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Biomedical subjects

G Har-El

Publications and source records attributed to G Har-El.

At least 19 recordsLinked to original sources
PubMed2001

Powered instrumentation for transcervical removal of gigantic intrathoracic thyroid.

BACKGROUND: It is widely accepted that almost all intrathoracic goiters can be removed through the neck. For those rare gigantic goiters that cannot be removed transcervically, median sternotomy is usually recommended. During the last 11 years we used intracapsular volume reduction techniques to facilitate transcervical removal of extremely large intrathoracic goiters. Materials and Methods Of 149 patients with intrathoracic goiters, 11 patients had gigantic lesions that could not be removed transcervically. Instead of sternotomy, we used the arthroscopic or sinus microdebrider or a large-bore suction device for controlled intracapsular volume reduction. This was followed by complete removal of the gland through the neck. RESULTS: The thyroid gland was removed completely in all 11 patients. None of the patients had any evidence of intraoperative spillage of thyroid tissue. No major complications were noted. CONCLUSIONS: We have found the use of the microdebrider and/or suction device for intracapsular volume reduction to be extremely helpful for transcervical removal of gigantic intrathoracic goiters.

Debridement↗
PubMed2001

Short-term and long-term quality of life after neck dissection.

INTRODUCTION: Quality of life (QOL) is an important outcome measure in cancer therapy. Neck dissection (ND) morbidity has been well studied, but no study has focused on the quality of life after ND specifically. METHODS: Fifty-one patients who have undergone ND completed a 6-item quality-of-life survey with a 7-point frequency and interference response scale. General QOL and comorbidity biases were evaluated with the SF-12 questionnaire and the Charlson comorbidity index. RESULTS: The following symptoms were the most commonly experienced after surgery: neck tightness (71%), numbness or burning of the ear (57%), and shoulder discomfort (53%). However, interference with daily activities was reported by only 37%, 32%, and 33% of patients with these symptoms, respectively. Within 2 years of surgery, interference with daily activities decreased to 17%, 18%, and 12%, respectively. QOL after ND was negatively associated with previous radiation, previous chemotherapy, tumor stage, and more radical neck surgery but was positively associated with time after surgery. Shoulder discomfort and neck tightness had the greatest affect on QOL. CONCLUSIONS: Our results suggest that patients should receive preoperative counseling regarding the morbidities from ND and the possible short-term and long-term impact on QOL. Further studies evaluating the relationship between primary tumor characteristics and quality of life after ND need to be undertaken.

Adult↗
PubMed2001

Transnasal endoscopic management of frontal mucoceles.

Traditional teaching has emphasized the need for complete removal of sinus mucocele to achieve a cure. With the introduction of endoscopic sinus surgical instruments and techniques, however, there has been a trend toward transnasal endoscopic management of frontal mucoceles with recurrence rates at or close to 0%. This article presents a useful classification of frontal mucoceles and the transnasal endoscopic surgical technique.

Frontal Sinus↗
PubMed2001

Frontal sinus obliteration with the pericranial flap.

BACKGROUND: Frontal sinus obliteration is often accomplished by autologous grafts such as fat, muscle, or bone. These avascular grafts carry an increased risk of resorption and infection as well as donor site morbidity. Vascular regional flaps may be used to obliterate small sinuses with less morbidity. OBJECTIVES: To review our experience with the use of the pericranial flap for obliteration of the frontal sinus. METHODS: The records of 10 patients who underwent obliteration of the frontal sinus with the pericranial flap were reviewed. Demographics, indications for frontal sinus obliteration, immediate and late complications, and long-term outcome were recorded. These results were compared with those in the current literature. RESULTS: Ten sinuses were obliterated with the pericranial flap. Indications included frontal sinus mucocele, mucopyocele, frontal sinus osteomyelitis, and frontal sinus fracture. The median follow-up was 3 years. There was 1 short-term complication of persistent headache for 1 month, and there was asymptomatic recurrence of a neofrontal sinus in 1 case. CONCLUSIONS: The pericranial flap is a vascularized local flap that is easily harvested. The use of the pericranial flap avoids donor site morbidity associated with free fat or cancellous bone grafts. The pericranial flap arms the head and neck surgeon with an effective alternative to other methods of frontal sinus obliteration.

Adipose Tissue↗
PubMed2001

Quality of life with functional pharyngeal preservation in advanced carcinomas of the base tongue complex using an integrated trimodality approach.

Standard management of advanced carcinoma arising from the base of the tongue or infiltrating that region from contiguous areas (henceforth referred to as base of tongue complex [BTC] tumors) with radical surgery and postoperative radiation therapy results in extensive loss of function affecting deglutition, speech, and physical appearance. From January 1995, 16 patients with advanced stage BTC tumors were entered in this phase II study. Eleven patients (74%) had N2-3 neck disease. To optimize neck control, those with clinical N+ nodes at presentation had neck dissection. This was followed by hyperfractionated radiotherapy at 120 cGy twice daily to a median dose of 7,320 cGy to the primary and 6,240 cGy to areas with pathologically positive nodes. Concomitant chemotherapy was administered during weeks 1 and 4 of the radiation therapy using bolus cisplatin 75 to 100 mg/m2 on day 1 and continuous infusional 5-fluorouracil 750 to 1,000 mg/m2/d from days 1 to 4 of each chemotherapy cycle. Survival curves were plotted for various events, using actuarial life table methods. A functional assessment was made at least 1 year after completion of treatment using a previously validated Head/Neck Performance Status Scale. The median follow-up period was 23 months. There was a 100% complete response to the treatment at the primary site. The actuarial 4-year local (primary site) control was 100%, locoregional control (including nodes) was 69%, and disease-specific survival was 70% at 4 years. The predominant acute toxicity (63% incidence) was reversible grade III mucositis resulting in a median of 9 days' interruption in treatment. All of the patients were able to complete the prescribed treatment course, and there were no treatment-related deaths. Quality of Life assessment after treatment examined all facets of oropharyngeal function. Of note, none of the patients required long-term tube feedings. For the nine patients who responded to the functional assessment questionnaire, the results were excellent (score >75). The mean score for ability to eat in public was 75, mean of 76 for normalcy of diet, and 91 for understandability of speech. Concomitant hyperfractionated chemoradiation therapy produced excellent functional preservation with good long-term control in this patient group with historically poor prognosis. A 4-year actuarial local control rate of 69% was obtained, which is comparable to results of radical surgery and adjuvant radiation therapy. Further studies with modifications of fractionation and use of newer chemotherapy agents/radioprotectors will improve on these gains while reducing toxicity.

Adult↗
PubMed2001

Endoscopic management of 108 sinus mucoceles.

OBJECTIVES/BACKGROUND: Traditional teaching has emphasized the need for complete removal of sinus mucoceles to achieve a cure. However, with the introduction of endoscopic sinus surgical instruments and techniques, there has been a trend toward transnasal endoscopic management of sinus mucoceles. The aim of this study is to establish the efficacy of endoscopic management of sinus mucoceles. STUDY DESIGN: Retrospective review. PATIENTS AND METHODS: Between 1988 and 2000, 103 patients with 108 paranasal sinus mucoceles were treated endoscopically. This series includes 66 frontal and frontoethmoid, 17 ethmoid, 7 sphenoethmoid, 12 sphenoid, and 6 maxillary mucoceles. Ninety patients (83.3%) had intraorbital extension and 85 of them presented with some degree of proptosis or eye displacement. Sixty patients (55.5%) had erosion of the skull base with varying degrees of intracranial extension of the mucocele. Follow- up ranged from 1 to 131/2 years with a median of 4.6 years. INTERVENTION: All patients underwent endoscopic-wide marsupialization of the mucocele cavity. Stents were used in frontal mucoceles only. RESULTS: Recurrence of a frontal mucocele was seen in 1 patient (0.9%). In 5 patients, out of 23 patients who presented with massive pansinus polyposis in addition to the mucocele, recurrent polyposis required revision surgery. However, the mucoceles did not recur in those patients. CONCLUSIONS: There is increasing evidence in the literature that endoscopic management of sinus mucoceles results in long-term control with recurrence rates at or close to 0%. Rhinologic surgeons should consider the endoscopic technique as the surgical treatment of choice.

Adolescent↗
PubMed2001

Deep neck abscess: a retrospective review of 210 cases.

This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998. Peritonsillar abscesses and limited intraoral abscesses were excluded. Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Tracheotomy is indicated in patients with Ludwig's angina.

Abscess↗
PubMed2001

Intraoperative fabrication of palatal prosthesis for maxillary resection.

BACKGROUND: Immediate placement of a palatal prosthesis has become the standard of care after maxillectomy or palatectomy, except when free-flap reconstruction is used. Palatal prostheses are usually fabricated preoperatively. Infrequently, the surgeon may face a situation where upper jaw resection has been performed and a prefabricated prosthesis is not available. OBJECTIVE: To describe a method of rapid intraoperative fabrication of a palatal prosthesis, which allows immediate oral intake and excellent speech. PROCEDURE: Two sheets of thermoplastic dressing (Aquaplast; WFR/Aquaplast Corporation, Wyckoff, NJ) were immersed in hot water. As they became soft and pliable, they were applied to the remaining hard palate and alveolar ridge. As the material cooled, it hardened, with its shape conforming to the remaining hard palate, alveolar ridge, and teeth. The rigid stent was then removed, trimmed, and fashioned to cover the palatal and maxillary defect. The stent was then wired to the remaining alveolar ridge and to the ipsilateral zygomatic buttress or lateral orbital rim. Removal of the stent was easily accomplished in an office setting. PATIENTS: Twelve patients required partial upper jaw resection without available prefabricated prostheses. Of these, 3 patients underwent emergency surgery for mucormycosis and 2 for bleeding malignant tumors; 3 underwent bone resection more extensive than that anticipated preoperatively; and 4 did not have prefabricated prostheses for other reasons. RESULTS: The thermoplastic prosthesis achieved its goals in all 12 patients. Eleven patients achieved oral food intake within 24 hours. One patient remained in a coma after extensive maxillary, orbital, and skull base resection for mucormycosis. The prosthesis was removed after 4 to 12 weeks and replaced with a permanent implant in 11 of the 12 patients. CONCLUSIONS: This simple, quick, and inexpensive intraoperative fabrication of palatal prosthesis requires no special expertise and equipment. It allows immediate oral intake and excellent speech.

Carboxymethylcellulose Sodium↗
PubMed2001

Quality of life after great auricular nerve sacrifice during parotidectomy.

OBJECTIVE: To determine the impact of great auricular nerve (GAN) sacrifice during parotidectomy on patients' quality of life. DESIGN: Historical cohort survey of patients who had undergone GAN sacrifice during parotidectomy. SETTING: Tertiary academic otolaryngologic practice. PATIENTS AND METHODS: Fifty-three patients who had undergone GAN sacrifice during parotidectomy completed an 8-item quality-of-life survey with a 7-point response scale designed to measure outcome after GAN sacrifice during parotidectomy. RESULTS: Thirty patients (57%) reported experiencing at least 1 abnormal symptom, but the mean number of symptoms decreased significantly with time, from a mean of 2.3 during the first year to 0.2 after 5 years (P<.001). Even among patients experiencing symptoms, 23 (77%) reported only a little or no bother caused by the symptoms, and 27 (90%) reported no interference or almost none with their daily activities. The degree of bother or interference reported had a moderate positive correlation with the number of abnormal sensations reported. CONCLUSIONS: The results suggest that, while many patients experienced sensory deficits, the overall quality of life was not significantly affected after GAN sacrifice during parotidectomy. Patients who report multiple abnormal sensations, however, would benefit from additional counseling and from reassurance that the number of sensations will diminish with time. Further study evaluating the effect of preservation of the posterior branch of the GAN during parotidectomy on patients' quality of life is needed.

Adult↗
PubMed2000

Unilateral pulmonary agenesis presenting as an airway lesion.

Otolaryngologists are frequently consulted to perform rigid bronchosopy in children with suspected foreign body aspiration, mucous plug occlusion of a mainstem or lobar bronchus, or other bronchial mass lesions. Chest radiographs that demonstrate unilateral lung or lobar collapse with a shift of mediastinal structures toward the affected side often prompt this referral. We describe 2 children, one with unilateral pulmonary agenesis and one with pulmonary aplasia, who presented with these radiologic findings. In each case, the definitive diagnosis was made at the time of bronchosopy. The diagnosis might have been suspected preoperatively if the chest radiographs had been reviewed with this clinical entity in mind. Because of its variable clinical presentation, diagnosis requires a high index of suspicion. Although computed tomography of the chest is diagnostic, the diagnosis may be suggested by chronic changes in the contralateral aspect of the chest wall and lung expansion on chest radiographs. Misdiagnosis may subject the patient to the unnecessary risks of bronchoscopy and to potential perforation of the rudimentary bronchus. Although pulmonary agenesis is a rare entity, it may mimic more common airway lesions. Therefore, unilateral pulmonary agenesis should be considered in the differential diagnosis of pediatric airway lesions. Arch Otolaryngol Head Neck Surg. 2000;126:1386-1389

Bronchoscopy↗
PubMed2000

Retropharyngeal abscess secondary to penetrating foreign bodies.

A retrospective study was conducted on patients with upper aerodigestive tract foreign bodies requiring operative intervention over a 12-year period to aid in the recognition and management of foreign body associated complications. Oesophagoscopies were performed for the removal of foreign bodies in 37 patients, age one to 82 years with a male to female ratio of 1.2:1. Retropharyngeal abscesses accounted for eight of 11 foreign body-associated complications. Fish bones were the cause in six cases, chicken bone and a pen refill in one case each. An abscess was already present at the time of initial procedure in six cases and developed in two cases after successful removal of the foreign body. A high level of suspicion for a retropharyngeal abscess should be maintained in cases with perforation, and in patients with immunodeficiency.

Adolescent↗
PubMed2000

Transcranial magnetic stimulation in acute facial nerve injury.

OBJECTIVE/HYPOTHESIS: Available electrodiagnostic tests that are used to evaluate facial nerve injury examine the nerve distal to the stylomastoid foramen; because most facial nerve injuries are within the temporal bone, the tests cannot evaluate the nerve at or across the injury site. The interpretation of these tests depends on the predictability (or unpredictability) of distal degenerative process. Transcranial magnetic stimulation may be able to stimulate the nerve proximal to the injury site. The hypothesis of the present study is that in cases of mild traumatic facial nerve injury where axonal integrity is maintained, proximal stimulation of the nerve using higher than normal stimulus intensities to "overcome" the block at the injury site result in recordable facial nerve activity. STUDY DESIGN: A prospective controlled animal study comparing response to transcranial magnetic stimulation of the facial nerve in the following groups: mild injury, severe injury/transection, and control. METHODS: We studied 44 facial nerves in 22 cats. Fifteen nerves were subjected to mild trauma. Five nerves were severely crushed, 2 nerves were completely transected, and 22 nerves were not traumatized. All nerves were examined with the transcranial magnetic stimulation system before the trauma, immediately after the trauma, and at 3, 8, and 12 weeks after trauma. RESULTS: All nerves in the mild and severe trauma groups showed complete clinical paralysis immediately after trauma. The nerves in the mild trauma group showed significant increase in threshold as well as significant increase in latency for recordable facial muscle response to transcranial magnetic stimulation. Thresholds and latencies decreased gradually within 3 to 12 weeks and returned almost to preinjury levels. This paralleled the return of clinical facial muscle movement. In the severe trauma/transection group, the nerves had no facial muscle response to transcranial magnetic stimulation after trauma. Neither facial muscle response to transcranial magnetic stimulation nor facial muscle movements recovered. CONCLUSIONS: In cats transcranial magnetic stimulation can assess the integrity of the facial nerve after trauma and predict its potential for regeneration. This technique can excite the nerve proximal to the injury site and may play a role in the clinical evaluation of the acute traumatic facial nerve paralysis. It can be used immediately after trauma, because it does not depend on wallerian degeneration to occur.

Acute Disease↗
PubMed2000

The role of fiberoptic nasopharyngoscopy in the management of the acute airway in angioneurotic edema.

BACKGROUND: Angioneurotic edema of the upper aerodigestive tract (AEUAT) often challenges the otolaryngologist with the decision of surgical intervention versus observation. OBJECTIVE: To develop a logical approach to the evaluation and management of the airway in patients with AEUAT, emphasizing fiberoptic examination (FOE) findings. METHODS: A computer-based retrospective review of all patients diagnosed with AEUAT was performed. The charts were reviewed for demographics, etiology, medical history, presentation, physical examination, imaging studies, intervention, and outcome. Findings on FOE as well as other covariants were statistically compared. RESULTS: Seventy patients with AEUAT were identified. The etiologies consisted of 24 cases of angiotensin converting enzyme inhibitor use (33%), 10 allergic reactions (17%), 1 hereditary (1.5%), and 35 idiopathic cases (48%). Fourteen patients underwent airway intervention, including 6 tracheotomies and 8 intubations. Of the 14 patients, 5 underwent emergent intervention before fiberoptic examination, 4 had laryngeal edema only, and 5 had both laryngeal and base of tongue edema. No patients with both laryngeal and base of tongue edema were observed. The remaining 52 patients were observed in a monitored setting and required no subsequent intervention. CONCLUSION: FOE is an invaluable tool in the assessment of the compromised airway in patients with angioneurotic edema Laryngeal edema alone is an ominous physical finding. When laryngeal and pharyngeal edema are present together, the physician should consider immediate intervention. Our findings indicate that symptoms, including stridor, hoarseness, and dysphagia, do correlate with disease severity; however, they must be confirmed with fiberoptic visualization. Although sound clinical judgment should always be exercised, we present our results in the management of the acute airway in angioneurotic edema.

Adolescent↗
PubMed2000

Is there a correlation between radiographic and histologic findings in chronic sinusitis?

OBJECTIVE: To determine if the degree of radiologic changes noted on computed tomography (CT) scan correlate with the severity of histologic changes. DESIGN: Retrospective analysis. SETTING: Academic tertiary care centre. METHODS: Sixty consecutive patients undergoing endoscopic sinus surgery for chronic sinusitis, with complete data obtained for 131 sinuses. MAIN OUTCOME MEASURES: Paranasal sinus CT scans and pathologic reports were examined. Respective findings were graded as mild, moderate, or severe, and the results were analyzed for agreement. CT scan grading was based on the extent of sinus opacification and pathologic grading was determined by the number of inflammatory cells found in the sinus mucosa. RESULTS: Of the 51 ethmoid sinuses, agreement between the radiographic and histologic grading occurred in 32 or 62.7%. In the maxillary group, a 57.1% (24 of 42) correlation was noted. Of the 20 frontal sinuses, agreement occurred in 8 or 40%, whereas a 22.2% (4 of 18) correlation was present in the sphenoid group. CONCLUSION: This study suggests that the severity of sinus disease based on preoperative CT scan does not correlate with the histologic degree of disease.

Chronic Disease↗