Malignant nasal paraganglioma: a case report and review of the literature.
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Adolescent↗
Biomedical subjects
D H Rice
Publications and source records attributed to D H Rice.
Autologous fat injection for vocal fold paralysis: long-term histologic evaluation.
Many techniques have been developed for medialization of the paralyzed vocal fold. The purpose of this study is to evaluate autologous fat as an alternative to alloplastic substances for use in vocal fold medialization. Eight dogs underwent left recurrent laryngeal nerve sectioning. Autologous fat was harvested, and the paralyzed vocal fold was medialized by injecting the fat into the thyroarytenoid muscle. The animals were divided into three groups for evaluation at 1, 3, and 6 months. Videolaryngoscopy was performed prior to sacrificing the animals. The larynges were sectioned coronally, and histologic studies were performed. The studies confirmed the preservation of viable fat at the injected site in all animals. Only a minimal inflammatory response was observed in the 1-month group. It would appear that fat injection is a viable alternative to Teflon injection and thyroplasty; it eliminates the need for alloplastic materials, does not appear to migrate, and does not require an open procedure.
Adipose Tissue↗
Gunshot wounds of the temporal bone: a rational approach to evaluation and management.
Gunshot injuries of the temporal bone are uncommon but are being seen more frequently with the increasing incidence of violent crimes and use of firearms. A retrospective analysis of 43 consecutive patients treated at our institution with this injury was undertaken to determine the clinical symptoms, associated injuries, and treatment outcome. This is the largest series from a single institution treated by a single group during a brief period of time. Most of these patients had injury to various structures within and around the temporal bone, including hearing loss (29), intracranial injury (23), facial nerve injury (22), vascular injury (14), and mandible fracture (6). Ocular trauma and paralysis of cranial nerves V and IX, X, XI, and XII were rare occurrences. A rational approach to the evaluation and management of these injuries will be discussed in detail to optimize outcome.
Adolescent↗
Management of traumatic hypopharyngeal injuries.
Violation of the hypopharynx by external penetrating trauma is an uncommon occurrence that may lead to life-threatening infectious complications if not recognized promptly and treated appropriately. A retrospective review of 48 such injuries seen during a 10-year period showed that flexible fiberoptic endoscopic examination is the best screening tool for recognition of a possible hypopharyngeal mucosal violation. Direct laryngopharyngoscopy is the best method of definitively diagnosing the injury. Size of the visualized mucosal violation alone is not sufficient information on which to base the decision for medical management versus surgical intervention (i.e., immediate exploration and drainage). Rather, the size, exact site of injury, and mechanism of the injury must be considered to have equal importance. Associated vertebral body fractures may negatively influence acute outcome if diagnosis and treatment of the hypopharyngeal injury are delayed by the cervical spine injury.
Adolescent↗
Management of thyroid nodules during pregnancy.
Guidelines for the management of thyroid nodules discovered during pregnancy have not yet been established. The authors reviewed the records of 23 patients with thyroid nodules that were first detected during pregnancy. These patients were divided into three groups according to how they were managed. Seven patients who presented early in pregnancy had their work-up completed during pregnancy, 11 patients underwent biopsy after delivery, and 5 patients were managed with observation alone. The incidence of malignancy in the series was 39%. Four patients underwent surgery during pregnancy, and 7 patients were operated on in the postpartum period. No fetal morbidity or mortality occurred. The authors recommend that fine-needle aspiration be performed in patients who present before 20 weeks of gestation with rapidly enlarging thyroid nodules, nodules associated with palpable cervical adenopathy, solid nodules larger than 2 cm, or cystic nodules larger than 4 cm. Growth of a nodule while a patient is receiving thyroid hormone suppression therapy is highly suspicious for malignancy; in this situation, consideration should be given to performing biopsy later in gestation.
Adult↗
Safety of thyroidectomy in residency: a review of 186 consecutive cases.
A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty-six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology--Head and Neck Surgery at the University of Southern California were reviewed. Sixty-nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.
Adolescent↗
Sensory recovery in noninnervated free flaps for head and neck reconstruction.
Recent studies have reported sensory recovery in innervated ("sensate") microvascular free flaps used for oromandibular reconstruction. To evaluate the efficacy of sensate free flaps used for head and neck reconstruction, the natural outcome of noninnervated flaps must be known. Data on the natural recovery of sensation in noninnervated head and neck free flaps are lacking in the literature. This study evaluates the degree of spontaneous sensory reinnervation in noninnervated microvascular free flaps used for reconstruction of a variety of head and neck defects. Eighteen flaps were evaluated--9 fibula osseocutaneous and 9 radial forearm. The fibula flaps were used to reconstruct composite defects of the mandible and oral cavity mucosa. The radial forearm flaps were used to reconstruct defects resulting from floor of mouth resection (3), total glossectomy (2), pharyngectomy (1), full-thickness cheek (1), and facial skin (2). Sensation to pinprick, light touch, and temperature discrimination were tested over the skin paddle at time intervals ranging from 6 to 24 months. The pattern of sensory reinnervation in these noninnervated flaps over time and by location is discussed.
Bone Transplantation↗
Sclerosing cervicitis: case report and literature review.
Sclerosing cervicitis is an idiopathic fibrosis of the soft tissue compartments of the neck. Reported cases in the past have been characterized by both benign and malignant courses, but the histopathology of the lesion has been invariably benign.
Aged↗
Endonasal surgery for nasal wall tumors.
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Humans↗
Acute airway compromise secondary to traumatic thyroid hemorrhage.
Hemorrhage into cystic thyroid nodules is a relatively frequent event. Most cases are mild, causing only pain and discomfort, and rarely cause significant neck swelling. Even more rarely, however, massive hemorrhage into a thyroid nodule can result in a rapidly expanding hematoma with airway compromise. We report a case of a rapidly expanding thyroid hematoma that occurred after minor trauma and resulted in airway compromise in a patient with no clinical or surgical evidence of thyroid disease. We also present a review of the literature.
Aged↗
Pulmonary chondroid hamartoma presenting as an inflatable neck mass. Case report and clinicopathologic analysis.
Pulmonary hamartomas most often present as solitary coin lesions of the lung. Less frequently, they can present as cystic lesions in the pulmonary parenchyma. We describe a case of a cystic pulmonary hamartoma presenting as an inflatable neck mass. The lesion was successfully treated by surgical excision using a stated transcervical and thoracotomy approach. The differential diagnosis of inflatable cervical masses is outlined along with a discussion of the pathogenesis and treatment of hamartomas. A clinical technique that is helpful in localizing the source of inflatable cervical masses is described for use when radiologic examinations are not specific in locating the source of the lesion.
Diagnosis, Differential↗
The prevalence of Escherichia coli O157.H7 in dairy and beef cattle in Washington State.
Escherichia coli O157.H7 was found in 10 of 3570 (0.28%) faecal samples from dairy cattle in 5 of 60 herds (8.3%). Several tentative associations with manure handling and feeding management practices on dairy farms were identified. Faecal/urine slurry samples, bulk milk samples, and milk filters from dairy herds were negative for E. coli O157.H7. E. coli O157.H7 was also isolated from 10 of 1412 (0.71%) faecal samples from pastured beef cattle in 4 of 25 (16%) herds. The prevalence of E. coli O157.H7 excretion in feedlot beef cattle was 2 of 600 (0.33%). The identification of cattle management practices associated with colonization of cattle by E. coli O157.H7 suggests the possibility that human E. coli O157.H7 exposure may be reduced by cattle management procedures.
Animals↗
Pott's disease of the cervical spine presenting as a deep neck infection.
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Abscess↗
Dynamic properties of the posterior cricoarytenoid muscle.
The aim of this research was to investigate the contractile properties of the posterior cricoarytenoid (PCA) muscle. Simultaneous measurements were made of the isometric force, temperature, and electromyographic activity of the dorsal cricoarytenoid muscle of anesthetized dogs during supramaximal stimulation of the recurrent laryngeal nerve for twitch and tetanic contraction. The conduction delay between stimulation of the recurrent nerve at the level of the larynx and the onset of the muscle action potential averaged 2.0 +/- 0.2 milliseconds (ms), and the latent period between the onset of electrical activity of the muscle and the onset of contraction had a mean duration of 3.3 +/- 0.8 ms. The mean of isometric contraction times found was 33.3 +/- 2.0 ms, shorter than most previous studies of canine PCA muscle. Tetanic frequency defined as smooth contraction was higher than previous estimates. Considerations of scaling of physiological time based on animal mass were applied to analysis of the experimental findings to make possible systematic comparison of previous findings across species and animal size.
Animals↗
Indications for endoscopic sinus surgery.
Thus, if the patient has an appropriate history, appropriate physical findings, and appropriate CT, endoscopic sinus surgery typically will be indicated and beneficial. One should be especially wary of the patient who does not fit these criteria. Particularly worrisome is the patient whose symptoms fail to respond to antibiotics. A careful examination should be done for a non-infectious cause of the symptoms in this case. Another group of patients who should be cause for concern are those whose pain is out of proportion to the disease found. This is doubly true if their pain does not respond to antibiotics. These patients will usually not be helped by operative intervention. With careful adherence to the above criteria, the appropriate surgery will usually result in a very satisfied patient.
Anti-Bacterial Agents↗
Transconjunctival blepharoplasty. Complications and their avoidance: a retrospective analysis and review of the literature.
The transconjunctival approach to lower eyelid blepharoplasty is becoming increasingly popular. From 200 transconjunctival blepharoplasties performed between 1984 and 1991, 40 randomly selected cases were reviewed to identify the complications associated with this technique. This represents the largest reported series (to our knowledge) in the English-language otolaryngology head and neck surgery literature. A review of the literature was performed to compare this series with reported complications associated with this approach, as well as to compare the reported complications from the transcutaneous method. Discussion on how to best avoid these complications is included. We found that the transconjunctival approach avoided the most common complication associated with transcutaneous blepharoplasty, lower lid malposition. Inadequate fat removal, the most common complication when the transconjunctival method was used, was believed to be best avoided by the careful graded and through removal of herniated lower lid fat. Patients exhibiting prominent fat without excess lower lid skin were found to be ideal candidates for transconjunctival blepharoplasty.
Adipose Tissue↗