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.

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 osteoradionecrosis (ORN) of the maxillary-orbital complex (MOC),STUDY DESIGN AND SETTING: Ail 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 (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.

Otolaryngology–Head and Neck SurgeryVolume 117, Issue 6 p. S153-S156 Article Mandibular Aneurysmal Bone Cyst Associated with Fibrous Dysplasia Dr. Richard L. Arden MD, Corresponding Author Dr. Richard L. Arden MD n/a@dne.dne Department of Otolaryngology-Head and Neck Surgery, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganReprint requests: Richard L. Arden, MD, Department Of Otolaryngology-Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201.Search for more papers by this authorDr. Samer J. Bahu MD, Dr. Samer J. Bahu MD Department of Otolaryngology-Head and Neck Surgery, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganSearch for more papers by this authorDr. David R. Lucas MD, Dr. David R. Lucas MD Department of Pathology, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganSearch for more papers by this author Dr. Richard L. Arden MD, Corresponding Author Dr. Richard L. Arden MD n/a@dne.dne Department of Otolaryngology-Head and Neck Surgery, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganReprint requests: Richard L. Arden, MD, Department Of Otolaryngology-Head and Neck Surgery, Wayne State University, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201.Search for more papers by this authorDr. Samer J. Bahu MD, Dr. Samer J. Bahu MD Department of Otolaryngology-Head and Neck Surgery, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganSearch for more papers by this authorDr. David R. Lucas MD, Dr. David R. Lucas MD Department of Pathology, Harper-Grace Hospitals, Wayne State University School of Medicine, Detroit, MichiganSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/S0194-59989770087-1Citations: 1Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume117, Issue6December 1997Pages S153-S156 RelatedInformation