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Biomedical subjects

R A Sofferman

Publications and source records attributed to R A Sofferman.

At least 37 records · Page 2Linked to original sources
PubMed1986

Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report.

An unusual case of unilateral anterior rotatory atlantoaxial fracture/dislocation with neurological deficit is presented. The injury could not be reduced by skeletal traction, but was successfully reduced by partial facetectomy at C-1, C-2 accomplished through a transoral exposure of the atlantoaxial region combined with labiomandibularglossotomy. To the best of our knowledge, this is the first instance of an injury of this type to be so managed. The details of the operative procedure are described, and the subject of rotatory atlantoaxial dislocation is reviewed.

Adult↗
PubMed1985

Adenoid cystic carcinoma of the nasopharynx after previous adenoid irradiation.

In 1978, Pratt challenged the otolaryngology community to identify an incidence of malignancy in individuals who have previously received radium therapy to the nasopharyngeal lymphoid tissues. This case report is a direct response to that quest and presents a well documented adenoid cystic carcinoma evolving 23 years after radium applicator treatment to the fossa of Rosenmuller. Although a cause-and-effect relationship cannot be scientifically proven, the case history raises several important questions concerning the stimulating effects of radiation on the later onset of frank malignancy.

Carcinoma, Adenoid Cystic↗
PubMed1984

Hyoid bone elevation: a sign of tracheal transection.

Evaluation of traumatic neck injuries should include analysis of the position of the hyoid bone on the lateral radiograph. Location above the level of the third cervical body or a greater cornu located less than 2 cm from the angle of the mandible, or both, coupled with the finding of cervical soft-tissue air, should alert the radiologist that tracheal transection is likely and that immediate surgical exploration is required. Five cases of severe neck injury are presented.

Adolescent↗
PubMed1983

Retrospective analysis of surgically treated Le Fort fractures.

Craniofacial suspension, in conjunction with intermaxillary fixation (IMF), is the time-honored method of Le Fort fracture repair. However, several patients with maxillary fractures treated at the Medical Center Hospital of Vermont in Burlington by the oral surgery and otolaryngology services have been managed with IMF alone. Twenty-one of these patients were examined retrospectively through comprehensive dental and otolaryngologic clinical analyses. Traditional concerns for facial elongation and nonunion were among the key questions addressed by this study. There was no evidence of nonunion in any patient examined. A comparison of each patient's lateral cephalometric roentgenogram with computerized norms suggested that facial elongation did not occur when IMF alone was the principal method of repair.

Adolescent↗
PubMed1983

Cavernous sinus thrombophlebitis secondary to sphenoid sinusitis.

Cavernous sinus thrombosis is a serious life threatening condition which usually results from midfacial skin infections. Preantibiotic era mortality rates of 80% have improved markedly because of an early awareness of the condition and prompt initiation of parenteral antibiotics. Sphenoid sinusitis is an uncommon associated cause of cavernous sinus infection and is itself a rare and elusive clinical problem. A case of sphenoid sinusitis and concurrent cavernous sinus thrombophlebitis is presented to highlight the clinical diagnostic considerations with special emphasis on bilateral eye signs as indicators of the impending thrombophlebitic process.

Adolescent↗
PubMed1981

Management of laryngotracheal trauma.

Blunt trauma to the neck requires a systematic analysis of the laryngotrachea, the esophagus and the cervical spine in addition to general trauma considerations. Acute airway decompensation is best managed by tracheotomy, although if the situation permits, an orderly physical examination including indirect laryngoscopy and selected roentgenographic studies will yield an appropriate picture of the injury. Although broad guidelines are helpful, each case may dictate an individual therapeutic modification.

Accidents, Occupational↗
PubMed1981

Sphenoethmoid approach to the optic nerve.

Five percent of all head injuries affect some portion of the visual system, and the most common locus of injury is the canalicular segment of the optic nerve. The classic surgical approach to this area is via the transfrontal craniotomy, although the Japanese have utilized an external ethmoidal technique to provide limited extracranial access to the optic canal. Harvey Cushing utilized the transsphenoidal hypophysectomy principally for pituitary tumors causing visual deficits. This paper presents a variation of the transsphenoidal hypophysectomy technique which will allow exposure of the optic nerve from the orbital apex to the optic chiasm through the use of microsurgical instrumentation. A detailed step-wise description of the surgical methodology is presented, along with drawings to define the approach fully. Four case reports and representative pre and postoperative radiographs illustrate the actual approach in the clinical setting.

Adolescent↗
PubMed1980

Lingual infarction in cranial arteritis.

Cranial arteritis is commonly found in elderly individuals with headache and visual loss. Although otolaryngologic manifestations of cranial arteritis are said to be infrequent, approximately 25% of patients may have complaints or objective findings limited to the oral cavity. Masticatory claudication, tongue pain, and frank lingual infarction are the most common and should be recognized as indicators of a serious underlying arteritis. These symptoms are often confusing to internists, neurologists, and otolaryngologists, resulting in delays in diagnosis and initiation of proper therapy.

Aged↗
PubMed1979

Unusual uses of the deltopectoral flap.

For the past decade the deltopectoral flap has become the premier reconstructive tool in oncologic head and neck surgery. It has achieved a level of reliability that has not been approached by any other single flap. Its most common application has been replacement of lost skin either from planned surgical resection or necrosis following ablative surgery. This paper illustrates a few unusual clinical settings in which the deltopectoral flap was used instead of other conventional methods: 1. Use of the same delopectoral flap in two different locations. 2. Employment of the base of the deltopectoral tube for skin coverage. 3. Successful application of bilateral simultaneous deltopectoral flaps. 4. Three-stage reconstruction of the cervical esophagus in a tenuous metabolic setting. 5. Two-stage technique for soft palate replacement. 6. An alteration of the design of the conventional deltopectoral flap because of an upper pectoral abscess.

Adolescent↗
PubMed1977

Side effects of minocycline: a double-blind study.

We studied the incidence and type of side effects of minocycline in a double-blind study. A total of 45 volunteers (18 men and 27 women) were given minocycline, and 44 volunteers (23 men and 21 women) were given placebo. The men in both the minocycline and placebo groups were significantly (P < 0.0001) larger than the women in the comparable groups. Minocycline dosage was 100 mg every 12 h for 5 days, and placebo was administered in an identical manner. Minocycline serum concentrations were determined in 12 volunteers at 1, 2, 4, and 6 h after the morning doses on days 1, 3, and 5 of the study. Side effects were recorded by volunteers in diaries and also through daily interviews and were evaluated by examination and electronystagmography. Peak minocycline serum concentrations were seen by day 3 and correlated with the peak onset of side effects. These concentrations were significantly higher in women than in men. Vestibular side effects occurred in 70.4% of the women on minocycline and significantly (P < 0.0001) exceeded the rate of the women on placebo (9.5%). Only loss of balance was significantly (P < 0.05) increased in the men taking minocycline as contrasted with men on placebo. Electronystagmography generally revealed no abnormalities. Side effects were usually not severe: four volunteers in the minocycline group and two in the placebo group discontinued their capsules because of side effects. It is concluded that women experience an unacceptably high incidence of side effects from minocycline, and this may be related to their higher serum concentrations, which in turn may relate to their smaller size.

Clinical Trials as Topic↗
PubMed1977

Traumatic carotid-cavernous sinus fistula.

Seventy-five percent of carotid-cavernous sinus fistulae result from high velocity head trauma. The most common symptom is a pulse synchronous bruit which usually becomes apparent when the patient regains his sensorium. The objective manifestations of such an arteriovenous fistula are characteristically localized to the ipsilateral orbit. A periorbital bruit and venous engorgement of the palpebral and bulbar conjunctivae are pathognomonic features. Bilateral carotid angiography confirms the diagnosis and determines which of several techniques might be used to obliterate the fistula. Occasionally the classic signs and symptoms may be delayed for days or weeks. Thus, the maxillofacial surgeon must be aware of this clinical entity to avoid untimely repair of facial fractures with potentially disastrous consequences.

Adult↗
PubMed1975

Malignant lymphoma of the paranasal sinuses.

Sinus lymphoma is a rare but potentially radiocurable malignant neoplasm. The disease is isolated to the sinus and adjacent local tissues on initial presentation, and concurrent generalized lymphoma is unusual. With rare exception, the histologic pattern is that of a diffuse histiocytic non-Hodgkin lymphoma (reticulum cell sarcoma). Radiotherapy to the involved sinuses without prophylactic neck irradiation is the treatment of choice, and a survival rate of 50 percent to 70 percent can be expected.

Aged↗
PubMedDate not supplied

An extracranial microsurgical approach to the optic nerve.

Lesions affecting the canalicular portion of the optic nerve have classically been addressed with intracranial surgical techniques. This article introduces a microsurgical extracranial approach to the optic canal that can be readily adapted by the neurosurgical-rhinologic team familiar with transsphenoidal hypophysectomy. The approach became clinically feasible with the advent of coaxial illumination, magnification, and special microinstrumentation. The technique is described in detail, potential and actual clinical applications are further outlined, and the advantages and disadvantages of the approach are discussed. Future adaptability of this technique to unusual clinical situations such as ophthalmic artery aneurysms and carotid-cavernous sinus fistulas may be possible but will first require careful laboratory study.

Adolescent↗
PubMedDate not supplied

Mondini dysplasia: spontaneous cerebrospinal fluid otorrhea. New perspectives in management.

The Mondini dysplasia represents a developmental arrest during the embryogenesis of the inner ear. The malformation, commonly associated with deafness, is frequently heralded by meningitis secondary to communication of the middle ear with the subarachnoid space. Early recognition and successful repair of the CSF leak is important to avoid the sequelae of repeated episodes of meningitis. We believe the addition of CSF diversion in the form of a lumbar drain during and after surgery will result in improved success.

Cerebrospinal Fluid Otorrhea↗