Biomedical subjects
Publications and source records attributed to J Templer.
This article portrays the anatomy of the ethmoid bone and lateral nasal wall in a detailed, but easily digested form. Understanding the anatomy of the lateral wall of the nose is the cornerstone of competent paranasal sinus surgery.
OBJECTIVE: To quantify accurately the suprahyoid and inferior constrictor releases, which are used to decrease tension across a tracheal anastomosis performed after tracheal resection. DESIGN: Intraoperative tension measurements at 0.5-cm intervals of the released laryngotracheal unit were obtained using a spring balance after division of the trachea. SUBJECTS: A selected series of eight patients undergoing total laryngectomy for laryngeal carcinoma, excluding those with cervical soft-tissue involvement, tongue-base involvement, or a history of radiation therapy to the head and neck. RESULTS: The suprahyoid and inferior constrictor releases together permit a tension-free, inferior displacement of 2 cm. The suprahyoid release alone permits an inferior laryngotracheal displacement of 3.5 cm without exceeding the critical, anastomotic failure tension of 1700 g. Using the releasing techniques together permits inferior displacement of 4 cm without notably exceeding this critical tension. CONCLUSIONS: The closure of 2-cm defects without a releasing procedure is supported by this study. Larger defects of 3.5 cm, and occasionally 4 cm, can be closed safely without exceeding the critical tension level using a suprahyoid release. This study supports the use of the suprahyoid and inferior constrictor releases together for the uncomplicated closure of 4-cm defects.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We report a case of a missile injury to the brain with an unusual complication. The bullet migrated by its mere weight to a distant location through the brain parenchyma after it initially lodged in a superficial site. Instances of similar phenomena reported in the literature are reviewed.
Ear injuries occur in people of all ages but predominate in active people such as wrestlers, boxers, and bike riders. The types and extent of injury are a function of the force causing the injury. Shearing forces of moderate intensity cause hematoma formation, whereas greater force causes lacerations or even amputation. Sharp objects cause lacerations determined by the force, direction, and point of impact. The high ratio of surface area to mass makes the auricle vulnerable to extremes of temperature. People participating in high-risk activities should wear protective headgear. The goal of treatment is to restore the normal contours while preventing infection. Hematoma results in disfigurement by organization or chondritis. Evacuation and pressure dressings using sterile technique correct the condition. Second-degree burns are treated by regular cleansing and application of topical antimicrobials. Deeper burns require debridement, biologic dressings, or burying the cartilage subcutaneously for later reconstruction. Simple lacerations are closed under aseptic technique using either skin-to-skin sutures only or sutures of the skin combined with intercartilage sutures. Extensive and complex lacerations require meticulous care to match all fragments and prevent infection or loss of tissue. Bare cartilage must be covered with vascularized tissue. The treatment of total amputation is controversial. Some advocate reattachment as a composite graft using intravenous low molecular weight dextrans and heparin as adjuvants. Mladick dermabrades the amputated pinna, reattaches it with sutures, and then slips it into a pocket of elevated postauricular skin for 2 weeks. Others urge microvascular reanastomosis of the small nutrient vessels. Brent and Byrd separate the cartilage from its overlying skin and envelope it first with vascularized temporoparietal fascia and then a split-thickness skin graft. Chondritis is the most feared complication of injury or surgery of the pinna. It is an aggressive process, and prompt removal of pus and necrotic cartilage is required. Exteriorization and removal of all cartilage is effective but disfiguring. Removal of only affected cartilage and constant irrigation with antibiotic solutions is effective but requires prolonged hospitalization. Iontophoresis of antibiotics into the auricle may be effective and conserve tissue. Traumatic deformities are corrected with composite grafts from the opposite ear, costal cartilage, and local pedicled flaps.(ABSTRACT TRUNCATED AT 400 WORDS)
Successful treatment of mandibular fractures involves proper fracture reduction and immobilization for an adequate length of time. A simple wire fixation technique that can be used in many situations involves suspension wiring from the base of the anterior nasal spine to a pair of circummandibular wires. The technique may be used alone or adjunctively with other methods of fixation. It offers several advantages over other methods, particularly in the treatment of pediatric mandibular fractures.
Electrodes were placed into the posterior cricoarytenoid and diaphragmatic muscles of five tracheostomized dogs. With the use of a sensor that would selectively detect diaphragmatic electromyographic activity, this activity served as a trigger and was amplified and interfaced with a muscle stimulator attached to electrodes placed in the posterior cricoarytenoid muscles. In all animals obvious physiologic synchrony of vocal fold abduction and a reduction of the negative inspiratory intratracheal pressure were observed during electrical pacing. This represents a preliminary step in the development of an alternative approach to the patient with bilateral recurrent laryngeal nerve paralysis.
Explore the source record for details and available documents.
Large ablative surgical tissue defects of the lateral face and head can pose a difficult task for the reconstructive surgeon who must choose from among a large variety of possible reparative techniques. In many situations the temporalis pericranial muscle flap offers the outstanding feature of providing a large amount of soft tissue at no direct expense of donor site skin cover. It is easily obtained and results in negligible functional loss. With care taken to preserve the neurovascular pedicle, this flap may be rotated in multiple directions and even overturned as either surface can receive surface skin closure. The amount of operative time and effort required is much less than for many of the more elaborate reconstructive flaps. Five representative cases are presented.
Explore the source record for details and available documents.
Small skin grafts are often the most appropriate treatment of skin defects on the face, as in the areas of the nasal tip and the anterior surface of the auricle. An improved technique for suturing the graft and applying the stent is described that uses rapidly absorbed 6-0 mild chromic sutures and a protective stent that is taped in a radial fashion. This technique has proved to yield appropriate graft results as well as avoiding a number of the inconveniences of traditional grafting and stent methods.
Explore the source record for details and available documents.
Adenocarcinomas with cervical metastases as their only manifestation are infrequent. They have been grouped with metastatic squamous carcinomas of unknown primary tumor in the ear, nose, and throat literature. Most cases represent distant metastases and will have a rapid downhill course to death despite all treatment. A diligent search should be made for treatable adenocarcinomas, eg, breast, ovary, prostate, and thyroid. The primary site will be found in only a small minority of cases by any means. Radical neck dissection should not be performed when the primary tumor is not localized to the head and neck.
Explore the source record for details and available documents.
Most laryngeal anomalies are supraglottic and laryngomalacia is the most common. Cysts, bifid epiglottis and absence of the epiglottis are uncommon. An 18-year-old Caucasian man had long-standing stridor caused by anomalous supraglottic structures: a small floppy epiglottis, enlarged accessory cartilages and redundant aryepiglottic folds. These structures were excised and the airway was improved. The ventral portions of the fourth arches become the aryepiglottic folds and lateral segments of the epiglottis. A disturbance in this portion of the fourth arch may explain the anomaly. The cartilaginous contributions to the epiglottis were possibly isolated as accessory cartilages. Epiglottic anomalies may be associated with other anomalies, especially the digits of the hand. This patient had a short lingual frenulum and mild macroglossia.
Explore the source record for details and available documents.