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Biomedical subjects

H M Tucker

Publications and source records attributed to H M Tucker.

At least 19 recordsLinked to original sources
PubMed1979

Hypopharyngeal diverticulum and the cricopharyngeus muscle: a posterior surgical approach.

Hypopharyngeal diverticulum and dysphagia due to cricopharyngeus muscle dysfunction are a continuing challenge to the head and neck surgeon. The ability to completely transect the cricopharyngeus muscle is generally agreed to be the key to successful relief of symptoms, and--to an even greater extent--to prevention of recurrence. In the past, the most significant complications arising from such surgery have been recurrent laryngeal nerve injury and recurrent diverticulum or cricopharyngeus spasm. Both of these problems have been prevented by a modified surgical approach which takes advantage of the relatively bloodless retropharyngeal space. The logic of this posterior approach to the cricopharyngeus, from an anatomic standpoint, coupled with the good visualization and relatively bloodless field when approaching the muscle, suggests that it might be a suitable substitute for the more common lateral approach if continued long-term experience in larger number of cases does not lead to significant complications.

Diverticulum↗
PubMed1979

Management of the patient with an incompetent larynx.

Incompetency of the larynx may vary from minimal occasional aspiration of saliva with a somewhat annoying cough to severe and life threatening aspiration. Management of these problems remains a significant challenge to the ingenuity of the well trained otolaryngologist. A review of the anatomic and physiologic factors involved both in normal function of the larynx and in derangement resulting in varying degrees of laryngeal incompetency would seem worthwhile. Several procedures are available that may be useful individually or in combination in the management of these patients.

Deglutition Disorders↗
PubMed1979

Glottic reconstruction after near total laryngectomy.

It is generally accepted that vertical partial laryngectomy can yield satisfactory cure rates in properly selected glottic carcinomas. Several authors have discussed different reconstructive techniques following extended vertical partial laryngectomy. These have included the use of stents, keels, various soft tissue "free" grafts, or muscle transplants. All of the above require prolonged tracheostomy and staged surgical procedures with the resultant upper airway sometimes being less than satisfactory.

Adult↗
PubMed1979

Restoration of selective facial nerve function by the nerve-muscle pedicle technique.

The nerve-muscle pedicle technique for selective reinnervation of paralyzed facial muscles, when combined with a modified muscle-fascia sling and neurotization from the temporal muscle, has been applied in 26 patients to date. The success rate has been 88 per cent for restoration of tonus and 77 per cent for restoration of voluntary motion as well. This procedure offers several significant advantages over other accepted means of reinnervation in patients in whom the seventh nerve itself is not available as a source for restoration of function. It also may have value as a method for rapid restoration of tonus while other means of reinnervation take effect.

Facial Muscles↗
PubMed1978

Human laryngeal reinnervation: long-term experience with the nerve-muscle pedicle technique.

The nerve-muscle pedicle technique for reinnervation of bilateral vocal cord paralysis has now been applied in 45 cases over the past four years. EMG studies, volume flow loop, pulmonary function studies, and the ability to extubate the patient with good to excellent exercise tolerance for day-to-day activity have been used as parameters to judge success or failure of this procedure. To date there has been a primary success rate of 91.1% (41/45) and a long-term success rate of 88.8% (40/45). There has been one serious complication in the entire series and no significant morbidity other than this. Age of the patient and length of paralysis are not necessarily contraindications to the procedure. These results suggest that the nerve-muscle pedicle technique may be successfully used for reinnervation of bilaterally paralyzed vocal cords without sacrificing residual voice, as is the case with arytenoidectomy type procedures.

Adolescent↗
PubMed1978

Diagnosis of juvenile angiofibroma by computed tomography.

Computed tomography (CT) accurately localized juvenile angiofibromata in 3 patients. The expanded pterygopalatine fossa and canal were visualized by CT in all three cases. Because of the hemorrhagic tendency of these tumors, a noninvasive modality such as CT is especially valuable in planning therapy.

Adolescent↗
PubMed1978

The management of facial paralysis due to extracranial injuries.

Improvements in surgical capabilities in the management of malignancies about the ear and parotid gland, increasing vehicular and interpersonal trauma, and greater concern with cosmetic factors by the public at large, have led to increasing need for the surgeon's ability to manage injuries to the facial nerve. Several important anatomic, physiologic and technical factors bear upon a logical approach to repair of such facial nerve injuries. Careful attention to these concepts had led to satisfactory return of facial function in most cases managed by the author.

Facial Nerve Injuries↗
PubMed1978

Recurrent laryngeal nerve pathology in spasmodic dysphonia.

Since it was first described in 1871, spasmodic (spastic) dysphonia has been considered a disease of psychogenic origin. Unsupported theories of possible organic etiology have appeared sporadically in the literature. In 1976 sectioning of the recurrent laryngeal nerve for patients with this disease was reported with resultant improvement in voice production. This was attempted because the spasmodic dysphonic has, in effect, already compensated vocal cords bilaterally. It was reasoned, therefore, that if one of these was paralyzed the patient would immediately be converted to a state approximating that of well-compensated unilateral vocal cord paralysis which situation, as is well known, usually carries with it a fairly good voice. A controlled study to evaluate the efficacy of this surgical approach has been undertaken at the Cleveland Clinic during the past year. In an attempt to elucidate the possible organic etiology of spasmodic dysphonia, a section of nerve was removed in every case and examined by both light and electron microscopy. Special stains for myelin were also used on the light microscopy specimens. Demyelinization has been found in most of the cases examined by electron microscopy. Possible correlation between this disease entity and other cranial nerve syndromes of unknown etiology is noted. Such conditions as trigeminal neuralgia, glossopharyngeal neuralgia, belpharospasm, hemifacial spasm, and even possibly Bell's palsy may exhibit a similar etiology.

Adult↗
PubMed1977

Selective experimental reinnervation of paralyzed facial muscles.

Amelioration of facial nerve dysfunction has been variably successful and often has resulted in only gross motion. An experimental model has been developed whereby the nerve-muscle pedicle technique used to reinnervate the larynx has been modified to achieve selective reinnervation of paralyzed facial muscles. A series of rabbits underwent facial denervation, following which a nerve-muscle pedicle was transposed to the denervated zygomaticus muscle to achieve selective reinnervation. Subsequent follow-up showed good clinical evidence of reinnervation one to four weeks postoperatively. This was confirmed by electromyographic and histologic findings. It is suggested that the nerve-muscle technique that has been used to correct laryngeal paralysis also may be applied to the selective reinnervation of paralyzed facial muscles.

Animals↗
PubMed1977

Composite resection in the elderly: a well-tolerated procedure.

The advisability of surgery in the elderly must be weighed against continued nonoperative care. The gloomy prospects of the patient with uncontrolled carcinoma of the head and neck led to the development and wide application of the composite resection for control of carcinoma of the oral cavity. The risks involved in this major undertaking in the elderly have not been previously reported. To this end a retrospective study of charts of patients over the age of 64 were reviewed and complications categorized. A representative group of younger patients were similarly reviewed for comparison. Wound complication rates were similar in the two groups, however the elderly were more likely to suffer associated medical problems which tended to be of a more serious nature. An overally complication rate of 29% was encountered with a mortality of 4%.

Aged↗
PubMed1977

Conservation laryngeal surgery in the elderly patient.

In the 100 years since Bilroth first undertook a total laryngectomy, general improvements in the prevention and management of childhood and adult disease have led to continuing increase in life expectancy to the point that, in many developed countries, 25% or more of the population is over the age of 65. Although many of these individuals are in otherwise reasonable health, major head and neck procedures are often not performed in favor of radiation therapy for cure, even for lesions that would otherwise be considered amenable to surgery in younger patients, on the grounds that the patient is too old to tolerate the necessary procedure. The same argument has been employed in favoring total laryngectomy over subtotal procedures in the older patient. Review of the author's experience (27 cases) with conservation laryngeal surgery in patients over the age of 65 at the time treatment was undertaken reveals that such procedures are well tolerated in this age group. There were no mortalities and an overall complication rate of 11.1% resulted. These findings compare favorably with complication rates reported for similar patients and surgery in the under 65 age group and strongly suggest that chronologic age alone need not be a contraindication to such surgery.

Age Factors↗
PubMed1976

Recognizing and treating deep neck infection.

Deep neck infection has ominous implications if not detected and treated in an early stage. The anatomic relationships of head and neck spaces encourage spread of infection. Immediate hospitalization and constant monitoring of the patient after diagnosis are mandatory.

Abscess↗
PubMed1976

Human laryngeal reinnervation.

Bilateral vocal cord paralysis is fortunately an uncommon occurrence although the incidence of this injury secondary to external neck trauma is increasing. In general, a patient with this lesion is faced with the choice between adequate airway at the expense of a breathy, weak voice or a fairly good voice with the need for a permanent tracheotomy. In an effort to provide a better solution to this dilemma, an attempt has been made to develop a means of reinnervation of at least one vocal cord without the problems inherent in the usual nerve anastomosis techniques. After extensive preliminary work in dogs the nerve-muscle pedicle technique for reinnervation has been developed. In this procedure the branch of the ansa hypoglossi to the anterior belly of the omohyoid is mobilized and a small block of muscle containing the terminal branches is freed from the muscle proper. Using an approach similar to the Woodman arytenoidectomy, the posterior cricoarytenoid muscle is exposed, and its fibers are partially incised. The previously prepared nerve-muscle pedicle is sutured to it. In the first five patients subjected to this procedure, return of spontaneous abduction of the reinnervated vocal cord was noted between six and eight weeks post surgery. In no case was the voice weakened nor was there any problem with aspiration. All five patients have achieved sufficient airway so that exercise tolerance for daily activities is adequate without a tracheotomy. The physiologic and histologic background of this technique is discussed in detail.

Airway Obstruction↗
PubMed1976

Penetrating wounds of the neck in civilians.

The management of penetrating neck wounds can be approached in a logical manner. The priorities in saving life are to ensure an airway and to maintain cardiocerebral perfusion. The initial evaluation and heroic life saving measure often rest upon the most inexperienced person, the house officer, who may be handicapped by the lack of experienced support personnel and sophisticated diagnostic and therapeutic equipment required for total management of these most challenging problems. It is hoped that this presentation provides the necessary guidelines for meeting this challenge. The pathophysiology, diagnostic approaches, and therapeutic measures are reviewed in the order in which they would be handled when the patient is brought to the emergency room, taken for special radiographic studies, and then subjected to surgical exploration. Special emphasis is placed upon diagnosis and management of traumatic arterial injuries, since these are the most challenging and most difficult to manage, as well as the most common causes of death following cervical penetrating wounds. Late vascular defects and associated injuries to the lymphatic, neural, airway, and foodway systems complete the discussion.

Angiography↗
PubMed1975

Laryngeal transplantation: current status 1974.

There are four major areas of concern that must be examined before human laryngeal transplantation can be considered feasible in clinical practice. These are: 1. surgical mechanics of revascularization; 2. reinnervation; 3. prevention of host rejection; and 4. justification. Of these criteria, the first two habe been met sucessfully at present. Safe suppression of rejection without increased risk of cancer recurrence remains to be achieved. Until this third criterion is satisfied, one is probably not justified to make further attempts at laryngeal transplantation in humans.

Animals↗
PubMedDate not supplied

Reinnervation of the paralyzed larynx: a review.

Our high-speed and increasingly aggressive society, coupled with a continuing rise in necessary surgery of the neck and adjacent areas, accounts for the current increase in patients affilicted with vocal-cord paralysis. Such patients may sustain relatively little persistent loss of function (e.g., when only one cord is involved, which then regains function or becomes compensated) or considerable loss (as in cases of bilateral vocal-cord paralysis). To improve on existing methods of dealing with these problems, the author has developed and refined the nerve-muscle-pedicle technique for reinnervating paralyzed muscles. A nerve-muscle pedicle obtained from the ansa hypoglossi branch to the omohyoid muscle or another strap muscle can be used to selectively reinnervate the posterior cricoarytenoid muscle in cases of bilateral-cord paralysis, or for selective reinnervation of the lateral thyroarytenoid muscle in cases of unilateral-cord paralysis. The bilateral reinnervation technique showed a 90% success rate in 90 patients, as demonstrated by their ability to sustain reasonable day-to-day activity without needing a tracheotomy tube and without manifesting further loss of voice. The unilateral technique has yielded promising results in a limited number of carefully selected patients.

Humans↗