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Biomedical subjects

H F Biller

Publications and source records attributed to H F Biller.

At least 163 records · Page 9Linked to original sources

Unusual and fatal complications of rhinoplasty.

Serious complications of cosmetic rhinoplasty are extremely rare. However, awareness of their existence is essential so that the surgeon can minimize the potential hazards of the procedure. This demands a careful preoperative examination, a meticulous intraoperative technique, and a careful postoperative monitoring of the patient. The complications of rhinoplasty have been classified into infectious, traumatic, hemorrhagic, systemic, and miscellaneous groups. The pertinent literature is reviewed, as well as cases of inclusion cyst formation, disturbance of eye closure, local activation of systemic disease, and fatalities from intracranial injury with brain laceration and pneumocephalus.

Adolescent↗

Sphenoid sinus pneumocele. Report of a case.

Only five previous paranasal sinus pneumoceles have been described and all occurred in the maxillary antra. To our knowledge, this is the first case report of a sphenoid sinus pneumocele. Clinically it was seen as recurrent episodes of left-sided blindness occurring only during airplane flights. The roentgenographic findings and the differential diagnosis are discussed.

Air↗

Tracheal reconstruction with a pleuroperiosteal flap.

Reconstruction of extensive tracheal defects remains a difficult surgical problem. In many experiments restoration of tracheal mucosa by autogenous or homologous soft tissue grafts has usually failed because of rejection or tracheal obstruction. This experimental work employed a two-stage surgical procedure that allowed reconstruction of extensive circumferential full-thickness defects of the trachea. Stage I involved the creation of a vascularized pleuroperiosteal flap that was formed into a rigid tube around a Silastic stent. Stage II consisted of creation of a full-thickness circumferential tracheal defect and repair with the flap in those animals in which a suitable rigid tube had been formed. The results of these experiments argue strongly that a vascularized composite pleuroperiosteal flap can produce an adequate tracheal replacement.

Animals↗

The role of conservative surgery in the management of inverted papilloma.

A group of 31 patients with inverted papilloma were treated at the Mount Sinai Medical Center. There were no multicentric cases, and one patient had an associated malignancy. A conservative procedure consisting of intranasal or transantral sphenoethmoidectomy was selectively performed in 8 patients with limited lesions. No recurrences were observed in this group after a mean follow-up of 2 years. Lateral rhinotomy with medial maxillectomy and en bloc resection of the ethmoid labyrinth was performed in 23 other patients. One recurrence appeared in this group, members of which were followed a mean of 3.8 years. Radiographic evaluation by multidirectional polytomography and CT scanning permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor excision.

Adolescent↗

Cervical tracheoesophageal fistula.

Four unusual cases of cervical tracheoesophageal fistula (TEF) are presented. The incidence, diagnosis and treatment of cervical TEF are discussed. Surgically, if the location is above the level of T2 a cervical approach may be utilized. The cases included a cervical "H" type TEF occurring in an adult. Congenital "H" type TEFs frequently occur in the neck. An adult presenting with a cervical "H" type TEF, having as an infant undergone repair of a thoracic TEF, is unique. Two layer closure of both trachea and esophagus with strap muscle interposition is preferred. The other cases include a TEF secondary to metastatic breast carcinoma, one associated with a stomal recurrence, and an acquired TEF following laryngectomy. Metastatic breast carcinoma resulting in a TEF is reported for the first time. Malignant TEF's are usually secondary to carcinoma of the esophagus, lung, or thyroid. Best palliation is achieved either by esophageal intubation, by colon bypass, or by gastric pull-up with esophageal exclusion. Stomal recurrence with TEF following laryngectomy is treated with one-stage resection and reconstruction with a pectoralis major myocutaneous flap and gastric pull-up. A patient 5 years post-laryngectomy illustrates an acquired non-malignant cervical TEF, a category which includes fistulas due to trauma, tracheotomy, or endotracheal tubes, instrumentation, and inflammatory disease. Prompt surgical closure as in congenital cases is the treatment of choice although select cases require medical therapy.

Adult↗

Maxillary sinusitis as a cause of cheek swelling. A rare occurrence.

Inflammatory swelling of the cheek is an extremely rare complication of antral sinusitis. When such swelling occurs, diagnostic search for a specific coexisting condition must be made. The differential diagnosis includes a postsurgical or posttraumatic defect in the anterior antral wall; an unusual fungal, granulomatous, or neoplastic disease of the maxillary sinus; dental infection; or dacryocystitis.

Adult↗

Liaison psychiatry-otolaryngology rounds.

In an attempt to define and resolve patient and staff needs with regard to the psychological, social and economic problems in clinical otolaryngology, psychiatry/otolaryngology rounds were established in the Department of Otolaryngology 18 months ago. These weekly rounds have contributed greatly to improved patient care and better physician-nurse relations. They have also served a significant educational role for residents, medical students and other members of the patient care team. At present the rounds are attended by the inpatient nursing staff, 2 physicians, 6 residents, 3 medical students, an otolaryngologic social worker and the liaison psychiatrist. The meeting begins with a 10 minute discussion and review of current problems among the staff. Attention is then directed to the patient who will be interviewed for the day. The medical and social history are presented. Then the patient is brought in and interviewed in a non-stressful session for 20 minutes. After the patient leaves, the staff discusses the problems which the patient has encountered or poses to them, and the conference participants formulate an appropriate therapeutic plan. Among the problems which have been discussed are noncompliance, organic mental syndromes, hypochondirasis, depression, death and dying, disfigurement, loss of bodily function, and chronic pain. For those patients in whom further psychiatric evaluation and treatment are deemed necessary, the psychiatrist becomes an active participant in their clinical care.

Adult↗

An analysis of 133 pectoralis major myocutaneous flaps.

Our experience with 133 consecutive pectoralis major island myocutaneous flaps in 126 patients is reviewed. The incidence of complications has been relatively low. Among the 133 flaps used in the head and neck area, 11 flaps (8 percent) failed to accomplish the intended purpose and required secondary repair. The pectoralis major myocutaneous flap with its abundant tissue and excellent blood supply and anatomic proximity provide a simple, reliable, and versatile method of primary reconstruction of various head and neck defects.

Adult↗

The early detection of antral malignancy in the postmaxillectomy patient.

A protocol was developed for the radiographic evaluation of the postmaxillectomy patient that called for a six- to eight-week postoperative, baseline computed tomography (CT) scan, followed by CT scans at four- to six-month intervals for at least three years. This protocol allowed for an early, more complete assessment of clinically discovered recurrences and the detection of clinically occult recurrences in three out of 18 patients who followed the protocol. The CT appearance of the normal partial and total maxillectomy is discussed, as well as the focal nodular soft-tissue findings suggestive of recurrent disease.

Follow-Up Studies↗

Experience with immediate and delayed mandibular reconstruction.

The functional disability and cosmetic deformity after jaw and neck dissection can be very severe due to soft tissue and mandibular loss. Reconstruction of the mandible alone without soft tissue coverage can be complicated with prosthetic exposure, infection and, finally, rejection. We attempted to reconstruct the mandible at the time of tumor resection in a group of patients, using titanium mesh with marrow, rib, scapular spine, and clavicle. We used myocutaneous flaps in order to obtain intraoral coverage of the mandibular grafts. In a second group of patients, delayed reconstruction of the jaw was performed 6 months to 2 years after tumor resection. Titanium mesh prostheses were used for reconstruction of the mandible in conjunction with myocutaneous flaps for soft tissue augmentation. Osteomyocutaneous flaps were also used. The results and complications in 54 patients are presented.

Bone Transplantation↗

Breast carcinoma metastasizing to the cervical esophagus.

Tumor metastasis to the esophagus is rare. While breast carcinoma metastasizing to the thoracic esophagus has been described, there are no reported cases of spread to the cervical esophagus. Two patients, having had mastectomy for breast carcinoma several years previously, presented with cervical esophageal obstruction secondary to metastatic disease. Tumor resection with cervical esophageal reconstruction is advocated for palliation. The details of the history, diagnosis and surgical technique are presented.

Adult↗

A new technique for wide-field exposure of the base of the skull.

Surgical exposure of the extracranial surface of the floor of the middle and posterior cranial fossa is difficult using the available techniques of skull base surgery. Considering this problem, cadaver dissections were performed and a new approach to the skull base developed. The parapharyngeal space is entered through a transcervical incision combined with a median labiomandibulotomy. This allows control of the major neurovascular structures up to their entrance at the skull base. The Eustachian tube is divided between the base of the skull and Rosenmüller's fossa. This allows the pharynx to be detached from the skull base and retracted to the contralateral side, exposing both the clivus and upper cervical vertebrae. Exposure of the posterior nasal cavity and body of the sphenoid is obtained by a transpalatal approach. The sphenoid sinus can be entered and, if necessary, the dissection extended to the pterygomaxillary space and anterior skull base. Herein, this technique is described in detail, as are the various disease states in which it may be indicated and its application in a representative clinical case.

Cadaver↗

The nonspecificity of the antral bowing sign in maxillary sinus pathology.

Although bowing of the posterior antral wall occurs most commonly with juvenile angiofibroma, it can occur with any slow growing noninvasive lesion involving the retromaxillary region. Cases of schwannomas, a lymphoepithelioma, and a fibrous histiocytoma are presented as examples of the nonspecificity of the antral bowing sign.

Adult↗

Some CT findings in occult thyroid disease.

The hyoid-laryngotracheal complex (HLTC) is a mobile, flexible unit that can be deviated by adjacent neck masses. We present two cases of thyroid disease in which a clinically "silent" lesion rotated the HLTC to an abnormal position. The abnormal location of these normal structures was clinically mistaken for the primary pathology. The essential role that computed tomography plays in the workup of these unusual cases is discussed.

Adenoma↗