摘要:

AbstractForty‐two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty‐one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell‐Luc operation, or intranasal approach.There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted.Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work‐up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow‐up is necessary. Further surgery may be indicated. Postoperative radiation therapy is recommended if malignancy is indee

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00001

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractFrom 1969 to 1990, 43 patients with tracheal stenosis were treated at the University of Mississippi Medical Center. Seventy‐four percent of these patients (n = 32) had intrinsic tracheal stenosis, most frequently as a complication of prolonged endotracheal trauma. A total of 41 distinctly separate stenotic segments were identified in the 32 patients. The stenoses were considered moderate or severe in 33 (80%) of the 41 cases and the length of the stenotic segment was greater than 1 cm in 23 (56%) of the cases. An overall 70% success rate was achieved following 93 surgical procedures in this group. The concurrent presence of glottic/subglottic stenosis, multiple segments of stenosis, bilateral vocal cord paralysis, tracheoesophageal fistula, and a tendency to marked hypertrophic scar formation were found to be significant factors in the surgical management of this patient grou

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00002

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractSince the first report of cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) in 1972, knowledge of the biological behavior of this tumor has continued to increase. This study reviews three previously unreported cases in addition to reports on 429 patients collected from the literature. The presenting features of these 306 patients were analyzed for frequency and then were analyzed by the Cox proportional hazard model for the relationship of each to recurrence and outcome. This study confirms that cutaneous neuroendocrine carcinoma is an aggressive disease; that the most common cause of death in these patients is by distant metastasis; and that men have succumbed more frequently than women. As a result of this study, aggressive treatment of cutaneous neuroendocrine carcinoma is recommended, especially in the male patient.

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00003

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe anterior cricoid split (ACS) operation has been documented as a successful treatment for the difficult‐to‐extubate infant or child. The exact mechanism by which this operation is successful is still being investigated. In an effort to further elucidate the effect of the ACS procedure on the subglottic airway, four groups of rabbits were studied. Both size and shape of the subglottic area after surgical manipulation were evaluated, comparing control rabbits with ACS, anteroposterior cricoid split (A‐PCS), and partial cricoid split with sparing of soft‐tissue lining (partial ACS). The animals were sacrificed 4 weeks after surgery, and the larynxes were harvested. Analysis showed a significant enlargement of the subglottic lumen in all experimental groups as measured at the inner lamina of the cricoid cartilage. However, the true subglottic lumen was significantly enlarged only in the ACS group. Findings showed that true enlargement of the subglottic lumen was limited in all experimental groups to increased thickness in the soft‐tissue lining of the subglottic lumen, which was most marked in the A‐PCS group. A significant change in subglottic lumen shape occurred in the A‐PCS group as well. These results suggest the A‐PCS should be approached clinically with caution when a st

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00004

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractAngioedema is a problem that the otolaryngologist—head and neck surgeon is often asked to treat. This report concerns 17 patients admitted for care during a 5‐year period. At their initial presentation, 94% of these patients manifested signs and symptoms of angioedema in the head and neck; three of them required urgent tracheotomy or intubation. As treatment of complement‐mediated angioedema is distinct, an etiology‐specific diagnostic and treatment protocol is presented.Of the patients, 35% had recent initiation of angiotensin‐converting enzyme (ACE) inhibitor therapy for hypertension, and 6% demonstrated classic hereditary angioedema. However, the majority of them (59%) had unclear etiologies for their symptoms. Since angioedema is the final result of several possible abnormalities, a thorough knowledge of the differential diagnosis and clinical presentation is vital to patient m

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00005

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe role of postoperative radiographic follow‐up of patients after acoustic neuroma or glomus jugulare tumor removal is unclear and not standardized. The incidence of both lesions is rare and recurrence thought to be unusual. However, a patient with an acoustic neuroma arising in the same ear afflicted with a glomus jugulare tumor removed 5 years earlier prompted a retrospective review of 999 acoustic neuroma and 98 glomus jugulare tumor patients. This review helps to determine the role and frequency of postoperative follow‐up, not only to assess recurrence of these lesions but to monitor for the possible development of potential clinically silent new lesi

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00006

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractDigital technological advances have made detailed voice analysis possible. This report proposes, with the use of such equipment, a new method of quantifying differences in the high‐frequency content of normal and breathy voices.The high‐frequency power ratio, a ratio of high‐frequency power versus total power, was calculated as the lower limit of the high‐frequency range (Fc) and varied from 1 to 10 kHz. The high‐frequency power ratio values of two groups, 16 normal and 24 breathy voice individuals, were then compared. Three breathy individuals were also studied after type I thyroplasty.High‐frequency power ratio values measured at an Fc of 6 kHz significantly separated normal from breathy voices. The specifications provided are appropriate for both the commercial voice lab and for clinical resources. Furthermore, a high‐frequency power ratio (6 kHz) is a useful tool for the evaluation of

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00007

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe paired posterior cricoarytenoid (PCA) muscle has three separate muscle bellies that differ in muscle fiber type (percentage of fast vs. slow twitch) and electromyelographic activity, and, in addition, produce different movements of the arytenoids when stimulated. An investigation of the innervation of the muscle was undertaken to demonstrate the existence of separate functional units.The intramuscular nerve supply of the PCA from five sacrificed dogs were microdissected. The intramuscular nerves of three additional dogs were removed and stained for acetylcholinesterase, which differentiates axons bound for fast‐ and slow‐twitch muscle, and sensory end organs.Three separate fascicles are described entering the PCA muscle from a single branch of the recurrent laryngeal nerve. The three fascicles differ in axon type composition and in sensory, autonomic, and motor percentages, with the ratio of fast twitch to slow twitch varying from 0.78 to 1.5 to 1.7 (P<.05). This variation supports separate functional capabilities for the three muscle bellies of the

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00008

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractThe current literature suggests that outpatient tonsillectomy is a safe, cost‐effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedur

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00009

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY

摘要:

AbstractPositron emission tomography (PET) has been shown to be effective in detecting intracranial malignancies based on cerebral glucose metabolism. To evaluate the ability of PET to detect extracranial head and neck neoplasms and cervical metastases, 16 patients with primary squamous cell carcinomas were examined. All patients received preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) scans and underwent PET evaluation using intravenous18F‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG). Histopathologic analysis compared tumor invasion and positive lymph nodes with findings on MRI, CT, and PET images. All primary tumors were delineated by PET, while MRI and CT failed to detect one superficial tumor involving the anterior tongue. Ten nodes were detected by CT and MRI versus 12 nodes demonstrated by PET. PET is highly effective in detecting head and neck carcinomas as well as metastatic cervical lymph nodes. In addition, PET may be useful in evaluating postsurgery and postradiotherapy patients for recurrent and new pri

ISSN:0023-852X    

DOI:10.1288/00005537-199203000-00010

出版商:John Wiley&Sons, Inc.    

年代:1992

数据来源: WILEY