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Biomedical subjects

W R Carroll

Publications and source records attributed to W R Carroll.

At least 37 records · Page 2Linked to original sources
PubMed1994

The platysma myocutaneous flap. Indications and caveats.

The platysma myocutaneous flap has enjoyed limited popularity despite its versatility, dependability, and ease of harvesting. In this article, we describe 12 consecutive patients who underwent platysma flap reconstruction of various oral cavity and oropharyngeal defects. Complications included loss of one skin paddle, one pharyngocutaneous fistula, and one intraoral wound dehiscence. In all patients, bare bone was covered or appropriate spacing between the tongue and other structures was maintained to avoid ankyloglossia. We discuss specific indications and caveats.

Adult↗
PubMed1994

Hemilaryngectomy for glottic carcinoma after radiation therapy failure.

OBJECTIVE: To determine the efficacy and safety of vertical hemilaryngectomy (VHL) for the treatment of early glottic carcinoma recurrent after radiation therapy (RT). DESIGN: Retrospective study. SETTING: Major referral center. PATIENTS: Forty patients were identified who underwent VHL for T1 or T2 glottic carcinoma between July 1975 and March 1991, and all were included in this study. Twenty-two patients had received full-course RT before VHL, and 18 patients underwent primary VHL. MAIN OUTCOME MEASURES: The local control rates were determined for T1 and T2 tumors in each group, along with actuarial survival rates and complications. RESULTS: Local control of tumor for VHL after RT failure was 85% for T1 tumors, 78% for T2 tumors, and 82% overall. Three of four of the local failures in this group occurred in patients who had contraindications to VHL. Total laryngectomy for treatment of local failures in this group increased the local control rate to 93% for T1 tumors, 89% for T2 tumors, and 91% overall. Local control rates for the primary VHL group were 90% for T1 tumors, 75% for T2 tumors, and 83% overall. Total laryngectomy for treatment of local recurrences increased local control to 87% for T2 tumors and 89% overall. Five-year actuarial survival was 85% for each group. Delayed tracheal decannulation occurred more frequently in the patients who had undergone RT. CONCLUSIONS: Our results support the oncologic safety and effectiveness of VHL for the surgical treatment of recurrent early glottic carcinomas after RT, with minimal increased morbidity.

Adult↗
PubMed1994

Nerve grafting and neuromuscular transfers.

In today's otolaryngology practice, surgeons frequently encounter situations in which soft-tissue augmentation is needed. Traditionally, fat, fascia, and nonvascularized muscle have been used for these purposes. This article reviews the history as well as the current applications and limitations of these materials. Although not ideal in all circumstances, these materials remain useful in selected situations.

Humans↗
PubMed1993

Ionized serum calcium levels following combined treatment for cancer of the head and neck.

Thyroid function may be reduced after treatment of cancer of the head and neck, and hypothyroidism is much more common after combination therapy. Whether hypoparathyroidism and subsequent hypocalcemia also occur after such treatment is unknown. Few related studies have been published in which changes in total serum calcium have been studied after cancer treatment with radioactive iodine or external radiation. Twenty-two disease-free head and neck cancer patients were studied, 1 to 3 years after multimodal treatment, to determine if changes in serum ionized calcium levels or thyroid function were present. Our results suggest that parathyroid function, as represented by ionized calcium levels remains normal after multimodality (surgery, radiation and/or chemotherapy) combined treatment.

Adult↗
PubMed1993

Tissue-integrated prostheses in the rehabilitation of auricular defects: results with percutaneous mastoid implants.

Functional and cosmetic rehabilitation of the severely atretic auricle poses a formidable challenge. Conventional autologous grafts for auricular reconstruction may produce inconsistent results, and revision of failed grafts is often unsatisfactory. Osseointegrated implant systems to retain auricular prostheses provide an alternative approach in rehabilitating patients with severe auricular defects. Fourteen patients were implanted with 30 osseointegrating implants for rehabilitating major auricular defects and were followed for 1 to 3.5 years, yielding 143 implant observations. Symptomatic skin reactions to the percutaneous implant were noted in 3.5 percent of the observations. Implant extrusion did not occur. This evaluation of tissue-integrated prosthetic systems suggests this approach to be an extremely reliable alternative for selected patients with major auricular defects. The technique of implanting the retention unit is readily adapted to atresia repair.

Ear Diseases↗
PubMed1993

Branchiogenic carcinoma.

The validity of the diagnosis 'branchiogenic carcinoma' has been debated for many years. Recently, Micheau, et al recorded 21 cases of metastatic squamous carcinoma that presented with cystic masses in the neck and concluded that most, if not all of the reported cases of branchiogenic carcinoma, were in fact of similar origin. This report contains histological evidence of the origin of squamous cell carcinoma from a branchiogenic cyst in an otherwise healthy young man. Five similarly convincing reports from the literature are also reviewed.

Adult↗
PubMed1992

Monitoring of revascularized jejunal autografts.

Free jejunal autografts have been widely used to reconstruct circumferential pharyngeal defects in a single stage. Close postoperative monitoring of the perfusion of the free jejunal autograft is extremely important in achieving a successful outcome. Presented herein is our method of postoperative monitoring of jejunal autografts in which a segment of jejunum pedicled on its connecting mesentery is exteriorized. This method of monitoring was performed in 17 cases, and there were no cases of late graft failure. Of three patients who had undergone this operation before the use of this monitoring technique, one had an unrecognized late graft failure. We present our experience with this simple and reliable method to monitor free jejunal autografts.

Humans↗
PubMed1992

Lateral arm free flap in head and neck reconstruction.

The lateral arm fasciocutaneous free flap is a versatile donor site of sensate soft tissue for reconstruction and augmentation of the head and neck. The lateral arm flap can be quickly harvested without interference to the head and neck team and with minimal morbidity to the patient. For these reasons, this flap has become our soft-tissue flap of choice.

Arm↗
PubMed1992

Extracapsular spread and the perineural extension of squamous cell cancer in the cervical plexus.

Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.

Aged↗
PubMed1991

Primary adenocarcinoma of the temporal bone. A case with 40-year follow-up.

Adenomatous tumors of the temporal bone are rare neoplasms. This article records the 40-year course of a patient with adenocarcinoma of the temporal bone and reviews the literature pertinent to the biologic behavior, histologic appearance, prognosis, and treatment of this group of tumors.

Adenocarcinoma↗
PubMed1991

Palatal inclusion cyst: an unusual complication of uvulopalatopharyngoplasty.

Inclusion cyst formation after uvulopalatopharyngoplasty has not been previously reported. We describe a case of postoperative inclusion cyst in a 62-year-old man who presented with recurrent obstructive sleep apnea symptoms. Simple transoral excision of the cyst was curative. Careful eversion of the mucosal edges at the time of the original palatal surgery may have prevented this problem from occurring.

Cysts↗
PubMed1990

The cutaneous scapular free flap in head and neck reconstruction.

Successful surgical reconstruction of complicated soft-tissue defects of the head and neck region has been greatly enhanced by free-revascularized tissue transfers. The scapular free flap has become a favored reconstructive option in our department and has been reported previously for one-stage mandibular reconstruction. This flap can also be transferred as a cutaneous free flap. We present our clinical experience with the fasciocutaneous scapular free flap and review the anatomy, surgical technique, and utility of this versatile flap.

Adult↗
PubMed1990

Representational guidance of action production in observational learning: a causal analysis.

This experiment tested the hypothesis that the number of model presentations and verbal coding of modeled actions affect reproduction accuracy through their effect on cognitive representation. Subjects viewed a complex action pattern either two or eight times with or without verbal coding to highlight the dynamic structure of the component actions and their temporal sequencing. They then received, in order, a recognition test and a pictorial-arrangement test to assess the accuracy of their cognitive representations of the modeled actions. Subsequently, all subjects were tested for their ability to reproduce the action pattern from memory. Results showed that increased exposure to modeled actions enhanced the accuracy of both the cognitive representation and the behavioral reproduction. Verbal coding also increased cognitive and reproduction accuracy, but only when combined with multiple opportunities to observe the modeled actions. A causal analysis confirmed that the effects of multiple exposures and verbal coding were entirely mediated by changes produced in the accuracy of cognitive representation.

Journal Article↗
PubMed1987

Translating cognition into action: the role of visual guidance in observational learning.

This experiment examined the role of two forms of visual guidance in facilitating the translation of cognitive representations into action. Subjects matched a modeled action pattern either concurrently with the model or after the modeled display. They then either did or did not visually monitor their actions during tests of production accuracy in the model's absence. Acquisition of the cognitive representation was assessed periodically. Concurrent matching of modeled actions or visual monitoring of productions both increased the level of observational learning. The more accurate the cognitive representation, the more skilled were subsequent reproductions of the modeled actions. After acquiring proficiency in converting cognition to action, subjects maintained their level of performance accuracy even though modeled and visual-monitoring guidance were withdrawn. These results are in accordance with the theory that cognitive representation mediates response production and that corrective adjustments through visual guidance aid in the translation of conception into action.

Journal Article↗
PubMed1985

Role of timing of visual monitoring and motor rehearsal in observational learning of action patterns.

This experiment tested the hypothesis that observational learning is enhanced by visual monitoring of enactments that is optimally timed for conception-action matching and by motor rehearsal that serves to refine the cognitive representation. Subjects observed a modeled action pattern, after which they enacted it with either concurrent, delayed, or no visual monitoring. They then engaged in motor rehearsal or did not rehearse the action pattern. Development of the cognitive representation of the modeled action was also measured. Concurrent visual monitoring of enactments greatly facilitated observational learning, whereas delayed visual monitoring did not affect the acquisition process. Rehearsal aided cognitive representation and behavioral reproduction. The more accurate the cognitive representation of the modeled action pattern, the more skilled were the subsequent reproductions of it. After gaining proficiency in converting conception to action, subjects showed no decline in reproduction accuracy when modeling and visual monitoring were withdrawn.

Journal Article↗
PubMed1982

The role of visual monitoring in observational learning of action patterns: making the unobservable observable.

The present experiment tested the hypothesis that concurrent visual feedback enhances observational learning of a novel action pattern that normally would be unobservable. Subjects repeatedly enacted a modeled action pattern with visual monitoring of their reproductions throughout enactments, during only early or late phases of enactment, or not at all. At periodic intervals the adequacy of their conception of the modeled pattern was also measured. Visual feedback during ongoing performance enhanced accurate reproduction of the modeled pattern; the facilitative effect was most pronounced for reproduction of complex response components. The superiority of subjects who had enacted these difficult response components with visual feedback was maintained even when both the model and feedback were withdrawn. Visual feedback did not facilitate accurate enactment of the modeled pattern before development of an adequate cognitive representation of it. The results support the social learning view that observationally-learned behaviors are cognitively represented and that visual monitoring serves to decrease discrepancies between conception and action.

Journal Article↗