PubMed Health⌕ Search

Biomedical subjects

G Y Shaw

Publications and source records attributed to G Y Shaw.

At least 19 recordsLinked to original sources
PubMed2001

Botulinum toxin treatment for cricopharyngeal dysfunction.

Hypertonicity and spasticity of the cricopharyngeal muscle (CPM) often result in dysphagia characterized by difficulty passing a bolus through the upper esophageal sphincter. Past treatments for this problem have included mechanical dilation and endoscopic and transcervical cricopharyngeal myotomy. More recently, botulinum toxin injections into the CPM have been successful, but only in isolated case studies and small series. This study reports pre- and post-botulinum toxin A injection results for 12 subjects, including patient ratings of symptom severity, changes noted during modified barium swallow studies, and, in some cases, manometry of the upper esophageal sphincter. Results indicate that botulinum toxin A treatment provided significant improvement in swallowing as indicated by patient symptom ratings and investigator ratings of function from modified barium swallow studies. Greater improvement was seen in those with more isolated CPM or Xth nerve dysfunction rather than those with more global dysphagia abnormalities.

Adult↗
PubMed2001

Electroglottographic and acoustic changes following type I thyroplasty or autologous fat injection.

This study identified the electroglottographic (EGG) and acoustic measures that were most predictive of change in the glottic gap size of patients undergoing type I thyroplasty or autologous fat injection. Simultaneous EGG and acoustic recordings were made before and after autologous fat injection in 23 patients and type I thyroplasty in 45 patients. Relative measures of glottic gap size were obtained before and after operation from videostroboscopic images. Regression and correlation analysis was used to determine the strength of associations between the EGG or acoustic measures and glottic gap changes. A significant regression equation for both patient groups was constructed. The strongest predictors of glottic gap size change were changes in the EGG open quotient, signal-to-noise ratio, and mean fundamental frequency. Glottography provided a clinically useful means of evaluating glottic gap changes in patients undergoing vocal fold medialization procedures. Preoperative-postoperative differences in signal-to-noise ratio and mean fundamental frequency also were correlated to glottic gap size changes, but to a lesser degree.

Adipose Tissue↗
PubMed2000

Application of ambulatory 24-hour multiprobe pH monitoring in the presence of extraesophageal manifestations of gastroesophageal reflux.

The recognition of extraesophageal manifestations of gastroesophageal reflux (GER) has gained acceptance in recent years. Objective measurements of acid reflux have been aided greatly by the advent of multiprobe pH monitoring. The development of the multiprobe pH monitor has enabled researchers and clinicians to objectively measure acid exposure in the pharynx and upper esophagus. The indications for use of this diagnostic technique for a variety of extraesophageal manifestations of GER are outlined.

Diagnosis, Differential↗
PubMed1997

Autologous fat injection into the vocal folds: technical considerations and long-term follow-up.

Numerous materials have been used over the years for vocal fold augmentation. Early use of bioreactive compounds, such as paraffin, gave way to relatively inert substances, such as Teflon. More recently biocompatible materials, such as collagen and autologous fat, have gained wider acceptance. Autologous fat, in particular, is an easily obtainable source for potential rehabilitation of scarred, paralytic, and atrophic vocal folds. However, long-term systematic follow-up has been lacking. Since 1991 we at the University of Kansas Center for Voice and Swallowing Disorders have employed autologous fat for vocal fold augmentation, primarily for either paralysis or repair of a volume-deficient vocal fold segment. Twenty-two patients have completed > or = 1 year of follow-up studies, including graded video-laryngostroboscopy, electroglottography, computerized acoustic analysis, and blinded perceptual analysis by two speech-language pathologists. Statistically significant improvement was demonstrated in many parameters tested, frequently improving with time. Although the volume-deficient group had more "normal" values, the paralysis group had greater improvement in many variables using fat injection. We conclude that while autologous fat injections of the vocal fold may have long-term benefits, certain technical considerations and criteria of selection of patients are critical for success.

Adipose Tissue↗
PubMed1997

Laryngeal manifestations of gastroesophageal reflux before and after treatment with omeprazole.

BACKGROUND: Laryngeal manifestations of gastroesophageal reflux disease are thought to be prevalent in our society. In general, diagnosis has been primarily based on symptoms. Historically, additional testing has included laryngoscopy, barium swallow, manometry, and single and double probe pH monitoring. METHODS: We assessed 96 patients who had symptoms suggestive of reflux laryngitis. We administered surveys grading their symptoms. All patients had standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then received a uniform regimen of dietary restrictions and omeprazole (a proton pump inhibitor) for 12 weeks, after which they were retested. RESULTS: Using the new laryngoscopic grading system, we found that this regimen produced statistically significant improvement in all symptoms except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measurements of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. CONCLUSIONS: We conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if the patient is hoarse, acoustic analysis are useful techniques to aid diagnosis and monitor therapy. Antireflux therapy with omeprazole is effective, and improvement can be objectively shown with the techniques described.

Adult↗
PubMed1996

The management of ectropion using the tarsoconjunctival composite graft.

OBJECTIVE: To demonstrate the technique, advantages, and results of autogenous tarsal grafts in the treatment of ectropion with lower eyelid retraction. DESIGN: Fourteen patients treated with autogenous tarsal grafts were evaluated. Follow-up ranged from 6 to 30 months (mean follow-up, 10 months). SETTING: All patients were treated at the University of Kansas Medical Center, Kansas City, December 1990 through June 1993. PATIENTS: Of 14 patients with ectropion who were treated with this technique, nine had facial nerve paralysis, three had had previous periorbital trauma resulting in cicatricial ectropion, one patient had orbital and congenital lower lid fibrosis, and one patient had Graves' ophthalmopathy with lower lid retraction. INTERVENTION: All patients underwent autogenous tarsal grafting. Eleven patients also underwent combined laterocanthal suspension (tarsal tongue technique). Seven patients underwent associated upper lid gold weight loading. One patient underwent a medial canthopexy. RESULTS: All patients had marked improvement functionally and cosmetically. One patient had slight under-correction. Results have remained stable for over 2 years. CONCLUSIONS: Autogenous tarsal grafts aid in the long-term stability of lower lid ectropion repair. Autogenous tarsal grafting has distinct advantages over other described techniques. When treating paralytic ectropion, other rehabilitative techniques must be additionally employed.

Adolescent↗
PubMed1996

Subjective, laryngoscopic, and acoustic measurements of laryngeal reflux before and after treatment with omeprazole.

Laryngeal manifestation of gastroesophageal reflux is felt to be prevalent in our society. In general, diagnosis has been based primarily on symptoms. Historically, additional testing included laryngoscopy, barium swallow, manometry, and more recently, single- and double-probe pH monitoring. We evaluated 68 patients who were symptomatically suggestive of having reflux laryngitis. We administered surveys grading their symptoms. All patients underwent standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then underwent a uniform therapy of dietary restrictions and omeprazole, a hydrogen ion inhibitor, for 12 weeks. Patients were then retested. This regimen demonstrated an 85% success of relieving symptoms. Utilizing the new laryngoscopic grading system, improvement was found to be statistically significant in improvement of all findings except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measures of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. The authors conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if hoarse, acoustic analysis are useful exam techniques to aide diagnosis and monitor therapy. Anti-reflux therapy with omeprazole is effective and improvement can be objectively demonstrated with the techniques described.

Adult↗
PubMed1995

Diagnosis and treatment of unilateral cricothyroid muscle paralysis with a modified Isshiki type 4 thyroplasty.

Cricothyroid adduction increases tension to the vocal folds, thus increasing fundamental frequency and upper pitch range. We treated 10 patients with cricothyroid muscle dysfunction using this technique. Preoperative electromyographic, acoustic, and perceptual analysis was performed. Intraoperatively the effect of increasing tension on the fundamental, falsetto, and basal frequencies was measured by using a strain gauge to the adducting suture at several tensions and a cervical microphone connected to a pitch meter. Postoperative acoustic and perceptual analysis was then performed up to 18 months later. Analysis of pitch vs. tension curves indicates a near-linear relationship until very high tensions are applied. Statistically significant improvement was achieved in both acoustic and perceptual analysis, although some deterioration was noted between early and late results. Cricothyroid adduction is indicated for a large range of vocal fold tension problems.

Acoustics↗
PubMed1994

Precise repair of orbital maxillary zygomatic fractures.

OBJECTIVE: To demonstrate the techniques, advantages, indications, and potential pitfalls of the transconjunctival approach with lateral canthotomy, sublabial approach, and coronal approach in the treatment of complex trimalar fracture with associated blow-out fractures. DESIGN: All patients diagnosed as having complex trimalar fractures with or without blow-out treated by either of us over a 2-year period were included. Follow-up ranged from a minimum of 6 months to 2 years. SETTING: All patients were treated with December 1989 to December 1991 at either Louisiana State University Medical Center, Shreveport, or University of Kansas Medical Center, Kansas City. PATIENTS: Eighteen patients with complex trimalar fractures were included in this study. Eight patients had associated orbital blow-out fractures. Simple isolated arch fractures were excluded. INTERVENTION: All subjects underwent a transconjunctival approach with lateral canthotomy. Seven subjects also had associated sublabial flaps. Five patients required hemicoronal or coronal approaches. RESULTS: There were seven minor complications. Ninety-three percent (14/15 [three didn't respond to the survey]) of patients surveyed were either very satisfied or satisfied with their functional and cosmetic results. CONCLUSION: The management of complex trimalar fracture with blow-outs is greatly facilitated by the rational application of the described techniques.

Aged↗
PubMed1992

An approach to management of keloids.

Keloids present a major therapeutic dilemma for the surgeon because of frequent recurrences. We use a new protocol for management of large primary or recalcitrant keloids. The technique employs carbon dioxide laser resection of the keloid and then allows the open wound bed to heal by secondary intention. The open wound is treated as though it were a third-degree skin burn. The wounds invariably orient their long axis parallel to the relaxed skin tension lines. No keloid has ever been noted to recur before epithelial migration is complete. Careful follow-up detects early recurrences that are then treated with injection consisting of 40 mg/mL of triamcinolone acetonide (Kenalog), 150 mg of hyaluronidase (Wydase), and 2% lidocaine via a dermajet. Thirty-seven patients were treated with this protocol and have been followed up for at least 2 years. A control rate of 84% has been achieved with compliant patients.

Adult↗
PubMed1992

The perichondrial cutaneous graft. A 12-year clinical experience.

The perichondrial cutaneous graft is a reliable and versatile composite graft that possesses unique properties for reconstructive surgery. The graft consists of epidermis, dermis, scant subcutaneous tissue, and the perichondrial layer. Our clinical experience completely mirrors our findings from animal studies. A clinical study of 112 perichondrial cutaneous grafts includes patients whose ages ranged from 7 days to 92 years. The various clinical applications for use of the perichondrial cutaneous graft include repair of auricular deficits, ectropion, certain facial defects, and a variety of nasal reconstructive situations. A review of our clinical experience demonstrates excellent cosmesis and no contraction of any of the graft. The graft is routinely harvested from the anterior conchal bowl, and the donor defect is closed after cartilage resection with a postauricular interpolated skin island ("flip-flop flap"). Numerous situations present many options for reconstructive surgery. The perichondrial cutaneous graft provides such an alternative, offering great reliability and superb cosmesis.

Adolescent↗
PubMed1991

Revision meatoplasty: management emphasizing de-epithelialized postauricular flaps.

Revision meatoplasty represents a unique reconstructive dilemma to the otolaryngologist. Often, the external canal and conchal skin are or have been involved in an inflammatory process and subsequent scarring that compromises or precludes its use in a reconstructive procedure. Our technique recommends one or more tongues of postauricular normal vascularized skin flaps be developed and rotated into the ear canal. The portion lying beneath the auricle is de-epithelialized as it is tunnelled under the conchal bowl. This random postauricular flap permits the introduction of healthy skin at the flap's tip for resurfacing the canal and meatus. Because the flap is introduced from a posterior direction, the inevitable scarring and forces of contraction serve to keep the meatus patent. This is marked contrast to usual repair attempts that introduce coverage at the meatus with a skin graft, which subsequently heals, with a circumferential scar compounding the stenosis. The exact design of the flap is generally determined by the presence or absence of previous postauricular healed scar. There is most often a previous postauricular incision from ear surgery that dictates the exact design of the flap or flaps. Superiorly and/or inferiorly based flaps have been used successfully. The segment that lies beneath the auricle is de-epithelialized using the CO2 laser. This greatly facilitates the speed and precision of the de-epithelializing maneuver. To date, 32 cases of conchal and external canal stenosis have been successfully managed using this technique. The indications, technical description, and representative examples are the basis of this manuscript, which offers the otolaryngologist a viable option in revision meatoplasty.

Adolescent↗
PubMed1990

Management of animal and human bites in the head and neck.

Management of bites requires both local wound and systemic considerations. The authors will highlight their experience in 32 cases. Interestingly in this series, human bites were more common than animal bites. The bacteriology, antimicrobial therapy, and surgical treatment of human and animal bites will be reviewed. A management protocol that we use is based on whether the bite was inflicted by a human, dog, or other animal. The discussion will include cases demonstrating immediate and delayed reconstruction. Long-term follow-up was possible for a number of these patients.

Adolescent↗
PubMed1990

Fungal diseases of the sinuses.

With recent advances in medicine, fungal diseases are becoming not only better understood, but also increasingly important in the management of patients with paranasal sinus disease. Fungal sinus diseases run the gamut from allergic fungal rhinitis and allergic fungal sinusitis, through fungus balls, to invasive and fulminant fungal sinusitis. Allergic fungal sinusitis may be thought of as the sinus counterpart of allergic bronchopulmonary fungal disease. Patients typically are first seen with chronic sinusitis. They may be atopic, and the peripheral blood often shows elevated IgE levels and absolute eosinophil counts. Such patients may be managed conservatively, requiring only surgical drainage and corticosteroid therapy. Fungus balls are typified by the so-called "aspergilloma." Although patients often have some predisposing factor, such as local tissue hypoxia or massive fungal exposure, most patients are not immunocompromised. Fungus balls may be treated with the traditional Caldwell-Luc operation or with newer endoscopic procedures. Invasive or fulminant fungal sinusitis generally occurs in immunosuppressed patients and merits aggressive surgical excision and debridement, as well as systemic chemotherapy, usually amphotericin B. In this article, we review fungal disease of the paranasal sinuses and present findings from our review of patients with chronic sinusitis.

Humans↗