Therapeutisches Management nekrotisierender Weichteilinfektionen des Halses

ZusammenfassungHintergrund Bei nekrotisierenden Weichteilinfektionen des Halses geht man ursächlich von toxinbildenden virulenten Bakterien aus. Die Mortalität einer Sonderform, der nekrotisierenden Fasziitis, wird in der Literatur mit bis zu 76% angegeben.Patienten und Methode Von 2000 bis 2001 wurden 4 Patienten mit schweren nekrotisierenden Halsweichteilinfektionen und 5 Patienten mit einer nekrotisierenden Fasziitis behandelt.Ergebnisse Das Keimspektrum reichte von Mischinfektionen mit Candida albicans, Streptococcus pyogenes, Fusobacterium, Propionibakterien bis hin zu Staphylokokken. Nach frühzeitiger operativer Intervention mit ausgedehnter Drainage der verschiedenen Halslogenund funktioneller Neck Dissection zur Begrenzung der Ausbreitung des Prozesses wurde in 8/9 Fällen eine vollständige Heilung erzielt. Ein Patient verstarb an einem septischen Schock, weil die Therapie zu spät eingeleitet wurde.Schlussfolgerung Entscheidend ist nach unserer Ansicht die frühzeitige und konsequente chirurgische Therapie mit Drainage aller Abszesshöhlen funktioneller Neck Dissection sowie interdisziplinärem Vorgehen inklusive der resistogrammgerechten Antibiose und hyperbarer Sauerstofftherapie als Ergänzung.

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Zum chirurgischen Vorgehen beim pleomorphen Adenom

Summary The best method of treatment for mixed parotid tumours are still controversial. Some surgeons prefer superficial and total parotidectomy depending on where the tumour is situated where others do an enucleation only. 660 patients with parotid disease were operated on in the Ear-Nose and Throat department of the University of Tübingen between 1967–1978. 158 of the patients had mixed parotid tumours. The histological examination of the specimens often showed fingerlike projections of tumour tissue through the capsule and/or incomplete encapsulation of the tumour. This clearly indicates that adjacent apparently normal glandular tissue should be removed en bloc with the tumour.     

Das Vorgehen zur primären Rekonstruktion von Nase und Oberlippe

Ohne Zusammenfassung     

Sofortige Rekonstruktion der frakturierten Stirnhöhlenvorderwand — Vorgehen und Verlaufskontrolle

Summary 701 cases of traumatic lesions of the facial soft tissues and facial bones were treated within 5 years at the Marburg University ENT Clinic. In 68 cases fractures of the anterior wall of the frontal sinus — often in combination with posterior wall-, rhinobasis- and other fractures were found.In all these cases, as early as possible after the trauma, in an often long time consumin procedure, the anterior wall of the frontal sinus was reconstructed immediately. Reconstruction was performed by wiring the osseus fragments using even particles down to a size of one squarecentimeter. In no case, even in cerebrospinal liquorrhoea and open brain damage, any complications — as inflammation or rejection of bone particles — have occurred. The excellent cosmetic results of this immediate reconstruction are lasting now up to 5 years.Bone scintigrams with TC 99 show that these bone particles from the desmocranium undergo a certain degree of transformation and are integrated again into the cranial bones without much resorption.     

Kombinationsverletzungen der Orbita. Diagnostik und Indikation für operatives Vorgehen

Summary Disturbances of the ocular motility following bone fractures of the orbit are frequently due to combined causes. They are sometimes caused not by or not only by fracture dislocation of the orbital floor but also by damage to the ocular muscles and their nerves. In such a case the consequences of a compression trauma at the apex of the orbit play an important part. In addition to preoperative x-rays and endoscopy of maxillary sinus it is therefore necessary to carry out an exact analysis of the respective disturbances of ocular motility. This is possible by the synoptometer of Cüppers. The possibility of an exact examination of orbital trauma according to this method is shown in cases of combined orbital injuries and also how a primary neuro-muscular damage can simulate an orbital fracture.     

Diagnostisches und therapeutisches Vorgehen beim spontanen Emphysem der Halsweichteile und des Mediastinums

BACKGROUND: Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge. PATIENT COLLECTIVE: Over the last 5 years, we treated four patients (three male, one female; aged 3-29 years) with cervical and/or mediastinal emphysema of unknown cause. RESULTS: Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment. After involution of the emphysema, we performed an endoscopy which revealed no abnormalities. A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema. The immediate endoscopies were without pathologic findings. All patients recovered completely without any complications or recurrences. CONCLUSIONS: If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided. The aim is to avoid any further spread of the emphysema and of pathogens. If there is a history of a foreign body or trauma, an immediate endoscopy is indicated.     

Metastasierendes Schläfenbasaliom oder Ausbreitung per continuitatem? Histologie,operatives Vorgehen und klinisches Ergebnis

Summary By means of histological sections taken during the operation the seldom diagnosis basalioma of the temporal area with regional metastases in the parotid gland and in the neck could be verified.The operation consisted of en bloc excision of the basalioma, the exstirpation of the parotid gland and the radical neck dissection. Since the tumor had also infiltrated the facial nerve, the nerve had to be sacrificed and reconstructed using the superficial peroneal nerve. In order to obtain immediately a satisfactory aesthetic result in the face region, in addition to the facial nerve graft, the corner of the mouth and the eyelids was taken up using lyophilized dura mater and parts of the temporal muscle and its fascia. A facelifting supported this procedure. The primary closure of the temporal skin defect was successfully performed using a regional skin flap from the scalp.     

Einsatz der Larynxmaske bei Adenotomie und Tonsillektomie bei Kindern

Sowohl für An?sthesisten als auch für HNO-?rzte bedeutet die Operationssituation bei Adenotomien (AT) und Tonsillektomien (TE) eine Arbeitsteilung auf kleinstem Raum, n?mlich im Bereich der Mundh?hle. Seit der Succinylcholindebatte der frühen 90er Jahre stellt sich mit der Frage nach dem geeigneten Muskelrelaxans die Frage nach der geeigneten Atemwegssicherung. Der Anwendung der Larynxmaske als Airway bei AT und TE wurde zun?chst mit Skepsis begegnet, wobei Ergebnisse und Erfahrungen die Larynxmaske hier als sichere Alternative zur Intubation darstellen.     

Risiko des autogenen Knorpeltransplantats bei laryngotrachealer Rekonstruktion bei Erwachsenen

Background

Laryngotracheal reconstruction with autogenous rib cartilage graft has become a well established surgical method for the repair of subglottic and glottic laryngotracheal stenoses in infants and children. There are far fewer reports on the application of this method in adult patients. In particular, detailed observations of the healing behaviour of autogenous adult rib cartilage grafts are lacking.

Material and method

The course of disease in five adult female patients (age 25?C47?years) who underwent one- or two-stage laryngotracheal reconstruction with rib cartilage grafts are reported.

Results

Primary healing was observed in the youngest patient (25?years) only. In the other four patients the cartilage graft had to be partly removed 4?C6?weeks postoperatively due to partial necrosis, followed by open wound treatment. As a result of these measures a sufficiently large laryngotracheal lumen could be achieved in all cases.

Discussion

Partial ossification of the adult rib cartilage was considered the reason for the observed healing difficulties. Endoscopic follow-up showed that epithelialization of the free endolaryngeal surface of the cartilage graft, i.e. graft healing, takes at least 3?months. Therefore, close endoscopic follow-up during this period appears indispensable.     

Tubenfunktion bei Septumdeviation

Summary We examined 143 ears in 89 patients before and after septum operation. We found that in 56.6% of the patients with negative pressure in the middle ear, this negative pressure was reduced by the operation. This result was supported by rhinomanometric examinations. The tubal resistance and the ability of opening the tubes actively were not influenced. This result indicates an improved pressure compensation between nose and middle ear after the operation, when a tympanic underpressure is present.     

Symbolspielkompetenz bei Vorschulkindern

Children with specific language impairment (SLI) are confronted with limitations in their language abilities that cannot be attributed to cognition, hearing impairments, or neurological deficits. However, there is evidence that children with SLI also have impairments. These include, for example, an impaired ability to pretend play. The current article aims to present firstly normal development of play behavior in children, followed by the Child-Initiated Pretend Play Assessment (ChIPPA). This test enables an objective and standardized assessment of whether a child’s ability to initiate and sustain pretend play is age-appropriate. SLI children with impaired play behavior should receive structured individual therapy.     

Kochleaimplantat bei Innenohrfehlbildungen

The radiologic evaluation of the temporal bone in cochlear implant candidates can detect malformations of the inner ear in up to 20% of cases. The aim of our study was to analyze and classify malformations of the inner ear in patients with cochlear implants carried out from 2001 to 2009. Malformations of the inner ear, including malformations of the internal auditory canal were detected in 12.7% of children and 3.4% of adults. Mondini dysplasia was most common and occurred in 45% of cases. The surgical procedure had to be adapted according to the individual malformation. Modification of surgical access, management of intraoperative CSF gusher, choice of electrode array, intraoperative imaging and the use of navigation were the most important factors. Rehabilitation results were generally very positive and corresponded to the expectation depending on the duration of deafness, if no additional handicaps were present.     

Strahlentherapie bei Kopf-Hals-Tumoren

In contrast to conventional radiotherapy, intensity modulated radiotherapy (IMRT) enables individually adjusted dose and intensity depending on tumor size and organs at risk, thus enabling radiotherapy of complex volumes in the head and neck area using high doses. Despite new data presented at the annual congress of the American Society of Clinical Oncology (ASCO), questions remain unanswered in two basic categories: (a) How do we use IMRT with other important advances in head and neck cancer treatment, such as altered fractionation, chemotherapy, and novel agents? (b) Does IMRT in its current form produce sufficient risk:benefit improvements in salivary gland sparing/less xerostomia, better targeting/local control and less late toxicity? Whether IMRT with its complex target volume definition and dose distribution leads to improved local control needs to be further investigated in relevant studies.     

Musiktherapie bei Tinnitus

Ohne Zusammenfassung     

Gerinnungsanalysen bei Nasenbluten

Ohne Zusammenfassung     

Behandlungsmethoden bei Larynxpapillomatose

Summary Three methods of treating the larynx-papillomas, which have been practiced in our clinic, are demonstrated. In addition to the possibility of removing the papillomas by direct laryngoscopy and the possibility of using cryo-surgery, the advantages of the radical removal of the papillomas through the larynxfissure and at the same time covering the defects through transplantation of the mucous-membranes of the vestibulum oris, are shown.     

Anti-Tumor-Impfung bei HNO-Tumoren

Ohne Zusammenfassung

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Antitumour vaccination in patients with ENT tumoursMoving towards success!

     

Olfakto-Corticogramme bei Laryngektomierten

Ohne Zusammenfassung     

Temperaturmessungen bei Knorpeleinbettungen

Zusammenfassung Unter Einhaltung eines bestimmten festgelegten Mischungsverhältnisses von Monomer und Polymer werden bei der Polymerisation von Palacos bei Raumtemperatur proteindenaturierende Maximaltemperaturen von 120°C erreicht. Bei völlig in Eiswasser eingetauchten Gußformen können die Maximaltemperaturen dagegen auf 11°C–15°C gesenkt werden, so daß eine durch die Polymerisationswärme entstehende Eiweißdenaturierung and -veränderung bei der Einbettung von Geweben in Palacos vermieden wird.

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Cartilage Embedding in Palacos : Temperature Measurementsin Palacos

Summary Although the ratio of monomer and polymer was maintained as prescribed, polymerization of Palacos at room temperature produced maximum temperatures of 120° that will certainly lead to denaturation of proteins. When the molds were completely submerged in ice water, however, temperatures did never exceed 11°C to 15°C. Such temperature limitation will prevent the denaturation of proteins while tissues are being embedded in Palacos.