PubMed Health⌕ Search

Biomedical subjects

D B Kuriloff

Publications and source records attributed to D B Kuriloff.

At least 19 recordsLinked to original sources
PubMed1996

Tracheal autograft prefabrication using microfibrillar collagen and bone morphogenetic protein.

OBJECTIVE: To investigate the feasibility of prefabricating a tracheal autograft capable of microvascular free tissue transfer using microfibrillar collagen (Avitene) as a carrier for bone morphogenetic protein (BMP). METHODS AND DESIGN: Using heterotopic bone induction and soft tissue molding, an attempt was made to prefabricate a homologous tracheal autograft in a rodent free flap model. In 12 male Sprague-Dawley rats, linear troughs were dissected along the length of the gracillis muscle, filled with BMP-saturated microfibrillar collagen, molded around a silicone tracheal stent, and left pedicled on the femoral vessels. Untreated microfibrillar collagen was buried in muscle at a distant control site in 3 animals. Autografts were susequently evaluated for lumen integrity, vascular patency, and bone induction at 3 weeks. RESULTS: With the exception of 2 nonviable grafts, rings of heterotopic bone were created in all 10 animals. Rings spanning at least one third of the tracheal circumference maintained a noncollapsible lumen. Microfibrillar collagen was replaced by cancellous bone that reproduced the exact shape and volume of the collagen carrier. The lumen was lined by smooth fibroplasia, and there was no significant inflammatory response, bone exposure, or overgrowth. Soft tissue between rings allowed longitudinal flexibility, homologous to the native trachea. Bone induction did not occur in any of the control sites. CONCLUSIONS: Microfibrillar collagen is an effective carrier for BMP and may serve as the ideal substrate for tracheal reconstruction without the need for stenting. The potential use of BMP to bioengineer microvascular free flaps with intrinsic skeletal support has an unlimited potential and will add a new dimension to head and neck reconstruction.

Animals↗
PubMed1995

Sarcoidosis of the sinonasal tract: a new staging system.

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.

Adult↗
PubMed1994

Prefabricated microvascular autograft in tracheal reconstruction.

Tracheal reconstruction continues to be a challenge in head and neck surgery. Numerous techniques, including the use of alloplasts, composite grafts, and staged laryngotracheal troughs, have met with limited success because of implant exposure, infection, persistent granulation tissue, and eventual restenosis. With recently introduced techniques for soft-tissue molding, bone induction with bone morphogenetic protein, and microvascular free tissue transfer, a rodent model was developed to create a well-vascularized tracheal autograft. In this model, a rigid tube having the same dimensions and flexibility as the native trachea was created by wrapping a cylindrical silicone tracheal mold with a layer of vascularized adductor thigh muscle pedicled on the femoral vessels in the groin. Tracheal rings were created by filing transverse troughs in the muscle bed with bone morphogenetic protein-primed demineralized bone matrix before wrapping around the silicone mold. Grafts harvested at 2 weeks demonstrated rigid skeletal support provided by heterotopic bone formation in the form of rings and a smooth inner lining produced by fibroplasia. Bone transformation was controlled and restricted to the muscle troughs, allowing intervening regions of soft tissue and thus producing a flexible neotrachia. With this model, a homologous, vascularized tracheal autograft capable of microvascular free tissue transfer was fabricated based on the femoral vessels. Prefabrication of composite grafts, through the use of soft-tissue molding, bone induction, and subsequent free tissue transfer, has an unlimited potential for use in head and neck reconstruction.

Animals↗
PubMed1992

Lateral arm free flap in head and neck reconstruction.

The lateral arm fasciocutaneous free flap is a versatile donor site of sensate soft tissue for reconstruction and augmentation of the head and neck. The lateral arm flap can be quickly harvested without interference to the head and neck team and with minimal morbidity to the patient. For these reasons, this flap has become our soft-tissue flap of choice.

Arm↗
PubMed1991

Mandibular reconstruction using vascularized bone grafts.

Total oromandibular reconstruction following cancer extirpation remains a significant challenge to the head and neck surgeon. Reconstructive goals must address occlusion, salivary continence, mastication, deglutition, and articulation. In this article, various methods of mandibular reconstruction, with special attention to the most recent advances in vascularized bone and free tissue transfer techniques, are reviewed.

Bone Transplantation↗
PubMed1990

Controlled laryngoplasty for vocal cord medialization: a technique using tissue expansion.

Laryngeal framework surgery has become an increasingly popular alternative to Teflon injection for vocal rehabilitation. Vocal cord medialization requires custom tailoring of the implant's size and shape to optimize individual vocal quality, whether it be via the interposition of Silastic implants between the thyroid ala and the inner thyroid perichondrium or through a cartilage window. A new technique is described for vocal cord medialization using an implanted miniature tissue expander. Intraoperative and postoperative vocal cord medialization was achieved in a canine model by controlled percutaneous filling of a remote injection valve. The implants were well tolerated and allowed continued control of vocal cord position for several weeks. Using this technique, vocal quality can be fine-tuned with a degree of precision not previously possible. The advantages, limitations, and technical aspects of expansion laryngoplasty are discussed.

Animals↗
PubMed1989

Squamous cell carcinoma of the thyroid: a diagnostic dilemma.

Four cases of primary squamous cell carcinoma of the thyroid gland are reported. Thorough evaluation confirmed these lesions to be of primary thyroid origin rather than from metastasis or direct invasion from contiguous structures. These cases illustrate the aggressive nature of the disease and the propensity for local and distant metastases. The clinicopathologic data presented here underscore the challenge in diagnosis and treatment of this rare entity.

Aged↗
PubMed1989

Detection of gastroesophageal reflux in the head and neck: the role of scintigraphy.

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.

Adult↗
PubMed1989

Delayed airway obstruction and neck abscess following manual strangulation injury.

Few reports describing manual strangulation injury to the neck are found in the otolaryngologic literature. Since most victims sustain immediate fatal asphyxiation, brain anoxia, or cardiac arrest, they are usually examined by a forensic pathologist. When strangulation attempts are nonfatal, neck injuries can lead to delayed airway obstruction. If not managed in a timely fashion, these injuries can be fatal or cause permanent laryngotracheal sequelae. We describe a patient who 36 hours following manual strangulation developed acute upper airway obstruction and neck abscess necessitating tracheotomy, neck exploration, and drainage. Patients suffering this unique type of compression injury may present initially with deceptively benign symptoms and signs. We discuss the overall management of these patients, stressing the need for early imaging studies, endoscopic assessment, and continued airway monitoring in an intensive care unit.

Abscess↗
PubMed1989

Laryngotracheal injury following cricothyroidotomy.

Airway complications following elective cricothyroidotomy were reviewed in 48 adult cardiothoracic surgery patients. A 52% incidence of airway complications was found and manifested by failed or delayed decannulation, extensive subglottic granulation tissue, stenosis, vocal cord paralysis, and aspiration pneumonia. The most common cause for decannulation difficulty was subglottic stenosis (50%). Several risk factors were specifically identified, including a period of cricothyroid cannulation exceeding 30 days, the presence of diabetes, and advanced age. These findings suggest that airway sequelae following cricothyroidotomy in cardiothoracic surgery patients is higher than previously reported. Indications and risk factors for cricothyroidotomy are discussed.

Aged↗
PubMed1989

Osteocartilaginous necrosis of the sinonasal tract following cocaine abuse.

As cocaine abuse has become increasingly widespread, there has been a concomitant rise in associated medical complications. Nasal inhalation ("snorting") causes profound effects on the upper respiratory tract in addition to the well known nasal septal perforation. Septal necrosis can be accompanied by bleeding, granulation tissue, ulceration, and sinusitis. There are few reports of extensive sinonasal tract osteocartilaginous necrosis from cocaine abuse. We present five patients with this complication, which must be distinguished from other destructive midface lesions such as Wegener's granulomatosis and polymorphic reticulosis.

Adult↗
PubMed1989

Nasal septal perforations and nasal obstruction.

Nasal septal perforations cause a wide range of symptoms that vary from mild discomfort and nasal obstruction to life-threatening epistaxis. The differential diagnosis, pathophysiology, and treatment of this disorder are reviewed.

Airway Obstruction↗
PubMed1987

The nasolabial cyst-nasal hamartoma.

The nasolabial cyst is an uncommon midfacial cyst. Twenty-six patients with nasolabial cysts were treated at the New York Eye and Ear Infirmary from 1969 to 1986. Most of these lesions manifested facial deformity, unilateral nasal obstruction, and pain when infected. The nasolabial cyst is often unrecognized or confused with other intranasal masses, or fissural and odontogenic cysts. Infection of these lesions--which occurred in 50% of the patients--may mimic facial cellulitis, periodontal abscess, acute maxillary sinusitis, or nasal furuncles. This cyst is considered to be a hamartoma because of its developmental origin from entrapped epithelium in an embryonic fusion plane. Simple aspiration invariably leads to recurrence, and complete surgical excision is the accepted treatment. The nasolabial cyst should be considered in the differential diagnosis of intranasal masses, midface infections, and swelling in the nasolabial area.

Adult↗