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Biomedical subjects

M L Shindo

Publications and source records attributed to M L Shindo.

At least 19 recordsLinked to original sources
PubMed1997

Management of external penetrating injuries into the hypopharyngeal-cervical esophageal funnel.

OBJECTIVE: To compare outcomes related to observation versus exploration for the hypopharynx and the cervical esophagus as the site of proven external penetrating injuries. METHODS: The records of 70 patients (47 with hypopharyngeal and 23 with cervical esophageal wounds) were retrospectively reviewed. RESULTS: No patient, observed or explored, who sustained a penetration into the hypopharynx above the level of the tips of the arytenoid cartilages of the larynx developed a complication. However, 22% of the patients with a hypopharyngeal injury below this level and 39% of patients with a cervical esophageal injury developed either a deep neck infection that required drainage or a postsurgical salivary fistula. CONCLUSIONS: Overall, the consequences of an external penetrating injury become more serious in the descending levels of the funnel formed by the hypopharynx and cervical esophagus. Injuries located in the upper portion of the hypopharynx can be routinely managed without surgical intervention. Neck exploration and adequate drainage of the deep neck spaces are, however, mandatory for all penetrating injuries into the cervical esophagus and most injuries into the lower portion of the hypopharynx.

Adolescent↗
PubMed1997

Necrotizing fasciitis of the face.

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Its occurrence in the head and neck region is uncommon, the majority of reported cases being limited to involvement of the neck, usually from infections of dental or pharyngeal origin. Involvement of the face from NF is rare; only 35 such cases have been reported in the literature since 1960. It is not only associated with a high mortality but can also result in severe disfigurement of the face, posing challenging reconstructive problems. Successful management of facial NF requires early diagnosis, prompt institution of broad spectrum antibiotics, aggressive surgical debridement to control the infection, and reconstruction of the resultant soft tissue defects. This report describes four additional cases of facial necrotizing fasciitis. One of the four patients died as a result of sepsis and multi-organ system failure. Two of the three surviving patients had significant facial disfigurement. A comprehensive review of the facial NF cases reported in the literature is also provided. Based on our experience with facial NF and the results of all previous case reports, the clinical manifestations, pathogenesis, and management of this disease are discussed.

Adult↗
PubMed1997

Concepts in neck reconstruction.

This article reviews the principles and techniques of reconstructing soft-tissue defects of the neck. The various surgical techniques, including local rotational flaps, tissue expansion, and free tissue transfer, are reviewed, and considerations in the selection of surgical techniques are discussed.

Humans↗
PubMed1996

Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer.

BACKGROUND: The use of mechanical microvascular anastomotic systems for free tissue transfer has previously been reported. Currently, a commercially available coupling device (3M Healthcare, St. Paul, Minn) is widely used for various microvascular free flaps. However, to our knowledge, there are no reports in the literature describing the efficacy of this particular device in regard to free tissue transfer in head and neck reconstruction. OBJECTIVE: To describe the surgical technique, limitations, and guidelines for application of this system for vascular anastomosis in head and neck free tissue transfer. DESIGN: The microvascular anastomotic device was used in 79 head and neck free flaps: radial forearm (n = 28), rectus abdominis (n = 27), fibula (n = 12), lateral thigh (n = 4), iliac crest (n = 3), gracilis (n = 2), jejunum (n = 1), pectoral (n = 1), and lateral arm (n = 1). Follow-up ranged from 6 months to 2.5 years. SETTING: Two major teaching/referral medical centers. PARTICIPANTS: Seventy-six patients ranging in age from 19 to 86 years. INTERVENTION: A total of 105 anastomoses (17 arterial and 88 venous) were performed. OUTCOME MEASURES: Anastomotic times and patency rates were evaluated. RESULTS: the anastomotic times ranged from 8 to 18 minutes for the arteries (average, 10 minutes) and from 4 to 16 minutes for the veins (average, 5 minutes). None of the flaps resulted in venous congestion due to thrombosis at the anastomosis. Two arterial anastomoses resulted in thrombosis, one of which was detected intra-operatively and successfully salvaged with conventional suture anastomosis. CONCLUSIONS: The patency rates with the microvascular anastomotic system appear to compare favorably with those of standard suture techniques. The major advantage is that the time of venous anastomosis is reduced, thereby decreasing the total ischemic time. An additional advantage is the ease with which anastomoses can be performed when the vessels are deep within a wound, where suture placement is difficult.

Adult↗
PubMed1996

Laryngotracheal manifestations of rhinoscleroma.

Rhinoscleroma is a rare, chronic granulomatous disease of infective causation. It usually begins in the nose and may progress to involve the larynx and trachea and cause dysphonia, stridor, and airway obstruction. Early rhinoscleroma is usually successfully treated with oral tetracycline, yet laryngotracheal disease may require operative intervention. The disease is rare in the United States, but with an increase in immigration from endemic areas, otolaryngologists should be familiar with the management of this rare disease. Current literature contains only a few reports describing the manifestations of this disease, mostly in the form of case studies. This study is a retrospective review of our institutional experience with the management of 22 patients with rhinoscleroma, 13 of whom had laryngotracheal involvement. The focus of this report is on the clinical manifestations of laryngotracheal scleroma. All of the patients were treated with long-term antibiotics. Nine patients underwent endoscopy with or without dilation and laser excision. Three patients required emergency tracheostomy, all of whom were ultimately decannulated without any sequelae. A rational approach to management of this unusual disease is provided.

Adult↗
PubMed1996

Autologous fat injection for unilateral vocal fold paralysis.

This study evaluates the efficacy of autologous fat injection for medialization of the paralyzed vocal fold. In 21 patients with unilateral vocal fold paralysis, autologous abdominal fat was injected into the thyroarytenoid muscle to achieve medialization. All patients were followed up with serial videolaryngoscopy and voice evaluation. At 2 months' follow-up, the voice was judged to be excellent in 10 patients, slightly breathy but significantly better than the preoperative voice in 6 patients, and markedly breathy in 4 patients. At 3 to 4 months' follow-up, of the 10 patients with excellent results, 5 maintained an excellent voice, 3 had developed slight breathiness, and 1 had developed severe breathiness. Long-term (6 to 12 months) results were available in 11 patients, and all of them maintained the same voice quality that was noted during the 3 to 4 months' examination. Magnetic resonance imaging of the larynx was obtained in 7 patients at intervals ranging from 1 to 7 months and compared to the baseline scan obtained at 1 week postoperative to assess the amount of fat remaining in the muscle. The images showed fat volume to persist, but a decrease in the fat signal was observed over time. The results suggest that the duration of medialization with autologous fat is variable, but appears to last at least 2 to 3 months. This loss of volume after 3 months seems to be due to absorption of the fat and possibly muscle atrophy. Autologous fat injection is relatively safe and easy to perform, and is an ideal method of temporary vocal fold medialization in patients in whom return of vocal fold function is expected.

Adipose Tissue↗
PubMed1996

Considerations in surgery of the thyroid gland.

The technique of thyroidectomy is covered in detail in various text-books and surgical atlases. The aim of this article is not to recount the details of the surgical procedure, but rather to emphasize important, pertinent surgical anatomy and discuss the management of various difficult situations and operative challenges that the thyroid surgeon may encounter from time to time.

Humans↗
PubMed1995

Autologous fat injection for vocal fold paralysis: long-term histologic evaluation.

Many techniques have been developed for medialization of the paralyzed vocal fold. The purpose of this study is to evaluate autologous fat as an alternative to alloplastic substances for use in vocal fold medialization. Eight dogs underwent left recurrent laryngeal nerve sectioning. Autologous fat was harvested, and the paralyzed vocal fold was medialized by injecting the fat into the thyroarytenoid muscle. The animals were divided into three groups for evaluation at 1, 3, and 6 months. Videolaryngoscopy was performed prior to sacrificing the animals. The larynges were sectioned coronally, and histologic studies were performed. The studies confirmed the preservation of viable fat at the injected site in all animals. Only a minimal inflammatory response was observed in the 1-month group. It would appear that fat injection is a viable alternative to Teflon injection and thyroplasty; it eliminates the need for alloplastic materials, does not appear to migrate, and does not require an open procedure.

Adipose Tissue↗
PubMed1995

Gunshot wounds of the temporal bone: a rational approach to evaluation and management.

Gunshot injuries of the temporal bone are uncommon but are being seen more frequently with the increasing incidence of violent crimes and use of firearms. A retrospective analysis of 43 consecutive patients treated at our institution with this injury was undertaken to determine the clinical symptoms, associated injuries, and treatment outcome. This is the largest series from a single institution treated by a single group during a brief period of time. Most of these patients had injury to various structures within and around the temporal bone, including hearing loss (29), intracranial injury (23), facial nerve injury (22), vascular injury (14), and mandible fracture (6). Ocular trauma and paralysis of cranial nerves V and IX, X, XI, and XII were rare occurrences. A rational approach to the evaluation and management of these injuries will be discussed in detail to optimize outcome.

Adolescent↗
PubMed1995

Management of traumatic hypopharyngeal injuries.

Violation of the hypopharynx by external penetrating trauma is an uncommon occurrence that may lead to life-threatening infectious complications if not recognized promptly and treated appropriately. A retrospective review of 48 such injuries seen during a 10-year period showed that flexible fiberoptic endoscopic examination is the best screening tool for recognition of a possible hypopharyngeal mucosal violation. Direct laryngopharyngoscopy is the best method of definitively diagnosing the injury. Size of the visualized mucosal violation alone is not sufficient information on which to base the decision for medical management versus surgical intervention (i.e., immediate exploration and drainage). Rather, the size, exact site of injury, and mechanism of the injury must be considered to have equal importance. Associated vertebral body fractures may negatively influence acute outcome if diagnosis and treatment of the hypopharyngeal injury are delayed by the cervical spine injury.

Adolescent↗
PubMed1995

Management of thyroid nodules during pregnancy.

Guidelines for the management of thyroid nodules discovered during pregnancy have not yet been established. The authors reviewed the records of 23 patients with thyroid nodules that were first detected during pregnancy. These patients were divided into three groups according to how they were managed. Seven patients who presented early in pregnancy had their work-up completed during pregnancy, 11 patients underwent biopsy after delivery, and 5 patients were managed with observation alone. The incidence of malignancy in the series was 39%. Four patients underwent surgery during pregnancy, and 7 patients were operated on in the postpartum period. No fetal morbidity or mortality occurred. The authors recommend that fine-needle aspiration be performed in patients who present before 20 weeks of gestation with rapidly enlarging thyroid nodules, nodules associated with palpable cervical adenopathy, solid nodules larger than 2 cm, or cystic nodules larger than 4 cm. Growth of a nodule while a patient is receiving thyroid hormone suppression therapy is highly suspicious for malignancy; in this situation, consideration should be given to performing biopsy later in gestation.

Adult↗
PubMed1995

Safety of thyroidectomy in residency: a review of 186 consecutive cases.

A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty-six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology--Head and Neck Surgery at the University of Southern California were reviewed. Sixty-nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.

Adolescent↗
PubMed1995

Sensory recovery in noninnervated free flaps for head and neck reconstruction.

Recent studies have reported sensory recovery in innervated ("sensate") microvascular free flaps used for oromandibular reconstruction. To evaluate the efficacy of sensate free flaps used for head and neck reconstruction, the natural outcome of noninnervated flaps must be known. Data on the natural recovery of sensation in noninnervated head and neck free flaps are lacking in the literature. This study evaluates the degree of spontaneous sensory reinnervation in noninnervated microvascular free flaps used for reconstruction of a variety of head and neck defects. Eighteen flaps were evaluated--9 fibula osseocutaneous and 9 radial forearm. The fibula flaps were used to reconstruct composite defects of the mandible and oral cavity mucosa. The radial forearm flaps were used to reconstruct defects resulting from floor of mouth resection (3), total glossectomy (2), pharyngectomy (1), full-thickness cheek (1), and facial skin (2). Sensation to pinprick, light touch, and temperature discrimination were tested over the skin paddle at time intervals ranging from 6 to 24 months. The pattern of sensory reinnervation in these noninnervated flaps over time and by location is discussed.

Bone Transplantation↗
PubMed1994

Muscular and myocutaneous pedicled flaps.

This article reviews the major regional myocutaneous flaps available for soft-tissue coverage in the head and neck region. Specific flaps discussed include the pectoralis myocutaneous, latissimus dorsi myocutaneous, trapezius myocutaneous, sternocleidomastoid muscle, and temporalis muscle flaps.

Head↗
PubMed1994

Soft-tissue microvascular free flaps.

Microvascular free flaps have revolutionized the reconstruction of soft-tissue defects in the head and neck region in the last decade. In this article, the anatomy, surgical techniques, advantages, and disadvantages of a variety of flaps are discussed.

Fascia↗
PubMed1993

Facial skeletal augmentation using hydroxyapatite cement.

This study investigates the use of a new calcium phosphate cement, which sets to solid, microporous hydroxyapatite, for facial bone augmentation. In six dogs, the supraorbital ridges were augmented bilaterally with this hydroxyapatite cement. On one side, the hydroxyapatite cement was placed directly onto the bone within a subperiosteal pocket. On the opposite side, the cement was contained within a collagen membrane tubule and then inserted into a subperiosteal pocket. The use of collagen tubules facilitated easy, precise placement of the cement. All implants maintained their original augmented height throughout the duration of the study. They were well tolerated without extrusion or migration, and there was no significant sustained inflammatory response. Histologic studies, performed at 3, 6, and 9 months revealed that when the cement was placed directly onto bone, progressive replacement of the implant by bone (osseointegration of the hydroxyapatite with the underlying bone) without a loss of volume was observed. In contrast, when the cement-collagen tubule combination was inserted, primarily a fibrous union was noted. Despite such fibrous union, the hydroxyapatite-collagen implant solidly bonded to the underlying bone, and no implant resorption was observed. Hydroxyapatite cement can be used successfully for the experimental augmentation of the craniofacial skeleton and may be applicable for such uses in humans.

Animals↗