摘要:

AbstractThe combination of a myocutaneous flap or free cutaneous tissue transfer with a three‐dimensional bendable reconstruction plate either of stainless steel or titanium has provided very satisfactory results in primary restoration of mandibular defects following surgical resections in irradiated patients or in those who require postoperative radiotherapy. Sixty‐four cases have been treated and evaluated pro‐spectively using this technique. Fifty‐three of the patients had the soft‐tissue defect restored with a myocutaneous flap, 8 had a free cutaneous tissue flap, 2 were reconstructed with tongue flaps, and 1 closed primarily. The stainless steel plate of the A.O. type was used in 53 cases and the titanium plate system and hollow screws in the other 11 cases. A success rate of 78.9% was found with a median follow‐up of 384 days. Thirty of the 64 cases had preoperative irradiation and 15 were treated postoperatively. A plate failure rate of 23% was encountered in those treated with preoperative irradiation and in 20% with those having postoperative irradiation. Forty‐nine of the 64 patients or 76.5% experienced no perioperative complications. Five or 7.8% of the complications were minor. Ten patients or 15.6% experienced a major complication with one death due to a myocardial infarct. A radiation dosimetric model was employed using both stainless steel and titanium. The results from this study showed that, when using a parallel pair of beams, an excess dose of irradiation for the lowest energy cobalt‐60 is 13%, for 6 mV it is 15%, and for 18 mV it is 20%. The excess tissue dose, both for stainless steel and titanium plates, extends for about 0.2 mm for cobalt‐60, 1.1 mm at 6 mV, and for 25 mm at 18 mV. Patients with plates, therefore, can be treated safely with postoperative irradiation using either cobalt

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00021

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractConventional computed tomographic display formats are not optimal for demonstrating three‐dimensional anatomic relationships. In otolaryngology—head and neck surgery these critical relationships are often highly complex, and their complete understanding is essential to a successful surgical outcome. A new computer‐generated image display format, high‐resolution volume rendering (HRVR), facilitates the understanding of these critical anatomic relationships by transforming conventional imaging data into clinically relevant 3‐D images. Unlike many other 3‐D reconstruction algorithms, HRVR suffers minimal data loss in the conversion process, which in turn provides for superior image resolution. This better allows the application of 3‐D technology to small or complicated anatomic structures such as those frequently encountered in otolaryngology—head and neck surgery. Advances in computer‐controlled manipulations that further enhance the evaluation of desired pathologic features have been achieved. This pilot study contains representative clinical cases chosen to illustrate the potential utility of HRVR in otolaryngology—head and neck surgery. The authors believe HRVR images will enhance the surgeon's understanding of the 3‐D anatomic relationships that exist between critical pathologic features and surroun

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00001

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractTo assess the ability of simultaneous cisplatin, 5‐Fluorouracil, and radiation to substitute for surgery and radiation in advanced head and neck cancer, we have retrospectively selected from our phase II study a subgroup of 29 patients having primary disease requiring either more than a hemiglossec‐tomy or a laryngectomy for control. Patients included 22 with stage IV and 7 with stage III disease, 12 tongue, 10 hypopharynx, and 7 larynx primaries. The treatment consisted of concurrent cisplatin, 5‐Fluo‐rouracil, and split‐course radiation every other week for a total of 7 cycles within 13 weeks. With a median follow‐up of 5 years, 86% of patients had preservation of speech and/or swallowing function. Median survival was 45 months, with 14 (48%) patients currently alive and disease free, 11 (38%) dead from their cancer, and 4 (14%) dead of other causes. The overall failure rate was 38%. Advanced‐stage presence of N3 nodal disease and fewer than 7 cycles of chemotherapy received were significantly associated with increasing failure rates. This program of concomitant cisplatin, 5‐Fluorouracil, and radiation produced control rates quite competitive with surgery and radiation and is appropriate for definitive testing in a r

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00002

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractTumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid‐sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid‐sheath contents, after‐loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal.There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6,20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid‐sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low‐dose‐rate interstitial brachytherapy without co

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00003

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractLyme disease is a systemic illness caused by the spirocheteBorrelia burgdorferiand transmitted by the bite of a tick in theIocodes ricinus complex. While the illness is often associated with a characteristic rash, erythema migrans, patients may also present with a variety of complaints in the absence of the rash. The otolaryngologist may be called upon to see both groups of patients, with any number of signs and symptoms referable to the head and neck, including headache, neck pain, odynophagia, cranial nerve palsy, head and neck dysesthesia, otalgia, tinnitus, hearing loss, vertigo, temporomandibular pain, lymphad‐enopathy, and dysgeusia. We review our institutional experience with 266 patients with Lyme disease, 75% of whom experienced head and neck symptoms. We also summarize the diagnostic and treatment modalities for this illnes

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00004

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractCough is a symptom frequently encountered by the otolaryngologist—head and neck surgeon. Although most coughs are self limited, chronic cough often proves to be a frustrating problem. Seventy‐two infants and children under age 16 with a normal chest radiogram have now been evaluated for chronic cough persisting for longer than 4 weeks. Cough‐variant asthma was the most common cause of cough, followed by sinusitis, gastroesophageal reflux, aberrant innominate artery, psychogenic cough, and sub‐glottic stenosis.Chronic cough is best managed by first following an individualized diagnostic protocol designed to determine the etiology of the cough. This is followed by specific therapy to treat the underlying disorder. Children with persistent cough and normal chest radiograph are best served when referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are not effective. Endoscopy is underutilized in practice and its importance understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00005

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractForty‐one children with congenital cholesteatoma of the middle ear seen from 1978 through 1989 are reviewed. The most common presentation was that of an asymptomatic white mass behind a normal intact tympanic membrane. Computed tomography (CT) scan was useful in documenting extension beyond the mesotympanum. Surgical removal was performed using an extended tympanotomy for lesions in the middle ear and tympanomastoidectomy for those that had extended into attic and mas‐toid air cells. Observation over an average 3.1‐year period indicated that 80% of children were free of disease after initial surgery. Residual disease that required further surgery was present in 20%.The importance of early diagnosis of congenital cholesteatoma is strongly advocated. The prognosis is better when the cholesteatoma is confined to the anterosuperior quadrant of the middle ear. Seventeen patients in this study had such a lesion, and extended tympanotomy allowed removal of an encapsulated closed cholesteatoma with normal postoperative hearing and no residual cholesteatoma. The average age was 2.3 years.Temporal bone histopathological studies of three cases of congenital cholesteatoma demonstrate two distinct pathological types of congenital cholesteatoma. A “closed” keratotic cyst in the anterior mesotympanum, which is easily removed, and an “open” infiltrative type in which there is no containment of the keratotic debris and the cholesteatoma matrix is in direct continuity with middle ear mu‐cosa. Surgical extirpation of the “open” type is difficult and more likely to be associated wi

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00006

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractForty‐five habitual snorers (mean respiratory disturbance index = 6) and 22 patients with obstructive sleep apnea syndrome (mean respiratory disturbance index = 36) were examined by polysom‐nography, radiocephalometry, rhinomanometry, na‐sopharyngeal videoendoscopy, and acoustic rhinometry. In 97% of these patients, hypertrophy of the inferior nasal turbinates was found by acoustic rhinometry, while increased nasal resistance of various degrees was measured in 93% of all patients by active anterior rhinomanometry.Acoustic rhinometry demonstrated that the most resistive segment was located in the anterior parts of the nasal cavity and was built up by two compartments: the region of the isthmus nasi and the region of the head of the inferior turbinate. In our snoring patients, the cross‐sectional areas at the head of the inferior turbinate were always smaller than the cross‐sectional areas in the isthmus nasi, which in normal controls presented the minimal cross‐sectional values of the whole nasal cavity. While rhinomanometry can only measure the amount of nasal resistance, acoustic rhinometry can clearly determine the exact size and location of the different stenoses in the nasal cavity that contribute to the increased nasal

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00007

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractThe clinicopathological aspects of 15 patients with necrotizing soft‐tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature.Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy‐appearing tissues at the periphery of the lesions.The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen‐section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the pat

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00008

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY

摘要:

AbstractSpecific antibody responses against the Epstein‐Barr virus‐coded nuclear antigen2 (EBNA2) were evaluated. Thirty‐five sera from pretreatment patients of nasopharyngeal carcinoma (NPC) and 12 from healthy adults were tested. Although the anti‐EBNA2 response did not show any correlation with T stage, overall stage, or histopathology, it showed a correlation with the N stage of the disease. In a se‐rological follow‐up study, 17 (85%) of 20 patients showed a correlation on the change of antibody levels to EBNA2 and clinical progression. This suggests that EBNA2 serology might represent a useful marker relative to t

ISSN:0023-852X    

DOI:10.1288/00005537-199106000-00009

出版商:John Wiley&Sons, Inc.    

年代:1991

数据来源: WILEY