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2.
Head Neck ; 43(1): 198-202, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33043533

RESUMO

BACKGROUND: The aim of the study was to describe a novel technique for reinforcement of salvage laryngectomy closure using a bipedicled musculofascial submental flap. METHODS: A retrospective cohort study design identified patients who underwent salvage laryngectomy reinforcement with a bipedicled submental hammock flap between January 2008 and December 2016 were compared to salvage laryngectomy patients treated with primary closure of the neopharynx during the same time period. Pharyngocutaneous fistula rates were compared between groups. RESULTS: Pharyngocutaneous fistula rate in the submental hammock group (2/31, 6.5%) was significantly lower compared to the primary closure group (14/45, 31%, P < .05). CONCLUSION: The bipedicled musculofascial submental hammock flap is a viable method for reinforcement of salvage laryngectomy defects. It has a favorable pharyngocutaneous fistula rate compared to primary closure alone and has unique advantages over conventional methods of reinforcement.


Assuntos
Fístula Cutânea , Neoplasias Laríngeas , Doenças Faríngeas , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Doenças Faríngeas/cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Terapia de Salvação , Retalhos Cirúrgicos
3.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567121

RESUMO

An otherwise healthy 24-year-old man presented with 1 week of fever, facial pain and swelling. He initially sought care at an outside hospital, where he was diagnosed with folliculitis and sent home with oral antibiotics. On arrival at our institution, CT neck was ordered, which demonstrated diffuse submental phlegmon, prompting incision and drainage. After initial improvement, the patient experienced high fevers and increased swelling just 12 hours later. The decision was made to take the patient for operative exploration, and wide debridement was performed due to suspicion for necrotising fasciitis intraoperatively that was ultimately confirmed on final pathology. Final speciation of intraoperative culture demonstrated a clindamycin-resistant and methicillin-resistant strain of Staphylococcus aureus The patient was managed with intravenous antibiotics, additional debridement and careful wound care. Delayed partial closure of wound was eventually performed once patient showed marked and persistent clinical improvement. The patient was discharged on hospital day 12 with close follow-up.


Assuntos
Fasciite Necrosante/microbiologia , Fasciite Necrosante/cirurgia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Celulite (Flegmão)/diagnóstico por imagem , Celulite (Flegmão)/cirurgia , Clindamicina , Desbridamento/métodos , Diagnóstico Diferencial , Drenagem/métodos , Dor Facial/diagnóstico , Dor Facial/etiologia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Humanos , Masculino , Meticilina , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
4.
Curr Opin Otolaryngol Head Neck Surg ; 20(4): 231-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22894990

RESUMO

PURPOSE OF REVIEW: This article reviews literature pertaining to advances in the reconstruction of segmental mandibular defects in the context of an established standard of care, microvascular transfer of free osteocutaneous flaps. RECENT FINDINGS: Most literature reiterates established reconstructive techniques. Exceptions include the use of computer-assisted modeling to preoperatively design the excision of both the mandible and fibula segments and to produce a template for contouring the neomandible, the design of new flaps, distraction osteogenesis and techniques for dealing with osteonecrosis. SUMMARY: The microvascular transfer of free osteocutaneous flaps remains the standard of care, with the fibula flap the clear favorite. Review of the evolution of this flap for segmental mandibular reconstruction provides the bulk of the literature. Improvement on this standard of practice continues to be elusive, in large part because of the effects of associated radiation. Tissue engineering holds promise but no current practical application is available.


Assuntos
Doenças Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular , Reconstrução Mandibular/métodos , Transplante Ósseo/métodos , Retalhos de Tecido Biológico/irrigação sanguínea , Mandíbula/efeitos da radiação , Microcirurgia/métodos , Reabilitação Bucal/métodos , Osteorradionecrose/cirurgia , Cirurgia Assistida por Computador/métodos
5.
Otol Neurotol ; 31(3): 460-6, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20195187

RESUMO

HYPOTHESIS: To investigate the early events in molecular progression toward schwannoma tumorigenesis, we developed an in vitro model of human Schwann cell tumorigenesis by merlin knockdown. BACKGROUND: Neurofibromatosis 2 (NF2)-related and sporadic vestibular schwannoma (VS) exhibit loss of functional merlin (schwannomin). After loss of merlin expression in the Schwann cell, the initial steps toward VS tumorigenesis are unknown. Merlin, a putative tumor suppressor protein, interacts with many cellular proteins, regulating their function. Among these are receptor tyrosine kinases, including the epidermal growth factor receptor family B (ErbB) family receptors epidermal growth factor receptor and ErbB2. Functional merlin interacts with and internalizes these growth factor receptors, silencing their proliferation and survival signaling. Deregulation of CD44, the cell adhesion/signaling molecule and cancer stem cell marker, has also been implicated in VS tumorigenesis. METHODS: Merlin knockdown was performed using small interfering RNA transfection into human Schwann cell primary cultures. Knockdown was confirmed by real-time quantitative PCR, immunofluorescence, and Western analysis. Expression profiles of ErbB, merlin, and the stem cell markers nestin and CD44 were examined in knockdowns. Proliferation rate was assessed with bromodeoxyuridine incorporation, and radiation sensitivity was assessed using the Annexin assay in knockdowns versus controls. RESULTS: Merlin knockdowns demonstrated increased proliferation rate, upregulation of epidermal growth factor receptor, ErbB2, and ErbB3, CD44, and nestin. Short-term merlin depletion had no effect on gamma irradiation sensitivity compared with controls. CONCLUSION: Merlin depletion results in deregulation of ErbB receptor signaling, promotes a dedifferentiated state, and increases Schwann cell proliferation, suggesting critical steps toward schwannoma tumorigenesis.


Assuntos
Proliferação de Células , Neurofibromina 2/genética , Células de Schwann/metabolismo , Western Blotting , Técnicas de Cultura de Células , Células Cultivadas , Receptores ErbB/genética , Receptores ErbB/metabolismo , Imunofluorescência , Regulação Neoplásica da Expressão Gênica , Humanos , Receptores de Hialuronatos/genética , Receptores de Hialuronatos/metabolismo , Proteínas de Filamentos Intermediários/genética , Proteínas de Filamentos Intermediários/metabolismo , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Nestina , Neurofibromina 2/metabolismo , RNA Interferente Pequeno , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Células de Schwann/citologia , Células de Schwann/patologia , Transdução de Sinais/genética , Regulação para Cima/genética
6.
Laryngoscope ; 118(8): 1458-63, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18670322

RESUMO

OBJECTIVES/HYPOTHESIS: Determine the role of estrogen receptor (ER) and progesterone receptor (PR) expression in sporadic and neurofibromatosis 2 (NF2)-related vestibular schwannomas (VS). Growth and proliferation signaling in human VS tumorigenesis may play a key role in molecular therapeutic targeting. VS carry mutations of the NF2 gene encoding the tumor suppressor, merlin, which interacts with ErbB2 in Schwann cells, implicating ErbB receptors in VS tumorigenesis. ErbB receptor family members are overexpressed or constitutively activated in many human tumors, and are effective therapeutic targets in some human cancers. VS occur more frequently in women and are larger, more vascular, and demonstrate increased growth rates during pregnancy. ER and PR may play a role in ErbB pathway activation and VS progression. STUDY DESIGN: Quantitative real-time polymerase chain reaction (qRT-PCR) for ER and PR messenger RNA was performed using greater auricular and vestibular nerve controls (n = 8), sporadic VS (n = 23), and NF2-related VS (n = 16) tissues. METHODS: The qRT-PCR data were normalized with standardization to a single constitutively expressed control gene, human cyclophylin. RESULTS: Reverse transcription of messenger RNA from control and tumor specimens followed by RT Q-PCR demonstrated differences in ER and PR gene expression between sporadic and NF2-related VS. CONCLUSIONS: ER and PR expression in VS might have implications for development of a VS-specific drug delivery system using antihormone and ErbB pathway small molecule inhibitors, due to crosstalk between these receptors. These signals may be critical for re-establishing ErbB-mediated cell density dependent growth inhibition.


Assuntos
Neoplasias da Orelha/metabolismo , Neuroma Acústico/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Vestíbulo do Labirinto/metabolismo , Adulto , Neoplasias da Orelha/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibromatose 2/complicações , Neuroma Acústico/etiologia , Reação em Cadeia da Polimerase , Regulação para Cima , Nervo Vestibular/metabolismo
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