PubMed Health⌕ Search

Biomedical subjects

J J Fagan

Publications and source records attributed to J J Fagan.

At least 19 recordsLinked to original sources
PubMed2006

Suprahyoid approach to base-of-tongue squamous cell carcinoma.

OBJECTIVE: To evaluate the suprahyoid approach to treatment of squamous cell carcinoma of the base of the tongue at Groote Schuur Hospital between 1999 and 2004. DESIGN AND METHOD: Retrospective analysis was done of patients with base-of-tongue squamous cell carcinoma treated using the suprahyoid approach. RESULTS: Seventeen patients underwent treatment for base-of-tongue squamous cell carcinoma utilising the suprahyoid approach. Complete medical records were available for 15 of these patients. The most common presenting symptoms were neck mass (40%) and referred otalgia (33%). Alcohol was a risk factor in more patients (64%) than smoking (47%). Adverse pathological findings were present in less than 50% of patients (involved margins 20%, perineural invasion 40%, vascular invasion 33%). Functional outcome in terms of speech intelligibility was excellent and there were minimal swallowing problems, with most patients using compensatory strategies and dietary modification. There were 2 subsequent deaths (13%) as a result of distant metastasis and a second primary. CONCLUSION: The suprahyoid approach to treatment of base-of-tongue squamous cell carcinoma provides good exposure, local tumour control and excellent functional outcome.

Aged↗
PubMed2004

Extensive calvarial tuberculosis: rare complication of tuberculous mastoiditis.

Tuberculous mastoiditis is a well-documented entity with decreasing incidence in recent years. Tuberculous osteitis of the skull is even rarer. The case of a 58-year-old male with tuberculous mastoiditis complicated by extensive tuberculous osteitis of the skull is presented. This case serves to demonstrate both the difficulty in establishing the diagnosis of tuberculosis and the potentially disastrous consequences of the disease.

Diagnosis, Differential↗
PubMed2000

Laser ablation of granulation tissue at the tracheoesophageal puncture site.

BACKGROUND: Tracheoesophageal fistula speech may be complicated by granulation tissue around the puncture site. Treatment includes antibiotics, antifungals, chemical or electrocautery, and surgical excision of the granulation tissue. Chemical cautery generally requires repeated treatment sessions. METHODS: We report our technique and results of CO(2) laser ablation of granulation tissue at the tracheoesophageal puncture site performed as an outpatient office procedure. RESULTS: Seven of 9 patients (78%) were cured with a single treatment. The prosthesis was replaced immediately after laser ablation of granulation tissue. Of the remaining 2 patients, 1 had a recurrence a year later, requiring repeated laser. The second patient had a large mass requiring 4 laser ablations. There were no complications. CONCLUSIONS: CO(2) laser has the following advantages compared with other methods of treating stomal granulation tissue: office procedure; 78% cured with single treatment; and the extent of tissue necrosis is predictable.

Aged↗
PubMed1999

A parapharyngeal myxoid liposarcoma.

We present a case of a parapharyngeal space myxoid liposarcoma. This case highlights the importance of wide surgical resection margins, and the difficult histological diagnosis.

Aged↗
PubMed1998

Histopathological features of a cochlear implant and otogenic meningitis in Mondini dysplasia.

The temporal bones of a 6-year-old boy with a cochlear implant for profound hearing loss associated with Mondini dysplasia were studied histopathologically. Despite having severe Mondini dysplasia, he was able to detect sound with the implant. On histological examination of the temporal bone, he had more than 10000 spiral ganglion cells. Histopathological changes in the inner ear associated with the cochlear implant were minimal. Patients with severe Mondini dysplasia and profound hearing loss may, therefore, benefit from cochlear implantation. In the contralateral ear, the patient had suppurative labyrinthitis and meningitis associated with chronic otitis media. Histopathological evidence of inflammatory necrosis of the round window membrane was consistent with suppurative labyrinthitis secondary to otitis media.

Abnormalities, Multiple↗
PubMed1998

Perineural invasion in squamous cell carcinoma of the head and neck.

OBJECTIVE: To determine if perineural invasion (PNI) of small nerves affects the outcome of patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract. DESIGN: Retrospective clinicopathological study of patients with at least 2 years of follow-up and with negative margins and no prior, synchronous, or metachronous SCC. SETTING: Academic otolaryngology department. PATIENTS: One hundred forty-two patients who had SCC of the oral cavity, oropharynx and hypopharynx, or larynx resected between 1981 and 1991. INTERVENTION: Surgery with or without adjuvant therapy. MAIN OUTCOME MEASURES: Local recurrence was examined with respect to PNI, nerve diameter, and microvascular or microlymphatic invasion. Perineural invasion was correlated with lymph node metastasis, extracapsular spread, and survival. RESULTS: Perineural invasion of nerves less than 1 mm in diameter was present in 74 patients, lymphatic invasion in 53, and vascular invasion in 9. Perineural invasion was significantly associated with local recurrence (23% for PNI vs 9% for no PNI; P=. 02), and disease-specific mortality (54% mortality for PNI vs 25% for no PNI; P<.001). With extralaryngeal tumors, PNI was associated with nodal metastasis (73% vs 46%; P=.03). Perineural invasion was not associated with extracapsular spread (P=.47). Microvascular invasion, lymphatic invasion, and nerve diameter were not significantly related to local recurrence. CONCLUSIONS: Perineural invasion of small nerves is associated with an increased risk of local recurrence and cervical metastasis and is, independent of extracapsular spread, a predictor of survival for patients with SCC of the upper aerodigestive tract.

Carcinoma, Squamous Cell↗
PubMed1998

Implications of cartilage invasion in surgically treated laryngeal carcinoma.

BACKGROUND: Cartilage invasion adversely affects the outcome of laryngeal carcinoma treated with radiotherapy. The UICC and American Joint Committee on Cancer (AJCC) classify laryngeal carcinoma with cartilage invasion as T4 or stage IV. METHODS: This study examines the prognostic significance of cartilage involvement in T3,4 N0,1 glottic carcinoma treated with total laryngectomy. Patients with tumor extension to pharynx, tongue, and thyroid gland, extracapsular spread, positive resection margins, and less than 2 years' follow-up were excluded. RESULTS: Sixty-seven pT3 (cartilage free of tumor) and 37 pT4 (cartilage invaded by tumor) cases were studied. The difference between the pT3 and pT4 groups in terms of local or regional recurrence, distant metastasis, and determinate survival was not significant. CONCLUSIONS: The results of this study question the use of cartilage invasion as a staging parameter for surgically treated laryngeal carcinoma. However, further studies with larger sample sizes are required to fully elucidate the prognostic significance, if any, of cartilage invasion in surgically treated cancer of the larynx.

Aged↗
PubMed1998

Treatment of the N+ neck in squamous cell carcinoma of the upper aerodigestive tract.

This article discusses the following aspects of the management of the N+ neck: evolution of neck dissection; specificity of staging of the clinically N+ neck; limitations of neck dissection in patients with adverse histologic features; management of bilateral nodal metastases, fixed nodes, and nodes with involvement of skin, nerves or the carotid artery; retropharyngeal nodes; and salvage treatment of the N+ neck following prior irradiation. A summary of the author's own approach is then presented.

Carcinoma, Squamous Cell↗
PubMed1998

Intranasal endoscopic excision of a juvenile angiofibroma.

Intranasal endoscopic excision of a juvenile nasopharyngeal angiofibroma (JNA) was performed in a 13 year old white male. The patient remains disease-free 24 months after the operation. Although endoscopic surgical techniques have been applied to the therapy of some benign nasal tumors, such as inverting papilloma, endoscopic resection of a documented JNA has not been previously reported. This technique is reserved for tumors which are limited to the nasal cavity and paranasal sinuses with minimal extension into the pterygopalatine fossa.

Adolescent↗
PubMed1997

Neurilemomas of the parapharyngeal space.

OBJECTIVE: To review the surgical management of neurilemomas of the parapharyngeal space (PPS). DESIGN: Retrospective survey of the clinical presentation, radiological features, surgical approaches, surgical findings, and postoperative neurological sequelae of neurilemomas of the PPS. SETTING: Academic tertiary care head and neck referral center. PATIENTS: Fourteen patients with neurilemomas of the PPS, 12 were in the poststyloid compartment. INTERVENTIONS: Preoperative evaluation with computed tomography and/or magnetic resonance imaging with or without angiography. Surgical resection was performed through a transcervical approach. MAIN OUTCOME MEASURES: Radiological features, adequacy of surgical approach, and neurological sequelae of surgery. RESULTS: Radiological studies could distinguish prestyloid from poststyloid tumors and, with poststyloid tumors, can usually differentiate between glomus tumor and neurilemoma. The transcervical approach permitted adequate surgical access. Five of the tumors in the poststyloid space were neurilomomas originating from the sympathetic nervous system, and all 5 patients with these tumors developed Horner syndrome postoperatively. CONCLUSIONS: Computed tomographic and/or magnetic resonance studies should be routinely obtained to evaluate tumors of the PPS, but angiography is indicated only in selected cases. Both prestyloid and poststyloid neurilemomas can be resected through a transcervical approach. Resection of neurilemomas has an attendant risk for neurological dysfunction.

Adult↗
PubMed1997

Nasopharyngeal angiofibromas: selecting a surgical approach.

BACKGROUND: A review of 16 juvenile nasopharyngeal angiofibromas, managed at the University of Pittsburgh, is presented. METHODS: A retrospective chart review was done. Surgical approaches and factors affecting recurrence are analyzed. RESULTS: Endoscopic transnasal, transpalatal, medial maxillectomy, facial translocation, and infratemporal fossa approaches, with or without craniotomy, were employed. The 37.5% recurrence rate reflects the advanced stage of the tumors. A major risk factor for recurrence was tumor involvement of the cranial base. CONCLUSIONS: The surgical approach should be selected according to tumor location and effectiveness of embolization. In young patients, the approach should minimize the potential for facial growth retardation. Tumors confined to the nasopharynx, nasal cavity, and paranasal sinuses may be removed endoscopically. Medial maxillectomy is recommended for tumors that extend to the medial intratemporal fossa or medial cavernous sinus. Significant involvement of the infratemporal fossa, cavernous sinus, or middle cranial fossa requires infratemporal fossa or transfacial approaches.

Adolescent↗
PubMed1997

Management of the thyroid gland with laryngectomy for cT3 glottic carcinomas.

Is routine hemithyroidectomy justified in laryngectomy for laryngeal carcinoma? Hemithyroidectomy with laryngectomy causes hypothyroidism in up to 25% of patients, and if combined with radiotherapy, in up to 70%. In this review of 102 total laryngectomies with routine hemithyroidectomy for cT3 glottic carcinoma, laryngeal carcinoma involved the thyroid gland in two. Both had subglottic tumour extension. The tumour approached within 3 mm of the thyroid capsule in seven. It is proposed that thyroidectomy should be performed only in selected laryngeal carcinomas. Intraoperative assessment of the thyroid gland should determine the need for thyroidectomy in glottic and transglottic carcinomas. Carcinoma invasion of the thyroid gland should be confirmed by frozen section before proceeding to thyroidectomy. In the absence of thyroid gland involvement, both thyroid lobes may be preserved. Total thyroidectomy should be performed if the thyroid gland has been invaded. Total thyroidectomy should be routinely performed with subglottic carcinomas.

Adult↗
PubMed1996

Late recurrences of laryngeal papillomatosis.

Laryngeal papillomotasis recurred in 2 patients after 44 and 47 years of remission. The recurrence of papillomatosis after such lengthy periods of remission underscores the fact that, while surgical treatment of laryngeal papillomatosis may maintain the airway and voice, and in some cases control clinically overt disease, it does not address the subclinical mucosal human papillomavirus infection that may lead to recurrence many years after surgery.

Humans↗
PubMed1996

Nasopharyngeal lipoma--a rare clinico-pathological entity.

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.

Female↗
PubMed1996

Tracheostomy and peristomal recurrence.

Emergency tracheostomy prior to laryngectomy for laryngeal carcinoma has been associated with peristomal recurrence. Is the peristomal recurrence caused by the tracheostomy per se, or is it due to the association of tracheostomy with subglottic tumours and locally advanced tumours? This study examines the association between tracheostomy, as an independent variable, and peristomal recurrence. Forty-three patients with T3 glottic carcinomas and treated by a combination of total laryngectomy and radiotherapy were studied. The difference in peristomal recurrence between the tracheostomy and non-tracheostomy patients was not statistically significant. Nor was there a correlation between the time interval between tracheostomy and laryngectomy, and the incidence of peristomal recurrence. It is concluded that tracheostomy, as an independent variable, does not cause peristomal recurrence.

Carcinoma, Squamous Cell↗
PubMed1995

Excision of adenoid cystic carcinoma of the cervical trachea via an anterior castellated approach.

Adenoid cystic carcinoma of the cervical trachea is rare and its diagnosis and surgical management challenging. We report a case with an unusual presentation and discuss the diagnosis and management. The preferred surgical management is tracheal resection, however this is often not feasible and many alternative techniques have been used. Here an anterior castellated approach is described, a modification of that more commonly used for benign tracheal strictures. We found it gave excellent access to the posterior tracheal wall which we feel is superior to a straight vertical tracheal incision. It also facilitates a tracheal widening procedure if indicated, and safeguards the recurrent laryngeal nerves which are particularly vulnerable in the cervical part of the trachea.

Carcinoma, Adenoid Cystic↗
PubMed1995

A prospective study of anaesthesia for quinsy tonsillectomy.

A prospective study of 50 adult quinsy tonsillectomy anaesthetics was performed. There were no significant anaesthetic or surgical complications and the mean intra-operative blood loss was 176 ml. The Mallampati score did not correlate with the Cormack and Lehane glottic view and there were no difficult intubations. Pre-operative trismus resolved completely during induction in 77.4% of cases. We concluded that the Mallampati grading system is not applicable in quinsies and in cases with palatopharyngeal arch distortion, that trismus in quinsies is due to muscle spasm and resolves completely during induction in most cases and that pre-anaesthetic drainage of the abscess together with rehydration and antibiotics are important contributing factors to safe anaesthesia for quinsy.

Adolescent↗