Biomedical subjects
G Har-El
Publications and source records attributed to G Har-El.
The transcervical approach to the superior mediastinum.
We describe our experience with the transcervical approach for the surgical treatment of nonthyroidal superior mediastinal masses. With careful patient selection, proper preoperative workup, and proper operative positioning and technique, the entire superior mediastinum may be explored, thus avoiding the significant morbidity associated with the transsternal route. The transcervical approach requires a thorough knowledge of the surgical anatomy. Nine patients underwent transcervical exploration of the superior mediastinum. The indications included parathyroid adenoma, thymoma, congenital cyst, hemangioma, adenocarcinoma, and thymectomy for myasthenia gravis. We specifically discuss the role of thymectomy in the treatment of myasthenia gravis.
Giant cell variant of malignant fibrous histiocytoma of the head and neck.
The giant cell variant of malignant fibrous histiocytoma is a rare entity in head and neck. Only eight well documented cases of this type are reported in the English literature. These tumours affect the superficial and deep structures of the neck most often and are best treated with prompt radical surgery. The prognosis of the giant cell type of malignant fibrous histiocytoma is dependent on the location of the tumour, with superficial tumours having a much better outlook.
Merkel's cell carcinoma.
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Choanal atresia and lymphedema.
The coexistence of bilateral bony choanal atresia and lower-extremity lymphedema was observed in a family with several consanguineous marriages. The combination of these two rare anomalies, in a hereditary form, has not been described before.
Multiple branchiogenic anomalies.
A family with three generations of male-to-male transmission of a rare syndrome is presented. The syndrome includes bilateral cervical branchial sinuses, bilateral preauricular sinuses, bilateral malformed auricles and bilateral hearing impairment. Two important aspects of this syndrome are discussed. First, male-to-male transmission rules out a sex-linked mode of inheritance. Second, the finding of both conductive and sensorineural hearing loss is puzzling since the middle and inner ear differ in embryogenesis as to both origin and timing. Few explanatory mechanisms are discussed.
Haemangioma in a cervical lymph node.
Haemangiomas of the head and neck are mainly cutaneous or mucosal; rarely, they may be found in bone or soft tissue. Haemangiomas of lymph nodes are extremely rare; here we present such a case in a cervical lymph node. This is, to the best of our knowledge, only the second report of such an entity.
Infectious mononucleosis complicated by lingual tonsillitis.
Although upper airway obstruction and superimposed infection are well-known complications of infectious mononucleosis, lingual tonsillitis in this context has not been mentioned in the literature. We describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis. The role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed.
Melanosis of the larynx.
A case of laryngeal melanosis is presented. This is followed by the analysis of the total of nine cases reported in the English literature. Patients are men in their sixth to eighth decade of life who present with hoarseness. Histopathologic findings include pigment deposits in the basal layer of the laryngeal epithelium. The possible relation of this lesion to carcinoma of the larynx is discussed.
Purpura fulminans of the head and neck.
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Physical rehabilitation after myocutaneous flaps.
The neck, shoulder, and upper trunk serve as donor sites for commonly used flaps in head and neck reconstruction. In order to prevent permanent functional disabilities, a physical therapy program was organized. The anatomy, physiology, and kinesiology of the shoulder muscles that are commonly used in myocutaneous flaps are reviewed. Their functional deficit and compensation are described. Exercise protocols for each group of muscles were developed. Prevention of postoperative "frozen shoulder" and the avoidance of tension and torsion of the transposed muscle pedicle are important during the immediate post-operative course. Strengthening the agonistic muscles and learning to use them correctly, in order to regain full range of motion, are the main long-term goals.
Actinomycotic granuloma masquerading as an infraorbital nerve neoplasm.
Actinomycotic infections of the head and neck region are rare and frequently present a confusing clinical picture. We document a case of actinomycosis that simulated a neoplasm of the infraorbital nerve, both clinically and surgically. To the best of our knowledge, this is the first report of actinomycosis involving this nerve. Correct diagnosis of actinomycotic infection in the head and neck relies most heavily on clinical suspicion. It is, therefore, imperative for the head and neck surgeon to be familiar with the etiology of this infection and its various modes of presentation as well as its appropriate management.
Carcinoma of the uvula and midline soft palate: indication for neck treatment.
According to common classification and staging systems, tumors of the uvula and soft palate are included in the group of oropharyngeal cancers. As such, the same staging systems apply and therapeutic decisions are made accordingly. Our experience with small tumors of the uvula and midline soft palate has shown that these common rules may not apply in these anatomical sites. A multicenter retrospective study was performed to examine the aspects of presentation and clinical course of tumors of the uvula. Only patients with small tumors, less than 2.0 cm in diameter, were included. Twenty-three cases were reviewed. Eleven (47.8%) patients had clinical or radiologic evidence of neck disease on presentation. Five of 12 (41.7%) patients who presented with negative neck were found eventually to have neck disease. Eight patients had cervical recurrence. Only one patient had local recurrence. We suggest that attention may need to be directed to the treatment of the neck of all tumors of the uvula and midline soft palate, regardless of size.
Streptococcal gangrene and purpura fulminans.
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Periosteum-wrapped alloplasts for reconstructive head and neck surgery.
Methylmethacrylate is widely used by orthopaedic and neurosurgeons for bone reconstruction. However, there is not much information about the interaction between methylmethacrylate and soft tissues. A prospective canine study was designed to examine the morphologic and histologic aspects of the use of methylmethacrylate with soft tissues. A previous study has shown that by wrapping the prosthesis with dense connective tissue, such as periosteum, better results can be achieved in tracheal reconstruction. Ten wrapped and 10 unwrapped pieces of methylmethacrylate were implanted in dogs, and were removed at intervals of 2, 4, 8, 11 and 16 weeks. Gross morphologic and histologic examination showed better incorporation of the wrapped implants into the surrounding soft tissues with less inflammation when compared to the unwrapped pieces. We suggest that connective tissue wrapped methylmethacrylate alloplasts are better tolerated by surrounding soft tissues and may lead to improved reconstructive results.