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Biomedical subjects

R H Ossoff

Publications and source records attributed to R H Ossoff.

At least 73 records · Page 4Linked to original sources
PubMed1991

Surgery for benign lesions of the glottis.

This article examines benign lesions of the glottis and adjacent structures commonly encountered in clinical practice. The goals of management are to understand the cause and the characteristics of these lesions and to provide the most conservative management possible. Nonsurgical management is selected, if possible, with surgical intervention reserved for refractory conditions. Traditional cold steel operative techniques as well as carbon dioxide laser techniques are discussed in this article.

Cysts↗
PubMed1990

Endoscopic laser arytenoidectomy revisited.

Arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis. Although both endoscopic and external approaches have been described, the endoscopic laser technique is more desirable because it requires no incision and allows for the immediate assessment of airway size. Eleven patients with bilateral vocal cord paralysis treated by endoscopic laser arytenoidectomy were presented in 1984. At that time, 10 of the 11 patients had been successfully decannulated. Follow-up on that group of patients revealed that 7 of the 10 successfully treated patients remain decannulated with a good airway, although 2 of these patients required a revision procedure to excise a granuloma. One patient failed at 15 months and has failed two subsequent revision operations, and 2 patients have been lost to follow-up. Since 1984, 17 additional patients with bilateral vocal cord paralysis have been treated by the authors using the same endoscopic laser arytenoidectomy technique; all have been successfully managed, with a minimum follow-up of 3 years. The technique of this operation will be reviewed. This study demonstrates the clinical usefulness of endoscopic laser arytenoidectomy in the treatment of bilateral vocal cord paralysis.

Arytenoid Cartilage↗
PubMed1990

Laser application in the tracheobronchial tree.

The use of lasers has greatly expanded our ability to treat diseases of the tracheobronchial tree. We must be aware of the advantages and disadvantages of each particular wavelength. In addition, the specific safety precautions for each laser wavelength must be followed closely.

Bronchial Diseases↗
PubMed1990

Recent advances in thyroid imaging.

Thyroid imaging has evolved from early radionuclide rectilinear thyroid scanning to the recently developed technique of single photon emission computed tomography. At the same time, x-ray fluorescent scanning, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography have improved identification of the thyroid gland. The appropriate use and relative roles of these imaging modalities in the investigation of patients with thyroid disease are discussed.

Diagnostic Imaging↗
PubMed1990

Evaluation and treatment of complications of thyroid and parathyroid surgery.

The major complications of thyroid and parathyroid surgery include hemorrhage, respiratory obstruction, hyperthyroid storm, hypoparathyroidism, and laryngeal nerve injury. In this article, the incidence, diagnosis, and treatment of various complications are reviewed, with emphasis on hypoparathyroidism and vocal cord paralysis, either bilateral or unilateral. Thyroplastic phonosurgery and carbon dioxide laser arytenoidectomy, two recent surgical additions to the rehabilitation of vocal cord paralysis, are described in depth.

Aluminum Hydroxide↗
PubMed1989

Laryngotracheal reconstruction with composite nasal septal cartilage grafts.

The composite nasal septal graft has been used successfully by us to reconstruct patients with high tracheal and laryngotracheal stenosis. We have treated ten patients and have been able to decannulate seven of these patients. When these ten cases are added to the six original cases presented in an earlier report (1981), certain conclusions can be drawn. The success or failure of these procedures, which is judged by the ability to decannulate the patient, appears to be related to the extent of the initial injury. We discuss the indications for the composite nasal septal graft and the use of additional treatment, including stents, steroid injections, dilatations, and flaps. In conclusion, the addition of these ten cases to the original six cases of composite nasal septal grafts now provides the opportunity to review indications and contraindications for the use of this graft in the management of advanced laryngotracheal stenosis.

Adult↗
PubMed1989

The use of magnetic resonance imaging with high-resolution CT in the evaluation of facial paralysis.

Magnetic resonance imaging (MRI) has been widely used in the evaluation of suspected acoustic neuroma, but has not received the same attention with respect to facial paralysis. High-resolution computed tomography (HRCT) has been the radiologic test of choice to evaluate the facial nerve. The necessary HRCT projections, slices, and enhancement techniques to visualize each segment have been outlined. We have developed a radiologic protocol that uses MRI in conjunction with HRCT, applying the strengths of each to evaluate the facial nerve. We have evaluated 15 patients and have found that MRI is the better study to evaluate the brain stem/cerebellopontine angle segment of the facial nerve and better evaluates bone-soft tissue interfaces. HRCT is better in the evaluation of the intratemporal segment of the facial nerve and the assessment of the anatomic perspectives of a lesion within the temporal bone. The results are discussed and case reports illustrate the efficacy of this approach.

Adolescent↗
PubMed1989

Laser lingual tonsillectomy.

Diseases of the lingual tonsils are generally overlooked in both clinical practice and medical literature. Infections of the lingual tonsils are usually treated medically, although in patients with symptomatic chronic inflammation or hyperplasia of the lingual tonsils, surgical intervention may be indicated. Eighty-two patients with benign inflammatory problems of the lingual tonsils, who were not improved by medical management, underwent laser lingual tonsillectomy at four different medical centers, between 1984 and 1987. The procedure was tolerated well by all of the patients, with no significant operative complications. Short- and long-term results were satisfactory. Laser surgery is an effective method for the treatment of benign hyperplastic and inflammatory diseases of the lingual tonsils.

Adolescent↗
PubMed1989

Laser safety in otolaryngology--head and neck surgery: anesthetic and educational considerations for laryngeal surgery.

Two investigations concerning anesthetic and educational considerations for laser safety in microlaryngeal carbon dioxide laser surgery have been performed. The first study demonstrated that attendance at a "hands-on" laser surgery course that stressed safety precautions was associated with a reduced rate of laser-related complications in the selected group of otolaryngologists who participated in the course, when compared to another selected group of otolaryngologists who were members of a senior otolaryngology society, and surveyed solely on the basis of their society membership. The second series of studies compared the incendiary characteristics of three endotracheal tubes in various mixtures of oxygen, diluted with either helium or nitrogen. It was determined that the polyvinyl chloride tube should not be used for laser surgery, even when wrapped with reflective, metallic tape. The safest anesthetic gas mixture was found to be 30% oxygen in helium; the addition of 2% halothane did not have an adverse effect, as had been previously reported. Both the Xomed Laser-Shield and Rusch red rubber endotracheal tubes were found to be safe, when used with the laser in the pulsed mode in an atmosphere of 100% oxygen. When the laser was used in the continuous mode, both tubes ignited in an atmosphere of 30% oxygen in helium. These findings challenged the previously reported levels of safety associated with the use of an unwrapped Xomed tube. Based on the results of this investigation, it has been concluded that both the Rusch red rubber tube and the Xomed Laser-Shield tube should be wrapped with reflective, metallic tape, when used for cases of microlaryngeal surgery with the carbon dioxide laser.

Anesthesia↗
PubMed1988

The advantages of laser treatment of tumors of the larynx.

The carbon dioxide (CO2) laser is safe and efficacious when used in conjunction with endoscopic excision of selected premalignant and malignant tumors of the larynx. Cure rates parallel those obtained with traditional surgical instruments. Advantages of laser excision of early glottic carcinomas include greater accuracy in establishing the true extent of the disease, minimal morbidity, and cost effectiveness.

Endoscopy↗
PubMed1987

The microtrapdoor technique for the management of laryngeal stenosis.

The use of the carbon dioxide laser as an endoscopic microsurgical instrument has stimulated interest in treating laryngeal and tracheal stenosis. Dedo and Sooy (1984) reported a significant improvement in the management of posterior commissure, subglottic, and high tracheal stenoses with the use of a microtrapdoor flap. A recent laboratory investigation of this method supported the clinical efficacy of this technique. Six patients are evaluated in this report, three with posterior commissure stenosis and three with subglottic or high tracheal lesions. All six patients had a tracheotomy present or performed at the time of their surgical procedures, and each patient had only one procedure. All six had improved airways after the microtrapdoor flaps. Five have been decannulated and one patient with associated hypopharyngeal stenosis still has a tracheostomy because of mild aspiration, although the airway lumen is moderately improved. It is felt that, as a group, the subglottic and high tracheal lesions respond to this technique better than the posterior commissure stenoses. Details of the technique are presented. This brief clinical report supports the efficacy of the microtrapdoor flap procedure in selected laryngeal and tracheal stenoses.

Adolescent↗
PubMed1986

Use of the CO2 laser for malignant disease of the oral cavity.

The CO2 laser has provided the otolaryngologist/head and neck surgeon with a valuable addition in the diagnosis and treatment of malignant disease of the oral cavity. It is also helpful in the treatment of the premalignant clinical leukoplakias of the oral cavity. Carcinoma in situ has been diagnosed and treated successfully with the CO2 laser. The T1 carcinomas of the tongue, floor of mouth, and tonsil can be successfully managed with the CO2 laser. It also offers the patient a relatively painless method of debulking large obstructing tumors. Other advantages of the CO2 laser include hemostasis, precise visualization, and less edema and pain than the conventional techniques.

Adolescent↗
PubMed1986

Anesthesia for bronchoscopic laser surgery.

Choice of anesthesia for bronchoscopic laser surgery depends on the surgical technique. Fiberoptic bronchoscopy can be managed with either topical or general anesthesia, while rigid bronchoscopy usually requires general anesthesia. In either case precautions for laser surgery must be taken. Preoperative evaluations should include cardiovascular status and the anatomy of the lesion. Preoperative medication should include an anticholinergic agent. The influence of total intravenous vs. inhaled anesthetics on prolonged respiratory depression is discussed, and the techniques for providing controlled vs. spontaneous respiration are described. Finally, postoperative care, including the management of airway obstruction and hemorrhage, is outlined.

Anesthesia↗
PubMed1986

Chin reconstruction with pectoralis myocutaneous flap.

Chin reconstruction after radical surgery for carcinoma of the oral cavity is a complex and controversial problem. We have developed a simple, single-stage, primary procedure for chin reconstruction. It is easily mastered and is based on a simple modification of the pectoralis major myocutaneous flap. Our experience includes seven cases, including two with total chin reconstructions. The number and type of complication is low and consistent with the magnitude of the surgical procedure. This operation provides acceptable aesthetic and functional results to patients undergoing partial or total resection of the chin.

Aged↗
PubMed1986

Bronchoscopic laser surgery: which laser when and why.

The use of the carbon dioxide (CO2) and neodymium: yttrium aluminum garnet (Nd:YAG) lasers for the endoscopic management of patients with diseases of the tracheobronchial tree is discussed. Advantages and disadvantages of each wavelength are presented. It would appear that there should be unique indications for both of these laser systems; however, each can be used relatively safely and interchangeably if certain precautions are followed.

Bronchial Diseases↗