Biomedical subjects
Publications and source records attributed to R H Ossoff.
A three-year-old male with histologically proven intraoral and cutaneous juvenile xanthogranuloma is described. In our review of the literature published in English we were unable to find a similar case report. The clinical and histologic features of this disorder are discussed.
Compression of the trachea by an anomalous innominate artery in association with reflex apnea is a frequent cause of respiratory arrest in infants. Once considered, tracheoscopy is mandatory to rule out this disorder. Surgical correction of this condition by innominate arteriopexy has proven to be a very effective method of management. Seventy-eight patients with tracheal compression by an anomalous innominate artery managed by the authors at The Children's Memorial Hospital in Chicago between January 1977 and December 1979 are presented. In this series, 28 patients had a history of one or more episodes of reflex apnea; all of these patients underwent an innominate arteriopexy. A complete review of this syndrome and methods of its diagnosis are scrutinized. We agree with previous authors that reflex apnea is a definite indication for surgical correction of this vascular anomaly causing tracheal compression, but other indications are delineated.
A new set of endoscopic couplers has been designed by the authors for laparoscopic, arthroscopic and bronchoscopic carbon dioxide laser surgery. Certain safety features have been incorporated into this design which heretofore have been unavailable. The bronchoscopic coupler was designed with a gimbeled, partially reflective germanium window to facilitate direct, coaxial vision with the laser beam. A "joy stick" has been incorporated into the design to allow the surgeon to manipulate the helium-neon-aiming laser within the lumen of the bronchoscope. Bronchoscopes as small as 4 mm in diameter and 30 to 40 cm in length have been used with this coupler.
Studies were undertaken by the Departments of Otolaryngology-Head and Neck Surgery and Anesthesiology at Northwestern University Medical School and the Medical College of Wisconsin (Milwaukee) to compare the potential for tissue injury to the trachea and lungs of canines. Polyvinylchloride (PVC), Rusch red rubber, and silicone tubes were tested. The effects of an intraluminal tube fire on the larynx and trachea were documented with laryngeal and bronchoscopic photographs taken immediately postburn and at the time of sacrifice six hours later. The most severe burns were associated with the PVC tube. Silica ash was seen in the airway after the silicone tube fires and raises the possibility of future problems with silicosis. Histological examination of the trachea showed acute injury in all of the animals; specimens from the dogs with the PVC tube fires demonstrated the most severe cellular damage.
A laryngoscope has been developed for microlaryngeal laser surgery in the posterior commissure of the larynx. The tip has been designed to facilitate exposure of one entire arytenoid and the posterior commissure. Other features include a concavity on the superior lip of the tip to hold the endotracheal tube anteriorly, a bifurcated smoke evacuation channel and a nonreflective finish. It is anticipated that this laryngoscope will be available in pediatric and adolescent sizes in addition to the adult size that we have worked with.
A steering device for the Nd:YAG laser fiber to be used in conjunction with the rigid carbon dioxide laser bronchoscope set has been designed. This device inserts into the proximal end of the rigid bronchoscope and has the ability to accept a rigid optical telescope and the Nd:YAG laser fiber, and to evacuate smoke from the operative field.
Laser technology has provided new options in the endoscopic management of patients with selected diseases of the tracheobronchial tree. At present, bronchoscopic laser surgery is performed using either the carbon dioxide laser or the neodymium:yttrium aluminum garnet (Nd:YAG) laser. Strong and his colleagues first performed bronchoscopic laser surgery over 10 years ago when they successfully coupled the CO2 laser to a rigid ventilating bronchoscope. Since that time, the indications for bronchoscopic laser surgery have expanded and the instruments used have become both safer and more "user friendly." Despite these advances in CO2 laser technology, certain limitations are associated with its use for the endoscopic management of patients with tracheobronchial lesions. This paper discusses these limitations, places this technology in perspective, and reviews recent publications which have suggested that the Nd:YAG laser may be more efficacious than the CO2 laser for the treatment of the same group of patients.
Twenty-five previously untreated patients with selected early midcordal squamous cell carcinomas have been treated by endoscopic excisional biopsy with the carbon dioxide laser and followed for a minimum of 3 years. Twenty-four of the 25 patients are alive and free of disease, and one patient died of local and regional recurrence 2 years after attempted endoscopic excision followed by partial laryngectomy. Indications, contraindications, advantages, and complications associated with this treatment option for patients with early glottic carcinoma are discussed.
A retrospective review of 20 cases of laryngeal stenosis treated with the carbon dioxide laser was conducted at the Medical College of Wisconsin and Northwestern University. The stenoses were grouped into four categories: supraglottic, glottic, subglottic, and combined glottic-subglottic. Twenty patients had 21 lesions excised by 40 laser procedures. Eleven of 21 stenoses were successfully managed by carbon dioxide laser endoscopy: 3 of 3 supraglottic, 6 of 10 glottic, 2 of 4 subglottic, and 0 of 4 combined laryngeal/tracheal stenoses. Eleven of the 20 patients had significant airway improvement or decannulation. Soft tissue stenoses of the supraglottic area respond favorably to carbon dioxide laser excision. In other regions of the larynx, the use of supplemental stents, steroid injections, dilatations, and the micro-trapdoor surgical flap technique in scar stenosis may increase the rate of success. The lower success rate in the posterior commissure, subglottic, and combined laryngotracheal stenoses is due to the circumferential, thick stenosis with a vertical depth of more than 1 cm and the fibrotic fixation of the arytenoid cartilages. Small cicatrices appear to respond better to laser vaporization than the large ones which frequently recur.
A subglottiscope for use in adult men and women has been developed for microlaryngeal laser operations in the subglottic region of the larynx. The tip has been designed to facilitate exposure of the subglottis and upper trachea in both short-necked and long-necked individuals. A smoke evacuation channel has been included, as has a nonreflective finish. Finally, a port for jet ventilation has been added to facilitate use of this anesthetic technique when indicated. The authors have used the prototypes of these subglottiscopes on six patients, four women and two men, and have found the exposure of subglottic and upper tracheal lesions to be improved over that obtained with existing microlaryngoscopes.
A 39-year-old man had three coexistent neoplasms of the larynx, squamous papilloma, verrucous carcinoma, and squamous carcinoma. In our review of the English literature, we could not find a similar case report. The potential transformation of benign laryngeal papilloma to verrucous carcinoma and infiltrating squamous cell carcinoma is discussed.
Vesiculobullous lesions of the upper aerodigestive tract are among the most frequently occurring disease processes of the oral soft tissues. Pemphigus vulgaris, mucous membrane pemphigoid, erythema multiforme, and erosive lichen planus are compared and contrasted with each other and with vesiculobullous eruptions of viral origin. Clinical photographs and photomicrographs of these disease processes are presented. Treatment modalities are briefly discussed.
Two cases of pemphigus vulgaris occurring in young men, aged 24 and 29, are presented. Prior to referral, each patient had persistent oral vesiculobullous and ulcerative mucous membrane lesions for at least six months and was treated with multiple courses of antibiotics and mouthwashes. On initial examination, both patients had the characteristic oral vesiculobullous lesions of pemphigus. A biopsy specimen of an intact vesicle confirmed the diagnosis.
An 11-year-old boy with laryngeal carcinoma underwent a partial laryngectomy. Subsequently, a cervical metastatic node developed eight months following a tonsillectomy; a radical neck dissection was performed. The patient has remained free of disease over a ten-year follow-up period. In our review of the English literature, no similar case report was found. The potential relationship of tonsillectomy to alterations in local T cell-mediated immune response is discussed.
An anatomic study is made to determine the role of the periosteum in the lymphatic drainage of the floor of the mouth in the dog. Microsurgical techniques are used to cannulate and perfuse a lymphatic vessel. Pathways are dissected to the proximity of the mandible, where a full-thickness mucoperiosteal flap is elevated. It is found that the floor-of-the-mouth lymphatics drained through the periosteum prior to entering the cervical lymphatic chain.
Epidermoid carcinoma and angiofibroma are the commonly diagnosed lesions of the nasopharynx. Less common are unusual tumors of epithelial origin as well as those from endothelial and mesenchymal precursors. Otolaryngologists must be knowledgeable in the literature associated with these tumors to facilitate early diagnosis and to institute appropriate therapy. Cases of verrucous carcinoma, inverted papilloma, adenoid cystic carcinoma, and extramedullary plasmacytoma are presented. Current literature is reviewed and accepted modes of treatment are outlined.
A 66-year-old man with benign mixed tumor of the lacrimal gland underwent an excisional biopsy in 1966. Three recurrences subsequently developed, which resulted in an orbital exenteration. In 1979 he came to us. We discovered radiographic evidence and surgical confirmation of recurrent disease involving the lesser wing of the sphenoid and dura in the floor of the anterior cranial fossa. The natural history and management of this tumor is discussed and the relevant literature is reviewed.
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