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Biomedical subjects

J Conley

Publications and source records attributed to J Conley.

At least 145 records · Page 8Linked to original sources
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The surgical treatment of extratemporal facial paralysis: an overview.

At present there is no single surgical approach that is ideally suited to rehabilitation of the paralyzed face. Dynamic reconstruction and neural reconstitution are usually preferred to static methods, except under special circumstances. Experience with over 150 autogenous facial-nerve grafts using epineural suture technique has resulted in return of movement in 95% of properly selected patients. When grafting is not feasible, as in the obliterated central facial nerve, hypoglossal-facial-nerve crossover is a simple and powerful source of reinnervation, usually resulting in minimal intraoral crippling and mild mass movement. A newer procedure, the cross-face nerve graft, is an alternative to hypoglossal crossover, although it results in less axonal input and longer regenerative time. In cases of long-standing facial paralysis with muscle atrophy, temporalis and masseter transfers are dependable and may sometimes be combined with a nerve graft.

Cervical Plexus↗
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The sternocleidomastoid muscle flap.

The sternocleidomastoid muscle has significant application in the head and neck following radical ablative surgery about the mandible, face, and oral cavity. It can be used in the following ways to rehabilitate the paralyzed face, to correct a soft-tissue defect about the upper neck and oral cavity, and to protect the major arteries in the head and neck. (a) It may be transposed with a segment of the clavicle and/or sternum as a composite pedicle flap for reconstruction of the mandible. (b) It may be transposed into the lower cheek and jaw to reconstruct a mandibular defect. (c) It may be transposed into the anterior floor of the mouth as a myocutaneous flap following major ablative surgery to assist in correcting the defect and rehabilitating the oral cavity. (d) It may assist in facial paralysis to reanimate the lower third of the face. (e) It may be used to reinforce a suture line and protect the carotid and innominate arteries. (f) It may assist in shoulder elevation following poliomyelitis when transposed to the acromial process of the clavicle.

Facial Paralysis↗
PubMedDate not supplied

Group remotivation therapy for the 90s.

The authors assert that some of the most regressed, treatment-resistant clients with persistent mental illness will show a favorable response to a group approach called remotivation therapy. The remotivation therapy techniques of the 1950s have been updated by psychiatric nurses and a social work clinician in one VA setting. The authors assert that remotivation therapy approaches are easy to implement, personally rewarding, and effective in promoting interaction in such clients.

Chronic Disease↗
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Intralaryngeal release for tracheal anastomosis.

An operation for obtaining additional length in order to achieve end-to-end anastomosis of the trachea without significant suture-line tension is described. The intralaryngeal procedure lengthens the larynx approximately 1 to 2 cm without restricting its function. It is an expedient, effective technique when used primarily, or adjunctively, with a suprahyoid or mediastinal release.

Female↗
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Adenoid cystic carcinoma of the subglottic region.

Adenoid cystic carcinoma is one of the most common malignancies of the minor salivary glands in the head and neck. However, adenoid cystic carcinoma of the larynx is very rare, with less than 75 cases reported in the literature. We present three cases of adenoid cystic carcinoma of the subglottic region with 6-year, 9-year, and 18-year follow-up, respectively. The literature on adenoid cystic carcinoma of the subglottic area is reviewed. Symptoms of long duration, slow progressive growth with tendency for local recurrence, and eventual development of pulmonary metastasis is common. Five-year survival statistics do not appear as relevant as 10- and 20-year survival rates in this entity because of the often slow but pernicious nature of adenoid cystic carcinoma of the subglottic area. Despite aggressive therapy, the disease often leads to the eventual death of the patient. In our series one patient died, and two patients are alive and free of disease. The evaluation, treatment, and clinical course of this disease is discussed.

Adult↗
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Olfactory neuroblastoma.

Olfactory neuroblastoma is an uncommon malignant tumor arising from olfactory epithelium. Generally considered to be a tumor of slow growth, it varies in aggressiveness and may cause death by distant metastasis or local invasion. The pathologic diagnosis is difficult, and this tumor is often erroneously diagnosed. Nine previously unreported cases are presented, and a review of the various treatment modalities and course of the disease is given. Maximum therapeutic succes is best achieved by radical excision followed by a full course of radiation. Because of the high incidence of local recurrence (46%) and slow growth, patients should be followed up closely for life.

Adolescent↗
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The new tongue.

Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rational of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a "new tongue" by the use of this flap. The criteria for these techniques in benign and malignant tumors of the tongue are outlined. The segmental innervation of the pectoralis major muscle from a variety of three to five nerve branches permits the development of a skin-muscle flap that may be transposed with its nerve supply intact or totally denervated, depending upon the status of the hypoglossal nerves and tongue in the operative field. This presents the possibility of transposing a skin-muscle flap into a glossal wound with a completely intact nerve supply where the new flap is under constant instruction in its new physiologic environment. It also presents the possibility of neurotization of the denervated section of the muscle flap by axones from the intact segment of tongue. A third possibility is the fabrication of a "new tongue" by the transfer of the hypoglossal nerves into the denervated segment of the peripheral aspect of the myocutaneous flap. This variety and combination of rehabilitative techniques introduces a new phase into the rehabilitation of the tongue.

Glossectomy↗
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Ethics in otolaryngology.

All organic life has a code of behavior that is predetermined by the laws of survival and propagation. Some of these codes and systems are curiously complicated, yet each behavioral pattern contains the moral and ethical laws that endorse survival. This single axiom is the over-riding ethic. Man has added inventions, dexterity and feeling to the living program, and this has increased the complexity of moral and ethical conduct. It is in this milieu of interrelations, which is beyond physical survival, where our conscience and our performance must try to equate our sense of right. With millions of years of atavistic inheritance in the brutal struggle for survival it would be unrealistic to believe that Man could accomplish this easily, or ever completely. It also injects the question as to whether this is the basic normative for humans, or whether it is an emotional addendum in what is identified as a civilizing process. In ancient times, ethics was a derivative of philosophical thinking. Today it is enmeshed in the management of ceaseless and sophisticated technical and scientific advances which have religious, sociological and legal implications which are energized by human emotion and personal opinion, and which, in some instances, present problems which can be solved only partially or are unsolvable. The medical profession is in the midst of this turmoil.

Ethics, Medical↗
PubMedDate not supplied

The meaning of life-threatening disease in the area of the head and neck.

The revelation that one has a life-threatening disease creates a sentient flood of emotions that infuse the patient with fear, confusion and depression. It contains the spectrum of pain, suffering, deterioration of life-style, crippling and possible annihilation. This burden falls first on the patient and his family, and then on his doctor. The drama is a dilemma of cure or palliation wrapped about the emotional core of that person with science, drugs, technology, mysticism and hope. The ongoing process is the most dynamic encounter of being alive, and before it is finished will have used and drained a large percentage of the vulnerable emotions that identify our humanness. An overview of these involvements as they relate to the area of the head and neck shows how complex the process has become, the remoteness of its solution and the truth of its experience.

Attitude to Death↗