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At least 19 recordsLinked to original sources

The deltoscapular flap.

The deltoscapular flap is described as an additional source of regional skin for head and neck reconstruction; this flap behaves in the manmer of an arterially based axial skin flap. On three occasions, I have used this back flap that is almost a mirror image of the deltopectoral flap.

Adult

Hypopharyngeal diverticulum and the cricopharyngeus muscle: a posterior surgical approach.

Hypopharyngeal diverticulum and dysphagia due to cricopharyngeus muscle dysfunction are a continuing challenge to the head and neck surgeon. The ability to completely transect the cricopharyngeus muscle is generally agreed to be the key to successful relief of symptoms, and--to an even greater extent--to prevention of recurrence. In the past, the most significant complications arising from such surgery have been recurrent laryngeal nerve injury and recurrent diverticulum or cricopharyngeus spasm. Both of these problems have been prevented by a modified surgical approach which takes advantage of the relatively bloodless retropharyngeal space. The logic of this posterior approach to the cricopharyngeus, from an anatomic standpoint, coupled with the good visualization and relatively bloodless field when approaching the muscle, suggests that it might be a suitable substitute for the more common lateral approach if continued long-term experience in larger number of cases does not lead to significant complications.

Diverticulum

Cricopharyngeus myotomy as the only treatment for Zenker diverticulum.

Cricopharyngeal dysfunction, one of the most common causes of pharyngeal dysphagia, exhibits a variety of manifestations, one of which is Zenker diverticulum. This paper examines the physiology of swallowing, pathophysiology of its aberrations, and various methods of treating Zenker diverticulum. It is our purpose to emphasize cricopharyngeus (CP) myotomy as the only needed treatment for this diverticulum. Even in its advanced stages, excision of the diverticulum is a needless surgical exercise. Seven cases of Zenker diverticulum are reported in elderly patients; one of them had an excision of the diverticulum prior to presentation. Some were either completely obstructed or aspirating on esophagram. Cricopharyngeus myotomy, the only treatment provided, proved to be safe and effective without morbidity or fatalities. Patients' ability to eat orally was restored on the night of or the morning after surgery. No Levin tube is necessary and there is no risk of suture line leakage after the conventional diverticulectomy and CP myotomy. Hospital stay is greatly reduced and there is no risk of structure formation. In contrast to endoscopic division of CP muscle, there is no risk of mediastinitis because there is no break through the mucosa.

Aged

Pharyngoceles of the hypopharynx.

The differential diagnosis of the complaint of dysphagia is extensive; however, a search of the literature gives the impression that pharyngocele as a cause of dysphagia is relatively infrequent, since only 18 well-documented cases have been reported. On the other hand, the author's experience reveals that pharyngocele occurs more commonly than indicated in the literature as, over the past 2 years, 24 patients with pharyngocele have been personally observed. This thesis is divided primarily into three sections: 1. a review of the physiology and anatomy involved in the swollowing mechanism; 2. a review of the English literature regarding pharyngocele, and 3. an evaluation of the author's 24 cases, allowing for discussion and conclusions. It is noted that laryngocele is frequently mistaken for pharyngocele; however, it is pointed out that a correctly performed barium swallow roentgenogram differentiates one from the other. Symptoms of laryngocele, Zenker's diverticulum and pharyngocele can be quite similar. Frequently, pharyngocele can be demonstrated by the Valsalva maneuver. Surgical repair is indicated when the symptoms are severe. Standard pharyngeal mucous membrane closure similar to the procedure utilized in the repair of Zenker's diverticulum should result in resolution of the problem.

Adult

Surgical advances in the treatment of lesions of the pediatric airway: the role of the carbon dioxide laser.

Transoral microsurgery of the larynx has now made it possible to treat multiple lesions heretofore only treatable by external approach. The introduction of the surgical carbon dioxide laser has been the single greatest advance in transoral surgery of the airway in the past 15 years. This modality of therapy offers many features not found in any other known form of surgery. It is especially useful in the pediatric airway where the avoidance of edema and the need for minimal scarring is most critical. Its unique aspects make this form of treatment most desirable in the pediatric laryngotracheal region.

Carbon Dioxide