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Biomedical subjects

M K Wax

Publications and source records attributed to M K Wax.

At least 73 records · Page 4Linked to original sources
PubMed1995

Drains in thyroid and parathyroid surgery. Are they necessary?

OBJECTIVE: To assess the postoperative complications in patients who underwent elective thyroid or parathyroid surgery without postoperative drainage. DESIGN: During a 6-year period all patients who met study criteria were prospectively evaluated. SETTING: General community and tertiary referral center. PATIENTS: Fifty-seven patients undergoing thyroid surgery and eight patients undergoing parathyroid surgery were evaluated. Twenty-four patients were excluded because drains were placed postoperatively. Reasons for exclusion included presence of a large dead space, substernal goiter, extensive neck dissection for malignant neoplasm, and large goiters. RESULTS: Major complications consisted of a hematoma requiring reexploration in one patient, and a recurrent nerve palsy in one patient. Minor complications consisted of temporary hypocalcemia (three), seroma (one), and superior flap edema that resolved in 3 months (20). CONCLUSION: Routine prophylactic drainage in a select patient population is unnecessary after uncomplicated thyroid or parathyroid surgery.

Adult↗
PubMed1995

Tracheostomal stenosis after laryngectomy: incidence and predisposing factors.

Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) (p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively (p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.

Adult↗
PubMed1995

Small cell carcinoma of the tonsil.

Extrapulmonary small cell carcinomas are rare tumors of the APUD system. They are most commonly seen in the esophagus with rare cases reported in the head and neck. We present the sixth reported case of primary small cell carcinoma of the tonsil. These tumors are usually widely disseminated initially. Aggressive locoregional treatment with radiation is the treatment of choice. Systemic treatment is needed for presumed metastatic disease. Surgery may be an adjunct treatment used for locoregional control.

Carcinoma, Small Cell↗
PubMed1995

Traumatic retropharyngeal hematoma: a case report.

We describe a case of retropharyngeal hematoma after a cervical hyperextension injury in an elderly man. Progressive hoarseness, dysphagia, and dyspnea were the early signs that necessitated oral endotracheal intubation and, ultimately, tracheostomy. The hematoma was explored and drained through a lateral cervical approach, and a bleeding vessel in a small tear in the anterior spinous ligament was noted and cauterized. The patient recovered uneventfully.

Aged↗
PubMed1995

Malignant melanoma of the lacrimal sac.

Although malignancies of the lacrimal sac are rare, malignant melanoma of the lacrimal sac is an exceedingly rare occurrence. Patients with abnormalities of the nasolacrimal system may come to otolaryngologists for evaluation. Treatment of lacrimal sac malignancies will necessitate consultation of a head and neck surgeon. The triad of symptoms commonly found in these patients includes epiphora, bloody reflux from the lacrimal punctum, and a medial canthal mass. Early local recurrence occurs frequently. Radical surgical treatment, including wide-field en bloc resection of the entire nasolacrimal system, affords the best protection against local recurrence and provides the best opportunity for enhanced patient survival. Adjunctive therapy in this disorder remains controversial.

Humans↗
PubMed1993

Epistaxis: a comparison of treatment.

Epistaxis is a common condition as well as a frequent otolaryngologic emergency, with up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention. Treatment is controversial, with many options being available. We retrospectively reviewed the hospital course and management of 65 patients who experienced epistaxis from January 1, 1986, to October 31, 1991, to compare medical and surgical treatment methods. Fifty-one patients were managed medically. Of these, 36 patients required one treatment (group 1), 10 required multiple treatments (group 2), and seven required multiple admissions (group 3). The mean lengths of hospitalization were 3.27, 4.90, and 5.57 days respectively. Fourteen patients were managed surgically. The preoperative stay of nine patients who underwent unsuccessful medical management at our institution (group 4) was 3.9 days, with an average postoperative stay of 7.3 days. The difference in length of stay was statistically significant between surgical and medical groups and the postoperative stay of group 4 was different from the length of stay of group 1 patients. The remaining five patients were initially treated elsewhere (group 5). Seventeen (33.3%) medical and only 1 (7%) surgical patients underwent unsuccessful initial therapy. Complication rates were not statistically different for each group. Transfusion requirements were evaluated as a possible predictive factor. Eighteen patients (35.3%) in the medically managed group required transfusions, compared with 11 patients (78.6%) treated surgically (p < 0.01). The medical group received an average of 0.91 units, compared to the surgical group that received 2.93 units preoperatively (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Extramedullary plasmacytomas of the head and neck.

Extramedullary plasmacytomas are solitary tumors consisting of neoplastic plasma cell proliferations that occur in locations other than bone. On initial presentation they must be differentiated from multiple myeloma. This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. Solitary extramedullary plasmacytomas represent up to 4% of nonepithelial lesions of the upper respiratory tract. From 1970 to 1990, at West Virginia University Hospitals, seven patients with solitary extramedullary plasmacytoma were identified. In four of these patients the tumor was located in the head and neck, with one tumor located in each of the following sites: temporoparietal scalp, maxillary sinus, nasopharynx, and cervical region. One patient had extensive destruction of the temporal bone, with extension intracranially to the middle cranial fossa. No patient had multiple myeloma, nor did any develop. Diagnosis was based on a combination of histology along with special immunoperoxidase staining for Ig lambda and kappa light chains. This will be demonstrated and discussed. Treatment consisted of radiotherapy in three cases, with doses ranging from 3175 to 6000 rad. One patient, treated with surgical excision, experienced a relapse at a distant site 6 years later. All patients have maintained local control and have been followed for a minimum of 1 1/2 years, with an average of 3 years. We describe our experience with these tumors and present a pertinent review of the literature. While these tumors may present as aggressive locally destructive lesions, their management should be as organ-sparing as possible because excellent control can be achieved in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

The craniofacial approach to anterior skull base tumors.

The craniofacial approach for resection of tumors of the nose, paranasal sinuses and orbit is well established. The operation must combine good access, sound oncologic resection, and acceptable cosmesis. Many techniques have been described that encompass all of these factors. Usually some sacrifice in cosmesis is inevitable. Most techniques also suggest removal of a plate of bone with subsequent replacement. With the removal of the tumor there is a communication between the nasal chamber and the extradural space (or brain if dura has been resected). This is usually closed with an inferiorly based pericranial flap. We have utilized a technique that hinges the bone flap laterally on the temporalis muscle. This results in the bone flap remaining vascularized. By maintaining a viable vascular bone flap this may allow for better wound healing and a decreased incidence of complications. Furthermore, we describe a technique of a contralaterally-based pericranial flap that is more extensive than the anteriorly based flaps. It may also be inset without fear of vascular compromise. Use of this technique in four patients will be described.

Adult↗
PubMed1993

Surgery and postoperative radiotherapy in the management of extensive cancer of the cervical lymph nodes from an unknown primary.

Over a 14-year period, from 1971 to 1985, there were 15 patients referred to the Princess Margaret Hospital in Toronto for postoperative radiotherapy to the cervical lymph nodes following radical neck surgery for metastatic cancer. An intensive investigation failed to yield a primary site in any patient. All of the patients had extensive neck disease with significant indications for postoperative radiotherapy (massive neck nodes, invasion of extra nodal structures or fixation to unresectable adjacent structures). Of this highly selected group of patients with advanced neck disease: 4/15 (27%) died within one year of uncontrolled local disease, a further 2/15 (13%) died within four years of metastatic/recurrent disease, 6/15 (33%) died of intercurrent disease and 3/15 (20%) were alive with at least four years follow-up. Although all patients presented with advanced disease, survival and significant palliation was possible in this select group of patients.

Adult↗
PubMed1992

Completion thyroidectomy in the management of well-differentiated thyroid carcinoma.

Completion thyroidectomy is the removal of any thyroid tissue that remains after less than total thyroidectomy. At our center, completion thyroidectomy is used when, on permanent sectioning, a frozen section diagnosis is revised from benign to malignant. We reviewed our experience with completion thyroidectomy to examine its indications and complications. We found that the carcinoma was misdiagnosed in 32 of 244 (13%) of cases. Twenty-five of these were initially designated follicular adenomas. The completion proved to be no more technically difficult than a routine hemithyroidectomy. There was one case of permanent hypoparathyroidism (3%). Transient vocal cord palsy occurred in one patient (3%) and transient hypocalcemia occurred in five patients (15%). Complete recovery occurred in all six of these patients. Focal areas of residual carcinoma were found in 8 of 32 (25%) of glands removed at completion. We found completion thyroidectomy to be a safe procedure with minimal morbidity. We recommend its use in those instances of well-differentiated thyroid carcinoma in which the frozen section diagnosis differs from the permanent section.

Adenocarcinoma↗
PubMed1992

Management of substernal goitre.

Goitres of the thyroid gland whose major component resides substernally would appear to have a different presentation and management protocol than those goitres that reside mainly in the neck. These goitres, as opposed to their supraclavicular counterparts, usually present with symptoms referrable to compression of the trachea or esophagus. Even in those patients who are asymptomatic, a precise history may elicit pertinent findings. Furthermore, these goitres do not respond to suppression and require surgical removal. The trans-cervical approach is the most desirable, but the surgeon must be willing to enter the chest on that rare occasion. We reviewed the charts of 938 patients undergoing thyroid surgery who were registered in the Head and Neck Tumour Registry of the University of Toronto. Approximately 2.4% of patients had substernal goitres. Their history, pathology and ultimate surgical management will be discussed.

Adult↗
PubMed1992

Carotid body tumors: a review.

Carotid body tumors are encountered rarely and can present a difficult surgical problem. We reviewed the records of 16 patients with 19 tumors, who were entered in the Head and Neck Tumour Registry of the University of Toronto. There were no functionally secreting tumors and no patients with metastases. Most tumors were identified pre-operatively by clinical examination and angiography. However, five were found at open biopsy and required a second procedure. The mortality rate was 0 following embolization. One patient suffered a severe CNS complication and one patient a TIA. The major morbidity resulted from cranial nerve palsies in seven out of 16 patients. Recently, we have utilized a new method for resection of these highly vascular tumors that results in less blood loss and an increased ease of removal.

Adult↗
PubMedDate not supplied

Bipolar scissors in facial plastic surgery.

BACKGROUND: Many methods are available to the facial plastic surgeon for elevating and separating tissue, from cold steel to monopolar cautery to various laser-cutting technologies. Bipolar cautery has replaced monopolar cautery as the optimal hemostatic technique because of its decreased tissue damage and improved capabilities. Bipolar scissors concurrently offer a dissecting technique with hemostatic capability. Little exists in the otolaryngology literature on the use of bipolar scissors for soft tissue dissection. OBJECTIVE: To describe our experience using bipolar scissors in a variety of facial plastic and reconstructive procedures. SETTING: Tertiary care referral academic center. DESIGN: We retrospectively reviewed 78 procedures performed using bipolar scissors between June 1997 and August 1999. In facial plastic cosmetic surgery, bipolar scissors were used 31 times for deep plane face-lifts and 16 times for endoscopic browlifts. In facial plastic reconstructive surgery, bipolar scissors were used in 15 radial forearm free flaps, 10 fibula osteocutaneous flaps, 3 rectus abdominis free flaps, and 3 latissimus dorsi myocutaneous free flaps. RESULTS: In all procedures, bipolar scissors facilitated the dissection. By allowing for a drier field, less time was required to elevate the flap and obtain hemostasis. Complications were not increased compared with historical controls. In the harvesting of fibula osteocutaneous free flaps, use of bipolar scissors allowed harvesting without use of a tourniquet. CONCLUSION: Bipolar scissors, a new technology in facial plastic surgery, allow the same control as sharp dissection and provide simultaneous hemostasis.

Dissection↗
PubMedDate not supplied

Epidermoid cysts of the cranial bones.

Ectodermally derived tissue in ectopic sites is seen in the head and neck. Extracranial dermoid and epidermoid tumors are relatively rare. While most otolaryngologists are familiar with the cholesteatoma of the otic area, not very many are exposed to this lesion in other sites. Those of the cranial bones are even rarer still. These tumors may expand (1) laterally in the cranial bones, (2) externally to present as masses in the scalp or facial region, or (3) internally to involve the intracranial contents. A patient with a frontal bone epidermoid, whose tumor had expanded in all three directions to erode both inner and outer cortex of cranium and laterally to rupture into the frontal sinus, is discussed. The literature is reviewed and the management of these rare masses is discussed.

Adult↗