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Biomedical subjects

D W Nuss

Publications and source records attributed to D W Nuss.

17 recordsLinked to original sources
PubMed1999

Squamous cell carcinoma of the sinonasal tract invading the orbit.

OBJECTIVE/HYPOTHESIS: The treatment of squamous cell carcinoma (SCC) of the sinonasal tract has evolved from routine exenteration of the orbital contents to sparing of the orbit when the SCC does not transgress the periorbita. Nonetheless, the influence of this change in treatment over the rate of local recurrence or survival has not been clearly elucidated. The objective was to ascertain whether orbital sparing surgery for the treatment of SCC of the paranasal sinuses influences the rate of local recurrence or survival. STUDY DESIGN: This is a retrospective study of patients presenting with SCC arising in the sinonasal tract, treated primarily at the University of Pittsburgh Medical Center from 1977 to 1990, including meta-analysis of the English literature regarding SCC of the sinonasal tract. METHODS: Review of medical records regarding demographics, histology, extension of tumor, pathologic results, type of surgery, adjunctive therapy, and outcome. Articles for meta-analysis were identified by Medline search and cross-referencing. RESULTS: Fifty-eight patients with orbital invasion, including bone and/or soft tissue invasion, were included in the study. Patients presenting with invasion of the bony orbit without soft tissue invasion were treated with maxillectomy and/or ethmoidectomy, sparing the orbital contents. Patients presenting with invasion of the orbital bones and soft tissues were treated with ethmoidectomy or maxillectomy, including orbital exenteration. At 3 years' follow-up, 52% of the patients whose orbit was exenterated were alive and without evidence of disease, compared with 59% of the patients whose orbit was spared. This difference was not statistically significant. Similarly, the rate of local recurrence was not statistically significant (P > .05). A meta-analysis of the literature revealed similar results. CONCLUSIONS: Our data suggest that sparing of the soft tissues of the orbit when the periorbita has not been transgressed by SCC does not downgrade the rate of cure or local control.

Carcinoma, Squamous Cell↗
PubMed1997

Utility of helical computed tomography in the study of arytenoid dislocation and arytenoid subluxation.

Conventional computed tomography (CT) has been considered a mainstay in the evaluation of the larynx. A major difficulty with utilizing this modality, especially in the study of the arytenoid, is the time necessary to perform a thin-slice examination through a structure that has a propensity to move with respiration and swallowing. Helical CT not only significantly reduces the time necessary to study the larynx, but enables one to perform multiple high-resolution multiplanar reconstructions. Eleven patients with arytenoid abnormalities documented by strobovideolaryngoscopy or direct laryngoscopy were imaged with helical CT. A comprehensive radiographic examination illustrating the cricoarytenoid relationship in all of the subjects was completed in less than 20 seconds by using axial reconstructions in 2-mm-thick slices at 1-mm intervals, with subsequently derived sagittal and coronal reconstructions. Helical CT may be a useful adjunct in the diagnosis of arytenoid subluxation or dislocation.

Adult↗
PubMed1996

Chondrosarcoma of the nasal septum: skull base imaging and clinicopathologic correlation.

Chondrosarcoma arising in the head and neck and craniofacial region is an uncommon lesion. The nasal septum is a particularly rare site of origin, with approximately 30 cases previously reported in the English literature. We present six new cases of chondrosarcoma arising in the nasal septum. Each of these tumors required cranial base surgical approaches for removal. Current imaging techniques allow a very accurate diagnosis to be made before biopsy. The characteristic ring-forming calcifications seen on computed tomography scans can be correlated with the histologic pattern of calcification. Magnetic resonance imaging techniques allow precise definition of tumor extent, which is particularly important because the disease is best treated with primary surgery. Advances in imaging and surgical techniques allow a much more complete tumor removal. It is hoped that this will increase the likelihood of cure in these patients. Surgical management and indications for adjuvant therapy are discussed.

Adult↗
PubMed1996

Dysphonia in the elderly: diagnosis and management of age-related voice changes.

In our laryngology practice, we have noted an increasing number of elderly patients referred to us for problematic dysphonia. We present our findings of the most common disorder affecting this age group. A sample of 47 consecutive patients over age 60 with dysphonia revealed presbylaryngis, ie, age-related anatomic and physiologic changes, as the most common etiology found in this tertiary referral practice, accounting for 30% (14 patients) of new diagnoses. None of the patients with presbylaryngis received this diagnosis from the referral source. Understanding the anatomic and physiologic changes of the aging vocal tract, along with the clinical correlation of each change, is crucial in evaluating this group of patients. Managing this disorder includes specific goal-oriented speech therapy, with surgery as an adjunct should conservative therapy prove unsuccessful. Earlier recognition of this disorder and prompt intervention are key factors in reversing vocal decompensation, with a primary effect of improving the quality of life for the patient with age-related dysphonia.

Aged↗
PubMed1994

Role of skull base surgery for local control of sarcoma of the nasal cavity and paranasal sinuses.

Sarcomas of the nose and paranasal sinuses are rare neoplasms and comprise less than 1% of the malignancies arising in the sinonasal tract. From 1977 to 1989, we had the opportunity to treat 15 patients presenting with these tumors at The Eye & Ear Institute of the University of Pittsburgh. The clinical charts of these patients were reviewed retrospectively for demographic data, characteristics of disease, treatment considerations and clinical outcome. Data were also analyzed with special attention to the role of skull base surgery for the local control of tumors. Seven patients underwent cranial base surgery as part of their original therapy. Two of these patients are alive with no evidence of disease, one patient died of other causes, and four are dead of disease. Two patients died with local disease. Although not statistically significant due to the small number of patients, these data suggest that cranial base surgery can improve the local control of sarcomas of the sinonasal tract that approach or invade the skull base.

Adolescent↗
PubMed1994

The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck.

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

Adipose Tissue↗
PubMed1993

Health care crisis: the head and neck cancer patient and affordable health insurance.

In an evaluation of 30 patients with head and neck cancer, we found that 14 (46%) were uninsured at the time of diagnosis and 15 (50%) had yearly incomes below the poverty level. Tobacco and alcohol were identified as risk factors in 25 (83%) of the patients. These patients spent an average of $2,781 on carcinogenic agents yearly, increasing the risk of cancer 55 times that of the unexposed population, whereas the cost of a health insurance policy was $2,321 per year. To remedy the disparities and incongruities of this situation, we advocate patient education to influence behavioral change in these high-risk groups, a lowering of insurance rates, legal reform, and continued physician activism toward managing the current health care crisis.

Adult↗
PubMed1992

Experimental tracheal replacement using a revascularized jejunal autograft with an implantable Dacron mesh tube.

Defects comprising more than 50% of the trachea cannot be reliably reconstructed by any current technique or prosthesis. A composite tracheal replacement implant consisting of a Dacron-urethane mesh tube and revascularized jejunal autograft was applied to this problem. This composite implant was used to replace 7 to 10 cm of trachea in eight dogs. The implant was sewn to the outside (serosal surface) of the jejunum to provide permanent structural support to the autograft, and an intraluminal silicone tube was placed inside the jejunal segment and left for 4 weeks following reconstruction. Six of eight animals survived the predetermined time periods and were killed painlessly in groups of two animals at 1, 2, and 6 months after removal of the intraluminal silicone tube. Postoperative intubation, ventilation, or tracheostomy was not necessary. Excessive secretions were not seen in any of the animals, and a fair to good performance status was maintained until death in all but one animal. Histologic examination revealed slight thinning of the jejunal mucosa, with no change in the jejunal muscularis. These data suggest that with further refinement this composite implant may be a viable reconstructive option in humans.

Animals↗
PubMed1991

Facial translocation approach to the cranial base.

Facial translocation is a new approach which has been developed for surgical management of extensive lesions of the anterolateral cranial base, including the nasopharynx, sphenoid sinus, clivus, infratemporal fossa, superior orbital fissure, and cavernous sinus. Temporary displacement of the craniofacial skeleton allows direct, wide access to this complex anatomic area, while giving the surgeon a high degree of control over critical neural and vascular structures.

Adolescent↗
PubMed1991

Midfacial split for access to the central base.

The technique of the midfacial split for access to the central cranial base is described. It provides--using bilateral facial osteotomies and soft tissue mobilization--a unified surgical field extending in the sagittal plane from the anterior cranial fossa floor and sphenoid sinus to the level of the fourth cervical vertebral body. In the axial plane, the periphery of the surgical access may extend to the jugular fossae and the hypoglossal canals. Experiences and results in eight patients are presented.

Chondrosarcoma↗
PubMed1991

Facial translocation for cranial base surgery.

The complexity of cranial base surgery is a reflection of skull base anatomy as well as technical demands for maximum visualization, control of essential structures, adequate tumor resection and/or reconstruction. Facial translocation has been developed as a new approach to cranial base. It consists of extensive modular facial disassembly which includes displacement of composite facial soft tissue flap and craniofacial skeleton. It creates surgical field with epicenter in nasopharynx and infratemporal fossa allowing easy expansion into sphenoid bone and cranial fossae as well as craniovertebral junction. Reconstruction is functional and esthetic. Versatility of this approach permits expansion into neighboring craniofacial regions. During a 14-month period (11/88-12/89), this facial translocation approach to cranial base was utilized in 20 patients. The approach provided excellent visualization of the involved cranial base permitting oncological as well as reconstructive procedures. All patients healed primarily. Two patients were reoperated on at 4 and 6 months postoperatively; one for a bone graft infection and the other for tumor recurrence. The facial translocation approach offers favorable exposure of the critical zones of cranial base resulting in increased surgical safety and benefit of cranial base surgery.

Adolescent↗
PubMed1991

Craniofacial disassembly in the management of skull-base tumors.

Craniofacial disassembly now plays a major role in the management of tumors that invade the skull base. The chief advantage of this technique is the greatly improved operative exposure it provides, allowing the surgeon to resect such tumors more completely and with an added margin of safety. Microneurosurgical advances have made it possible to preserve cranial nerve function in many cases, and modern reconstructive methods employing vascularized flaps have helped to reduce postoperative complications and deformity. Through the combination of craniofacial techniques and oncologic principles, the outlook for patients with skull base tumors is improving.

Adult↗
PubMed1990

Chronic cough due to angiotensin-converting enzyme inhibitors.

The ACE-inhibiting drugs enalapril and captopril may result in a chronic and sometimes severe cough for which no pathologic cause can be found. Drug-induced cough should therefore be considered in any symptomatic patient taking these medications. In such cases, prompt withdrawal of the drug and substitution of a non-ACE inhibitor is curative and conserves the time and resources of the patient and the physician by avoiding unnecessary diagnostic and therapeutic measures.

Aged↗