Factors Leading to Oro-Facial Herpetic Eruptions in Patients Undergoing Surgery for Vestibular Schwannoma.

OBJECTIVE: To study factors influencing oro-facial herpetic eruptions (HEs) in patients undergoing retromastoid suboccipital craniectomy for vestibular schwannomas (VS). METHODS: A retrospective analysis of the prospectively collected database (from July 2014 to December 2015). A total of 87 patients underwent retromastoid suboccipital craniectomy for VS at our center. For the purpose of analysis the patient subset was divided into 2 groups, HE and non-HE. Pearson χ2 test or Fisher exact test were used to identify the factors. RESULTS: The overall incidence of postoperative HE was less than 1% (0.89%, 26 patients of 2916 cases); whereas after VS surgery, it was 20.69% (18 of 87). Demographic profiles of patients in the 2 groups were comparable. Average tumor size (with HE 3.19 ± 2 × 0.67 cm, non-HE 3.38 ± 2 × 1.07 cm), consistency, and laterality also were comparable between the 2 groups. Factors favoring development of postoperative HEs were large size (12 vs. 22, P = 0.013) and preoperative trigeminal nerve (CN V) involvement (9 of 18, 50%, P = 0.046). All patients developed HE in maxillary division of trigeminal nerve (V2), whereas involvement of ophthalmic (V1) and mandibular (V3) divisions were involved less commonly in combination with V2 (V2, 72.2%; V2 + V3, 22.2%; V1 + V2 + V3, 5.6%). The majority of the patients (55.56%) developed HE on postoperative day 3 and none beyond postoperative day 5. All patients responded to empirical oral acyclovir. CONCLUSIONS: The study highlights the relatively high incidence and factors associated with this rare but benign complication.

Is prophylactic acyclovir treatment warranted for prevention of herpes simplex virus infections in facial burns? A review of the literature.

Both cosmetic facial resurfacing and facial burns cause an injury to the dermal layer of the skin. This injury renders the patient susceptible to primary herpes simplex virus (HSV) infection or, more commonly, to HSV reactivation. This in turn can lead to bacterial superinfection, possibly resulting in scarring and systemic dissemination in the immunosuppressed burn patient. HSV reactivation rates have been reported to be up to 50% in cosmetic procedures without acyclovir prophylaxis and up to 25% in patients with burn injury. Currently, acyclovir prophylaxis is a common practice in facial resurfacing, but no such recommendations have been issued for patients with burn injury. HSV usually presents in a febrile burn patient between the first and third postburn weeks as a cluster of small, umbilicated vesicles or vesicopustules on an erythematous base found within or around the margins of healing partial-thickness wounds. Diagnosis is confirmed through viral culture from the base of an unroofed vesicle, and treatment is begun with intravenous acyclovir. Antiviral prophylaxis should be strongly considered for HSV infection prevention in patients with major burn injury, particularly with burns involving the face. Acyclovir is the primary drug of choice, and contact precautions should be practiced. High suspicion levels and alertness to this entity can help prompt diagnosis and timely treatment while alleviating late complications.

[Vaccination for stab and bite injuries in the facial region]. / Impfschutz bei Stich- und Bissverletzungen im Gesichtsbereich.

In cases of stab and bite injuries to the face there is a risk of general infection and the necessity for an active and/or passive immunization must be considered by the first treating physician. In Central Europe tetanus, rabies, hepatitis B and C as well as HIV must be taken into account as possible consequences of such injuries. With regard to a tetanus immunization the indication for the post-exposition prophylaxis (PEP) should generally be as wide as possible. For other protective vaccinations a differentiated decision in co-operation with other fields of activity and public health authorities should be realized. The current recommendations for the systemic infections relevant in Central Europe are described.