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Biomedical subjects

H F Biller

Publications and source records attributed to H F Biller.

At least 91 records · Page 5Linked to original sources
PubMed1990

Reinnervation of the canine posterior cricoarytenoid muscle with sympathetic preganglionic neurons.

This experiment investigated the reinnervation of the canine posterior cricoarytenoid (PCA) muscle with preganglionic neurons of the sympathetic nervous system. Six dogs had their right recurrent laryngeal nerve (RLN) sectioned. Four of these dogs had the sympathetic cervical trunk (SCT) implanted into the right PCA muscle, and the two remaining dogs served as denervated controls. Four months later all dogs underwent videolaryngoscopy, electromyography, and electrical stimulation of the SCT. The PCA muscles were excised, sectioned, and stained for glycogen and ATPase. All four experimental PCA muscles demonstrated electrically evoked abduction and tonic electromyographic activity. In two of the specimens, staining (ATPase and PAS) revealed areas of reinnervation with fiber type grouping and glycogen depletion. These results are consistent with the successful reinnervation of the PCA muscle. Further refinement of this technique could be of benefit to patients with bilateral vocal cord paralysis.

Adrenergic Fibers↗
PubMed1989

The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases.

Microvascular free tissue transfer techniques using composite flaps are the most reliable method for the combined bone and soft-tissue reconstitution of oromandibular defects. Functional oromandibular reconstruction requires that maximum tongue mobility be achieved along with dental prosthetic rehabilitation. The internal oblique-iliac crest osseomyocutaneous microvascular free flap was used in 20 patients for oromandibular reconstruction. The internal oblique muscle, based on the ascending branches of the deep circumflex iliac artery and vein, was used to resurface mucosal defects of the oral cavity and pharynx. The iliac bone, because of its length, width, and natural contour, is the best source of vascularized bone for mandibular reconstruction. The improved soft-tissue component of this composite flap markedly improved the functional results. Reconstruction failed in one patient. Eleven patients underwent dental rehabilitation with either a tissue-borne or osseointegrated implant-borne denture. Follow-up of longer than one year showed minimal donor site morbidity.

Adult↗
PubMed1989

Geometry of the vascular pedicle in free tissue transfers to the head and neck.

Traditionally, the most important parameters for success in free tissue transfer have been expertise in performing small vessel anastomoses, meticulous donor site dissection, and careful recipient vessel preparation. It has been our experience, in free flap transfers for head and neck reconstruction, that a very crucial, often unrecognized, parameter is the geometry of the vascular pedicle. This term encompasses the three-dimensional positioning of the nutrient vascular pedicle as well as vessel tension and redundancy. The ideal axis for the lie of the vascular pedicle in the neck is in the longitudinal direction. This configuration helps to eliminate the kinking of the pedicle that is observed with side-to-side movements of the head. The primary objectives in recipient vessel selection are to use a healthy artery and vein and to perform the anastomoses in a location that provides easy access for the surgeon and assistant. Recipient vessel selection is also a major determining factor in the achievement of the desired pedicle geometry. We believe that the transverse cervical artery and the external jugular vein are the best recipient vessels for free tissue transfer. The reasons for this selection, as well as technical details to improve pedicle geometry, are discussed in depth. Representative cases that demonstrate pitfalls in vascular pedicle geometry are presented.

Adult↗
PubMed1989

Free flap design in head and neck reconstruction to achieve an external segment for monitoring.

Postoperative monitoring of the perfusion of a free flap used in head and neck reconstruction is vitally important in achieving a favorable outcome. There are a wide range of methods that have been advocated to assist in this surveillance. However, at this time, there is no one technique that is universally efficacious in detecting early arterial and venous occlusion. In our experience, the most reliable means of monitoring has been the clinical assessment of flap color, capillary refill, tissue turgor, and bleeding. To assess these parameters, a portion of the flap must be accessible for observation. When the defect is buried, as is often the case in head and neck reconstruction, flap design is critical to achieve a reliable external segment for monitoring. The methods for exteriorizing a well-vascularized portion of tissue in the most commonly used flaps are described.

Gastric Mucosa↗
PubMed1989

Superior rhinotomy for en bloc resection of bilateral ethmoid tumors.

Ethmoid sinus neoplasms have traditionally been associated with a poor prognosis. Their advanced stage at presentation and proximity to vital structures have made them difficult to treat. Bilateral ethmoidal tumors impinging on or actively infiltrating the cribriform plate have been particularly resistant to cure. We have used the superior rhinotomy in conjunction with a bifrontal craniotomy in three patients to effect an en bloc resection of both ethmoid labyrinths and cribriform plate in an oncologically acceptable fashion.

Adenocarcinoma↗
PubMed1989

Psychiatric consultation on an otolaryngology liaison service.

Otolaryngology patients (especially those with tracheostomies) present a significant challenge to psychiatrists from both a diagnostic and therapeutic standpoint. To date, no study has been made of psychiatric disorders among this important group of patients. At the Mount Sinai Medical Center, a liaison psychiatrist has been involved with a specialized otolaryngology cluster unit since 1979. Using a 384-item computerized database protocol developed at Mount Sinai, data on 139 otolaryngology patients were recorded and compared with 1662 "Other" inpatient psychiatric consultations on the medical and surgical services during 1980-1987. The otolaryngology patients as a group were more likely to be male (p = 0.011), married (p = 0.001) and employed (p less than 0.001). Cancer was the most common medical disorder, and the average level of stress as reported on DSM-III's Axis IV (5.1, severe) was significantly greater (p less than 0.0001) than that for the "Other." The most common psychiatric response was adjustment disorder (36%). The length of stay of those ENT patients seen in psychiatric consultation was 26.4 days, in contrast to 11.1 days for all ENT patients. However, the length of stay of those patients on ENT receiving a psychiatric consultation was not different from the "Other" psychiatric consultation cohort (26.3 days). Despite the higher level of stress, the incidence of significant psychiatric morbidity was lower for the ENT cohort. The primary effect of the liaison psychiatrist was to lower the threshold for case identification that enhanced the referral rate on the ENT unit.

Adaptation, Psychological↗
PubMed1989

The internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction.

The iliac crest osseocutaneous free flap, based on the deep circumflex iliac artery and vein, was a landmark contribution to head and neck reconstruction. Two major problems associated with this flap are the lack of flexibility in placement of the skin paddle with relation to the bone graft, and the excessive thickness of the skin paddle when used in the oral cavity. The scapular osseocutaneous flap has achieved recent popularity for mandibular reconstruction based, in part, on its thin skin paddle that is easily positioned in three dimensions with relation to the bone graft. However, the segment of bone that can be harvested from the iliac crest is superior to that of the lateral border of the scapula because of its increased length, thickness, and natural contour. In 1984 the internal oblique free muscle flap based on the ascending branch of the deep circumflex iliac artery was described for use in reconstruction of the extremities only. The authors introduce the application of the internal oblique-iliac crest osseomyocutaneous free flap for mandibular reconstruction. The mobility of the internal oblique muscle with relation to the iliac bone graft has permitted its use for inner mucosal defects or outer cutaneous defects when covered with a skin graft. Following denervation atrophy, the muscle component becomes a thin, pliable piece of tissue that easily conforms to three-dimensional defects of the head and neck. This increased flexibility, the established benefits of the iliac bone, and the ease of intraoperative positioning for a two-team approach make this composite flap an outstanding tool for mandibular reconstruction. Two representative cases and a detailed description of flap harvesting, insetting, and donor-site closure are presented.

Carcinoma, Squamous Cell↗
PubMed1989

Benign and malignant sinonasal lesions with intracranial extension: differentiation with MR imaging.

Most sinonasal lesions that extend into the anterior cranial fossa are malignant tumors. However, benign inflammatory polypoid disease can also rarely be manifested in this manner. Fourteen surgically proved cases of such benign and malignant disease were studied with magnetic resonance (MR) imaging. The appearances of the benign and the malignant lesions were quite different and allowed the seven chronic polypoid lesions to be distinguished from the tumors. The benign lesions had nonhomogeneous appearances on MR images due primarily to varying degrees of free-water resorption and protein concentration. The tumors had primarily homogeneous low-to-intermediate signal intensities due to their highly cellular composition.

Carcinoma, Squamous Cell↗
PubMed1989

High-grade malignancies of the parotid gland: identification with MR imaging.

Most tumors in the parotid gland are either benign neoplasms or low-grade malignancies. The magnetic resonance (MR) images of 29 patients with such tumors were reviewed. These masses typically have low T1-weighted and high T2-weighted signal intensities and have clearly defined margins. The signal characteristics presumably reflect the serous and mucinous products that are characteristic of these lesions. The MR images of six patients with aggressive parotid tumors were reviewed and correlated with operative and pathologic findings. These high-grade parotid lesions are uncommon, usually have poorly defined margins, and have low T1- and T2-weighted signal intensities. These signal characteristics presumably reflect the lack of serous and mucinous products, the high mitotic ratio, and the high nuclear to cytoplasmic ratios that are characteristic of these lesions. The authors conclude that the findings of these tumors on MR images are characteristic and should be suggestive of their diagnosis. The preoperative diagnosis of these high-grade tumors allows a more radical surgical treatment to be well planned before surgery. The primary differential diagnoses of these aggressive tumors with MR imaging include fibrosis and sialolithiasis.

Humans↗
PubMed1989

Glomus vagale tumors.

Eighteen patients with glomus vagale tumors treated by surgical resection are reviewed. Computed tomography and magnetic resonance imaging are diagnostic. Arteriography is used to determine multicentric tumors. The incidence of multicentric tumors in this series was 40%. Adequate surgical exposure is necessary for removal of the tumor without injury to the carotid artery. Vagal paralysis was present in all cases postoperatively and resulted in dysphagia and aspiration. Cricopharyngeal myotomy and Teflon injection aided in rehabilitation of deglutition. Curability with surgery is high, but radiation therapy is recommended in selected patients.

Adult↗
PubMed1989

Transmucosal electrical stimulation of laryngeal muscles.

A new technique is described that enables discrete activation of individual laryngeal muscles by electrical stimulation across overlying mucosa. In 15 dogs, we defined six distinct motor points by transmucosal stimulation at 3 mA while observing the resulting characteristic position of the arytenoid and true vocal cord. Five dogs were then paralyzed with succinylcholine in order to simulate bilateral vocal cord paralysis. Application of a 3-mA stimulus at each motor point yielded no motion of the cords, but when the current was increased to 20 mA, characteristic responses were elicited. In five other dogs, botulinum toxin was injected directly into laryngeal muscles. Stimulation was used in an attempt to quantify the degree of neuromuscular blockade. In the last group of five dogs, we simulated cricoarytenoid arthritis by scarifying the joint. The extent and nature of the joint's impairment could be demonstrated by stimulation. Transmucosal stimulation appears promising as a clinical technique for correlating particular vocal cord movements and thresholds of activation with specific laryngeal disorders. Additionally, such a technique may be useful in clarifying how each laryngeal muscle acts upon the cricoarytenoid joint.

Animals↗
PubMed1989

Complications following rhinotomy. Review of 148 patients.

For the period 1974 to 1988, 148 patients undergoing 162 rhinotomies at The Mount Sinai Medical Center, New York, for a variety of benign and malignant neoplasms were reviewed with particular attention to postoperative complications. The effects of certain predisposing factors such as prior rhinotomy, lateral versus total rhinotomy, additional medial maxillectomy or craniofacial resection, and preoperative irradiation or nasal bone erosion are discussed. In addition, a surgical technique of rhinotomy with medial maxillectomy is presented that includes maneuvers designed to prevent these complications.

Female↗
PubMed1989

Overcoming laryngospasm by electrical stimulation of the posterior cricoarytenoid muscle.

The intent of this study was to demonstrate that the technique of transmucosal electrical stimulation of laryngeal muscles may be of clinical use in airway management. Specifically, its ability to overcome laryngospasm was evaluated. Laryngospasm was induced in eight tracheotomized dogs by hyperventilating each dog, and then applying 0.1 M ammonia to the laryngeal mucosa while administering continuous positive airway pressure (CPAP). Laryngospasm was defined by steady apposition of the vocal cords, massive electromyographic activity in the laryngeal adductor muscles, absence of such activity in the posterior cricoarytenoid muscle (PCA), and intraglottic pressure greater than 80 mm Hg. Upon transmucosal application of 10 mAmp current to the PCA bilaterally, the vocal cords abducted for the duration of the stimulus. We theorize that overcoming laryngospasm by electrostimulation involves a reflexive inhibition of the laryngeal adductors. This study provides an objective model for laryngospasm, and demonstrates that electrical manipulation of the vocal cords may have clinical relevance.

Animals↗
PubMed1989

Diverticulopexy and cricopharyngeal myotomy: treatment for the high-risk patient with a pharyngoesophageal (Zenker's) diverticulum.

Although diverticulopexy for the treatment of Zenker's diverticulum was described more than 75 years ago, its use has been infrequently reported in the surgical literature. Between 1974 and 1987, thirty-two patients manifested dysphagia caused by a pharyngoesophageal diverticulum. Twelve patients underwent diverticulopexy with cricopharyngeal myotomy, whereas the others had a one-stage resection of the diverticulum with myotomy. Complications of diverticulectomy were rare, but included an instance of esophageal leak, which responded to conservative therapy. Despite this low complication rate, diverticulopexy with myotomy was used in patients who possessed risk factors that made them unsuitable candidates for diverticulectomy. These factors included a debilitated state from effects of the diverticulum, a history of postsurgical complications, multiple medical illnesses, advanced age with inability to ambulate, and insulin-dependent diabetes mellitus. A nasogastric tube was not necessary after diverticulopexy. This allowed oral intake on the first postoperative day, immediate ambulation, and a shorter hospital stay. Objective recurrence occurred in one patient who underwent diverticulopexy and myotomy caused by manipulation of the sac during a subsequent surgical procedure, but significant dysphagia did not occur. Thus, although diverticulectomy has proved to be a relatively safe procedure, diverticulopexy with cricopharyngeal myotomy is recommended for high-risk patients in whom potential complications from diverticulum excision and prolonged hospitalization could be devastating.

Adult↗
PubMed1989

Primary placement of osseointegrated implants in microvascular mandibular reconstruction.

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations in which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1989

Isolated sphenoid sinus disease.

Forty-three cases of isolated sphenoid sinus disease were reviewed. In 33 cases, headache was a presenting symptom. Seven of 29 cases of inflammatory disease and nine of 13 patients with tumors of the sinus presented with cranial nerve findings. When nonspecific visual disturbances were eliminated, two of 29 cases of inflammation and eight of 13 cases of tumors of the sphenoid sinus had cranial nerve deficits. Ten of 12 CT scans performed on patients with tumors of the sinus demonstrated bony erosion or perisinus extensions. This was not found in any of the 27 scans of patients with inflammatory disease. A thorough cranial nerve examination and a CT scan should be performed early in patients who present with vague and unusual headaches.

Adolescent↗
PubMed1989

Inverted papilloma: an analysis of 87 cases.

A group of 87 patients with inverted papilloma, a locally aggressive benign sinonasal tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumor's local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy and en bloc resection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy. Among our ten patients treated with conservative surgery, there was recurrence in one case (10%). Seventy-five patients underwent rhinotomy and medial maxillectomy, with seven cases recurring (9%). The overall recurrence rate was 9% (8 of 87). Among the 87 cases, 5 patients had carcinoma (6%). The literature is reviewed and the principles of case selection and management are discussed.

Adolescent↗