Biomedical subjects
Publications and source records attributed to H F Biller.
We encountered an unusual case of a mucocele arising from the submandibular gland. Among the limited number of cystic salivary gland neoplasms reported in the literature, there have been no reports, to our knowledge, of a similar cystic lesion. The unique characteristics of this mass permitted definitive diagnosis by computed tomographic scanning.
A new procedure corrects glottic incompetence in patients following extended horizontal partial laryngectomy. The procedure consists of making vertical, cartilaginous cuts to collapse one half of the cricoid cartilage to a fixed midline position. In selected patients, this procedure has been demonstrated to permit decannulation where conventional methods have failed.
A rare case of a carotid body tumor that completely occluded the internal carotid artery is presented. To our knowledge this is only the second such case documented by angiography. In the present computed tomography era, the role of vascular imaging in these tumors is discussed and the varied clinical presentations of these neoplasms are reviewed. The confusion between the locally malignant behavior of some of these lesions and the accepted definition of a malignant carotid body tumor is discussed.
The authors have studied the effects of various circulatory settings on flap survival. The dog model was used to study the survival of venous flaps without arterial inflow both as island and free flaps. Venous flaps were compared with arterial flaps without venous outflow and standard island flaps with arterial inflow and venous outflow. Attempts were made to study their vascular morphology and blood gas changes. The venous flaps without arterial inflow survived with normal hair growth and wound healing, as did the standard island flaps. These observations suggest that capillary diffusion can occur without the continuous flow of blood through a capillary. Several possible mechanisms to explain survival of the venous flaps without arterial inflow were discussed. These observations could be important in providing an animal model to study microcirculation and a possible new area for microsurgical transfer of a skin flap.
Twenty-eight patients had combined conventional drip infusion CT scans. The information about the anatomic location of the lesion, its configuration, its cross-sectional appearance, its vascularity (as determined by dynamic signature curves), and its clinical presentation were considered as a single overall unit. This diagnostic approach allowed a diagnosis to be made on virtually all of these enhancing lesions without resorting to either a digital venous imaging study or angiographic procedure. In 17 of these cases, such an invasive second procedure was performed either to confirm the CT impression as part of this study or as part of a therapeutic embolization procedure.
Combined conventional drip infusion-dynamic CT scanning was performed on 28 patients with clinically discovered neck or parapharyngeal space masses. Seventeen of these also had digital venous study or angiographic studies either to confirm the CT diagnosis or as part of an embolization procedure. The studies indicate that the initial portion of the dynamic scan curve can be characteristically classified as either an arterial, venous, or hypovascular signature curve. The current ideas of how these curves are generated, the specific appearance of these signature curves, and the types of pathologic conditions that correlate with each curve are discussed.
We report on the appearance of parathyroid, thyroid, and cervical thymic cysts on computed tomography (CT) scans. The differential diagnostic considerations include thyroglossal and branchial cleft cysts, cystic hygromas, primary and metastatic tumors, dermoids, teratomas, choristomas, tracheoesophageal and cervical bronchogenic cysts, as well as cystic neuromas, abscesses, and lipomas. Most cannot be differentiated using CT alone and require clinical observations, laboratory testing, and surgical and histologic findings for definitive diagnosis. Our experience with these rare lesions is reported, and the differential diagnoses are discussed.
Unilateral laser excision of the thyroarytenoid muscle combined with suture lateralization of the vocal ligament was successful in 13 of 14 patients (93%) treated for bilateral abduction immobility sufficient to require tracheotomy. Among the four patients requiring revision surgery, three had cricoarytenoid fixation and one had vocal cord paralysis. All patients had a satisfactory voice after surgery. The anesthetic management of laser microsurgery is discussed.
Explore the source record for details and available documents.
Localized laryngeal amyloidosis is a benign, rare tumor of the larynx. Six cases of laryngeal amyloidosis were evaluated and treated from 1967 through 1984. One case is that of an 8-year-old female: the youngest reported case. Therapy is directed towards surgical resection. The cases in this report had significant laryngeal involvement necessitating extensive surgery.
Tumors of the skull base with carotid artery involvement have heretofore required carotid ligation or been deemed inoperable. Two case reports are presented in which en bloc resection of malignant base of skull tumors included removal of a portion of the internal carotid artery. In the first case, the tumor was primarily in the parapharyngeal space and extended to the base of skull. Partial temporal bone resection was carried out to obtain exposure for carotid reconstruction. The second case involved an en bloc temporal bone resection for a recurrent, malignant, mixed tumor that had invaded the carotid canal. Revascularization was achieved in both cases by an autogenous, saphenous vein graft. The patients suffered no postoperative ischemic neurologic sequelae. These are the first known cases of a carotid bypass with distal anastomosis to the intratemporal portion of the internal carotid artery for a malignant base of skull neoplasm. The authors propose this procedure as an alternative to carotid ligation during surgery of tumors of the skull base requiring carotid resection.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Cystic hygromas most often occur in the neck in children and are benign lesions not associated with cranial nerve palsies. We present two cases in which a facial nerve paralysis was one of the presenting symptoms. The computed tomographic (CT) scans localized the lesions, suggested a diagnosis, and obviated angiography. Secondary otitis media and intraparotid invasion and hemorrhage were responsible for the reversible facial nerve palsies. We suggest that CT of the temporal bone, parotid bed, and neck is the diagnostic procedure of choice in children clinically suspected of having cystic hygroma as the cause of a facial nerve paralysis.
Orbital decompression is an excellent surgical procedure to relieve acute increased intraorbital pressure. The most commonly used approach is via a Caldwell-Luc incision. Far less often a lateral orbitotomy is used. The postoperative CT findings of these procedures are described. It is important to recognize these changes so that they are not mistaken for primary sinus and orbital lesions.
Surgical and CT examinations of 104 patients, each of whom presented with a parapharyngeal space mass, has resulted in the development of an updated CT protocol designed to provide a preoperative diagnosis. When dynamic scanning is used, diagnostic angiography or digital venous imaging (DVI) can be avoided in almost all of these cases. A specific preoperative diagnosis can be made in 88% of the patients and a limited differential diagnosis, which includes the final diagnosis, can be made in virtually all cases. The protocol and the problems encountered in differential diagnosis are presented. Evidence to suggest that minor salivary gland benign mixed tumors may arise in salivary rest tissue, rather than pharyngeal mucosal glands, is also presented.
To evaluate the reliability of frozen section diagnosis we reviewed a series of 1146 consecutive frozen sections performed during a 5-year period. The frozen section diagnosis was then compared to that found on paraffin section and the results categorized into 12 regions in the head and neck. We found an overall reliability of 96%. The total percentage of false positive and false negative results were 0.35% and 3% respectively. Frozen section diagnosis was most accurate on the submandibular gland (no errors), nose and paranasal sinuses (no error), followed by the thyroid gland (0.8% error). Areas in which frozen section diagnoses were least accurate included the nasopharynx (12.5% error) and the oropharynx (8.7% error). We conclude that frozen section diagnosis is highly accurate in most regions of the head and neck.
A series of 15 patients undergoing total glossectomy for advanced carcinoma of the tongue was analyzed with regard to operative management, oral reconstruction, rehabilitation of deglutition and speech, and survival. While patients often underwent elective total laryngectomy to prevent aspiration previously, a method of laryngoplasty has now been devised that permits retention of the larynx with preservation of swallowing and speech. This technique of laryngoplasty may be used for the management of chronic aspiration of any cause.