Procedure for resection of carcinomas of the oral cavity and oropharynx.
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Humans↗
Biomedical subjects
R B Stanley
Publications and source records attributed to R B Stanley.
Mandibular lingual releasing approach to oral and oropharyngeal carcinomas.
Resection of a carcinoma of the oral cavity or oropharynx requires adequate exposure for direct visual and bimanual examination. Transoral resection of tumors of the oral cavity using the "pull-through" procedure can be difficult due to interference by the circumoral tissue and mandibular arch. Exposure of carcinomas involving the base of tongue may require mandibulotomy or lateral mandibulectomy even when margin control does not mandate removal of the jaw. Alternatively, surgical techniques routinely used for exodontia and periodontal surgery can be applied to the creation of a mandibular lingual mucoperiosteal flap that allows for the entire tongue and floor of mouth to be delivered into the neck. Oral cavity and base of tongue lesions can then be resected with excellent direct visual and palpable control of margins, but without lip splitting, mandibulotomy or mandibulectomy.
Humans↗
Manual strangulation injuries of the larynx.
Laryngeal injuries secondary to manual strangulation are seen more often by the forensic pathologist than by the otolaryngologist. Forces sufficient to cause thyroid and cricoid cartilage fractures are usually sufficient to cause acute asphyxia and death. However, due to the static nature of the compressive forces applied in strangulation, fractures of the cartilaginous framework may occur without obvious mucosal disruption or submucosal hematoma formation. If the victim survives the initial assault and the injuries go unrecognized and untreated, delayed life-threatening airway obstruction of long-term vocal dysfunction may result. Computed tomography seems to be an excellent noninvasive technique to evaluate and verify cartilaginous laryngeal fractures and soft-tissue injury. Recognition of the potential for such injuries is the key to management and treatment.
Aged↗
Cervicofacial mycobacterial infections presenting as major salivary gland disease.
Mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally--if not more--difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy.
Adult↗
Evaluation and correction of combined orbital trauma syndrome.
Injuries to the inferior and lateral orbital walls are traditionally classified as either "blow-out" or trimalar fractures. This simplified system has helped considerably in the understanding of the causes of the two types of injury and methods of repair. Unfortunately, simultaneous occurrence can cause immediate and delayed problems that potentiate each other. Enophthalmos and globe ptosis, in combination with a depressed malar eminence, present a major challenge to the reconstructive surgeon's efforts to achieve satisfactory function and appearance. This paper reports the results of combined orbital floor and lateral wall injuries as an important clinical trauma syndrome. The interaction of the two fractures with regard to pathophysiology, sequelae, and methods of correction will be discussed. A review of cases will be used to describe the authors' techniques of repair, and to illustrate the preferred methods of bone grafting for correction of retrusion and depression of the globe, muscle entrapment and depression of the malar eminence.
Adult↗
Gunshot wound to the mandible with secondary neck injuries.
Four consecutive patients were initially seen with witnessed, low-velocity gunshot wounds to the mandible with deflection of the bullet into the neck, causing a life-threatening situation. The mechanics of injury were similar in all four patients who were shot at close range with a moderately heavy caliber handgun and sustained comminuted fractures from the parasymphyseal area to the ascending ramus of the jaw. Severe vascular injuries were seen in three cases and lacerations of the pharynx and cervical esophagus in one. Aggressive management of these injuries is recommended, with neck exploration after endoscopy playing a major role. Management of the mandibular fracture at the time of the initial surgery is favored. However, if roentgenograms are unavailable, reduction and fixation may need to be deferred.
Adult↗
Management of cervical thorium dioxide granulomas.
Thorium dioxide (Thorotrast) was used extensively in the United States from the 1930s through the 1950s for contrast radiography, including cerebral angiography. Its use was discontinued after the pathologic consequences of tumor formation and local fibrotic reaction (thorium dioxide granuloma) were recognized. The latency period for the development of these consequences is 20 to 30 years and, thus, has not expired. Radical surgical excision in an attempt to remove cervical thorium dioxide granulomas and their ionizing radiation has been advocated previously. A case prompted reconsideration of this management. Total surgical removal does not seem possible and is extremely hazardous in those cases with a patent carotid artery adjacent to the cervical granuloma. More cases should be expected, and each case should be approached individually as to benefits and risks of attempted surgical removal of the granuloma. Radical surgery is not always the treatment of choice.
Adult↗
Use of intraoperative computed tomography during repair of orbitozygomatic fractures.
OBJECTIVE: To assess the practicality and potential benefits of intraoperative computed tomography using a mobile scanner in the operating room during repair of orbitozygomatic fractures. SETTING: Level I trauma center. DESIGN: Twenty-five patients undergoing open reduction of a unilateral displaced fracture of the zygoma and/or repair of a blow-out fracture of the orbit with cranial bone grafts were placed into a radiolucent head holder and interfaced with the mobile scanner. Spatial vectors were drawn on scans displayed on a computer monitor to allow intraoperative side-to-side comparison of the position of the malar prominences and orbital walls. Corrections of fracture reduction or bone graft position were made as indicated by the comparisons. RESULTS: All scans were accomplished without apparent contamination of the surgical field. Major revisions were performed, based on the scans, in 2 patients whose displaced, comminuted zygoma fractures had been initially reduced with wide exposure of all fracture sites. Minor revisions were performed in 3 patients with displaced but less severely comminuted fractures that had been reduced without exposure of all fracture sites. Bone grafts were repositioned within the orbit in 2 patients with large 2-wall blow-out fractures. CONCLUSIONS: Intraoperative computed tomographic evaluation of the adequacy of repair of orbitozygomatic fractures is feasible with the mobile computed tomographic scanner. The scanner allows correction of discrepancies in position of the malar prominences and orbital walls at the time of acute repair, rather than during costly, more difficult delayed revisions. It may eliminate the need for direct visualization of all fracture sites to ensure adequate reduction in selected cases with displaced, comminuted fractures, thus decreasing operating room time and expense. Further study is required to fully document the cost-effectiveness of this approach to facial fracture management.
Humans↗
Reversible visual loss due to impacted lateral orbital wall fractures.
Impaction of the sharp medial edge of the orbital plate of the greater sphenoid wing into the orbital apex is a unique type of lateral orbital wall fracture that can produce a potentially reversible optic neuropathy. Two patients in whom the lateral or temporal approach to the orbit was used to reduce this type of fracture will be presented. In both patients, improvement in vision appeared to be related to removal of a bone fragment compressing the optic nerve in the orbital apex.
Adult↗
Carcinosarcoma of the nasal cavity and paranasal sinuses.
Malignant neoplasms consisting of an epithelial element and 1 or more nesenchymal components are variously termed teratocarcinosarcoma, carcinosarcoma, malignant teratoma, spindle cell carcinoma, and pseudosarcomatous squamous cell carcinoma. Carcinosarcoma, consisting of a malignant epithelial element and a single malignant mesenchymal component, is extremely rare in the sinonasal tract. We report a case of carcinosarcoma involving the nasal cavity, paranasal sinuses, and anterior cranial fossa. Rapid growth and extensive local destruction are prominent features of this tumor, emphasizing the need for early diagnosis and prompt institution of aggressive therapy. The clinical presentation, pathologic features, and clinical course are detailed.
Carcinosarcoma↗
Thorium-dioxide--induced pharyngeal hemorrhage.
Thorium dioxide, a producer of alpha particle radiation, was used in the United States from 1930 to 1950 for carotid and cerebral angiography. Cervical thorium dioxide granuloma is a well-recognized sequela of extravasation of this material near the carotid bifurcation. Radical neck dissection to remove the granuloma for aesthetic and functional reasons may lead to massive postoperative hemorrhage if a patent, but radiation-weakened, carotid artery is present. Additionally, hemorrhage may occur spontaneously because of pharyngeal necrosis or following infection of a pharyngeal biopsy site. The case described illustrates that life-threatening, thorium-dioxide--induced pharyngeal hemorrhage may occur even with an occluded carotid system. The bleeding site may go unrecognized, and laryngopharyngectomy with radical neck debridement may be required for hemostasis. Extension of an infection into the retroesophageal space and thoracic inlet requires exteriorization of the entire neck wound to prevent placing the great vessels of the superior mediastinum at risk for rupture. Spontaneous rupture of the aorta may occur due to thorium-dioxide--induced necrosis of its wall.
Arterial Occlusive Diseases↗
Strangulation: a full spectrum of blunt neck trauma.
Strangulation accounts for up to 10% of violent or criminally related deaths in the United States annually. Strangulation techniques include hanging, throttling, garrotting, and chokeholds. These methods are thought to cause unconsciousness or death by compression of either the airway or the major vessels of the neck. A review of the records of 112 nonsurvivors and 59 survivors of strangulation revealed that hyoid bone and laryngotracheal fractures occurred in both groups, particularly in throttling victims. The laryngeal injuries themselves could not be implicated as the cause of death, and survivors usually presented without airway compromise. However, failure to appreciate such injuries in survivors may lead to permanent voice complications. A full understanding of the spectrum of strangulation is also required if the otolaryngologist is called to testify as an expert witness in such cases.
Adult↗
Phonatory effects of thyroid cartilage fractures.
Blunt trauma can cause a wide range of injuries to the cartilaginous framework of the larynx. The severity of injury that is required to cause a permanent disorder of vocal function if left untreated has not been defined. A study using excised canine and human larynges was undertaken to identify the effects of minimal displacement or malalignment in simulated thyroid cartilage fractures on selected voice production measurements. These fractures were found to cause changes in glottal configuration sufficient to affect glottal resistance as well as amplitude and noise content of the voice signal produced by each larynx. Therefore, relatively minor injuries of the thyroid cartilage may cause potentially serious disorders of phonation.
Animals↗
Acute epiglottitis in adults. A review of 48 cases.
Acute epiglottitis was diagnosed infrequently in adults until the late 1960s and early 1970s. Because it is relatively rare, it may present a problem to the physician who sees an adult with sore throat and dysphagia, but does not think of epiglottitis. In this paper, we report our experience with 48 cases of acute epiglottitis in adults between the years 1963 and 1987. A discussion of the diagnosis and treatment of adult epiglottitis is presented. An adult with acute painful dysphagia should be considered to have epiglottitis until the diagnosis is proven otherwise.
Acute Disease↗
Osteogenesis from a free periosteal graft in mandibular reconstruction.
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Animals↗