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Biomedical subjects

H H Dedo

Publications and source records attributed to H H Dedo.

At least 37 records · Page 2Linked to original sources
PubMed1983

Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia.

Recurrent laryngeal nerve section for spastic dysphonia was first performed in 1975 because prior forms of treatment had failed. Virtually every patient has had a detailed postoperative follow-up which includes a tape recording and a self-assessment questionnaire. The majority of patients remain free of spasticity at this medium-term follow-up. In some, spasticity recurred with less than preoperative severity. A small percentage of patients have a persistent breathy phonation. The first group is treated with vocal fold lateralization procedure using the CO2 laser; the second, with Teflon. When needed, voice therapy is also given. This paper provides a basis for diagnosis, indications for surgery, primary and secondary surgical techniques, encountered problems, and medium-term follow-up results.

Communication↗
PubMed1983

Problems with surgical (RLN section) treatment of spastic dysphonia.

For over a century spastic dysphonia--a disorder of phonation--remained enigmatic and highly resistant to treatment. Recurrent laryngeal nerve surgery provides patients with elimination of their spastic dysphonia symptoms. Maintenance of long-term surgical results has been a problem in some cases. Management of this problem and of problems in the diagnosis and treatment of patients with spastic dysphonia are discussed. The observations and conclusions are based on almost 300 patients examined and/or treated for this disorder.

Humans↗
PubMed1982

The significance of laryngeal edema following radiotherapy of carcinoma of the vocal cord.

Laryngeal edema persisting for more than three months following radiotherapy developed in 38 of 247 (15.4%) patients irradiated for carcinoma of the vocal cord. In 17 (44.7%) of these patients, the laryngeal edema was associated with persistent or recurrent disease, although only 25.4% of the patients with uncontrolled disease had laryngeal edema. The incidence of laryngeal edema was 13.1% for T1 disease, 23.8% for T2, and 21.4% for T3 and T4 disease. It increased significantly with increase of minimum tumor dose greater than or equal to 7000 rads or with NSD greater than 1900 ret, being 46.2% with minimum tumor dose greater than or equal to 7000 rad and 13.7% with minimum tumor dose less than 7000 rad and 43% with NSD greater than 1900 ret and 17% with NSD less than or equal to 1900 ret. It also increased with increase of field size, being 13.4% with field sizes less than 6.0 x 6.0 cm2, and 24.4% with field sizes greater than or equal to 6.0 x 6.0 cm2. When laryngeal edema is progressive and unresponsive to conservative measures, multiple biopsies should be performed to establish the presence of persistent or recurrent disease before salvage surgery is attempted. However, if it is mild, stable, no visible recurrence develops, and especially if it is limited to the arytenoids, no biopsy should be attempted because of the risk of inducing laryngeal necrosis.

Adult↗
PubMed1981

Treatment of carcinoma of the vocal cord. A review of 20 years experience.

At the University of California, San Francisco, 323 patients were treated for carcinoma of the vocal cord between January 1956 and December 1975. Patients with early T1 or T2 lesions were treated with radiotherapy or conservative surgery. Patients with T3 or T4 lesions were treated with total laryngectomy, radiation alone, or combined therapy. Of the 247 patients treated with definitive radiotherapy, initial control of the primary lesion was achieved in 100% of T1S, 80% of T1, 52% of T2, and 50% of T3 and T4 lesions. Surgical salvage of radiation failures was 86%, giving ultimate control rates in this group of 100% for T1S, 97% for T1, 91% for T2 and 64% for T3 and T4. Involvement of the anterior commissure did not significantly affect local control or survival rates of the irradiated patients. Voice quality was satisfactory in 95% of controlled patients. Surgery alone was used as the primary treatment modality in 63 patients, with ultimate local control achieved in 75% of T1S, 83% of T1, 85% of T2, 81% of T3 and T4 lesions. Planned combined therapy was successful in 9/13 patients in whom it was used. The overall 3 and 5 year actuarial survival rates were 84% and 77% respectively corresponding determinate survival rates were 90% and 86%.

Aged↗
PubMed1981

Ophthalmic surgery in malignant exophthalmos.

Malignant exophthalmos or the ophthalmic component of Graves' disease is a functionally impairing and cosmetically deforming disorder of orbital tissue, separate from the sympathetic effects of thyrotoxicosis. The deposition of immune complexes of thyroglobulin and its antibodies within orbital muscles results in progressive exophthalmos, ophthalmoplegia, chemosis, and lid fullness. Increasing intraorbital edema and optic nerve tension may produce irreversible retinal ischemia. If unresponsive to medical treatment, patients exhibiting increasing loss of visual acuity are therefore candidates for emergency surgery. Early attempts at surgical correction of the mechanical aspect of Graves' ophthalmopathy were unsuccessful. The current technique of transantral orbital decompression, when done before extreme advancement of the ocular disease, is successful and meets the following objectives: It restores visual loss and prevents further deterioration of visual acuity, protects the cornea, restores extraocular muscle movements, decreases intraorbital pressure, produces a satisfactory cosmetic result, and avoids serious complications. Patients with persistent extraocular muscle imbalance or lid lag may ultimately require oculoplastic surgery.

Diagnosis, Differential↗
PubMed1980

Carcinoma of the larynx in childhood.

The unusual case of a 12-year-old boy with well differentiated in situ, and focally invasive squamous carcinoma of the larynx is reported, together with a review of the medical literature. In addition to this one, 54 cases of laryngeal carcinoma in children 15 years of age or younger have been reported since 1868. All were squamous except for one adenocarcinoma of a laryngeal minor salivary gland. Carcinoma of the larynx in children parallels that of adults in terms of squamous histology, predominantly vocal cord involvement, pattern of local spread, and response to treatment. However, the incidence of female patients is higher in childhood (40% of childhood cases vs. less than 10% of adult cases), and risk factors, except previous irradiation of papillomas, are rare. Although unusual, carcinoma of the larynx in children is probably more common than thought and the diagnosis should be considered in any case of a child with persistent hoarseness or cough.

Adolescent↗
PubMed1980

Surgical correction of the convex vocal cord after Teflon injection.

Teflon injection of paralyzed and bowed vocal cords has been performed since 1962. It has been generally accepted that nothing could be done if an excess is injected or a granuloma reaction within the cord occurs causing an early or late convex cord which projects across the midline. A technique is described to correct such convex cord problems and the results are given for 12 patients for whom corrective surgery was done.

Hoarseness↗
PubMed1980

Separation of the larynx and trachea for intractable aspiration.

Aspiration becomes an intractable problem for some patients who have lost normal neurological function of the glottis. Over the long term, a cuffed tracheotomy tube is inadequate. Several methods have been developed to relieve this problem surgically. These include the use of muscle flaps, tracheoesophageal anastomosis, and use of an epiglottic flap. In this paper, we discuss these previous surgical attempts to alleviate aspiration and present our own technique, which involves creation of a tracheostome and closure of the larynx at the level of the first tracheal ring. This has been used with success in three patients. we feel this technique is less complex and results in less surgical trauma to the larynx, important factors when dealing with critically ill patients. This technique is theoretically reversible by re-anastomosing the trachea to the cricoid cartilage after excising the first tracheal ring.

Adolescent↗
PubMed1979

Prevention of major and minor fistulae after laryngectomy.

Every Head and Neck surgeon has special techniques which he uses to get maximum rates of five-year survival and minimum fistula formation, especially major fistula and carotid rupture. The literature reflects a wide variation in the rate of fistula formation. We reviewed the senior author's prior 78 total laryngectomies and noted a fistula rate of 10.3% (6.4% minor fistulae and 3.9% major fistulae). We also reviewed contributing factors and discuss surgical techniques designed to minimize fistula formation.

Anti-Bacterial Agents↗
PubMed1978

Clinical aspects of spasmodic dysphonia.

The clinical features of 12 patients with spasmodic dysphonia are described. In 11 patients, the voice was strained, harsh, tight, and tremulous, and was low in volume and pitch. Speech, which was sometimes barely intelligible, was interrupted by irregular stoppages and catches of the voice; it required considerable effort, and was accompanied by facial grimacing. The dysphonia was part of a more widespread neurological disorder (idiopathic torsion dystonia) in one case, while it coexisted with blepharospasm in another, and with postural tremor in two. There was a buccolingual hyskinesia in another of these 11 patients, but this may have been related to her previous drug regime. In the twelfth patient, who had a familial tremor, the voice was characterised by marked breathiness, with intermittent aphonia. The disorder is probably due to a focal dystonia of the laryngeal musculature, and this would be consistent with the type of neurological disorders that were associated with it in our cases. Symptomatic benefit follows the therapeutic division of one of the recurrent laryngeal nerves, in selected cases.

Adult↗
PubMed1977

Cranial neuropathies in sinus disease.

To study the problem of cranial neuropathies in sinus disease the inpatient experience at the University of California, San Francisco, and San Francisco General Hospitals was reviewed. The incidence of cranial nerve involvement in acute and chronic sinus inflammations was low (8 percent and 4 percent respectively). The incidence in neoplastic disease of the sinuses was considerably higher (32 percent). Cranial neuropathies occurred in inflammatory disease more frequently when associated with mucopyocele, mucormycosis, and orbital cellulitis. In both inflammatory and neoplastic disease, when cranial nerve deficits occurred, there was a high predelication for sphenoid sinus involvement. Several instructive case histories are included. The important anatomy of the cavernous sinus region and of the orbital apex as it pertains to this problem is discussed.

Adult↗
PubMed1977

Results of integrated management of supraglottic carcinoma.

Between January 1957 and June 1974, 173 patients with carcinoma of the supraglottic larynx were treated by an integrated approach at the University of California in San Francisco. The policy was to use radiotherapy or surgery alone for Stage I and II disease, radiotherapy combined with either supraglottic laryngectomy or total laryngectomy for resectable Stage III and IV disease, and radiotherapy alone for advanced unresectable disease. Control of the disease in the primary site was achieved in 92% of T1a, 88% of T1b, 80% of T2, 79% of T3 and 56% of T4 lesions. Of the 36 patients with late Stage I and resectable Stages III and IV disease treated by combined preoperative radiotherapy and supraglottic or total laryngectomy, the primary lesion was controlled in 33 (92%). Recurrent disease in the primary site after radiotherapy alone, when detected early, was usually controlled by subsequent surgery, whereas recurrent disease after surgery was not controlled by radiotherapy. Preservation of a functioning vocal apparatus was achieved in 44% of the patients whose primary lesion was controlled. Control of cervical lymph node metastasis was achieved in 71% of N1, 38% of N2, and 25% of N3 disease. No disease recurred in the radically dissected neck which received preoperative radiotherapy. Radiotherapy also reduced the incidence of subsequent neck disease in patients without cervical lymph node metastasis initially from 23% to 14%.

Adult↗
PubMed1977

Pharyngogastrostomy for treatment of severe caustic stricture of the pharynx and esophagus.

Four cases of combined pharyngeal and esophageal stricture were managed by pharyngogastrostomy 4 months to 42 years after injury. The stomach was brought up to the neck via the posterior mediastinum after the esophagectomy. A thoracotomy was not used. The results were suprisingly good in 3 patients followed to 3 years. A fourth patient died 6 months after the operation. In those patients benefiting from the operation, regurgitation was minimal when a few precautions were observed. The patients have normal hunger pains and appetite. They are able to eat a full-sized meal. The advantages of stomach compared to colon replacement of the esophagus are discussed.

Adult↗
PubMed1976

Pharyngoesophageal caustic stricture. Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft.

Four cases of combined hypopharyngeal and cervical esophageal stricture secondary to caustic ingestion are presented. Although gastropharyngostomy has rarely been used for treatment of patients with caustic stricture of the pharynx and cervical esophagus, we believe that it is a useful procedure and has several advantages over use of the colon. We prefer total esophagectomy and posterior mediastinal transposition of the stomach to the neck followed by gastropharyngostomy in those patients who have minimal stomach involvement.

Adolescent↗
PubMed1976

Radiotherapy for verrucous carcinoma.

Radiotherapy of verrucous carcinoma has frequently been associated with anaplastic transformation and poor response. No anaplastic transformation was observed in the 6 patients receiving radiotherapy as the primary treatment, and control of disease was favorable compared with 5 surgically treated patients. Four of the 6 undergoing radiotherapy are alive NED 1-4 years later. Review of the literature and of the University of California cases fails to substantiate an increase in anaplastic transformation in in verrucous carcinoma patients. We recommend that verrucous carcinoma be treated as other squamous cell carcinomas of similar sites and stages.

Carcinoma, Papillary↗