Biomedical subjects
Publications and source records attributed to C T Yarington.
A method of reconstruction of the entire floor of the mouth and chin is presented, utilizing interdigitated ventral tongue flaps for reconstruction of the floor of the mouth, and a deltopectoral flap for reconstruction of the chin, which, even with loss of bony support of the mandible, provides a watertight, competent oral sphincter with adequate communication and nutrition.
Electron microscopy has proved to be a valuable diagnostic tool in surgical pathology. As shown in three illustrative cases, the procedure is most useful in accurately classifying light microscopically diagnosed undifferentiated tumors of the head and neck, and is also helpful in predicting the origin of cervical lymph node metastasis in occult cancer. It also serves to quality control diagnoses made by light microscopy. All surgical specimens are fixed in a fixative that gives adequate ultrastuctural preservation and allows retrieval and examination by electron microscopy, if indicated. Recent technical improvements have resulted in a turn-around time of less than two days, thus making diagnostic electron microscopy clinically useful. The ultrastructural examination of undifferentiated tumors has a high diagnostic yield, often obviating additional diagnostic procedures and exploratory surgery. The correct diagnosis results in appropriate therapy and accurate assessment of prognosis.
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The problems which the primary physician or flight surgeon might expect to encounter with regard to acute sinusitis are presented. The need for exact diagnosis, the goals of treatment, and the management of the progress of the disease processes are reviewed.
Evaluation in maxillofacial trauma is primarily an extension of the art of the physical examination, with inspection, palpation, and evaluation of loss of normal function as the primary requisites. X-ray evaluation is critical, and best results are usually obtained by taking films as soon following the injury as possible, before opacification of the sinus with blood, swelling, or hematoma obscures critical bone landmarks. Primary reduction and surgical management of these fractures can usually be delayed for a reasonable period; however, the most accurate findings on both physical examination and x-ray studies are those obtained as soon as possible after the injury.
The management of trauma to the air and food passages has been reviewed briefly, with emphasis on the management of the acute problems based upon a thorough evaluation.
The manifestations of diseases of the paranasal sinuses that may present as acute emergency situations and the more common complications of these diseases are briefly reviewed with suggestions for initial evaluation therapy.
Primary closure of intraoral wounds can be done up to 24 hours after the injury. A mucosal seal decreases the possibility of infection and allows the wound to heal more rapidly and less painfully than a wound left open to heal by secondary intention. Defects of the lips must be closed with exact alignment of the vermilion-cutaneous margins. Nerve repairs must be done without tension at the repair site. Parotid duct repairs are mandatory to prevent cyst and fistula formation. Anterior permanent teeth may be replanted.
In summary, cavernous sinus thrombosis is still with us. Patients now survive the disease more often than not, and therapy and diagnosis are reasonably clear cut. An increasing array of antibiotic-resistant bacteria have been balanced by an increasing army of antibiotics. The controversy over anticoagulation has not changed since reviewed by Parsons (1967). Ancillary measures remain more of value in diagnosis than in therapy. It is a disease primarily diagnosed by physical signs and symptoms, which requires prompt treatment. In our modern age of computerization and laboratory-based medical care, cavernous sinus thrombosis demands the diagnostic skill of the clinician, whose prompt ministrations should usually yield a favourable result.
The management of soft tissue injuries of the face is best approached in an organized manner. The goal is early functional and cosmetic rehabilitation. The steps to be undertaken should be: initial evaluation, planning, repair and follow-up. Thorough cleansing with minimal debridement, use of fine suture material and early suture removal are some of the important principles.
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As reported previously, it remains our conclusion that the radical neck dissection can be performed expediently in a reasonable period of time, usually without the need of blood replacement, and is not characterized by major physiologic disability or wound complications secondary to the neck dissection alone. The presence of preoperative radiation, composite resections entering the oral cavity or pharynx, and systemic disease or debilitation, however, vastly enhance the risk of significant life threatening complications and prolong hospitalization; therefore, the use of postoperative radiation therapy in combined treatment, the use of planned fistulas and generally accepted reconstructive techniques, and a careful evaluation of the methods and technique for protection of the carotid artery are recommended.
A total of five ears with perichondritis secondary to burns was treated using a method of excising cartilage. This treatment resulted in the need for general anesthesia, frequent repeat debridement and frequent loss of structure of the ear with subsequent deformity. The presentation, etiology, pathology and present modes of therapy are presented. Our experience stresses the importance of early recognition and treatment and further consideration for the use of drains with continuous antibiotic and proteolytic enzyme administration.
Clinical experience in six patients in whom the tracheoesophageal diversion procedure or a modification thereof has been performed is presented. Two of these patients have been reconstructed with resulting normal laryngeal and esophageal function. Three of the patients have successfully undergone tracheoesophageal anastomosis and are candidates for reconstruction. One patient in whom the tracheoesophageal anastomosis has been present for 2 1/2 years may never demonstrate neurological return sufficient for reversal of the procedure. On the basis of these six cases, we consider the tracheoesophageal anastomosis to be an effective, yet reversible, procedure for intractable aspiration.
Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microcsopy alone.