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Biomedical subjects

R L Crumley

Publications and source records attributed to R L Crumley.

At least 55 records · Page 3Linked to original sources
PubMed1984

Schwannomas of the jugular foramen.

Schwannoma is an important entity in the differential diagnosis of the enlarged jugular foramen. Our recent experience with 4 consecutive large schwannomas over a 12-month period is presented. As these tumors are usually less vascular than glomus jugulare tumors, they are frequently more amenable to surgical extirpation. Radiologic clues to their identity include discrete borders and less angiographic vascularity when compared with glomus jugulare tumors. Our operative treatment of these cases has evolved to include preoperative embolization with Ivalon sponge particles, followed by a lateral temporal bone resection in exposing the jugular foramen. A posterior fossa craniotomy is done as a second stage when necessary. This staging allows for less morbidity and greater chance for total tumor removal. The surgical technique and relevant anatomy are reviewed and illustrated.

Adult↗
PubMed1984

Surgical treatment of pyriform sinus cancer: a retrospective study.

Patients with squamous cell carcinoma of the pyriform sinus treated surgically from 1959 through 1979 at the University of California, San Francisco were reviewed. As several reports had previously suggested that the addition of radiation therapy, preoperatively or postoperatively, did not increase survival, our data collection and analysis was performed in such a way as to determine whether similar trends were present in our patients. Data were tabulated for patients having: 1. surgery alone (SA); 2. preoperative radiation and surgery (RS); and 3. surgery and postoperative radiation (SR). The surgery alone group demonstrated the best results, with 65% 3-year determinant survival, and 56% 5-year survival, compared to 50% 3-year and 33% 5-year survivals in the combined groups. In this patient population, the increased death rate in the combined therapy group appeared to be due primarily to a higher distant metastasis rate (50% vs. 26% for the surgery alone group). Although our numbers are too small for any of the comparisons to be significant, the findings of similar cure rates of pyriform sinus cancers by surgery alone support similar data from other authors. As staging was similar in the two groups, and none of the other variables examined appeared to explain these results, we could only conclude that further data is needed, and that the exact role of radiation therapy, in combination with surgery for pyriform sinus cancer remains to be defined.

Age Factors↗
PubMed1983

Phrenic nerve graft for bilateral vocal cord paralysis.

For bilateral vocal cord paralysis, the phrenic nerve graft procedure has been used in five patients. Data from four of these patients suggest that the technique may in some way improve the glottic airway without long-term diaphragmatic paralysis. No patient to date has demonstrated visible inspiratory vocal cord abduction however. The mechanism of action, if any, is unclear at this time, and we have no electromyographic nor other physiologic data to confirm that true posterior cricoarytenoid muscle reinnervation has taken place.

Adult↗
PubMed1982

Experiments in laryngeal reinnervation.

Laryngeal reinnervation surgical procedures were performed in 26 dogs. Nineteen animals comprise the data reported in this thesis. Two different operative procedures were investigated, the ansa hypoglossi neuromuscular pedicle in 5 dogs, and the split phrenic nerve graft in 14 dogs. The studies were designed to evaluate whether either procedure resulted in inspiratory abduction of the vocal cord: and, if so, the mechanism by which abduction was produced. Five dogs in Experiment 1 demonstrated similar results from the ansa hypoglossi neuromuscular pedicle procedure. Apparent vocal cord abduction was seen during hyperpnea from airway obstruction, but was abolished by superior laryngeal nerve transection, or detachment of the sternothyroid muscle. None of the nerves in the neuromuscular pedicles was electrically excitable. Fourteen dogs in Experiment 2 underwent the split phrenic nerve graft operation. Vocal cord abduction, synchronized with inspiration, was noted in 5 animals. Two dogs had inspiratory abduction in quiet respiration. Electromyography, nerve action potentials, endoscopic motion pictures, and histologic study confirmed that posterior cricoarytenoid muscle reinnervation had occurred via the nerve graft from the phrenic nerve. Vocal cord abduction and electromyographic activity in the posterior cricoarytenoid muscle were abolished by transection of the nerve graft or the phrenic nerve. Conclusions of the study include the following: 1. The neuromuscular pedicle procedure does not result in reinnervation of the posterior cricoarytenoid muscle the pedicle's nerve and muscle block. 2. The phrenic procedure may result in reinnervation of the posterior cricoarytenoid via the nerve graft, and inspiratory abduction of the paralyzed vocal cord. Failure of the phrenic procedure to produce reinnervation appeared to be due to a. recurrent laryngeal nerve regeneration, or b. avulsion of the nerve graft due to swallowing and other laryngeal movements.

Animals↗
PubMed1982

What is otolaryngology--head and neck surgery?

Under the influence of significant developments in the area of otolaryngology over the past two decades, this specialty has evolved into a comprehensive discipline of medicine and surgery of the head and neck region. The official name change in 1980 to "Otolaryngology--Head and Neck Surgery" indicates this shift (and expansion) in emphasis. Problems that may now be considered to fall into the jurisdiction of the otolaryngologist--head and neck surgeon are discussed.

Head↗
PubMed1982

Diagnosis and treatment of idiopathic facial paralysis.

Bell's palsy is a diagnosis of exclusion; other causes of facial paralysis that might be confused with Bell's palsy should be considered in order that appropriate treatment for these conditions is not delayed. Diagnostic tests for Bell's palsy are presented. Prednisone is the recommended treatment for patients with complete facial paralysis; occasionally, selected patients may require surgical decompression.

Craniocerebral Trauma↗
PubMed1981

Auricular malignant neoplasms. When is chemotherapy (Mohs' technique) necessary?

A prospective study of 71 auricular malignant neoplasms was performed to identify lesions with a high risk of recurrence. Previously recommended margins for conventional surgical excision were marked. Then, all lesions were excised by the Mohs' technique. The Mohs' defect was compared with previously marked margins for conventional excision. Conventional excision would have been inadequate in 13% of primary and initially recurrent lesions smaller than 1 cm (clinical examination) and in 27% of primary lesions and 33% of recurrent lesions larger than 1 cm. All cases successfully excised by conventional excision would have resulted in a larger defect than the actual Mohs' defect. Morpheaform basal cell carcinoma was the most common lesion inadequately excised. Either cases of this histologic type or lesions larger than 1 cm or both require consideration for the use of the Mohs' technique.

Adult↗
PubMed1980

Interfascicular nerve repair. Is it applicable in facial injuries?

The reapproximation of individual fascicles has been advocated as a microsurgical method of improving neural regeneration following peripheral nerve injuries. To date, this technique has met with limited success, in part owing to an unclear understanding of the anatomic location of fibers in the proximal nerve relative to their distal distribution on the face. Fascicular repair is indicated in clean lacerations of the nerve trunk distal to the stylomastoid foramen. For long defects or injuries proximal to the midmastoid region (where the nerve is monofascicular), simple nerve trunk sutures should be performed until more detailed information on the fascicular anatomy of the intratemporal facial nerve becomes available. A case is reported in which a stab wound of the parotid region was complicated by hemorrhage and infection. A delayed neurorrhaphy was performed using a modified interfascicular grafting technique with sural nerve grafts.

Adult↗
PubMed1980

Spatial anatomy of facial nerve fibers--a preliminary report.

Horseradish peroxidase (HRP) was used to tag axons to the orbicularis oculi muscle in eight adult cats. Retrograde axonal transport in some animals resulted in fiber labelling such that the spatial anatomy of fibers was determined. In those few animals in which labelling occurred, a definite spatial orientation was retained in the extra-temporal nerve. Problems with the HRP technique are discussed in the paper, and the literature is reviewed with regard to spatial orientation of facial nerve axons. This technique, previously used to label neurons in the facial nucleus, appears to be of value in labelling of the peripheral fibers as well.

Animals↗
PubMed1979

The opercular syndrome--diagnostic trap in facial paralysis.

We describe a patient with a left facial paralysis and hemotympanum following left parieto-occipital skull trauma. The initial admission diagnosis of intratemporal facial nerve injury secondary to temporal bone fracture was incorrect. Normal facial movements during involuntary activity (yawning, laughing at a joke) and focal seizure activity on the paralyzed side of the face, seen subsequently, indicated the site of lesion as supranuclear. The diagnosis of opercular syndrome was made. This syndrome can result when the contralateral frontal lobe is injured. Supranuclear weakness of muscles supplied by the hypoglossal or spinal accessory nerves is also present. Unlike other central paralyses, the facial paralysis in operculum syndrome may not demonstrate "forehead sparing" and consequently it may be mistaken for a peripheral paralysis. The neuroanatomic basis for the syndrome is discussed. Signs and symptoms are outlined to help the otolaryngologist avoid this diagnostic pitfall.

Adult↗
PubMed1979

Mechanisms of synkinesis.

When the facial nerve is injured, changes occur in muscle, proximal nerve, distal nerve, and the cell body in the nucleus. All of these changes contribute to the quality of regeneration and repair. This paper describes the usual processes of neuronal regeneration with the objective of a better understanding of why some injuries inevitably result in poor return of motion and synkinesis, while others recover completely. The possible mechanisms of synkinesis include: imperfect regeneration due to axonal misdirection, demyelination, microglial scarring in the facial nucleus, neuron depopulation, multiple axon sprouting, and misdirection of regenerating axons via vertical anastomotic filaments.

Axons↗
PubMed1977

Fractures of the orbital floor.

The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures. On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty-seven percent of the patients had demonstrable ocular injury at the time of initial examination. Treatment was surgical in 336 of the fractures and non-surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only. Postoperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months, were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non-surgically, none had persistent diplopia.

Diplopia↗