PubMed Health⌕ Search

Biomedical subjects

R L Hilsinger

Publications and source records attributed to R L Hilsinger.

At least 19 recordsLinked to original sources
PubMed1997

A comparison of masticatory function in patients with or without reconstruction of the mandible.

BACKGROUND: The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft-tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established. METHODS: We evaluated objective measures of oral function and patient reports of function in 10 reconstructed mandibulectomy patients, 10 without reconstruction, and 10 controls. Measures of oral function included bite force assessed at the first molar and incisal edge, a measure of tongue and cheek function, and patient reports of food they could eat. RESULTS: Both reconstructed and nonreconstructed patients presented decreased biting force, a more restricted diet, and compromised cheek and tongue function as compared with normals. However, reconstructed patients had significantly better measures of tongue function and ability to eat a varied diet than did nonreconstructed patients. Of the objective measures used to measure masticatory performance, bite force was poorly correlated, whereas measures of tongue function strongly correlated with successful mastication. CONCLUSION: Both reconstructed and nonreconstructed patients presented with a significant functional deficit when compared with normals, with reconstructed patients having better overall function than nonreconstructed patients.

Aged↗
PubMed1997

Efficacy and cost-effectiveness of multihole fine-needle aspiration of head and neck masses.

To determine whether the specimen from fine-needle aspiration (FNA) biopsy of head and neck masses has greater diagnostic accuracy when using multihole needles than when using conventional, single-hole needles, we did a prospective, randomized, single-blinded study comparing diagnoses obtained using both types of needles in FNA biopsies of head and neck masses. Eighty-eight patients served as their own controls and had 91 FNA biopsies with both multihole and single-hole, 22-gauge needles. Order of biopsy was randomized and was unknown to the cytopathologist. No statistically significant differences were noted in quantity of specimen material obtained, quality of fixation, or diagnostic value between the multihole and conventional needle. We found no advantage in using the more costly multihole needle in FNA biopsy of head and neck masses.

Biopsy, Needle↗
PubMed1995

Relation between age and head and neck cancer recurrence after surgery: a multivariate analysis.

Recent reports have described an increase in squamous cell carcinoma of the upper aerodigestive tract in young adults. As the preponderance of epidemiologic data exists for the population between 50 and 70 years of age, controversy has developed regarding the clinical course of head and neck cancer in youth. Some authors advocate more aggressive management, calling attention to the lack of "classic" predisposing factors and suggesting genetic disorders or immunodeficiency. Basic science researchers have reported greater DNA fragility, sensitivity to carcinogens, and altered immune responses in young patients with carcinoma. To further elucidate the clinical aspects of this controversy, we performed a retrospective review using multivariate analysis to determine factors that affect recurrence. After screening 820 charts, 155 patients were found who met strict entrance criteria to the study. The patients were separated into five age groups, and 16 clinical variables were collected on each patient. Cox proportional hazards modeling revealed no significantly higher likelihood of recurrence in the 15- to 39-year-old age group. The model did find that metastatic adenopathy was predictive of recurrence (p = 0.034). The overall model further suggested a trend toward higher relative risk of recurrence in the middle-aged groups (p = 0.0541). In our review of the English biomedical literature, this is the first study to directly compare the outcome of young head and neck cancer patients with that of old patients using multivariate analysis. Future research is indicated in developing precise outcome predictions according to TNM staging, aneuploidy status, and DNA fragility in young patients. Efforts at limiting carcinogen exposure should continue.

Age Factors↗
PubMed1994

Problems with tracheoesophageal fistula voice restoration in totally laryngectomized patients. A review of 95 cases.

OBJECTIVES: Tracheoesophageal fistula (TEF) construction, performed during or after total laryngectomy, is used for voice and speech restoration but has been associated with mild to severe complications. Our goal was to study the successes and complications in the application of this technique to restore voice function after laryngectomy in 95 consecutive patients. RESEARCH DESIGN: Retrospective cohort study with a mean follow-up time of 3.5 years. SETTING: Five medical facilities in northern California: the Veterans Affairs Medical Centers in San Francisco and Martinez, the Kaiser Permanente Medical Center in Oakland, and private practice offices in San Francisco and Pinole. PATIENTS: Ninety-five patients (90 men and five women) who had undergone total laryngectomy with subsequent or primary TEF construction. Patients' ages ranged from 35 to 80 years. INTERVENTIONS: Three- or two-layer closure was used, depending on whether TEF construction was done as a secondary or a primary procedure. Most patients underwent radiation therapy, and most used surface or intraoral electrolarynx devices before TEF construction. Insufflation tests were performed by clinicians, or self-insufflation tests were performed by the patient. Patients' voices were recorded and analyzed. In many cases, respiratory and pulmonary function studies were performed before and after total laryngectomy or TEF. Blom-Singer and Groningen voice prostheses were used. MAIN OUTCOME MEASURES: Voice restoration was considered successful when the patient was able to communicate effectively via the TEF. RESULTS: Approximately 92% of patients who underwent TEF construction and had voice prostheses placed were considered to be successfully rehabilitated. Complications ranged from mild to severe and included problems with predictive values obtained during insufflation, fistula retention, TEF angulation shifts, fungal colonization of the prosthesis, valve retention problems, difficulty with digital occlusion, pressure necrosis, postradiation necrosis, dysphagia, phonatory gagging, emesis, gastric distention, pouching, stenosis, infection, hypertrophy, shunt insufficiency, persistent spasm, myotomy, inadvertent fistula closure, and aspiration of the prosthesis. CONCLUSIONS: Acoustic measures indicate that speech produced with the TEF compares better with normal laryngeal speech than does esophageal or electronic speech. Thus, TEF should remain the preferred procedure to rehabilitate patients undergoing total laryngectomy.

Adult↗
PubMed1993

Septal pleomorphic adenoma masquerading as squamous cell carcinoma.

A 43-year-old woman had left midfacial pain and a left intranasal mass. Pathologists from three different institutions agreed that the biopsy specimens from the mass represented squamous cell carcinoma. The final pathologic diagnosis made from the resected specimen was pleomorphic adenoma of the septum. This report describes a case which was initially misdiagnosed on the basis of misleading tissue biopsy results, but the excised tumor was finally diagnosed as pleomorphic adenoma. Otolaryngologists treating an intranasal mass must be aware of the difficulty of correctly diagnosing the initial tissue biopsy specimen in order to guard against unnecessary radical surgery.

Adenoma, Pleomorphic↗
PubMed1992

Fine-needle aspiration in the diagnosis of salivary gland disorders in the community hospital setting.

From 1983 to 1988, 47 patients with salivary gland disorders were assessed with fine-needle aspiration (FNA) before surgery. The preoperative fine-needle diagnoses were then compared with the postoperative pathologic findings. In the same period, 63 patients from two other community hospitals who had been evaluated preoperatively with FNA were studied retrospectively. The overall sensitivity of FNA for salivary neoplasms was 80.6%. Fine-needle aspiration was more sensitive in identifying benign tumors (88.4%) than malignant neoplasms (58.3%) and was least sensitive in identifying nonneoplastic salivary diseases (35.3%). Pleomorphic adenomas were correctly identified preoperatively in 96.2% of cases, whereas for malignant neoplasms, the diagnostic accuracy was highest for mucoepidermoid carcinoma (50%). To demonstrate the strengths of FNA as a diagnostic tool, as well as to delineate its limitations, we present our 5-year experience. Our FNA results are similar to those reported by the major European and American referral centers. Because our medical centers are community based, our results may more accurately reflect those seen by otolaryngologists in private practice. To date, no evidence of tumor seeding along the FNA tract has been reported.

Biopsy, Needle↗
PubMed1992

Transfusion, recurrence, and infection in head and neck cancer surgery.

The detrimental effects of transfusion have been documented--particularly by surgical oncologists, who believe transfusion-induced immunosuppression increases the incidence of recurrence and infectious complications. We examined this relation in surgical oncology of the head and neck. After meeting strict inclusion criteria, 104 patients were entered into the study, in which 31 variables of a clinical, surgical, pathologic, laboratory, and treatment nature were studied. Multivariate analysis showed transfusion did not significantly affect recurrence or infectious complications. However, by univariate analysis, infectious complications were related to transfusion (p = 0.029). The variables age (p = 0.024), postoperative hemoglobin level (p = 0.049), and spread to regional lymph node (p = 0.0015) were found to significantly affect the incidence of recurrence. In the three previous otolaryngologic studies, transfusions had been shown to affect recurrence; however, two studies used univariate analysis only. Since this is one of the first otolaryngologic studies to examine the relation of transfusion with infectious complications, prospective studies using multivariate analysis are warranted. Meanwhile, the decision to transfuse should continue to depend on the clinical status of the patient.

Aged↗
PubMed1991

Infiltration of epinephrine in tonsillectomy: a randomized, prospective, double-blind study.

A variety of hemostatic agents and techniques have been used in an attempt to reduce intraoperative blood loss and postoperative bleeding in tonsillectomy. The efficacy of most of these substances and techniques has been judged primarily on clinical impressions. Because of the paucity of prospective studies, a randomized, prospective, double-blind study, using the patients as their own controls, was conducted. Ninety-two patients were injected before tonsillectomy in a random, double-blind fashion with normal saline solution in one tonsil and 1:100,000 epinephrine in the other. The blood loss, time of dissection, and postoperative bleeding were recorded separately for each tonsil. Cardiac manifestations were also monitored. The tonsils injected with epinephrine had a statistically significant reduction in blood loss and dissection time when compared with those injected with normal saline. Subjectively, dissection was easier on the epinephrine-injected side. There was no difference in the incidence of postoperative hemorrhage. Cardiac manifestations of epinephrine were minimal and transient. This study demonstrates that epinephrine is useful in reducing hemorrhage during tonsillectomy and can be used safely with the appropriate inhalation anesthetics.

Adolescent↗
PubMed1989

Retronasopharyngeal lipoma: a case report.

We present an unusual and challenging case of impending upper airway obstruction in a pediatric patient that resulted from a benign disease process. Although rare, a lipoma should be considered in the differential diagnosis of nasopharyngeal obstruction. When a nasopharyngeal lipoma is discovered, radiologic and histopathologic studies should be performed to rule out an aggressive lipoma, such as an infiltrating (intramuscular) lipoma or angiolipoma. The use of CT scanning or magnetic resonance imaging is invaluable in diagnosis, evaluation of extent of disease, adn management of this condition. Close followup is imperative.

Airway Obstruction↗
PubMed1989

Relation of lymph-node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: a case series and literature review.

A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph-node metastasis. These parameters have been inconsistent and not readily reproducible. In an attempt to confirm these parameters, a retrospective analysis of 22 patients with T1 to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow-up. Chi-square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph-node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory infiltrate.

Adult↗
PubMed1988

Recurrent Bell's palsy: analysis of 140 patients.

Of 1,700 patients with facial paralysis seen in a retrospective study from 1969 through 1977 and 280 patients seen prospectively from 1983 through 1986, 7.1% had recurrence of Bell's palsy. In this group, the frequency of ipsilateral recurrence was equal to that for contralateral recurrence. The mean age at onset of Bell's palsy was 33.0 years; Bell's palsy recurred a mean of 9.8 years later. Recurrent facial paralysis did not indicate a worse prognosis for recovery regardless of which side was affected. There was no statistical difference between results for male patients or female patients, nor was there a statistically significant sex predominance, except in the age group 10 to 19 years. In our results, computed tomography (CT) scan in patients with recurrent Bell's palsy detected no facial-nerve neuroma. Of 77 patients followed a mean of 33 years after the first episode (range, 2.8 to 60 years), none showed progressive facial-nerve dysfunction or any signs of tumor. We conclude that an ipsilateral recurrence of facial paralysis without documented evidence of a tumor does not warrant a transmastoid decompression of the facial nerve. The results of our analysis were verified prospectively as well as retrospectively. A new classification system is introduced for ease of computer analysis and for simplified discussion of recurrent facial paralysis.

Adolescent↗
PubMed1986

Ramsay Hunt facial paralysis: clinical analyses of 185 patients.

In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kaiser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella-zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs, and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bell's (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bell's (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed.

Facial Paralysis↗
PubMed1985

Bilateral chylothorax from radical neck dissection.

Bilateral chylothorax is a rare complication occurring after head and neck surgery, with only six cases reported. The diagnosis is not difficult if a high index of suspicion is held. Early recognition and treatment prevent the devastating metabolic effects of excessive chyle loss and reduce the respiratory restriction that can progress to fatal anoxia. Dietary management with medium-chain triglycerides is essential to successful outcome. Repeated invasive therapy should be minimized.

Adult↗
PubMed1985

Facial paralysis and Bell's palsy: a protocol for differential diagnosis.

In the past, most cases of facial paralysis have been erroneously labeled Bell's palsy. Bell's palsy has been synonymous with and defined as idiopathic facial paralysis affecting only the facial nerve within the confines of the temporal bone. In the last ten years, Bell's palsy has been redefined as viral polyneuritis, probably caused by herpes simplex reactivation, and its diagnosis is no longer reached by exclusion. This article discusses the signs, symptoms, and testing necessary to confidently and accurately differentiate Bell's palsy from other forms of facial paralysis. The nonspecificity of topographic diagnosis is discussed and statistical analysis of factors affecting prognosis are included.

Cranial Nerve Diseases↗