Subject(s)
Otitis Media, Suppurative/therapy , Otitis Media/therapy , Administration, Oral , Administration, Topical , Amoxicillin/therapeutic use , Child, Preschool , Chronic Disease , Drug Administration Schedule , Drug Therapy, Combination , Hearing Tests , Humans , Injections , Middle Ear Ventilation , Otitis Media, Suppurative/drug therapy , Otitis Media, Suppurative/physiopathologyABSTRACT
Mucopyoceles of the frontoethmoid sinuses occurring as an epidural mass are uncommon. Four patients with this condition have been managed over the last eight years by the authors. Two patients had early recurrence of their disease following carefully performed ablation and frontal craniectomy. Marsupialization, or permanently draining the ablated frontal sinus cavity into the nose, was the initial treatment of the other two patients, and subsequently the therapy of choice for all patients in this series.
Subject(s)
Ethmoid Sinus , Frontal Sinus , Mucocele/surgery , Adult , Drainage/methods , Epidural Space , Humans , Male , Middle Aged , Mucocele/diagnosis , Recurrence , Skull/surgeryABSTRACT
Management to prevent cervical osteomyelitis in transpharyngeal gunshot wounds which involve the cervical spine consists of triple endoscopy to identify the pharyngeal injury, anteroposterior and lateral view roentgenograms to localize the injury to the cervical spine, administration of penicillin and gentamicin intravenously, exploration of the neck and repair of pharyngeal wounds, debridement of the cervical spine and external immobilization of the spine for six weeks. This management protocol has proved successful in five patients.
Subject(s)
Cervical Vertebrae/injuries , Pharynx/injuries , Wounds, Gunshot/surgery , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Endoscopy , Gentamicins/administration & dosage , Humans , Male , Osteomyelitis/etiology , Osteomyelitis/prevention & control , Penicillins/administration & dosage , Pharynx/diagnostic imaging , Pharynx/surgery , Radiography , Wounds, Gunshot/complications , Wounds, Gunshot/diagnostic imagingABSTRACT
The first case of malignant fibrous histiocytoma of the frontal sinus is reported. The aggressive nature of the tumor despite its relatively benign histologic pattern and value of electron microscopy are emphasized. Ultrastructural examination reveals a progression of several principal cell types, lending support to the multi-potent mesenchymal cell origin of these malignancies. These cells may have arisen from the supporting stroma of the ectodermally derived respiratory epithelium of the paranasal sinuses. Wide local excision is currently the primary mode of therapy. The value of radiation therapy or chemotherapy in this tumor in unproven.
Subject(s)
Frontal Sinus , Histiocytoma, Benign Fibrous/pathology , Paranasal Sinus Neoplasms/pathology , Adult , Histiocytoma, Benign Fibrous/diagnostic imaging , Humans , Male , Microscopy, Electron , Paranasal Sinus Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A 13-year retrospective review of 53 patients with laryngeal trauma seen between 1965 and 1975 at the University of Texas Health Science Center at Dallas affiliated hospitals is presented. Patient management fell into four groups: observation following direct laryngoscopic examination or observation alone (7 patients), direct laryngoscopic examination and tracheostomy (5 patients), open reduction of fractures without stenting (14 patients), and open reduction of fractures with stenting (27 patients). These cases were analyzed according to initial signs and symptoms, duration between time of injury and surgery as pertains to success of management, indications for open reduction of laryngeal fractures, and associated injuries.
Subject(s)
Larynx/injuries , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/therapy , Humans , Laryngeal Cartilages/injuries , Laryngeal Cartilages/surgery , Laryngoscopy , Larynx/surgery , Postoperative Complications , Respiration , Retrospective Studies , Tracheotomy , VoiceABSTRACT
Four cases of cervical osteomyelitis complicating transpharyngeal gunshot wounds to the neck are discussed. Thorough debridement of bone and soft tissue, adequate drainage, broad-spectrum antibiotics, and rigid immobilization of the cervical spine are essential for the successful treatment of this complication. Inadequate or delayed treatment may result in prolonged hospitalization, the need for multiple surgical procedures, and possible neurologic deficits.
Subject(s)
Neck Injuries , Osteomyelitis/etiology , Spinal Diseases/etiology , Wounds, Gunshot/complications , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Female , Humans , Male , Neck/surgery , Osteomyelitis/drug therapy , Pharynx/injuries , Pharynx/surgery , Spinal Diseases/drug therapy , Wounds, Gunshot/surgeryABSTRACT
A case of osteosarcoma arising in the soft tissue of the larynx in an elderly man is presented with light and electron microscopic documentation. The patient developed chronic hoarseness and a recurring polypoid laryngeal tumor, causing acute airway obstruction. He was treated by total laryngectomy, but he died with multiple pulmonary metastases within three months of laryngectomy. This is the third (or possibly fourth) recorded case of osteosarcoma arising in the soft tissues of the larynx, and the previous cases were clinically and pathologically similar to this one. The prognosis of sarcoma of the larynx is poor but may be improved with early recognition and adequate surgical excision.
Subject(s)
Laryngeal Neoplasms/ultrastructure , Osteosarcoma/ultrastructure , Soft Tissue Neoplasms/ultrastructure , Aged , Carcinosarcoma/diagnosis , Diagnosis, Differential , Humans , Male , Microscopy, Electron , Neoplasm Metastasis , Prognosis , RecurrenceABSTRACT
The rhomboid flap is a practical and efficient method of repairing small- to moderate-size surface defects of the head and neck. This flap has the advantage of combining the lateral shift and rotational methods of transfer that aid in the closure of the donor site as the flap is transposed. A description of this flap, the principle of its design, its clinical application, and potential pitfalls are presented.
Subject(s)
Skin Transplantation , Face/surgery , Humans , Methods , Transplantation, AutologousABSTRACT
The rhomboid flap was initially popularized by a Russian, Alexander Limberg, and modified by Claude Dufourmentel of Paris. Numerous variations on the flap have been proposed more recently by Webster and Gunter. This flap has found its way into the practice of most surgeons doing head and neck surgery, with its primary advantage being that it is an extremely simple flap operation to learn, with great versatility. The general principles and their clinical application are presented in order to increase proper utilization of the flap.
