摘要:

AbstractThe modern day otolaryngologist commonly faces reconstructive problems related to tissue loss secondary to neoplasms, trauma, infections and congenital deformities.Basic understanding of tissue types and flap configuration will allow the otolaryngologist to handle these problems adequately. Basic principles such as tissue texture, color, and varieties of flaps will be covered.Major emphasis will be placed on reconstructive flaps for the lips, nose and cheek.

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00001

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractOwing to the increased use of automobiles, minibikes, motorcycles and other devices for recreational activities, we are now seeing a growing number of severe head and neck injuries. In this paper we will discuss a rare and often fatal injury of the neck, namely, traumatic laryngotracheal separation. There are isolated reports in the literature of heroic efforts to save the lives of such patients, but little has been said regarding surgical repair of the injury and possible late complications.Seven case reports of laryngotracheal avulsion injuries are presented with emphasis placed on the methods of repair of the acute injury and reconstruction of late complications. The etiology of the injury in all cases was a severe localized blow to the extended neck at the level of the cricoid cartilage. Most patients arrived in the emergency room near death, showing obvious signs of upper airway obstruction. A rapid tracheostomy was responsible for saving their lives. In most cases the avulsed trachea was repaired primarily over an internal stent. Associated laryngeal and cricoid fractures were reduced and immobilized. A thorough exploration of the neck was done in most of these patients, and injury to the recurrent laryngeal nerves was commonly noted. Late sequelae depended on the type and extent of associated injuries, the type of repair performed, and timing of the definitive reconstruction. The most satisfactory results were obtained in patients receiving early reconstruction with the use of an internal stent. Equally as important in determining a favorable result following reconstruction was an accurate preoperative and operative assessmet of the extent of injury. Despite optimal early treatment of the acute injury, some patients will remain disabled either from a compromised airway or a poor voice. Additional surgical intervention is possible in most cases, and the variety of problems encountered taxes the versatility of the surgeon.

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00002

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractSeveral clinically different benign lesions can arise from the saccular appendage. The precise lesion at a given time depends on:1.the size of the saccule;2.whether free communication is possible between the appendage and the laryngeal lumen; and3.the presence or absence of inflammation. These lesions represent a spectrum of lesions in that clinical manifestations can vary from those of one type of lesion to another.A tiny saccule of only a few millimeters in length, with its lumen isolated from the ventricle, presents as a cyst of the anterior ventricle. A larger appendage, also closed from the laryngeal lumen, presents as a cyst of the lateral larynx, the so‐called congenital cyst or lateral saccular cyst. This same cyst can extend into the neck through the thyrohyoid membrane. This cyst can be seen at any age but is most common in the newborn and infant.An air sac or cyst (laryngocele) also can present as a small lesion of the anterior ventricle or as a larger sac within the lateral intrinsic larynx or can extend into the neck by way of the thyrohyoid membrane. Whether the growth is a mucus‐containing cyst or an air sac depends upon whether there is a communication with the air column of the larynx at the ventricle; a laryngopyocele is an infected air sac.Recognition of the developmental spectrum of saccular lesions should simplify terminol

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00003

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractSince Le Forte's experiments in the 19th Century, craniofacial dysjunction (Le Forte III fracture) has been recognized as a serious facial injury. A multidisciplinary approach to the management of these patients is often required by concurrent injuries to the eye, brain, chest, abdomen and extremities. The otolaryngologist is particularly equipped to deal with the problems of hemorrhage and upper airway distress, as well as with the functional and cosmetic repair these injuries require. This paper reports the management of craniofacial dysjunction in 26 patients during a three‐year period. Facial damage in the majority of cases was more extensive than that originally described and classified by Le Forte as Type III. Most cases resulted from automobile collisions. Males in the third decade of life predominated. Four patients died before care could be instituted. All patients had severe epistaxis, midfacial flattening and malocclusion, and six required emergency tracheostomy. Marked comminution of the nasal bones and septum was present in all. Fractures of the maxillary sinus were common and 16 of 22 survivors sustained nasofrontal injury, with pseudohypertelorism noted in all. Abrasions and lacerations to the face occurred in 12. Frontal sinus fractures were present in 15 cases and mandibular fractures in six. Other findings included seven with skull fractures, eight with fractured teeth, three with lacrimal sac and duct tears, two with severe intraocular damage, six with CSF rhinorrhea and 15 with diplopia. Repair of the facial fractures was initiated within the first 10 days following injury. All patients required intermaxillary fixation of the dental arches. No instance of delayed malocclusion resulted. When feasible, internal cranial suspension was employed, but in three severely comminuted fractures, external traction utilizing a special head cap was necessary. Frontal sinus obliteration with fat by osteoplastic technique was necessary in 10 patients. Fifteen patients had orbital floor explorations. Delayed findings included epiphora in two cases, diplopia in one, pseudohypertelorism and a flattened nose in three; jagged facial scarring in one, and CSF rhinorrhea in one. Individual follow‐up periods varied from one year to three years. It is the management of these delayed findings during the long follow‐up period that this paper particularly empha

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00004

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe effects of large doses of vitamin A during gestation on the embryo rat are described. Cleft palate formation, dose‐related disorganization of mandibular and maxillary growth due to abnormal cartilage deposits, and relative macroglossia are described. The previously described lathyrogenic and teratogenic affects of vitamin A in high doses is confirmed and further study suggested for possible deformities of the developing ea

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00005

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractOne of the most distressing complications of rhinoplasty is the settling of the nasal tip leading to a fullness in the supratip area, the so‐called “polly‐beak” deformity.An evaluation of the anatomical factors was carried out in the live patient and had two objectives in mind: to define the elements of nasal tip support and to evaluate some of the more popular surgical methods which are used to maintain or augment tip projection.The three elements of tip support, commonly destroyed during rhinoplasty, are the relationship between the upper and lower lateral cartilages, the fibrous union of the tip cartilages with the septum, and the lowering of the nasal skeleton secondary to hump removal.Since sacrifice of the superior margin of the alar cartilages is performed in most rhinoplasties, the fibrous overlapping relationship of the upper and lower cartilages is necessarily destroyed. Preservation of relationship of the mesial crural feet to the septum helps to maintain tip support without the necessity of cartilage struts and columellar sutures.When a complete transfixion incision is employed, the most effective method to augment tip projection is by the division of the alar cartilages and the re‐approximation of the medial portions in th

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00006

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00007

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractPost surgical and traumatic cicatricial stenosis of the ears and larynx are among the most disabling complications in otolaryngology. It is common knowledge that open procedures are mandatory when these stenoses are produced by the collapse of the superstructures supporting these cavities. Some strictures, however, are produced only by bands of adhesions or transposed cicatricial tissue. These stenoses may be corrected through surgical operations of a more conservative nature. This paper describes the practical applications of a surgical adjunct, the microcautery, in the rehabilitation of these latter patients. To date, about 25 patients have been treated successfully with this instrument.

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00008

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractA total of 91 cats were evaluated to determine the effectiveness and nature of closure of total tympanic membrane perforations with homografts preserved in buffered formaldehyde, 70 percent alcohol, benzalkonium in Tis‐U‐Sol (1:750 solution), or Cialit (1:5,000 aqueous solution). Controls consisted of unoperated ears, ears with partial and total perforations that were not grafted, ears in which the total tympanic membrane was removed and immediately replaced, and ears grafted with fresh homograft tympanic membranes.The study revealed that the removal of the tympanic annulus was necessary to prevent spontaneous regrowth of a new tympanic membrane. The percentage of successful closures of tympanic membrane perforations according to the preservative was formaldehyde 50 percent, alcohol 50 percent, benzalkonium 45 percent, and Cialit 30 percent. The rate of successful closures with fresh autograft tympanic membranes was 40 percent and with fresh homografts 25 percent. The homografts preserved in formaldehyde or alcohol were more rigid and easier to handle than were those preserved in benzalkonium or Cialit.The histologic findings were similar in ears that had developed a new tympanic membrane after grafting with preserved homograft tympanic membranes and in ears with fresh homografts or autografts. The graft served as an inert scaffold for the new tympanic membrane to grow across. Gelfoam used in the middle ear to support either a homograft or an autograft became incorporated into the new tympanic membrane and was associated with a foreign‐body reaction. There was, however, no evidence of an immunologic reaction to the homo

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00009

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractAn earlier monkey experiment, in which half the animals received short and long‐acting corticosteroids following stapedectomy, encouraged the author to conduct a study on human patients, in an effort to alleviate serous labyrinthitis. The results show that the group receiving steroids fared less well than the control group.From this study, it is concluded that long‐acting corticosteroids are contraindicated in patients undergoing stapedect

ISSN:0023-852X    

DOI:10.1288/00005537-197408000-00010

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY