RESUMEN
A supraglottic thyroid cartilage flap was used to reconstruct vertical partial laryngectomy defects in seven patients, including three radiation failures. Local control was maintained in six of seven patients, with one radiation failure recurring in the subglottis and anterior neck skin. Reconstructively, the radiation failures healed more slowly, but all patients were decannulated in 1 to 4 weeks with normal deglutition. The majority of the ipsilateral arytenoid was preserved in two patients. In the first case, the thyroid cartilage flap was shortened and sutured to the cut surface of the arytenoid. This patient later developed laryngeal stenosis. In the second case, a muscle flap was used to reconstruct the cord, and the thyroid cartilage flap was used externally. This was successful, and we prefer this modification of the Bailey procedure when the arytenoid is preserved.
Asunto(s)
Cartílagos Laríngeos/cirugía , Laringectomía , Laringe/cirugía , Colgajos Quirúrgicos , Cartílago Tiroides/cirugía , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Glotis/cirugía , Humanos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Laringectomía/efectos adversos , Laringoestenosis/etiología , Recurrencia Local de Neoplasia/terapia , Reoperación , Colgajos Quirúrgicos/efectos adversosRESUMEN
The treatment of Bell's palsy with steroids is controversial. Several series of patients have shown steroids to be beneficial to a statistically significant degree; however, their experimental design was of poor quality and made this data less clinically valuable. The negative trials showing no benefit with steroids did not examine enough patients to have a chance to show a clinically important difference. These series must be considered as partially completed studies and not as conclusive negative trials. A Type I error analysis is the accepted method of statistically analyzing the data of these trials. After reviewing the evidence, it becomes clear that further scientific research is needed.
Asunto(s)
Corticoesteroides/uso terapéutico , Parálisis Facial/tratamiento farmacológico , Proyectos de Investigación , Ensayos Clínicos como Asunto , Humanos , Estadística como AsuntoRESUMEN
Reconstruction of the larynx following vertical partial laryngectomy may be undertaken with many techniques. Methods using soft tissue employ readily accessible structures within the operative field with straightforward reconstructive designs. However, decannulation is often delayed, and variable degrees of atrophy must be planned for. Methods using cartilage may lead to early decannulation without long-term atrophy as a problem. However, grafts or flaps are less accessible, and reconstructive designs are often complex. In addition, chondritis may be a significant problem, especially in radiated patients. A supraglottic thyroid cartilage flap is described that is readily accessible and maintains its blood supply from external and internal perichondrium, as well as internal mucosa. Its use is reserved for unilateral glottic lesions without supraglottic spread. Experience with this technique is described in two patients.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Cartílagos Laríngeos/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Laringe/cirugía , Colgajos Quirúrgicos/métodos , Cartílago Tiroides/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A female newborn had a rare case of congenital multiple fibromatosis, consisting of multiple fibrous lesions that histologically resemble myofibromas. Bony and soft-tissue lesions usually undergo spontaneous resolution, but excision may be required if vital structures are compromised as was the case in this patient. When the lesions involve the viscera in a generalized form of the disease, the result is often fatal.
Asunto(s)
Enfermedades Óseas/congénito , Neoplasias Faciales/congénito , Fibroma/congénito , Leiomioma/congénito , Neoplasias Primarias Múltiples/congénito , Enfermedades Óseas/patología , Neoplasias Faciales/patología , Femenino , Fibroma/patología , Humanos , Recién Nacido , Leiomioma/patología , Neoplasias Primarias Múltiples/patologíaRESUMEN
More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.
Asunto(s)
Complicaciones Posoperatorias , Rinoplastia/efectos adversos , Adulto , Anciano , Cartílago/cirugía , Cicatriz/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Rinoplastia/métodos , Colgajos Quirúrgicos , Técnicas de SuturaAsunto(s)
Cateterismo , Várices Esofágicas y Gástricas/cirugía , Circulación Extracorporea , Vena Porta/cirugía , Trombosis/prevención & control , Animales , Presión Sanguínea , Carbono , Cateterismo/instrumentación , Perros , Circulación Extracorporea/instrumentación , Heparina , Métodos , Poliuretanos , Polivinilos , Venas UmbilicalesAsunto(s)
Ganglios Simpáticos , Neoplasias de Cabeza y Cuello , Neurilemoma , Neoplasias del Sistema Nervioso Periférico , Adolescente , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Neurilemoma/diagnóstico , Neurilemoma/cirugía , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neoplasias del Sistema Nervioso Periférico/cirugíaAsunto(s)
Enfermedades de las Glándulas Salivales , Glándulas Salivales Menores , Glándulas Salivales , Sialadenitis , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Glándulas Salivales/patología , Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Sialadenitis/patologíaAsunto(s)
Oído Externo/lesiones , Adulto , Mordeduras Humanas/cirugía , Oído Externo/cirugía , Humanos , Masculino , ReoperaciónRESUMEN
Laryngeal cysts of thyroid cartilage origin are unusually rare. A patient had a degenerative cyst of the thyroid cartilage. This presented as a unilateral false cord swelling. Computed tomography helped to localize the lesion to the left thyroid ala. An external laryngeal approach was used for excisional biopsy, and this also proved to be curative. The cyst probably resulted from a traumatic episode 35 years earlier.
Asunto(s)
Quistes/patología , Cartílagos Laríngeos/patología , Enfermedades de la Laringe/patología , Cartílago Tiroides/patología , Quistes/diagnóstico por imagen , Humanos , Enfermedades de la Laringe/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The utility of gray scale ultrasonography in evaluation of extrathyroid masses of the head and neck is demonstrated by correlating ultrasonic data with clinical and histologic findings in 40 cases. This technique is valuable in differentiating cystic from noncystic masses in determining the nature of inflammatory masses, and in many cases allows determination of the margins of a mass and its relationship to adjacent structures.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Cabeza , Cuello , Ultrasonografía , Absceso/diagnóstico , Quistes/diagnóstico , HumanosRESUMEN
Mucoepidermoid carcinomas originating within the body of the mandible are uncommon tumors with histogenesis and treatment reviewed. The second youngest patient in the literature is reported with a tumor originating within the angle of the mandible. Treatment consisted of wide local excision, including composite resection of the mandible without evidence of recurrence at two years.
Asunto(s)
Carcinoma/patología , Neoplasias Mandibulares/patología , Carcinoma/cirugía , Niño , Femenino , Humanos , Neoplasias Mandibulares/cirugíaRESUMEN
The external rhinoplastic method provides a rapid and convenient route for transseptal transsphenoid surgery of the pituitary gland. This procedure offers several practical advantages over the conventional subnasal approach and should be seriously considered by rhinologists active in this area.
Asunto(s)
Hipofisectomía/métodos , Rinoplastia/métodos , Estudios de Evaluación como Asunto , Humanos , Tabique Nasal/cirugía , Silla Turca/cirugía , Seno Esfenoidal/cirugíaRESUMEN
The external (combination) rhinoplasty approach has gradually gained acceptance as an approach to expose the nasal infrastructure. Its wide exposure has sharpened diagnostic skills by correlating pre-operative clinical impressions with specific anatomic deformities found at surgery. Its wide access has greatly increased as well as simplified the range of surgical maneuvers used in reconstruction. Following a review of the external approach, attention is focused on some of the problem nasal deformities where this approach has been helpful in obtaining good results. Nasal valve obstruction, nasal tip problems, nasal pyramid depression, and the crooked nose are discussed in terms of pathological anatomy and techniques of repair.
Asunto(s)
Rinoplastia/métodos , Femenino , Humanos , MasculinoRESUMEN
Only 15% to 25% of cold nodules on conventional static thyroid scans are malignant. Radionuclide angiography of the thyroid and conventional static scans using sodium pertechnetate Tc 99m were performed on 114 patients who underwent thyroid surgery within a five-year period. The combined use of radionuclide angiography and conventional static scans increased the specificity for the diagnosis of thyroid carcinoma from 42% to 79% over static scans alone. The incidence of carcinoma in solitary cold nodules in our population was increased from 26% on static scans to 60% if the lesion was hypervascular on radionuclide angiography. Eighty-seven percent of hypervascular solitary cold nodules were neoplasms (carcinomas and adenomas). Hypervascularity as demonstrated by radionuclide angiography is predictive of thyroid neoplasia. The finding of a hypervascular, solitary cold nodule makes a recommendation for surgery predictive and reasonable.
Asunto(s)
Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Adenocarcinoma/patología , Adenoma/patología , Carcinoma/patología , Carcinoma Papilar/patología , Diagnóstico Diferencial , Enfermedad de Graves/patología , Humanos , Cintigrafía , Pertecnetato de Sodio Tc 99m , Enfermedades de la Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugíaRESUMEN
Using an experimental animal model, we studied the stability of the size (gross morphology) and structure (histomorphology) of the fascia autograft. Fascia from a rabbit's leg was grafted in the subcutaneous tissue of the ear and abdomen and also into the intra-abdominal cavity. The weight and size of the autograft were recorded during the study period. Our findings showed that the size of the autograft remained stable, but there was a substantial weight reduction. Microscopic examination of histopathologic sections disclosed that there was no inflammatory response to the fascia. It also appeared to maintain its histomorphologic structure. Clinical trials with patients receiving facial plastic surgery are also reported. We believe a fascia autograft can be used to augment facial areas. We base this conclusion on the findings from previous reports, our animal experiment, and clinical trials.