THE NOSE

Here is our poor girl again with the nasal infection, after 2 weeks and numerous surgeries. Dr. Kelechi has done a fantastic job saving her life. We  suspect a fungal source but we are also treating for bacterial infection, as well. Her face looks terrible BUT, she is slowly improving and the edema is decreasing. At this point, I am just glad that she will probably survive. I will see her in several weeks and do further debridement. In September, if she is well, I plan a nasal reconstruction.

RETURN

I will return to Nigeria again in about 3 weeks. This will be a special trip since my daughter Maraya (20), son Deryk (16), sister Alisse, brother-in-law Mark and nephew David (19) are coming. In addition, Tom Carr, head of the International Health care Foundation and Barbara Maufas, RN (and three time visitor to NCH) are also coming. It will be a short, ultra-busy trip. Many surgeries are waiting and dozens of people will be coming for followup.

MUCORMYCOSIS

Last trip, I saw a young girl with maxillary swelling and foul breath. She had a CT that showed sinusitis. We performed a caldwell-Luc procedure and she improved. Interestingly, the wall of her maxillary sinus was already destroyed. She returned to the hospital 2 days ago with dramatic facial and periorbital swelling. She also has an area of necrosis on the nose. 

I think this poor girl has rhinocerebral mucormycosis. This is a terrible disease with a 50% mortality. I had a teleconference with Dr. Kelechi, a doctor at NCH,  and the girl's family today via gmail. We have decided to explore her nose and sinus.Dr. Kelechi will do the surgery even though he is not a surgeon. He is a brave man!

ADDENDUM: The surgery went well and the patient is stable so far. A significant amount of necrotic tissue was debrided, especially from the right nasal passageways.