摘要:

AbstractSelected facial bone locations were impacted to simulate clinical trauma conditions. Locations selected included the nose, zygoma, mandible, maxilla, and frontal bone. The experiment clearly delineate tolerance bands for the facial bones for both sexes. These data should permit the improved design of injury producing structures.

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00011

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractSome unfortunate patients suffer disorders which in one way or another, usually neurologically, severely restrict the larynx in its role as a protector of the lower airway. Aspiration ensues, and unless it can be successfully managed, repeated episodes of a violent pneumonitis may lead to terminal chest problems.In some patients, even the cuffed tracheostomy tubes of new and improved design do not adequately prevent aspiration over an extended time interval, as evidenced by repeated bouts of aspiration pneumonia despite these cuffed tubes and despite optimal intensive care.For these patients with intractable aspiration, and in whom recovery is expected only after a prolonged period of time, we have suggested a diverting procedure which employs a tracheo‐esophageal anastomosis, as an effective yet reversible solution. Such an anastomosis with concomitant tracheostomy allows aspiration of saliva and even food to occur through the malfunctioning larynx but diverts it back into the esophagus through the tracheo‐esophageal anastomosis.In normal mongrel dogs we demonstrated that an end‐to‐side tracheoesophageal anastomosis is well tolerated and can be performed without damage to the intrinsic larynx or recurrent laryngeal nerves. The tracheoesophageal lumen remained patent and the anastomosis intact for as long as these animals were observed prior to reconstruction.The reversibility of the tracheo‐esophageal anastomosis was demonstrated in these dogs by excising the anastomosis, repairing the esophageal defect, and restoring the continuity of the trachea by end‐to‐end anastomosis. Vocal cord motion remained intact, the dogs ate normally, and barked once again.A tracheo‐esophageal anastomosis was performed in a 60‐year‐old white female who had suffered lower cranial nerve damage as a result of a large acoustic tumor and the excision thereof. Despite every effort to control aspiration, pneumonitis occurred and became fulminant.The diverting tracheo‐esophageal anastomosis was performed with relative ease and was well tolerated by the patient. Aspiration was totally and dependably controlled, and no further chest complications occurred. Her nasogastric feeding tube was removed, and she ate a regular diet with very little difficulty. She gained in strength, became much more alert mentally, and is now taking care of herself in a nursing home.We are following her progress by indirect laryngoscopy and barium swallow examinations and at five months post anastomosis, we are possibly seeing the first signs of lower cranial nerve recovery. We hope that reconstruction and restoration of function will soon be possible.We feel that the results to date of our animal experimentation and of our case report are satisfactory. Many questions remain unanswered, however, and for this reason we must emphasize a very conservative approach to the clinical applicat

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00012

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractTwo case reports illustrate different ways for restoration of quality of the voice. In both instances the vocal cords were displaced by trauma and restored by surgical correction.

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00013

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractInverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainty surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill‐defined clinical approach to their management.The designationInverted Schneiderian Papillomais suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character.The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm.The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach.A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision to split the upper lip and reflect the cheek flap as is customarily done with the Weber‐Fergusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma.An associated malignancy was found in 12.5 percent of the cases.A uniform system of classification is proposed in which the tumors are placed into one of three categories:1.those which appear typical;2.those which contain atypical features; and3.those which contain an associated malignancy. With the uniform system of classification, reliable data may be compiled and factual correlations established between the clinical and pathologic features of the inverted Schneiderian papill

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00014

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00015

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00016

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY