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Biomedical subjects

E C Everts

Publications and source records attributed to E C Everts.

At least 19 recordsLinked to original sources
PubMed2000

Congenital laryngeal webs: surgical management and clinical embryology.

Laryngeal webs are uncommon congenital anomalies. The formation of a laryngeal web represents anomalous embryologic development of the larynx. The extent of airway involvement varies which ultimately affects surgical management. A series of five congenital laryngeal webs each with subglottic involvement is reported. One patient also had a ventral laryngeal cleft. All patients ultimately required open laryngeal reconstruction, either laryngotracheal reconstruction (LTR) or thyrotomy (laryngofissure) and silastic keel, to correct the defect and all were decannulated. Findings at surgery correlate with recent descriptions of embryonic laryngeal development though the actual mechanism by which webs develop remains unknown. The findings suggest that congenital glottic webs require accurate endoscopic diagnosis and open airway reconstruction for definitive treatment.

Female↗
PubMed2000

Sensory changes associated with selective neck dissection.

OBJECTIVE: To evaluate sensory changes in the head and neck region associated with selective neck dissection with or without preservation of cervical root branches. DESIGN: Retrospective cohort study. SETTING: University tertiary referral hospital and a Veterans Affairs hospital. PATIENTS: Fifty-seven patients who had undergone 84 neck dissections with or without preservation of the sensory cervical root branches 3 or more months before evaluation. INTERVENTIONS: Questionnaire combined with head and neck sensory examination. MAIN OUTCOME MEASURES: Neck and facial sensory function. RESULTS: Neck dissections with preservation of the cervical rootlets were most likely to be associated with a small area of anesthesia in the upper neck below the body of the mandible and anterior to the mid-body of the mandible (P=.03). Neck dissections without rootlet-preserving technique increased the area of anesthesia to include all other areas of the neck (P= .02). CONCLUSIONS: Preservation of the cervical root branches resulted in a small, limited, and uniform area of the neck rendered permanently anesthetic. Conversely, sacrifice of the nerve branches led to a pattern of anesthesia involving the entire neck.

Aged↗
PubMed1998

Nodal disease in purely glottic carcinoma: is elective neck treatment worthwhile?

OBJECTIVE: Although there is a generalized understanding of the relatively low overall incidence of nodal disease from purely glottic carcinoma, the exact role for elective neck treatment in the management of this disease remains controversial. The purpose of this study was to identify the incidence of occult nodal disease (including paratracheal) in patients who have glottic carcinoma without significant extraglottic extension and to identify which patients are at risk for this. A retrospective chart review of 92 such patients who had either undergone neck dissection or been observed for a minimum of 2 years was performed. RESULTS: For the 92 patients, neck treatment consisted of observation in 68 patients, paratracheal node dissection in four, unilateral neck dissection in four, unilateral neck dissection and excision of paratracheal nodes in 14, and bilateral neck dissection with paratracheal node excision in two. Of the 24 nodal dissections performed, four were positive for occult metastatic disease. No patient in the observation group developed nodal disease. CONCLUSION: The incidence of occult nodal disease in NO glottic carcinoma is low, 0% in early stage disease (T1-T2) and 19% in late stage disease (T3-T4). Nodes at highest risk included only the paratracheal, level II, and level III. Elective neck treatment should only be undertaken for advanced (T3-T4) disease and even then is of questionable benefit. If undertaken, it should have a low potential morbidity, such as selective neck dissection or radiation. Computed tomography was not useful in staging the neck for this subset of patients.

Adult↗
PubMed1997

Endovascular management of hemorrhage in patients with head and neck cancer.

OBJECTIVE: To present selective endovascular embolization as a therapeutic alternative to surgical ligation in the management of hemorrhage in patients with head and neck squamous cell carcinoma. DESIGN: Retrospective chart review of patients with head and neck cancer and significant hemorrhage who were treated with selective endovascular embolization. SETTING: A university medical center. PATIENTS: A total of 12 patients, aged 26 to 72 years, with 13 episodes of hemorrhage were treated at Oregon Health Sciences University, Portland, between November 1991 and January 1996. INTERVENTION: All patients underwent angiography with selective endovascular embolization at the interventional radiology suite using a combination of endovascular balloons, platinum coils, and microparticles. OUTCOME MEASURES: All charts were reviewed for diagnosis, treatment, factors that may have contributed to hemorrhage, bleeding site, therapeutic measures, control of hemorrhage, postembolization course, complications, and number of hospital days. RESULTS: The cause of the bleeding was tumor in 5 patients, pharyngocutaneous fistula in 4 patients, radiation necrosis in 3 patients, and postoperative complication in 1 patient. Bleeding arose from the common carotid artery in 4 patients, external carotid artery and its branches in 8 patients, and internal jugular vein in 1 patient. Hemorrhage was successfully controlled in all patients; a permanent left-sided hemiplegia and facial weakness developed in 1 patient. There were no recurrences of hemorrhage. All patients were discharged from the hospital. CONCLUSION: Angiography with selective embolization is a safe and effective alternative to surgical ligation for control of hemorrhage in patients with squamous cell carcinoma of the head and neck.

Adult↗
PubMed1997

Midline mandibular osteotomy: an analysis of functional outcomes.

Although the oncologic validity and perioperative complications of midline mandibular osteotomy are well described, little attention has been directed toward the long-term functional problems that may be associated with its use. Thirty-one patients who had undergone this procedure were examined to assess postoperative sensation, temporomandibular joint (TMJ) function, occlusion, and cosmesis. The majority (27 of 31) patients had some sequelae but these were minor in nature. Twenty of 31 patients had abnormal sensation, 24 of 31 noted a changed occlusion, and 15 of 31 had signs or symptoms of TMJ myofascial pain. Although patients should be advised of the potential for functional problems with this procedure, they can be reassured that these are likely to be relatively minor in significance. If technically feasible and if an exact restoration of occlusion is a priority, a prefabricated lingual splint should be used.

Dental Occlusion↗
PubMed1996

Near-total laryngectomy. Patient selection and technical considerations.

OBJECTIVES: To investigate the speech and swallowing outcomes of patients undergoing near-total laryngectomy and to determine those perioperative factors that are associated with success. DESIGN AND SETTING: Retrospective analysis of a case series obtained from a hospital-based academic tertiary care center. PARTICIPANTS AND INTERVENTION: Records of all patients who underwent near-total laryngectomy at this institution were reviewed. OUTCOME MEASURES: Wound healing problems, quality of speech, degree of aspiration, and need for shunt revision were recorded. RESULTS: Thirty-nine patients during a 10-year period underwent near-total laryngectomy. Good speech was obtained in 30 (76%). Severe aspiration was a complication in eight patients (21%), necessitating reversal of the shunt in four (10%). Certain technical aspects of this procedure that produce a "hooded" myomucosal shunt were crucial to proper shunt function. Severe aspiration and poor voice outcome were most likely in patients who experienced a postoperative pharyngocutaneous fistula. These fistulas tended to occur at the junction of the pharynx and the upper end of the myomucosal shunt. When this region broke down, the hooding of the shunt was disrupted and its function impaired. CONCLUSIONS: Careful patient selection is crucial to the creation of a functional myomucosal speaking shunt after near-total laryngectomy. In patients at high risk for developing a pharyngocutaneous fistula, where irreversible aspiration through the shunt is then likely, this operation should be avoided and a total laryngectomy with tracheoesophageal puncture considered instead.

Adult↗
PubMed1996

Selective neck dissection and the management of the node-positive neck.

OBJECTIVE: To assess the oncologic effectiveness of the selective neck dissection (SND) in patients with both clinically and pathologically proven regional metastases. METHODS: A 4-year retrospective medical chart review was conducted in an academic tertiary care referral center. Twenty-nine patients with a newly diagnosed upper aerodigestive tract squamous cell carcinoma, and both clinically and histologically proven cervical metastases who underwent 36 SND, had their records reviewed. Minimum follow-up was 2 years. RESULTS: Regional metastasis were staged N1 in 13 patients, N2A in 1, N2B in 8, and N2C in 7. Seventeen supraomohyoid and 19 lateral neck dissections were performed. Extracapsular spread of tumor was present in 11 patients. Postoperative radiation therapy was administered to 20 patients. Actuarial disease-specific survival at 4 years was 47% overall, 67% in N1 patients, and 41% in N2 patients. Only 1 failure in the treated neck occurred for a 4-year actuarial regional failure rate of 4%. The actuarial local failure and distant metastasis rate were 36% each. CONCLUSIONS: In carefully selected patients with clinically and histologically apparent regional metastases, the selective neck dissection can be an oncologically effective procedure.

Adult↗
PubMed1991

Intrathecal narcotics for relief of pain from head and neck cancer.

We describe our experience with nine patients with head and neck pain of malignant origin who were treated with continuous low-dose intrathecal morphine via a lumbar catheter and implantable subcutaneous drug delivery pump. All patients had failed prior attempts at oral narcotic pain control due to either poor pain control or intolerable side effects. Using a visual analogue scale where the most severe pain is rated as 10 and no pain is rated as 0, the mean visual analogue scale was reduced from 7.6/10 (range, 5 to 10/10) before implantation to 1.9/10, 2.0/10, and 0.5/10 at 1 week, 1 month, and 2 months after implantation, respectively. Complications were acceptable. We conclude that intrathecal administration of morphine is a safe and effective means of pain control. This method deserves serious consideration in patients with intractable pain secondary to head and neck malignancy.

Analgesia↗
PubMed1988

Malignant nerve sheath tumors of the head and neck.

Malignant nerve sheath tumors comprise approximately 5% of all soft tissue sarcomas; only 8% to 15% of these tumors arise in the head and neck. Most tumors appear as a rapidly expanding nonpainful mass in the face or lateral neck. Reported association with Von Recklinghausen's disease varies from 26% to 70%. Wide surgical excision is generally the recommended primary treatment. Recently, there has been a trend to include postoperative radiation therapy as a primary modality.

Adult↗
PubMed1986

Dacron mesh tray and cancellous bone in reconstruction of mandibular defects.

We used a Dacron-urethane mesh tray filled with cancellous bone for mandibular reconstruction in 17 patients. Five patients with traumatic defects and two with benign tumors developed solid, functional mandibles. Among ten patients with squamous cell carcinoma, eight had successful reconstruction; one required a second procedure. Mandibles of two of three patients with osteoradionecrosis were successfully reconstructed, but only one of three primary reconstructions was initially successful. The Dacron-urethane mesh tray has the advantage of being stiff but malleable. It easily fits the defect, is radiolucent, and may be used either before or after radiotherapy. We recommend delayed reconstruction, adequate soft-tissue coverage, good immobilization of the mandible, no intraoral contamination, especially with osteoradionecrosis, and hyperbaric oxygen in patients who have been irradiated or have osteoradionecrosis.

Adult↗
PubMed1985

Dexamethasone vs. placebo for cisplatin-induced emesis. A randomized cross-over trial.

A randomized cross-over trial of dexamethasone (10 mg I.V. before therapy, and 4 mg I.V. q 4 h X 6 doses) vs. placebo as antiemetic therapy was conducted in 19 patients receiving high-dose cisplatin. Sixteen patients and 32 treatment courses were fully evaluable. There was no significant difference between regimens in the number of emesis-free patients or the number of emetic episodes, though the duration of nausea symptoms may have been reduced. We conclude that dexamethasone as used in our trial is not an effective antiemetic in patients receiving cisplatin.

Aged↗
PubMed1984

Aberrant right subclavian artery--esophageal fistula: a cause of overwhelming upper gastrointestinal hemorrhage.

A patient had massive hematemesis due to a fistula between an unsuspected aberrant right subclavian artery and the esophagus, with the fistula caused by prolonged esophageal intubation. Lack of awareness of this complication delayed the correct diagnosis, which was eventually made at a second angiographic study. With knowledge of the fistula, this potentially fatal situation can be promptly diagnosed by endoscopy and emergency angiography. Transcatheter embolization is suggested as a potential alternative to surgery in the treatment of the aberrant right subclavian artery--esophageal fistula.

Adult↗
PubMed1981

Advanced squamous cell carcinoma of the maxillary sinus. Results of combined regional infusion chemotherapy, radiation therapy and surgery.

Sequential intraarterial chemotherapy using bleomycin and methotrexate followed by high dose radiation and surgery was evaluated in 10 patients with stage III and IV squamous carcinomas of the maxillary sinus. Seven of 10 patients had extensive tumor necrosis in the surgical specimen, and no evidence of residual tumor was found in 4 of these patients. After a median follow up period of 24 months, there has been only one local recurrence in resected patients. Three patients died from pulmonary metastases. Although many unanswered questions remain regarding the efficacy of triple therapy for maxillary sinus malignancy, these results are encouraging and establish that surgical resection and healing are not compromised by preoperative chemotherapy and radiation.

Adult↗
PubMed1980

Combined intraarterial chemotherapy, radiation therapy, and surgery for advanced squamous-cell carcinoma of the head and neck.

From 1973 to 1978, 20 patients with T3 and T4 squamous cell carcinoma of the head and neck were treated according to a triple-therapy protocol at the University of Oregon Health Sciences Center. Intraarterial chemotherapy (IAC) with bleomycin and methotrexate was given prior to high-dose preoperative radiation therapy and then, when possible, the lesion was resected. The treatment results are presented. The initial clinical response to IAC and radiation correlated well with the findings in the pathologic examination of the resected specimen in 11 patients, but it did not correlate well with the subsequent clinical course of the patient. In view of the results of this pilot study, we do not feel that it is justified to continue IAC with bleomycin and methotrexate prior to conventional therapy in the very advanced and aggressive cancers of the head and neck. However, IAC might be justified in treating patients with operable Stage III carcinomas of the maxillary antrum.

Adult↗