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Biomedical subjects

J D Osguthorpe

Publications and source records attributed to J D Osguthorpe.

At least 19 recordsLinked to original sources
PubMed2001

Adult rhinosinusitis: diagnosis and management.

Rhinosinusitis can be divided among four subtypes: acute, recurrent acute, subacute and chronic, based on patient history and a limited physical examination. In most instances, therapy is initiated based on this classification. Antibiotic therapy, supplemented by hydration and decongestants, is indicated for seven to 14 days in patients with acute, recurrent acute or subacute bacterial rhinosinusitis. For patients with chronic disease, the same treatment regimen is indicated for an additional four weeks or more, and a nasal steroid may also be prescribed if inhalant allergies are known or suspected. Nasal endoscopy and computed tomography of the sinuses are reserved for circumstances that include a failure to respond to therapy as expected, spread of infection outside the sinuses, a question of diagnosis and when surgery is being considered. Laboratory tests are infrequently necessary and are reserved for patients with suspected allergies, cystic fibrosis, immune deficiencies, mucociliary disorders and similar disease states. Findings on endoscopically guided microswab culture obtained from the middle meatus correlate 80 to 85 percent of the time with results from the more painful antral puncture technique and is performed in patients who fail to respond to the initial antibiotic selection. Surgery is indicated for extranasal spread of infection, evidence of mucocele or pyocele, fungal sinusitis or obstructive nasal polyposis, and is often performed in patients with recurrent or persistent infection not resolved by drug therapy.

Acute Disease↗
PubMed2001

Frontal sinus malignancies.

Frontal sinus malignancies comprise 2% to 3% of those occurring in the paranasal region. Patients commonly present with forehead pain and swelling, orbital disturbances, epistaxis, and nasal purulence. A combination of CT and MR imaging delineate the tumor and its relationship with the adjacent dura and periorbita. Low-grade malignancies are addressed with en bloc extirpation, with lower frontal sinus and adjacent ethmoid lesions approached through a superior rhinotomy, and more extensive lesions through a combination of a bicoronal flap and rhinotomy. Postoperative irradiation is appropriate for medium- to high-grade lesions. Small to medium defects are closed with local rotation flaps and larger defects with free flaps. Bony reconstruction can range from a split calvarial bone graft to mini plates and wire mesh.

Combined Modality Therapy↗
PubMed2001

Craniofacial approaches to tumors of the anterior skull base.

An approach that combines extracranial and intracranial components-termed a craniofacial approach-allows en bloc extirpation of paranasal malignancies that abut or penetrate the skull base. When combined with radiotherapy, cure rates for such tumors rose from near zero in the 1950s to 39% to 86% by 2000, with the higher rates reflective of esthesioneuroblastomas, well-differentiated adenocarcinomas, vasoformative tumors, and meningiomas. Transfacial tumor access can involve a transnasal (endoscopic or with magnification loupes) exposure, a midfacial degloving, or a lateral rhinotomy, depending on tumor location and size. Adjunctive exposures for tumors penetrating the nasopharynx, pterygomaxillary fossa, or sphenoid include the lateral facial split and the mandibular swing. The standard transcranial accesses are a sub-basal variation of frontal craniotomy, which encompasses en bloc the superior orbital rims, the nasion, and the lower frontal bones; or, a frontotemporal craniotomy with mobilization of the lateral orbital rim and the zygoma.

Humans↗
PubMed2001

Orbital tumors.

Neoplasms involving the orbit are divided into primary and secondary types. Primary orbital tumors are rare, include a wide variety of histopathologic types, are usually benign, and most often are managed surgically. Secondary orbital tumors are most often malignant, arise from the paranasal sinuses, and are managed with multiple modalities in a planned fashion. This article discusses primary and secondary orbital tumors, including their evaluation and management.

Humans↗
PubMed2000

Geographic variation in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) has a worldwide distribution. This survey of 20 otolaryngologic practices throughout the United States confirmed a variation in the frequency of AFRS relative to endoscopic sinus procedures performed for all other diagnoses. The highest incidence occurred in Memphis, Tennessee at 23%, with three other southern practices reporting a frequency of at least 10%. In the northern locations the frequency ranged from 0 to 4%. No correlation with mould counts was demonstrated, possibly because of incomplete mould data relative to most of the surgical locations.

Humans↗
PubMed1999

Rhinosinusitis. Current concepts in evaluation and management.

Sinusitis is one of the most common health complaints leading to a physician office visit in the United States. Recently standardized terminology with diagnostic parameters are outlined. Following this is a detailed discussion of the basics of relevant history and physical examinations, laboratory and radiology testing, the appropriate selection of pharmacotherapy, and the indications for surgical intervention.

Anti-Bacterial Agents↗
PubMed1998

Evolution to current otolaryngic allergy techniques.

The evolution of current otolaryngic allergy techniques for the diagnosis and management of inhalant and food allergens is presented in this article. Skin titration, in vivo diagnostic techniques, and symptom-relieving immunotherapy are emphasized for the former sensitivities and oral challenge tests, skin titration, and elimination or rotary diets for the latter.

Allergens↗
PubMed1998

Management of the neck in nonmelanocytic cutaneous carcinomas.

Cutaneous malignancies are the most common causes of cancer in the United States, and the preponderance occur in the head and neck region. From 0.3% to 13.7% of cutaneous squamous cell carcinomas and from 0.0028% to 0.4% of cutaneous basal cell carcinomas metastasize to the cervical nodes. A description of the head and neck cutaneous lymphatic drainage is presented, followed by recommendations regarding neck dissection modifications appropriate to the primary sites and nodal eschalons involved.

Basal Cell Carcinoma↗
PubMed1998

Facial nerve neuroma management.

Three facial nerve neuromas were identified in the academic year 1994-1995. Each case illustrates different management dilemmas. One patient with a grade III facial nerve palsy had a small geniculate ganglion neuroma with the dilemma of decompression versus resection clear nerve section margins. The second patient underwent facial neuroma resection with cable graft reconstruction, but the permanent sections were positive. The last patient had a massive neuroma in which grafting versus other facial reconstructive options were considered. These three cases illustrate some of the major controversies in facial nerve neuroma management. We discuss our decision-making plan and report our results.

Case Reports↗
PubMed1997

Neurotropic cutaneous tumors of the head and neck.

OBJECTIVE: To determine the outcomes of patients with neurotropic cutaneous tumors of the head and neck. DESIGN: A retrospective review was conducted of 7852 charts of patients who underwent micrographically controlled excisions of skin cancers of the head and neck between 1984 and 1995, identifying neurotropic tumors and the outcomes of their treatments. SETTING: Tertiary care center (university hospital). PATIENTS: Thirty-seven patients with neurotropic tumors were identified (and confirmed by secondary histological review), constituting 0.47% of all patients. The median age at presentation was 68 years and all except an albino were white. Nine patients had basal cell carcinomas and 28 had squamous cell carcinomas. Twenty-five patients (69%) were referred after at least 1 prior excision was performed a median of 16 months previously. INTERVENTION: All patients underwent micrographic mapping and excision of the cutaneous portion of the tumor. As necessitated by tumor spread, additional soft tissue, skull base, and/or intracranial surgery and postoperative irradiation were also conducted. MAIN OUTCOME MEASURES: Thirty-four patients (3 patients were unavailable for follow-up) were assessed by physician examination a minimum of 19 months after treatment (median, 33 months). RESULTS: Of 25 patients with extracranial disease only, 19 had no evidence of disease during follow-up and 1 died of intercurrent disease at 20 months without evidence of tumor persistence. Of the 9 patients with intracranial neurotropic tumors at the time of presentation, 1 remained with no evidence of disease, 1 died of intercurrent disease at 21 months without evidence of tumor persistence, and the other 7 either died of or are living with an intracranial tumor. CONCLUSIONS: Micrographic tissue mapping to detect and then encompass neurotropic cutaneous malignancies, along with conventional surgery for deeper tumor invasions and irradiation in selected cases, was successful in 19 patients (76%) with an extracranial tumor. For those with neurotropic tumors approaching or penetrating the skull base, the prognosis was poor regardless of therapy method.

Aged↗