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Biomedical subjects

C W Gross

Publications and source records attributed to C W Gross.

At least 37 records · Page 2Linked to original sources
PubMed1996

Transnasal endoscopic repair of cranionasal fistulae: a refined technique with long-term follow-up.

Although the management of cranionasal fistulae has historically plagued otolaryngologists, recent reports of endoscopic techniques for repair of these lesions offer promising results. We present our series of 42 patients whose cranionasal fistulae were managed endoscopically between December 1989 and August 1995. Follow-up ranged from 5 to 68 months, thereby including long-term results from our previously reported series of 29 cases. Resolution of cerebrospinal fluid rhinorrhea was achieved in 35 (83.3%) of 42 patients with one endoscopic procedure, and 3 patients had successful closure at a second surgery. All five cephaloceles were successfully treated with one procedure. We have refined our technique to include specific indications for the use of free grafts depending on the location and size of the cranionasal fistula.

Adult↗
PubMed1995

The soft-tissue shaving procedure for removal of adipose tissue. A new, less traumatic approach than liposuction.

OBJECTIVE: To introduce the soft-tissue shaving cannula, a new, precise alternative to conventional liposuction that embodies an entirely different method of soft-tissue extraction and that appears to be less traumatic and more precise than methods currently used in liposuction. DESIGN: Nonrandomized, nonblinded comparison of the soft-tissue shaver and conventional liposuction devices in fresh cadavers, followed by clinical use of the liposhaver in selected patients undergoing cosmetic facial liposuction. INTERVENTIONS: Conventional liposuction devices and the soft-tissue shaving cannulas in fresh cadavers (< 8 hours old). A submental lipectomy and a melolabial fold liposhaving were performed in a clinical setting. OUTCOME MEASURES: Subjective evaluation by the operating surgeons. RESULTS: The fat was cleanly shaved and the contour result was even, without dimpling or asymmetry. CONCLUSIONS: Our early experiences suggest that this new liposhaving technique may offer a precise, less traumatic alternative to conventional liposuction. Fat can be shaved in an open fashion under direct vision. It does not rely on a vacuum seal. The soft-tissue shaving cannula shaves fat one layer at a time. The depth of each layer removed, the depth of soft-tissue injury, and the optimal settings and sizes for various procedures remain to be reported.

Adipose Tissue↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration.

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Adult↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure: further considerations.

The Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum to create a large frontonasal communication. However, the external approach often allowed medial collapse of soft tissue and stenosis of the nasofrontal communication. We describe a modified transnasal endoscopic Lothrop procedure in which drills are used for cases in which frontal recess exploration fails to relieve obstruction of the frontal sinus. The lateral bony walls are preserved, and medial collapse does not occur. The mucosa of the posterior table and posterior nasofrontal duct is preserved, and a single common frontal opening is created. We have found this approach to be safe and reliable. Fourteen patients have undergone this procedure without complication, achieving resolution or improvement of their symptoms and maintaining wide patency of the frontonasal opening. We recognize that long-term follow-up will be required but remain encouraged with our favorable results to date.

Adult↗
PubMed1994

Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia.

OBJECTIVE: To develop a technique for evaluating the severity of chronic sinus disease and to examine the correlation with allergy, asthma, and eosinophilia. DESIGN: A survey of 104 patients undergoing surgery for chronic sinusitis. SETTING: A university hospital ear, nose, and throat clinic. PATIENTS: A referral population of adult patients being scheduled for endoscopic sinus surgery was eligible; 104 completed questionnaires and agreed to participate. MAIN OUTCOME MEASURES: Computed tomographic scans were reviewed and scored for extent of disease. Serum samples were assayed for total IgE and specific IgE antibodies to common inhalant allergens. Peripheral blood samples were analyzed for total eosinophil count. Surgical biopsy specimens were examined for eosinophilia and cultured for bacteria and fungi. RESULTS: Extensive disease was present in 39% of subjects and correlated well with asthma, specific IgE antibodies, and eosinophilia, but not with elevated total IgE. Among patients with peripheral eosinophilia, 87% had extensive disease. All cultures grew aerobic bacteria; anaerobes and fungi were uncommon. CONCLUSIONS: We present a system for quantitation of disease extent using computed tomographic scans of patients with chronic sinusitis. The well-accepted associations of chronic sinusitis with asthma and allergy appear to be restricted to the group with extensive disease. The presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease.

Adult↗
PubMed1994

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects: a review of twenty-nine cases.

The management of cerebrospinal fluid rhinorrhea has historically plagued the neurosurgeon and the otolaryngologist-head and neck surgeon. Intracranial repair is still favored at many institutions, despite its inherent morbidity. Extracranial nonendoscopic techniques have been previously described but have not gained wide acceptance. More recently, several reports have been published describing a variety of endoscopic techniques in limited patient series used to manage cerebrospinal fluid rhinorrhea. We present our series of 29 patients with cerebrospinal fluid rhinorrhea, treated with endoscopic techniques between December 1989 and June 1993, with follow-up ranging from 3 to 43 months. This represents the largest reported series to date of patients treated with this technique. Our technique has evolved during this time period but centers around the use of free tissue grafts from various donor sites. The causes of the skull base defects in this series included neurosurgical procedures (9), functional endoscopic sinus surgery (8), and trauma (3). Defects occurred spontaneously in 9 cases. The fovea ethmoidalis and sphenoid sinus were the site in 11 and 12 cases, respectively, and the cribriform plate was involved in 6 cases. Cerebrospinal fluid rhinorrhea was documented by nasal endoscopy with or without intrathecal fluorescein, laboratory studies, computed tomography with or without contrast cisternography, and radioisotope cisternography in various combinations. Resolution of cerebrospinal fluid rhinorrhea was achieved in 22 of 29 patients (75.9%) with one endoscopic procedure and 25 of 29 patients (86.2%) after a second attempt. Four patients required neurosurgical intervention for recurrent cerebrospinal fluid rhinorrhea. Complications were minimal and were related primarily to the original pathology or procedure. Cerebrospinal fluid rhinorrhea can be managed safely and effectively with endoscopic techniques in a majority of cases, and the morbidity of open procedures can be avoided.

Adult↗
PubMed1994

Preliminary report: endoscopic versus external surgery in the management of inverting papilloma.

Since January 1977, twenty-four patients with inverting papilloma of the nose and paranasal sinuses have been treated at the University of Virginia. Two patients had bilateral disease, for a total of 26 surgically treated sides. Patients were aged from 10 to 83 years, and 71% were male. Most tumors originated on the lateral nasal wall, with 62% involving the adjacent sinuses. Nineteen sides were treated by external approach and 7 were treated intranasally. There was a total of 5 recurrences in 4 patients and no associated squamous cell carcinomas. Seven patients were treated with endoscopic excision (4 primary tumors and 3 recurrences). There have been no recurrences since endoscopic treatment. These preliminary data give further evidence that endoscopic excision is a viable surgical option for many inverting papillomas.

Adolescent↗
PubMed1994

Toxic shock syndrome after functional endonasal sinus surgery: an all or none phenomenon?

Reported cases of toxic shock syndrome (TSS) following nasal surgery or functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting from Staphylococcus aureus phage I toxic shock syndrome toxin 1 (TSST-1), and it is characterized by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, prior S aureus phage I colonization, as well as low antitoxin antibody levels. Of the 1700 FESS procedures performed at our institution, 3 cases were complicated by classic TSS, with 2 additional patients having a postsurgical course compromised by a milder degree of TSS. Diagnostic criteria, clinical presentation, management, and etiology are discussed, and the possibility of a continuum from mild-to-classic TSS is addressed.

Adolescent↗
PubMed1994

Endoscopic septoplasty.

Often there is a need to address the status of the nasal septum during functional endonasal sinus surgery. The outcome of a sinus procedure can be enhanced if the surgeon has better exposure of the operative area or if the patient receives a larger nasal airway, which provides laminar air flow. We present a technique of managing septal deviations and obstructions that adds little additional time to the sinus procedure and allows direct evaluation of the septum with the endoscopes. We describe this relatively simple technique, indications for its use, and results of the first 38 cases.

Adult↗
PubMed1994

Post-operative care for functional endoscopic sinus surgery.

In summary, functional endoscopic sinus surgery has become a widespread tool for the treatment of chronic sinus conditions. Within the office, under local anesthesia, aggressive post-operative care can greatly diminish the need to return to the operating room for revision endoscopic sinus surgery. Under local anesthesia, most limited procedures performed in the operating room can also be performed in the office. Effective post-operative care is critical to obtain the best possible results. Any and all means necessary must be taken to assure expert, detailed, and timely post-operative care.

Endoscopy↗
PubMed1992

Revision functional endonasal sinus surgery.

Revision functional endonasal sinus surgery (FESS) is recommended for patients whose symptoms of chronic or recurrent sinusitis persist despite primary FESS, long-term maximal medical therapy, and no sign of other abnormalities as demonstrated by computed tomography. After analyzing the charts of 673 patients who underwent primary FESS, we reviewed the 63 cases of revision surgery performed between 1986 and 1989. This retrospective analysis presents the management and outcome of 16 children (less than 16 years) and 47 adults who had revision FESS. The overall success rate of revision FESS was 78%, with no major complications, reflecting the improved management of sinus disease offered by this procedure.

Adolescent↗
PubMed1991

Schwannomas of the paranasal sinuses. Case report and clinicopathologic analysis.

Schwann's cell tumors are common neoplasms arising from the neural sheath of autonomic, cranial, or peripheral nerves. We describe a case of destructive malignant schwannoma of the right ethmoid and sphenoid sinuses. The tumor was successfully treated by surgical excision, external radiotherapy, and radon seed implants. The patient remains symptom free 3 years after therapy ended, emphasizing the previously unrecognized benefits of radiotherapy for these types of tumors. The value of endoscopy in diagnosing and following schwannomas of the nasal and paranasal sinuses is highlighted in our review of the clinicopathologic features and radiologic findings of this tumor.

Ethmoid Sinus↗
PubMed1990

Morbidity in pediatric tonsillectomy.

Tonsillectomy is one of the most common operations performed in the pediatric age group. Previous literature on morbidity in tonsillectomy has dealt predominantly with postoperative hemorrhage. Children undergoing tonsillectomy were divided in a prospective and random fashion into eight study groups to evaluate postoperative morbidity as it relates to the surgical technique used (electrocautery, dissection, KTP laser), methods of hemostasis (electrocautery, suture ligature), and the use of postoperative antibiotics. A total of 80 children were evaluated. Using the parameters of morbidity as defined in this study, blunt dissection tonsillectomy using suture ligatures for hemostasis, without postoperative antibiotics was found to result in the least morbidity in the pediatric age group.

Adolescent↗
PubMed1989

Adipose plug myringoplasty: an alternative to formal myringoplasty techniques in children.

Adipose myringoplasty is presented as a simple and cost-effective technique in managing small tympanic membrane perforations in children. A review of 76 fat plug myringoplasties performed on 62 children with drum perforations over a 15-year period was done. Fifty-nine myringoplasties were postinflammatory and/or after extrusion of pressure-equalizing (PE) tubes. Sixteen were residual perforations following temporalis fascia tympanoplasty, and one was posttraumatic perforation. Criteria for selection, operative technique, and results are discussed.

Adipose Tissue↗
PubMed1989

Functional endonasal sinus surgery (FESS) in the pediatric age group.

Functional endonasal sinus surgery has become a popular mode of surgical treatment for sinus disease in the United States. The literature has primarily addressed its use in the adult population. We present our series of 57 children who underwent functional endonasal sinus surgery. The children ranged in age from 3 to 15 years. Follow-up was from 3 to 13 months. Fifty-four of the patients were treated for chronic or recurrent sinus infections. Three patients were treated for complications of acute sinusitis. All patients tolerated the procedure well, and there were no major complications. We conclude that functional endonasal sinus surgery is a safe procedure in the pediatric age group. Although postoperative follow-up in the series was very short, early results appear encouraging. The technical approach is similar to that used in the adult procedure. The pediatric procedure, however, requires a follow-up nasal endoscopy under general anesthesia to achieve optimal results.

Adolescent↗
PubMed1989

Malignant germ cell tumors of the head and neck in childhood.

From 1962 through 1987, four children were diagnosed at our institution with primary germ cell malignancies of the extracranial head and neck regions. Ages of the children ranged from 2 to 44 months. Histologic findings included 2 yolk sac carcinoma (endodermal sinus tumor), 1 malignant teratoma with nephroblastoma (Wilm's tumor), and 1 malignant teratoma with neuroblastoma (primitive neuroectodermal) components. Complete clinical and surgical staging was performed to rule out additional sites of disease. All patients initially underwent either biopsy or, when technically feasible, resection. Three patients received combination chemotherapy and two received irradiation. Three patients died of progressive disease. One patient who had yolk sac carcinoma of the temporomandibular region is alive and free of disease 40 months after therapy. Complete surgical resection is indicated for teratomatous tumors, if technically feasible. The malignant components of these tumors are sensitive to both chemotherapy and irradiation and combined therapy may be beneficial.

Cervical Vertebrae↗
PubMed1989

Pediatric functional endonasal sinus surgery.

Functional endoscopic sinus surgery has been used to treat children in whom medical and traditional surgical therapy have failed. Special approaches are necessary in children because of the small size of the paranasal sinuses. Modifications of the techniques used in adults that are appropriate for use in children are fully explained.

Child↗