Case Report
Clinical Pathology
Avascular necrosis of the midface secondary to disseminated intravascular coagulation

https://doi.org/10.1016/j.ijom.2014.09.017Get rights and content

Abstract

To the authors’ knowledge, avascular necrosis of the midface secondary to disseminated intravascular coagulation has yet to be described following a hypoxic syncopal episode secondary to ‘heat stroke’. A slow, progressive loss of anterior maxillary bone and the collapse of the nasal dorsum in a healthy young man with no other known medical co-morbidities led to the diagnosis. Following debridement, a staged reconstruction of the maxilla–nasal complex was successfully performed.

Section snippets

Case report

A 29-year-old male bricklayer, with no known co-morbidities, suffered an episode of ‘heat stroke’ while returning home on foot from a building site. He was found lying unconscious on the roadside with twitching limbs, and an initial Glasgow Coma Scale score of 3/15 was recorded. After transfer to a nearby tertiary hospital, a clinical, biochemical, and radiographic assessment indicated that he had suffered an anoxic brain injury with severe cognitive deficits. He was immediately intubated,

Discussion

DIC is a complex systemic disorder characterized by widespread activation of the coagulation cascade, resulting in thrombosis and ischaemia of organs and soft tissues. The depletion of clotting factors, fibrinogen, and platelets leads to extensive haemorrhage and secondary activation of the plasminogen pathway. This can occur through the extrinsic pathway via the activation of thromboplastin on factor VII. Tissue factor, or thromboplastin, is found in high concentrations in the heart and lungs.

Funding

None.

Competing interests

None.

Ethical approval

Not required.

Patient consent

Written patient consent was obtained.

References (9)

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