Face the facial furuncle

The furuncle is a staphylococcal infection of a single hair follicle which can occur on the skin in the maxillofacial region. Untreated, this infection can lead to life-threatening situations. This article discusses the etiology, clinical findings, possible complications as well as a series of differential diagnoses. In addition, several therapeutic and preventive strategies are described.     

Cervical necrotizing fasciitis of odontogenic origin involving the temporal region – A case report

Necrotizing fasciitis (NF) is a soft-tissue infection, usually polymicrobial, that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle. We report a case of cervical NF complicating dental infection in a 50-year-old woman, who presented with infection involving mucosa of the right mandible and temporal muscle, and masticator spaces, requiring extensive surgery and antibiotic therapy. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections.     

Rapid healing of MRSA infection at the suprafascial radial donor site

Methicillin-resistant Staphylococcus aureus (MRSA) infection at the radial suprafascial donor site resulted in significant loss of the skin graft, but no tendon exposure, in two patients. The complication was successfully managed with wound debridement, appropriate antibiotics, a negative-pressure wound dressing and early partial-thickness skin grafting. The suprafascial dissection creates a donor site that resists both skin graft loss and tendon exposure. It also allows early re-grafting with no loss of function in the event of skin graft loss from infection. These advantages have not been described previously.     

Efficacy of pre-expanded forehead flap based on the superficial temporal artery in correction of cicatricial ectropion of the lower eyelid

Lower eyelid retraction or ectropion bring suffering to the patients both physically and mentally. Efforts to explore pertinent surgical treatments are still needed. Here we have described our preferred surgical technique for lower eyelid ectropion repair with pre-expanded island forehead flaps or pedicled forehead flaps. Between July 2007 and March 2017, a retrospective review of 12 patients who suffered from cicatricial lower eyelid ectropion as a result of trauma, surgery, or infection was conducted. Forehead skin flap based on the superficial temporal artery was expanded depending on the area of defect of the lower eyelid. Tissue expansion, flap transfer, pedicle delaying and division were involved in this process. There were no major complications, such as expander exposure, infection, haematoma or large skin flap necrosis in all the 12 patients. Venous congestion was reported in two patients. No recurrent ectropion was noted in any patient. During the three-month to two-year follow-up all patients were satisfied with the results in terms of the skin texture, colour, and flexibility after the treatment with an expanded forehead skin flap. This study suggests that expanded forehead skin flaps are effective for correction of cicatricial lower eyelid ectropion.     

The effect of pre-operative perioral skin preparation with aqueous povidone-iodine on the incidence of infection after third molar removal.

A study was carried out to measure the incidence of dry socket and wound infection following third molar removal under endotracheal general anaesthetic. One group of patients received pre-operative preparation of the perioral skin with a 10% solution of povidine-iodine, while the other received no skin preparation. Routine skin preparation imposes a risk of contact dermatitis and necessarily involves expense. In relation to postoperative wound infection, this practise was of no benefit. The results of this study provide evidence that skin preparation with povidine-iodine prior to third molar extractions should be discontinued.     

Juvenile juxtavermilion candidiasis: yet another form of an old disease?

Five cases of a chronic, self-limiting Candida albicans infection of the lip vermilion and juxtavermilion skin in young persons are presented. These infections typically appeared as erythematous, pruritic, yellow crusting plaques of the juxtavermilion skin, with or without desquamation of vermilion surfaces. Evidence of intraoral candidiasis, especially loss of filiform lingual papillae, was present in several cases. The disorder mimics the early stage of chronic mucocutaneous candidiasis but remains within a few millimeters of the mucocutaneous junction and affected individuals appear (with a possible exception) to be immune competent. Mild trauma apparently triggers the infection. The authors emphasize that a scientifically sound cause-and-effect relationship between this new disease and Candida albicans is not herein established and present these cases in the hope that others will thereby be identified and a firmer causal relationship be established.     

Surgical treatment of aplasia cutis in the Adams-Oliver syndrome.

Aplasia cutis is one of the features of the Adams-Oliver syndrome, beside limb anomalies. Aplasia cutis, congenital absence of skin, is a lesion that usually presents over the vertex of the skull. Management of aplasia cutis depends on the size of the skin defect and the child's physical condition. Scalp defects larger than approximately 1 cm should be treated surgically. In patients with aplasia cutis, surgery should preferably be performed using rotation scalp flaps, and additional split skin grafts. The history of two babies with the Adams-Oliver syndrome is presented. In the Adams-Oliver syndrome, large rotation scalp flaps are not reliable due to the abnormal vascularity of the skin. Skin grafting is the safest way, preventing hemorrhage and infection, in the operative treatment of aplasia cutis in these babies.     

Oral eumycetoma of infancy: A rare presentation and a brief review

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissue, which may involve bone. The disease is caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Both types of organism are important soil saprophytes, and therefore infection is normally acquired by traumatic inoculation of the skin by contaminated material. Clinically, mycetomas are characterized by tumefaction, draining sinuses and discharging grains. The grains are aggregates of fungal hyphae or bacterial filaments, and grain size, colour and consistency provide the initial clue to the causative organism. To our knowledge, this probably is the first case report of oral eumycetoma of infancy. Review of literature shows only ten cases of eumycetoma involving the head and neck, including the present case. Histological examinations of the biopsies were the cornerstone in the diagnosis of mycetoma. The distinction between eumycetoma and actinomycetoma is essential for treatment. Direct microscopic examination of the grain and histopathological examination, using histochemical staining will distinguish between the two. Treatment consists of long courses of antifungals and antibacterials agents, often combined with surgery.     

洗必泰碘在口腔颌面部术前消毒中的实验及应用研究

术前皮肤消毒是外科手术的一项常规准备工作,也是预防术后切口感染的重要步骤之一。由于口腔颌面外科手术大多位于口腔和邻近污染的鼻腔,发生感染的机会较多,而且颌面部的皮肤薄而娇嫩,富有弹性,因此,选择的化学消毒剂应具备高效而温和、不致敏、无刺激、对人体安全无害等优点。目前,临床上使用的皮肤消毒剂种类相当多,但很少能完全达到理想要求。我们用0.5％洗必泰碘水溶液经动物实验和人体皮肤消毒试验,各项结果均理想,杀菌率达99.69％。在此基础上,将其用于口腔颌面部皮肤、粘膜的术前消毒240例,术后切口甲级愈合238例,乙级愈合2例,无丙级愈合。使用过程中未发现有因使用该消毒剂而出现各种不良反应和影响切口愈合的因素存在。在使用时,只需将其在皮肤、粘膜上涂擦一遍,即可达到要求,操作简便,省时省力。本文认为0.5％洗必泰碘水溶液是一种理想的新型皮肤消毒剂,具有目前常用的各种消毒剂所不能替代的优越性,值得推广应用。     

Conditioning in laser skin resurfacing – Betulin emulsion and skin recovery

Laser skin resurfacing of the face by CO₂-laser ablation is causing superficial wounds that need rapid recovery to reduce the risk of infection, the risk of chronification and as a result the risk of unaesthetic scars. The question being addressed by this study is to demonstrate benefit of betulin emulsion skin care after CO₂-laser wounds. The outcome of this aesthetic comparison between betulin emulsion, moist wound dressing and gauze covering in promoting the recovery process in laser skin ablation is to demonstrate improved aesthetic benefit for the patient.     

Noma (cancrum oris) in the South African context

Noma (cancrum oris) is a destructive necrotising disease affecting orofacial tissues predominantly of malnourished young children. It is characterised by a rapid acute onset which usually starts in the mouth, spreads intra‐orally destroying soft tissue and bone and progresses to perforate the facial skin, causing disfigurement. Polybacterial anaerobic infection is critical too, but is not alone sufficient for the initiation of noma. Cofactors, first and foremost malnutrition, but also systemic viral and bacterial infections are crucial to the development of noma. A patient with necrotising stomatitis or noma must be admitted to hospital for antibiotic treatment, fluid and electrolytes as well as nutritional supplementation and general supportive treatment. The epidemiology of noma in the South African population is unknown, and the clinicopathological features are poorly characterised. Although worldwide there is no evidence that HIV infection is a strong risk factor for noma, HIV infection may play a substantial role in the pathogenesis of noma in South Africa.     

The first step in infection control is hand hygiene

A dental health care worker (DHCW) has an obligation to prevent the spread of health care associated infections. Adhering to proper hand hygiene procedures, selecting appropriate hand hygiene products and the use of gloves are all important elements of infection control. The CDC Guidelines for Hand Hygiene state that improved hand hygiene practices can reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. DHCWs must also protect themselves by recognizing pitfalls such as irritants or allergies that may pose obstacles to proper hand hygiene. Occupational irritants and allergies can be caused by frequent hand washing, exposure to hand hygiene products, exposure to chemicals and shear forces associated with wearing or removing gloves. Since the primary defense against infection and transmission of pathogens is healthy, unbroken skin, DHCWs must take steps to ensure that their skin remains healthy and intact. These steps include evaluating different types of hand hygiene products, lotions and gloves for the best compatibility. If the DHCW sees a breakdown of his or her skin barrier, steps should be taken to determine the cause and remedy. Remedies can include the use of alcohol-based hand sanitizers containing emollients and moisturizers and regular use of a medical grade hand lotion. The bottom line: healthy skin protects you at work and at home. Selection and use of appropriate hand hygiene products, including moisturizers, are an essential part ofa dental office infection control program. My coworker lost the use of her thumb for several months due to complications of a staph infection. She was unable to work and found even simple tasks such as closing a button hard to do. Think of how difficult your work would be if something happened to your hands. Injury, irritation or allergies could alter your ability to work or even perform routine tasks. Our hands provide us with the ability to work in clinical dentistry. It makes good sense to protect your hands, your most valuable tools.     

Amount of ampicillin in surgical wound of rat skin

Ampicillin is widely used for the treatment and prevention of infection. When ampicillin is administered for the prevention of postoperative infection, the target tissue is a surgical wound. Since the surgical wound differs from the normal tissue, the distribution of ampicillin into the surgical wound might be affected. Thus, the present investigation was undertaken to compare with the amount of ampicillin in surgical wound and normal tissue. The vascular permeability and water content in the surgical wound were also determined. Wistar strain SPF male rats, 12 weeks old were used. Ampicillin.Na (50 mg/kg) was administered intravenously. Each rat head skin was incised 30 seconds after administration of ampicillin.Na. Specimens of serum, incised skin (surgical wound), and intact skin (normal tissue) were collected at 0.25, 0.50, 0.75, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0 and 8.0 hours after incision. Amount of ampicillin in serum and skins were assayed by a thin layer disc plate method. Vascular permeability was determined by a dye diffusion method. Water content was obtained by subtracting the dry tissue weight from the wet tissue weight. The results are as follows: 1. The amount of ampicillin in serum at 0.25 hours after incision was 78.37 +/- 16.15 micrograms/ml. Ampicillin level was rapidly decreased during 0.25 to 1.0 hours after incision, and then gradually decreased to reach 0.04 +/- 0.02 micrograms/ml at 8.0 hours. 2. The amount of ampicillin in incised skin was significantly higher than that of intact skin during 0.50 to 8.0 hours after incision (t-test, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Proprionibacterium acnes in shoulder surgery

Proprionibacterium (Cutibacterium) acnes is the organism most commonly associated with deep infection after shoulder surgery, including shoulder arthroplasty. It is abundant in the sebaceous follicles of the axilla and skin around the shoulder girdle, being implicated in the pathology of acne. It is adapted to the environment of the hair follicle, where it secretes enzymes that digest sebum and provide nutrients. However in this location it is unaffected by skin preparation immediately prior to the skin incision and can therefore be carried into deeper layers Indeed, it is so commonly found in the deep tissues around the shoulder in cases with no suspected infection that the line between contaminant and pathogen can be extremely difficult to draw. To add to this, it is slow growing and culture in anaerobic conditions often does not yield a positive result until the second week of culture or later. An understanding of the organism and its impact on shoulder surgery is therefore crucial to those operating in this region.     

Mucosal disease series. Number IV. Erythema multiforme

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane lesions. Occasionally EM may involve the mouth alone. EM has been classified into a number of different variants based on the degree of mucosal involvement and the nature and distribution of the skin lesions. EM minor typically affects no more than one mucosa, is the most common form and may be associated with symmetrical target lesions on the extremities. EM major is more severe, typically involving two or more mucous membranes with more variable skin involvement - which is used to distinguish it from Stevens-Johnson syndrome (SJS), where there is extensive skin involvement and significant morbidity and a mortality rate of 5-15%. Both EM major and SJS can involve internal organs and typically are associated with systemic symptoms. Toxic epidermal necrolysis (TEN) may be a severe manifestation of EM, but some experts regard it as a discrete disease. EM can be triggered by a number of factors, but the best documented is preceding infection with herpes simplex virus (HSV), the lesions resulting from a cell mediated immune reaction triggered by HSV-DNA. SJS and TEN are usually initiated by drugs, and the tissue damage is mediated by soluble factors including Fas and FasL.     

Cicatricial deformation of the face after herpes simplex infection

One of the most wide-spread virus infections causing various diseases of dermal integuments, central and peripheric nervous system, viscera, eye, oral cavity and genitalia is Herpes simplex (HS). The clinical case of a 10-year child who had at early age HS infection complicated by extensive cicatrical deformation of frontal-temporoparietal skin is reported. The cicatrical deformation has caused disfunction of periorbital tissues. Principles of treatment are considered and practical references are given.     

Extra-oral endosseous craniofacial implants: current status and future developments

The published experience of extra-oral endosseous craniofacial implants (EOECIs) is reviewed. The definition of osseointegration, concept of success, the relative merit of one- or two-stage implant placement, EOECI design and control of peri-abutment skin infection are discussed. A plea is made for more consistent and objective reading of clinical experience of this technique.     

Skin necrosis of a pectoralis major myocutaneous flap, caused by methicillin-resistant Staphylococcus aureus

A case of MRSA-induced skin necrosis of part of a pectoralis muscle flap is described. It highlights the importance of recognising potential MRSA infection following surgery and treating it early and aggressively.     

Infantile systemic hyalinosis

Infantile systemic hyalinosis (ISH) is a rare familial autosomal recessive disease of unknown etiology. The clinical features are evident either at birth or within 6 months of life. The presentation is painful progressive joint contractures, thickened skin with hyperpigmentation over prominences, small pearly facial papules, gingival hypertrophy, fleshy nodules in the perianal region, diarrhea, increased susceptibility to bone fractures, infections, and failure to thrive. This is a progressive disorder that may lead to death within first 2 years of life, mostly due to recurrent chest infection and diarrhea. Two patients with ISH, one aged 14 years and another aged 10 years, with all the clinical features, though crippled but surviving, were seen at our center. Debulking of hypertrophic gingiva and excision of some symptomatic skin masses in these patients are indicated for comfort and smooth nursing care of the patients and to allow better rehabilitation.