Craniocervical necrotizing fasciitis: an 11-year experience.

OBJECTIVE: We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN: All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS: A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION: Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE: This is the largest single institution report of CCNF with thoracic extension identified to date.

Osteoradionecrosis of the maxillary-orbital complex after neutron beam radiotherapy.

OBJECTIVE: Neutron beam radiotherapy (NRT) has been advocated for treatment of malignant salivary gland tumors and adenoid cystic carcinoma of the paranasal sinuses. The purpose of this study is to determine whether primary or adjuvant NRT results in a significantly increased rate of osteora-dionecrosis (ORN) of the maxillary-orbital complex (MOC). STUDY DESIGN AND SETTING: All patients who received primary or adjuvant NRT involving the MOC and/or maxillofacial prosthetic rehabilitation at Wayne State University from 1992 to 1997 were evaluated (n = 9). RESULTS: ORN did not develop in any of the 5 patients who received primary NRT. All 4 patients who received adjuvant NRT after surgical resection had ORN involving the MOC within the irradiated fields. CONCLUSION: The reported trend of ORN after definitive surgery and NRT shows a markedly increased complication rate. SIGNIFICANCE: The use of adjuvant NRT after definitive surgical resection involving the MOC should be considered with great caution.

Reflex sympathetic dystrophy of the face: current treatment recommendations.

Reflex sympathetic dystrophy (RSD) of the face is an infrequently reported clinical pain syndrome characterized by dysesthesia, hyperalgia, hyperpathia, and allodynia. Treatment strategies, extrapolated from RSD and causalgia of the extremities, remain variable and poorly defined. Sympathetic blockade is generally the diagnostic and therapeutic treatment of choice; however, the frequency, timing, and duration of injections; need for neurolytic blocks; and role of sympathectomy are not well understood. The objectives of this report are to highlight the clinical behavior of facial RSD and contrast its essential differences from extremity RSD in response to standard treatment regimes. The case studies of two patients with this syndrome, following vascular surgery in the neck, are retrospectively reviewed with existent reported cases. Age, gender, etiology, symptoms, onset, triggers, and examination findings; timing, duration, and method of treatment; and outcome are summarized, forming the database for this study. Findings demonstrate an infrequent association of vasomotor and sudomotor changes with facial RSD, and lack of progression to a dystrophic or an atrophic stage, in contrast to extremity RSD. Furthermore, treatment response to sympathetic blockade is durable and less critically dependent on timing. The authors conclude that facial RSD has a favorable prognosis and should be managed conservatively with nonneurolytic stellate ganglion blocks, even when initiated as a delayed and repetitive injection series.

In vivo vestibular blood flow in the Mongolian gerbil: angiotensin III-provoked changes in systemic and local factors.

The current literature contains little information on vestibular end organ blood flow. The absence of an accepted model, difficulties applying dynamic in vivo measurement techniques and the inaccessibility of the inner ear organs contribute to the shortage of experimental findings. The purpose of the current study is to introduce the gerbil as a viable model for the in vivo study of vestibular blood flow dynamics. The potent vasoactive peptide, angiotensin III (AIII), was used to provoke blood pressure and blood flow changes. The results of this study demonstrate that viable blood flow measures may be obtained from the vestibule of the gerbil. Dose-dependent changes in blood pressure and vestibular blood flow were observed in response to high concentrations of AIII. Pretreatment with the receptor antagonist, sarthran, attenuated both blood pressure and blood flow increases in response to subsequent AIII infusions. The gerbil model offers the advantages of easily accessible and identifiable peripheral vestibular organs, as well as responsive local blood flow. Investigations using this model may provide information on the regulation of blood flow during presentation with a variety of stimulus modalities. Information from such studies may lead to development of strategies for treatment of vestibulopathies suspected to be of vascular origins.