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Biomedical subjects

C M Myer

Publications and source records attributed to C M Myer.

162 records · Page 9Linked to original sources
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Management of tonsillectomy hemorrhage: results of a survey of pediatric otolaryngology fellowship programs.

PURPOSE: To reach a consensus on the preoperative evaluation and management of intraoperative and postoperative tonsillectomy hemorrhage. METHOD: A survey on the preoperative evaluation and the management of intraoperative and postoperative tonsillectomy hemorrhage was given to one of the faculty members at each of the pediatric otolaryngology fellowship programs in the United States. RESULTS AND CONCLUSIONS: Seventeen surveys were distributed with 100% response. The majority obtained preoperative laboratory evaluation. Nearly an equal number of respondents preferred either cold or electrocautery dissection techniques, but the majority used electrocautery to control hemorrhage. After a postoperative bleeding episode, the results are as follows. (1) The majority favor admission for observation. (2) Little difference exits in the management of immediate and delayed hemorrhage. (3) When clot exists in the tonsillar fossae, removal is recommended. (4) Approximately two thirds of respondents attempt control of active bleeding in the emergency room, whereas the remaining proceed directly to the operating room. (5) After multiple episodes, a full hematologic evaluation is warranted. (6) Age and cooperativeness of the child is an important determinant in the decision-making process.

Fellowships and Scholarships↗
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Second primary malignancies of the head and neck in children.

Second malignant neoplasms are not uncommon in children, especially following multimodality therapy. The incidence of second cancers may approach 12% at 20 years following the initial cancer. Diligent surveillance is mandatory over a patient's lifetime to minimize morbidity and mortality from second malignant neoplasms.

Adolescent↗
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Contemporary surgical management of laryngeal stenosis in children.

Both congenital and acquired subglottic stenoses are common problems in pediatric otolaryngology, but their treatment remains controversial. While conservative therapy, consisting of dilation and observation, may be appropriate for congenital stenoses, open surgical procedures are generally needed to correct acquired stenoses. Two major reconstructive methods, costal cartilage grafting and laryngotracheoplasty, are currently in use. The anterior cricoid split is a specialized procedure used for extubation in the neonate. Aggressive surgical intervention has produced consistently good results and early decannulation. Laryngeal growth has not been affected adversely by these external operations.

Child↗
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Otolaryngologic manifestations of chronic granulomatous disease.

Patients with chronic granulomatous disease (CGD) have a greatly increased incidence of infection, particularly in the region of the head and neck. For this reason the health care team treating the patient with CGD often includes an otolaryngologist. Because the disease process is associated with an altered host defense mechanism, standard medical and surgical plans must often be modified. In this paper, a representative case is presented illustrating the symptoms, clinical course, and therapeutic regimen of a typical patient. The necessity for aggressive treatment is emphasized.

Adolescent↗
PubMedDate not supplied

Presentation and diagnosis of unilateral maxillary swelling in children.

Facial asymmetry secondary to pathologic processes involving the maxillary sinus and its surrounding structures presents a challenge for the clinician. An organized approach to evaluate these patients is essential in order to differentiate inflammatory sinus pathology from disease processes primarily involving the surrounding maxilla, parotid gland, orbital contents, and dental structures. In addition to a thorough history and physical examination, appropriate imaging studies must be obtained to localize the pathologic processes and develop a meaningful differential diagnosis. Once this is accomplished, specific treatment modalities can be developed. Representative cases will be presented to illustrate this organized approach to unilateral maxillary swelling, including soft tissue and osseous masses, fibro-osseous lesions, osseous cysts and inflammatory lesions.

Child↗
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A new role for computed tomography in the diagnosis and treatment of pyriform sinus fistula.

Neck abscess located in or around the thyroid gland should raise the suspicion of acute suppurative thyroiditis, pyriform sinus fistula, a 3rd or 4th branchial cleft anomaly. Differentiating between these entities on a clinical basis is difficult. After treating the initial infection, computed tomography, barium esophagography, ultrasound, and endoscopy can be used in search of the fistulous tract that can be associated with a pyriform sinus fistula or a 3rd or 4th branchial anomaly. We present a case of a pyriform sinus fistula involving the use of oral contrast, combined with computed tomography, to delineate the tract and its surrounding structures. This method, in combination with endoscopy, aided in the removal of this branchial anomaly.

Branchial Region↗
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Aneurysmal bone cyst of the frontal sinus.

Aneurysmal bone cysts are benign, vascular, cystic osseous tumors. Approximately 2% of all aneurysmal bone cysts are found in the head and neck region, with the most common site being the mandible. We report a case of an aneurysmal bone cyst arising from the frontal sinus in a pediatric patient. The diagnosis was suggested through various radiographic studies, with the final pathologic diagnosis confirmed after tumor excision. Complete en-bloc excision was performed by using a bifrontal craniotomy approach, with immediate reconstruction of the defect by using a split calvarial bone graft.

Bone Cysts, Aneurysmal↗
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Adjunctive measures for successful laryngotracheal reconstruction.

The field of reconstructive surgery of the laryngotracheal complex has been the object of considerable enthusiasm in recent years. New surgical techniques, better surgical tools, and improved diagnostic skills all have contributed to a more confident approach to severe laryngotracheal stenosis. Just as the surgeon's judgment is crucial for a successful primary laryngotracheal reconstruction, so are his or her skill and judgment vitally important in managing the various problems that frequently are found following reconstructive surgery of the larynx and trachea. These problems, although seemingly minor, may prevent successful decannulation if not managed appropriately. This paper discusses the various problems that have been encountered while achieving decannulation following laryngotracheal reconstruction. An approach to such frustrating problems as suprastomal collapse, granulation tissue, and the inability to decannulate are presented.

Catheterization↗
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Study of humidification potential of a heat and moisture exchanger in tracheotomized dogs.

Though a heat and moisture exchanger (HME) has been used in clinical practice following a tracheotomy on a limited basis, no work has been done to document the humidification potential of an HME in this situation. Eighteen dogs underwent tracheotomy and were killed at either 1 day (nine dogs) or 10 days (nine dogs) postoperatively. Following the tracheotomy, the animals were divided into three groups according to the type of humidification received: ambient conditions, warm mist, or HME. The tracheal mucosa was studied for histologic changes in the cilia, the epithelium, submucosal reaction, and mucus production at the level of the carina. The results were significant (p = .02) for the interaction of the experimental type and method of treatment in their effect on the histologic changes noted at the carina. The study supports the use of an HME as an alternative for long-term humidification in a patient with a tracheotomy.

Animals↗
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Percutaneous transnasal sphenoidotomy with sphenoid window.

Ten percutaneous transnasal sphenoidotomies were performed in nine children; and in seven, a sphenoid window was also created. All procedures were performed in the special procedures laboratory, with biplane fluoroscopic guidance used in each case. Under general anesthesia, with the child in the supine position, a 14-gauge antral trocar was placed transnasally into the sphenoid sinus. The sinus was aspirated and material was obtained for culture. A Takahashi forceps was placed via the same tract into the sphenoid sinus. The cusps were centered across the anterior cortex, and under fluoroscopic visualization, opened and rotated 360 degrees, creating a sphenoid window. All procedures were completed without complication, and no child required further surgery.

Adolescent↗