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Biomedical subjects

C W Gross

Publications and source records attributed to C W Gross.

At least 19 recordsLinked to original sources
PubMed2001

The modified Lothrop procedure: indications, results, and complications.

The modified Lothrop procedure or frontal sinus drill-out is a completely intranasal technique that creates a common frontonasal communication to allow drainage and ventilation of the chronically infected frontal sinus. It is an effective alternative to the classic frontal sinus obliteration. The modified Lothrop is usually performed on an outpatient basis, leaves no external scars, provides excellent visualization of the frontal sinus in the postoperative setting, and yields a high cure rate in chronically infected patients.

Chronic Disease↗
PubMed2001

Aggressive endoscopic resection of inverted papilloma: an update.

OBJECTIVE: Endoscopic resection has been proposed for sinonasal inverted papilloma (IP). Our objective was to determine the efficacy of aggressive endoscopic resection of IP. METHODS: Retrospective analysis was performed on patients undergoing endoscopic resection of IP at the University of Virginia between 1990 and 1996. Total ethmoidectomies, wide maxillary antrostomies, frontal recess explorations, sphenoidotomies, and turbinate resection were performed as required. Once all visible papilloma was removed, residual mucosa was removed by using a diamond burr to polish bone at the site of origin. RESULTS: Twenty-one patients were treated with endoscopic resection of IP. Only 1 of 21 patients had an adjunctive external procedure (an osteoplastic flap without obliteration). Average follow-up was 41.9 months after initial aggressive endoscopic resection at the ureterovesical angle. Recurrences occurred in 19% (4/21) of patients. One of the 4 had two recurrences. Recurrences occurred in 16 months or less, except for one noted at 35 months and another at 56 months. CONCLUSIONS: Aggressive endoscopic resection of IP by experienced rhinologists is an acceptable treatment.

Adolescent↗
PubMed2001

Autologous fibrin sealant reduces pain after tonsillectomy.

OBJECTIVES/HYPOTHESIS: Pain is a major cause of morbidity after tonsillectomy. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of care. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain after this operation. STUDY DESIGN: A prospective, randomized, blinded study was performed on 20 children aged 5 to 17 years who were undergoing tonsillectomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain. METHODS: All patients pre-donated 40 mL of blood from which autologous concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. The 10 patients in the control group (C) received no fibrin sealant. Patients rated their level of pain immediately after surgery and at regular intervals for 3 days after surgery using the Wong-Baker Faces Pain Rating Scale (1-6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated. RESULTS: At 7.00 P.M. on postoperative day (POD) 0, the mean +/- SD fibrin sealant group pain score (2.9+/-0.41 units) was significantly lower than for the C group (4.1+/-0.43 units; P < or = .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 P.M. on POD 1, with a mean of 3.5+/-0.43 units versus 2.4+/-0.48 units for C (P = .15). The odds of a patient in C experiencing emesis were 8.16 times higher, (P < or = .05) than for patients in the fibrin sealant group. CONCLUSIONS: Fibrin sealant significantly reduced pain the evening after pediatric tonsillectomy and also decreased the chance of experiencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.

Administration, Topical↗
PubMed2001

Microbiology of chronic frontal sinusitis.

OBJECTIVES: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis. STUDY DESIGN: Retrospective, nonrandomized study. METHODS: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis. RESULTS: Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery. CONCLUSIONS: This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.

Adult↗
PubMed2000

Ludwig's angina in the pediatric population: report of a case and review of the literature.

Ludwig's angina is a rapidly progressing cellulitis involving the submandibular neck space. It is characterized by brawny induration of the submental region and floor of mouth, bearing the potential for rapid airway obstruction. Airway management, antibiotics, and judicious surgical intervention are the mainstays of successful therapy. We present a case of Ludwig's angina in a 5-year-old child and offer a meta-analysis of pediatric cases of Ludwig's angina described in the literature over the past 30 years. The presentation, etiology, management, and potential complications of this disorder in the pediatric population are discussed.

Anti-Bacterial Agents↗
PubMed2000

Elevated nitric oxide metabolite levels in chronic sinusitis.

Decreased exhaled nitric oxide (NO) is found in chronic sinusitis. NO metabolites (nitrates, nitrites, and S-nitrosothiols) were measured in sinus lavages with a rabbit model of chronic sinusitis. NO metabolite levels (mean +/- SD) were 3.0+/-1.6 micromol/L in uninfected rabbits, 10.7+/-11.4 micromol/L in infected animals, and 7.6+/-5.4 micromol/L in postantrostomy recovering animals. Infected sinuses had elevated levels of NO metabolites that were statistically significant (P<0.01) when compared with uninfected sinuses. Mucociliary transport velocity was measured in uninfected (16.0+/-5.7 mm/minute), infected (5.2+/-1.3 mm/minute), and recovery phases (3.0 mm/minute). Endoscopic appearance, light and electron microscopy, and bacterial cultures improved during recovery. Elevated levels of NO metabolites were found during chronic sinusitis and began to return to normal levels during recovery. The possible link between NO in epithelial autotoxicity and host defense mechanisms warrants further investigation.

Animals↗
PubMed1998

Transnasal endoscopic repair of congenital choanal atresia: long-term results.

OBJECTIVE: To evaluate the short- and long-term success of the repair of congenital choanal atresia using the transnasal endoscopic approach with and without power instruments. DESIGN AND SETTING: Retrospective case series in a tertiary care center. PATIENTS: Fifteen patients with either unilateral or bilateral congenital choanal atresia were treated using the transnasal endoscopic approach. Postoperative stenting was used in all 15 patients. INTERVENTIONS: The senior surgeon (C.W.G.) currently uses the transnasal endoscopic drill-out technique. We describe our experience and long-term follow-up of 15 patients (9 with unilateral atresia, 5 with bilateral atresia, and 1 with unilateral stenosis) who were treated with the use of the transnasal endoscopic technique during a 7-year period. In 8 patients, the transnasal endoscopic technique was performed using conventional biting instruments, and in 7 patients, the transnasal endoscopic technique with power instruments was used. MAIN OUTCOME MEASURE: The patency of the surgical repair of congenital choanal atresia by the transnasal endoscopic approach. RESULTS: Of 14 patient procedures, 12 remained patent. One patient required minor debridement of granulation tissue 1 week following stent removal, and 1 patient required surgical transnasal revision 2 months after the primary procedure, with a patent result after the second procedure. Despite patent choanae being achieved, 1 patient died of cardiac anomalies 8 months after the atresia repair. CONCLUSIONS: The transnasal endoscopic route offers excellent visualization of the posterior choana and, hence, the ability to open the defect widely with a high surgical success rate. Newer powered instrumentation further enhances the ability to perform this technique cleanly.

Adolescent↗
PubMed1998

Suppurative intracranial complications of sinusitis.

OBJECTIVES: To familiarize the contemporary surgeon with the pathogenesis, diagnosis, and appropriate management of suppurative intracranial complications of sinusitis. STUDY DESIGN: Retrospective chart review. METHODS: All patients admitted to the University of Virginia Health Sciences Center with a diagnosis of intracranial suppuration between 1992 and 1997 were reviewed. RESULTS: One hundred seventy-six cases were identified, of which 15 patients had 22 suppurative intracranial complications of sinusitis. These were epidural abscess (23%), subdural empyema (18%), meningitis (18%), cerebral abscess (14%), superior sagittal sinus thrombosis (9%), cavernous sinus thrombosis (9%), and osteomyelitis (9%). CONCLUSIONS: The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series.

Adolescent↗
PubMed1997

Chronic sinusitis: risk factors for extensive disease.

BACKGROUND: Chronic sinus disease is one of the most common diseases in the United States, and little is understood about its pathogenesis. OBJECTIVE: To characterize prospectively the immunologic parameters that accompany extensive chronic sinusitis. METHODS: Eighty adult patients with chronic sinus symptoms had a complete blood count with differential, coronal computed tomographic (CT) scan of the sinuses, and serum assays for total IgE, specific IgE, IgA, IgG, IgG subclasses, and pneumococcal titers. RESULTS: Thirty-seven (46%) patients had extensive sinusitis, defined as a CT score > or = 12. A highly significant correlation was noted between the extent of disease and the peripheral eosinophil count (r = 0.53, p < 0.0001). In keeping with this finding, an eosinophil count > or = 200/microl was strongly associated with extensive disease (odds ratio [OR] = 19.2, 95% confidence interval [CI] = 5.4 to 72.7). Asthma (OR = 6.8, 95% CI = 2.2 to 22.0), atopy (OR = 4.3, 95% CI, 1.5 to 12.8), and age > or = 50 years (OR = 6.5, 95% CI = 2.0 to 22.2) were also associated with extensive disease. However, the association of eosinophils with extent of disease was independent of asthma, atopy, or age. Levels of IgG1, IgG2, and IgG3 subclasses did not correlate with extent of disease seen on CT scan. Although total IgE and IgG4 levels did correlate with disease, on multiple stepwise regression they did not add to the predictive value of the eosinophil count in identifying patients with extensive disease. CONCLUSIONS: The association of asthma, atopy, eosinophilia, and elevated levels of IgE and IgG4 with extensive disease on CT scan is compatible with the hypothesis that chronic sinusitis may be a disease of immune activation of the T(H2) type.

Adult↗
PubMed1997

Powered instrumentation for dorsal reduction.

We describe the use of powered instrumentation for precise modification of the bony nasal dorsum. Specific modifications were made to design a drill specifically for the bony nasal dorsum. This drill has a protective sheath that covers all but the active part of the drill, protecting the skin-soft tissue envelope, and it also has suction at the resection site. In some cases an osteotome is used to reduce the hump and the drill is used to achieve additional reduction and to smooth the exposed edges under direct vision. In other cases the entire bony hump is reduced using the drill. The nasal dorsum drill offers a precise alternative to the rasp. The precision of the drill is highlighted in cases in which limited reduction is needed, as in cases of a single or several spicules requiring reduction and smoothing after osteotomy, or a single 4 mm raised area requiring limited reduction. The design of rasps makes it difficult to work on these focal areas without unnecessarily rasping surrounding areas, whereas the drill may be used to reduce the entire hump, to smooth the edges after osteotomy, or in a more precise and limited fashion when indicated. The drill may be less traumatic to the skin-soft tissue envelope because it does not rely on the potentially bruising back and forth motion typical of rasping. The nasal dorsum drill may decrease the incidence of bony dorsal irregularities after rhinoplasty.

Female↗
PubMed1997

Soft-tissue shavers in pediatric sinus surgery.

Powered instrumentation represents the newest advance in endoscopic sinus surgery. These instruments can be used in a variety of areas of the nose and paranasal sinuses. They can be particularly helpful for sinus surgery in children, who have smaller anatomic spaces and closer proximity of vital structures. The shaving action combined with continuous real-time suction of the soft-tissue shavers can provide the technical advantage to allow greater precision and ease in performing pediatric endoscopic sinus surgery.

Choanal Atresia↗
PubMed1997

Advanced drill technology in treatment of congenital choanal atresia.

Congenital choanal atresia is a challenging clinical problem requiring prompt diagnosis and intervention. The method of repair is controversial, with no technique having gained universal acceptance. Proponents of the transnasal repair must acknowledge the variability of results, especially with thick bony plates, and the technical difficulties associated with this method. Advocates of the transpalatal route must recognize the associated morbidity of this technique in the newborn. The adaptation of the endoscopic technique and the development of new powered instrumentation have significantly improved the transnasal technique so that safe controlled repair may now be accomplished in the newborn.

Choanal Atresia↗
PubMed1996

The liposhaver in facial plastic surgery. A multi-institutional experience.

OBJECTIVE: To report a multi-institutional clinical experience with the liposhaver in facial plastic surgery. DESIGN: Nonrandomized, nonblinded, multi-institutional evaluation of the liposhaver in a clinical setting in patients presenting for cosmetic facial liposuction. INTERVENTIONS: Cosmetic facial surgery with the liposhaver was performed in 19 patients (21 procedures) who underwent submental lipectomy, facelift with defatting beneath the facelift flap, and/or correction of deep nasolabial folds. Standardized preoperative and postoperative photographs were obtained. Fat obtained from the abdomen of 1 patient was also studied histologically. This fat was excised sharply and was then liposhaved at varying oscillation speeds. OUTCOME MEASURES: Subjective evaluation by the operating surgeons. RESULTS: The liposhaver was used successfully in all cases. The fat was cleanly shaved and the contour results were even, without dimpling or asymmetry. Operative time was comparable to that for conventional liposuction. Preferred cannula sizes and settings were determined. There were no cases of facial nerve injury, no evidence of increased bleeding intraoperatively, and no hematomas in the immediate postoperative period. One patient developed a small hematoma on postoperative day 5 that was effectively treated with needle aspiration and a pressure dressing. Histologic evaluation of liposhaved abdominal fat showed normal fat cells and well-preserved architecture. CONCLUSIONS: The liposhaver offers a precise alterative to conventional liposuction. It may be less traumatic because it requires low suction pressures and does not rely on the potentially bruising, vigorous, back-and-forth motion for fat extraction typical of conventional liposuction.

Adipose Tissue↗