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Biomedical subjects

Y P Krespi

Publications and source records attributed to Y P Krespi.

At least 19 recordsLinked to original sources
PubMed1995

Sarcoidosis of the sinonasal tract: a new staging system.

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.

Adult↗
PubMed1995

Nd:YAG laser turbinate surgery animal experimental study: preliminary report.

The chronically hypertrophic nasal turbinate is a challenging problem for otolaryngologists. Although some success has been achieved with a number of medical and surgical methods, other forms of treatment are still needed. In this study, encouraging results were achieved using the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser on canine turbinates. Clinical and histological results showed that with Nd:YAG laser surgery, coagulation occurs in the deep cavernous vessels and submucosal glands of the turbinate, while the overlying mucosa remains intact.

Animals↗
PubMed1994

Laser-assisted serial tonsillectomy.

Laser ablation of the palatine tonsils is a useful alternative to tonsillectomy in adults. Cryptic tonsillitis is a common problem causing recurrent infection, sore throat, and halitosis. Elimination and/or obliteration of surface pockets (crypts) of the palatine tonsils utilizing the CO2 laser was effective in 86 patients treated in the past 4 years. Ablation of the tonsil surface was performed in stages under local anesthesia in an office setting; CO2 laser energy delivered through the "SwiftLase" handpiece extension provided char-free, superficial layer ablation of tissue. "SwiftLase" is easily installed onto existing CO2 laser units and provides high-power densities by utilizing a focused laser beam in an extremely fast uniform scan over an extended area (up to 4 mm) within a fraction of a second. This method and results of its use are discussed.

Adolescent↗
PubMed1994

Laser-assisted uvula-palatoplasty for snoring.

Laser-assisted uvula-palatoplasty (LAUP) is a new and effective surgical method for the elimination of habitual snoring. LAUP is safely performed under local anesthesia in the office, and it provides progressive enlargement of the oropharyngeal air space by reshaping and restructuring the uvula, soft palate, and pharyngeal pillars utilizing the CO2 laser with special attachments. LAUP can also reduce oropharyngeal obstruction that may occur during sleep in patients with obstructive sleep apnea syndrome. Our experience includes over 335 patients evaluated and treated within the past year. Successive laser ablation of the vibrating structures, such as the uvula, soft palate, and posterior pharyngeal pillars, provided an 84% cure rate. In addition, 7% of the patients reported significant improvement in the loudness of their snore. The major advantage of this surgical technique is that it is a safe, simple, reliable, and bloodless procedure that can be performed in the office. This method and the results of its use are discussed.

Adult↗
PubMed1992

The transcervical approach to the superior mediastinum.

We describe our experience with the transcervical approach for the surgical treatment of nonthyroidal superior mediastinal masses. With careful patient selection, proper preoperative workup, and proper operative positioning and technique, the entire superior mediastinum may be explored, thus avoiding the significant morbidity associated with the transsternal route. The transcervical approach requires a thorough knowledge of the surgical anatomy. Nine patients underwent transcervical exploration of the superior mediastinum. The indications included parathyroid adenoma, thymoma, congenital cyst, hemangioma, adenocarcinoma, and thymectomy for myasthenia gravis. We specifically discuss the role of thymectomy in the treatment of myasthenia gravis.

Adult↗
PubMed1991

Multiple branchiogenic anomalies.

A family with three generations of male-to-male transmission of a rare syndrome is presented. The syndrome includes bilateral cervical branchial sinuses, bilateral preauricular sinuses, bilateral malformed auricles and bilateral hearing impairment. Two important aspects of this syndrome are discussed. First, male-to-male transmission rules out a sex-linked mode of inheritance. Second, the finding of both conductive and sensorineural hearing loss is puzzling since the middle and inner ear differ in embryogenesis as to both origin and timing. Few explanatory mechanisms are discussed.

Abnormalities, Multiple↗
PubMed1990

Endoscopic laser arytenoidectomy revisited.

Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described, the endoscopic laser technique is more desirable because it requires no incision and allows for the immediate assessment of airway size. Eleven patients with bilateral vocal cord paralysis treated by endoscopic laser arytenoidectomy were presented in 1984. At that time, 10 of the 11 patients had been successfully decannulated. Follow-up on that group of patients revealed that 7 of the 10 successfully treated patients remain decannulated with a good airway, although 2 of these patients required a revision procedure to excise a granuloma. One patient failed at 15 months and has failed two subsequent revision operations, and 2 patients have been lost to follow-up. Since 1984, 17 additional patients with bilateral vocal cord paralysis have been treated by the authors using the same endoscopic laser arytenoidectomy technique; all have been successfully managed, with a minimum follow-up of 3 years. The technique of this operation will be reviewed. This study demonstrates the clinical usefulness of endoscopic laser arytenoidectomy in the treatment of bilateral vocal cord paralysis.

Arytenoid Cartilage↗
PubMed1990

Controlled laryngoplasty for vocal cord medialization: a technique using tissue expansion.

Laryngeal framework surgery has become an increasingly popular alternative to Teflon injection for vocal rehabilitation. Vocal cord medialization requires custom tailoring of the implant's size and shape to optimize individual vocal quality, whether it be via the interposition of Silastic implants between the thyroid ala and the inner thyroid perichondrium or through a cartilage window. A new technique is described for vocal cord medialization using an implanted miniature tissue expander. Intraoperative and postoperative vocal cord medialization was achieved in a canine model by controlled percutaneous filling of a remote injection valve. The implants were well tolerated and allowed continued control of vocal cord position for several weeks. Using this technique, vocal quality can be fine-tuned with a degree of precision not previously possible. The advantages, limitations, and technical aspects of expansion laryngoplasty are discussed.

Animals↗
PubMed1989

The combined use of muscle flaps and alloplasts for tracheal reconstruction.

This report documents our experience with a different concept in reconstructive head and neck surgery. This concept, we hoped, would enable us to reconstruct anatomic regions with a special contour that is otherwise difficult to achieve with conventional flaps and grafts. The first stage of this method includes implantation of a preshaped alloplastic material in a donor site of a commonly used myocutaneous flap and waiting 4 to 6 weeks for the implant to "take." The second stage includes raising the pedicled flap with the implant and transferring it to reconstruct the defect. As a model for this approach, tracheal defects in dogs were created and reconstructed. The technique used in this study can be specifically applied to reconstruction of tracheal defects, ie, subglottic stenosis, and also can be used for other defects in the head and neck region.

Animals↗
PubMed1989

Laser surgery for vocal cord carcinoma involving the anterior commissure.

Endoscopic laser surgery is an established means of treatment for benign laryngeal lesions. Laser surgery for early (stages I and II) squamous cell carcinoma is still being tested. Treatment of glottic tumors extending to the anterior commissure is in itself controversial. Approximately 20% of all glottic tumors involve the anterior commissure, with only 1% of these lesions being purely anterior commissure tumors. The anatomy of the anterior commissure is such that an apparent T1 lesion may actually be a T4 lesion if it involves the thyroid cartilage. The distance between the anterior commissure ligament and the thyroid cartilage is only 2 to 3 mm. A preoperative computed tomographic scan can aid us in evaluating this space. Therefore, tumors of the anterior commissure present as a therapeutic challenge. Radiation therapy has proven to be inadequate, with a high rate of recurrence and increased risk for radiochondronecrosis. The literature with regard to radiotherapy varies widely as to survival rates. Conservation surgery has consistently demonstrated an 80% survival in T1 lesions. Recently, it has been suggested that laser surgery in the region of the anterior commissure might offer satisfactory results. We have found the opposite. We will report on five patients who underwent endoscopic laser surgery on T1 vocal cord lesions involving the anterior commissure. All of these patients had tumor recurrence and subsequently have undergone salvage surgery and/or radiation therapy. The difficulties associated with endoscopic laser surgery of the anterior commissure will be discussed with a supporting animal study.

Aged↗
PubMed1989

Computed tomography after skull base resection.

We have obtained serial CT scans in the evaluation and follow-up of 80 patients with lesions of the skull base. CT scanning has been useful for assessment of recurrence in this group of patients, many of whom underwent complex ablative and reconstructive procedures.

Follow-Up Studies↗
PubMed1989

Laser lingual tonsillectomy.

Diseases of the lingual tonsils are generally overlooked in both clinical practice and medical literature. Infections of the lingual tonsils are usually treated medically, although in patients with symptomatic chronic inflammation or hyperplasia of the lingual tonsils, surgical intervention may be indicated. Eighty-two patients with benign inflammatory problems of the lingual tonsils, who were not improved by medical management, underwent laser lingual tonsillectomy at four different medical centers, between 1984 and 1987. The procedure was tolerated well by all of the patients, with no significant operative complications. Short- and long-term results were satisfactory. Laser surgery is an effective method for the treatment of benign hyperplastic and inflammatory diseases of the lingual tonsils.

Adolescent↗
PubMed1989

Lateral skull base surgery for cancer.

The management of malignant tumors of the lateral skull base remains a challenging problem. Sixty-two patients underwent lateral skull base resection for cancer. Preoperative evaluation included complete neurotologic examination, CT scan, MRI, and carotid angiography. During surgery, the nasopharynx, the posterior maxilla, the infratemporal fossa structures, the mandibular ramus, and the parotid gland were resected en bloc. Reconstruction of the surgical defect was performed using pectoralis and/or rhombotrapezius myocutaneous flaps. Although the overall cure rate was not greatly improved, patients with lateral skull base malignancies now enjoy extended periods of palliation and a better quality of life.

Craniotomy↗