Bismuth subnitrate and Iodoform paste

Iodoform, a halogenated organic compound, has been a cornerstone in surgical practice due to its potent antiseptic and antimicrobial properties. This comprehensive review examines the historical evolution, mechanism of action, clinical applications, and safety profile of iodoform across various surgical disciplines. Historically significant formulations like Whitehead's varnish and bismuth iodoform paraffin paste (BIPP) demonstrated remarkable efficacy in wound healing during the late 19th and early 20th centuries. BIPP, extensively used for cavity packing, combines bismuth subnitrate for its antibacterial and astringent effects with paraffin to minimize tissue trauma. The antimicrobial action of iodoform is attributed to the release of iodine upon activation by free radicals, leading to the denaturation of bacterial proteins and cytotoxic effects on inflammatory cells, thereby enhancing therapeutic efficacy. Clinically, iodoform has diverse applications in ear, nose, and throat surgery, neurosurgery, oral and maxillofacial surgery, and general dental practice. It is utilized for dressing wounds, packing surgical cavities, and managing conditions such as nasal fractures, epistaxis, cerebrospinal fluid leaks, and dry sockets. The radiopacity of BIPP, due to its bismuth content, aids in radiographic identification but necessitates clear communication with radiologists to prevent misinterpretation. Despite its benefits, iodoform use is associated with potential complications. Bismuth and iodoform toxicities, though rare, can lead to neurotoxicity and systemic symptoms, requiring prompt recognition and intervention. Allergic reactions, particularly in patients with prior exposure, and dermatological side effects like dermatitis herpetiformis flare-ups have been documented. Mechanical complications and considerations during pregnancy, owing to the potential transfer of iodine to the fetus, highlight the need for cautious application. This review underscores the enduring significance of iodoform in surgical settings while emphasizing the importance of awareness regarding its potential risks. Careful clinical judgment and ongoing research are imperative to optimize its therapeutic benefits and enhance patient safety.

Abstract licence: CC BY

BackgroundNecrotising fasciitis is an aggressive life-threatening infective process rarely making an appearance in the head and neck region and its development secondary to parotid abscess is exceptionally rare and scarcely reported in the literature. This case report serves to guide otolaryngologists with respect to its recognition and offers an alternative approach to craniocervical necrotising fasciitis with multiple neck explorations, use of antimicrobial impregnated packing enabling delayed reconstruction with lower morbidity.Case descriptionA 76-year-old female with a body mass index of 36.2 kg/m2 and a 30-year history of poorly controlled type 2 diabetes mellitus (HbA1c 91 mmol/moL), presented to the outpatient otolaryngology clinic with right sided parotid mass with minimal erythema, hyperglycaemia (19.2 mmol/L) and no cranial neuropathies. However, the aggressive nature of the parotid abscess triggered by group A streptococcus and Staphylococcus epidermidis led to sepsis and extensive non-odontogenic necrotising fasciitis involving the lateral neck mandating multiple surgical debridement and neck explorations, prolonged intravenous antibiotics with interval definitive reconstruction. A cervicofacial rotational sternocleidomastoid flap was utilised to conceal the defect with patient experiencing a remarkable recovery. The patient's immunosuppressive state from poorly controlled diabetes mellitus and multi-lineage cytopenia is likely to have contributed to a prolonged recovery.ConclusionsThis case report highlights the significance of repeat explorations and the need to give time for tissue healing as it unlocks options for reconstruction and reduce overall patient morbidity. Bismuth iodoform paraffin paste packing is a valuable tool with this case demonstrating its use an antiseptic and haemostatic agent in necrotising fasciitis and its ability to create an atmosphere to enable tissue healing minimising need for large-scale reconstructions. The absence of crepitus should not discourage the treating clinician from suspecting necrotising fasciitis of the neck. To limit successive cases, early prevention through aggressive control of predisposing systemic conditions including diabetes mellitus is needed. Moreover, when aggressive infections arise, the clinician should investigate for contributing systemic conditions.

Abstract licence: CC BY-NC-ND

Bismuth compounds are considered relatively non-toxic, with their low solubility in aqueous solutions (e.g., biological fluids) being the major contributing factor to this property. Bismuth derivatives are widely used for the treatment of peptic ulcers, functional dyspepsia, and chronic gastritis. Moreover, the properties of bismuth compounds have also been extensively explored in two main fields of action: antimicrobial and anticancer. Despite the clinical interest of bismuth-based drugs, several side effects have also been reported. In fact, excessive acute ingestion of bismuth, or abuse for an extended period of time, can lead to toxicity. However, evidence has demonstrated that the discontinuation of these compounds usually reverses their toxic effects. Notwithstanding, the continuously growing use of bismuth products suggests that it is indeed part of our environment and our daily lives, which urges a more in-depth review and investigation into its possible undesired activities. Therefore, this review aims to update the pharmaco-toxicological properties of bismuth compounds. A special focus will be given to in vitro, in vivo, and clinical studies exploring their toxicity.

Abstract licence: CC BY

Bismuth basic nitrates (BBNs) were synthesized via an electrochemical method, i.e., by electrodeposition from an acidic solution of bismuth nitrate, followed by thermal treatment in an air environment. For the first time, the influence of various electrochemical parameters on the morphology, crystal structure, and chemical structure of BBNs was examined. The following synthesis parameters were investigated: electrodeposition current density, thermal treatment temperature of the obtained deposit, and working electrode material (cathode). The obtained materials were characterized by SEM-EDX, XRD, FTIR, TG, and N2 adsorption/desorption methods and were applied for the sorption of the textile dye RB19. The results showed that the electrodeposition current density and thermal treatment temperature affect the surface morphology, chemical composition, and crystal structure of the obtained materials, as well as the RB19 sorption efficiency. On the other hand, the working electrode material does not affect the properties of the synthesized materials mentioned. Kinetic, isotherm, and thermodynamic analysis of the sorption process were also examined.

Abstract licence: CC BY

Abstract Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days (p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

Abstract licence: CC BY 4.0