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Biomedical subjects

A D Cheesman

Publications and source records attributed to A D Cheesman.

At least 19 recordsLinked to original sources
PubMed1998

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses--a 17-year experience.

BACKGROUND: The rarity of sinonasal tumors has precluded long-term follow-up of large series of craniofacial resections until now. METHODS: A series of 209 patients suffering from a wide range of histologies who had undergone craniofacial resection for sinonasal neoplasia with up to 17 years' follow-up were analyzed. RESULTS: An overall actuarial survival of 51% at 5 years and 41% at 10 years was found for the cohort as a whole. For malignant tumors, the 5-year actuarial survival was 44%, falling to 32% at 10 years. For benign pathology, the actuarial survival was 75% at both 5 and 10 years. Statistical analysis identified three factors which significantly affect outcome and survival: malignant histology, brain involvement, and orbital involvement. Few complications are associated with the surgery, with the mean post-operative stay being 16 days. CONCLUSIONS: The improved survival and minimal morbidity and mortality associated with craniofacial resection make it the optimum approach to sinonasal tumors.

Actuarial Analysis↗
PubMed1998

A skull base extradural hypoglossal neurilemmoma resected via an extended posterolateral approach.

The case of a 43-year-old man with a right skull base hypoglossal neurilemmoma excised via the extended posterolateral approach is presented. There is only one previous case of hypoglossal neurilemmoma in the literature. The surgical technique described is a new approach to the posterior skull base involving a suboccipital craniectomy, mastoidectomy and the removal of the lateral process of the atlas. It provides an inferior approach to the jugular foramen and hypoglossal canal that allows the lower cranial nerves to be identified as they exit from their skull base foramina. In the discussion we compare this technique to other surgical approaches previously described for access to the region of the jugular foramen.

Adult↗
PubMed1996

Enhanced magnetic resonance imaging and subtraction techniques in postoperative evaluation of craniofacial resection for sinonasal malignancy.

The use of magnetic resonance imaging (MRI) enhanced with gadolinium. and diethylenetriamine pentaacetic acid (DTPA) in the preoperative evaluation of sinonasal malignancy is well established and has an accuracy of over 98%. Since 1979, 208 patients have undergone craniofacial resection at London's Institute of Laryngology & Otology, primarily for sinonasal neoplasia affecting the anterior skull base. Thirty-five "high-risk" patients had MRI at follow-up. The MRI scans were assessed before the patients were examined under anesthesia. MRI was assessed before examination under anesthesia and the results compared with histologic findings demonstrating a reasonable degree of positive correlation but one which is inferior to that found preoperatively (80%). An extension of this technique using the subtraction of T1-weighted MRI with Gd-DTPA highlights areas of increased vascularity, which significantly improves the ability to predict recurrence at the skull base and above the surgical repair in the anterior cranial fossa (94%).

Adult↗
PubMed1996

Inspiratory coactivation of the genioglossus enlarges retroglossal space in laryngectomized humans.

To investigate the relationship between the electrical activity of the genioglossus (GG-EMG) and associated tongue movement, seven laryngectomized subjects breathing through a tracheal stoma (without pressure or flow change in the upper airway) were studied in the supine position. Tongue movement, with the use of lateral fluoroscopy, and GG-EMG expressed as a percentage of maximum voluntary genioglossal activation were monitored simultaneously during 1) spontaneous inspiration (SI), 2) resistive loaded inspiration (LI), and 3) rapid inspiration (RI). Tongue position during each maneuver was compared with its position during spontaneous expiration. Peak GG-EMG during the three maneuvers was significantly different from each other (SI: 5.4 +/- 1.6, LI: 11.9 +/- 1.8, and RI: 51.6 +/- 9.4 (SE) %, respectively). Associated forward movement of the posterior aspect of the tongue was minimum during SI; however, significant movement was observed during LI, and this was increased during RI. Significant covariance existed between peak GG-EMG and this movement. Genioglossal coactivation with inspiration enlarges the glossopharyngeal airway, particularly in its caudal part. In subjects with intact upper airways, this activation may protect or enhance upper airway patency in an effort-dependent manner.

Aged↗
PubMed1995

Iodine seeds in the treatment of slowly proliferating tumours in the head and neck region.

Locally recurrent/persistent disease is a major cause of morbidity and mortality in patients suffering from tumours arising in the head and neck region. Iodine-125, with its long half-life of 60 days, is particularly suited for the treatment of slowly proliferating tumours (e.g. adenoidcystic carcinomas) of this site. We report our experience with 18 patients using iodine-125 seeds, placed at the time of surgery in patients with such tumours. Eleven of the patients were treated for recurrent disease following previous radical treatment. Disease free survival was 89% at 2 years and 53% at 5 years after treatment. These results are encouraging in a group of patients in whom achieving and maintaining local control can be extremely difficult.

Adult↗
PubMed1995

Cordectomy: a solution to Teflon granuloma of the vocal fold.

Teflon injection has been widely used for the treatment of unilateral vocal fold paralysis. Complications are few and infrequent. Overinjection and Teflon granuloma are the two commonest problems encountered. Treating such complications and restoring vocal quality is widely regarded as difficult. Endoscopic transmucosal excision of the excess Teflon and/or granuloma has not been successful in improving phonatory quality. Cordectomy is proposed as an alternative surgical approach for managing both the convex vocal fold and Teflon granuloma after injection.

Female↗
PubMed1995

Laryngeal papillomatosis with subsequent development of papillomata in the paranasal sinuses--is it seeding by intubation?

Concern has been expressed regarding the seeding of viral DNA, in laryngeal papillomatosis, to other sites in the respiratory tract during treatment. Controversy exists regarding the concept of seeding by the laser plume. However, instrumentation and anaesthetic intubation are also strongly implicated in seeding DNA to the proximal respiratory tract. No cases of recurrent laryngeal papillomatosis and subsequent papilloma in the paranasal sinuses have been reported.

Adult↗
PubMed1995

Metastatic adenocarcinoma of the ethmoids in a patient with previous gastric adenocarcinoma: a case report.

Metastatic carcinoma of the ethmoids is very rare. Of the few cases reported in the literature, the majority are renal in origin. Although metastases from the gastrointestinal tract have been reported, there are no known cases of metastases from the stomach. We present a rare case of metastatic adenocarcinoma of the ethmoids in a patient previously treated for adenocarcinoma of the stomach and describe the possible mechanisms of spread. The patient had a craniofacial resection of the tumour but unfortunately died four weeks post-operatively from acute liver failure probably caused by a liver metastasis.

Adenocarcinoma↗
PubMed1994

Glomus jugulare tumours: a review of 61 cases.

A retrospective study of 61 patients with glomus jugulare tumours treated at the National Hospital for Neurology and Neurosurgery, and at the Royal National Throat, Nose and Ear Hospital, London. The average age at presentation was 41.7 years. The patients were mainly treated by a posterolateral combined otoneurosurgical approach. 42/61 of the patients had total or subtotal excision of their tumours, 7/61 had partial removal and the remaining 11/61 had no operation. Only one case required a 2-staged procedure. There were two deaths in the postoperative period, one from intracerebral haemorrhage and the other from the left hemisphere infarction. Postoperative radiotherapy was given to 5/7 of the patients who had partial removal. 3/40 of the patients with total removal had postoperative radiotherapy, and a further 3/40 had received radiotherapy pre-operatively. Of the 11 patients who did not undergo surgery, 7/11 were treated with radiotherapy and 4/11 had embolisation only.

Adult↗
PubMed1994

The 'Allan Johnson' voice prosthesis. A modification of the Bivona voice prosthesis for immediate post-fitting aphonia after secondary tracheo-oesophageal puncture.

The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The 'Allan Johnson' modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.

Aphonia↗
PubMed1993

Weekly cisplatinum concomitant with radical radiotherapy in the treatment of advanced head and neck cancer.

A total of 36 patients with advanced head and neck cancer were treated with radical radiotherapy and weekly concomitant cisplatinum chemotherapy. Rapid tumour response of both primary tumours and nodes was notable and an initial complete response rate of 75% was obtained. The disease free survival was 64% at 1 year and 52% at 2 years. The protocol proved feasible with little increase in toxicity from the addition of chemotherapy. Considering the advanced stage of the tumours treated the initial results are promising and this approach would seem to warrant further investigation.

Adult↗
PubMed1993

Brachytherapy for recurrent nasopharyngeal and naso-ethmoidal tumours.

Recurrent or persistent carcinoma of the nasopharynx or naso-ethmoid region occurs even after combined surgery and radical external irradiation. The confined bony access and proximity of vital structures may compromise resection margins. Brachytherapy using implantable radioactive gold or iodine seeds is a useful adjunct to the skull base surgeon in eliminating residual microscopic disease. We report nine cases with recurrent or persistent disease of the nasopharynx or naso-ethmoid regions treated with brachytherapy with encouraging results.

Adolescent↗
PubMed1993

Complications of pharyngeal myotomy for alaryngeal voice rehabilitation.

Over the eight-year period to May 1991, 256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngo-oesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4-41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

Aged↗
PubMed1993

Neuromas of the facial nerve: a report of 12 cases.

Twelve patients with facial nerve neurinoma have been treated at The National Hospital, Queen Square, London, during the last 20 years. Nine tumours lay in the middle fossa arising from the area of the geniculate ganglion, two lay in the posterior fossa arising from the segment of the facial nerve in the internal auditory canal, and one tumour arose from the vertical segment of the facial nerve with extracranial extension through the stylomastoid foramen. Two patients had neurofibromatosis. The clinical and radiographic features of those tumours, the operative approaches employed, and the postoperative outcome are described. Complete tumour excision was achieved in all patients; all 12 remain free of recurrence 3-80 months after surgery. Facial nerve function was restored at least in part in all cases by transposition with end-to-end anastomosis, placement of a cable graft from the sural nerve or hypoglosso-facial anastomosis. The major determinant of the outcome of facial nerve function was the duration of preoperative facial paralysis, the results being invariably poor when this was of long duration.

Adolescent↗
PubMed1992

The demonstration of glomus tumours by subtraction MRI.

Thirteen patients with 14 glomus tumours have been examined by subtraction gadolinium-enhanced magnetic resonance imaging (MRI), with T1-weighted MR sequences before and after intravenous gadolinium-DTPA. To eliminate movement between subtraction pairs, the patient remains in the tunnel of the imager during administration of the contrast medium, and the venepuncture is made into the dorsum of the foot. The effect of the subtraction process is to remove the NMR signal from the final image so that the photographic densities recorded are dependent on the vascularity of the tissue concerned, normal or abnormal. A particular advantage is the removal of fat signal: the low vascularity of adipose tissue ensures that it is recorded as of minimal density. The extent of skull base glomus tumours has been shown optimally by this technique. Subtraction can also help differentiate glomus tympanicum from glomus jugulare lesions, which may be of crucial importance when deciding the surgical approach. In addition to diagnosis, the technique is also important post-operatively, when imaging is needed to show residual or recurrent tumour and to monitor the effects of radiotherapy.

Adult↗
PubMed1992

Use of a portable manometer as a screening procedure in voice rehabilitation.

Abnormal tone in the pharyngo-oesophageal (PO) segment may lead to failure in developing oesophageal speech. Videofluoroscopy may give a qualitative assessment of the PO segment but is expensive, time consuming and lacks quantification. A custom built PO segment manometer was therefore assessed as a means of predicting eventual oesophageal speech outcome. Two groups of patients were studied. In group 1 (18 patients) the PO segment pressures were compared to their videofluoroscopy findings. Videofluoroscopy categorized the patients into four groups. The PO pressures corresponded to this grouping, pressures above 20 mmHg being associated with voice failure. In group 2 (12 patients) the PO pressures in the early post-operative period were compared to their eventual speech outcome. In all cases the pressures predicted the eventual speech outcome. The pressure manometer is a simple, cheap and portable device which is a reliable screening test to predict the potential for oesophageal speech.

Esophagus↗
PubMed1992

Autologous fibrin glue in the repair of dural defects in craniofacial resections.

Cerebrospinal fluid leakage is a serious and well recognized complication of craniofacial resection for ethmoidal tumours in which the integrity of the dura has been breached. Autologous fibrin glue is a safe, inexpensive and simple method of improving the seal of dural repair and hence minizing CSF leakage. The principles and method of autologous fibrin glue preparation are described. The technique has proven satisfactory in 20 consecutive craniofacial resections with dural defects and is recommended as an adjunct to current techniques of dural repair.

Dura Mater↗