Facial paralysis: diagnosis and treatment.
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Diagnosis, Differential↗
Biomedical subjects
R C Hamaker
Publications and source records attributed to R C Hamaker.
Four chest flaps.
A modification of the deltopectoral flap is described, which allows for the use of the anterior oblique chest flap from the same side. The deltopectoral flap is extended laterally over the shoulder, but is modified to extend the inferior incision medially to, but not beyond, the vertical plane of the nipple. This modification does not limit the range of the deltopectoral flap but does allow for development of a second flap that is based on the same four perforating vessels. Two flaps served by the same base provide for four individual chest flaps for use in undelayed reconstruction. A bilobed chest flap can be utilized, undelayed, where the deltopectoral and oblique flaps are raised simultaneously from the same side.
Face↗
Melanoma of the head and neck.
A retrospective review from 1935 to 1962 of 772 melanomas involving the head and neck seen at the Pack Medical Foundation (PMF) is presented with the main emphasis of 660 cutaneous and mucosal melanomas. Clark's levels for pathologic invasion are presented and correlated to 289 cases with 19 percent in Level II and 81 percent deeply invasive at Level III, IV, and V. The face was the most commom location with the cheek alone accounting for 22.3 percent of all the cases. The male to female ratio was 1.5 to 1 with 76 percent of the cases being equally distributed among the fourth through the seventh decades. 55.9 percent were local disease, Stage I, with 33.5 percent, Stage II, and 10.6 percent, Stage III or distal disease. The five-year or greater absolute cure rate in positive nodal disease was 12.6 percent. Elective versus no elective neck dissection in Stage IA disease demonstrated a five-year or greater absolute cure rate of 55 percent as compared to 38.5 percent. Distal metastases occurred in 30 percent of cases with elective neck dissection but in 70 percent of those cases with therapeutic neck dissection. The absolute five-year or greater cure rate was able to be analyzed in 556 cases. The rate was 25.6 percent for the mucosal and cutaneous lesions combined; an 8 percent rate for mucosal alone and 27.8 percent for cutaneous melanoma. The five-year or greater absolute cure rate for those cases treated totally at PMF was 35.4 percent.
Female↗
Goldenhar syndrome. Associated with submandibular gland hyperplasia and hemihypoplasia of the mobile tongue.
We report of a case of Goldenhar syndrome with submandibular gland hyperplasia and hemihypoplasia of the mobile tongue. This association has not been noted in the literature. A vascular abnormality or hemorrhagic phenomenon occurring during embryogenesis have been proposed as an explanation for the spectrum of defects seen in this syndrome. Congenitae hearing loss, when it occurs in Goldenhar syndrome, is usually unilateral and conductive in nature; however, inner ear defects may be more common than previously recognized.
Abnormalities, Multiple↗
Prognosis of malignant tumors of the parotid gland with facial paralysis.
A parotid malignant tumor with spontaneous facial nerve involvement is a serious prognostic sign. Of 34 patients reported, 29 have been followed for at least five years. In this group, 20 are dead of disease (one at five years), one is dead of other causes (at seven years), one is living with disease, and seven are free of disease. Four of these seven cases have been followed for more than ten years, with two being free of disease for 12 years. Thus, it is not a hopeless situation, as some studies have shown, and not a contraindication to combined radical surgery and radiotherapy treatment for cure if not palliation.
Adenocarcinoma↗
Modified nondelayed forehead flap.
The versatility and benefit of the forehead flap need not be lost when the external carotid artery system has been ligated. By basing the forehead flap laterally on the scalp, nourishment from the opposite external carotid artery gives the head and neck surgeon another advantage in reconstruction with nondelayed expedience. We report three cases of wide cheek ablative surgery, external carotid ligation, and utilization of the forehead flap. The occasions to use this modified nondelayed forehead flap are few, but it offers the same advantage without staging. It definitely can be used in any situation requiring a forehead flap when the external carotid artery system has been ligated.
Aged↗
Long-standing facial paralysis rehabiltation.
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Facial Muscles↗
Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection.
A multiinstitutional study to define the impact of total treatment programs involving radical neck dissection (RND) and modified neck dissection (MND) on patients' permanent disability was undertaken. A total of 243 patient responses were included in the study. Comparative analyses between the treatment groups show no advantage of one surgical operation over the other in returning patients to their pretreatment employment status. Radiation therapy was identified as adding significantly to the patient's permanent disability.
Adaptation, Psychological↗
Further experience with voice restoration after total laryngectomy.
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Esophagus↗
Tracheostoma valve for postlaryngectomy voice rehabilitation.
Newer surgical techniques for postlaryngectomy voice rehabilitation provide a simple, effective method of communication but require manual occlusion of the tracheostoma during speech. We report the development of a unique tracheostoma valve that avoids the necessity for covering the stoma. This airflow-sensitive valve closes during speech and remains open with normal respiration. Results of a clinical trial with 50 patients over a ten-month period are encouraging. Our experience suggests that excessive vocal tract resistance to airflow is the principal limitation to effective valve use. Approaches to decreasing airflow resistance through the vocal tract to improve both voice production and tracheostoma valve use are discussed.
Clinical Trials as Topic↗
Bilobed chest flap.
The bilobed chest flap is presented as an additional method of reconstruction in head and neck surgery. The flap is a combination of two previously described flaps: the deltopectoral flap and the anterior-superior-oblique chest flap. It is based on four perforating vessels supporting an area of 480 to 560 sq cm. The superior and inferior lobes can be used simultaneously for external cervical coverage or in combination for external coverage and internal lining. The importance of this flap is appreciated in the patient who needs two deltopectoral flaps but who has had previous chest surgery on one side, or in one who requires two deltopectoral flaps with a planned fistula which then requires a third flap for closure.
Head↗