Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstrasse 5, Freiburg. email@example.com
BACKGROUND: Malignant melanoma of the rhinobasal mucosa is very rare and makes up less than one percent of all malignant melanomas. Symptoms are unspecific in most cases, and patients often present with large tumours. During the past two decades, a variety of therapeutic modalities has been proposed. MATERIALS AND METHODS: In a retrospective quality assessment, we analysed the charts of fifteen consecutive patients suffering from malignant melanoma of the skull base who where treated in our department since 1993. The influence of specific surgical and adjuvant therapy on recurrence and outcome was evaluated. RESULTS: Initial symptoms were unspecific in all patients. Thus, melanoma was an accidental finding of a biopsy or sinus surgery in most patients, including all cases with amelanotic melanoma. All patients underwent surgery as the initial treatment, in 8 cases followed by adjuvant therapy. In these patients the disease specific survival was slightly better than in patients treated with surgery only. When recurrence was treated by radical mutilating surgery, this did not influence the overall prognosis. CONCLUSION: We conclude from our data and analysis of literature that the prognosis of MM has not developed favourably during the past two decades. Radiation therapy and adjuvant immuno- or chemotherapy seems to have a positive impact. Mutilating surgery is usually not indicated nor is it associated with an improvement of outcome.
Other papers by authors:
Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg, Killianstrasse 5, D-79106 Freiburg. firstname.lastname@example.org
BACKGROUND: Defects of the dura in the rhinobasal area can be closed transnasally. Various procedures with autologous or alloplastic material can be chosen. METHOD: From 2001 to 2004, we closed a rhinobasal dura defect with Ethisorb or Ethisorb durapatch in sandwich technique in 8 patients. After smoothing the bone edges, Ethisorb is applied under microscopic or endoscopic view endocranially, extradurally as "underlay" to seal and absorb the liquor pressure pillar. Additionally, another Ethisorb implant as "underlay" is applied extracranially from endonasally as "underlay", and sealed with a further layer of nasal concha mucosa with fibrin glue. RESULTS: All patients were successfully treated with this technique. There were no evidences for persisting rhinoliquorrhoe after the period of wound healing. For hemostasia, a nasal package was applied for compression at the donor site of the inferior nasal concha. The former dura defect was at all times freely accessible in order to be able to recognize a possible new rhinoliquorrhoea early and to prevent a possible congestive secretion with superinfection. DISCUSSION: The material of Ethisorb and Ethisorb durapatch is stiff and can be easily modelled, so it is an alternative as an alloplastic material for endonasal closure of defined substantial defects of the dura with rhinoliquorrhoe.
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Medical Center Freiburg, Germany. email@example.com
HNO-Klinik und Sektion Cochlear Implant, Universität Freiburg, Freiburg, Germany. firstname.lastname@example.org
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.
Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg (ärztlicher Direktor: Professor Dr. med. Dr. h. c. R. Laszig).
BACKGROUND: Both LAV-(large or enlarged vestibular aqueduct) and Pendred-syndrome are autosomal recessive diseases. In contrast to Pendred-syndrome, LAV-syndrome is characterised only by an enlarged vestibular aqueduct. Pendred-syndrome is a more complex disease. Classically it is characterised by sensorineural hearing loss and enlargement of the thyroid gland. Up to now, only mutations in SLC26A4 gene are known as being responsible for both syndromes. The gene for Pendred-syndrome (SLC26A4) has been localised by linkage analysis of chromosome 7q31. This protein is expressed in the inner ear, thyroid gland, kidney, and placenta. Functional analysis of the gene product (pendrin) in Xenopus laevis oocytes revealed that pendrin acts as an iodide/chloride and chloride/formate exchanger. METHOD: Each of the exons and flanking splice regions of the SLC26A4 gene were analysed by direct sequencing. Haplotype analysis was undertaken with microsatellite markers spanning a 5 Mbp area around the localisation of the SLC26A4 gene. RESULTS: In sequence analysis of 42 patients with bilateral enlargement of the vestibular aqueduct, no mutation could be identified in 30 % of cases. In some of these cases, a linkage to the gene localisation on chromosome 7q31 could not be detected. CONCLUSION: Our results indicate evidence for a second gene involved in the development of LAV-syndrome.
Rotational tomography of the normal and reconstructed middle ear in temporal bones: an experimental study.
Ch Offergeld, J Kromeier, A Aschendorff, W Maier, Th Klenzner, Th Beleites, Th Zahnert, J Schipper, R Laszig
Department of ORL, HNS, University of Freiburg, Freiburg, Germany. email@example.com
Imaging is an essential diagnostic tool in reconstructive middle ear surgery, especially in pre-operative planning. Due to ongoing improvement of imaging quality and development of new imaging techniques like e.g. rotational tomography (RT) post-operative follow-up and immediate evaluation of surgical results may become more important. The aim of this experimental study was to evaluate RT as a new tool for postoperative determination of middle ear anatomy and implant position in temporal bones. RT was performed in ten temporal bone specimen after insertion of different middle ear prostheses concerning material, shape and length (PORP; TORP; Stapes piston). An implantable hearing device (Symphonix Soundbridge) was also implanted and visualized. For comparison some specimen additionally underwent conventional computed tomography (CT), including the newest technology. Characterization of anatomical structures of the temporal bone using RT was of comparable quality to conventional CT-scans in all investigated specimen while requiring approximately 30% of the CT's irradiation exposure. Unlike CT the RT showed almost no problems due to metallic artefacts of the implanted prostheses. Furthermore RT enabled a 3-dimensional view of the temporal bone and angle determination of inserted prostheses towards the tympanic membrane and/or the malleus handle. Detailed imaging of the prostheses allowed determination of shape, material and localization within the specimen's reconstructed middle ear. The new imaging technique of RT allows precise presentation of anatomical structures and middle ear implants in temporal bones. Following these experimental results it will be our future work to evaluate this method in clinical practise.
HNO. 2006 Oct ;54 (10):761-7 16528503
[Single and temporally displaced second nerve lesions in an animal model and their clinical significance.]
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover,.
BACKGROUND: Surgical optic decompression after trauma has been discussed controversially. The surgical trauma is supposed to produce an additional nerve lesion with the danger of complete loss of vision. Alternatively, conservative high dose cortisone therapy has been recommended. METHODS: The functional and morphological consequences of a lesion after calibrated optic compression in one or two sessions were examined in an animal model using 29 Wistar rats.RESULTS: Depending on the duration and intensity of the lesion, we observed a linear decline in the number of neurons in the RGC (retinal ganglion cell) layer as well as an increasing reactivity to GFAP (glial fibrillary acidic protein) as an indication of central gliosis of astrocytes; however, this was independent on whether optic compression was performed in one or two sessions.CONCLUSIONS: To reduce secondary damage to the visual nerve and the central visual system that might increase with a persisting lesion, the indication for surgical relief of an eye affected by afference should be considered liberally, especially in view of the low morbidity of rhinosurgical intervention.
BACKGROUND: Computer assisted surgery (CAS) permits the visualization of hidden bony covered structures invisible for the human eye with radiological 3d data sets. The surgeon might be able to orientate anatomically during surgery without having to prepare the according landmarks. This would mean less surgical traumatization and a shorter and smaller operation corridor. METHOD: We determined the use of CAS in a quality assurance analysis with the subtemporal approach in 8 patients with supra-meatal tumors type A of the cerebellopontine angle. Various navigation systems and methods for referencing for the registration of the patients' heads were used. The question was whether it is possible intraoperatively without preparation of known anatomical landmarks to define the borders of an optimal positioned temporary bone cap and to identify the bony covered inner auditory canal and its neuronal structures without orienting neurostimulation. RESULT: It was possible with CAS to assess intraoperatively the borders of a temporary bone cap above the cranially positioned mastoid cell. However, the objective inaccuracy of 2 to 28 mm observed during surgery did not allow a secure identification of the inner auditory canal. CONCLUSIONS: CAS with the subtemporal approach cannot replace the conventional preparation of known anatomical landmarks nor neurostimulation to identify neural structures, due to the expected high inaccuracy with the non-invasive referencing systems that are available today.
INTRODUCTION: One of the advantages of endoluminal diverticolotomy in Zenker's diverticulum with the staple is the possibility of early rehabilitation. As the stapler allows to close the cut wound margins of the diverticulum threshold simultaneously with a clip suture, the patient can start oral food intake as early as 24 hours after surgery. The overview for the surgeon for correct placement of the clip device is limited due to the physiological narrowness of the pharyngeal tube. PATIENTS AND METHODS: We reduced the danger of malplacement by placing a temporary stomach tube as well as endoscopic control of the position of the stapler at the diverticulum threshold. RESULTS: 61 patients with Zenker's diverticulum stage Brombart I - IV have been successfully treated with this surgery technique since 1998. In two other patients a transcervical diverticulotomy was done because the diverticulum threshold could not be exposed clearly with the spread laryngoscope. In 10 patients a clinically symptomatical recurrent diverticulum (Brombart stage II) could be safely removed by a repeated endoscopically assisted stapler diverticulotomy. CONCLUSION: The advanced endoscopically assisted endoluminal stapler diverticulotomy in Zenker's diverticulum is convenient for the patient allowing prompt food intake and showing low morbidity and no mortality.
Universitäts-HNO-Klinik Freiburg. firstname.lastname@example.org
BACKGROUND: Cochlear implant surgery is a well standardized therapy for rehabilitation of congenital or acquired deafness at all ages. Mastoidectomy, posterior tympanotomy, cochleostomy and electrode insertion are performed consistently worldwide. Recently newly developed types of incision are taken into account. In our experience over more than 15 years the extended endaural incision has proven to be reliable with a low complication rate. OBJECTIVE: To evaluate a modified retroauricular incision for clinical use and complication rate in cochlear implant surgery with devices of different manufacturers. MATERIAL AND METHODS: We performed a prospective analysis of cochlear implant surgeries between 03/2003 and 03/2004. In all cases a modified retroauricular incision was used. Necessary adaptations of incision, depending on the device used, and postoperative complications were evaluated. RESULTS: In 76 ears a retroauricular incision was performed. Depending on the shape and size of receiver/stimulator an extension of the incision was necessary. The mean observation time was 6.3 months. Intra- or postoperative complications were not observed. In one case a skin dehiscence following trauma 28 days after surgery was reported without dehiscence of fascia or implant failure with uneventful healing after secondary suture. CONCLUSIONS: With regard to the results with the extended endaural incision the modified retroauricular incision allows a safe access for cochlear implant surgery. Observation of long term results and outcomes in revision surgery is mandatory.
[Electrophysiologic examinations in low frequency hearing impairment: clinical and prognostic aspects]
Universitäts-HNO-Klinik Freiburg. email@example.com
INTRODUCTION: Low-frequency hearing impairment (LFHI) is mainly associated to endolymphatic hydrops and shows a high variety of possible outcomes. Electrophysiologic examinations are widely recommended in diagnostics of LFHI, wheras up to now no data exist about the prognostic value of these examinations in a conservative therapeutic regimen. METHODS: In a quality assessment, we retrospectively evaluated the records of 90 patients, and performed an audiometric follow-up for analysis of long-time hearing data. All patients had undergone diagnostic electrocochleographic examination (ECochG) and then had been treated with rheologic infusions, followed by dehydrating infusions in patients lacking complete remission. The results of both therapeutic strategies and of long-time results were correlated to electrophysiologic findings. RESULTS: The prognosis of LFHI is significantly reflected by pretherapeutic electrocochleographic data. All significant parameters were associated to compound action potential (CAP) whereas parameters associated to cochlear microphonics (CM) did not include any utilizable prognostic value. In patients with a good outcome, the latency of CAP complex was significantly shorter, and the width of CAP complex significantly smaller than in patients with poor hearing outcome after rheologic and after dehydrating therapy and in long time assessment. The relation of summating potential (SP) und CAP was significantly smaller when the outcome was sufficient or good for either therapy and in long time analysis. Steep CAP-input-output-curves were associated to insufficient outcome after rheologic therapy and in long time assessment, but not for dehydrating therapy. CONCLUSIONS: The results indicate that ECochG is of significant prognostic value concerning hearing outcome after conservative therapy in patients suffering from LFHI. It can help the physician to counsel the patient and perform an effective management of the disease. We conclude that ECochG should be performed before the onset of therapy, including collection of SP and CAP data whereas CM parameters may be omitted.