Wertigkeit der Feinnadelpunktionszytologie bei Neoplasien der Glandula parotis

BACKGROUND: In many parts of Germany fine-needle aspiration biopsy (FNAB) is still not part of the routine preoperative diagnostic evaluation of salivary gland neoplasms. Most opponents consider the study unnecessary and recommend that all salivary gland neoplasms should be excised. OBJECTIVE: Because of this an evaluated the ability of FNAB to provide an accurate diagnosis of parotid gland neoplasms. PATIENTS AND METHOD: Between January 1992 and October 1995, 336 patients referred for operative therapy of salivary gland neoplasms underwent retrospective analysis of preoperative FNAB compared with the excised tumor histology. RESULTS: Results showed that the FNAB had a sensitivity of 93.1%, a specificity of 99.2%, a positive predictive value of 93.1%, a negative predictive value of 99.2% and an accuracy of 98.6%. Complications were observed in less than 1%. DISCUSSION: Our findings demonstrated that the FNAB is a safe diagnostic tool that has a reliable sensitivity and high specificity for the assessment of salivary gland pathology. Since many malignant salivary gland neoplasms present with a virtual lack of symptoms indicating actual malignancy we believe that there is need for FNAB in routine preoperative diagnostic testing.     

Plattenepithelkarzinom in einer Gangzyste der Glandula submandibularis

Squamous cell carcinomas are rare malignant tumors of the major and minor salivary glands in the head region. This is the report of a squamous cell carcinoma within a cyst of the submandibular gland. Clinical, histological and immunohistochemical findings are presented, and the importance as well as the therapeutic strategy of this very rare malignant tumor of the salivary glands are discussed.     

Azinuszellkarzinome der Glandula parotidea Eine retrospektive Analyse

BACKGROUND AND OBJECTIVE: Acinic cell carcinoma of the parotid gland is a rare malignant tumor, which is generally regarded as low grade. However, rapidly fatal courses do occur. PATIENTS AND METHODS: Eighteen patients with acinic cell carcinoma were studied retrospectively who had undergone treatment between 1968 and 1997 at the University Ear, Nose, and Throat (ENT) Hospital in Homburg (Saar), Germany and between 1994 and 1997 at the Marienhospital ENT Hospital in Stuttgart, Germany. RESULTS: The distribution of the T category (UICC 1997) was as follows: T1 n = 8, T2 n = 7, T3 n = 1, and T4 n = 2). Treatment was exclusively surgical in 14 cases and a combination of surgery and postoperative radiotherapy in 4 cases. The recurrence rate according to Kaplan-Meier was 6% after 3 years and 19% after 5, 10, and 15 years. The survival rate was 87% after 3 years and 73% after 5, 10, and 15 years. None of the 12 patients with low-grade tumors according to Batsakis et al. (1979) died from the tumor, whereas survival at 5 years was only 33% for 6 high-grade tumors (p = 0.02). CONCLUSIONS: We recommend complete surgical removal of the tumor, in general by total parotidectomy. Postoperative radiotherapy may be useful in advanced high-grade tumors.     

Degenerativ verändertes parapharyngeales Schwannom “ancient schwannoma”. Fallbericht und Literaturübersicht

Schwannomas are rare, slow-growing, benign neoplasms derived from the schwann cells of the nerve sheath of peripheral nerves. Extracranial schwannomas are most frequently localized within the extremities or the head and neck region. For example, they are common in the skull base, the carotid sheath, and the parapharyngeal space. Beneath several histological variants, schwannomas showing prominent degenerative changes (so-called,,ancient schwannomas") are exceedingly rare. Histopathological features, such as degenerative changes and nuclear atypias in ancient schwannomas, may be easily confused with malignant mesenchymal neoplasm.We present the case of a 32-year-old female who required surgery for a parapharyngeal neoplasm. Histological examination revealed features of an ancient schwannoma.     

Die Tauchranula Ein seltenes Krankheitsbild

Zusammenfassung In dieser Fallbeschreibung wird über eine 24j?hrige Patientin mit einer seit 3 Monaten bestehenden, ausgedehnten rechtsseitigen Halsschwellung berichtet. Nach der operativen Entfernung der rechten Glandula sublingualis, der Glandula submandibularis und des rechts zervikalen, polyzystisch konfigurierten, fest mit dem umliegenden Bindegewebe verwachsenen Tumors wurde histologisch eine Retentionszyste, die mit einer Tauchranula vereinbar war, nachgewiesen. Die ?tiologie, Pathogenese, Klinik und Diagnostik der Tauchranula wurden beschrieben. Die verschiedenen Therapiem?glichkeiten werden im Hinblick auf deren Wertigkeit kontrovers diskutiert. Zur Sicherung der Diagnose Tauchranula und zur Dignit?tsabkl?rung wird eine operative Entfernung mit histologischer Aufarbeitung des entnommenen Gewebes empfohlen. Da es sich bei der Tauchranula histologisch um eine Retentionszyste oder Pseudozyste handelt, die von der Glandula sublingualis ausgeht, wird die gleichzeitige Entfernung der Drüse angeraten, um Rezidiven vorzubeugen. Bei ausgedehnten Befunden einer Tauchranula, wie in dem vorliegenden Fall, kann eine zus?tzliche Entfernung der Glandula submandibularis erforderlich werden.      

Mikrochirurgische Reanastomosierung des Ductus parotideus

Zusammenfassung Tiefe Weichteilverletzungen im lateralen Gesichtsbereich k?nnen durch Sch?digungen des N. facialis und seiner ?ste, der Glandula parotidea und des Ductus parotideus kompliziert sein. W?hrend die prim?re mikrochirurgische Versorgung von Fazialisverletzungen in der Literatur einhellig empfohlen wird, ist die Diskussion bei Verletzungen des Speichelgangs kontrovers. Anhand des Falles einer sekund?ren Reanastomosierung eines vollst?ndig durchtrennten Speichelgangs wird die mikrochirurgische Technik und deren Indikation dargestellt.      

Diagnostik und Therapie der Laryngitis gastrica

We treated 64 patients with the diagnosis of laryngitis gastrica with Antra (Omeprazol) in doses of 10, 20, and 40 mg. To determine the success of the therapy, pH monitoring of the esophagus and hypopharynx, the voice status and measurement of vocal penetrating capacity were used. The results prove that a 20-mg dose of Antra is suitable for the therapy of laryngitis gastrica with a high rate of success. Problems which arose during the investigation, consequent changes of the original concept of the project as well as new aspects and questions which resulted from this are discussed with respect to further investigation.     

Phoniatrische Begutachtung vor der Stimmangleichung bei Mann-zu-Frau-Transsexualismus

Sex change surgery for patients with gender identity disorders has been performed successfully during the last decade, especially for males becoming females. A troublesome problem for some of these individuals is the retention of a male voice. Castration and estrogen therapy may produce only minor changes in pitch, with patients requiring further surgical treatment. Techniques used include glottoplasty, crico thyroid approximation and/or anterior commissure advancement. Although the voice is highly gender-specific, the standards of care for transsexuals do not cover guidelines for a diagnostic approach and surgical therapy. For medical jurisprudence, questions concerning specific aspects of German social law are answered in a representative case of a male-to-female transsexual. A review of the literature shows that there is no common thought about whether and when a specific surgical procedure should be performed in a gender-transforming process and which method should be used for long-term results and patient satisfaction. Although worldwide experience with these operations and overall good results are assumed, further reports by phonosurgeons performing these operations are required concerning actual results. We propose that medical scientific societies should offer phonosurgery as an optional treatment for male-to-female transsexuals in their guidelines and standards of care.     

Schwierige Intubation in der HNO-Laserchirurgie Gibt es einen prädikativen Parameter?

Zusammenfassung Bei der Planung laserchirurgischer Eingriffe in der HNO-Heilkunde stellt sich h?ufig die Frage, ob Intubationsprobleme zu erwarten sind. Die unterschiedliche Bauart der laserresistenten Tubi und der pathologischen Befunde im oberen Aerodigestivtrakt kann mit erh?hten Intubationsschwierigkeiten einhergehen. Ziel unserer Studie war es, zu untersuchen, ob mit der pr?operativen Anwendung eines bekannten pr?dikativen Parameters ein Instrument mit ausreichender Sensitivit?t und Spezifit?t gegeben ist, um Intubationsprobleme bei laserchirurgischen Eingriffen praktikabel vorherzusagen. An 91 Patienten bestimmten wir den pr?diktiven Mallampati-Score (mod. nach Samsoon & Young [20] und verglichen ihn mit einem Score für die tats?chliche Intubationssituation [5]). Die Resultate zeigten einen signifikanten Zusammenhang (p <0,05, x²), allerdings waren die Spezifit?t (72%) und die Sensitivit?t (60%) nicht ausreichend, um von praktischem Nutzen zu sein. Die Resultate waren unabh?ngig vom verwendeten Tubustyp. Obwohl der laserchirurgische Eingriff eine besondere Situation für den An?sthesisten darstellt, ver?nderte sich die Spezifit?t und die Sensitivit?t nicht ausreichend. Diese Problematik wird in einem umfassenden Literaturvergleich aufgezeigt.      

Die Plattenepithelkarzinome der Ohrmuschel

BACKGROUND AND OBJECTIVE: Squamous cell carcinoma of the pinna seems to be associated with a worse prognosis as compared to other locations. PATIENTS/METHODS: We studied 88 patients treated between 1975 and 1990 for a squamous cell carcinoma of the pinna. RESULTS: Lymph node metastases were present in eight cases (9%) prior to treatment. Treatment was intended to be curative in 83 patients (94%). Tumor therapy was operative in all cases. Radiotherapy was instituted postoperatively in three patients; five patients (5.7%) died due to the tumor. Of 83 curatively treated patients, only 2 died of tumor progression. The survival rate was 98% after 2 years and 95% after 5 years. The recurrence rate was 7% after 1 year, 13% after 2 years, and 18% after 5 years. The outcome with regard to local tumor control and survival was significantly poorer when neck metastases were present. CONCLUSIONS: We recommend tumor excision with wide margins (5-10 mm) as first-line treatment. Neck dissection with parotidectomy is indicated when suspicious lymph nodes are detected by ultrasound sonography, the tumor diameter is > 4 cm, cartilaginous invasion is present, and vertical tumor thickness is > 5 mm.     

Einfluss der mikroneurochirurgischen Operation bei Akustikusneurinom auf dessen Symptome Schwindel und Tinnitus

After exstirpation of an acoustic neuroma one trends to concentrated on the preservation of hearing and facial function. But how does the surgical removal for an acoustic neuroma, influence the symptoms of tinnitus and vertigo? Our report follows a retrospective evaluation of 78 patients. Based on these results we will also discuss aspects of the origin of these symptoms. Our patients suffered from tinnitus at a rate of 73% preoperatively and 59% postoperatively. With increasing tumor size tinnitus occurred less often, therefore we considered the size of the tumor exclusively. Also, an intraoperative dissection of the cochlear nerve often did not result in an improvement of the symptoms. Vertigo was stated prooperatively in 44% of the cases, postoperatively in 22%. Again as with tinnitus, there was an inverse relationship between the size of the tumor and the severity of the symptoms. In conclusion a deafferention-like syndrome has to be considered as the major causative factor for the tinnitus in patients with acoustic neuromas. However, in the vertigo cases, the symptoms seem to be caused vestibularily due to the increasing tumor and then after a temporary compensation a cerebellar ataxia occured which the patients often perceive as vertigo.     

Pharynxdruckmeßsonden in der Topodiagnostik der obstruktiven Schlafapnoe

Zusammenfassung Bisheriges Wissen zum Thema: Um den chirurgischen Erfolg operativer Ma?nahmen in der Behandlung der obstruktiven Schlafapnoe zu verbessern, wird eine pr?operative Lokalisation des Kollapsortes im Bereich des oberen Luftwegs gefordert. Eine solche Methode sind Messungen mit intra?sophagealen und intrapharyngealen Drucksonden. Aus der Literatur geht hervor, da? obstruktive Schlafapnoiker mit ausschlie?lich retropalataler Obstruktion in etwa 50% erfolgreich durch eine Uvulopalatopharyngoplastik (UPPP) im Sinne einer Heilung therapiert werden k?nnen, w?hrend Apnoiker mit anderen Obstruktionsorten eine Heilungsquote von unter 10% aufweisen. Ziele der Arbeit: In dieser Arbeit werden die bisher beschriebenen Erkl?rungsmodelle kritisch diskutiert. Ergebnisse: Einerseits bedingen Messungen in unterschiedlichen Schlafstadien und unterschiedlichen Aktivit?tszust?nden sowie ungenau positionierte Me?sensoren falsch-positive und falsch-negative Ergebnisse. Zum anderen beeinflu?t jede chirurgische Ma?nahme im Pharynx offenbar eine ?nderung der Kollabilit?t in den angrenzenden Segmenten. Eine Erkl?rungshypothese hierfür ist, da? man den Muskelschlauch des Pharynx zwischen Nasopharynx und mittlerem Hypopharynx wie mehrere hintereinander geschaltete Starling-Resistoren betrachten kann, die sich gegenseitig beeinflussen. Schlu?folgerung: Inwieweit aufwendigere Pharynxdruckmessungen mit h?herer zeitlicher und r?umlicher Aufl?sung unter Berücksichtigung von Schlafstadien und Aktivit?tszust?nden eine weitere Verbesserung der Vorhersage des Operationserfolges bringen, ist Gegenstand weiterer Forschung. Der Me?aufwand wird allerdings zu hoch sein, um der Methode für die klinische Routine einen sicheren Stellenwert zu verleihen.      

Einsatz des offenen MRT in der Kopf-Hals-Chirurgie

The vertical open MRI (Signa SP, 0, 5 Tesla) is ideal for interventional diagnosis and therapy. From our point of view indications in Otorhinolaryngology are biopsies of tumours which are difficult to access such as the petrous apex and the petroclival region, the parapharyngeal space and neck and the orbit. Furthermore the open MRI is useful in the surgery of paranasal sinuses, in the evaluation of tissue-resection and helpful in detection of the anatomy of delicate structures as the internal carotid artery, the skull-base and the orbit. Also navigation in open MRI is possible for example with a flash-point-system. The advantage to conventional navigation systems is the possibility of real-time-imaging, which allows detection of tissue shift occurring during the procedure. We report about our experience with ten biopsies of the petrous apex and the petroclival junction and two biopsy of the parapharyngeal space and the neck. Further experience was gained with MR guided placement of afterloading tubes into large neck metastases in three cases and microscopic surgery of paranasal sinuses in five cases. In all operative procedures an excellent resolution was found especially for soft tissue structures as for example blood vessels. With the aid of special pointer systems or artefacts by surgical instruments all relevant anatomical structures could be detected intraoperatively, concerning normal and pathologic tissue. Thus open MRI proved to be a helpful instrument in these operative procedures.     

Kalzifizierender Pseudotumor der Orbita

Orbital pseudotumor can be divided histopathologically into three basic types: lymphoid, granulomatous and sclerosing. Chronic lymphoid and granulomatous types may eventually transform into the sclerosing type. The calcifying orbital pseudotumor is a very rare disorder due to a chronic, idiopathic inflammatory process of the orbit. The granulomatous type shows a good response to steroids while radiotherapy is the method of choice for lymphoid lesions. In general, calcifying pseudotumors can be treated only by operative exploration and tumor removal. We report a patient with a calcifying pseudotumor of the orbital apex that was removed through an endonasal approach. Preoperative diagnostic procedures and differential diagnosis are discussed.     

Telemedizin in der HNO-Heilkunde Grundlagen und Anwendungsmouml;glichkeiten

Telemedicine includes all medical activities involved in diagnosis, therapeutics or social medicine undertaken by an electronic transfer medium. This technique requires the transmission of visual and acoustic information over long distances and does not require the specialist to be personally present at the requested consultation. In the last few years, the digital data transmission, e.g., ISDN (ISDN (Integrated Service Digital Network), has become available and has facilitated the use of telecommunication. Recently, the real-time transmission of acoustic and visual signals will be improved by use of asynchronous transfer mode (ATM). Advanced telecommunication applications in minimally invasive ENT surgery are experimental in most cases. We can distinguish three different telesurgical developments: surgical teleconsultation, surgical teleassistance, and surgical telemanipulation. The different applications and transmission media are explained and discussed.     

Statistik zur Allergologie und Umweltmedizin in der HNO-Heilkunde in Deutschland

Environmental medicine and allergy were found to be important in the daily ENT practice after statistical analysis and an inquiry among all ENT doctors in Germany. 64% of ENT colleagues do practice allergy, 20% environmental medicine. With reference to all registered ENT doctors 24% are titled allergists, 4% specialists in environmental medicine. Focussing on the teaching there is a big difference between both groups. Whereas training facilities for allergists are reasonable, there are only a few chief instructors for environmental medicine in the ENT society. This fact has to be considered on educational plannings in future.     

Glomustumoren der Nase

Between May 1995 and March 1996 we were able to diagnose and remove glomus tumors of the left nasal cavity from three female patients. Ages of the patients were 9, 36 and 74 years. All patients suffered from a frequent epistaxis and all were extremely sensitive to the slightest nasal touch. One patient reported breathing difficulties due to nasal congestion. Examination revealed a tumor that filled the entire nasal cavity. The method of choice in treatment of these tumors is surgical removal. Hemangiopericytoma, non-chromaffin paraganglioma, hidradenoma, cavernous hemangioma and nevus cell nevi have to be excluded by histology and immunohistochemical techniques. From a clinical perspective the bleeding septal polyp (granuloma telangiectaticum sive pyogenicum sive pediculatum) has to be considered because it often comes from Kieselbachi's plexus, has a mushroom-like appearance and bleeds slightly.