Biomedical subjects
R H Mathog
Publications and source records attributed to R H Mathog.
Ototoxicity of ethacrynic acid and aminoglycoside antibiotics in uremia.
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Tongue mobility in speech after partial glossectomy.
Recovery of tongue mobility in speech was investigated in 5 partial glossectomy patients. Jaw range of motion used in speech, and tongue contour changes relative to the jaw, were assessed using sequential videofluoroscopic data recorded presurgery, postsurgery, and postradiotherapy. Data from 2 normal controls were included for comparison. Tongue mobility relative to the jaw was found to be restricted postsurgery. Approximately 4 months later, following radiotherapy, tongue mobility increased. Range of jaw motion used in speech was unchanged. Results are interpreted as preliminary evidence that in this small group of cancer patients, radiotherapy following surgery did not prevent continued recovery of tongue function for speech in the early postradiation period.
Objective assessment of swallowing function in head and neck cancer patients.
Swallowing function was evaluated with scintigraphy in 37 patients with head and neck cancer. The patients were examined before and during the course of either surgery, chemotherapy, and/or radiotherapy. A total of 118 scintigraphic studies were performed. Scintigraphic results of bolus flow and aspiration were correlated with clinical findings. Both scintigraphic and clinical studies indicated a worsened swallowing function in 12 patients. These same studies indicated improvement of swallowing in another 13 patients. In 11 patients, both studies revealed either no apparent change or mixed changes in swallowing function after the course of therapy. In only 1 patient was there disagreement between the scintigraphic and clinical assessment of swallowing function. It is our opinion that scintigraphy is a useful method for objective assessment of swallowing function during and after the course of treatment of head and neck cancer patients.
Swallowing of bolus types by postsurgical head and neck cancer patients.
BACKGROUND: Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections. METHODS: Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post-operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4-8 months posttreatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium-coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the videotaped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed. RESULTS: The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups. CONCLUSIONS: Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used.
Temporal artery-based forehead flap.
The historical development of the forehead flap is reviewed, and an operative experience using delayed and nondelayed techniques in 30 cases is described. The reliability of the forehead flap is evaluated with regard to patient morbidity and correction of deformity and dysfunction in such sites as the cheek, lip, corner of the mouth, floor of the mouth, tongue, pharyngeal wall, and tonsil. Analyses include length of hospital stay and complications, as well as the relationship of these factors to the methods employed in the reconstructive processes. The advantages and disadvantages of the various techniques are illustrated using individual cases.
Fractures of the sphenoid bone.
Fractures of the sphenoid bone occur following injury to the orbit and base of the skull. Such fractures are important since they can cause loss of vision and damage to various neural and muscular tissues. Ocular injury is also commonly associated. This paper reviews the hospital records of 112 consecutive patients with fractures of the base of the skull for the cause, frequency of signs and symptoms, and treatment of the sphenoid bone injury. Various deformities and dysfunctions are correlated with imaging data and classified to describe specific clinical syndromes. Several cases of sphenoid bone fracture serve as examples of diagnostic and treatment techniques.
Surgery of massive fibrous dysplasia and osteoma of the midface.
Since most bony lesions of the midface will stop growing or regress, it is generally not appreciated when fibrous dysplasia and osteoma occasionally continue to grow, causing functional and cosmetic problems. To demonstrate the potential of the disease processes and management options available to the surgeon, a series of patients with massive fibrous dysplasia and osteoma of the midface is reviewed. Most of the patients show a facial deformity alone or in combination with telecanthus, epiphora, exophthalmos, or nasal obstruction. Several types of radical and conservative surgical procedures are described to remove or control the bony lesions, to restore facial contour, and to reconstruct the sinuses, nasal passageways, lacrimal collecting system, and medial wall of the orbit.
Injury to the orbital plate of the frontal bone.
Twelve cases of fracture of the orbital plate of the frontal bone are reviewed to clarify this important clinical problem and to suggest satisfactory methods of management. Common signs and symptoms include forehead laceration and deformity, and fracture of the frontal sinus. Loss of vision can occur, and in the seeing eye, diplopia can develop in several fields of gaze. Downward or upward projection of the orbital plate of the frontal bone can cause exophthalmos or enophthalmos. Cerebrospinal fluid leak, with or without meningitis, and seizures can also be part of the syndrome. Effective treatment consists of repairing or obliterating the frontal sinus, reducing the orbital root fracture, and repositioning the globe. Rib or iliac crest grafts, acrylic implants, and temporalis muscle-galea flaps are useful in correcting the deformity and restoring appropriate function. Long-term follow-up examinations are an important part of patient care.
Aspiration in patients with head and neck cancer and tracheostomy.
Tracheopulmonary aspiration is a common occurrence in patients with dysphagia associated with head and neck cancer. We performed quantitative scintigraphic analysis of tracheopulmonary aspiration in 125 patients with head and neck cancer; 58 of these patients had a tracheostomy. Tracheopulmonary aspiration occurred in 58% of patients with a tracheostomy and in 23% of patients without a tracheostomy. In six of seven patients with a tracheostomy, tracheopulmonary aspiration significantly increased when the obturator was removed and, in these patients, occlusion of the tracheostomy tube during feedings eliminated or reduced the complication. Our studies suggest that aspiration can be monitored accurately and conveniently by scintigraphy, and that this technique is useful in the evaluation and management of dysphagia in debilitated patients.
A clinical approach to dysphagia.
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Exercise and recovery from vestibular injury.
Exercise after vestibular injury is potentially an important modality in the recovery process. In this study, the effects of injury on the vestibular system were examined experimentally in cats. Data from healthy normal cats, labyrinthectomized cats, and labyrinthectomized cats treated with exercise were examined. Evaluation of performance was accomplished with caloric, optokinetic, and sinusoidal acceleration testing. Results in normal cats indicated stable, symmetrical vestibular responses on repetitive testing, without evidence for habituation. Comparison of the experimental groups showed that the animals treated with exercise had a significant difference in terms of recovery. The exercised group demonstrated a diminished directional preponderance, a shorter period of complete asymmetry, and a shorter recovery time, which was 58 to 70 per cent faster than that of the non-exercised group. The authors conclude that a general type of exercise will markedly affect and shorten the recovery pattern in the labyrinthectomized cat.
Ethacrynic acid, furosemide, and vestibular caloric responses.
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Hearing function and chronic renal failure.
In order to evaluate the degree and type of hearing loss in patients with chronic renal failure, 61 patients undergoing chronic hemodialysis were examined. Hearing threshold levels, adjusted for age and sex, demonstrated a significant high frequency deficit, which in some patients was noted early in the course of hemodialysis. Fluctuations in hearing were noted over single dialysis events but were transient and apparently independent of corresponding changes in Na, K, Ca, BUN, creatinine, glucose, mean blood pressure, and weight. Preliminary attempts to evaluate hyperlipidemia as a possible cause of hearing loss did not reveal any hearing deficit or gain as related to triglyceride or cholesterol levels. The data suggested other possible causes of observed auditory loss.
Ototoxic interactions of ethacrynic acid and streptomycin.
Various aminoglycoside antibiotics and potent diuretics are known to depress cochlear and vestibular function. Several clinical and research studies suggest that the drugs administered together produce enhanced ototoxicity. The present series of experiments determines the depressive effects of ethacrynic acid and streptomycin, alone or in combination, upon the vestibular system of the cat. The changes in function, when quantified, indicate an addition, rather than a potentiation of toxicity, and suggest different sites of action.
Combined flap-wire reconstruction of the oral cavity.
The concept of immediate reconstruction for head and neck defects following tumor resection provides the impetus for the development of new reconstructive techniques. In this article, the authors describe the evolution of local and regional flaps and the more recent use of composite tissues. The application of a combined forehead-deltopectoral flap and Kirschner wire for the reconstruction of a large defect involving the oral cavity, mandible and facial-cervical skin is presented in a case report and evaluated as to its efficacy in the treatment of head and neck cancer.
Sinusoidal harmonic acceleration.
The need for accurate and reliable diagnostic tests for the evaluation of vestibular function has stimulated investigation of rotational methods and more recently, an evaluation of harmonic angular acceleration. Initial studies, using these techniques in humans, demonstrated a linear input-output function from 0.24 to 0.04 cycles/s at 0.4 radians/s2, but a reduction in the increase of response with an increase of acceleration or a decrease of frequency from this range. Nystagmic responses were symmetrical in these same normal individuals. In patients with vestibular disease, input-output functions, as well as symmetry, were altered, and appeared related to the degree of pathology. Evaluation of the test system in animals, rendered ototoxic with streptomycin, showed a depression in response similar to caloric tests. All data suggested that harmonic angular acceleration provided a reliable and sensitive method for evaluation of vestibular function, and a useful and important confirmation to the other methods that are available for these evaluations.
Testing of the vestibular system by sinusoidal angular acceleration.
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