Death Triangle Essay

902 words - 4 pages

THE DANGER OF INFECTION ABOUT THE FACE BY J. WILLIAM HINTON, M.D.
OF NEW YORK, N. Y. ADJUNCT ASSISTANT VISITING SURGEON, BELLEVUE HOSPITAL
THE complications which small furuncles around the upper lip and nares may produce are not generally recognized. In active hospital services one sees one or two deaths yearly from maltreated face infections. The fatalities do not result from medical procrastination, but from overzealous surgical intervention. It is essential to have a clear conception of the mode of spread of infection about the face before intelligent treatment can be instituted. The danger of the infection is producing a thrombophlebitis of the facial vein, with a resulting cavernous sinus thrombosis. Thrombosis of the cavernous sinus is nearly always fatal. Figure i shows the distribution of the venous blood supply about the face, and one sees a direct connection from the facial vein, to the cavernous sinus. There is one area marked in heavy outline about the upper lip and nares which is the critical area of face infections. Accord- ing to Dixon,' the factors which produce serious complications in this locality are four. First, early and frequent trauma. Second, absence of subcu- taneous fat on the upper lip. Third, active muscular supply of this region. Fourth, the inability of the veins that drain this region to collapse. The most important factor seems to be the rich venous plexus, both superior and deep in relation to the muscles of the upper lip. Trauma causes the thrombi to be spread to the facial veins, with resulting cavernous sinus thrombosis in a high per cent. of cases. The danger zone of infection about the face can be roughly outlined as the area between the hair line of the forehead above and the chin below, with two parallel lines connecting this area at the outer wall of the orbit on each side. As can be seen in Fig. I, all of this area has a venous drainage connecting with the cavernous sinus. To get a clear concep- tion of the venous return of the face, I will quote from Gray.3 " There are some points about the facial vein which render it of great importance in surgery. It is not so flaccid as are most superficial veins, and, in consequence of this remains more patent when divided. It has, moreover, no valves. It communicates freely with the intracranial circulation, not only at its com- mencement by its tributes, the angular and supraorbital veins, communicating with the ophthalmic vein, a tributary of the cavernous sinus, but also by its deep tributaries, which communicates through the pterygoid, plexus with the cavernous sinus by tributaries which pass through the foramen ovales and foramen lacerum medium. These facts have an inmportant bearing upon the surgery of some diseases of...

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