Biomedical subjects
Publications and source records attributed to R V Argamaso.
One patient with a solitary plasmacytoma of the frontal bone was treated with complete surgical resection. To reconstruct the large calvarial defect, a split-thickness calvarial graft was harvested from the parietal area and secured in place with miniplates. Solitary plasmacytomas of the calvaria are not common. Clinical presentation, diagnostic criteria, therapeutic approaches, and prognosis are discussed.
A technique for the construction of a frontal bar and a forehead plate as a single unit is described. This technique could be used in any procedure in which a frontal bandeau is advanced and the forehead needs to be remodeled. By using microscrew fixation, the bulkiness of miniplates and wires is eliminated.
A modified glossopexy is described with results of the operation in 24 patients who were specifically selected based on nasopharyngoscopic examination of the upper airway. Only patients with documented glossoptosis on endoscopy were selected for glossopexy. The procedure is designed to use two points of attachment for the tongue, one at the mandibular alveolus and the other at the lower lip. The genioglossus is also released to lengthen the tongue. All patients had resolution of their upper airway obstruction. There was only one partial dehiscence. The glossopexies were all released at the time of palate repair, usually before the first birthday.
Using a protocol specifically designed to decrease the risk factors for postoperative morbidity and upper airway obstruction, we have essentially eliminated major complications after pharyngeal flap surgery while maintaining excellent speech results. The protocol includes inserting a short pharyngeal flap into a tissue "sandwich" and keeping an NP tube in place for 48 hours postoperatively. The complications reduced by use of this protocol include apnea and other upper respiratory complications, as well as bleeding. In addition, postoperative discomfort is decreased with the current protocol. Using this approach, pharyngeal flap surgery is highly effective in improving speech and is associated with low morbidity.
The elimination of hypernasal speech in patients with cleft palate following pharyngeal flap surgery in childhood is well established. However, pharyngeal flaps in adults have been considered to yield more modest results. This study reports on 20 adult patients with cleft palate-related hypernasality who underwent pharyngeal flap surgery. Normal nasal resonance was achieved in 15 cases, hyponasality occurred in 3 cases, and hypernasality persisted in 2 cases. However, speech intelligibility was not always dramatically improved. Indications and outcome were found to be highly dependent on preoperative articulation.
A multidisciplinary International Working Group of scientists was assembled to address the question of standardizing reporting techniques for multiview videofluoroscopy and nasopharyngoscopy, the generally accepted standards for direct observation of the velopharyngeal valve. This report is a first attempt to propose standards while seeking feedback from the readership in order to further develop a common methodology.
A tongue flap is frequently used for closure of fistulae following cleft palate repair. Early tongue flap dehiscence is a troublesome complication. While the tongue flap is a very effective means of functionally obliterating the transpalatal oronasal opening, the final appearance of the repair leaves much to be desired. More often than not, the tongue tissue appears bulky and unnatural in the roof of the mouth. A method is described that overcomes the problem of flap detachment during the early postoperative period by suspending and supporting the tongue pedicle with a palatal sling. On peroral view, the repaired area has a better appearance when the tongue flap lines the nasal side rather than the oral side as in conventional procedures.
Ear reduction has been performed occasionally for aesthetic considerations. This series is comprised of 8 patients representing 7 bilateral reductions and 1 unilateral reduction for a total of 15 ears. Historically, surgery for macrotia consisted of resections of full-thickness wedges from the periphery of the ear. The surgical defect was repaired by directly approximating the wound edges. Additional removal of triangular or crescent-shaped segments from adjacent sides of the wound prevented the cupping of the reconstructed ear. Secondary deformities were not uncommon consequences. The most distressing were cruciform scars that defaced the lateral surface of the ear. These were frequently exacerbated by the uneven coaptation of the underlying cartilages. The current technique places the incisions at strategic locations where the scars that form are less conspicuous. The initial steps are essentially identical with the lateral transhelical approach to otoplasty for protruding ears. In some patients, both procedures have been combined during the same operative session.
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Three methods of pharyngeal flap surgery were analyzed with multiview videofluoroscopy and nasopharyngoscopy at least six months post-operatively. It was found that, by varying the type of insertion of the flap into the palate, post-operative flap width could be "tailored" to the size of the gap in the velopharyngeal sphincter. The value of varying flap width according to gap size was assessed by analyzing speech results in 60 patients specifically assigned for narrow, moderate, or wide flaps. Results show a marked improvement in the effectiveness of pharyngeal flap surgery when operations are prescribed according to the degree of lateral pharyngeal wall motion seen pre-operatively.
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We report a case of Wernicke's sensory aphasia, caused by a localized cerebritis of the left temporal lobe. The condition developed in the second week after an esthetic rhinoplasty. There was an associated small abscess in the right inner canthal area.
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This report describes a pattern of similarities among 12 patients which are felt to represent a newly recognized congenital malformation syndrome. The symptoms shown most consistently by the 12 patients were overt or submuscous clefts of the secondary palate, ventricular septal defects, typical facies, and learning disabilities. Other symptoms were noted with varying frequency. The occurrence of velopharyngeal insufficiency in all twelve patients reflected poor motion in the lateral pharyngeal walls, thus necessitating specific forms of treatment. Treatment was often dependent on the extent of cardiac lesions.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.