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Biomedical subjects

G A Sisson

Publications and source records attributed to G A Sisson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Preoperative combination chemotherapy for advanced stage head and neck cancer. Promising early results.

We treated 19 consecutive patients with cisplatin, bleomycin, and methotrexate before definitive surgery or radiation therapy. Fourteen patients (74 percent) had partial or complete tumor regression after chemotherapy. With a minimum follow-up time of 27 months, none of the 4 patients who had a major histologic response relapsed, and only 2 of the remaining 15 patients continued disease-free. The achievement of a complete histologic response after preoperative chemotherapy may correlate with long-term disease-free survival after surgery and radiation therapy for head and neck cancer.

Aged↗
PubMed1984

Tracheoesophageal puncture for voice restoration: modification of the Blom-Singer technique.

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.

Esophagus↗
PubMed1984

Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis.

Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually compromised. The management of such patients presents a challenge to the otolaryngologist-head and neck surgeon. Numerous surgical procedures have been developed in an attempt to improve the patients's airway insufficiency without leaving him with a breathy, weak voice. Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described for performing an arytenoidectomy, the endoscopic technique is more desirable since it requires no incision and theoretically allows for the immediate assessment of airway size. The addition of the CO2 laser to the surgical armamentarium offers certain refinements to the technique of endoscopic arytenoidectomy. Eleven patients with bilateral vocal cord paralysis of the larynx have been treated by endoscopic laser arytenoidectomy by the authors utilizing a technique developed by the two senior authors and subsequently taught to over 200 participants of the CO2 laser workshops sponsored by the Department of Otolaryngology-Head and Neck Surgery at Northwestern University Medical School; 10 of the 11 patients have been successfully decannulated. The technique and problems of this operation will be discussed.

Aged↗
PubMed1984

Modified tracheoesophageal diversion for chronic aspiration.

Breakdown of the normal protective function of the larynx, either through primary laryngologic or neurologic causes, leads to chronic aspiration, recurrent pneumonitis and possibly death. In this paper we discuss the existing surgical treatments for chronic aspiration. Tracheal separation and trecheoesophageal diversion are discussed, as are the difficulties of using these procedures in patients with pre-existing tracheostomies. A modification of tracheoesophageal diversion is presented whereby this procedure can now be utilized in those patients with pre-existing tracheostomies. The modified tracheoesophageal diversion is performed in five patients successfully. Since most patients have already had tracheotomies in an attempt to control aspiration, we feel that our technique of modified tracheoesophageal diversion enables this group of patients to benefit from this procedure as well.

Adult↗
PubMed1983

Carcinoma of the tongue in persons younger than 30 years of age.

Squamous cell carcinoma of the tongue in young people is a rare disease. The usual causal agents associated with this disease in older patients may not be operative in this younger age group or may involve a greatly reduced latency. Failure to perform a biopsy of tongue lesions in young patients often leads to late diagnosis. The prognosis is similar, stage for stage, as for older patients. Thirteen cases of squamous cell carcinoma of the tongue occurred in patients younger than 30 years of age. Their clinical appearance, stage and histologic state, treatment, and survival are discussed. A high index of suspicion leading to early diagnosis and systematic adequate treatment are needed to alter the unfavorable prognosis of this lesion.

Adolescent↗
PubMed1983

A randomized trial of adjuvant BCG immunotherapy in head and neck cancer.

Fifty-two patients with locally advanced squamous cell cancer were entered into a randomized trial of BCG vaccine following definitive local therapy. Patients were stratified and randomized to receive BCG vaccine (25 patients) or no adjuvant immunotherapy (27 patients). The BCG vaccine therapy began two weeks following definitive therapy with 2 to 4 X 10(6) Tice strain BCG organisms given intradermally (ID) in alternating sides of the neck every two weeks six times, then every four weeks nine times. In addition, all patients received methotrexate prior to definitive therapy. Median duration of follow-up at the time of analysis was 41 months. Groups were balanced by sex, disease site and stage, histologic grade, and prior therapy. Thirteen (52%) of the BCG vaccine-treated group remain disease free v seven (26%) of the controls. Similarly, 17 (68%) of the BCG vaccine-treated group survived v 11 (41%) of the controls. We conclude regional ID BCG vaccine increases disease-free and actuarial survival in this study population and adjuvant immunotherapy should be further explored in ear, nose, and throat cancer.

Adult↗
PubMed1983

Complications after pectoralis major myocutaneous flap reconstruction of head and neck defects.

This article reviews our experience with 86 patients undergoing 95 pectoralis major myocutaneous flap reconstructions. Complications and their incidence were very similar to those reported in previous series. Three cases of hidden recurrences appear to be previously unreported complications. The problem of delayed detection of recurrence in at-risk patients is an important one and may be unique to myocutaneous flaps. With the exception of the problem of hidden recurrence, the pectoralis major myocutaneous flap compares favorably with other methods of reconstruction of head and neck defects. Its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction.

Fistula↗
PubMed1983

CO2 laser in otolaryngology-head and neck surgery: a retrospective analysis of complications.

A retrospective review was conducted of all patients undergoing CO2 laser surgery by members of the Department of Otolaryngology-Head and Neck Surgery at Northwestern University Medical School from January 1, 1980 through December 31, 1981; 204 cases were identified and all are included in this report. Early in our department's experience with laser surgery, an endotracheal tube fire occurred. This incident precipitated a departmental review of complications associated with the use of the CO2 laser and resulted in the formulation of a laser safety protocol. All patients in this group were treated under the directives of this protocol; the operative complication rate was low. This retrospective analysis of complications associated with the use of the CO2 laser under a strictly applied protocol demonstrates the relative safety associated with judicious use of this instrument.

Equipment Safety↗
PubMed1983

Endoscopic laser arytenoidectomy.

Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually inadequate for day-to-day exertion. In some patients, the airway may be inadequate for even quiet respiration and an indwelling tracheotomy is required. Solution to this problem has involved the following techniques: tracheotomy, lateralization of the vocal cord by either endoscopic or external routes, or vocal cord reinnervation by the nerve-muscle transposition technique. Endoscopic laser arytenoidectomy has been mentioned in the literature. However, the actual technique as well as the attendant morbidity associated with this procedure has not been highlighted. Four patients with bilateral vocal cord paralysis of the larynx have been treated by endoscopic laser arytenoidectomy at Northwestern University Medical School. The technique, problems, and results are discussed.

Aged↗
PubMed1983

Reconstruction after total or subtotal glossectomy.

Total or subtotal resection of the tongue for malignant lesions creates difficult reconstructive problems. Though the introduction of myocutaneous flaps revolutionized the reconstruction of the oral cavity, most patients with total and subtotal (more than 75 percent) glossectomy require laryngectomy as a concommittant or subsequent procedure to prevent persistant aspiration. Two groups of patients have been compared in this study. Group I consisted of 10 patients in whom an attempt was made to preserve voice with a total (4 patients) or subtotal (6 patients) glossectomy without laryngectomy. To decrease the chance of aspiration, the tip of the epiglottis was sutured to the posterior pharyngeal wall (epiglottopexy). This additional surgical step allowed swallowing without aspiration by blocking the glottic entrance. Group II consisted of six patients who underwent total glossectomy and laryngectomy. They had reconstruction with a pectoralis myocutaneous flap in one stage. These patients were rehabilitated without any major morbidity and they resumed an oral diet within 3 weeks after surgery. The muscle bulk of the flap and the additional protection of the airway by epiglottopexy in Group I were the keys to successful reconstruction.

Combined Modality Therapy↗
PubMed1983

Auricular reconstruction with postauricular myocutaneous flap.

In the past reconstruction of large auricular defects more than 2 cm have been repaired with the use of local skin flaps from various sites in multiple stages. This entails longer hospitalization and a poorer aesthetic result. We developed a postauricular myocutaneous flap that has been used successfully in five patients. The cosmetic results are superior to previously described reconstructive techniques. This flap, which can be used in immediate one-stage reconstruction, is based on the auricular branch of the posterior auricular artery. This vessel supplies the auricularis posterior muscle, the skin over the mastoid, and the cranial surface of the auricle. This vessel was dissected and found to be anatomically consistent in five cadavers.

Aged↗
PubMed1982

Skull base surgery in composite resection.

We extended the limits of standard jaw and neck dissection in large tumors of the oropharynx with extension to the soft and hard palate. Resection of the primary tumor with adequate margins and the lymphatics of the infratemporal fossa is required for tumor control in these extensive lesions. Splitting the lip in the midline and developing a large cervicofacial flap gives an excellent exposure to the region. The resection includes the hemimandible and the soft tissues of the intratemporal fossa. The internal carotid artery is followed to the skull base and all structures medial to this vessel, including the cartilaginous portion of the eustachian tube and the external carotid, are included in the en bloc specimen. The resection of the posterior maxilla, pterygoid plate, and palate may vary according to tumor size. The surgical defect is usually reconstructed with a pectoralis myocutaneous flap.

Humans↗
PubMed1982

A compendium of intranasal flaps.

The reconstructive surgeon is frequently called upon to repair intranasal defects which require the use of grafts and/or flaps. In general, flaps are difficult to design and utilize because of 1. limited intranasal exposure and 2. the complex design requirements for movement of the flap through three dimensions. Intranasal exposure is increased by the transoral premaxillary approach, the lateral alotomy, the lateral rhinotomy, the transethmoid, and the open rhinoplasty. The flaps to be designed all utilize the basic principles for skin flaps. However in contrast to movement on a relatively two-dimensional surface, they frequently require movement in the three dimensions, i.e., from the floor of the nose up to the septum, from the side to the center, etc. We review the following flaps: 1. mucoperichondrial advancement and rotation flaps of the septum, 2. composite septal flap, 3. inferior turbinate flaps, 4. nasal floor mucoperiosteal flaps, 5. middle turbinate flaps, 6. composite lateral cartilage flaps, 7. buccal sulcus flaps, and 8. nasolabial flaps.

Adult↗