Management of odontogenic myxoma of the maxilla.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
B D Birt
Publications and source records attributed to B D Birt.
Predicting postlaryngectomy voice outcome in an era of primary tracheoesophageal fistulization: a retrospective evaluation.
OBJECTIVES: Not all laryngectomees appear to have the same potential to develop functional spoken communication. Our goal was to evaluate voice outcome in different functional subgroups of laryngectomees and to identify physical and demographic factors associated with success and failure to achieve functional spoken communication. DESIGN: Retrospective chart review. SETTING: Surgery was performed at a tertiary care hospital. Multidisciplinary follow-up was conducted at weekly head and neck clinics held at the associated regional cancer centre. Voice rehabilitation procedures took place in both settings. PATIENTS: Sixty-four consecutive patients who had undergone total laryngectomy during the era of primary tracheoesophageal fistulization (TEF) at this facility. Patients were subdivided into four groups according to whether they had undergone primary TEF, or whether this had been contraindicated by locoregional factors of TEF candidacy/performance status, or both. INTERVENTIONS: Primary TEF was performed whenever technically feasible and traditional TEF candidacy criteria were met. Voice rehabilitation procedures were initiated prior to discharge. OUTCOME MEASURES: A judgement of voice outcome was assigned based on documentation on at least one of three patient treatment records by a physician or speech-language pathologist that a patient had demonstrated functional spoken communication within the clinical setting. RESULTS: Forty-five of 64 patients (70%) achieved functional spoken communication. Six laryngectomized subgroups were ultimately identified and characterized. Voice outcome varied considerably between these subgroups. Prelaryngectomy communication status and age emerged as predictors of voice outcome. CONCLUSIONS: Voice outcome is related to several factors present prior to or at laryngectomy. Different combinations of such factors create various postlaryngectomy recovery streams for which voice outcome may be predicted more specifically.
Adult↗
Is selective neck dissection sufficient treatment for the N0/Np+ neck?
OBJECTIVE: The purpose of this study was to evaluate the therapeutic role of selective neck dissection performed electively in the N0 patient. METHOD: Fifty-four patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx, without clinical evidence of lymph node metastases, underwent 72 selective neck dissections over a 6-year period. The preoperative tumour and patient data were recorded in all patients. Mean follow-up was 59 months. Outcome data pertaining to pathologic nodal status, tumour recurrence, and survival were recorded on all patients. RESULTS: Eighty-one percent of patients were histologically and clinically node negative. Seven percent of N0/Np0 patients failed in the neck compared to 50% of patients with occult nodal metastases (N0/Np+). Salvage treatment following nodal recurrence was successful in only one patient. CONCLUSION: Selective neck dissection does not compromise survival and may minimize surgical morbidity in the N0/Np+ population.
Adult↗
How we do it: rescuing the patient whose tracheoesophageal fistula has closed inadvertently.
Explore the source record for details and available documents.
Dilatation↗
Free forearm flap in oral reconstruction. Functional outcome.
OBJECTIVE: To examine functional outcome associated with free radical forearm flap reconstruction of oral cavity and oropharyngeal defects. DESIGN AND SETTING: Case series obtained from a head and neck clinic conducted at a regional cancer center. Patients underwent surgery at the associated tertiary care center. PATIENTS: Thirty consecutive patients treated for oral and oropharyngeal malignant neoplasms staged from T1 to T4 were studied. Subjects were assigned to five groups based on the site and extent of their surgical resections, as specified on a resection template. INTERVENTION: All patients had undergone free radial forearm flap reconstruction of their surgical defects. OUTCOME MEASURES: Ten factors reflecting functional properties and processes of the upper aerodigestive tract were evaluated clinically or with videofluoroscopy or both. RESULTS: Near-normal and fair oral and oropharyngeal function wholly characterized the sample. Patients who underwent reconstruction of unilateral tongue, floor of mouth-ventral tongue, and retromolar trigone-buccal defects functioned well on most measures; the function of patients with anterior tongue-jaw and tongue base-tonsil defects varied. CONCLUSIONS: Functional outcome with free radial forearm flap reconstruction was favorable for three of five subgroups of oral and oropharyngeal cancer patients. Qualitatively different functional profiles emerged for subgroups based on resection site. Methodologic issues for research on surgical reconstruction and functional outcome include the need for a meaningful, reliable system of classifying oral and oropharyngeal resections, and the development of standardized procedures for evaluating functional outcome.
Adult↗
Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases.
Fifty-one patients undergoing surgical reconstruction of mandibular defects with the titanium hollow screw reconstruction plate over a 4-year period were analyzed. Plate failure was defined as flap necrosis, plate extrusion, or plate fracture necessitating a further surgical procedure and occurred in 12 patients (24 percent). The incidence was highest for patients who had more than three mandibular regions resected. It was not affected by the primary site of the tumor or whether the patient had received radiation therapy. Although the failure rate was the same whether the patient attained full oral function or was fed by gastrostomy, plate fracture was limited to the former group. The overall cause-specific survival rate for this group of patients was 68 and 56 percent at 1 and 2 years, respectively. In addition, 81 percent of patients attained a full oral diet.
Adult↗
Cancer of the tongue.
Squamous cell carcinoma of the tongue is the most common intraoral malignancy. It may be preceded by visible precursor lesions showing hyperkeratosis, erythroplakia or a combination of these conditions. The clinical appearance is highly variable, and ranges from asymptomatic white patches to large fungating, infiltrating lesions. Earlier detection of squamous cell carcinoma of the tongue should improve survival rates for this malignancy, which have not appreciably increased over the past several decades. The oral cavity is an accessible site and the dentist has an important role to play in early detection.
Adult↗
Fungal sinusitis.
Fungal disease of the paranasal sinuses is an important and underrecognized entity that affects both immunocompromised and previously healthy subjects. The spectrum of disease includes fungal balls, allergic fungal sinusitis, chronic indolent fungal sinusitis, and invasive fungal sinusitis. The radiologic, immunologic, and histopathologic findings are unique for each of these conditions. The surgical and medical management of these diseases is discussed and four case studies are presented.
Adult↗
The surgical management of Melkersson-Rosenthal syndrome.
A triad of facial palsy, orofacial edema, and furrowed tongue constitutes an uncommon condition known as Melkersson-Rosenthal syndrome (MRS). We report on 14 patients with Melkersson-Rosenthal syndrome. Two patients had facial palsy, 12 had orofacial edema, and 1 patient had a furrowed tongue. Nine patients were treated medically. Intralesional steroid therapy had a 75 percent recurrence rate. Systemic steroid therapy resulted in remission in two of three patients. Surgical excision and reconstruction were carried out in five patients with chronic lip or eyelid edema. This provided relief in all cases. The etiology, clinical presentation, and histologic features are discussed. Three illustrative cases are presented. An algorithm is provided that guides the surgeon with regard to both the medical and surgical treatment of the patient with Melkersson-Rosenthal syndrome.
Adolescent↗
Hypertrophic lichen planus of the oral mucosa.
Hypertrophic lichen planus is a variant of the condition not previously recognised as occurring in the mouth. Four cases are described that have been followed clinically for 18, 9, 6 and 3 years. The histopathology is described.
Adult↗
A-O plate mandibular reconstruction: a complication critique.
Immediate A-O plate mandibular reconstruction was used in 31 patients, following the excision of malignant disease. This five-year retrospective study shows that 48% (15/31) of the patients are living (one with recurrence), with a mean follow-up of 30 months (range nine to 60 months). The mean survival of the deceased patients was 11 months (range two weeks to 46 months). Postoperative complications are evaluated with respect to the mandibular defect, radiation status, dentition, adjuvant onlay bone grafting and T stage. Briefly, 11/31 patients (36%) enjoyed an uneventful recovery, 9/31 (29%) developed a minor wound complication, 6/31 (19%) developed a major wound complication and 5/31 (16%) had significant aspiration. Four plates were removed and an additional three plates were exposed. In general, those patients in whom the condylar head was removed, or in whom the mandibular resection crossed the midline, experienced more wound complications (67% vs. 37%). Simultaneous onlay bone grafting almost doubled the complication rate and this reconstructive technique has been abandoned. No significant contribution to complication rate was made by radiation status, T stage or dentition in our patient population. In addition, four plates have been uneventfully irradiated postoperatively, and five patients have been successfully fit with dentures over their reconstruction plates.
Adult↗
Angiolymphoid hyperplasia with eosinophilia: a case report and literature review.
Angiolymphoid hyperplasia with eosinophilia is a rare, benign vascular tumor affecting principally the head and neck region of young adult females. Microscopic analysis reveals hyperplastic blood vessels lined by a hypertrophic endothelium. An inflammatory infiltrate rich in eosinophils is also present. Etiology of the lesion is unknown. Various treatment modalities have been described. We describe a case successfully treated by extensive excision and reconstruction.
Adult↗
Versatility of temporal muscle and fascial flaps.
The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. The present paper reviews the anatomy, surgical technique and utilisation of temporal flaps.
Adult↗
Metastatic neck disease. A clinical/radiographic/pathologic correlative study.
The concept of treating prophylactically the neck of the patient with head and neck cancer is based on the presence of neck metastases in a large number of cases, even if not always detected by physical examination. A modality that could reveal abnormal nodes accurately would change this management attitude so that a number of necks could be left untreated. A retrospective comparative study was undertaken to determine whether high-resolution computed tomographic (CT) scanning might play this role, and whether it has any advantage over physical examination. The radiographic findings of 79 patients with head and neck cancer who had undergone a total of 100 neck dissections were compared with the findings of physical and histopathologic examinations. This study shows similar sensitivity rates for both physical examination and CT scanning (61.55% and 59.6%, respectively) and slight superiority of the positive predictive values of physical examination (91.4%) over those of CT scanning (81.6%). The study suggests that CT offers no advantage over physical examination and should therefore not be used for neck management decisions. Measuring the size of involved lymph nodes showed that occult nodes fall within the same range as normal nodes and thus cannot be differentiated from normal nodes by size alone.
Head and Neck Neoplasms↗
Benign lymphoid hyperplasia of the palate.
Seven patients with benign lymphoid hyperplasia of the palate are reported. Clinically, these lesions presented as painless non-ulcerated masses that were unilateral in 6 of the cases and bilateral in one. Microscopically, the lesions were characterized by a mixed lymphoid infiltrate, germinal centres and vascular channels with hyperplasia of endothelial cells. The patients were followed for 3-10 years subsequent to diagnosis. One patient had 2 sequential lesions on opposite sides of the palate. Another patient with lesions of both submandibular salivary glands in addition to the palate developed rheumatoid arthritis, xerophthalmia and serologic changes consistent with systemic autoimmune disease. To date, none of the patients developed signs and symptoms of lymphoma or leukemia. The etiology of these lesions is unknown. Their distinction from lymphoma of the palate, as well as their possible relationship to the benign lymphoepithelial lesion of palatal mucous glands, is discussed.
Adult↗
The temporalis muscle flap for head and neck reconstruction.
The temporalis muscle receives its blood supply from the anterior and posterior deep temporal arteries. These run between the muscle and the periosteum and, therefore, subperiosteal elevation of this fan-shaped muscle from its origin in the temporal fossa results in a viable muscle flap whose arc of rotation and reach can be increased by resection of the zygomatic arch and the coronoid process of the mandible. The flap is useful in reconstruction of the mouth where it reaches at least to the ipsilateral lower canine tooth, the palate to the midline, the orbit and the ear. Skin grafts are readily accepted on its surface. The surgical technique is described in detail and the use of the flap in two representative cases is documented.
Aged↗
Dysphagia due to simultaneous laryngocele and Zenker's diverticulum.
A case is reported of an elderly woman, a resident in a nursing home, who developed dysphagia over a short period. Clinical and radiological examination disclosed that she had a large laryngocele and a moderate sized consideration of her social circumstances, and careful ranking of the medical priorities. Both the laryngocele and the Zenker's diverticulum were excised at a single operation and she was successfully returned to her nursing home environment.
Aged↗
Intra-oral reconstruction using the nasolabial flap.
The nasolabial flap is a versatile instrument for intra-oral reconstruction. Eleven flaps were used in nine patients, six of whom had been previously irradiated. A homolateral neck dissection was performed at the same operation in six instances. Most patients had floor of mouth cancer with excisions involving exposure of the mandible. The defect at the donor site was minimal and well tolerated by these patients, five of whom are women. There was 100% survival of the flap in 10 of the 11, there being some necrosis of the tip in one flap which was doubled on itself to reconstruct both aspects of a lip defect.
Aged↗