Schwere Komplikationen nach endonasalen Nasennebenhöhlenoperationen—ein ungeklärtes Problem

Functional endoscopic sinus surgery is one of the most common procedures in our field. Despite modern techniques, major and even fatal complications may occur. We describe 3 cases of unilateral blindness due to retrobulbar hematoma and one case of an internal carotid artery injury with fatal outcome.     

Funktionelle und ästhetische Ergebnisse nach osteoplastischen Stirnhöhlenoperationen und Profilplastiken über bitemporalen Bügelschnitt

Background and objective. The majority of inflammatory frontal sinus diseases requiring operative intervention can now be managed successfully by endonasal surgery. In problematic cases, however, optimal exposure of the entire frontal sinus and possibly complete mucous membrane removal combined with sinus obliteration must be achieved. In these cases, external frontal sinus surgery is indicated. Patients/Methods. The operative approach and findings of 35 osteoplastic sinusotomy operations and 5 forehead reconstruction operations with porous polyethylene are reviewed. Median follow-up was 3.7 years, ranging from 1 to 7 years. Indications for surgery were trauma (12), infections (8), tumors (11), muco- or pyoceles (4), and frontal deformities (5). Results. The overall functional and esthetic result was excellent. No recurrent infection was noted. None of the patients have required revision surgery so far, and no serious complications occurred. Abnormal forehead sensation was reported by 12 patients (30%). Temporary double vision was described in 3 cases (7.5%). Conclusions. Due to optimal sinus exposure and advantageous incision, osteoplastic frontal sinusotomy leads to excellent functional and esthetic results. Porous polyethylene demonstrates superior material properties and seems to be, in comparison with other implants, the current material of choice in frontal reconstruction.     

Alloplastik (Zelluloidprothese) zur kosmetischen Verbesserung der Stirngegend nach entstellenden äußeren Stirnhöhlenoperationen

Ohne ZusammenfassungMit 5 TextabbildungenNach einem in der Wiener Laryngologischen Gesellschaft am 5. 12. 33 gehaltenen Vortrag mit Krankenvorstellung.     

Maligne Nasennebenhöhlentumoren

BACKGROUND: Malignant neoplasmas of the paranasal sinuses are rare and present usually in advanced tumor stage due to the lack of early clinical symptoms. PATIENTS AND METHODS: In the last 10 years, 63 patients with paranasal malignancies were treated at the Department of Otolaryngology, Head and Neck Surgery of the University of Würzburg. 33% of the patients showed an occupational exposition (wood-processing or metal industry). At the time of the first visit to our institution 95% of the patients presented with an extensive disease, staged T3 and T4. Adenocarcinoma (24%), squamous cell carcinoma (22%) and malignant melanoma (19%) were the most common histologies. Surgery combined with radiotherapy was the treatment strategy in 55 patients (87%). RESULTS: Patients with a complete surgical resection showed a higher 5-year-survival rate (77%) than patients with an incomplete resection (56%). In 38% (n=21) of the patients treated with surgery and radiotherapy, a local recurrence of the tumor was observed. This recurrence localised in the skull base and/or the orbita/periorbita occurred most frequently in the first (46%) or the second year (31%). CONCLUSION: The prognosis of malignant paranasal tumors depends mainly on the control of the local tumor growth. Modern strategies of surgical treatment in combination with radiotherapy need to be implemented in an effort to achieve a continuous remission.     

Interdisziplinäres Therapiemanagement maligner Nasennebenhöhlentumoren im Kindesalter

BACKGROUND: Malignant tumors of the paranasal sinuses, such as rhabdomyosarcoma or Ewing's tumors, often have a mesenchymal origin. In the recent years, several prospective, randomized, multicenter studies have demonstrated a better outcome after new oncology therapy protocols. PATIENTS AND RESULTS: In the period from January 2000 to June 2001, we operated 610 patients with sinus disease. Only 23/610 were children or teenagers (3.8%). Half of the juvenile group suffered from chronic sinusitis, but 5/23 (22%) had a malignoma of the paranasal sinuses. In the adult population, malignoma was diagnosed in less than 1% of cases. We diagnosed and treated, in cooperation with our radiology, pathology and children's hematooncology department, one rhabdomyosarcoma, two malignant peripheral neuroectodermal tumors (PNET), one myelosarcoma and one malignant lymphoma in the paranasal sinuses. Two patients died. SUMMARY AND CONCLUSION: These five cases of paranasal sinus malignomas are discussed in relation to their history and clinical course. We suggest that interdisciplinary treatment involving otorhinolaryngology, pathology, children's hematooncology, radiology and radiation therapy is obligatory for the therapy and for the best possible outcome of such cases.     

Solitärer fibröser Tumor der Nasenhaupt- und Nasennebenhöhlen

Objective

The solitary fibrous tumor is an uncommon, benign lesion with a mesenchymal origin which arises most commonly from the pleura and, in extremely rare cases, from the mucosa of the nose and paranasal sinuses.

Patient and methods

We describe a case of solitary fibrous tumor in the nasal cavity with an extension into both ethmoid sinuses and destruction of the nasal septum in a 64-year-old woman presenting with nasal obstruction and frontal headache. In the histopathologic examination and by immunohistochemistry, the tumor was composed of spindle cells and nodular collagen, and was confirmed as a solitary fibrous tumor. It was completely removed using an endonasal approach with the patient being free of any complaints and without evidence of disease 2 years after surgery.

Conclusions

Solitary fibrous tumor should be included in diagnostic considerations in patients with sinonasal masses, especially in cases with the appearance of spindle cells. Diagnostic procedures, clinicopathological features, therapeutic options and prognosis of the such tumors are discussed.     

Komplikationen der Nasennebenhöhlen-Chirurgie

Surgery of the paranasal sinuses is one of the most frequently performed surgical interventions in otorhinolaryngology today. The potential for surgical complications with damage to paranasal structures in the close vicinity (orbit, endocranium, vital arteries) is still significant despite very elaborate, minimally invasive endoscopic and microscopic techniques. Reviewing the wide range of surgical complications of paranasal sinus surgery in a systematic and topographical fashion, elucidated by typical clinical case reports, we discuss the therapeutic management of such surgical sequelae. In addition, medicolegal aspects of informed patient consent as well as general recommendations to possibly avoid such complications are given.     

Kehlkopfschädigung nach Röntgenbestrahlung

Ohne ZusammenfassungMit 2 Abbildungen     

Grundsätzliches über die Entwicklung der Nasennebenhöhlen

Ohne ZusammenfassungMit 4 Textabbildungen.     

Stellenwert der präoperativen Röntgendiagnostik der Nasennebenhöhlen vor Septumplastik

Introduction

There is still disagreement concerning the significance of sinus x-ray prior to septoplasty: according to the previous guidelines for Diagnostic and Therapy of the German Society for Oto-Rhino-Laryngology and head and neck surgery in 1996, a sinus x-ray prior to septoplasty was seen as “necessary.” According to the guidelines from 2010, a suitable radiology imaging is just “optional.” In the present study, we analyzed the significance of a sinus x-ray to exclude a chronic sinusitis prior to septoplasty.

Patients and methods

A total of 96 patients were included in this study. All were admitted to the hospital by an ENT specialist for septoplasty with conchotomy. The preoperatively performed sinus x-ray was evaluated with regard to an already existing sinusitis. These results were correlated with the patients’ anamnesis and the nasal endoscopic view.

Results

A sinus x-ray (occipitomental) was obtained in all 96 patients. No pathological result was observed in 82 patients, while 14 patients showed pathology in the paranasal sinus. After a detailed appraisal of the sinus x-ray with pathology, 7 patients with pathological findings in the paranasal sinus remained. In the other 7 patients, the statement was false positive. In only 3 patients was a CT image obtained, which resulted in modification of the surgical procedure.

Conclusion

Our findings show that a routinely performed sinus x-ray is not necessary prior to septoplasty. If there is reasonable suspicion for pathology in the paranasal sinus, radiological imaging is necessary, whereby a CT scan should be performed.     

Neuritis retrobulbaris und Nasennebenhöhlenleiden

Ohne ZusammenfassungHerrn Prof.Güttich zum 60. Geburtstag.     

Zur Technik der endonasalen Tränensackoperation

Ohne Zusammenfassung     

Zur Kenntnis sekundärer Geschwülste der Nasennebenhöhlen

Zusammenfassung Die sekundäre Geschwulstbeteiligung des Nasennebenhöhlenbereiches durch Fernmetastasen scheint ein sehr seltenes Ereignis zu sein. Tatsächlich aber wird ihre Erkennung durch die hierbei zu beobachtenden verwickelten Verhältnisse besonders erschwert, ihre Abgrenzung ist gegenüber primären Nebenhöhlengewächsen oftmals unmöglich, falls nicht ein charakteristischer, feingeweblicher Geschwulstaufbau, wie etwa bei Hypernephrommetastasen, die Aufklärung der Zusammenhänge erleichtert. Diesem Umstand verdanken Tochtergeschwülste vonGrawitzschen Tumoren in den Nebenhöhlen offenbar ihre bessere Kenntnis, obwohl für Geschwülste anderer Gewebe auch die gleichen Gesichtspunkte gelten dürften.Unter Hinweis auf eigene Beobachtungen mit klinisch stummen Primärtumoren und Fernmetastasen in die Nasennebenhöhlen werden diese Feststellungen erläutert.Mit 7 Textabbildungen.     

Das Osteoidfibrom der Nasennebenhöhlen

Zusammenfassung Pathologie und Klinik der Osteoidfibrome der Nasennebenhöhlen werden beschrieben. Es wird angenommen, daß es sich um eine eigene, vorwiegend bei Jugendlichen auftretende Form gutartiger Knochengewächse handelt, die weder mit sogenannten ektopischen Meningeomen noch mit Zementoblastomen identisch ist. Diese Geschwülste kommen nach den bisherigen Beobachtungen nur in den Nasennebenhöhlen vor und unterscheiden sich histologisch deutlich von den ossifizierenden Fibromen des übrigen Skelets und den gewöhnlichen Nebenhöhlenosteomen.Mit 2 Textabbildungen     

Die bösartigen Neubildungen der Nasennebenhöhlen

Ohne Zusammenfassung     

Sekundäre Erblindung nach orbitaler Holzfremdkörperverletzung

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.