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Biomedical subjects

B H Haughey

Publications and source records attributed to B H Haughey.

At least 37 records · Page 2Linked to original sources
PubMed1994

Fibular and iliac crest osteomuscular free flap reconstruction of the oral cavity.

A method for reconstruction of oral cavity soft tissues using segmentally or axially supplied free muscle flaps harvested as a unit with their bone components is presented. Both fibular/soleus and iliac crest/internal oblique free flaps are documented, and the pros and cons of each donor site are presented. Twenty-one patients, 17 with cancer or osteoradionecrosis and 4 with benign or congenital conditions of the mandible, have undergone this operation. Ten bone grafts were simultaneously embedded with osseointegrated implants. All free flaps except one survived and resulted in a smoothly mucosalized oral lining. Six patients have had their implants successfully uncovered, all of whom are wearing prostheses. Four other patients are using tissue-borne prostheses. Transfer of free, nonbulky muscle flaps for mucosalized oral soft-tissue reconstruction is feasible in selected patients using first the fibular and, second, the iliac donor site; this soft-tissue technique also contributes to prosthetic dental rehabilitation.

Adolescent↗
PubMed1994

The jejunal free flap in oral cavity and pharyngeal reconstruction.

The jejunal free flap is comprehensively reviewed in this article. Information on the historical development, the anatomy and physiology of the jejunum flap, and the particular suitability of this donor site for creation of free-tissue units is described. The correct abdominal harvest and vascular anastomosis techniques are also reviewed. A detailed description of how jejunal free flaps are placed into the oral cavity and oropharynx is then provided with particular reference to the split jejunal flap and its disposition in these recipient sites. It is concluded that this flap continues to maintain an already well developed place in the armamentarium of the head and neck reconstructive surgeon.

Humans↗
PubMed1993

Tongue reconstruction: concepts and practice.

Total or subtotal tongue resection results in the potential for severe speech and swallowing disruption and life-threatening aspiration. This report documents the development of a new design for latissimus dorsi flaps used in tongue reconstruction. In order to create a contractile muscle sling which will raise the neotongue toward the palate for speech and swallowing, the flap is harvested with muscle fibers oriented transverse to its long, skin component axis. The flap is then transferred to the oral and oropharyngeal defect and sutured at the level of the mandibular angle to the remaining muscles of mastication. Conventional microvascular anastomosis for free flaps is followed by end-to-end reanastomosis of the hypoglossal nerve stump to the nerve to latissimus dorsi. The skin component is set into the floor of mouth with a curved wedge resected anteriorly, raising a mound to assist with articulation. Fourteen such reconstructions have been performed on patients undergoing glossectomy for cancer. If not invaded by cancer, the glottic larynx was preserved, and the decannulation rate was 80% at a median postoperative interval of 3.2 weeks. Seventy percent of patients achieved oral intake with pureed food or better, and upward motion of the flap was documented by video swallowing studies. Articulation was particularly good. This innervated latissimus dorsi flap design therefore is a viable method for rehabilitation after total or subtotal glossectomy.

Carcinoma, Squamous Cell↗
PubMed1992

Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol.

A meta-analysis was performed on data from the Washington University Department of Otolaryngology Head and Neck Tumor Registry and 24 studies reporting synchronous and metachronous malignancies in head and neck cancer patients. The overall second malignant tumor (second primary) prevalence was 14.2% in 40,287 patients, the majority of tumors being metachronous. Site relationships between index tumors and second primaries revealed significantly high risks along the digestive tract axis or the respiratory tract axis, although lung second primaries were prevalent in all groups. Head and neck second primaries were the largest group, being significantly more common in the oral cavity, oropharynx, and hypopharynx than in the larynx. Oral cavity index tumors showed the highest overall rate of second primary formation. Half of all aerodigestive tract second primaries are detected by 2 years from index tumor presentation, but non-aerodigestive tract tumors are common beyond 5 years. A significantly higher detection rate was proven for the prospective panendoscopy studies. We recommend routine interval endoscopic intervention within 2 years of treatment for optimum detection of second primaries in head and neck cancer patients. Also, a lifetime of clinical surveillance is suggested for aerodigestive tract second neoplasms in oral cavity, oropharynx, and hypopharynx cancer patients and for lung and non-aerodigestive tract neoplasms in larynx cancer patients.

Humans↗
PubMed1992

Free jejunal graft: effects of longitudinal myotomy.

Pharyngoesophageal reconstruction using the free vascularized jejunal graft results in dysphagia in approximately 20% to 40% of patients. This may be caused by graft contractility, and we therefore developed this canine model to assess the functional effects of myotomy on transplanted jejunum. Nine female dogs underwent microvascular transposition of jejunum to the neck, the bowel being placed subcutaneously with two end jejunostomies. Baseline functional manometry was performed. Five animals then underwent complete longitudinal myotomy and four animals underwent a sham procedure. Graft function was then reevaluated after complete would healing. Contraction frequency, contraction amplitude, and total work done by the graft were recorded; all grafts demonstrated activity and were more active postrecovery than at the time of operation. Although myotomy animals showed a within-group trend to decreased contractility postintervention, this was not statistically significant. Furthermore, there was no significant postintervention difference between the sham and myotomy groups. We conclude that our model is effective for the study of activity in the free jejunal graft and that longitudinal myotomy does not significantly reduce, let alone ablate contraction.

Animals↗
PubMed1992

Effect of blood transfusion on recurrence of head and neck carcinoma. Retrospective review and meta-analysis.

To study the effect of transfusion on recurrence of squamous cell carcinoma of the head and neck, we analyzed the records of 143 patients with stage II through IV squamous cell carcinoma of the supraglottic larynx or hypopharynx for whom follow-up to recurrence or 5 years after surgical therapy was available. Variables studied were age, gender, TNM staging, duration of operation, estimated blood loss, units of blood products transfused, surgical margins, number of pathologic nodes, radiotherapy, chemotherapy, hematocrit, and serum albumin. Multivariate logistic regression demonstrated that transfusion, number of pathologic nodes, and preoperative hematocrit were significantly related to recurrence. The univariate odds ratio for tumor recurrence in patients receiving any blood products was 3.2 (95% confidence interval 1.5 to 6.9; p = .004). Based on a meta-analysis of the data from this study and the five published studies, the combined odds ratio for recurrence after transfusion was 2.6 (95% confidence interval 1.9 to 3.7; p less than .0001). These data identify a clinically important adverse effect of transfusion of blood products on tumor recurrence in patients with advanced head and neck cancer. We recommend a policy of blood conservation surgery to enhance cancer control, and we encourage further research to clarify the mechanism(s) of this effect.

Adult↗
PubMed1991

The latissimus dorsi donor site. Current use in head and neck reconstruction.

Reconstruction of head and neck defects after trauma, tumor extirpation, or disease has improved with the modern development of multiple donor sites. However, the selection of a particular pedicled or free flap should balance the required sophistication of repair with donor site morbidity. The latissimus dorsi donor site is capable of providing a versatile group of tissues; ie, muscle, skin, subcutaneous tissue, bone, nerve, and vascular pedicle. We present a series of 30 latissimus dorsi flaps (20 pedicled and 10 free) used for craniotemporal, craniofacial, midfacial, oral, oropharyngeal, mandibular, and neck skin reconstructions. The flap survival rate was 90%, a result similar to other large series. The indications for using the latissimus dorsi as opposed to other donor sites were large skin defects, cephalad defects, total glossectomy defects, defects requiring free tissue transfer, and defects where other regional donor tissue was unavailable. We also present a novel flap design for total glossectomy reconstruction.

Adolescent↗
PubMed1989

New canine model for free jejunal graft studies.

The need to more fully understand the function and physiology of the free jejunal graft prompted us to develop a new canine model. Twelve dogs were used to transplant a free jejunal graft in the neck with proximal and distal stomas exteriorized to the skin. The techniques used, complications encountered, and the potential for acute and chronic studies with this animal model are presented.

Anastomosis, Surgical↗
PubMed1989

Cerebral shift after lateral craniofacial resection and flap reconstruction.

The biomechanical effects on the cranial contents after craniectomy and immediate soft-tissue flap reconstruction are substantial and potentially life threatening. Once the rigid protective covering of the skull is removed, the cerebral component of the cranial contents is vulnerable to rising extrinsic pressure. Intracranial pressure falls, brain compliance rises, and contralateral cerebral shift may occur by virtue of the craniectomy alone. However, if flaps filling the defect should compress by weight or swelling, even greater midline or craniocaudal shift of the brain may occur. We present three cases in which midline cerebral shift was documented by CT scan after flap reconstruction of lateral craniofacial/craniotemporal resection. Three other patients undergoing anterior craniofacial resection during the same time period for skin cancer (one patient) and esthesioneuroblastoma (two patients) had no shift in intracerebral contents. Symptomatic or asymptomatic intracranial shift may occur soon after substantial craniectomy and soft-tissue flap reconstruction. Midline shift from lateral resection and reconstruction is more likely than anteroposterior shift from anterior craniofacial resection. Strategies for minimizing this compression or shift are described.

Adolescent↗
PubMed1989

A porcine model for multiple musculocutaneous flaps.

The purpose of this study was to develop and describe in detail a reproducible porcine model for musculocutaneous flap study. The model was required to demonstrate the following: 1. consistent, easily identifiable anatomical landmarks for muscles and muscular vascular pedicles; 2. flap survival, consistent with the musculocutaneous perforator arrangement of blood supply; 3. ease of islanded- or free-flap formation; 4. arrangement of flaps on each animal, allowing paired studies of control and experimental flaps; and 5. a maximum number of flaps per animal, without undue morbidity or mortality. Pilot dissections were made of the pectoralis, trapezius, latissimus dorsi, gracilis, biceps femoris, and tensor fasciae latae muscles and their major vascular pedicles. After establishing the anatomical landmarks, we formed musculocutaneous flaps at each site to verify the above five requirements. A total of 72 muscle/vessel pedicle dissections were performed, incorporating formation of 61 island musculocutaneous flaps. The skin component overlying an islanded muscle block survived in 60 instances, confirming the reliability of the flap model. We concluded that five pairs of musculocutaneous flaps could be fashioned on one pig, using the bilateral control/experimental paradigm if desired. The pectoralis, latissimus dorsi, trapezius, gracilis, and biceps femoris muscles were used. The ventral muscle group (pectoralis, gracilis) was raised in one operating session, and the lateral muscles (trapezius, latissimus dorsi, biceps femoris) were raised in one further session per side. Three new porcine flaps are described--the pectoralis, biceps femoris, and trapezius. Morbidity was confined to mild splinting of the limbs for one day. This is also the first example of the use of ten musculocutaneous island flaps on one pig, and represents an opportunity for performing physiological, pathological, or pharmacological experiments on the musculocutaneous flap.

Animals↗
PubMed1988

Massive angiofibroma: a surgical approach and adjunctive therapy.

A case of "end-stage" juvenile angiofibroma is presented which, by physical airway obstruction, almost killed the patient before treatment. With preoperative, adjunctive hormonal and especially embolization therapy, complete surgical removal of a 160 gm tumor was facilitated, with relatively little blood loss. A lateral transfacial approach was used that maximized the exposure created by tumor growth and minimized risks of permanently arrested growth in the severely displaced and compressed maxilla. This approach should be limited to tumors of similar size, location, and configuration; the specific indication is spread into the parotid region and out beneath or through the peripheral facial nerve.

Adolescent↗
PubMed1985

Extension of the musculocutaneous flap by surgical delay.

The musculocutaneous flap has limits on survival of its skin segment. Random skin extensions beyond muscle margins have, by clinical experience, been shown to survive. It has not been proved, however, what quantity of random skin will survive or whether its viable dimensions can be augmented by surgical delay. Twenty-five porcine musculocutaneous island flaps were created with a random skin extension running beyond the likely limit of survival. Twenty-five paired contralateral flaps subjected to a surgical delay one week earlier were raised simultaneously. The surviving dimensions of random skin on both control and experimental flaps were measured 14 days after delay. The control flaps sustained random skin segments one to 48 times their area of muscle while the delay doubled this, engendering more predictable survival. A new, successful experimental technique of increasing skin survival in musculocutaneous flaps is documented.

Animals↗
PubMed1984

Upper airway obstruction presenting as exercise-induced asthma.

A patient presented with a ten-year history of exercise-induced wheezing. After trials of metaproterenol and cromolyn failed to improve her symptoms, she was observed during exercise. She proved to have inspiratory stridor caused by collapse of the posterior aryepiglottic folds over the vocal cords during inspiration only following exercise. Symptoms primarily improved with physical conditioning. Further improvement came after treatment of her chronic rhinitis and post-nasal drip with a steroid nasal spray.

Adult↗
PubMedDate not supplied

Baseline motility of the free jejunal graft in a new canine model.

Reconstruction of pharyngoesophageal defects using free jejunal grafts has become an accepted technique of reconstruction. However, there are functional problems associated with the jejunal graft. We developed a canine model that allows us easy access to perform various studies on grafted jejunum, including videofluoroscopy and pressure manometry to determine baseline function. Using a microvascular technique, free jejunal grafts 10 to 30 cm in length were implanted in 11 mongrel dogs. The jejunal segments were implanted subcutaneously and exteriorized proximally and distally. The grafted dogs underwent videofluoroscopic studies. These studies revealed three different types of jejunal graft contractions of variable intensity: circumferential, longitudinal, and mixed. These contractions resulted in four patterns of barium movement: anterograde propulsion, retrograde propulsion, to-and-fro motion, and peristaltic propulsion. Videofluoroscopic studies were repeated on five dogs after an intravenous injection of metoclopramide (Reglan), which caused a significant short-term increase in the intensity of the basic jejunal contractions and barium propulsion. Pressure manometry studies using intraluminal pressure transducers were performed, revealing an inherent baseline contractility. Each dog has its own individual pattern of activity. The pressure generated by the contractions ranged from 5 to 350 mm Hg. Intravenous injection of Reglan produced a marked increase in pressure, but no change in the frequency of contractions. This study suggests that a free jejunal graft will maintain baseline motility. However, this graft may cause dysphagia by discoordination of contractions, retrograde propulsion of a bolus, or a sustained local contraction, demonstrating the clinical problems associated with free jejunal graft reconstruction of the cervical esophagus. Our results with Reglan suggest that it might be possible to improve the function of these grafts using pharmacologic agents.

Animals↗
PubMedDate not supplied

c-myc oncogene copy number in squamous carcinoma of the head and neck.

PURPOSE: Altered resident cellular genetic sequences (oncogenes) may result in malignant transformation, maintenance of tumor growth, and metastatic propensity. In this pilot study, we have elected to probe c-myc oncogene in evaluating specimens from human squamous cell carcinoma. MATERIALS AND METHODS: Samples were obtained from 24 patients with squamous cell carcinoma of the head and neck. The ratio of tumor DNA values to that of control DNA was used to estimate the c-myc copy number. RESULTS: Data from material obtained from eight patients was analyzed to the point of c-myc copy number. Tumors varied from stage II through IV. Five originated in the oral cavity and three in the larynx. Analysis of primary tumors demonstrated that two of eight had increased c-myc copy numbers. Histologically positive neck specimens were encountered in five of the study patients. Three demonstrated elevated c-myc copy numbers, two of which had had increased copy number at the primary site. CONCLUSION: This study confirms that c-myc amplification can be present in squamous cell carcinoma of the head and neck. c-myc Amplification may also be present in neck metastasis. Oncogene amplification in neck metastasis may indicate an increased metastatic propensity for individual tumor cells demonstrating c-myc amplification.

Adult↗