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Biomedical subjects

H M Tucker

Publications and source records attributed to H M Tucker.

At least 73 records · Page 4Linked to original sources
PubMed1989

Near-total laryngectomy with epiglottic reconstruction. Long-term results.

A previous report reviewed the technique and indications for near-total laryngectomy with epiglottic reconstruction in the management of squamous cell carcinoma of the glottis. This approach permits removal of most of both vocal folds, with immediate reconstruction using the epiglottis without the need for stenting or multistage procedures. Forty-eight patients underwent the procedure and were followed up for at least 2 years or until death. Seventeen underwent the surgery for recurrence after failure of radiation therapy for cure. Complications included one wound infection and one laryngocutaneous fistula. All patients underwent decannulation, with little or no compromise of swallowing. All but 1 now have functional voices. Of 8 patients with recurrence, 6 have been salvaged. Two patients died of disease. The value of near-total laryngectomy with epiglottic reconstruction for management of glottic cancer is reviewed.

Adult↗
PubMed1989

Advantages of the rotary door flap in laryngotracheal reconstruction: is skeletal support necessary?

Most attempts at laryngeal reconstruction have sought to reestablish skeletal support. Bone and cartilage grafts have been used for this purpose, but they have often failed to maintain position in the larynx and/or trachea following reconstruction, and they tend to be reabsorbed. The rotary door flap can provide an undelayed, one-stage epithelial resurfacing of the larynx and trachea while simultaneously restoring luminal support without the need for transfer of cartilage or bone. Luminal support for the trachea is provided by the bulk, turgor, and anterior traction of the intact sternohyoid muscle, which serves as the carrier for the rotated skin island. During inspiration the intact muscle, whose points of attachment are anterior to the plane of the larynx and trachea, contracts and tends to open the airway to provide dynamic luminal support. The need for internal stenting is minimized. The technique is described and experience in 20 patients is presented.

Adolescent↗
PubMed1989

Laryngeal framework surgery in the management of spasmodic dysphonia. Preliminary report.

Spasmodic dysphonia continues to be a management problem for otolaryngologists. Selective lysis of the recurrent laryngeal nerve has been useful in the management of this disease. Reported long-term results, however, reveal that spasm recurs in approximately 40% to 50% of initially successful patients in spite of persistence of the unilateral vocal fold paralysis. Although some of these failure can be recaptured with subsequent laser surgery, the overall "cure" rate does not exceed 70%, even in the best hands. The contributions of Isshiki, LeJeune, and Tucker have demonstrated that tension in the vocal folds can be adjusted by laryngeal framework surgery. Experience with 16 patients suffering from adductor spasmodic dysphonia suggests that laryngeal framework surgery is useful in the management of this disorder.

Female↗
PubMed1989

Long-term results of nerve-muscle pedicle reinnervation for laryngeal paralysis.

Between 1976 and 1986, 214 patients with bilateral vocal fold paralysis and 73 patients with unilateral vocal fold paralysis were managed by the author using the nerve-muscle pedicle technique for reinnervation. Follow-up of at least 2 years has been obtained on 202 of the bilaterally and 70 of the unilaterally involved patients. Long-term success has been achieved in 74% of the bilateral group and 88% of the unilateral group. Successful reinnervation of unilateral paralyses usually maintains voice correction indefinitely, but there is late (2 to 5 years postsurgery) deterioration of successful airway restoration in approximately 17% of bilateral cases, which appears to be due to development of cricoarytenoid arthritis.

Follow-Up Studies↗
PubMed1989

Dynamic rehabilitation of the paralyzed face--II. Electronic control of the reinnervated facial musculature from the contralateral side in the rabbit.

This work is the continuation of a previous pilot study in the rabbit in which motion originating on the face was picked up by miniature strain gages and channeled synchronously to strap muscles reinnervated via crossover nerve-muscle pedicles. In the current series of experiments, we modified the distal limb of the system to reinnervate the previously paralyzed opposite side of the face via an ansa hypoglossi nerve--thyrohyoid muscle pedicle in five animals. Muscular contraction was induced on the intact side by stimulating different branches of the facial nerve, and corresponding information was channeled to the reinnervated side through an upgraded electronic stimulator via monopolar electrodes placed around the nerve pedicle in the neck. In addition to demonstrating perfect synchrony between intact and reinnervated sides, this facial stimulator allowed the reinnervated side of the face to follow the intact side in a graded and sustained fashion, thus demonstrating that fine tuning of reinnervated facial musculature was possible.

Animals↗
PubMed1989

An artificial myotatic reflex: a potential avenue to fine motor control.

When a striated muscle becomes paralyzed, not only its motor function, but its sensory innervation may be impaired. Methods of rehabilitation have previously focused only on motor innervation, although striated muscles are submitted to self-regulation of length and tension. Indeed, reinnervated muscle may not contract appropriately unless sensory information is available, nor is it known whether sensory receptors are included in the reinnervation process. We hypothesized that the myotatic reflex (MR) would be absent in the event these sensory organs are not reinnervated, and that an artificial myotatic reflex (AMR) would be useful in reestablishing fine motor control. The strap muscles were exposed in six anesthetized rabbits. The MR was verified by stretching an intact sternohyoid muscle. Next, loss of the reflex was documented after the ipsilateral ansa hypoglossi was divided, and a crossover nerve-muscle pedicle (NMP) was brought in from the opposite sternothyroid. After 3 months, the MR was still absent; however, stretch of the contralateral sternohyoid produced a reflex response on the reinnervated side. A strain gauge sutured to the reinnervated muscle was linked to an electronic modulator so that stretch induced electric stimulation of the NMP and contraction (the AMR). We conclude that (1) proprioception is not reestablished in the reinnervated muscle; (2) by contrast, sensory information from the muscle of origin of the NMP is conveyed to the reinnervated side; and (3) the AMR offers promise toward more sophisticated control of paralyzed (i.e., facial, laryngeal) musculature.

Animals↗
PubMed1989

Artificial agonist/antagonist coupling in paralyzed muscles: electronic balance of reinnervated straps from facial activity in the rabbit.

Normal striated muscular contraction such as occurs in the face is the result of finely balanced activities monitored by the central nervous system. Previous approaches to rehabilitation have been limited to restoring only motor function, ignoring the proprioceptive input that normally originates at the level of each muscle. In this pilot study, proprioceptive information originating in facial muscles (considered as agonists) is artificially channeled to nerve pedicles, reinnervating straps in the rabbit to produce antagonist action. Further development of this concept can lead to finer control of reinnervated muscles of the face or elsewhere.

Animals↗
PubMed1989

Squamous cell carcinoma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986.

Fifty-four of 103 malignancies of the paranasal sinuses treated at the Cleveland Clinic Foundation between 1977 and 1986 were squamous cell carcinomas. Six arose from the ethmoid sinus and 48 from the maxillary sinus. Of the maxillary sinus patients, 11 presented with T1 or T2 lesions, 20 with T3, 16 with T4, and 7 of these had nodal disease. Treatment was surgery and/or radiation therapy. There was local recurrence in 25 of 48 maxillary sinus patients and in 1 of 6 ethmoid patients. Overall 5-year survival was 38.2% in the maxillary sinus group: T1, 100.0%; T2, 85.7%; T3, 31.8%; and T4, 6.7%. Three of six patients with ethmoid tumors were cured. There was a statistical trend for better prognosis in those patients presenting with ethmoid primaries, with early lesions, treated with both radiation and surgery, and with history of inverting papilloma. There were complications of treatment in 10 patients, four of which resulted in death. Local control was the major problem for these patients; therefore, early detection and aggressive local treatment are desirable.

Adult↗
PubMed1988

Dysphagia and dysarthria as a result of cocaine abuse.

A 22-year-old black woman had a bilateral pontine stroke soon after she had used cocaine. Otolaryngologists should be alert to the potential for possible cerebrovascular accident and other complications of cocaine, in both clinical and recreational use.

Adult↗
PubMed1988

Artificial reflex arc: a potential solution for chronic aspiration. II. A canine study based on a laryngeal prosthesis.

Long-term and repeated aspiration can result in pneumonia and eventually death. To avoid current techniques which divert or close off the incompetent larynx, the authors have recently described an artificial reflex arc (ARA), in hopes of providing a dynamic solution to this problem. With this concept, a segment of skin surface with intact sensory innervation is implanted into the pharynx in the path of the food bolus. Resulting neural impulses would be detected by a perineural electrode and then channeled to both recurrent laryngeal nerves via an electronic pacemaker to cause vocal fold adduction at the critical time during swallowing. A pilot study using a tubed cervical cutaneous surface has yielded promising results in the canine. In this current study, an alternate means for information pickup based upon use of a miniature strain gage is presented. Mechanical stimulation of the hypopharynx using this "sensory" detector resulted in synchronous laryngeal adduction of the vocal folds, as documented graphically and on videotape.

Animals↗
PubMed1988

Squamous cell carcinoma of the head and neck in patients 40 years of age and younger.

Squamous cell carcinoma of the head and neck is largely a disease of the middle-aged and elderly. When it occurs in younger patients, the prognosis for long-term survival appears to be worse than in the older age group. The records of 41 patients aged 40 years and younger who presented with squamous cell carcinoma of the head and neck were reviewed. Twenty-eight of these patients (68%) developed recurrence; of these, 21 (51%) died with disease, and two are alive with disease. These results indicate a trend toward poorer survival than previous rates reported nationally for all patients with carcinoma of the head and neck over a similar time period. Lesions of the oral tongue, nasopharynx, and paranasal sinuses seem to have a particularly poor prognosis.

Adult↗
PubMed1987

Laryngotracheal reconstruction. Sternohyoid myocutaneous rotary door flap.

The vascularized sternohyoid myocutaneous rotary door flap has been used for laryngotracheal reconstruction in ten patients in the past two years. Nine were reconstructed for laryngotracheal stenosis and one for immediate reconstruction after conservation laryngeal surgery for carcinoma. Before reconstruction, the nine patients with stenosis had each undergone a mean of eight surgical attempts at correction. Eight patients were tracheostomy dependent, and only two patients had effective voices. To date, seven patients have been decannulated and all ten have effective voices. No significant complications have been noted. This flap can provide a readily applicable, dependable technique that is useful in management of difficult laryngotracheal stenosis and for reconstruction after conservation laryngeal surgery.

Adult↗
PubMed1987

Planning and management of long-standing tracheostomy.

Long-term effects of tracheostomy can include structural changes in the anterior tracheal wall and larynx as a result of pressure, friction, and deformation by the relationship between the curved cannula, the trachea, the larynx, and the upper border of the sternum. High-placed stoma, flexed cervical position, and short, obese necks are predisposing anatomic relationships. In some long-standing tracheostomies, progressive erosion of the upper anterior tracheal wall and cricoid arch is observed, often with secondary subglottic stenosis. No discussion of measures to prevent or correct these problems was found in a review of the literature. This article discusses surgical techniques to (1) prevent laryngotracheal erosion and (2) repair and reconstruct an airway that is already damaged. A superiorly based tracheostomy flap and a muscular sling are designed to buttress the tracheostomy. Results and follow-up are also reported.

Follow-Up Studies↗
PubMed1987

Dynamic rehabilitation of the paralyzed face: I. Electronic control of reinnervated muscles from intact facial musculature in the rabbit.

An entirely satisfactory solution to dynamic rehabilitation of the paralyzed facial musculature has not yet been found. Recent interest in selective reinnervation of the laryngeal musculature, synchronous with appropriate afferent information, has led us to propose that miniature strain gauges be placed on one or more muscles of facial expression on the intact side to channel electrical signals to the opposite corresponding facial musculature reinnervated via nerve-muscle pedicles. In order to avoid introducing extraneous factors related to facial motion, this principle was first studied on crossover ansa hypoglossi nerve-muscle pedicles in New Zealand white rabbits. Surgery was performed on a total of five animals that were under general anesthesia with xylazine and ketamine, through a midline neck incision. The animals were reexplored after 12 weeks, and after verification that reinnervation had taken place, a vertical incision was made under the external canthus, in order to expose the facial nerve. A miniature strain gauge was then sutured on the facial musculature and connected to a central modulating unit that was, in turn, linked to the nerve-muscle pedicle via a monopolar electrode. Facial wiggle that resulted from direct electrical facial nerve stimulation caused synchronous contraction of all reinnervated strap muscles under study; this was documented on film and through facial and strap muscle activity tracings. Our next step will be to extend this principle to paralyzed facial muscles. If successful, this system could be miniaturized for long-term implantation in human beings.

Animals↗
PubMed1987

A vented laryngeal stent with phonatory and pressure relief capability.

This prototype vented laryngeal stent incorporates a dome-shaped, one-way valve that allows articulation of transmitted vibrations to produce speech, while preventing aspiration and not interfering with deglutition. The stent is placed endoscopically and is used in conjunction with a T-tube or a tracheostomy tube. The stent has been placed in seven patients for chronic aspiration, after partial laryngectomy, and with laryngotracheal reconstruction for stenosis. Aspiration pneumonia has not been seen in any patient after placement of the appropriate stent, with follow-up of 2 to 6 months. One patient's swallowing improved and none deteriorated. All patients were able to phonate with the stent in place. No significant long-term sequelae are apparent in three patients whose stents were removed after resolution of their primary diseases.

Adult↗
PubMed1987

Artificial reflex arc: a potential solution for chronic aspiration. I. Neck skin stimulation triggering strap muscle contraction in the canine.

Aspiration can occur when the reflex of deglutition occurring in the brain stem is impaired. Surgical procedures involving the airway have so far failed to provide a long-term solution to this problem. Because the sphincteric properties of the larynx could be used to help separate the air from the food passages on a dynamic basis, we present the concept of an artificial reflex are (ARA) in the canine. The afferent limb of this system consists in a cervical cutaneous sensory surface containing the specific biologic sensors for pressure and stretch, subtended by a corresponding sensory nerve, destined to be eventually implanted into the pharynx. The efferent limb picks up the information resulting from the sensor's distention via a frequency modulator and an amplifier, prior to transmitting it to the recurrent laryngeal nerves through monopolar electrodes, resulting in synchronous glottic closure. In order to test this new concept as a pilot study, this principle was applied in three dogs by using an island of cervical skin tubed on itself and the contralateral strap muscles as effector. Inflation of a Foley catheter introduced into the lumen of this tube resulted in synchronous strap muscle contraction, following corresponding increase in the firing frequency in the subtended sensory nerve. The data obtained in this series of experiments should permit further application at the laryngeal level.

Animals↗
PubMed1986

The rotary door myocutaneous flap. A reliable technique for laryngotracheal reconstruction.

We examined the possible uses of the "rotary door" sternohyoid myocutaneous flap (RDF) in laryngotracheal reconstruction. This well-vascularized myocutaneous flap, when rotated axially, can replace or widen the anterolateral walls of the airway. It provides a large epithelial surface, together with bulky structural support. The flap is readily available within the immediate surgical field and can replace large defects in the airway, from the level of the glottis to the cervical trachea. After extensive structural and soft-tissue loss of the larynx and trachea were produced to simulate commonly encountered traumatic and postsurgical stenotic conditions, the RDF was employed in 23 dogs in a single-stage laryngotracheal reconstruction. A stable, widely patent airway was achieved. The dogs were followed up for periods varying from three to six months. No complications or secondary stenoses were encountered. Photographic, radiologic, and endoscopic examinations demonstrated the viability and usefulness of this newly described flap. Long-term tracheostomy was used so that intraluminal stents and cannulas could be avoided. Histopathologic studies confirmed the integration of the RDF into the framework of the larynx and trachea. Application of this technique in cases of tumors, trauma, and stenosis of the airway is suggested.

Airway Resistance↗