Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.
Introduction: Disc displacement without reduction with limited opening is an intracapsular
biomechanical disorder involving the condyle-disc complex. With the mouth closed,
the disc is in an anterior position in relation to the condylar head and does not
reduce with mouth opening. This disorder is associated with persistent limited
mandibular opening. Case report: The patient presented severe limitation to fully open the mouth, interfering in
her ability to eat. Clinical examination also revealed maximum assisted jaw
opening (passive stretch) with less than 40 mm of maximum interincisal opening.
Magnetic resonance imaging was the method of choice to identify the
temporomandibular disorders. Conclusion: By means of reporting this rare case of anterior disc displacement without
reduction with limited opening, after traumatic extraction of a mandibular third
molar, in which manual reduction of temporomandibular joint articular disc was
performed, it was possible to prove that this technique is effective in the prompt
restoration of mandibular movements.
It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.
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