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P J Gullane

Publications and source records attributed to P J Gullane.

At least 19 recordsLinked to original sources
PubMed1996

Flap selection in cranial base reconstruction.

We have compared our local, pedicled, and free-flap reconstructions for 90 skull base defects performed over the past 10 years. The pericranial flap was found to provide a reliable dural seal. Free-flap reconstructions exhibited a significantly higher incidence of uncomplicated primary wound healing (95 versus 62.5 percent) and a much lower incidence of flap loss (0 percent), cerebrospinal fluid leak (5 percent), meningitis, and abscess (0 percent) when compared with defects reconstructed with pedicled myocutaneous flaps. We conclude that microvascular free-tissue transfer is the safest, most economical procedure when faced with moderate to large composite defects of the cranial base.

Female↗
PubMed1996

Tobacco, alcohol, and oral cancer: the patient's perspective.

It is well known that smoking, chewing tobacco, and alcohol play a significant role in the etiology of oral cancer. Although this is common knowledge in the medical community, it appears that patients are not aware of this association. We performed a prospective study on all patients newly diagnosed with oral cancer and a control group without any head and neck cancer. Patients completed a questionnaire assessing their awareness of these causative factors. Other parameters measured as possible influences of patient perception included patient age, sex, smoking status, education level, occupation, and place of residence. Patients were also questioned about their knowledge of the causes of lung cancer to allow for comparison. A total of 134 patients were questioned, with 22 of the patients assigned to the oral cancer group and the second group being comprised of 112 patients without head and neck cancer. Only 20 patients (14.9%) were aware of the causative factors of oral cancer. There was no significant difference in the knowledge of causation when comparing the cancer and control group. The patient age, sex, smoking status, or place of residence did not affect their knowledge of the causes of oral cancer. There was a highly significant difference between patients of different education levels and occupations, with the more educated and higher level occupations being better informed about the causes of oral cancer. In contrast, the majority of patients were aware of smoking as a causative factor in the development of lung cancer. The results from this study demonstrate a serious lack of knowledge in the general population of known causes of oral cancer. The relevant issues are discussed and recommendations are made.

Adolescent↗
PubMed1995

The free flap and plate in oromandibular reconstruction: long-term review and indications.

The purpose of this study was to define the role of reconstruction plates as bone replacement in oromandibular reconstruction. From 1987 through 1991, 71 consecutive oral cancer patients underwent composite resection and reconstruction and were entered into one of two studies. In the first study of 31 patients, 15 underwent oromandibular reconstruction using a radial forearm osteocutaneous flap, while the remainder (16) received a radial forearm fasciocutaneous flap together with a mandibular reconstruction plate. The second study involved 40 subsequent patients, all receiving the latter form of reconstruction. Twenty-one of the plates were stainless steel, and the remaining 19 were of the titanium hollow screw (THORP) type. We followed the patients prospectively. We defined success as a reconstruction that we did not have to remove. Additionally, since the patients had limited life expectancy, we developed the idea of days of life lost and incorporated it into our definition of a successful outcome. Vascularized autogenous bone proved to be more successful than metallic plates used alone in terms both of reconstruction survival and of minimizing days of life lost. The overall success rate of mandibular plate reconstruction was 78.9 percent, but analysis by defect type revealed a failure rate of 35 percent when the defects were anterior and only 5 percent when they were lateral. THORP plates demonstrated a trend towards more durability. We would now recommend plate reconstruction only in lateral defects in patients with a poor prognosis.

Bone Plates↗
PubMed1995

Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases.

Fifty-one patients undergoing surgical reconstruction of mandibular defects with the titanium hollow screw reconstruction plate over a 4-year period were analyzed. Plate failure was defined as flap necrosis, plate extrusion, or plate fracture necessitating a further surgical procedure and occurred in 12 patients (24 percent). The incidence was highest for patients who had more than three mandibular regions resected. It was not affected by the primary site of the tumor or whether the patient had received radiation therapy. Although the failure rate was the same whether the patient attained full oral function or was fed by gastrostomy, plate fracture was limited to the former group. The overall cause-specific survival rate for this group of patients was 68 and 56 percent at 1 and 2 years, respectively. In addition, 81 percent of patients attained a full oral diet.

Adult↗
PubMed1995

Postirradiated submandibular gland: a potential model to study salivary gland radioprotection and tumourigenesis.

Theoretical reserve cells located in the intercalated and excretory ducts are postulated to be responsible for salivary gland tumourigenesis, with acinar cells playing no role in this process. Animal models, one using low-dose radiation to rat submandibular glands, indicate that this hypothesis is incorrect. Few human models have been devised to demonstrate and verify this theory. Submandibular glands in the field of ionizing radiation, as external-beam radiotherapy for head and neck tumours, were examined using an immunocytochemical technique and an antibody to proliferating cell nuclear antigen (PCNA), a specific marker for cycling cells. In the nonirradiated gland, nuclei positive for PCNA were seen in acinar as well as ductal cells of all types. Six months post irradiation, human submandibular glands show increased proliferative rates in both ductal and acinar cells that are significantly greater than control glands (p = .012). Based on this regenerative capacity, postirradiated human submandibular glands might serve as a model to investigate various treatment modalities for the prevention of radiation damage to acinar cells and the consequent patient morbidity that develops due to xerostomia. As well, these results suggest that even in humans, acinar cells are potential targets for carcinogenic agents and that current histogenic concepts for salivary gland tumourigenesis are incorrect.

Adult↗
PubMed1994

Acinic cell carcinoma of salivary glands. Prognostic relevance of DNA flow cytometry and nucleolar organizer regions.

OBJECTIVE: To test the prognostic ability of flow cytometry and counts of silver-enhanced intranuclear nucleolar organizing regions (AgNORs) in acinic cell carcinoma. DESIGN: Using statistical methods to establish if analysis of DNA content, percentage DNA synthetic (S)-phase, and the AgNOR counts on 45 cases of acinic cell carcinoma with clinical follow-up ranging from 10 to 379 months are predictors of time to recurrence or time to death due to acinic cell carcinomas. MAIN OUTCOME MEASURES: Whether tumors with low AgNOR counts and diploid DNA are favorable acinic cell carcinomas and the converse, aneuploid DNA and elevated AgNOR count, predict unfavorable neoplasms. RESULTS: Tumors with a diploid DNA content had as unfavorable a clinical course as aneuploid acinic cell carcinomas. Similarly, S-phase and AgNOR count results showed considerable overlap when separated into carcinomas with or without local recurrence, metastasis, or death due to tumor. Statistical evaluation also failed to provide predictors of clinical course based on ploidy, percentage S-phase, or AgNOR counts. CONCLUSION: The results, although negative, are important in showing that data on DNA content, cell cycle, and nuclear limits useful in other neoplasms are of limited practical application in establishing predictors of time to recurrence or time to death in acinic cell carcinomas. Solving the enigmas, for clinicians and pathologists, associated with acinic cell carcinomas will require further information about the biology of this neoplasm.

Adult↗
PubMed1994

How I do it: Zenker's stapler diverticulectomy.

Zenker's diverticulum is an outpouching of the hypopharyngeal mucosa through Killian's area, a dehiscent or weak area between the cricopharyngeus muscle and the inferior constrictor muscle. Although this entity was described more than a century ago, these pulsion diverticuli continue to challenge surgeons to this day. The authors would like to reintroduce a method of resection that has proved useful in our practice.

Esophagoscopy↗
PubMed1994

Kimura's disease: an unusual cause of head and neck masses.

This article presents a case report of a patient who presented with Kimura's disease. Kimura's disease is an unusual condition with predilection to involve the head and neck. Since Kimura's disease often imitates a neoplastic or inflammatory process of the head and neck it behooves the otolaryngologist-head and neck surgeon to be able to recognize this entity.

Adult↗
PubMed1994

Complications associated with rigid fixation of mandibulotomies.

The complications associated with the use of rigid internal fixation in 31 consecutive patients who had undergone a mandibulotomy for the treatment of pathology of the oral cavity or oropharynx were reviewed. Rigid fixation was accomplished with two major types of systems: compression plates and reconstruction plates. Complications occurred in 11 patients (35%) with an average of 1.7 complications per patient. Most complications were minor in nature, and were treated successfully with conservative measures. Patients who had preoperative radiotherapy were more likely to develop nonunion and osteoradionecrosis. Plate exposure was the single, most common complication, accounting for 13% of the complications. No major differences were noted in the complication rates between the two systems.

Adult↗
PubMed1993

Pathobiology of salivary glands. IV. Histogenetic concepts and cycling cells in human parotid and submandibular glands cultured in floating collagen gels.

Localization of cells with proliferative capacity in human major salivary glands lacks extensive study. Minced fragments of human parotid (n = 3) and submandibular (n = 3) glands embedded in a floating collagen gel matrix and cultured for up to 28 days allowed maintenance of the three-dimensional relationship of the various cell types in these glands. Immunocytochemistry and electron microscopy of a time-dependent series of cultured gland fragments showed gradual cytologic modification of acinar cells so that acini became duct-like but also established that even after 28 days of culture certain cellular features allowed continued identification of acinar cells. Serial section immunostaining for amylase, cytokeratins, and proliferating cell nuclear antigen (a specific marker for cycling cells) revealed that acinar, intercalated duct, and excretory duct (both basal and luminal) cells are all capable of entering the cell cycle. At day 5 of culture, the number of cycling cells increased 16-fold in the parotid gland and 9-fold in the submandibular gland over that in the respective in situ gland. In this in vitro system, which perhaps simulates regenerative processes in human salivary glands, none of the samples showed cycling cells localized only to segments of intercalated duct or the basal cells of excretory duct as suggested by current histogenetic concepts.

Cell Adhesion↗
PubMed1993

Role of hyperbaric oxygen therapy in the management of mandibular osteoradionecrosis.

Hyperbaric oxygen (HBO) has been used as a tool in the management of osteoradionecrosis (ORN). However, it has not been conclusively proven to be of benefit. The precise role and guidelines for its use also have not been clearly defined. This report retrospectively analyzes 41 patients treated at the Hyperbaric Chamber Unit at the Toronto Hospital (Toronto General Division) with proven mandibular ORN from 1980 to 1985. The results show that 83% of the patients had a significant improvement with HBO therapy, judged by at least a 50% decrease in the size of the exposed bone, closing of the fistulous tract, or complete relief of symptoms. Within the group of patients who were significantly improved, 15% showed complete resolution of ORN. Seven (17%) of the patients did not benefit from the HBO. All seven patients had radiological evidence of dead bone. Based on these observations, the following conclusions can be made: 1. HBO is of benefit in the management of ORN. 2. Patients with ORN may be divided into two groups: mild and severe. 3. Cases of mild ORN will heal with HBO alone, but, in severe ORN, surgery is necessary to remove dead bone. 4. All patients with ORN should receive dental evaluation, local wound care, and a strict oral hygiene regimen. Diseased teeth should be removed prior to radiotherapy. Subsequently, any teeth that became abscessed should be extracted in conjunction with prophylactic HBO. Antibiotics play an ancillary role in the management of ORN. For patients who have received radiation to the mandible, the authors propose regular follow-up in order to detect ORN at a time when HBO can arrest the disease.

Combined Modality Therapy↗
PubMed1993

Classification of mandibular defects.

A classification of mandibular defects based on functional as well as aesthetic factors is presented. By taking into account the difficulties in restoring form and function and not simply relying on traditional anatomic landmarks, it is hoped that this method will allow different types of reconstructions to be fairly evaluated. It also should help surgeons to tailor individual reconstructive techniques to specific clinical situations. Major difficulties in mandibular reconstruction arise when a condyle requires replacement, when there is a mucosal and/or skin component to the defect, and when the area to be reconstructed involves the anterior arch. The classification is based on three upper-case and three lower-case characters: H, C, L and o, m, s. H defects are lateral defects of any length, including the condyle but not significantly crossing the midline; L defects are the same only without the condyle; C defects consist of the entire central segment containing the four incisors and the two canines. Combinations of these letters are possible (an angle-to-angle defect, for example, is represented as LCL). Thus H and L defects may reach or even extend slightly beyond the midline but are not referred to as LC or HC unless they contain the entire central segment. The letters o (neither a skin nor a mucosal component), s (skin), m (mucosa), and sm (skin plus mucosa) are added to denote the epithelial requirement.

Bone Plates↗
PubMed1992

Massive pharyngocutaneous fistulae: salvage with two-layer flap closure.

Massive pharyngocutaneous fistulae may be arbitrarily defined as those involving two-thirds or more of the circumference of the pharyngeal wall. Three such patients are presented, all after failed radiotherapy and surgery. The principles of management consist of salivary diversion, complete debridement, nutritional support, prophylactic antibiotics, and two-layer, well-vascularized overlapping closure. We currently recommend a radial forearm flap used in conjunction with a pectoralis muscle (or musculocutaneous) flap for rapid rehabilitation of these patients, particularly in the presence of obesity or an irradiated bed.

Aged↗
PubMed1992

Hyoid bone involvement by squamous cell carcinoma: clinical and pathological features.

The incidence of hyoid bone involvement by neoplasia is undetermined, despite its importance in hyoid-preserving surgery. Eleven (1.46%) of 755 whole-organ laryngeal specimens examined demonstrated hyoid bone infiltration. These included 6 cases originating from the larynx, 3 from the vallecula, and 1 case each from the pyriform fossa and tongue base. Clinically, vallecular involvement was helpful in determining hyoid invasion; however, computed tomography (CT) was disappointing. The greater cornu was the sole site of invasion in six cases. Ten of 11 cases were secondary to direct tumor spread. All carcinomas were advanced, with variable differentiation. Vascular and neural invasion was a prominent feature. Hyoid bone invasion is rare, and associated with a poor prognosis. Hyoid bone preservation is feasible in a majority of patients.

Aged↗
PubMed1992

Juvenile angiofibroma: a review of the literature and a case series report.

Juvenile angiofibroma is a rare, histologically benign tumor which occurs almost exclusively in adolescent boys. The morbidity and mortality associated with this tumor are related to its prominent vascularity and its propensity for aggressive local growth. From 1974 through 1988, 21 male patients with a diagnosis of juvenile angiofibroma were managed at the Toronto General Hospital or the Hospital for Sick Children, Toronto. Preoperative computed tomography was performed on 20 patients, selective angiography on 21 patients, and preoperative embolization on 15 patients. Primary surgery was performed on 67% of these patients, with radiation therapy used for advanced stage II and stage III disease or in response to patient preference. Pterygopalatine fossa involvement was demonstrated in 90% of the patients; as a result, the lateral rhinotomy approach was most commonly used in the surgical cases. A successful outcome was achieved in 86% of patients treated with surgery alone. Two patients underwent radiotherapy for salvage following postoperative recurrence. There were no treatment-related deaths and no major surgical complications. The value of computed tomography is discussed, the authors' treatment protocol is outlined, and the case series results are presented.

Adolescent↗
PubMed1992

Subglottic tracheal resection and synchronous laryngeal reconstruction.

Postintubation injury of the upper airway commonly results in stenotic lesions of the larynx, subglottis, and adjacent trachea. The traditional approach to surgical correction is laryngofissure for the laryngeal component and staged plastic reconstruction of the subglottic stenosis. Reported results are variable and unpredictable, and permanent extubation is impossible in a significant number of patients. We report experience with 15 patients with combined laryngeal, subglottic, and tracheal stenosis who were managed by a one-stage operation: circumferential resection of the subglottis and trachea with primary thyrotracheal anastomosis, combined with laryngofissure and laryngeal reconstruction. These procedures required the collaboration of the Departments of Otolaryngology and Thoracic Surgery of the Toronto General Hospital. Between 1972 and 1991, our thoracic surgical division did 53 circumferential subglottic tracheal resections with primary thyrotracheal anastomosis for benign disease. There were no operative deaths and 51 of 53 patients were successfully extubated. In 15 of these patients, a concomitant laryngofissure for laryngeal reconstruction was required. Laryngeal repair included excision or incision of interarytenoid scar (n = 13), interarytenoid mucosal graft (n = 6), or mobilization of cricoarytenoid joint (n = 3). A temporary laryngotracheal stent (usually a Montgomery T tube) was maintained after the operation in all cases (duration 3 to 42 months). Thirteen of these 15 patients are now permanently extubated and none has functionally significant restenosis. Vocal function is satisfactory to good in these patients. The approach described for these combined laryngotracheal lesions provides better results than those reported with traditional staged and plastic techniques of reconstruction. The collaboration of the departments of otolaryngology and thoracic surgery was essential to achieve these results.

Adolescent↗
PubMed1992

Chondrosarcoma of the larynx: a histo-radiologic analysis.

Chondrosarcoma of the larynx is a rare malignant cartilaginous neoplasm. To date, the serial sectioned laryngeal specimens of this disease have not been correlated with the pre-operative computed tomographic findings. A retrospective analysis of 833 serially sectioned laryngeal specimens found chondrosarcoma in six cases (0.72%), of which four cases had a pre-surgical computed tomography (CT). Radiologic axial sections were compared with microscopic sections in the same plane. Whole organ sections showed the tumor to have an expansile growth pattern, showing little impulse to infiltrate adjacent cartilage. CT scanning successfully predicted the diagnosis of a cartilage neoplasm prior to surgery, and accurately reflected the site and extent of laryngeal involvement. We conclude that CT is a reliable method of evaluating chondrosarcoma of the larynx, thereby predicting the feasibility of partial laryngeal resection.

Aged↗