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Biomedical subjects

M S Benninger

Publications and source records attributed to M S Benninger.

At least 37 records · Page 2Linked to original sources
PubMed1996

Vocal fold scarring: current concepts and management.

Scarring of the vocal folds can occur as the result of blunt laryngeal trauma or, more commonly, as the result of surgical, iatrogenic injury after excision or removal of vocal fold lesions. The scarring results in replacement of healthy tissue by fibrous tissue and can irrevocably alter vocal fold function and lead to a decreased or absent vocal fold mucosal wave. The assessment and treatment of persistent dysphonia in patients with vocal fold scarring presents both diagnostic and therapeutic challenges to the voice treatment team. The common causes of vocal fold scarring are described, and prevention of vocal fold injury during removal of vocal fold lesions is stressed. The anatomic and histologic basis for the subsequent alterations in voice production and contemporary modalities for clinical and objective assessment will be discussed. Treatment options will be reviewed, including nonsurgical treatment and voice therapy, collagen injection, fat augmentation, endoscopic laryngoplasty, and Silastic medialization.

Cicatrix↗
PubMed1995

Accelerated fractionation radiotherapy and concomitant chemotherapy in patients with stage IV inoperable head and neck cancer.

BACKGROUND: Stage IV inoperable head and neck cancer has a 2-year mortality rate of greater than 70% when treated with conventional radiotherapy. A Phase II study was undertaken to evaluate the effects of concomitant chemotherapy and accelerated, interrupted, twice-a-day radiotherapy on tumor response, locoregional control, survival, and morbidity. METHODS: Thirty-four patients with Stage IV inoperable squamous cell carcinoma of the head and neck and a minimum follow-up of 36 months were evaluated. Concomitant chemoradiotherapy was administered during weeks 1, 3, and 5 (with planned breaks during weeks 2 and 4), consisting of cisplatin 60 mg/m2 on day 1, continuous 5-day infusion of 5-fluorouracil, 750 mg/m2 per day, and radiotherapy, 2 Gy twice a day, more than 6 hours apart, followed by 3 days of radiation therapy alone (final "boost") in week 6, for a total dose of 70 Gy and treatment duration of 5 1/2 weeks (38 days). RESULTS: Twenty-seven patients achieved a clinical complete response (82%). Actuarial locoregional control at 3 years was 73% and the actuarial 3-year survival probability, including all deaths, was 38%. All locoregional recurrences were manifested within 12 months. Of the 20 deaths, 12 were tumor related (locoregional and/or metastatic), 3 were treatment related, and 5 were due to other causes. Acute toxicity consisted of grade 3 mucositis and dysphagia and grade 2-3 leukopenia, not requiring treatment interruption or cessation. CONCLUSION: Concomitant accelerated radiation therapy and chemotherapy is a feasible treatment approach in this prognostically poor patient population, yielding dramatic tumor responses and impressive locoregional control at the cost of somewhat increased acute toxicity. Although serious late complications have not been observed, caution should be exercised in view of the relatively short follow up.

Adult↗
PubMed1995

Common clonal origin of synchronous primary head and neck squamous cell carcinomas: analysis by tumor karyotypes and fluorescence in situ hybridization.

Two synchronously arising primary squamous cell carcinomas (SCC) originating from separate sites in the anterior floor of mouth (FOM) and the pyriform sinus (PS) were evaluated by karyotype and fluorescence in situ hybridization (FISH) to determine whether they were of common or independent ancestry. The primary tumors were designated Henry Ford Hospital (HFH)-SCC-8a (FOM) and HFH-SCC-9a (PS), and the respective recurrent tumors after chemotherapy and radiation were designated -8b and -9b. HFH-SCC-8a and -8b were cultured and had closely related hypotetraploid karyotypes of monoclonal origin. Karyotypes could not be obtained from the second primary tumor HFH-SCC-9a or its recurrence -9b. However, we used karyotypes from HFH-SCC-8a and -8b as a guide to select FISH probes for the histological evaluation of genetic markers in tumor sections. Fluorescence in situ hybridization on metaphase chromosomes from the cell cultures was useful in modifying the tumor karyotypes. Fluorescence in situ hybridization identified a chromosome Y rearrangement that was not obvious from the HFH-SCC-8a and -8b karyotypes, and this Y rearrangement served as a unique clonal marker. Using two probes for the Y chromosome we showed that all four tumors shared the same Y rearrangement with loss of Yq (DYZ1) and retention of Ycen (DYZ3). Furthermore, FISH showed that all four tumors had the same aneuploidy patterns for chromosomes X, Y, 7, 9, 15, 16, and 17. From karyotypic and FISH analysis disomy for X and 9 centromere regions and the rearranged Y were all predicted and observed in the tumor tissue sections. Tetrasomy and trisomy for 7, 15, 16, and 17 were predicted from the karyotypes and this also was observed using FISH in all four tumors. These FISH aneuploidy patterns and the presence of a clonal Y marker in all four tumor samples indicate that the synchronous primaries and their recurrences were of monoclonal origin.

Adult↗
PubMed1995

Management guidelines for improvement of otolaryngology referrals from primary care physicians.

OBJECTIVE AND DESIGN: A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines developed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disorders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary care physician and patient satisfaction were measured before and after guideline implementation. RESULTS: A significant decrease in appropriate to unnecessary referrals was seen, from 55% before to 12% after guidelines. The percentage of patients seen within 1 month of scheduling improved from 39% to 59%. Guideline-addressed disorders decreased from 63% to 40%. The need for patients to see another physician for the referred symptom while waiting to see an otolaryngologist decreased from 31% to 3%. Patient satisfaction with wait times improved. Eighty-six percent of the primary care physicians used the guidelines, and 85% wanted to expand the guidelines to other specialty areas. CONCLUSIONS: Management and referral guidelines are effective in improving patient access and the ratio of appropriate to unnecessary referrals. Such guidelines are well accepted and used by primary care practitioners in this setting.

Appointments and Schedules↗
PubMed1995

Vocal nodules, microwebs, and surgery.

Successful treatment of vocal nodules is primarily accomplished through the direction of voice-language pathologists and teachers of music and speech. Rarely is surgical treatment necessary, although recent reports have suggested a correlation between vocal nodules and failed voice training with anterior commissure microwebs. One hundred fifteen consecutive patients with vocal nodules were evaluated. Eight anterior commissure microwebs were identified (7%), four of these in performers. Of the 96 patients with sufficient follow-up, 65 (68%) had complete resolution of their nodules and 17 (18%) had sufficient improvement to return to normal vocalization without surgical treatment. Nine patients required surgery, two of these with anterior commissure microwebs. All eight patients with microwebs had resolution of their nodules with either nonsurgical or surgical therapy. In total, 94% of patients were able to return to normal voice function, while the 6% of failures either did not receive or were noncompliant with voice therapy. Microwebs were found to be uncommon in patients with vocal nodules. Microwebs and other laryngeal pathologies in patients with nodules may be associated with a higher incidence of patients failing conservative voice therapy treatment.

Adolescent↗
PubMed1995

The endoscopic management of sphenoid and ethmoid mucoceles with orbital and intranasal extension.

Mucoceles of the sphenoidal and ethmoidal sinuses act as benign neoplasms and can result in bony erosion extending from within the confines of the sinuses into the intracranial and orbital spaces. Endoscopic management of such mucoceles has been debated, and, by some, considered a radical form of therapy. A review of consecutive patients with sinus mucoceles revealed eight sphenoid and six ethmoid mucoceles. Four of these were confined to the sinuses and 11 extended outside of the confines of the sinuses. There were four with intracranial extension, two with orbital extension, three with both intracranial and orbital extension, and two involving the clivus. All 15 patients were managed with endoscopic decompression. Two patients with ethmoid-frontal mucoceles also had frontal sinus obliteration, via an osteoplastic flap along with sphenoethmoidal decompression with an endoscopic approach. Thirteen patients had more than one year of follow-up. Two patients with ethmoid mucoceles with intracranial extension had recurrences of the mucoceles which again have been decompressed endoscopically. There were no orbital or intracranial complications in relationship to these procedures or from the mucoceles. Symptoms related to the mucoceles including loss of vision and severe headaches were resolved with decompression. The endoscopic management of sphenoid and ethmoid mucoceles with orbital and intracranial extension is a safe and reliable approach, obviates the need for major intracranial surgery and diminishes post-operative morbidity. Close follow-up is necessary and secondary decompression can be accomplished should the mucocele recur.

Endoscopy↗
PubMed1994

Recurrent cytogenetic abnormalities in squamous cell carcinomas of the head and neck region.

We characterized the breakpoints, gains, and losses of chromosome material in squamous cell carcinomas of the head and neck region from 29 patients. Cell lines were karyotyped in 1/3 of cases, direct preparations or early in vitro harvests in 1/3, and both in 1/3 of cases. GTG-banding was employed in all cases, as were C-banding and RBG- and AgNOR-staining in most. Some tumors were near-diploid and others near-tetraploid, but many had mixed populations, with diploid, tetraploid, and octoploid subclones representing essentially the same karyotypic pattern. The most frequent changes were deletions. Losses affecting 3p13-p24, 5q12-q23, 8p22-p23, 9p21-p24, and 18q22-q23 ranged in frequency from 40% to 60% of tumors. Loss of the short arm of the inactive X occurred in 70% of tumors from female patients, and loss or rearrangement of the Y occurred in 74% of tumors from male patients. Loss of 18q appeared to be associated with short survival, as did the presence of multiple deletions. There was gain (2-5 extra copies) of 3q21-qter, 5p, 7p, 8q, and 11q13-q23 in 28-38% of tumors. Three tumors had an hsr involving 11q13-q21. Gain of material at 11q13 is postulated to be associated with amplification of the PRADI/CCND gene at that locus. A translocation between proximal 1p and either an acrocentric short arm or proximal 8p or 9p was observed in squamous cell carcinomas of the head and neck region but not in female genital tract tumors. No other abnormalities appeared to be site specific, suggesting a pattern of genetic evolution in squamous cell carcinoma that is independent of anatomic site.

Adult↗
PubMed1994

Evaluation and treatment of the unilateral paralyzed vocal fold.

The evaluation and treatment of patients with unilateral vocal fold paralysis have evolved as improvements in objective measurements of phonatory function and new modalities for treatment have developed. A thorough history, physical examination, subjective voice evaluation, objective voice analysis, and electromyography are used to make a diagnosis, determine the cause, and plan treatment. The goal of treatment of the patient with a unilateral vocal fold paralysis is to restore normal phonatory function without aspiration. Multiple modalities have developed to allow for restoration of nearly normal phonatory function, and these include voice therapy alone or in combination with injection medialization, laryngoplastic phonosurgery, or laryngeal reinnervation. Otolaryngologists should be familiar with the incidence, cause, evaluation, and state-of-the-art treatment of unilateral vocal fold paralysis of optimize patient care and avoid suboptimal results often seen with antiquated or inappropriate treatment.

Humans↗
PubMed1994

Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas.

Evaluation of 63 patients undergoing primary radiation therapy for treatment of T1 and T2 glottic carcinomas was undertaken to evaluate the success of primary treatment and to identify factors which might influence recurrence or voice quality. Twelve patients (19%) recurred following radiation therapy, with ultimate salvage in 11, for a 3-year survival rate of 98%. Voice preservation was achieved in 83%. Continued smoking after radiation therapy was associated with significantly greater risk of recurrence. Stage of tumor and anterior commissure involvement were not associated with increased recurrences. Sixty-seven percent of patients who did not recur had good voice quality after treatment. Vocal fold stripping or excisional biopsy rather than limited biopsy for initial diagnosis, complications of treatment, and continued smoking after treatment were all significantly associated with an increased risk of poorer voice quality after treatment while bilateral vocal fold tumors were associated with risks that approached significance. Voice analysis of five patients revealed that objective changes in voice can be detected after radiation therapy in those with associated risk factors but may be normal in those without these risk factors.

Adult↗
PubMed1993

Clonal cytogenetic evolution in a squamous cell carcinoma of the skin from a xeroderma pigmentosum patient.

Cytogenetic changes in epithelial neoplasms are often complex, making it difficult to determine which are the primary abnormalities and which are secondary. In this report, we describe clonal evolution in a cytogenetically simple, but clinically aggressive squamous cell cancer of the skin from a patient with xeroderma pigmentosum. Chromosome preparations were analyzed from a direct harvest, three independent primary harvests, and passaged cell lines. Three closely related tumor subclones were identified in the primary cultures, and all three proliferated in vitro. Monosomy 4 and a chromosome 9 rearrangement were present in all three subclones and monosomy 21 was present in two subclones. An i(9p) and an i(9q) were derived from the same chromosome 9, and there was concurrent loss of the homologous chromosome 9. In addition, each subclone was characterized by a further specific evolutionary change: t(5;7) (q11.2;p22) in subclone 1, der (11)t(10;11) (q21;p14) in subclone 2, and der (14)t(13;14) (q14;q32) in subclone 3. All three subclones were represented by hypodiploid and hypotetraploid metaphases. Loss of chromosomes from hypotetraploid cells and an 11q+ were the only other changes found in this tumor. The early genetic events in the evolution of this squamous cell cancer, monosomy 4, i(9p), i(9q), and monosomy 21, represent loss of chromosome regions that are commonly lost in other squamous cell carcinomas of the head and neck region. Taken together, these observations indicate that genes on these chromosomal regions are probably important and possibly sufficient for the development of squamous cell carcinoma.

Adult↗
PubMed1993

Facial nerve morbidity following parotid surgery for benign disease: the Cleveland Clinic Foundation experience.

Standard surgical management for benign tumors of the parotid gland requires either superficial, subtotal, or total parotidectomy with preservation of the facial nerve. Although this approach is effective in minimizing recurrence, the resultant facial nerve morbidity is seldom addressed. Two hundred fifty-six consecutive patients who underwent parotid surgery for benign neoplasia at this institution in the past 15 years are reviewed, with attention to postoperative facial nerve function. Immediate dysfunction was frequently encountered (46.1%), but permanent dysfunction was uncommon (3.9%). The incidence of long-term dysfunction may be higher in revision cases and when an extended (total or subtotal) parotidectomy is performed.

Facial Nerve↗
PubMed1993

Natural ostiotomy vs. inferior antrostomy in the management of sinusitis: an animal model.

An animal model was used to compare the surgical treatment of chronic sinusitis by opening the natural ostium vs. inferior antrostomy. Fifteen rabbits had surgical occlusion of the natural maxillary sinus ostia to induce sinusitis. At a second operation, the sinuses were entered and in each animal the natural ostia was reopened on one side and an inferior antrostomy was performed on the opposite sinus. Eight weeks after these operations the sinuses were evaluated. No differences were found in antrostomy patency rates, gross evidence of acute or chronic inflammation, or light or electron microscopic findings between sinuses with natural ostiotomy and those with lower antrostomy. The gross appearances and light and electron microscopic findings are discussed.

Animals↗
PubMed1992

Nasal patency, aerobic capacity, and athletic performance.

The patency of the nasal airway may directly affect pulmonary ventilation, with obstruction and increased nasal resistance resulting in increased pulmonary resistance, hypoxia, and hypercapnea. Nine aerobic athletes were evaluated to assess the role of the nasal airway on aerobic capacity and athletic performance. A step-ladder graded maximal aerobic capacity test was performed under three test conditions: obstructed, decongested with oxymetazoline hydrochloride, and saline control. No differences in maximum VO2, work load, oxygen saturation, maximal blood pressure, heart rate, or respiratory rate were noted between test conditions. Pre-exercise nasal resistance was lower in the decongested compared to control conditions, but no differences were found after exercise. Athletic performance was not influenced by nasal patency in this model.

Airway Resistance↗
PubMed1992

Presentation and evaluation of patients with epidermoid head and neck cancers.

Epidermoid cancer of the head and neck occurs most frequently in individuals with predisposing factors for neoplastic development. Primarily these include exposure to smoking and alcohol, although other predisposing factors may be present. Site-specific symptoms along with a history of predisposing environmental exposure can direct physicians to suspect head and neck cancer. Endoscopy and ancillary testing are performed for tumor staging and subsequent treatment planning.

Alcohol Drinking↗