Transoral resection of lesions of the oral cavity with the carbon dioxide laser.
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Anesthesia↗
Biomedical subjects
G T Simpson
Publications and source records attributed to G T Simpson.
Lasers in bronchology.
Endoscopic application of carbon dioxide and YAG laser technology is an important surgical adjuvant for the treatment of tracheobronchial airway obstruction. In cases of malignant disease of the tracheobronchial tree, laser surgery should be considered when definitive treatment (surgery, radiotherapy, and chemotherapy) has failed or is not applicable. The importance of careful selection of patients cannot be overemphasized. In selected cases of benign tracheobronchial lesions and stenosis, endoscopic laser surgery may be used with minimal morbidity. Rapid advances and refinements in laser technology and instrumentation present "new frontiers" for the bronchologist. Endoscopic laser surgery has established its place along with standard therapeutic modalities.
Bronchial Diseases↗
Recurrent respiratory papillomatosis: the role of the carbon dioxide laser.
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Anesthesia↗
Rhinologic surgery with the carbon dioxide laser.
Microscopic nasal surgery with the CO2 laser is easily performed. It offers the advantages of excellent hemostasis (even with coagulopathies), excellent healing, minimal discomfort and minimal complications. A wide variety of lesions may be excised, obliterated, or corrected in any age group. We report our experiences with 26 cases of rhinologic surgery with the CO2 laser. These cases represent a variety of pathologic lelsions including telangiectasias, papillomas, nasal polyps, synechiae and granulomas, rhinophymas, sebaceous adenomas, and an adenocarcinoma. This is the first comprehensive report of the use of this technique in nasal surgery.
Adult↗
A comparison of combined modalities and single modality in the management of advanced head and neck tumors.
Advanced head and neck cancer patients can be managed by single modality or combined modalities. Between 1976 and 1979, three treatment groups were retrospectively identified. One group received induction chemotherapy, surgery, and postoperative radiation therapy. The second group received chemotherapy followed by radiotherapy. The third group was treated during the same time period with radiation alone. These groups were matched with respect to age, site of primary tumor, nodal status, absence of metastatic disease, and no prior cancer treatment. The combined modality groups were initially treated with two doses of cis-platinum and a bleomycin infusion. Evaluation of tumor response was done 2 weeks following chemotherapy; 24 patients had surgery and postoperative radiation, 23 had radiotherapy without surgery and 24 patients were treated with radiotherapy alone. Median survival was 22 and 13 months respectively for the 2 combined modality groups and 4.7 months for the radiotherapy group. Disease-free survival was a projected value of 40 and 35 months for the combined modality groups and an actual 3 months for the radiotherapy group. Combined modality treatment with chemotherapy and surgery and/or radiotherapy offers a higher response rate and prolonged survival than radiotherapy alone.
Bleomycin↗
Transantral sphenopalatine artery ligation.
Posterior epistaxis from branches of the sphenopalatine artery can be rapidly and effectively controlled by a new ligation technique. The sphenopalatine artery or its branches are directly ligated as they exit the sphenopalatine foramen to enter the nose, completely avoiding the pterygomaxillary fossa. The vessels are exposed via a transantral approach, through the posterior portion of the medial antral wall. The mucoperiosteum of the lateral wall of the nose (medial antral wall) is preserved, elevated medially and posteriorly and used to tense the sphenopalatine vessels, bringing them into view and accessible for ligation at the foramen. Advantages of this technique include direct, specific ligation of the end vessels; ease and speed of operation; and avoidance of complications associated with the pterygomaxillary space. The technique was defined in multiple dissections of anatomic specimens and has been successful to date in 14 cases of severe posterior epistaxis.
Arteries↗
Hemophilus influenzae type B soft tissue infections of the head and neck.
Hemophilus influenzae soft tissue infections produce a variety of specific and dangerous pathologic manifestations in the head and neck. Problems include periorbital cellulitis and abscess, sinusitis, supraglottitis and otitis media. Complications include meningitis, airway obstruction and death. Pediatric patients are especially susceptible to these infections and complications. Effective management includes correct diagnosis, prevention of complications, and high doses of appropriate antibiotics. Increasing ampicillin resistance necessitates alternative antibiotic regimens. Specific physical findings, diagnostic studies and appropriate current treatments are discussed with illustrative cases from Children's Hospital Medical Center, Boston, and reference to pertinent recent literature.
Airway Obstruction↗
Hemophilus influenzae soft tissue infection of the head and neck.
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Cefamandole↗
The evaluation and management of neck masses of unknown etiology.
Most neck masses appearing in adults are malignant metastases. With proper evaluation the majority of primary malignant tumors can be located. The diagnosis is obtained by assembling sufficient data in the most efficient, productive, and logical way without compromising future treatment modalities. The best selection of therapeutic methods for cure or palliation is based on the histologic features of the primary malignant tumor or its metastases and their locations. At the present time the most effective treatment for cervical metastasis from an unknown primary is a combination of wide field high dose radiation therapy and surgical resection, the exact therapeutic modality being dependent on the histologic features of the metastatic mass and its location on the neck.
Biopsy↗
Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques.
Preoperative percutaneous transfemoral catheter embolization of feeding vessels in glomus jugulare tumors, followed by immediate application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete hemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed and intricate anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugular bulb, venous sinuses, and dura, while reducing surgical error and functional deficit for the patient. Review of the last 11 cases of glomus jugulare tumors at UCLA shows that even extensive Alford grade 2 tumors of the middle ear, jugular bulb, and mastoid had only minor blood losses with this combined technique of embolization-immediate surgery, as compared with earlier surgical methods. Pertinent literature on glomus jugulare and its treatment is reviewed. Combined embolization and immediate surgery offer the best approach for treatment of resectable glomus jugulare tumors.
Adult↗
The use of the carbon dioxide laser in the pediatric airway.
Congenital and acquired lesions of the pediatric airway present difficulties in management. Until recently, correction of these problems frequently involved an external approach to the larynx and trachea. Development of fiberoptic instrumentation, as well as the introduction of the Zeiss operating microscope, has now given the surgeon a new means to visualize the larynx and trachea. Soon after its development, the carbon dioxide surgical laser was coupled to these instruments to permit an extremely precise form of tissue excision and ablation. Its unique properties, including an extraordinary hemostatic effect, as well as minimal postoperative edema and scarring, make it an ideal tool for management of lesions of the pediatric airway. It has been employed successfully in the treatment of 177 lesions.
Bronchial Neoplasms↗
Postoperative anisocoria in a patient undergoing endoscopic sinus surgery.
OBJECTIVE: Anisocoria after sinus surgery can be related to serious complications such as intraorbital hematoma or increased intracranial pressure secondary to an expanding hematoma. CASE REPORT: A 51-year-old man underwent endoscopic surgery of sinuses, and developed anisocoria; likely a result of the local spread of cocaine used to provide local anesthesia and vasoconstriction. The localized effect of this anesthetic agent produced a typical picture of nasociliary ganglion block that subsided in a few hours. In the results, the nasociliary nerve block was noticed on recovery from anesthesia with no other neurologic deficit. Ophthalmologic examination demonstrated a short-lasting anisocoria with loss of accommodation and sensory block over the tip of the nose. CONCLUSION: The central spread of the local anesthetics should be considered as a differential diagnosis of unexplained anisocoria, especially when it is associated with loss of corneal reflex.
Anesthetics, Local↗
Benign tumors and lesions of the larynx in children. Surgical excision by CO2 laser.
Benign lesions of the airway in infants and children may endanger the airway and compromise laryngeal function. The CO2 laser provides an elegant method of transoral surgical excision without compromising laryngeal function or airway competence. It avoids the risks of such other treatment modalities as external surgical approaches, prolonged steroid therapy, and radiation. It is applicable to a wide variety of lesions without the necessity of tracheotomy. Hospitalization is minimized. Ten cases are presented to show the wide applicability of this technique. Gross pathology and pre- and postoperative findings are demonstrated and discussed, as is the safety and efficacy of the laser soft-tissue interaction.
Carbon Dioxide↗
Acute cricoarytenoid arthritis: local periarticular steroid injection.
Acute cricoarytenoid arthritis is a frequent complication of rheumatoid arthritis and the most frequent otolaryngologic manifestation of the disease. Over 25% of rheumatoid arthritis cases have discomfort from this problem. Other etiologies can produce cricoarytenoid arthritis. Symptoms range from mild discomfort through hoarseness to complete airway obstruction requiring emergency tracheotomy. Chronic cricoarytenoid arthritis may result in joint ankylosis and vocal fold fixation. Single periarticular triamcinolone injections may bring rapid and dramatic relief of the symptomatology of nonankylosed acute cricoarytenoid arthritis for periods of up to one year if other medical management is adequate. Six cases illustrate the problem and the efficacy of this treatment methodology. Findings, pathology and pertinent literature are discussed. Specific criteria for considering this technique are outlined. This form of therapy has not been described previously.
Acute Disease↗
Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.
Stenosis of the larynx and/or trachea presents perplexing problems. No one technique has proved totally satisfactory in the management of all varieties of stenosis. Recent reports have described the successful use of the CO2 laser in the endoscopic management of stenosis of the larynx and trachea. Failures of this technique need emphasis to assure appropriate selection of therapeutic method. Retrospectively, 49 cases of laryngeal stenosis, 6 cases of tracheal stenosis and 5 cases of combined laryngeal and tracheal stenosis were studied (total 60 patients) following treatment at the Boston University Affiliated Hospitals. Follow-up ranged from 1 to 8 years. Multiple procedures were required in 35 laryngeal patients. Of the laryngeal patients 39 were successfully managed (average number of procedures in successful cases 2.18). Of 11 tracheal patients with combined laryngeal and tracheal procedures, 3 were successfully managed (average number of procedures in successful cases 6). Failures in laryngeal stenosis included four patients in whom an adequate airway was not established though voice was present while maintaining tracheostomies. Thirteen patients failing endoscopic management required open surgery with good result. Factors associated with poor result or failure include circumferential scarring with cicatricial contracture, scarring wider than 1 cm in vertical dimension, tracheomalacia and loss of cartilage, previous history of severe bacterial infection associated with tracheostomy, and posterior laryngeal inlet scarring with arytenoid fixation. In these circumstances, multiple procedures, more extensive alternative open surgical techniques, or maintenance of tracheostomy were necessary. In successful cases only three or fewer procedures on average were required. The factors associated with failure or success of endoscopic methods in the management of laryngotracheal stenosis, including use of the CO2 laser and soft Silastic stents, are analyzed.
Adolescent↗
Localized amyloidosis of the head and neck and upper aerodigestive and lower respiratory tracts.
Seven cases of localized amyloidosis limited to structures of the head and neck and upper aerodigestive and lower respiratory tracts evaluated and treated at Boston University Hospitals in a recent 7-year period were reviewed. Negative Congo red staining of abdominal adipose aspiration biopsy or rectal biopsy specimens established that the amyloidosis was not systemic. Localized amyloidosis occurred in discrete masses in a variety of sites in the aerodigestive tract including the orbit, nasopharynx, lips, floor of mouth, tongue, larynx, and tracheobronchial tree. Five patients required surgical excision because of significant airway obstruction or organic dysfunction. Amyloid deposits completely excised with the carbon dioxide laser have not recurred, though other amyloid masses may appear elsewhere within the same organ or region. Amyloidosis may occur primarily or secondarily to other disease states. Localized amyloidosis has not been chemically identified but is usually defined by the absence of systemic features. While rare, amyloidosis must be recognized and understood by the otolaryngologist/head and neck surgeon to allow appropriate diagnostic and therapeutic planning.
Adipose Tissue↗
Clinical characteristics of nosocomial sinusitis.
Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.1 +/- 3.9. Nineteen patients were intubated nasotracheally, and five were intubated orally. Sinus air fluid levels, indicative of bleeding into the sinus, were seen on 17 initial computed tomographic scans. Maxillary sinus suppuration occurred in 23 patients; in 20 it was the initial sinus involved. Twenty-one patients developed polymicrobial sinusitis. Coexisting infections were common. In 15 patients with concurrent tracheobronchitis or pneumonia, organisms identical to those in sinus aspirations were recovered from the sputum. Seven patients had associated bacteremia. Meningitis in six patients shared a common pathogen with their sinusitis. Nonoperative management successfully resolved sinus infection in 19 cases. Five patients required open sinusotomy.
Adult↗
Prediction of lymph node metastases by lymphoscintigraphy of the neck after peri-cancer injection of a radiocolloid.
Radionuclide imaging is used to evaluate the status of neck nodes preoperatively in small group of patients with oral squamous cell carcinoma. An area adjacent to the carcinoma, and a similar area on the opposite side of the oral cavity, are injected with Technetium (Tc) 99m labeled sulfur minicolloid. Differences in imaging intensity between both sides of the neck is used to predict the presence of metastases. Neck dissection confirms the histologic status of the nodes. The scan correctly predicts the presence of metastases in 100% (2/2) of patients with palpable nodes, and the absence of metastases in 75% (3/4) of patients with clinically tested negative necks.
Carcinoma, Squamous Cell↗