Intracortical haematogenous osteomyelitis

We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patient’s blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.     

Acute mastoiditis: Clinical,microbiological, and therapeutic aspects

The charts of 73 children (31 girls, 42 boys) aged 4 months to 14 years (mean 4.5 years) with acute mastoiditis managed during a 16-year period were reviewed. Of the patients 36% were less than 24 months old. Retro-auricular swelling was described in 63 of the 73 children, tenderness in 59, erythema in 58, and protrusion of the auricle in 45. A pathological tympanic membrane was noted in 33% of the patients and fever in only 29%. Apart from local inflammation, the most frequent complaints and symptoms were otalgia (n=42), recent upper respiratory tract infections (n=22), and fever alone (n=22). A subperiosteal abscess was found in 36 patients, and CNS involvement in 5. Nearly half of the patients (48%) were on antibiotic therapy at admission. The isolation rates in bacterial cultures from subperiosteal aspirates (81%) and from mastoid mucosa (68%) were considerably higher than from blood cultures (14%) and were not influenced by previously administered antibiotics. Pneumococci (9/32) andStaphylococcus epidermidis (6/32) were the agents most often isolated. The incidence of the bacteria isolated from patients pre-treated with antibiotics differed from the incidence in patients not previously treated. In 24 patients (33%) the lesion healed with antibiotic therapy without mastoid surgery. Myringotomy and the insertion of a ventilation tube is indicated initially, if acute otitis media with effusion is found. In the absence of a subperiosteal abscess and of CNS involvement, a 48-hour trial of intravenous antibiotic therapy, directed also against staphylococci, is justified before mastoid surgery is considered.     

无痛局麻仪在拔除下颌阻生第三磨牙中的应用观察

目的探讨应用口腔无痛局麻仪行骨膜下浸润麻醉拔除下颌阻生第三磨牙的麻醉效果与优势。方法将190名患者分为两组,试验组使用TheWand进行骨膜下浸润麻醉,对照组使用传统手推式下颌阻滞麻醉。通过视觉模拟尺表,记录患者疼痛程度。比较两组病人的疼痛程度。结果应用无痛局麻注射仪进行骨膜下浸润麻醉,注射时疼痛程度明显小于手推式加压麻醉法。拔牙的麻醉效果两者无明显差别。结论口腔无痛局麻仪行骨膜下浸润麻醉效果良好,并有效减轻注射时的疼痛感,增强患者的术中配合程度,值得临床推广应用。     

小儿骨膜下血肿的影像学演变特点及个体化治疗

目的 通过对小儿颅骨骨膜下血肿的影像学演变特征分析,提出临床个体化治疗方案.方法 50例诊治的小儿颅骨骨膜下血肿行常规CT检查,测量血肿的厚度,根据血肿厚度选择不同的治疗方案,全部随访一年并复查头颅CT进行回顾性分析.结果 本组50例中：12例血肿厚度〈1cm随访观察1个月全部吸收,14例1～2cm随访观察一个月,其中10例全部吸收,4例不吸收予以干预治疗吸收,24例〉2cm中,10例予以干预治疗吸收,14例未行干预治疗中9例伴有不同程度的骨化.结论 CT可以明确颅骨骨膜下血肿的诊断,血肿厚度≤1cm者予以观察随访,1～2cm者以随访观察为主,若血肿未消退或增大,予以干预治疗,≥2cm者建议积极干预治疗防止血肿骨化.     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。     

Cervicofacial Rhytidectomy: The Superficial Plane

During the past 20 years, numerous techniques have been described to improve the results of facelifting as well as the duration of its rejuvenating effect. These increasingly aggressive techniques have increased the operating time, the potential morbidity of the operation, and the duration of convalescence. No one can ensure that this evolution in sophistication of rhytidectomy techniques give longer lasting results. Therefore, a simple technique applied under the appropriate indications gives good and predictable results.     

Subperiosteal facelift: Open and endoscopic approach

The endoscopic subperiosteal facelift as an isolated procedure is indicated for patients with grade I rhytidosis. It is also indicated in cases of grades II and III rhytidosis in males in whom the coronal incision is contraindicated due to alopecia and without conspicuous damage to the forehead. In these cases, the procedure is combined with subcutaneous rhytidectomy of the neck. It can also be used in cases of secondary facelift. The small incisions used in this procedure allow sufficient and effective access for dissection and suspension of the tissues released during the facelift. The coronal incision is not necessary, thus avoiding the resulting discomfort and scar. These patients do not receive anesthesia and experience almost no paresthesia in the frontal region, as in cases in which a coronal incision is performed. The endoscopic approach reduces surgical trauma as well as postoperative edema. Since neither the veins nor the lymphatic vessels of this area are sectioned, swelling subsides faster and recovery is shorter.     

鼻源性眶骨膜下脓肿的诊治策略

目的探讨鼻窦炎引起的眶骨膜下脓肿的临床特征及治疗策略。方法回顾分析16例鼻源性眶骨膜下脓肿的临床资料,包括成人11例、儿童5例。11例成年患者入院24 h内行眶骨膜下脓肿引流及内镜下鼻窦开放,其中5例眶骨膜下脓肿位于眶内侧或内下方者采取经鼻窦引流,6例位于眶上方者采取B超引导下穿刺引流。5例儿童患者采取抗感染治疗,其中1例症状无好转而改行手术。结果 15例治愈,随访6-32个月无复发;1例因合并颅内感染死亡。结论鼻源性眶骨膜下脓肿应根据脓肿部位与患者年龄采用不同的治疗方法,以达到微创目的;尽早行鼻窦引流消除原发感染病灶,高度警惕合并颅内并发症。     

The role of osteitis of the lamina papyracea in the formation of subperiosteal orbital abscess in young children

BackgroundSub-periosteal orbital abscess (SPOA) typically presents as a collection of pus in the space between the periorbita and the lamina papyracea, adjacent to acute suppurative ethmoiditis. Osteitis of the lamina papyracea may lead to sequestrum formation, with progression of the infectious process to cause suppuration beneath the orbital periosteum.Materials and methodsA case series of children with rhinosinusitis and SPOA admitted to our institute, from January 2005 to December 2011, was carried out. Included were children operated upon, in whom the lamina papyracea was submitted for histological examination, and in which bacteriologic studies were obtained.ResultsNine children with SPOA with a mean age of 5.03 years (range 1–12 years) were included in the present study. In five of them (55.5%), features of osteitis were noted histologically. No pathogens were observed histologically in the sections. Bacteriologic studies revealed Streptococcus viridans in four patients, and coagulase negative Staphylococcus in one.ConclusionSPOA in rhinosinusitis children was associated in our small cohort with high rate of lamina papyracea osteitis. The direct spread through the involved bone was raised as a possible pathophysiology of SPOA formation.     

额眶颧骨膜下除皱与SMAS提紧联合除皱术

目的 探讨额眶颧骨膜下除皱与ＳＭＡＳ提紧联合除皱术的临床效果。方法 额眶颧部采用骨膜下分离,同时面部采用ＳＭＡＳ除皱,耳前制作ＳＭＡＳ舌瓣及眼轮匝肌向外上、外下、外侧同时提紧以消除中皱纹。结果 本组２６例术后上下面部及双眼角除皱均达理想效果。无１例并发症。结论 采用额眶颧骨膜下除皱及ＳＭＡＳ提紧联合除皱术,能够解决皮肤衰老的解剖生理的根本问题,术后面部及双眼角除皱能达到较理想状态,是一种行之有效的