Abraham M. Baruchin

Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases.

PURPOSE This article describes the use of endoscopy for diagnostic and surgical intervention in the major salivary glands of patients who have obstructive pathology, reviews past experience with this technique, and describes the microanatomy and pathophysiologic findings encountered during endoscopy of these glands. PATIENTS AND METHODS A total of 154 salivary glands (96 submandibular glands, 57 parotid glands, 1 sublingual gland) suspected of having obstructive pathology (89 males, 65 females; aged 5 to 72 years) were treated using a mini-endoscope. Most procedures were performed under local anesthesia in an outpatient clinic. All patients underwent preoperative and postoperative screening by routine radiography, sialography, and ultrasound. The indications for endoscopy were: 1) calculus removal that could not be performed by conventional methods, 2) screening of the salivary ductal system for residual calculi after sialolithotomy, 3) positive evidence of ductal dilatation or stenosis on the sialogram or ultrasound examination, and 4) recurrent episodes of major salivary gland swellings without known cause. RESULTS Of the 154 endoscopies performed, 9 were immediate failures as a result of technical problems. Of the remaining 145 glands, 112 had obstructions and 33 had sialadenitis alone. The success rate was 82% for calculus removal. Thirty-two percent of the submandibular and 63% of the parotid sialoliths, and the 1 stone in the Bartholins duct, were undetected before sialoendoscopy. Multiple endoscopic findings were encountered. No major complications were noted. CONCLUSIONS Sialoendoscopy is a minimal invasive technique for the diagnosis and removal of obstructive pathologic tissue in the major salivary glands.

Salivary gland endoscopy : A new technique for diagnosis and treatment of sialolithiasis

PURPOSE To describe the use of endoscopy as a technique for diagnosing and treating sialolithiasis. Sialolithiasis is a common pathology of the major salivary glands, yet its accurate detection and treatment is still intriguing. PATIENTS AND METHODS Eight cases of sialolithiasis were treated with our new technique which combines endoscopy and treatment. Two illustrative patients treated by this technique are described in detail. CONCLUSION Endoscopy, has gained popularity in most surgical fields. We found that the available standard equipment used for TMJ arthroscopy can be used for exploration and extraction of calculi from the salivary ductal system.

On the History of the Free Skin Graft

Skin graft procedures had already been performed prior to Reverdins great discovery. Skin grafting apparently originated with the Hindus 3,000 years ago, but until the beginning of the nineteenth century only a few trials were reported. In the first half of the nineteenth century, skin graft procedures were done by Baronio, Cooper, Bünger, and Dieffenbach. Berts experimental work in 1963 opened the way for the pioneers Reverdin, Ollier, Wolfe, and Thiersch, who contributed the free skin graft.

Povidone-iodine related burns.

Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in patients placed in the lithotomic position undergoing gynaecologic or urologic operations, the burn being on the buttocks, and in those undergoing orthopaedic operations, the burn being on the extremities and under a tourniquet. The basic mechanism involves irritation coupled with maceration and pressure. If the betadine solution has not been allowed to dry and has been trapped under the body of the patient in a pooled dependent position, such as the buttocks or under a tourniquet, the solution may irritate the skin and result in a skin burn. The irritation coupled with pressure leads to a situation analogous to that seen in the development of an acute accelerated decubitus ulcer; irritation, maceration, friction and pressure compounding each other to result in a skin burn or superficial ulcer in the skin. Our experience with three illustrative patients who presented with various burns following exposure to povidone-iodine (betadine) is described below.

On burn injuries related to airbag deployment

Airbags have been shown as a vital, supplemental restraining device that save lives and reduce morbidity associated with motor vehicles crashes. However, as with any developing technology, airbags have also been identified in some instances, as the source of injuries which, have been well described in the literature. To a significantly lesser degree, burns due to airbag deployment (about 7-8% of these injuries) have been reported. These injuries will be seen more frequently as more vehicles are equipped with airbags and should be suspected in drivers and passengers involved in accidents in which airbags have been activated. This article, reviews the various types of burns and their pathogenesis, found in crashes involving airbag deployments.

Oro-maxillofacial skeletal deformities resulting from burn scar contractures of the face and neck

The deforming forces of the scar contracture associated with burns of the head and neck region involve primarily the skin and secondarily the facial musculoskeletal structures. A case of severe face and neck burn accompanied by extreme facial skeletal deformity is reported. Best results are obtained in patients treated properly and promptly by a team including plastic and maxillofacial surgeons as well as orthodontists.

Burns of the oral mucosa. Report of 6 cases.

Burns of the oral cavity may be caused by prolonged use of certain drugs by the patient or by incorrect use of caustics by the dentist. Unwillingly-acquired self-inflicted injuries are also encountered, such as caustic ingestion (out of curiosity or by accident), excessive consumption of fresh fruit and fresh fruit juice, and wrong oral hygiene practice. Our experience with six infrequent and unfamiliar types of oral burns, caused by various components and material, is described and discussed.

Chemical burns of the eye with special reference to alkali burns

Alkali burns of the eye are more severe than acid burns because of the rapid penetration through the cornea and anterior chamber, combining with cell membrane lipids, thereby resulting in disruption of the cells and stromal mucopolysaccharides with concomitant tissue softening. Effective emergency measures must be instituted immediately followed by careful clinical evaluation in order to recognize and treat problems as they arise. We present our experience with 27 patients who sustained corneal lime burns, two of which are discussed in detail. The problem of chemical burns of the eye is reviewed with special emphasis on alkali burns.

Central palatal burns associated with the eating of microwaved pizzas

Burns of the oral mucosa can be caused by heat, cold, radiation, electricity and mechanical or chemical stimuli. Acids, alkalis and salts can cause considerable damage to the oral mucosa, membranes and lips. Most damage is found in the oropharynx, besides the pharynx and tonsils, the alveolar mucosa of the tongue and the masticatory mucosa of the palate or gingiva show localized or diffused damage. The clinical appearance depends on the severity of the tissue damage and the destructive properties and mode of application of the causative agent. We present an illustrative case of central palatal burn associated with the eating of microwaved pizzas and discuss similar mechanisms of injury.

Burns caused by bromine and some of its compounds

Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.