Distraktionsosteogenese der Mandibula bei kraniofazialen Fehlbildungen

In recent years, lengthening the human mandible by distraction osteogenesis has become an accepted treatment to correct severe mandibular hypoplasia. Using intraoral unidirectional and extraoral bidirectional distraction devices we report about our experiences and results in the application of the bone distraction technique in four selected cases of syndromal disease, including various forms of mandibular hypoplastic malformations. The patients involved were a boy with Pierre Robin syndrome, a girl with unilateral facial hypoplasia in Goldenhar's syndrome, a case with Nager's syndrome, and a rare case of midline deficiency caused by partial deletion of chromosome 18 (18p-syndrome). The distraction period lasted from 6 to 30 days and new bone formation, ranging from 6 to 28 mm, was achieved.     

Tierexperimentelle endoskopische intrauterine Chirurgie bei kraniofazialen Fehlbildungen am Beispiel der Lippen-Kiefer-Gaumen-Spalten

INDICATION FOR FETAL SURGERY: The widespread use of high-resolution ultrasound in prenatal diagnosis allows nowadays an accurate and early diagnosis of congenital malformations. Some of these can be corrected surgically. In certain cases intrauterine surgery could present functional and aesthetic advantages or be even lifesaving. Due to the extreme sensitiveness of the fetal patient and the fetal membranes, only some defined anomalies currently meet the criteria for intrauterine surgery. However, the list can change in the future since prenatal diagnosis, technical advances, and knowledge of pathophysiology improve constantly. ENDOSCOPIC INTRAUTERINE SURGERY: Additionally, the recent development of endoscopic intrauterine surgery represents a new and more careful possibility for intrauterine surgery. Endoscopic procedures could avoid the disadvantages of open intrauterine surgery and thus make fetal operations safer, in life-threatening as well as in non-life-threatening malformations such as cleft lip and palate (CLP). The main advantages of these procedures are (1) scarless wound healing and bone healing without callus formation that leave to expect normal growth of the midface and (2) lower fetal and maternal morbidity. DISCUSSION: Based on the results achieved until now, it can be stated that at present the intrauterine operation of CLP on humans cannot be recommended. The high morbidity and mortality risk for mother and fetus cannot be counterbalanced by the unsatisfactory results of a prenatal operation. CONCLUSION: In this study first results of an experimental investigation with the new endoscopic techniques are presented, whereby the possibilities for optimization and quality improvement of the intrauterine surgical procedures are analyzed in detail.     

Laryngospasmus bei Tetanie nach Strumaoperation

Ohne Zusammenfassung     

Langzeitergebnisse nach Kochleaimplantatversorgung bei Kindern

The treatment of deaf and hearing-impaired children with cochlear implants has been established for several years. Nonetheless, no long-term results exist for studies of a representatively large number of children in the German-speaking area. These are necessary in order to formulate prognoses regarding the development and results of children undergoing implantation at various ages. In a retrospective study, we assessed the data of 156 children with various implantation ages and a minimum follow-up period of 5 years for whom speech and audiological data (Oldenburg Sentence Test, Freiburg words/numbers test) were available. Our findings confirm the assumption that early-implanted children (<2 years) achieve the best speech-comprehension results. For this reason, support for a sufficient universal neonate hearing screen should be emphatically given so that implantation, after a hearing test phase, can be targeted in the first year of life. The surgical, anesthesiological, and rehabilitation conditions must be fulfilled, and surgical experience is required for operation on infants and small children.     

Der Schluckakt bei Patienten nach Kehlkopf-Teilresektion

Ohne Zusammenfassung     

Eitrige Lymphadenitis nach Abszesstonsillektomie bei Immunsuppression

In the present case study, a 75-year-old, immunosuppressed man presented with recurrent cervical abscesses after a peritonsillar abscess. In the cervical region, an ulcer developed with persistent wound healing deficit. Subsequently, the patient's general condition deteriorated, showing symptoms of a Landouzy sepsis. In the course of the examination, Mycobacteria tuberculosis was detected in the cervical ulcer. He suffered from latent tuberculosis, which was reactivated by a combination of his disease, immunosuppressive therapy and the preceding peritonsillar abscess. Upon treatment with tuberculostatics, the patient fully recovered.     

Outcome nach Tonsillektomie bei chronischer Tonsillitis

Ohne Zusammenfassung

---

Outcome after tonsillectomy for chronic tonsillitis

     

Periphere hypoglossusparesen bei malignompatienten nach hartstrahlentherapie

Ohne Zusammenfassung     

Die epithetische Versorgung von kraniofazialen Defekten

Zusammenfassung Die Rehabilitation von kraniofazialen Defekten und Deformit?ten hat durch die Einführung der modernen Silikone und die Entdeckung von Titan als idealem biokompatiblen Implantationsmaterial einen gro?en Fortschritt erlebt. Damit gelingt eine zuverl?ssige solide Fixierung von Gesichtsepithesen, die dank der modernen Herstellungstechniken eine au?erordentliche Camouflage des Defektes gestatten. Für die Rekonstruktion komplexer ?sthetischer Einheiten wie z.B. Ohr, Nase und Orbita stellen die knochenverankerten Epithesen mehr als lediglich eine Alternative zu plastisch-chirurgischen Verfahren dar. Gerade nach Tumoroperationen bieten sie die M?glichkeit, ein Rezidiv frühzeitig zu entdecken. Die Grundzüge der Implantologie und die verschiedenen, kommerziell erh?ltlichen Systeme für den extraoralen Bereich werden dargestellt, ebenso Indikationen und Kontraindikationen sowie eigene Erfahrungen bei 120 Patienten, die an der Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde der Universit?t des Saarlandes in Homburg mit knochenverankerten Epithesen versorgt wurden.      

Beobachtungen nach experimenteller Recurrensdurchtrennung bei der Katze

Ohne Zusammenfassung     

Beobachtungen nach experimenteller Recurrensdurchtrennung bei der Katze

Ohne ZusammenfassungMit 1 TextabbildungI. Mitteilung: Arch. Ohren usw. Heilk. u. Z. Hals- usw. Heilk.169, 242 (1956).     

Zur Hydrodynamik der Schnecke bei Diplakusis nach Fensterungsoperation

Zusammenfassung Nach Fensterungsoperation kommt es gelegentlich innerhalb der Zeit der üblichen postoperativen Wiederverschlechterung des Gehörs zu einer Änderung der Tonhöheempfindung auf dem operierten Ohr in einem wechselnden Teil des Hörbereiches. Es wird gezeigt, daß sich als Entzündungsfolge bei Änderung der Kanalquerschnitte oder der Elastizität und Masse der Schneckentrennwand die Stelle verschieben muß, an der infolge der hydrodynamischen Vorgänge das Sinnesorgan unter normalen Verhältnissen durch Schalleinwirkung erregt wird, und daß in gewissen Intervallgrenzen auf diese Weise das vorübergehende Auftreten einer Diplakusis erklärt werden kann. Diese zeigte sich bei unseren Fällen nur unter Luftzuleitung des Schalles, nicht dagegen bei Knochenleitung.Herrn Prof.Zange zum 70. Geburtstag.     

Ergebnisse nach Neurektomie bei Morbus Menière

Zusammenfassung Es sollten 54 Patienten, bei denen wegen eines Morbus Menière eine Vestibularis- oder Vestibularis-Cochlearis-Neurektomie erfolgte, mittels eines Fragebogens über ihr prae- und postoperatives Befinden Auskunft geben.Die Befragung fand frühestens 1/2 Jahr nach dem Eingriff statt. Die Schwindelattacken verschwanden bei mehr als 90% der Patienten, während Unsicherheitsgefühl, Kopf druck und Ohrensausen in unterschiedlicher Ausprägung weiterhin bestanden.Das Ausbleiben der Schwindelattacken führte zu einer insgesamt positiven Bewertung des Operationsergebnisses.

---

Results after neurectomy in patients with Menière's disease

Summary Fifty-four patients who underwent vestibular-cochlear neurectomy procedures for the control of their Menière's disease were inquired after their state of condition.The poll was taken at least half a year after surgery. The attacks of vertigo had disappeared in more than 90% of the cases. Tinnitus, unsteadiness and pressure in the ear and head remained in individual intensity.On the whole, the results of the surgery were viewed favourably.

     

Zur Entstehung der Perichondritis nach Strahlenbehandlung bei Kehlkopfcarcinom

Zusammenfassung Bei 98 röntgenbestrahlten Fällen von Kehlkopfcarcinom wurde 34 mal eine Perichondritis beobachtet (34,7%).Bei 33 mit Fensterung und Radiumeinlage behandelten Stimmbandcarcinomen entstand 6mal eine Perichondritis (18,2%).Von den 34 Röntgenfällen müssen 11, von den 6 gefensterten müssen 5 als Strahlenschädigung angesehen werden.Eine Tumorperichondritis war bei diesen Patienten auszuschließen, da zur Zeit der Entstehung der Perichondritis kein Tumor mehr vorhanden war, was teils durch Probeexcision, teils durch histologische Untersuchung exstirpierter Kehlköpfe, teils durch den weiteren tumorfreien Verlauf nachgewiesen wird. Zur Belegung dieser Behauptungen werden einige Beispiele genauer beschrieben.Die Entstehung der Perichondritis wird durch die lokale Strahlenschädigung des Gewebes, vermutlich unter Mitwirkung zusätzlicher hämatogener infektiöser oder toxischer Reize erklärt, wobei der Bestrahlung aber die entscheidende Rolle zufällt. Fehlerhafte Strahlendosierungen lagen nicht vor.Zur Vermeidung der Perichondritisgefahr wird die Röntgenbestrahlung jetzt unter Penicillinschutz durchgeführt.Mit 2 Textabbildungen.Vortrag gehalten vor der Vereinigung schleswig-holsteinischer Hals-, Nasen-, Ohrenärzte am 26. März 1955.     

Histologische Untersuchung nach Adenotomie und Tonsillektomie bei Kindern

BACKGROUND: The histological examination of lymphatic tissue resected in children during adenoidectomy or tonsillectomy has to be considered as a screening method. Its purpose is to detect rare diseases that differ from "chronic inflammation" or "lymphatic hyperplasia". That this examination is economically reasonable in relation to the frequency of surprising results with therapeutic consequences is doubtful. The aim of this study was to define the frequency of surprising or clinically relevant results in histological reports following adenoidectomy and/or tonsillectomy in children. METHODS: From both 1999 and 2004, 200 patients were identified, 10 years old or less, who underwent adenoidectomy/tonsillectomy due to recurrent throat infections or stenotic symptoms of the upper airways or upper swallowing path. The histological reports on these 400 children were evaluated. RESULTS: At the date of surgery, the median age was 4 years. In 140 children, an adenoidectomy-tonsillectomy was performed, 26 underwent tonsillectomy alone and 234 adenoidectomy alone. No reports with a histological diagnosis other than "lymphatic hyperplasia" or "chronic tonsillitis" were found. DISCUSSION: A histological report that is surprising or might influence the further treatment of the patient is rare. From the literature, an unusual diagnosis in children occurs in less than 1 per 1,000. The routine histological examination of adenoidectomy/tonsillectomy tissue cannot nowadays be economically justified. On the other hand, the ethical aspects of the abolition of this inefficient but established method should be discussed. If routine histological examination is abandoned, the surgeon would be responsible for the decision of whether a histological examination is necessary for each individual case (asymmetry of tonsils, extraordinary cervical lymph node status, striking history e.g.).     

Langzeitergebnisse nach Velopharyngoplastik bei Patienten mit Spaltbildungen des Gaumens

BACKGROUND: Children with cleft palate frequently demonstrate speech and resonance disorders following primary cleft repair. In some patients no improvement can be achieved with conservative therapy and a velopharyngoplasty (VPP) may be indicated. This study was performed to evaluate the long-term results after VPP. MATERIAL AND METHODS: Twenty-six patients were followed up on an average 9 years after VPP (mean age: 16+/-5 years). Apart from the phoniatric-pedaudiologic findings, the speech intelligibility and nasality were judged by speech pathologists and by laymen. The extent of the speech handicaps was evaluated with a questionnaire. The nasalance was measured with NasalView. The vowels, two test sentences, and three reading texts (LT(1-3)) were used as test materials. RESULTS: The phoniatric-pedaudiologic examination revealed a clear improvement of hearing, language, and speech function. Compared to the previous results, decreased nasality and improved ability in articulation were detected. The judgment of laymen was also positive. The speech intelligibility was mostly evaluated as favorable. A speech handicap was present in only a few patients. The evaluation using NasalView showed significantly increased nasalance values for the LT(2) ( p=0.030). Moreover there were lower nasalance values for all the reading texts compared to the control group (LT(1) p=0.257, LT(2) p=0.408, LT(3) p=0.187). CONCLUSION: A clear improvement can be achieved with VPP in patients with a high degree of therapy-resistant nasality. In many cases even normal colloquial language is possible. The evaluation of nasalance has proved to be successful for rating surgical outcome.     

Anaphylaktische Reaktion nach Sojagenuss bei einem Patienten mit Birkenpollenallergie

Patients with birch pollen allergy may suffer from severe anaphylactic reactions after ingestion of foodstuffs containing soya. The reason for this is similarities in protein structure between a major birch pollen allergen (bet v 1) and Gly m 4, a pollen-related protein in soya. A 65-year-old patient allergic to birch pollen developed an adverse systemic reaction after consumption of a soya-containing drink. The diagnosis could be confirmed by in vitro and skin testing methods. Patients who suffer from birch pollen allergy should strictly avoid the intake of soya-containing foodstuffs.     

Resorbierbare Platten und Schrauben in der kraniofazialen Chirurgie

In ten patients with craniosynostoses resorbable plates and screws (Lactosorb) consisting of poly-L-lactic acid (82%) and poly-glycolic acid (18%) were used to stabilize the segments after frontoorbital advancement. As our experience increased, an exact adaptation of the plates and simple handling proved to be possible. The plates were stable enough to retain a favorable functional and aesthetic result after redraping the soft tissue envelope. In one patient with Chotzen's syndrome the intended use of the resorbable material was abandoned: the thin osseous structures did not offer enough primary stability to the high pitch of the screws. During an observation period of up to 21 months no infection, exposure, instability or dislocation was observed. The clinical use of the resorbable material in frontoorbital advancement proved to be a stable method of segment fixation if the bone was of sufficient thickness. These promising preliminary results will have to observed in a larger group and over a longer period of time.     

Vergleichende Resultate nach Deckung des ovalen Fensters mit Gelatine und nach Deckung mit «getrockneter» Fascie nach Stapedektomie bei Otosklerose

Ohne Zusammenfassung     

Tracheotomie oder geplante Nachbeatmung nach Operationen bei Patienten mit OSAS

Background

Patients suffering from obstructive sleep apnea syndrome (OSAS) and obesity have an elevated risk of postoperative complications independent of each other. Within the framework of expert opinions for courts the question arose whether postoperative prolonged intubation or tracheotomy are standard routine approaches which are to be carried out in the normal course of operations on patients with OSAS.

Material and methods

A search of the literature was performed using PubMed, Web of Science, Scopus, EMBASE, the Cochrane database of systematic reviews and the Cochrane central register of controlled trials. Furthermore, 78 German otorhinolaryngology (ENT) departments participated in a nationwide survey.

Results

The results of the survey showed that after normal complication-free surgery planned postoperative prolonged intubation is not performed in the majority of ENT departments and no department performs a tracheotomy. In contrast, the standard approach for patients with OSAS and obesity who undergo two-level surgery is intubation and subsequent monitoring without ventilation for the first postoperative day. In the literature no evidence of a scientific basis for carrying out prolonged intubation or a tracheotomy could be found.

Conclusion

Neither tracheotomy nor prolonged intubation are standard procedures for OSAS patients with obesity after complication-free surgery.