[abstract] SUCCESSFUL CLOSURE OF PHARYNGOCUTANEOUS FISTULAE IN A PATIENT WITH BRUTON'S DISEASE USING ADJUNCTIVE HYPERBARIC OXYGEN THERAPY.

Abstract

A 26 year old white male with Bruton's Disease (congenital, sex linked, agammaglobulinemia), suffered abscesses of his left peritonsillar and parapharyngeal space which eroded through the skin laterally at the angle of the jaw and submentally to the hyoid bone. These had been present for many months and had shown no signs of healing on a regimen of antibiotics, surgical exploration, hyperalimentation and immuno modulation consisting of 12 grams of gamma globulin and 750 ml of fresh frozen plasma weekly, the latter donated by his mother. Prior infections had necessitated a left radical mastoidectomy, left Caldwell-Luc procedure, inferior sinus debridement and ligation of the right and left external carotid arteries and the left common carotid artery for massive hemorrhage secondary to erosion from pharyngeal infections. He suffered odynophagia and dysphagia since September, 1988, necessitating large doses of narcotics and T.P.N. Because of progression of his lesions, he was referred to our facility for adjunctive hyperbaric oxygen treatment. The patient had been hospitalized at this time for 6 weeks; 6/15/89-7/25/89. His supportive measures were continued and he underwent 16 H.B.O. treatments at 2 ATA over 11 days. He was then transferred to an outpatient setting and an additional 44 treatments were rendered over the next 78 days at 2.4 ATA for 2 hours daily. Skin closure was complete at 42 treatments. Complete healing at the completion of 6D treatments. The rationale and possible mechanism for success using H.B.O. will be discussed.