Xeroradiographic detection of foreign bodies

A study was designed to assess the efficacy of xeroradiography for the identification of tracheal and esophageal foreign bodies. AP, lateral, and oblique conventional X-rays and xeroradiograms were taken of non-radio-paque objects placed in the trachea and esophagus of a canine subject. Randomly numbered foreign body projections shown by conventional and xeroradiography were presented to radiologists with a list of the foreign bodies employed in the study. Series of films were also presented to radiologists and otolaryngologists who had no prior knowledge of types of foreign bodies used. There was no significant advantage of xeroradiography over conventional radiography in identification of the foreign bodies. Lateral and oblique projections were shown to be far superior to the AP projection for demonstration of foreign bodies. Based on these data we do not feel that the increase in radiation exposure necessitated by xeroradiography justifies its routine use. It is recommended only as an adjunctive diagnostic tool in specific circumstances.     

Subtraction magnetic resonance for tumours of the skull base and sinuses: a new imaging technique

A new imaging technique is described, in which photographic subtraction as practised in angiography, is combined with Gadolinium enhanced Magnetic Resonance (GdMR) imaging and applied to the investigation of the paranasal sinuses and skull base. The densities on the subtraction image are dependent upon the blood supply of the tissues examined, thus producing a record of their vascularity: in effect a vasculogram. The method has proved to be technically feasible, and is advantageous in certain situations, particularly those in which the anatomy is complex as in the skull base or where normal structures have been distorted by previous surgery. The technique provides a more accurate record of tumour extent than that shown on unsubtracted GdMR scans.     

Complementary tests in the evaluation of velar insufficiency

In order to assess the degree of velar deficiency as accurately as possible, three tests can be made: a nasofibroscopy, X-rays, and notably xeroradiography, a radiography made under brightness amplification. This check-up indicates the course of action to be undertaken: orthophonic rehabilitation followed, depending on the results, by a surgical operation. These tests are incorporated into a pluridisciplinary treatment.     

Comparison of new telescopic video microlaryngoscopic and standard microlaryngoscopic techniques.

A new approach to microlaryngeal surgery using a specially designed video microlaryngoscope with a rigid endoscopic telescope and an attached video camera was introduced by Kantor et al in 1990. The ability to video document and perform surgery of the larynx by viewing a high-resolution television image was demonstrated. This method was recommended over the standard microscopic technique for increased visibility with greater depth of field, unimpeded instrument access, instant documentation, and superior teaching value. The authors tried this new method and the standard microscopic technique at the same sitting on a series of patients. This paper will compare these two different techniques and discuss their advantages and disadvantages. Although the new method has many advantages, the standard microscopic technique remains as a valuable method in laryngeal surgery.     

Image-guided osteoplastic frontal sinusotomy

BACKGROUND: A 6-ft Caldwell radiograph template and transillumination, typically, are used to elucidate the frontal sinus outline for osteoplastic frontal sinusotomy (OFS). These techniques can be fraught with imprecision. The consequences of imprecise OFS may result in significant complications. Computer-aided surgery may offer a safe and accurate alternative to these techniques in selected cases. Several disadvantages were noted with early computer-aided assistance. Current infrared and electromagnetic systems have eliminated many of these disadvantages. We describe our technique and experience with an infrared image-guidance system (The LandmarX Evolution; Medtronic Xomed, Jacksonville, FL) to create a precise OFS that maximizes exposure while minimizing morbidity. METHODS: We describe the use of an infrared image guidance system, the LandmarX Evolution for OFS in three cases. RESULTS: The LandmarX Evolution allowed for accurate placement of the OFS in each of the three cases and successful treatment of two symptomatic frontal sinus osteomas and a recurrent inverted papilloma. No complications were encountered. CONCLUSION: Image-guided OFS results in a confident and accurate entry into the frontal sinus. Image-guided OFS creation should be considered for select cases (i.e., complete opacification and altered anatomy) where performing an OFS by standard techniques may increase the complication rate. More experience with the technique and increased accessibility to image-guided equipment must be made possible before establishing this technique as a standard.     

Open-cavity tympanomastoidectomy.

A large number of considerations determine whether an open-cavity or closed-cavity technique is most appropriate for an individual patient. These considerations in the selection of technique, as well as the advantages and disadvantages of both open-cavity and closed-cavity tympanomastoidectomy are reviewed in this article. Emphasis is placed on the technical details required to produce a problem free and functional open-cavity tympanomastoidectomy.     

High speed glottographic diagnostics in laryngology

INTRODUCTION: High speed imaging (HSI) allows thousands of pictures to be taken of the vibrating vocal folds per second. Although already developed in 1939 in the USA, this method only became clinically useful a few years ago as the amount of data exceeded the capacity of physical memory. MATERIALS AND METHODS: Rigid endoscopes are normally used for high speed glottography. After clinical investigation of the patient, kymographic analysis can be carried out off-line. Up to 8,000 grayscale images of 256 x 256 pixels can be stored by the Wolf HS Endocam 5560 that we used in our study. A maximum of 4,000 images/s can be taken by the high speed camera. RESULTS: In high speed glottography, analysis and documentation of single vocal fold movements within the vibratory cycle is possible. In contrast to stroboscopic investigations, aperiodic movements of the vocal folds can be visualized. The duration of a recording differs from 2 to 4 s depending on the capture speed. The data transfer to the computer for archiving and analysing the images takes a few minutes. CONCLUSION: HSI has advantages and disadvantages compared to videoendoscopy and videostroboscopy. The main advantage is the visualisation of aperiodic movements, the disadvantages are the transfer time for the data and the poorer image quality compared to conventional videoendoscopy. Nevertheless HSI is a very promising technique in laryngological investigation.     

虚拟现实技术在颅底外科术前计划及青年医师培养方面的作用

随着医疗技术和设备的不断进步,颅底外科手术亦不断发展。由于颅底结构的复杂性以及疾病的多样性特点,颅底外科手术难度较大,个体化要求较高。虚拟现实技术在制定术前计划、确定最佳手术人路,进而提高手术的安全性和有效性方面发挥了重要作用,同时,其对于颅底外科青年医师的成长也具有推动作用。虚拟现实技术通过20多年的发展,在制定术前计划方面具有一定优势,表现在：①解剖的准确性高;②有效量化解剖间关系;③有助于确定最佳手术入路。在人才培养方面,虚拟现实技术具有省时、经济及可多次重复等优势,并可以通过“颅底外科虚拟现实病例库”的方式,进行各种手术人路的模拟训练及考核。虚拟现实技术仍有不足,但随着技术改进,以及其与神经导航技术、术中影像技术的联合应用,虚拟现实技术在颅底外科诊疗方面将会发挥更大的作用。     

鼻腔填塞材料研究进展

随着鼻内镜外科技术发展,鼻-鼻窦疾病治疗已从最初的经鼻内镜鼻窦手术拓展到眶颅底手术,手术技术不断提高的同时也对术后鼻腔填塞材料提出了新的要求。鼻腔填塞是治疗鼻出血和防止鼻腔鼻窦术后出血粘连或再狭窄的重要措施。目前可应用的鼻腔填塞材料很多,然而针对不同的疾病术后选择哪种鼻腔填塞材料以及填塞物在鼻腔留置多久为宜等这些问题,目前尚无公认标准。因此填塞材料的合理应用为鼻腔填塞的关键。本文从对鼻腔各填塞材料优缺点、适应证等方面进行综述。     

Minimally invasive approach and fixation of cochlear and middle ear implants

One of the conventional surgical approaches for cochlear implantation is a retro-auricular incision with a posterior-inferiorly based skin and subcutaneous tissue flap and a superiorly based periosteal flap. The obvious advantage is an open operating field but the disadvantages are a large wound and a lengthy operating time. It may also result in more wound-related complications. To overcome these disadvantages, we have developed a minimally invasive technique that includes a small retro-auricular single layer incision. We have used a metal bridge beneath the posterior flap to increase accessibility when creating a recess for the implant. A novel technique is used to place the securing suture deep to the flap. This technique has been used in 49 paediatric and adult patients, and there have been no wound-related complications. Although this technique was initially designed for the CLARION CII implant, it has been used to place and secure the new CLARION HiRes 90 K, the Nucleus device, the MEDEL device and the Vibrant Soundbridge.     

Pectoralis myocutaneous flap in head and neck cancer reconstruction

This review of 50 consecutive myocutaneous flaps provided an opportunity to assess the value of this particular reconstructive technique in head and neck cancer surgery. There is no question that the flap has certain disadvantages. In this series, it was not found to be a reliable means of one-stage pharyngoesophageal reconstruction. However, its technical ease, versatility, and reliability as a one-stage reconstructive technique strongly outweigh any disadvantages and prove it to be a valuable recent addition to head and neck cancer surgery reconstruction.     

A technique for the reconstruction of the posterior canal wall and mastoid obliteration in radical cavity surgery

The open technique in cholesteatoma surgery has, besides a higher security concerning the recurrence of disease, some disadvantages: lifelong care for the cavity, often discharging granulations, and vestibular vertigo due to the lack of labyrinthine protection. Most of the disadvantages can be avoided by the obliteration of the mastoid cavity, for which many different techniques have been described in literature. The authors recommend a new method: the reconstruction of the posterior canal wall using autograft conchal cartilage and the obliteration of the mastoid cavity with hydroxyapatite granulate. The technique can be used for the treatment of old cavities as well as for one-stage surgery. The results of 25 cases are reported. Due to the elevation of the tympanic membrane on a nearly physiologic level and suitable tympanoplastic procedures an air-bone gap of less than 30 dB can be reached in more than 70%.     

Principles of cholesteatoma surgery

As a potentially life-threatening disease, cholesteatoma of the petrous bone generally requires a surgical approach. Surgery aims to produce an ear that is easy to care for and is free of recurrent or residual cholesteatoma. Hearing improvement is of secondary importance. Nevertheless the sound conduction system is generally reconstructed as a single-stage procedure. There are various possible methods of dealing with a cholesteatoma: (i) preserving or reconstructing the posterior meatal wall with an aerated mastoid (closed technique) or obliteration of the mastoid completely or partially after removal of the posterior wall (closed technique); and (ii) leaving the cavity open for inspection (open technique). In our opinion any technique where the mastoid is not open for inspection should be called a closed technique. Both techniques have their specific advantages and disadvantages.     

Prinzipien der sanierenden Cholesteatomchirurgie

As a potentially life-threatening disease, cholesteatoma of the petrous bone generally requires a surgical approach. Surgery aims to produce an ear that is easy to care for and is free of recurrent or residual cholesteatoma. Hearing improvement is of secondary importance. Nevertheless the sound conduction system is generally reconstructed as a single-stage procedure. There are various possible methods of dealing with a cholesteatoma: (i) preserving or reconstructing the posterior meatal wall with an aerated mastoid (closed technique) or obliteration of the mastoid completely or partially after removal of the posterior wall (closed technique); and (ii) leaving the cavity open for inspection (open technique). In our opinion any technique where the mastoid is not open for inspection should be called a closed technique. Both techniques have their specific advantages and disadvantages.     

Hochgeschwindigkeitsglottographische Diagnostik in der Laryngologie

Introduction

High speed imaging (HSI) allows thousands of pictures to be taken of the vibrating vocal folds per second. Although already developed in 1939 in the USA, this method only became clinically useful a few years ago as the amount of data exceeded the capacity of physical memory.

Materials and Methods

Rigid endoscopes are normally used for high speed glottography. After clinical investigation of the patient, kymographic analysis can be carried out off-line. Up to 8,000 grayscale images of 256×256 pixels can be stored by the Wolf HS Endocam 5560 that we used in our study. A maximum of 4,000 images/s can be taken by the high speed camera.

Results

In high speed glottography, analysis and documentation of single vocal fold movements within the vibratory cycle is possible. In contrast to stroboscopic investigations, aperiodic movements of the vocal folds can be visualized. The duration of a recording differs from 2 to 4 s depending on the capture speed. The data transfer to the computer for archiving and analysing the images takes a few minutes.

Conclusion

HSI has advantages and disadvantages compared to videoendoscopy and videostroboscopy. The main advantage is the visualisation of aperiodic movements, the disadvantages are the transfer time for the data and the poorer image quality compared to conventional videoendoscopy. Nevertheless HSI is a very promising technique in laryngological investigation.     

Allograft tympanoplasty

Tympano-ossicular allografts are human transplants of the tympanic membrane alone or with the ossicles included. The authors review its use in their department since the introduction of the technique 40 years ago by J. Marquet. The advantages of the technique (near normal anatomical and physiological reconstruction) are discussed, as well as its disadvantages (time consuming harvesting, risk of disease transmission). Some technical modifications for specific indications have been adapted in our department and are described in detail. The authors believe that the tympano-ossicular allograft is the material of choice in extensively diseased middle ears destroyed by chronic otitis media with or without cholesteatoma.     

Closure of oroantral fistula with the septal cartilage graft

For the closure of oroantral fistula, many techniques have been described. There are advantages and disadvantages of all these techniques. We present a technique in which nasoseptal cartilage graft is used for the closure of the oroantral communication.     

High frequency needle dissection rhytidectomy

Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.     

Suction Pressure Electrodes for Electric-Response Audiometry

The advantages, as well as the disadvantages, of some electrode types for use in bioelectric measurements are discussed, with the intention of finding the types which are most suitable for measuring cortical responses, when undertaking electric-response audiometry (ERA). Two factors must be considered; the comfort of the patient and the relation to the measuring technique. The construction and the clinical test are discussed.     

Rhinoplastik

The present article gives a short historical overview of rhinoplasty. Frequency as well as advantages and disadvantages of the open and closed techniques are discussed. The choice of the surgical access depends on the current flow and the surgeon’s experience. Regional differences do exist. It is essential to have sufficient knowledge of both techniques, in order that the surgeon can choose the appropriate technique according to the wishes of the patient. Primarily, an endonasal approach should be aimed for.