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Biomedical subjects

R C Hamaker

Publications and source records attributed to R C Hamaker.

At least 37 records · Page 2Linked to original sources
PubMed1987

Sternocleidomastoid myocutaneous flap.

The sternocleidomastoid myocutaneous flap has several applications for reconstruction of defects about the head and neck. It is used for augmentation of facial defects, carotid artery protection, and repair of oral cavity defects. Additional reconstructive efforts suggest the sternocleidomastoid myocutaneous flap can be used for facial reanimation and as an osteomyocutaneous flap incorporating the clavicle for mandibular reconstruction. Reports of unreliable viability and resection of the sternocleidomastoid muscle during neck dissection decreases the applicability of the flap. Twenty-seven sternocleidomastoid flaps were used in 26 patients for head and neck reconstruction. In contrast to the reported 40% to 50% incidence of superficial slough or total flap necrosis, three (11%) flaps developed superficial (cutaneous) slough while two patients developed inclusion cysts. The technique includes elevation of the sternocleidomastoid muscle with the overlying platysma and skin originally described by Owens. The procedure is modified by removing the epithelium on the tunneled portion of the flap. This allows the flap to be used as a one-stage method of reconstruction without sacrificing the additional blood supply from the platysma and overlying dermis.

Humans↗
PubMed1986

Irradiated mandibular autografts update.

Nineteen patients underwent primary mandibular reconstruction with irradiated mandibular autografts. Ten were successful, with the longest follow-up being 7 1/2 years; nine failed within six months. Although an excellent graft for size and contour, a 53% success rate is no better than any other primary grafting technique. We have abandoned this technique in most situations and presently are evaluating split-rib grafts and intraoperative radiation to in situ mandibles.

Carcinoma, Squamous Cell↗
PubMed1986

A prospective study of tracheoesophageal speech.

Gates et al suggested that commonly accepted statistics on esophageal speech acquisition may be inflated because they are compiled from retrospective observations that tend to exclude high-risk or poor-outcome patients who are unavailable or unwilling to be assessed. Using a multi-institution prospective study design, they demonstrated that at six months following laryngectomy only 12 (26%) of their 47 patients used esophageal speech. We prospectively assessed a group of 47 laryngectomees' pretracheoesophageal puncture and posttracheoesophageal puncture to determine the efficacy of this speech-rehabilitation method. Forty-four patients (94%) achieved good to superior tracheoesophageal speech, and, at one year, 39 patients (83%) continued to use their voice prosthesis. Results of this study reveal (1) preoperative speech intelligibility and acceptability, (2) predictive value of the preoperative esophageal insufflation test, (3) speech intelligibility and acceptability four days following initial voice prosthesis placement, (4) cost profiles, and (5) results and experiences at one year.

Adult↗
PubMed1986

Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation.

Pharyngeal constrictor and cricopharyngeal spasm have been implicated as deterrants to esophageal speech acquisition as well as tracheoesophageal phonation. Recent efforts to reduce the resultant hypertonicity include pharyngeal constrictor myotomies and modifications of pharyngeal reconstruction during laryngectomy. Investigation of the innervation of the muscular wall of the pharynx led to the development of a pharyngeal plexus neurectomy technique to alter the tonicity of the pharynx without myotomy. The resultant alaryngeal speech is fluent, and acoustic parameters compare favorably to esophageal speech.

Adult↗
PubMed1985

Primary voice restoration at laryngectomy.

The tracheoesophageal puncture techniques of secondary voice restoration have been applied to primary restoration at laryngectomy. Satisfactory speech resulted in 48 patients (69%). This figure was improved by revision surgery to 75% and case selection may produce even higher success rates.

Esophagus↗
PubMed1985

An improved esophageal insufflation test.

Previous investigations identified that insufflation of the esophagus may elicit reflex pharyngoesophageal closure, impeding airflow and subsequent voice production. A simplified method for esophageal insufflation consistently evaluates the capacity for alaryngeal speech acquisition. Although primarily a method for predicting tracheoesophageal speech, it may also be an important prognostic indicator for traditional esophageal speech development.

Catheterization↗
PubMed1985

Pharyngeal reconstruction after total laryngectomy with preservation of phonation.

The goal of pharyngeal reconstruction after laryngectomy is to prevent fistulization and to permit rapid resumption of satisfactory deglutition. Alaryngeal speech acquisition by the traditional method of esophageal speech is effective if insufflation is rapidly learned and tolerated by the pharyngoesophageal segment. Experience with tracheoesophageal phonation revealed an incidence of pharyngoesophageal spasm in 40% of an esophageal speech failure population which prevented useful air flow for speech production. This is related to esophageal distention and reflexive upper esophageal sphincter hypertension. It is suggested that pharyngeal reconstruction after total laryngectomy may permit higher wall tension than is desirable for speech acquisition. The problem of post laryngectomy pharyngoesophageal spasm may be reduced by myotomy of the pharyngeal constrictors with resultant higher air flows in the residual vocal tract for speech. Alterations in the pharyngeal wall tonicity will affect the pitch of the speech and listener acceptability. Recently identification and division of the pharyngeal plexus has produced a similar result in improved phonatory air flows with subjective vocal pitch approximating more normal voices. The above mentioned techniques are readily applied to the laryngectomy procedure and enhance the likelihood of alaryngeal speech acquisition.

Humans↗
PubMed1985

Restoration of the airway following bilateral recurrent laryngeal nerve paralysis.

Bilateral recurrent laryngeal nerve paralysis has been treated by a number of ingenious techniques that include arytenoidectomies, vocal cord lateralizations, cordectomies, and, recently, reinnervation procedures and laser arytenoidectomies. An arytenoidectomy is recommended by a thyrotomy approach without lateralization of the vocal cord. The resulting airway is adequate for decannulation by expansion of the posterior glottic aperture, with preservation of the anterior glottis for phonation.

Arytenoid Cartilage↗
PubMed1985

Vocal rehabilitation after laryngectomy.

The evolution of treatment of laryngeal cancer has passed a number of milestones. The maintenance of useful communication is of paramount importance in all cases and, with the newer modalities of tracheoesophageal phonation and voice prostheses, the quality of life after laryngectomy is clearly improved. Future advances may restore continuity of the upper respiratory tract with resumption of normal nasal function, humidification of the lower respiratory tract, and elimination of the permanent tracheostoma.

Humans↗
PubMed1983

Irradiated mandibular autografts.

The cosmetic and functional disability associated with mandibular resection has been a major problem to the patient with direct invasion of the mandible by oral cancer. Marginal resections with combined postoperative radiation therapy have frequently been substituted for the more preferred segmental resections and resultant deformities. Presented are 15 cases of oral cavity cancer involving resection of the mandible, immediate radiation to 10,000 rad, and primary reconstruction as irradiated mandibular autografts. The longest following is 4 years and 3 months, with a success rate of 66%. Morbidity is minimal as compared to autogenous bone grafting. Tumor size, previous radiation, or use of regional flaps have not been a factor in the success of this method in reconstruction of the mandible primarily.

Adult↗
PubMed1983

Role of needle biopsy in thyroid nodules.

The role of fine-needle aspiration cytology of thyroid nodules is analyzed in 116 cases. Forty-six percent of the patients with "cold" solid nodules were operated on with a 1% known false-negative and a 5% false-positive result. Ninety-four percent of the aspirations provided adequate cytologic material for evaluation. A new approach to the assessment and management of the thyroid nodule with fine-needle aspiration is proposed as the initial step in the evaluation.

Biopsy, Needle↗
PubMed1983

Voice rehabilitation after total laryngectomy.

More than 100 years after the first laryngectomy, voice preservation remains a remarkable challenge. A number of surgical techniques have been proposed, yet complications related to aspiration, recurrent disease, or voice failure have been frequent. Representative historical examples are described and their results reviewed. The advent of tracheo-esophageal phonation with a silicone voice prosthesis simplified the approach to this perplexing problem. The principles learned from the secondary application of this method are applied to a primary technique for vocal rehabilitation immediately after laryngectomy. The results are promising without risking alteration of the basic laryngectomy technique and expected cure rates.

Aged↗
PubMed1981

Mediastinal dissection. A multi-institutional assessment.

Mediastinal dissection was first described by George A. Sisson, MD, in 1962. However, there are no other reports in the literature describing the experience of other surgeons with this procedure. This study retrospectively analyzes the multi-institutional experience with mediastinal dissection to examine critically its effectiveness in controlling superior mediastinal neoplastic disease and to evaluate the complications of the procedure. This article describes 21 patients from three medical centers who have undergone mediastinal dissection by three surgeons for stomal recurrences. There are six patients who are free of disease for periods ranging from three months to six years postoperatively. Reconstructive techniques ranged from deltopectoral flap, gastric pull-up, or jejunal free grafts for esophageal reconstruction, myocutaneous flaps for tracheal reconstruction, to deltopectoral or thoracoacromial skin flaps for external resurfacing. This article also describes modifications designed to decrease mortality and to expedite the reconstruction, considering that this series suggests that mediastinal dissection probably should be considered as a palliative rather than curative attempt.

Aged↗
PubMed1981

Feasibility of low doses of I-131 for thyroid ablation in postsurgical patients with thyroid carcinoma.

The feasibility of using low doses of I-131 (30 mCi) for ablation of thyroid remnants following surgery for papillary and follicular thyroid carcinoma was examined in 21 patients. Six weeks following near-total thyroidectomy and three days following intramuscular thyroid-stimulating hormone (10 IU), patients were given 30 mCi of I-131 and scans were performed 24 to 72 hours later. Remaining thyroid tissue was identifiable in the thyroid bed in 19 patients, and two patients also had evidence of cervical metastases. Patients with metastases received an additional 100 mCi of I-131. Follow-up I-131 scans were performed at nine to 15-month intervals in ten patients who initially received 30 mCi of I-131, and only one patient showed complete ablation of the residual thyroid tissue, whereas the remaining nine patients had persistent uptake of I-131 in the same regions in which the uptake was seen in the initial postoperative scans. One of the nine patients had evidence of a cervical metastasis as well. It is therefore apparent that total or near-total thyroidectomy rarely removes all thyroid tissue and that an "out-patient" dose of I-131 is not adequate for ablation of postoperative thyroid remnants.

Adenocarcinoma↗
PubMed1981

Irradiation autogenous mandibular grafts in primary reconstructions.

The procedure, irradiated mandibular autografts, for primary reconstruction, is presented with an immediate success rate of 88%. Eight cases have undergone primary mandibular reconstruction with the tumorous mandible irradiated to 10,000 rads in a single dose. The longest follow-up is 2 3/4 years. The autograft has proven to be an ideal implant. Major resections of the mandible in conjunction with large myocutaneous flaps have been reconstructed utilizing this implant.

Animals↗
PubMed1979

Surgical treatment of hypopharyngeal stenosis in children.

Five cases are presented of severe scarring, in the hypopharynx in children, which did not respond to conservative measures. These patients were treated by excision of the scar tissue and reconstitution of the area by Z-plasty, local mucosal flaps, regional chest flaps and colon transfer depending upon the severity of the problem. All had rehabilitation undertaken of the structural integrity of deglutive, respiratory, and vocal mechanisms. It is recommended that in this type of problem early rehabilitation is warranted rather than subjecting the child to prolonged gastrostomy and tracheotomy into puberty. When extended, the morbidity has a physical and psychological affect on these children.

Child↗