Maxillary sinus neoplasm.
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Carcinoma, Squamous Cell↗
Biomedical subjects
M D Maves
Publications and source records attributed to M D Maves.
Deferoxamine decreases necrosis in dorsally based pig skin flaps.
Deferoxamine, a free radical scavenger and iron chelator, has been shown to improve skin flap survival in ischemic flap surgery in rats. The present study investigates the value of deferoxamine in ischemic flap surgery in the porcine model. Four 4 x 12 cm flaps, 3 cm apart and 3 cm from the dorsal midline, were elevated on each of six female pigs, weighing 50 to 60 pounds each. The animals were divided into two test groups. Group 1 received six 1 gm doses of deferoxamine in 4 ml of sterile water intramuscularly every 6 hours preoperatively for five doses, followed by the administration of 1 g every 6 hours for the first 6 days postoperatively. Group 2 received 4 ml of normal saline administered intramuscularly as above. The percentage of flap necrosis was assessed on postoperative day 7 by the weighing paper technique. Group 1 had 17.1% necrosis and group 2 had 33% necrosis (p less than 0.005). Deferoxamine has decreased flap necrosis in the porcine model and may be of use in augmenting the surviving length of flaps in human beings.
Animals↗
Cancer of the cheek.
The combined skills of the micrographic surgeon and the head and neck surgeon offer excellent cure rates and reconstructive techniques for primary cutaneous tumors of the cheek. In most instances, structures crucial to facial function and appearance can be preserved or rehabilitated. This interspecialty approach to such tumors results in the best care for the patient and a high sense of professional satisfaction for the surgical team.
Cheek↗
Irradiated homologous cartilage grafts. Long-term results.
The use of irradiated homologous cartilage for the restoration of facial contour defects remains a controversial issue in reconstructive surgery. Both favorable and unfavorable reports can be found in the literature. Some basic research concerning the rate and mechanism of resorption has been completed but has failed to resolve the issue of the usefulness of this material in day-to-day practice. One frequently cited reference concerning the use of irradiated homologous cartilage in reconstructive surgery was coauthored by two of the present investigators ten years ago. In an effort to place this study in a long-term perspective, we examined 42 of the original 107 patients who formed the initial population base. Sixty-two of the original 145 irradiated homologous cartilage grafts have been followed up for an average of nine years, with an average resorption rate of approximately 75%. Eighteen of 24 grafts followed up from 11 to 16 years completely resorbed. In spite of complete graft resorption, some patients have maintained satisfactory facial contour with fibrous tissue replacement of the cartilage.
Absorption↗
Effects of Oxypherol-ET on random skin-flap survival in the swine model.
Random skin flaps are an important and frequently used technique in head and neck reconstruction. Fluorocarbons (Oxypherol-ET) have a low viscosity and high oxygen solubility that allow them to enhance the microcirculation and reduce skin-flap necrosis. These properties were evaluated using the swine model. Group 1 (four flaps) served as controls, with no hematologic or pharmacologic manipulations. Group 2 (16 flaps) had 20% of their blood volume removed and replaced with an equal amount of lactated Ringer's solution. Group 3 (16 flaps) also had 20% of their blood volume removed and replaced with an equal amount of Oxypherol-ET. Necrosis in group 1 (controls) averaged 32.6%; in group 2 (lactated Ringer's solution), 27.8%; and in group 3 (Oxypherol-ET), 8.34%. This study has shown a statistically significant enhancement of random skin-flap survival in the swine model with Oxypherol-ET.
Animals↗
The use of composite auricular grafts in nasal reconstruction.
Composite auricular grafts are extremely valuable in head and neck reconstruction. They are most commonly used in reconstruction of the ear, eyelid, and nose. Composite grafting provides a relatively simple technique of reconstruction with excellent cosmetic and functional results. The advantage of a one-stage reconstruction is particularly valuable to the patient.
Ear Cartilage↗
Anchoring the palatal prosthesis after maxillectomy.
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Bone Screws↗
The trapezius myocutaneous flap. Dependability and limitations.
Many reports of the trapezius myocutaneous flap have centered on a single form of the flap. However, three distinct myocutaneous segments, the superior, the lateral island, and the extended island flaps, can be harvested from the trapezius muscle and its overlying skin. Fifty-five patients underwent reconstruction for head and neck defects using 56 trapezius myocutaneous flaps consisting of 28 superior, 24 lateral island, and four extended island flaps. The four vascular supplies of the trapezius muscle are discussed, with emphasis on the variable nature of the transverse cervical and dorsal scapular arteries. Major complications developed in two of 28 superior, five of 24 lateral island, and one of four extended island flaps. The superior flap, although the most dependable, has the most limited range of application. Both the lateral and extended island flaps have a broader range of clinical application, but their usefulness may be limited by previous neck surgery or occult neoplasm in the neck, as well as by the variable vascular supply. Due to the above limitations, 30% of our attempts to utilize the lateral island flap had to be aborted at the time of surgery and an alternate means of reconstruction used. The trapezius myocutaneous flaps are excellent reconstructive tools for selected defects.
Female↗
Tissue expansion in the treatment of giant congenital melanocytic nevi.
Treatment of giant facial congenital melanocytic nevi (CMN) is recommended due to the potential for malignant degeneration, although therapy may be complicated because of cosmetic and functional considerations and the results problematic. We present the case of a 2-year-old child with a giant CMN of the scalp, excision of which was facilitated by the use of a tissue expander. This technique allows the creation of skin similar in appearance and type to that immediately adjacent to the defect. The giant CMN, which covered approximately one third of the scalp, was excised and simultaneously resurfaced with the remaining expanded normal scalp.
Child, Preschool↗
Pathologic quiz case 1. Acinous cell carcinoma.
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Carcinoma↗
Non-Hodgkin's lymphoma of the head and neck: the University of Iowa experience.
The evaluation of a patient with a mass in the head and neck may require the consideration of lymphoma in the process of differential diagnosis. Non-Hodgkin's lymphoma is a well-described heterogeneous group of lymphoid malignancies characterized by a natural history ranging from indolent to aggressive growth. Little has been written, however, concerning the specific features of this disease in the head and neck. Between 1974 and 1984, 287 patients were treated for non-Hodgkin's lymphoma presenting in the head and neck. A multivariant analysis of these cases forms the basis of this report. All case material was reviewed and classified according to the working formulation of the National Cancer Institute and the Ann Arbor Classification System for lymphomas. Sites of initial presentation, methods of diagnosis, choice of therapy and subsequent response to treatment were related to the manifestations of non-Hodgkin's lymphoma in the head and neck. Of particular interest to the head and neck surgeon is the constellation of presenting signs and symptoms which point one to the possibility of non-Hodgkin's lymphoma.
Combined Modality Therapy↗
Surgical anatomy of the scapular spine in the trapezius-osteomuscular flap.
Measurements of the spine of the scapula in relationship to the trapezius-osteomuscular flap were made in a series of cadavers. These measurements enable estimation of the amount of available bone present and give the reconstructive surgeon a series of guidelines for using the trapezius-osteomuscular flap in correcting mandibular defects. A related phase of this investigation was the development of a roentgenographic technique using the 30 degree cephalic view of the shoulder for preoperative assessment of the spine of the scapula.
Aged↗
Radiographic identification of ingested disc batteries.
Recently, the hazards posed by the accidental ingestion and impaction of small disc batteries have been widely publicized in the medical and lay press. These foreign bodies, when lodged in the esophagus, leak a caustic solution of 26 to 45% sodium or potassium hydroxide which can cause a burn injury to the esophagus in a very short period of time. Because of the considerable clinical morbidity and mortality from this foreign body, it becomes imperative for the radiologist to quickly and accurately identify disc batteries on plain radiographs. This communication offers a series of radiologic signs important in the identification of disc batteries. When viewed in an anterior projection, disc batteries demonstrate a double density shadow due to the bilaminar structure of the battery. On lateral view, the edges of most disc batteries are round and again present a step-off at the junction of the cathode and anode. These findings are differentiated from the more common esophageal foreign body of a coin which does not have a double density on frontal projection, has a much sharper edge and no visible step-off.
Child, Preschool↗
Tagliacotian cross-arm flap reconstruction of facial defects.
The tagliacotian cross-arm flap finds its basis in one of the oldest reconstructive techniques known, the brachial flap of Gaspar Tagliacozzi. Although not commonly employed today, it remains useful in difficult orbital and nasal reconstructions. Our report deals with the historic development, applicability, timing, and technique of this procedure and is well illustrated by a case report. Advantages of the tagliacotian flap include no additional scarring in the exposed area and a hidden donor site. A considerable amount of usually non-hair-bearing tissue can be transferred without sacrifice of valuable muscle and without special surgical techniques. The tagliacotian cross-arm flap should be considered when local and regional tissue supply is inadequate, when aesthetic desires of the patient preclude additional local scarring, and when time allows for the training and transfer of this flap.
Adult↗
Calvarial bone grafting of facial defects.
Bony defects of the face continue to challenge the reconstructive surgeon. Traditional sources of autologous bone from the rib or pelvis have been associated with the limitations of pain at the donor site, the need for a second operative field, variable "take" of the graft with poor eventual survival and, ultimately, less than optimal reconstruction. Calvarial bone grafting provides a readily accessible source of bone from an inconspicuous donor site, usually within the same operative field. The morbidity is minimal. The calvarial bone graft is especially useful in repair of the frontal sinus, orbital floor, nasal and malar regions, as well as in certain instances of cleft palate with alveolar involvement.
Adult↗
Squamous cell carcinoma of the head and neck in patients under 40 years of age.
Between 1960 and 1983, 63 of 3,489 patients treated for squamous cell carcinoma of the head and neck at the University of Iowa Hospitals and Clinics, Iowa City, were under the age of 40 years. Malignancies in these patients occurred in the oral cavity (41%), pharynx (28%), larynx (25%), and other sites (6%). One third of the patients were females and half the patients were smokers. Approximately 50% of the patients presented with a cervical mass. Management consisted of surgery, radiation, or a combination of the two. Actuarial five-year survival for the entire group was 67%. The best prognosis was for patients with cancer of the larynx, while the poorest was for those with cancer of the pharynx.
Adolescent↗
Congenital syngnathia or fusion of the gums and jaws.
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Abnormalities, Multiple↗
Extended latissimus dorsi myocutaneous flap reconstruction of major head and neck defects.
The purpose of this article is to familiarize th surgeon with the latissimus dorsi flap and some particularly useful applications of it. This flap has proved extremely versatile, with many uses, among them immediate coverage for extensive head and neck wounds. It has been equally successful in repairing defects in both normal and irradiated tissue. The range of the arc of utilization has been exceptional, easily reaching the skull vertex from the chest wall. However, to be able to extend this flap so far requires careful dissection of the neurovascular pedicle and intimate anatomic knowledge of the posterior axilla region. This flap's muscle bulk is quite acceptable and the donor site may almost always be closed primarily. There appears to be less functional disability from sacrifice of this muscle than with pectoralis or trapezius myocutaneous flaps. Accordingly, it is ideal when much tissue is needed for single-stage coverage. Additional uses are available when flaps from other sites have failed.
Adolescent↗