Biomedical subjects
Publications and source records attributed to W A Alonso.
The historical aspects of the use of hyoid bone autografts are reviewed. The technique of hyoid bone transposition is described. The graft has proved to be an excellent adjunct in the repair of glottic and subglottic stenosis and for the reconstruction of small anterior tracheal defects.
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Xerophthalmia, or dry eye, is an old human affliction. Among the many causes are trachoma, surgical or traumatic destruction of the lacrimal gland, and paralysis of the greater superficial petrosal nerve after Bell's palsy or from the presence or removal of an intracranial posterior fossa tumor. The technique of parotid duct transfer is a well established effective means to rehabilitate the dry eye. A method of parotid duct transfer is described.
Facial reconstruction and cosmetic surgery following extensive bone and soft tissue resection for carcinoma of the ear has not been emphasized in the past. Poor long term survival and local recurrence rates previously recluded considering extensive rehabilitative effort. A patient is presented, illustrating the problems resulting from major ablative surgery of the temporal bone. The surgical concepts and techniques used in this patient's facial rehabilitation are enumerated and described from both the functional of the principles used to other aspects of facial reconstruction are mentioned.
Autogenous hyoid bone grafts for the repair of subglottic stenosis have been used successfully in canine experiments. This technique was subsequently modified for human use, and the experience in six patients over the past year at Washington University is reported. In five of the six patients, satisfactory results were obtained. Several case reports are included, and the surgical procedure is described in detail.
We have recently encountered three cases of first branchial cleft syndromes, two of which had prominent hearing losses. The cases are described, and the literature pertaining to first branchial cleft syndrome is reviewed. Because of the frequent coexistence of various congenital anomalies, we feel that the prevalence of congenital otologic problems associated with a first branchial cleft syndrome may be greater than has previously been suspected.
Published reports by Delahunty et al and Alonso et al described the feasibility of correcting subglottic defects with cricoid arch transplantation. Using normal dogs, satisfactory results, including airway patency and vocal cord function, were reported. This report describes a second series of dogs in which subglottic stenosis was first induced by an open procedure and was subsequently repaired with an allotransplanted cricoid arch. The resulting subglottic defect in the donor dogs was repaired by autogenous hyoid arch transposition. No immunosuppressive measures or stents were used in either group. The animals were followed for periods up to one year prior to histologic study. Satisfactory results were obtained in both groups.
"Pseudosarcoma", initially considered a benign response of connective tissue to an adjacent squamous carcinoma, is now regarded as a spindle cell variant of epidermoid carcinoma. Nine cases of spindle cell carcinoma of the larynx are presented. Characteristically, the lesion appears as a large, gray, polypoid tumor. In contrast to other reports, a correlation between gross morphology and prognosis could not be made. The prognosis is more closely related to the size and location of the tumor. Biopsy specimens of the tumors in seven of the nine cases showed only the spindle cell pattern. This may be confused with granulation tissue. Spindle cell carcinoma was metastatic to the neck and lungs in three patients. Our average follow-up time was 3.8 years with two of the nine patients dying of recurrent disease. Most of our patients were successfully treated with conservation surgery.
The efficacy of autogenous dermal grafts for carotid artery protection in head and neck surgery has been investigated experimentally and propounded clinically. A review of 194 dermal grafts from 1966 to 1972 at the otolaryngology service of Washington University Medical Center revealed two broad categories of complications that were unique to dermal graft protection of the carotid artery. Two cases of inclusion cysts that developed two years after implantation of the dermal graft were classified as a complication secondary to technical problems of taking the graft. The second category of complications arose as a result of epithelialization of the exposed dermal graft. While the overall incidence of complications that were attributable to the dermal graft was approximately 6%, autogenous dermis continues to provide an excellent method for carotid artery protection.
This paper deals with the limitations of conservation surgical therapy for cancer in various sites. The detailed techniques are not included in this paper, but rather its pathophysiological approach to partial surgery. The technique has been reported many times previously.
A major complication of head and neck cancer surgery following radiation and extensive resection is pharyngocutaneous fistula. A retrospective analysis of 36 fistula patients out of 376 major head and neck procedures between January 1971 and July 1973 revealed certain guidelines for improved clinical management. Since a large discrepancy existed in the incidence of fistulas between the different surgical procedures, each operative group was examined separately. The incidence, predisposing factors, and methods of treatment for this complication following composite jaw-neck resections and various laryngeal procedures are analyzed and discussed.
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Extensive research has been done to elucidate the cellular and biochemical events of a healing wound. Similarly, new techniques are continually being investigated which would stimulate and augment the reparative process. This paper describes the uses and biochemistry of povidone-iodine which has gained widespread acceptance as a surgical preparation. However, its use as a topical agent for treating head and neck wound infections, dehiscences, and salivary fistulas has gained little recognition. Povidone-iodine is a unique compound formed by binding free iodine to polyvinylpyrrolidone. Previously, the toxic effects of iodine limited its use to preparation of the skin for surgery. When bound to the pyrrolidine molecule, iodine becomes water soluble and markedly less toxic. As a result, the broad antimicrobial spectrum of iodine may be used topically to control wound sepsis. It can be applied to mucosal surfaces without producing burns. The brown color acts as an indicator of its clinical effectiveness. When the dressings become light yellow or pale, free iodine is no longer being released and the dressing should be changed. Povidone-iodine is not a panacea for correcting interruption in the healing process during the postoperative period. The basic management of wound infections, dehiscences, and fistulas remains unchanged. Incision and drainage, debridement and flap contracture, lateralization, and diversion are necessary to initiate the healing process. Familarity with each phase of healing provides the basis for managing each of these surgical problems. Topical povidone-iodine not only controls wound sepsis but augments wound healing. The physiologic correlation with each phase of wound healing for these various surgical problems is elaborated and clinical cases presented.
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