Biomedical subjects
Publications and source records attributed to N B Solomons.
Leiomyosarcoma of the larynx is extremely rare. Histological diagnosis excluding other tumours, in particular fibrosarcoma and spindle cell carcinoma is often difficult. Immunohistochemical studies are helpful in arriving at an unambiguous diagnosis and we present a case characteristically positive for actin and desmin. The difficulties of determining treatment are discussed.
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Peri-operative acute upper airway obstruction may be life-threatening. A case is reported of a child with severe adenotonsillar hypertrophy who developed acute upper airway obstruction after a routine surgical procedure and required emergency adenotonsillectomy. The importance of pre-operative assessment is stressed.
A 67-year-old man presented with a 45-year history of a week voice. This was result of polio which had left him with a right vocal cord palsy. The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.
Angiosarcomas are extremely rare in the head and neck and the histological diagnosis is often difficult. We present a case of a haemangiosarcoma of the maxillary antrum in a 33 year old male. The histological diagnosis and subsequent management are discussed.
A case of atypical supraglottitis in an 11-year-old boy is presented. The epiglottis was only mildly inflamed. The organism isolated from blood culture was Streptococcus sanguis. This organism is a normal commensal of the oral cavity and has not previously been reported as a cause of supraglottitis.
The authors report on a series of 25 patients who, in the process of undergoing tympanoplasty, were noted to have erosion of the long process of the incus. This was repaired with bone pâté in an attempt to restore ossicular continuity. The methods and results are presented and the prospects for the future are discussed.
Epistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma. We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.
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The authors report on a series of 24 patients in whom open cavity mastoidectomy cavities were obliterated with bone pâté. The aim of the procedure is to provide the patients with a dry ear which then also reduces the need for frequent out-patient attendances.
An unusual case is presented in which large cervical osteophytes caused upper airway obstruction. The presenting features of acute-on-chronic respiratory failure and cor pulmonale were alleviated by permanent tracheostomy.
Laryngomalacia with its characteristic inspiratory collapse of lax supraglottic tissues into the laryngeal inlet may on occasion cause obstruction of such severity as to require airway intervention. The anatomy of the condition and the physiological explanation for its clinical presentation are examined and the pathological changes that precipitate a life-threatening situation discussed. Surgical correction of the abnormal tissue represents an acceptable alternative to tracheostomy in this situation. Simply 'trimming' the lax tissue over the arytenoid mounds may suffice in some cases but complications can occur and stabilisation of the epiglottis should be attempted as well. A series of 11 infants on whom such surgery was performed is presented with discussion of the surgical procedures performed and the complications experienced. The current uniformly successful surgical management of severe laryngomalacia by 'supraglottic trimming' combined with 'anterior epiglottopexy' is advocated for correction of severe laryngomalacia.
Reported is a case of fracture of a tracheal T-tube caused by the patient, a child, pulling on it. A discussion of the use of such tubes is presented and their removal in the event of such an accident.
Rupture of the patellar tendon is uncommon. A case of indirect traumatic rupture of the ligamentum patellae occurring in a 54-year-old man is reported.
Traumatic third nerve palsy is an unusual condition. It is a serious prognostic feature, not for life but for permanent, serious neurological deficit. It can only be diagnosed with confidence if it is known to have been present from the moment of impact and if adequate investigation excludes a compressing haematoma.