologic features of multiple miliary osteomas of the facial skin. STUDY DESIGN: Facial skin was obtained from 33 cadavers. After contact radiographs were taken, osteomas were examined by photo and scanning electron microscopy. Radiographic microanalysis of inorganic elements of the osteomas was also performed. In addition, clinical dental radiographic examinations were performed on 158 living subjects. RESULTS: Radiographic examination revealed milia-like osteomas in the facial skin of all of the cadavers. Nodules of 0.5 to 2.0 mm in diameter were scattered symmetrically in the skin of the cheek, mandibular angle, and forehead. Each nodule consisted of a concentric, multilamellated, osteoid cortex and an adipose medulla. Microanalysis suggested the presence of hydroxyapatite similar in composition to that of normal cortical bone. The condition was detected in 28% (44/158) of the living subjects by clinical dental radiographic examination. CONCLUSION: Multiple miliary osteoma is a very common condition and may not be related to specific diseases.