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Biomedical subjects

R L Crumley

Publications and source records attributed to R L Crumley.

66 records · Page 4Linked to original sources
PubMed1977

Airway management in croup and epiglottitis.

Treatment techniques for airway obstruction in croup and epiglottitis are reviewed in the medical literature. Series totaling 295 nasotracheal intubations, and 591 tracheostomies were reviewed. There were two deaths attributable to airway complications in 126 patients in whom nasotracheal intubation was carried out. In three patients subglottic granulation tissue and subglottic stenoses developed from short-term nasotracheal intubation. There were no subglottic stenoses or tracheal stenoses reported in the 591 tracheostomies. From this review, it would seem feasible to use nasotracheal intubation for short-term airway treatment in croup and epiglottitis. The increasing occurrence of laryngeal and tracheal complications with long-term intubation suggests that tracheostomy be considered in such cases.

Airway Obstruction↗
PubMed1976

Postoperative chylous fistula prevention and management.

Postoperative chylous fistulas occur as a complication in 1-2% of all radical neck dissections. Twelve cases are reviewed herein. Chylous fistulas are more common with left neck dissections, but 25% occurred on the right side in this series. An intraoperative chylous fistula was recognized and treated in 75% of the cases which later developed a postoperative fistula. Postoperative fistulas may be divided into two groups: minor fistulas may be treated with pressure dressings and repeated aspirations; fistulas which do not respond to conservative management should be re-explored early and the fistula ligated.

Aged↗
PubMed1976

Sinusitis.

The treatment of acute bacterial sinusitis is medical, the regimen including oral and nasal decongestants and antibiotics. Progression to chronic sinusitis can sometimes be prevented by periodic sinus washings until the acute process subsides. Sinus x-ray examinations are important in follow-up when symptoms or signs persist.

Acute Disease↗
PubMedDate not supplied

Burn of the auricle.

Silvadene cream and Sulfamylon make up the treatment regimen for one contributor (Dr. Crumley). No systemic antibiotics would be given. Any areas of obvious third-degree burns would be debrided and grafted. The tympanic membrane perforation would be treated with antibiotic/steroid drops. The second author concurs with use of Silvadene cream and would avoid any pressure on the area (Dr. Abemayor). While he agrees that systemic antibiotics should be avoided, he also would not prescribe ear drops. He recommends evaluation for a pulmonary or ophthalmologic injury. There is a disagreement regarding imaging studies. One expert would order a CT scan to rule out facial fractures (Dr. Crumley). His counterpart would not order a CT but would check a baseline chest x-ray if there were any sign of pulmonary compromise (Dr. Abemayor). Both experts would obtain an audiogram after the acute problems are treated. In the case of foul drainage, burn reconstruction would be delayed. In addition to treating the otorrhea with ear drops, one physician would add oral antibiotics (Dr. Abemayor). The other author believes tympanoplasty should be performed prior to reconstruction (Dr. Crumley). There were several procedures suggested for the reconstruction. Both authors discuss a method of creating a postauricular pocket, burying the ear pedicle, and using costal cartilage for an inlay helical graft. Another approach involves minimal debridement of the cartilage and letting the wound mature for 6 to 8 months. At that time the area would be debrided and the postauricular skin used for external coverage (Dr. Crumley). If the facial scar is a cosmetic problem 1 year after the injury, triamcinolone injections and local massage should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Selective reinnervation of vocal cord adductors in unilateral vocal cord paralysis.

Laryngeal reinnervation procedures were performed in a series of dogs. An attempt was made to reinnervate the vocal cord adductors with one nerve graft, while a different nerve was grafted to the abductors. The recurrent laryngeal nerve was dissected distally to its terminal branches, where the abductor-adductor sorting out occurs. The abductor branch was reinnervated with a phrenic nerve graft as previously described. The adductor division was grafted with one of the following nerves: proximal recurrent laryngeal, external branch of superior laryngeal, or ansa hypoglossi. Results revealed that in most cases it was indeed possible to reinnervate the adductive and abductive vocal cord muscles separately. Recurrent laryngeal nerve anastomosis to the distal adductor division produced strong reinnervation, but appeared to inhibit in some way the phrenic reinnervation of the abductor branch. Ansa hypoglossi anastomosis to the adductor division seemed to induce satisfactory reinnervation of the adductor musculature with the least noticeable donor deficit.

Animals↗
PubMedDate not supplied

Laryngeal reinnervation using the split-phrenic nerve-graft procedure.

A new operative procedure for reinnervation of the paralyzed larynx is described. Initial successes in a series of animals have shown that use of the split-phrenic nerve-graft procedure results in functional abduction of the paralyzed vocal cord, while preserving innervation to the diaphragm. Electromyography, microlaryngoscopic movies, chest fluoroscopic examination, and nerve compound action potential recordings were all used to document these findings. This procedure appears to have several advantages over the neuromuscular pedicle operation described by Tucker.

Action Potentials↗
PubMedDate not supplied

Current status of muscle biopsy in facial paralysis.

The six abnormalities found in pathologic muscle biopsies are described and discussed. Those changes which are indicative of nerve denervation or muscle regeneration are tabulated. Muscle biopsy, as it related to facial paralysis, must still be considered, for the most part, an experimental tool. In certain puzzling situations, eg, neonatal facial paralysis, it can be of value as an adjunct to nerve excitability and electromyographic tests.

Atrophy↗
PubMedDate not supplied

Facial paralysis in the newborn.

A group of 95 patients with facial paralysis in the neonatal period are presented. In 74 patients it was believed to be secondary to trauma associated with pregnancy and delivery, and in 21 to be secondary to congenital lesions. The cause, extent, and clinical course of the paralyses are discussed. A classification is outlined to help in organizing a logical and systematic evaluation plan for these patients. Patients may be divided into four groups based on the time they are seen after birth, whether the nerve is stimulable, or whether the nerve loses its stimulability. On the basis of this classification, electromyogram studies, and roentgenographic findings, a presumptive diagnosis may be made and a treatment plan formulated. The treatment plan is based on the diagnosis, facial nerve excitability testing, and degree of deformity present. If there is evidence of facial nerve disruption, a facial nerve exploration is indicated. In congenital cases, reanimation procedures may be necessary.

Delivery, Obstetric↗
PubMedDate not supplied

Regeneration of the recurrent laryngeal nerve.

Ten dogs underwent exploration and section of the right recurrent laryngeal nerve. A segment was removed and both stumps were ligated. Reoperation at three months and again at 15 months revealed neural regeneration through the ligated site and reconstitution of the distal nerve in seven of the eight dogs surviving the 15-month period. This strong regenerative capability of the recurrent laryngeal nerve may explain recurrences of spastic dysphonia after nerve section. It is recommended that patients be advised of the possibility for return of the spasms. Investigators should always note whether the recurrent laryngeal nerve has regained stimulability in reporting results of experimental laryngeal paralysis and reinnervation.

Animals↗