Brown Recluse Spider Bite to the Face

Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Louisville, Louisville, KY 40292, USA.
Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.43). 01/2006; 63(12):1774-8. DOI: 10.1016/j.joms.2005.08.012
Source: PubMed


Oral and maxillofacial surgeons must be prepared to manage a variety of maxillofacial infections, both odontogenic and non-odontogenic in nature. While odontogenic infections are quite common, non-odontogenic infections can present with diagnostic and therapeutic challenges. An uncommon non-odontogenic infection is the cellulitis secondary to a spider bite. Few spider species have the ability to bite through human skin. Most of these insults result in only a small, red nodule centered within a larger, erythematous plaque. Symptoms are usually limited to pruritus and perhaps mild tenderness. The brown recluse and the black widow are 2 types of spiders that inhabit the United States that can cause serious injury or major medical problems to their victim. The bite of the brown recluse spider (Loxosceles reclusa) results in an envenomation that can have deleterious effects on the patient. Within 6 hours after the bite, pain and erythema develop at the site. The area of erythema spreads during the first 24 hours and may turn bluish-purple. Necrosis of the skin often occurs 24 to 48 hours later. Signs include bullae formation, cyanosis, and hyperesthesia. Depending on their size, complete resolution of these lesions can take from weeks to months. Systemic symptoms include fever, chills, malaise, vomiting, and arthralgias. Less common but more severe reactions to the venom have resulted in hemolytic anemia, convulsions, renal failure, shock, disseminated intravascular coagulation, and rarely, death. Brown recluse spider bites usually occur on the extremities or the trunk, but bites to the face have been reported. Treatment of a brown recluse spider bite is controversial and ranges from conservative comfort measures including rest, ice compresses, and elevation, to drug therapy and surgical excision.

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Available from: George M Kushner, Oct 03, 2015
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    • "Distinguishing features include fiddle-shaped brown markings on its dorsum and characteristic 3 dyads (6 eyes as opposed to the usual 8 for most spiders).4 Brown recluse spiders commonly bite exposed lower or upper extremities, but bites to the face have been reported.5 "
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    ABSTRACT: Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury. We present a case of a previously unreported incidence of osteomyelitis of the mandible as a result of a brown recluse spider bite. A review of the literature and discussion of diagnosis and treatment of brown recluse spider bites are presented. Osteomyelitis of the mandible causing a chronic wound was the presenting finding of a patient with a history of spider bite and exposure to brown recluse spiders. Operative debridement and wound closure resulted in successful treatment. Brown recluse spider envenomation varies in its presentation and treatment is based on the presenting clinical picture. Treatment regimens for brown recluse spider bite envenomation should include the basics of wound care. Systemic antibiotics, topical antimicrobials, dapsone, and surgical debridement are valuable adjuncts of treatment, as indicated, based on the clinical course.
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    ABSTRACT: A description of 60 cases of extreme osteonecrosis and osteomyelitis of the jaws is presented. The patients attended the dental clinics of the medical charity organisation Mercy Ships, over a 2.5-year period when the hospital ship the 'Africa Mercy' was docked in the West African countries of Liberia, Benin and Togo. Possible reasons for the development of these clinical conditions are discussed including aetiologies, genetics (coagulopathies, osteopetrosis), Gorham's disease, infective conditions (tuberculosis, herpes zoster, HIV infection, osteomyelitis), toxicity (bisphosphonates, spider bites), and environmental effects (phossy jaw, radium jaw). The possible causes of these cases of osteonecrosis and osteomyelitis of the jaw are under investigation.
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