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Biomedical subjects

R H Mathog

Publications and source records attributed to R H Mathog.

At least 19 recordsLinked to original sources
PubMed1991

The "plateau effect" of cis-platinum-induced hearing loss.

Cis-platinum-induced hearing loss has been reported to exhibit a "plateau effect" over the 2 to 8 kHz range. We examined serial audiometry data from 27 patients treated with cis-platinum. Although a plateau at 60 to 70 dB HL often occurred, this hearing loss was clearly exceeded in a number of patients. We identified 14 patients with sufficient cis-platinum-induced sensorineural hearing loss to evaluate a plateau limit to hearing loss over the 4 to 8 kHz range. Half of these 14 patients had hearing losses that exceeded the plateau level. More severe 4 to 8 kHz hearing losses did not correlate with number of treatments, cumulative dosages of cis-platinum, pre-existing hearing loss, radiation therapy, other chemotherapeutic agents, or even hearing losses below 4 kHz. Although cis-platinum therapy can induce a plateau of moderate hearing impairment for some patients over the 4 to 8 kHz range, a significant proportion of patients will experience more severe hearing impairment in this range, even after only one or two courses of cis-platinum.

Acoustics↗
PubMed1991

Management of orbital blow-out fractures.

The sequelae of the blow-out fracture can be predicted from a knowledge of the pathophysiology of the fracture as well as an accurate history and clinical and radiologic examination of the patient. The main indications for exploration and repair are acute changes in globe position and mechanical restriction of gaze. Surgery should be performed at 7 to 10 days posttrauma. For the surgeon who possesses the skills and expertise, reparative procedures should help the patient and infrequently cause complications.

Humans↗
PubMed1990

Mastication in patients treated for head and neck cancer: a pilot study.

Patients with head and neck cancer will experience alteration of oral anatomy and physiology caused by the disease and the treatment required. Despite the implied effects on the dynamics of mastication, objective studies have not been conducted to evaluate masticatory function of these patients. Masticatory performance and swallowing threshold performance were evaluated with Frito corn chips as the test substance. Edentulous patients treated for cancer demonstrated deficiencies in both tests. Masticatory performance and swallowing threshold performance improved with prosthodontic rehabilitation but this improvement was less than with comparable controls. Techniques to evaluate masticatory factors such as dentition, dentures, biting force, temporomandibular joint status, range of motion, and saliva are suggested.

Aged↗
PubMed1990

Flap reconstruction techniques in conjunctivorhinostomy.

Dacryocystorhinostomy is usually the standard approach to treat epiphora caused by lower lacrimal tract obstruction. When the pathologic condition lies in the upper lacrimal passage, however, alternate bypass or reconstructive options must be considered. Conjunctivodacryocystorhinostomy, using the Jones tube, can effectively bypass the upper tract, but the technique may be complicated by granulation tissue formation, infection from unapposed mucosal flaps, and inefficient passage of tears through scar as a result of healing by secondary intention. Canaliculodacryocystorhinostomy affords the advantages of a physiologic reconstruction, but is limited by availability of sufficient canaliculus, requires a lengthy and tedious dissection, and must be performed using a microsurgical approach. We describe an alternate technique of conjunctivorhinostomy that provides total lacrimal bypass and has the advantages of bipedicled mucosal flap apposition, temporary stenting, and symptomatic improvement of epiphora. Several case examples illustrate the indications, advantages, and disadvantages of this technique.

Adolescent↗
PubMed1990

Vestibular effects of chronic perilymph fistula in the cat.

Chronic, unilateral perilymph fistulae were created in cats by removal of the round window membrane and placement of a tympanostomy tube into the round window. Rotary chair, fistula, caloric, and vestibulospinal tests were performed before and after fistulization, and periodically for 2 weeks. At 2 weeks, patency of the fistula was documented by fluorescein injection into the spinal fluid and visualization of leakage into the middle ear bulla via the fistula. All the cats had a patent fistula at 2 weeks, but one of the three cats had a greater perilymph leak than the others. The cat with the more active leak had a spontaneous nystagmus toward the side of the fistula on the first postoperative day; this changed to nystagmus toward the opposite side by the third postoperative day. The other cats had a spontaneous nystagmus toward the opposite side from the first postoperative day. Most abnormal test results returned to normal in the first week after fistulization. Histologic study of the temporal bones revealed that the cat with the greater leak had a wider cochlear aqueduct than the other cats.

Animals↗
PubMed1989

Surgical correction of enophthalmos and diplopia. A report of 38 cases.

Enophthalmos, hypophthalmos, and diplopia are complications of orbital injury. This article reviews the causes of these sequelae, describes a method of strategic implantation of bone grafts to the orbit (and malar bone), and reports the long-term (six months to eight years) results in 38 cases. As a result of bone grafting, all but two patients had a correction of the enophthalmos to within 1 to 2 mm of the opposite eye. Of the 20 patients with diplopia, 15 had correction, and an additional four had an improvement of diplopia so it occurred in only one field of gaze. Of the 22 patients with grafts to the malar bone, 16 were thought to have good to excellent results; however, six developed some degree of reabsorption at the graft site. No patients had any decrease in vision. The advantages and disadvantages of the surgical procedure are described and compared with other methods.

Adolescent↗
PubMed1989

Repair of orbital floor fractures with Marlex mesh.

The best method for reconstructing the acutely fractured orbital floor is controversial. In this review, the outcome of 81 patients with an operatively confirmed pure orbital blow-out fracture is evaluated with respect to postoperative enophthalmos, diplopia, infection, and extrusion. A Marlex mesh implant was used to repair 58 of the fractures, with minimal resultant complications. We believe that Marlex mesh is an ideal implant for use in repairing the early blow-out fracture.

Adolescent↗
PubMed1988

Orbital wall and volume relationships.

Assuming that intraorbital volume is a space defined by the orbital walls, and that intraorbital contents represent a space occupied by soft tissues, changes between volume and contents will result in movement of the globe in usually a forward (exophthalmic) or backward (enophthalmic) direction. An understanding of the phenomenon is important if the clinician is to judge the effects of traumatic displacement of an orbital wall on globe positions and if the clinician is to design a reconstructive procedure to correct these changes. To study such relationships, we have designed physical models based on measurements of five dry human skulls. With these models, it has been possible to move a whole wall or part of a wall and, thereby, adjust the orbital volume. The experimental manipulations are useful in predicting the relationship of the orbital wall position and volume-information that can be ultimately used for diagnosis and reconstructive purposes.

Exophthalmos↗
PubMed1988

Self-inflicted shotgun wounds of the face: surgical and psychiatric considerations.

This study reviews the evaluation and treatment of patients with extensive self-inflicted shotgun wounds to the face. Five cases are presented and assessed with regard to reason for suicide, psychological reaction to facial reconstruction, and the potential for social rehabilitation. Mechanisms of injury, acute management, and definitive surgical and psychiatric treatment programs are discussed. Survival is expected for most patients, and carefully planned surgical reconstruction must be coordinated with skilled psychiatric intervention.

Adult↗
PubMed1987

Open treatment of condylar fractures with biphase technique.

Most fractures of the condyle of the mandible are managed by closed reduction techniques. Commonly used methods include intermaxillary fixation with a natural dentition or with dentures or splints. Fixation for a variable period of time provides for union of the fragments. In patients in whom the condyle is badly displaced and/or the adjoining mandibular segment is unstable, open techniques are often applied. This article discusses the indications for surgery and presents a method of reducing and maintaining fixation with an external device. Although the approach requires a major surgical procedure and can potentially cause injury to the facial nerve, there is a decided advantage in the direct visualization of the reduction and immobilization of the fracture. Several cases are presented to demonstrate the method and result.

Adult↗
PubMed1987

Detection and quantification of laryngotracheopulmonary aspiration with scintigraphy.

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

Deglutition↗
PubMed1987

Temporalis muscle-galea flap in craniofacial reconstruction.

With the advent of increasing technological and surgical sophistication in craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalization. When dural integrity is compromised in the face of nasopharyngeal or paranasal communication, the risk of ascending infection and potential life-threatening meningitis mandate cranial and facial compartments, separated by sufficient and healthy soft tissues. This paper describes a method of providing pedicled soft tissue coverage and support for the contents of the anterior cranial fossa using a temporalis muscle-galea rotation flap. The vascularized myofascial tissues, capable of carrying skin and bone grafts, are well suited to cover and protect large areas of the skull base. Several cases are described to show the advantages and disadvantages of the technique.

Adult↗
PubMed1986

Posttraumatic enophthalmos and diplopia.

Malposition of the globe and failure to fuse visual images are late-developing complications of orbital injury. This article reviews the causes of specific sequelae, such as enophthalmos, hypophthalmos, and diplopia, and describes a procedure of strategic implantation of autogenous bone grafts to correct the condition(s). Using quantifiable methods of assessing globe position and motility, the authors demonstrate improvement in 18 of 19 patients. Vision is reported unchanged or improved in 13 sighted patients. Several cases are presented with analyses of preoperative and postoperative photographs. Indications, contraindications, advantages, and disadvantages of the surgical procedure are described and compared to others.

Adolescent↗
PubMed1985

Temporalis muscle-galea flap in facial reanimation.

When substantial destruction of the facial nerve occurs as a result of trauma, measures to animate the face, such as transfer of masticatory muscles, must be considered. Unfortunately, these techniques have been limited by a difficult reeducation process for the patient and failure of these muscles to reach sufficiently large areas. A method of extending the temporalis muscle with galea allows rotation into important areas of the face. Case presentations illustrate specific indications, advantages, and disadvantages of this technique.

Adult↗
PubMed1985

Malar fractures associated with exophthalmos.

Although fracture of the malar bone is often associated with enlargement of the orbit and subsequent development of enophthalmos, occasionally, a blowin type of orbital floor fracture and exophthalmos occurs. The causes of the injury and the differential diagnosis of the blowin fracture are reviewed. An explanation is offered for the development of the symptoms. Early recognition, open reduction and fixation of the malar bone, and repair of the floor of the orbit defect are important for successful management of the injury.

Adolescent↗