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Biomedical subjects

Steven D Pletcher

Publications and source records attributed to Steven D Pletcher.

13 recordsLinked to original sources
PubMed2006

Endoscopic orbital and optic nerve decompression.

Endoscopic orbital decompression has become the surgical treatment of choice for many patients with orbital manifestations of Graves' disease, including proptosis and optic neuropathy. The unparalleled visualization provided by endoscopic instrumentation allows for a safe and thorough decompression, particularly when operating along the orbital apex and skull base. Although the benefits of and indications for decompression of the orbit are well established, the role of optic nerve decompression remains controversial.

Decompression, Surgical↗
PubMed2006

Endoscopic orbital and optic nerve decompression.

The endoscopic transnasal approach is well suited for decompression of both the orbit and optic canal. High-resolution nasal endoscopes provide excellent visualization for bone removal along the orbital apex and skull base. Endoscopic orbital decompression has proved to be safe and effective for the treatment of patients with Graves' orbitopathy; however, the indications and outcomes for endoscopic decompression of the optic nerve remain controversial.

Decompression, Surgical↗
PubMed2005

Management of superior canal dehiscence syndrome with extensive skull-base deficiency.

Superior canal dehiscence syndrome is a recently described condition resulting in noise- or pressure-induced vertigo. We review the case of a 50-year-old woman who presented with debilitating pressure and noise-induced vertigo as well as a low-frequency conductive hearing loss. Imaging was consistent with superior semicircular canal dehiscence syndrome. An extradural middle fossa approach was used to approach the dehiscent superior canal. Intraoperatively, our patient was found to have extensive idiopathic skull base dehiscence of the temporal floor. Middle ear and mastoid mucosa was exposed with focal areas of dura prolapsed into the mastoid cavity. Because of these findings, temporalis fascia and bone pate were used to cover the dehiscent canal as well as a large area of the temporal floor. Additionally, a temporalis muscle flap was rotated between the dura and the dehiscent temporal floor to reconstruct the middle fossa skull base and prevent encephalocele.

Bone Diseases↗
PubMed2005

Reversal of laryngotracheal separation: a detailed case report with long-term followup.

Chronic aspiration is a difficult and potentially lethal problem. Patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.

Aged↗
PubMed2005

Current concepts in cheek reconstruction.

For cutaneous cheek defects, the reconstructive surgeon should strive to optimize tissue match and scar camouflage while minimizing the distortion to neighboring facial landmarks. The surgeon must have an intimate understanding of the local anatomy and must be able to use the appropriate flap for the given characteristics of each defect and patient. Knowledge of several types of flaps and versatility in modifying these flaps from their "textbook" geometry are required. This article highlights an approach to local flap reconstruction with a review of flap modification for particular situations.

Aged↗
PubMed2005

Complications and the time to repair of mandible fractures.

OBJECTIVE: Treatment delays in the operative management of mandible fractures are often unavoidable. We were interested in determining whether delays increased the incidence of complications in these patients. STUDY DESIGN AND SETTING: A retrospective chart review was performed on all patients who presented to the San Francisco General Hospital with an operative mandible fracture in 2002. On the basis of the number of days from initial injury to surgery, the patients were divided into two groups: those repaired in 3 days or less and those repaired after 3 days. The incidence of infectious and technical complications was then compared between these groups. Substance abuse was also evaluated for its role in complication risk. RESULTS: Of the 84 patients in the study, 11 had infectious complications, and 10 had technical complications. Although treatment delay did not increase the risk of developing an infectious complication, substance abuse considerably increased this risk. The incidence of technical complications was remarkably higher in patients repaired after 3 days. CONCLUSION: Although patients with mandible fractures treated after 3 days do not have a higher risk of developing an infectious complication, this risk is elevated in patients who abuse substances regularly. The risk of technical complications increases with treatment delay, and therefore the surgical team must be even more vigilant when reducing these fractures.

Adult↗
PubMed2003

Management of cervical metastases in advanced squamous cell carcinoma of the base of tongue.

OBJECTIVE: To clarify the role of neck dissection following primary radiotherapy for treatment of squamous cell carcinoma of the base of tongue. DESIGN: Case series. SETTING: Academic, tertiary care medical center. PATIENTS OR OTHER PARTICIPANTS: A consecutive series of 45 patients with biopsy-proven squamous cell carcinoma of the base of tongue and cervical metastases treated with primary radiotherapy at The University of California, San Francisco, was examined. Patients with a prior history of neck irradiation, neck dissection, or head and neck cancer within 5 years were excluded. MAIN OUTCOME MEASURES: Overall survival and regional control. RESULTS: Of the 45 patients treated with definitive radiotherapy, 25 (56%) achieved a complete response, 13 (29%) achieved a partial response, 4 (9%) were nonresponders, and 3 (7%) did not complete radiotherapy. Two thirds of the complete responders had N2 or N3 disease; 3 had recurrences in the neck, 1 of which was an isolated neck recurrence. Of the 13 partial responders, 5 had isolated persistence of disease, with 4 undergoing neck dissections. The only long-term survivors among the partial responders were those 4 who underwent a neck dissection. Overall survival was 50% at 3 years and 32% at 5 years. Regional control for complete responders was 84% at 5 years. CONCLUSIONS: The low rate of isolated regional recurrence in patients with a complete response to radiotherapy supports the practice of surveillance alone in such patients. Patients with less than a complete response appear to benefit from prompt surgical salvage.

Adult↗
PubMed2003

Syphilis and otolaryngology.

Syphilis is the oldest known sexually transmitted disease. Because of its multiple clinical manifestations it is known as "the great imitator." Although the antibiotic era has greatly diminished the prevalence of syphilis, sporadic outbreaks continue to occur. Because of its multiple head and neck manifestations, the otolaryngologist should be familiar with the basic pathogenesis and clinical presentations of this disease.

Head↗
PubMed2002

Ocular findings in children with congenital sensorineural hearing loss.

OBJECTIVE: To examine the yield of ophthalmologic examination in the diagnostic workup of unexplained sensorineural hearing loss (SNHL) in children. DESIGN: Retrospective analysis of ophthalmologic findings in children with unilateral or bilateral SNHL between January 1998 and May 2000. SETTING: Tertiary care university hospital. PARTICIPANTS: Children 18 years or younger presenting with unilateral or bilateral SNHL. OUTCOME MEASURES: Ophthalmologic findings. RESULTS: Of the 49 patients with SNHL for whom ophthalmologic examination results were available, 15 (31%) had ocular abnormalities. Hyperopia was the most common abnormality, present in 7 patients (46%). Myopia was found in 2 patients (13%) and astigmatism in 1 (2%). Two other patients had multiple abnormalities: one with hyperopia and astigmatism and the other with myopia and astigmatism. The remaining 4 patients had the following abnormalities: Lisch nodules, esotropia, ptosis, and allergic conjunctivitis. As a result of ophthalmologic examination, 5 interventions were performed in 4 children: 2 children received prescription lenses; 2 children underwent surgery; and 1 child was treated with eyedrops. Ophthalmologic examination in 2 children contributed to the diagnosis of a hearing loss syndrome. CONCLUSION: In children with SNHL, ophthalmologic examination is useful in evaluating visual acuity and determining or confirming the cause of hearing impairment.

Adolescent↗
PubMedDate not supplied

Use of acupuncture in the treatment of sinus and nasal symptoms: results of a practitioner survey.

BACKGROUND: The use of complementary medicine is increasingly popular in the United States. The use of acupuncture and its efficacy in treating chronic sinus and nasal symptoms is not well studied. METHODS: Regional licensed acupuncturists (1516) were mailed our acupuncture and chronic sinus and nasal symptoms survey. RESULTS: Three hundred thirty-one surveys (22%) were returned. Ninety-nine percent of those who returned surveys reported treating patients with chronic sinus and nasal symptoms. On a five-point scale the mean perceived efficacy for the overall treatment of chronic sinus and nasal symptoms was 4.2. The mean cost of an acupuncture treatment course for chronic sinus and nasal symptoms was calculated to be dollar 730.00. CONCLUSION: Complementary medicine practitioners frequently use acupuncture in the treatment of patients with chronic sinus and nasal symptoms. Although practitioners report good efficacy using acupuncture to treat such patients, quantitative data are certainly needed to substantiate these self-reports.

Acupuncture Points↗