摘要:

AbstractA method for reconstruction of oral cavity soft tissues using segmentally or axially supplied free muscle flaps harvested as a unit with their bone components is presented. Both fibular/soleus and iliac crest/internal oblique free flaps are documented, and the pros and cons of each donor site are presented.Twenty‐one patients, 17 with cancer or osteoradionecrosis and 4 with benign or congenital conditions of the mandible, have undergone this operation. Ten bone grafts were simultaneously embedded with osseointegrated implants. All free flaps except one survived and resulted in a smoothly mucosalized oral lining. Six patients have had their implants successfully uncovered, all of whom are wearing prostheses. Four other patients are using tissue‐borne prostheses. Transfer of free, nonbulky muscle flaps for mucosalized oral soft‐tissue reconstruction is feasible in selected patients using first the fibular and, second, the iliac donor site; this soft‐tissue technique also contributes to prosthetic dental rehabil

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00001

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractSupraglottitis is a rapidly progressive, life‐threatening airway emergency in pediatric patients typically caused byHaemophilus influenzaetype B (HIB). With distribution of the first efficacious vaccine for HIB in April 1985, changing disease patterns have begun to emerge; however, certain characteristics have remarkably persisted.The authors reviewed 252 pediatric patients with acute supraglottitis spanning the prevaccination and postvaccination years 1980 to 1992 at three major regional pediatric hospitals in Massachusetts, Ohio, and California, as well as at two community hospitals in Massachusetts. Findings include a decline in disease prevalence in all geographic areas with demographic, etiologic, and management evolution all seen. Children who had been immunized yet developed supraglottitis have been examined as predictive of future trend

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00002

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe Vanderbilt Free Electron Laser (FEL) is capable of lasing between 2.0 and 8.0 μm with a high peak intensity pulsed structure. The FEL is used to investigate potential applications in otolaryngology. Charring of temporal bones and thermal stress patterns in Plexiglas indicate thermal buildup at 20 and 10 Hz repetition rates of the laser. Also, transient temperature changes measured with thermocouples in a gelatin model reveal that significant heat production occurs at these laser repetition rates. To utilize the fastest laser repetition rates and maintain minimal lateral thermal damage, a computer‐controlled scanning system was devised. The authors have also used the computer control with the carbon dioxide laser and experienced improved ablati

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00003

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe authors established a means of effective gene transfer into human thyroid follicular cells via retroviral‐mediated mechanisms. Using specific harvest and culture techniques, we investigated the selection of human thyroid cells in serum‐free media. Normal adult human thyroid tissue was obtained after thyroidectomy from fresh specimens sent for frozen‐section analysis. Follicular cells were harvested and grown in hormonally defined, serum‐free media to prevent fibroblast growth with selection for differentiated function assessed by immunohisto‐chemical staining for thyroglobulin. The efficiency of gene transfer into human thyroid cells was compared between the zen‐β‐gal and LNL6 retroviral vectors. The zen‐β‐gal retrovirus encodes the product β‐galactosidase, and gene expression was demonstrated by histochemical staining in 0.1% to 1% of the cells. An improved efficiency of 2% to 3% transduction was demonstrated using the LNL6 vector which carries the gene for neomycin resistance (NEO‐R). Polymerase chain reaction (PCR) identification of the integrated proviral sequence (NEO‐R gene) with Southern blot confirmation was used to quantitate LNL6 transductions and compare confluent versus actively dividing cell cultures. Follicular cell gene therapy has significant potential for treating congenital or acquired diseases of the thyroid as well as disorders of circulating proteins such as diabetes, hypopituitarism, and hemophilia. The ability to culture human follicular cells and perform effective gene transfer is paramount in the eventual realizati

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00004

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractMutational activation and overexpression of the family ofrasproto‐oncogenes have been associated with many human tumors. The role of mutations of H‐ras, K‐ras, and N‐ras, as well as expression of the respective protein products (p21s) in normal mucosa, dysplastic mucosa, and squamous cell carcinomas (SCCs) of the head and neck has not been fully described. In our study, 51 tumors (40 paraffin embedded and 11 fresh frozen) were examined to determine if mutational activation ofrasis an important molecular event in head and neck SCC. Analyses of codons 12, 13, and 61 of H‐ras, K‐ras, and N‐rasrevealed no mutations, suggesting that mutational activation ofrasis not important in the majority of head and neck SCCs.Immunocytochemistry (ICC) was used to define the expression of H‐ras, K‐ras, and N‐rasin normal mucosa, dysplastic mucosa, and SCC of the head and neck and to determine if expression ofrasfamily members correlated with early or late events in the development of SCC. Expression of p21N‐rasin nine samples of histologically normal head and neck mucosa revealed moderate staining in the basal proliferative layers with progressively less staining as cells matured. The most superficial layers of normal mucosa failed to express p21N‐ras. A low level of p21H‐raswas expressed in all layers of normal mucosa while K‐raswas not expressed. ICC of SCC tumor sections revealed cytoplasmic expression of N‐rasin nine of nine tumors, H‐rasin five of nine tumors, and K‐rasin one of nine tumors. Expression of H‐ras, K‐ras, and N‐rasin head and neck SCC was not related to histologic differentiation or TNM staging; however, p21N‐raswas overexpressed in seven of nine tumors. Furthermore, the pattern of N‐rasexpression in dysplastic lesions revealed expression in all layers of the mucosa in contrast to normal mucosa, which expresses p21N‐rasprimarily in the basal proliferative layer. The change in p21N‐rasexpression pattern in dysplastic mucosa and its overexpression in the majority of tumors suggest that loss of control of N‐rasexpression may be an

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00005

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn a series of 571 acoustic neuromas, 23 were identified as cystic tumors. An immunohistochemical study including nervous system‐associated protein (S‐100), glial fibrillary acidic protein (GFAP), neurofilament protein (NF), laminin, fibronectin, vi‐mentin, factor VIII (von Willebrand factor)–related antigen, and the nuclear antibody Ki‐67 was performed. The cyst walls contained numerous S‐100‐positive fibrils distributed throughout the whole extent of the walls. Laminin, fibronectin, and vi‐mentin were predominantly located around the vessel walls, factor VIII was found inside the vessels. GFAP‐positive lamellae occurred in 50% of the cases near the surface of the cyst walls. Ki‐67 is an antigen associated with cell proliferation. The density of Ki‐67–positive cells was found to be 36 times lower in 16 noncystic controls than in the 23 cystic neuromas, indicating that the increase in tumor size in cystic acoustic neuromas may be caused by expansion of the cysts and not by an actual increase in the growth rate of the tumor cells.The data achieved in this series may contribute to better planning of the surgical approach. Because of the risk of sudden expansion of cystic elements, a wait‐and‐see policy should not be applied to patients wi

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00006

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractDisruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state‐of‐the‐art diagnostic techniques and new concepts in management helps optimize the chances for good voice qu

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00007

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractFifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) diagnosed by nocturnal recordings of respiration movements by a static charge sensitive bed (SCSB) and oximetry, alone or combined with polysomnography, were studied. Renewed SCSB—oximetry recordings evaluated treatment. Six months after surgery, 30 of 50 were classified as responders. Twenty‐one months after surgery, 19 of 49 were responders. Patients who relapsed showed a significant increase in mean body mass index (BMI). Four years after surgery, 24 of 48 patients were responders. Preoperative BMI was significantly lower in the responder group. Subsequent treatment was required in 15 nonresponders. There was no correlation between patients' subjective improvement and objective results. The study resulted in the following conclusions:1.The responder rate to UPPP in unselected patients is low.2.Obesity and high indices of nocturnal respiratory disturbance are negative predictors.3.The patients' subjective recovery alone must not be used for postoperative evaluation.4.With regular follow‐up and the use of the treatment alternatives available today, the majority of OSAS patients can receive effective trea

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00008

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractVocal fold nodules are a common cause of dys‐phonia generally attributed to vocal abuse. Anterior commissure microwebs have been reported as an incidental finding in surgical patients with nodules. In a series of 105 nodule patients evaluated at the University of Wisconsin Clinical Science Center voice laboratory (1987–1992), 11 microwebs were identified. Ten of these microweb patients were among the 20 nodule patients who did not respond to voice therapy and underwent microsurgery. In patients with nodules whose hoarseness is refractory to voice therapy, symptoms that occur early in life suggest the presence of occult vocal fold pathology. Microweb detection requires a high index of suspicion, observation during maximal vocal fold abduction, and clearance of secretions from the anterior commissure. Definitive identification is facilitated by gentle separation of the anterior vocal folds during direct microlaryn‐goscopy. The presence of these tiny shelves of tissue might be coincidental, or they might represent another expression of the tissue response to traumatic factors known to produce vocal nodules. We found little difference in vocal function parameters between two similar groups of nodule patients, one with and one without associated microwebs. Further work is needed to determine the significance of micr

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00009

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThis study was undertaken to determine the activation and coordination patterns of the three suprahyoid muscles—geniohyoid, mylohyoid, and anterior belly of the digastric muscle—in elevating the larynx during swallowing. Electromyographic activity was also recorded from two intrinsic laryngeal muscles (vocalis and lateral cricoarytenoid) and the anterior genioglossus. Ten adults served as participants. Each participant produced 15 swallows of 15 mL of tap water both normally and with a 12‐mm bite block placed between the molars. The electromyographic data were ensemble‐averaged with a laboratory computer. Analyses showed that the three suprahyoid muscles were used selectively by different participants. Some participants used all three muscles for hyoid elevation, while others used different pairs of two of the muscles. The activation patterns of the suprahyoid muscles during swallowing also varied with respect to each other and the onset of the laryngeal constrictor muscles; however, use of at least one suprahyoid muscle always preceded the onset of the laryngeal adductors, indicating that larynx elevation consistently preceded glottal adduction. The way in which the muscles responded to the bite block varied considerably both within and among participants. Some maintained temporal stability but increased overall muscle activity; others reorganized temporal relations either with or without corresponding muscle activity adjustments. These findings suggest that the laryngeal elevation system is an adaptive function rather than an immutable

ISSN:0023-852X    

DOI:10.1288/00005537-199411000-00010

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY