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Biomedical subjects

H M Tucker

Publications and source records attributed to H M Tucker.

At least 55 records · Page 3Linked to original sources
PubMed1992

Complications of secondary tracheoesophageal puncture: the Cleveland Clinic Foundation experience.

One hundred forty-six secondary tracheoesophageal puncture (TEP) procedures were performed on 132 patients at the Cleveland Clinic Foundation in the past 10 years. The complications of these procedures are reviewed, along with assessment of potential risk factors such as irradiation, esophageal/hypopharyngeal stricture, alcoholism, diabetes, or chronic obstructive pulmonary disease. Among the subgroups studied, only stricture dilation was associated with an increased incidence of postsurgical complications. The majority of these, however, were immediate, and were probably related to the esophagoscopy or dilation itself. The incidence of TEP-related complications in all groups of patients may be higher than previously suspected.

Dilatation↗
PubMed1991

Reconstruction of pediatric larynx and upper trachea with the sternohyoid rotary door flap.

The sternohyoid myocutaneous flap, the rotary door flap, is optimally oriented to serve in laryngotracheal reconstruction. It provides immediate, highly vascularized lining and structural support to the augmented airway. Therefore, it is one of the most versatile alternative methods available for surgical reconstruction of the stenosed larynx and trachea. Thirteen of 14 patients who were managed by the rotary door flap technique have been successfully decannulated. The features of the flap and the surgical technique are described with reference to modifications in the pediatric age group.

Adolescent↗
PubMed1991

Dynamic rehabilitation of the paralyzed face: III: Balanced coupling of oral and ocular musculature from the intact side in the canine.

We have recently demonstrated the feasibility of artificial agonist/antagonist coupling between intact facial and reinnervated strap muscles in the rabbit. The present study broadens this principle to involve bi-level cross-facial innervation. After severing the facial innervation unilaterally in four dogs, a nerve pedicle from a cervical motor nerve was implanted into the orbicularis oris and from the deep temporal nerve into the orbicularis oculi. After neurotization (5.6 months), the pedicles were electrically stimulated to verify muscular response. Graded contraction on the intact side was induced by stimulating the ipsilateral facial nerve with currents of various pulse widths. The resulting compression of a strain gauge on the intact face triggered a two-channel, opto-isolated, pulse width-modulated stimulator to produce agonistic graded contraction at one level of the reinnervated side (e.g., oral) and reciprocal relaxation in its reinnervated counterpart (e.g., ocular). The sophistication of the present model--as compared to the original pilot study--brings us one step closer to dynamic human facial rehabilitation.

Animals↗
PubMed1991

Topical anesthesia for peroral endoscopy.

Before the advent of safe and readily-available intubation anesthesia, most endoscopic procedures were carried out under topical or local anesthesia. Reawakening interest in cost effectiveness in medical practice and improved safety suggests that these techniques should be reexamined. The authors' experience in nearly 2,000 topical anesthetics for peroral endoscopy is reviewed. A preferred technique is presented which has proven effective and has resulted in an overall complication rate of less than 1%.

Administration, Topical↗
PubMed1990

Prevention of hair growth in myocutaneous flap reconstruction.

Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncologic procedures in the head and neck. Transfer of hair-bearing skin into the reconstructed upper digestive tract can be a major disadvantage associated with the pectoralis major flap. De-epithelialization of skin to the dermal level, removing the majority of skin appendages, can convert a myocutaneous flap to a "myodermal" flap. Platysma myocutaneous and myodermal flaps were grafted into the oral cavity of 13 dogs. Gross and histologic evaluation confirmed decreased hair growth in the experimental myodermal flap. Wound complications and graft survival were similar for both techniques. Diminished hair growth further supports the utility of myodermal flaps in hairy male patients undergoing upper digestive tract reconstruction.

Animals↗
PubMed1990

Carotid body tumors.

The surgical management of carotid body tumors requires identification and preservation of neural and vascular structures without compromising resection of the neoplasm. Fifteen patients were examined and treated for carotid body tumors at the Cleveland (Ohio) Clinic Foundation from 1979 through 1987. The benchmark of diagnosis is bilateral carotid angiography. When neural structures are free of tumor, meticulous dissection facilitates their preservation. Large tumor size increases risk for arterial resection necessitating reconstruction. The use of a vascular shunt minimizes the risk of cerebral ischemia. Postoperative intravenous digital subtraction angiography allows for evaluation of arterial repair. A retrospective review of 15 carotid body tumor resections performed in 14 patients revealed no evidence of tumor recurrence, no mortality associated with surgical intervention, no postoperative cerebrovascular accident, and limited morbidity associated with unavoidable sacrifice of neural elements.

Adult↗
PubMed1990

Nonsquamous cell malignancies of the paranasal sinuses.

Nonsquamous cell malignancies represent half of paranasal sinus cancers. Since 1975, 103 patients have been treated at The Cleveland Clinic Foundation for sinus malignancies. Forty-nine patients had nonsquamous cell malignancies: 12 (25%) sarcoma, 10 (20%) adenoid cystic carcinoma, 9 (18%) adenocarcinoma, 9 (18%) lymphoma, and 9 (18%) miscellaneous tumors. Ten patients presented with T1 or T2 disease at the primary site, 16 with T3, and 23 with T4. Ten patients had primary ethmoid malignancies; the remainder of the tumors originated in the maxillary sinus. Five patients had evidence of regional or distant metastases at presentation. Twelve patients were free of disease after initial management. Three patients with recurrent disease were salvaged with additional therapy. Two patients died of complications in the immediate postoperative period. Patients with less extensive primary lesions have an improved prognosis. Survival was similar for the different histologic diagnoses.

Adenocarcinoma↗
PubMed1990

Combined laryngeal framework medialization and reinnervation for unilateral vocal fold paralysis.

The laryngeal framework-Silastic implant technique has become an increasingly attractive alternative to Teflon injection, particularly when there is fixation of the cricoarytenoid joint or the defect to be corrected is larger than usual; but it does not restore ability to change tension in the vocal fold. Unilateral vocal fold reinnervation can overcome this drawback and, when used in conjunction with surgical medialization, may offer return of function very close to normal. Twenty-nine patients with unrecovered unilateral vocal fold paralysis and/or fixation of the cricoarytenoid joint have been managed by use of a Silastic implant combined with unilateral vocal fold reinnervation with no complications. Voice improvement has been assessed on preoperative and postoperative voice recordings. The combined surgical techniques for reinnervation and a modification of Silastic implantation via the laryngeal framework approach are reported.

Humans↗
PubMed1990

Inverted papillomas and associated squamous cell carcinomas.

Inverted papillomas of the nose and paranasal sinuses are found to be associated with squamous cell carcinomas in a small percentage of cases. The records of forty-six patients treated for inverted papillomas in these areas over a 10-year period were reviewed. Eleven patients (24%) were found to have squamous cell carcinoma, and one carcinoma in situ, in relationship to the inverted papillomas. This is a much higher percentage than generally reported. Four of these patients were found to have inverted papillomas coincidentally in surgical specimens resected for squamous cell carcinoma. Patients with squamous cell carcinoma were found to be in older age groups, were more likely to manifest epistaxis than the more common unilateral nasal obstructive symptoms, and had less time between the onset of symptoms and presentation than those with inverted papillomas alone. The clinical presentation, treatment, and outcome of inverted papillomas and squamous cell carcinomas in association with inverted papillomas are discussed.

Adult↗
PubMed1990

Correlation between histology and nerve excitability after reinnervation of paralyzed strap muscles in the rabbit.

We have recently shown that the mean muscle chronaxie for nerve pedicle implanted into denervated rabbit strap muscle is comparable to that of normal nerve. This study correlates excitability with histologic characteristics of muscles reinnervated via nerve-muscle pedicles (NMP) and direct nerve implants (DNI). Strength duration curves were measured in 13 rabbits 3.5 to 5 months after reinnervation by NMP (n = 6) and DNI (n = 7). Following this, control (n = 5) and reinnervated straps were harvested immediately before the animals were killed and frozen in liquid nitrogen. The material was submitted for hematoxylin-eosin stains as well as trichrome stains for general morphology, myofibrillar ATPase and NADH for fiber typing, and cholinesterase for determination of denervated fibers. In all animals with low chronaxie, expected type grouping from reinnervation was noted (n = 10). By contrast, the three animals in which chronaxie was abnormally elevated demonstrated fibrosis, inflammation, and absence of or poor type grouping. This suggests that type grouping is necessary for excitability after reinnervation of paralyzed striated muscles.

Animals↗
PubMed1990

Primary squamous cell carcinoma of the parotid gland.

Primary squamous cell carcinoma of the parotid gland is an uncommon malignancy. It can be diagnosed only after squamous cell carcinoma metastatic to the parotid gland has been excluded. Histologic evaluation must differentiate primary squamous cell carcinoma from high-grade mucoepidermoid carcinoma or adenocarcinoma. Retrospective review of parotid gland neoplasms seen in the Department of Otolaryngology and Communicative Disorders between 1972 and 1987 identified eight cases for an incidence of 1.8%. The majority of these patients had advanced disease and were treated with both surgery and radiation therapy. Fifty percent of the cases demonstrated no evidence of disease at an average follow-up of 29 months.

Adult↗
PubMed1990

Electronic control of laryngeal spasm. I. Blockage of orthodromically induced action potentials in intact canine recurrent laryngeal nerves.

Spastic dysphonia is a central nervous system phenomenon of unknown etiology characterized by uncoordinated voice tremor with erratic patterns of laryngeal contraction. Standard treatments have not been entirely satisfactory. The authors propose to apply a concept of selective nerve activity blockage, which leaves normal contractions undisturbed, as the basis for suppression of laryngeal spasticity. Single pulses of constant duration and increasing amplitude were injected into specially designed blocking electrodes placed around six recurrent laryngeal nerves (three dogs). Vocal cord adduction was reduced or arrested within given "windows" of stimulation levels of the blocking electrodes, while it increased with higher amplitudes when the current was injected via standard bipolar electrodes (controls). Although this study demonstrates the feasibility of blocking action potentials passing along recurrent laryngeal nerves, it might eventually allow control of laryngeal spasm from information taken directly from the affected musculature.

Action Potentials↗
PubMed1990

Artificial restoration of voice. I: Experiments in phonatory control of the reinnervated canine larynx.

Coordinated electronic pacing of implanted nerve pedicles into paralyzed laryngeal muscles has allowed selective dynamic control of abduction, adduction, and elongation of the vocal cords. Modifications of the original circuit in a cervical muscle model has added fine tuning to basic "all-or-none" pacing. Rehabilitation of phonation illustrated the sophisticated nature of voice and the need for restoration of fine tuning. Five mongrel dogs received nerve-muscle pedicles into the thyroarytenoideus, cricothyroideus, and posterior cricothyroideus after denervation of one hemilarynx. Following appropriate reinnervation time, pedicles and intact recurrent laryngeal nerves were injected with currents of variable amplitudes and pulse widths to achieve graded vocal fold control while air was blown intratracheally towards the glottic chink. Videoscopic and spectral analyses indicated that artificial phonation could be restored to frequencies measured in the normal state. These experiments suggested that rehabilitation of the impaired voice by servocontrol might eventually be feasible.

Animals↗
PubMed1990

The deep temporal nerve-orbicularis oculi muscle pedicle as a possible means for reanimation of the upper face.

Selective reinnervation of paralyzed facial musculature using the ansa hypoglossi nerve-muscle pedicle has been shown to be feasible in laboratory animals and in people. Because this structure cannot be brought beyond the level of the orbicularis oris muscle, the deep temporal nerve-orbicularis oculi nerve-muscle pedicle was investigated in six human cadavers as a possible source for reanimation of the paralyzed upper face. These studies show that it is possible to create a nerve-muscle pedicle that can easily reach the orbicularis oculi muscle in all specimens. Interest in electrical control of paralyzed structures to reestablish facial expression may allow further application of our findings.

Facial Muscles↗
PubMed1989

Secondary tracheoesophageal puncture for voice rehabilitation after laryngectomy.

Since the introduction of the tracheoesophageal puncture technique for restoration of voice in 1980, 125 secondary punctures have been performed in 117 patients at the Cleveland Clinic Foundation. Preoperative evaluation, pharyngeal preparation, and their relation to final speech results were reviewed retrospectively. Critical factors in the rehabilitation of these patients are discussed based on our experience and a review of the literature.

Adult↗
PubMed1989

Nonrigid reconstruction of the mandible.

Immediate rigid reconstruction of sacrificed portions of the mandible is desirable, but experience has shown that as many as 50% of bony or alloplastic implants are ultimately rejected or removed within the first few months after reconstruction. Functional and cosmetic reconstruction of the mandible, floor of the mouth, and, where necessary, skin of the lower lip and chin can be achieved with various local and myocutaneous flaps, to be followed after approximately 1 year by secondary bony reconstruction with a significantly lower complication rate. We describe the results in 43 patients treated by this approach.

Humans↗