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Biomedical subjects

V Grybauskas

Publications and source records attributed to V Grybauskas.

13 recordsLinked to original sources
PubMed1989

[Epiglottitis in the adult. A proposition for a clinical classification and therapeutic strategy].

Because lack of criteria for staging and treatment of epiglottitis can lead to unnecessary morbidity and mortality, we have introduced a staging system for early classification and appropriate management of adult epiglottitis patients. We retrospectively staged 20 adults with epiglottitis to see in their final outcome would have been altered using our protocol. We found that staging and management according to our protocol were appropriate and possibly could have reduced mortality from 10% to nearly 0%.

Adult↗
PubMed1987

The bilobed deltopectoral advancement flap.

The bilobed deltopectoral advancement flap is a versatile reconstructive option for selected cervical defects. This modified version of Bakamjian's classic deltopectoral flap utilizes thin anterolateral neck skin to cover complex anterior neck defects. It offers the safety of a minimally rotated pedicle to reduce the chance of flap necrosis from kinking, and the convenience of a single-stage procedure. We have used this flap six times in our clinical experience. Typically, the defects were located in the anterior cervical region, and many of them were reconstructed following total laryngectomy and radical neck dissection. There was no incidence of flap necrosis in the patients, including those who had had preoperative irradiation.

Humans↗
PubMed1987

Benign neoplasms of the oral cavity.

A wide variety of benign tumors present in the oral cavity. These tumors are for the most part rare and are classified by the tissue of origin. Although benign oral cavity tumors are not life-threatening, they can result in extensive loss of soft tissue and/or bone. Furthermore, many patients are subject to the threat of recurrence, multiple surgical procedures, and the possibility of malignant degeneration. Because many tumors vary little clinically, an adequate biopsy specimen must be obtained for diagnosis. Radiographs are, in general, nondiagnostic. Collaboration with an experienced pathologist is necessary to determine the tumor's probable clinical behavior. Therapy, which is dictated by tumor type, is almost always surgical.

Adolescent↗
PubMed1986

Parietal occipital nape of neck flap. A myocutaneous flap for selected head and neck reconstruction.

Reconstruction in head and neck surgery has been greatly advanced with the use of the pectoralis major and trapezius myocutaneous flaps. Most surgical defects can be repaired with one of these flaps alone, or in conjunction with cutaneous flaps. Specific problems, however, occur that cannot be successfully reconstructed by these standard flaps. The traditional scalp flaps are cutaneous flaps. Use of these flaps is limited because of their shortened arc of rotation and accompanying forehead deformity. Three patients underwent reconstruction with a parietal occipital nape of neck myocutaneous flap. Its advantages include the following: large segments of hairless skin from the contralateral side of the neck can be used, an extensive arc of rotation and distance can be achieved with excellent vascularity in the overlying skin, and cosmetic results are superior. Angiographic studies were used to demonstrate the vascular pattern and supply to this flap. Cadaver dissections were performed to determine the pattern of distribution of the perforating vessels to the skin from underlying muscle.

Carcinoma, Squamous Cell↗
PubMed1986

Nonrecurrent laryngeal nerves and their clinical significance.

The anomalous position of a nonrecurrent laryngeal nerve predisposes the nerve to injury during thyroidectomy and to compression by a thyroid mass. We present three cases in which a seemingly benign thyroid mass traumatized a nonrecurrent laryngeal nerve resulting in either vocal cord paralysis or a vague pressure sensation over the larynx. Some of these patients feel as if they need to clear a foreign body and present with a chronic cough. Normally the nerve is protected from thyroid masses as it passes through the tracheoesophageal groove. In all three patients, surgical excision of the thyroid mass and release of the nerve resulted in recovery of the nerve and resolution of the symptoms. We have found that small, benign, or otherwise asymptomatic lesions of the thyroid gland have a greater tendency to cause vocal cord paralysis in patients with nonrecurrent laryngeal nerves. The surgeon must always be aware of the possibility of the presence of a nonrecurrent laryngeal nerve.

Adenoma↗
PubMed1986

Juvenile nasopharyngeal angiofibroma.

JNA is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. Diagnosis is based on history, physical examination, and radiographic findings. CT scanning is invaluable for evaluating tumor extent. Angiography combined with embolization aids surgeons in identifying the main feeding vessels and decreasing intraoperative blood loss. Surgery is the mainstay of therapy with radiation therapy reserved for inoperable masses. For highly aggressive, recurrent angiofibroma, chemotherapy has shown some promise.

Adolescent↗
PubMed1986

Malignant tumors of the major salivary glands.

A total of 512 patients with major salivary gland tumors were treated at our institution between the years 1960 to 1975. The 147 cases of malignant salivary gland tumors were reviewed according to presenting characteristics and stage, histology, and outcome. Treatment for each type is summarized. The battery of diagnostic aids and prognostic indicators available to the physician are also reviewed. The newer and more controversial procedures of CT scanning, nuclear magnetic resonance scanning, and fine-needle aspiration are discussed in detail. In the past, salivary gland tumors have been classified by histology alone. Current trends employ the TNM staging system in planning treatment and predicting end results. We have found a far better survival rate in patients with various tumor types presenting with stage I or II disease, but point out that patients with high-grade tumors often present with advanced disease. All major salivary gland tumors should be approached according to the principles of cancer surgery. The minimum procedure is thus superficial or total parotidectomy with preservation of the facial nerve. In low-grade malignancies, the diagnostic procedure will have accomplished this definitive treatment. Salivary gland tumors are rare in the pediatric population. Such malignancies often defy radical treatment. Although cure rates in many categories of high-grade tumors are low, the only hope for survival is an initial aggressive surgical approach. Although radiation was used for recurrent disease only during the years of this study, it is currently being used as adjuvant therapy in almost all malignancies except low-grade mucoepidermoid. Recurrences are almost always fatal.

Adult↗
PubMed1986

Surgical treatment of hyperparathyroidism.

During the past decade, major advances have been made in many crucial areas of the surgical management of hyperparathyroidism. An up-to-date protocol is presented and stresses preoperative localization, operative technique, intraoperative diagnosis, cryopreservation, and autotransplantation designed for practical application.

Adenoma↗
PubMed1984

Metastatic neck disease. Evaluation by computed tomography.

Computed tomographic (CT) scanning has been used in the preoperative examination of patients with head and neck cancer. Although early reports on the use of CT scanning for cervical lymphadenopathy were encouraging, the accuracy of CT in detecting nodal metastases has not been well established. Fifty consecutive patients underwent radical neck dissection and preoperative CT scanning. The clinical staging of the neck, CT diagnoses, and pathologic findings were correlated; CT accuracy was then compared with clinical accuracy. Our findings show the overall accuracy of CT diagnoses to be 90%. Comparison with clinical accuracy shows the CT scan to be superior to the clinical examination, particularly in detecting occult metastases.

Diagnostic Errors↗
PubMedDate not supplied

Reconstruction of the subglottic larynx with a myoperiosteal flap: clinical and experimental study.

The literature describes numerous techniques for reconstruction of the subglottic larynx. The use of rigid bone grafts or flaps has been associated with problems because the rigid bone cannot conform to the defect and form an airtight seal. We have performed subglottic reconstruction using the sternocleidomastoid myoperiosteal flap with very optimistic results on long-term follow up. The sternocleidomastoid myoperiosteal flap is a relatively simple procedure that can be used for a large variety of defects. The pliable periosteal flap used for closing the defect can be molded over a stent to form an airtight seal. We have demonstrated bone formation in the periosteum which is crucial to the stability of the airway and long-term success of the procedure. The sternocleidomastoid myoperiosteal flap yields a pliable, durable tissue capable of airtight closure and a tension-free suture line. This technique will make the closure of subglottic defects a much more practical task.

Aged↗
PubMedDate not supplied

Sternomastoid myoperiosteal flap for reconstruction of the subglottic larynx.

Reconstruction of the subglottis is usually required after resection of cricoid cartilage or tracheal tissue in cases of trauma, subglottic stenosis, or invasive thyroid carcinoma. There are multiple techniques available for reconstruction of the subglottic larynx, but most of them have a high rate of complications or graft failure. We have found the sternocleidomastoid myoperiosteal flap to be an ideal means of reconstruction. In an experimental study, we performed subglottic reconstruction using the sternomastoid myoperiosteal flap on 15 mongrel dogs to determine the presence of bone formation versus calcified fibrous scar. Radiologic studies suggested apparent metaplastic bone formation at the graft site, and histologic studies confirmed this. Functionally, 12 dogs had stable airways without stridor or subglottic narrowing. Three dogs died of complications. With successful reconstruction of large defects in the canine subglottis, attempts to repair large subglottic and tracheal defects in the human are feasible.

Animals↗
PubMedDate not supplied

Treatment of spastic dysphonia without nerve section.

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.

Adult↗