Biomedical subjects
Publications and source records attributed to B D Birt.
A patient with a small mass occupying the laryngeal ventricle is reported. The rare histological diagnosis of an epithelial hamartoma is discussed, with reference to the other sites of occurrence in the head and neck.
Meningiomas not uncommonly spread outside the central nervous system, but primary extracranial meningiomas are much less common, the sites described including the orbit, the calvarium, the neck, the temporal bone and the paranasal sinuses. Reported here is the first instance of extracranial meningioma of the nasopharynx. The histological appearance of meningiomas is diverse, and in ectopic sites can be mistaken for malignant epithelial tumors, as happened here initially. The tumor was excised via a transpalatal flap using an intracapsular debulking approach borrowed from the armamentarium of the intracranial surgeon. Prolonged follow-up with interval CT scans are recommended in patients with apparent ectopic meningioma, in case undemonstrable intracranial disease later becomes manifest.
Use of an extended superiorly based posterior wall pharyngeal flap for the immediate reconstruction of the soft palate in three patients undergoing commando excision of oropharyngeal neoplasms recurrent after radiotherapy is described. The technique appears to be simple, fast, safe, and effective.
A youth impaled his neck when thrown from a car. No major vessels were damaged but the pharyngeal wall was so extensively disrupted that no repair was possible on the left side. Skin closure was effected and a large drain withdrawn slowly over several days during which he was hyperalimented. He made a rapid and complete recovery from this injury which also included mandibular damage and penetration of the brain.
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The authors wonder if the success rate with stapedectomy performed by a group of surgeons in a local general hospital can be expected to equal the results published from certain major centres. A 10 year review at Sunnybrook where 12 surgeons performed 160 operations showed a 78 per cent favorable result and an eight per cent unfavorable result in primary stapedectomy. In general older patients with more extensively affected footplates did worse. There were only minor differences between the results achieved with different prostheses, and virtually none between the various surgeons. Revision stapedectomy showed considerably worse results with 21 per cent achieving a favorable result against 42 per cent whose hearing became worse. A conservative approach to revision surgery is advised.
Pigmented lesions of the oral mucosa may be due to collections of blood, metallic particles of melanin. Any of these substances will appear of a blue tinge if at any depth in the tissues, while superficial collections may be red, black or brown respectively. Lesions associated with blood will be hematomas, dilated veins, hemangiomas or telangiectases. Metallic particles are found in amalgam tattoos. Melanotic pigmentation may occur as a normal variation, following hormonal disturbance and inflammation, and sometimes iatrogenically. Benign and malignant melanoma of the oral cavity is highly lethal. 25% of malignant melanomas in this site present as nondescript brown spots, and isolated broid overlooking an early malignant melanoma.
The indications for a lip shave operation include actinic cheilitis with dysplasia, carcinoma in situ, or very early carcinoma with micro-invasion. In addition it may be combined with V wedge excision for larger carcinomas. The procedure consists in the excision of the vermilion epithelium with immediate repair of the lip by advancement of a flap of labial mucosa. The functional and cosmetic results of the operation are perfectly acceptable. The incidence of subsequent carcinoma in lips treated this way is very low.
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A group of 66 patients with newly acquired hearing aids were seen at intervals over a two year period. The hearing aids' performance was measured at each visit. Many aids were not performing according to manufacturer's specifications but their performance as a group did not deteriorate over two years. Aids required on average nearly two repairs in the two year period, eyeglass aids being slightly more fragile than other types. Most of the patients were satisfied with their aids and their degree of satisfaction was found to correlate with their aided speech discrimination score.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.