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Biomedical subjects

D W Nuss

Publications and source records attributed to D W Nuss.

10 recordsLinked to original sources
PubMed1992

Experimental tracheal replacement using a revascularized jejunal autograft with an implantable Dacron mesh tube.

Defects comprising more than 50% of the trachea cannot be reliably reconstructed by any current technique or prosthesis. A composite tracheal replacement implant consisting of a Dacron-urethane mesh tube and revascularized jejunal autograft was applied to this problem. This composite implant was used to replace 7 to 10 cm of trachea in eight dogs. The implant was sewn to the outside (serosal surface) of the jejunum to provide permanent structural support to the autograft, and an intraluminal silicone tube was placed inside the jejunal segment and left for 4 weeks following reconstruction. Six of eight animals survived the predetermined time periods and were killed painlessly in groups of two animals at 1, 2, and 6 months after removal of the intraluminal silicone tube. Postoperative intubation, ventilation, or tracheostomy was not necessary. Excessive secretions were not seen in any of the animals, and a fair to good performance status was maintained until death in all but one animal. Histologic examination revealed slight thinning of the jejunal mucosa, with no change in the jejunal muscularis. These data suggest that with further refinement this composite implant may be a viable reconstructive option in humans.

Animals↗
PubMed1991

Facial translocation approach to the cranial base.

Facial translocation is a new approach which has been developed for surgical management of extensive lesions of the anterolateral cranial base, including the nasopharynx, sphenoid sinus, clivus, infratemporal fossa, superior orbital fissure, and cavernous sinus. Temporary displacement of the craniofacial skeleton allows direct, wide access to this complex anatomic area, while giving the surgeon a high degree of control over critical neural and vascular structures.

Adolescent↗
PubMed1991

Midfacial split for access to the central base.

The technique of the midfacial split for access to the central cranial base is described. It provides--using bilateral facial osteotomies and soft tissue mobilization--a unified surgical field extending in the sagittal plane from the anterior cranial fossa floor and sphenoid sinus to the level of the fourth cervical vertebral body. In the axial plane, the periphery of the surgical access may extend to the jugular fossae and the hypoglossal canals. Experiences and results in eight patients are presented.

Chondrosarcoma↗
PubMed1991

Facial translocation for cranial base surgery.

The complexity of cranial base surgery is a reflection of skull base anatomy as well as technical demands for maximum visualization, control of essential structures, adequate tumor resection and/or reconstruction. Facial translocation has been developed as a new approach to cranial base. It consists of extensive modular facial disassembly which includes displacement of composite facial soft tissue flap and craniofacial skeleton. It creates surgical field with epicenter in nasopharynx and infratemporal fossa allowing easy expansion into sphenoid bone and cranial fossae as well as craniovertebral junction. Reconstruction is functional and esthetic. Versatility of this approach permits expansion into neighboring craniofacial regions. During a 14-month period (11/88-12/89), this facial translocation approach to cranial base was utilized in 20 patients. The approach provided excellent visualization of the involved cranial base permitting oncological as well as reconstructive procedures. All patients healed primarily. Two patients were reoperated on at 4 and 6 months postoperatively; one for a bone graft infection and the other for tumor recurrence. The facial translocation approach offers favorable exposure of the critical zones of cranial base resulting in increased surgical safety and benefit of cranial base surgery.

Adolescent↗
PubMed1991

Craniofacial disassembly in the management of skull-base tumors.

Craniofacial disassembly now plays a major role in the management of tumors that invade the skull base. The chief advantage of this technique is the greatly improved operative exposure it provides, allowing the surgeon to resect such tumors more completely and with an added margin of safety. Microneurosurgical advances have made it possible to preserve cranial nerve function in many cases, and modern reconstructive methods employing vascularized flaps have helped to reduce postoperative complications and deformity. Through the combination of craniofacial techniques and oncologic principles, the outlook for patients with skull base tumors is improving.

Adult↗
PubMed1990

Chronic cough due to angiotensin-converting enzyme inhibitors.

The ACE-inhibiting drugs enalapril and captopril may result in a chronic and sometimes severe cough for which no pathologic cause can be found. Drug-induced cough should therefore be considered in any symptomatic patient taking these medications. In such cases, prompt withdrawal of the drug and substitution of a non-ACE inhibitor is curative and conserves the time and resources of the patient and the physician by avoiding unnecessary diagnostic and therapeutic measures.

Aged↗