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Biomedical subjects

J D Osguthorpe

Publications and source records attributed to J D Osguthorpe.

At least 19 recordsLinked to original sources
PubMed1991

'Medial maxillectomy' for lateral nasal wall neoplasms.

Lateral rhinotomy and "medial maxillectomy," an en bloc resection of the medial maxillary sinus, ethmoid sinus with the lamina papyracea, medial orbital floor, and lacrimal fossa-duct, have been advocated for lateral nasal wall neoplasma. Experience with 35 (of 41) patients followed up at least 30 months (median, 57 months) postoperatively is reported. There was a 9% recurrence for benign tumors and 15% for malignant neoplasms, the latter only in the patients with nonmelanoma malignant neoplasms not receiving postoperative radiotherapy. The most frequent complications were cavity crusting, epicanthal scarring, and epiphora.

Adolescent↗
PubMed1991

Head and neck burns. Evaluation and current management.

More than half of the 150,000 burn patients hospitalized in the United States each year have head and neck involvement, with 3% to 7% sustaining concomitant inhalation injury. With advances in fluid replacement therapy and specialized burn care units, mortality has fallen from near 100% to 24% for burns of 75% to 90% of body surface area. The most common causes of death are respiratory complications and sepsis. Inhalation injuries can be diagnosed by laryngoscopy, and compromised airways can then be intubated (with tracheotomy for long-term management) and sloughing mucosa and inspissated mucus removed by serial bronchoscopy. Sepsis is minimized by early excision of burn eschar and autografting or, in the widely burned, temporary coverage with cadaver allograft, porcine xerograft, or skin substitutes until successive crops of autografts are available. The head and neck presents substantial reconstructive and rehabilitative challenges, which must be addressed in aesthetic units.

Burns↗
PubMed1991

Orbital wall fractures: evaluation and management.

Over a 49-month period, 121 orbital wall fractures were treated and 92 were followed for a median of 6.5 months (minimum, 3 months). Associated injuries included a 17% incidence of serious globe or optic nerve injuries and 13% incidence of lacrimal drainage disruption. Diplopia occurred in 23% and dystopia in 11%. Management was by observation alone in 14% and exploration in the remainder, with layered gelfilm for defects smaller than 4 cm2, alloplastic sheeting for defects to 6 cm2, and outer cortex of parietal bone for larger dehiscences. There were no decrements in vision from operation, dystopias were corrected to within 2 mm of normal, and diplopia persisted only in those with extraocular muscle paresis. There was no benefit to exploration of orbital wall defects smaller than 2.5 cm2 or with reduction of other midfacial fractures (e.g., malar) when neither dystopia nor entrapment was present, because defects not obturated in such cases had no sequelae.

Adult↗
PubMed1991

Management of trauma of the facial nerve.

The general principles of management of trauma to the facial nerve from a variety of causes are presented and the indications for and timing of surgery are reviewed. Attention is given to management techniques unique to injuries of the extracranial, intratemporal, and intracranial divisions of the nerve.

Cranial Nerve Diseases↗
PubMed1991

Occupational hearing conservation.

Chronic exposure to high-intensity noise can produce permanent hearing loss, the amount of which depends on noise intensity, temporal and spectral characteristics, and the length of exposure. OSHA regulates workplace noise exposure in accordance with the Hearing Conservation Amendment of 1983. When noise levels equal or exceed an 85 dBA time-weighted average (TWA), the employer is required to provide annual audiometric screening. When noise levels exceed 90 dBA TWA, the worker's exposure must be reduced by engineering methods, administrative changes, or personal hearing protectors. If a worker demonstrates a standard (significant) threshold shift (10 dB or greater increased average hearing threshold at 2, 3, and 4 kHz in either ear) that is attributed to noise, the worker's exposure must be further reduced by one of the aforementioned methods.

Ear Protective Devices↗
PubMed1991

Nasolacrimal injuries. Evaluation and management.

The tear drainage system is disrupted in 17% to 21% of nasoethmoidal fractures and, to a lesser degree, other midfacial fractures. When epiphora or dacryocystitis occurs, evaluation should include the Jones dye tests, probing of the ductal system, or dacryography. Dacryocystorhinostomy is the treatment of obstruction distal to the common canaliculus.

Humans↗
PubMed1989

Indications and limitations of Mohs micrographic surgery.

Mohs micrographic surgery is most suitable for cutaneous and mucosal neoplasms that exhibit a contiguous growth pattern and have minimal potential for metastases. Thus, a higher failure rate will be observed for tumors that exhibit multicentricity, disconnected foci, or give rise to metastases or satellite lesions. Because of its superior microscopic control, MMS offers the maximum chance for cure and preservation of normal tissue in properly selected tumors. Consequently, MMS is the treatment of choice for tumors located in cosmetically and functionally important areas of the head and neck (such as the periocular and perinasal areas), not only because of its tissue-sparing properties but also because tumors in some of these same anatomic areas also exhibit a high recurrence rate when managed by routine modalities. Variables to consider when selecting MMS to manage a neoplasm include, in addition to its anatomic location, its histology, its size, its tendency for recurrence, and whether or not it has been inadequately or previously treated. Field-fire BCC and ill-defined tumors are also best managed by MMS. When the management of a tumor exceeds the capabilities of the Mohs surgeon, an interdisciplinary approach utilizing other oncologic specialists is required (for example, reconstructive surgery, preservation of vital anatomic structures, deeply penetrating and extensive tumors, or the presence of or high risk for metastases). Because MMS is usually performed with local anesthesia on an outpatient basis, it is cost effective, safe, and extends operability to patients who are poor candidates for general anesthesia. However, when a multidisciplinary approach is employed, general anesthesia is often required. If the neoplasm is extensive, several operative sessions may be required to complete the extirpation of the tumor and the reconstruction of the defect. Although offering the greatest chance of cure for many difficult cutaneous neoplasms, MMS may at times become tedious and prolonged. Frozen sections are adequate in tracing out the microscopic extensions of most neoplasms; however, permanent sections may at times be required to provide the best microscopic control of margins, and this, too, may prolong the procedure. Histologic preparations must be of superior quality to ensure maximum microscopic control, and the surgical specimens removed must be properly oriented. On microscopic examination, benign, reactive changes and normal anatomic structures must be distinguished from tumor to avoid the unnecessary sacrifice of normal tissue, and inflammation, which may obscure tumor, must be carefully scrutinized.(ABSTRACT TRUNCATED AT 400 WORDS)

Combined Modality Therapy↗
PubMed1988

Pseudotumor of the head and neck masquerading as neoplasia.

Four unusual cases of pseudotumor, which had clinical and radiographic findings suggesting neoplasia, are presented. One involved the maxillary sinus, destroying the lateral wall, and extending to the infratemporal fossa and the orbit. The second presented as an enlarging lacrimal gland tumor with ipsilateral parotid adenopathy, and the third as a large parapharyngeal mass that was diagnosed as a lymphoma on aspiration cytology. The fourth case documented the rare occurrence of a congenital pseudotumor, manifesting as proptosis in a neonate and thought to be a fibrosarcoma on frozen section study. Aggressive pseudotumors must be distinguished from malignancy to avoid unnecessary surgery or irradiation. Some cases can be distinguished from neoplasms by their dramatic response to oral steroid therapy, and others by characteristic features on CT or MRI. Due to the diverse cellular proliferation, aspiration cytology is infrequently helpful and diagnosis can be difficult on frozen section study. An approach to the diagnosis and management of pseudotumors is detailed.

Adrenal Cortex Hormones↗
PubMed1988

Surgical management of choanal atresia.

Our experience with the diagnosis and surgical management of 37 patients with congenital atresia or severe stenosis of both posterior nasal choanae is presented. Twenty-five were repaired transnasally and 12 were repaired transpalatally. Soft stents were fashioned from Silastic tubing and used for 6 to 12 weeks postoperatively. In 64% of the transnasal operations and 83% of the transpalatal operations, full patency of both choanae was achieved without the necessity of dilatations. In most of the remaining operations, one lumen remained patent.

Child↗
PubMed1988

The efficacy and safety of transantral ethmoidectomy.

With the advent of new endoscopic instruments, rhinologists are reassessing and modifying ethmoidectomy techniques. Despite this renewed interest, the transantral ethmoidectomy has received little attention, even though this procedure has the advantages of avoiding an external incision, safely delineating the medial orbital wall, and simultaneously treating ethmoid and maxillary sinus disease. The present study compared 74 transantral ethmoidectomy procedures and 47 external ethmoidectomy procedures. The two groups of patients were comparable with respect to age and gender. There was no statistical difference between the two groups with regard to blood loss. Complications were less frequent in the transantral group. Of the 97 patients treated for ethmoid sinusitis, outcome was more successful in the transantral group than in the external ethmoidectomy group when assessed by the need for additional medical or surgical treatment.

Adult↗
PubMed1988

Optic nerve decompression.

Post-traumatic deterioration of vision requires thorough ophthalmologic evaluation, as well as computed tomographic scanning of the orbits and central visual pathways if no obvious ocular origins of the visual decrement are detected. When optic nerve trauma is a suspected etiology, the patient should be treated with megadose intravenous steroids, as well as optic nerve decompression performed after 12 to 24 hours if improvement of vision fails to occur.

Craniocerebral Trauma↗