[Surgery of the nose and paranasal sinuses]. / Chirurgie der Nase und Nasennebenhöhlen.

A compromised overview of surgical techniques regarding the nose (functional) and para nasal sinus inflammation surgical treatment is exposed in this article. The nasal septum is within the focus for function, form and stability for the nasal structure (especially for tip and back of the nose) and for success of a rhinoplasty. An important role play the lower nasal turbinates regulating nasal air flow and thus having a great effect after turbinate surgery (submucosal resection and lateral fracturing).The endonasal endoscopy is of utmost importance for diagnosis, therapy and detection of recurrence. In severe cases of nasal polyps, functional endoscopic sinus surgery (FESS) remains the ultimate therapy. However, the indication to operate will be carried out after exhaustion of medical treatment. The most important recurrent prophylaxis for rhino sinusitis and nasal polyps is an appropriate post operative nasal care.

[Faults and failure: aesthetic rhinoplasty plus brow, eyelid and conchal surgery]. / Fehler und Gefahren: Die ästhetische Rhinoplastik sowie Brauen-, Lid- und -Ohrmuschelkorrektur.

Within the last years aesthetic surgery enjoys greater popularity and acceptance. One of the most frequently asked operations has been the aesthetic rhinoplasty. Hardly any other field of surgery is exposed to such a critical analysis than aesthetic rhinoplasty because the results are so obvious. According to the "International Society of Aesthetic Surgery" (ISAPS) over 980 000 cosmetic rhinoplasties have been performed in 2010. This corresponds to 10.4% of all registered aesthetic procedures worldwide. Complications can not be eliminated in such a large number of nasal operations. Up to 15% of all patients re-consult a doctor for a revision because they are dissatisfied with their final rhinoplasty result. Findings of the tip followed by functional problems and irregularities of the nasal dorsum are named most frequently. The responsible rhinosurgeon has to regard all anatomical and physiological details and to consider ethical and psychological aspects in the preselection and postoperative care of the patient. Aesthetic surgeons should be acquainted with terms and definitions like body image, dysmorphophobia or Thersites complex. Acronyms, like "SIMON" or "SYLVIA", support the physician additionally to analyze and assess the patient. The following article describes the most frequent faults, complications and pitfalls after aesthetic rhinoplasty listed by the anatomical structure. Results will be analyzed, strategies and techniques will be suggested to correct the faults and to prevent them in the future. Furthermore psychologic, social and psychiatric aspects will be discussed and handling with aesthetic patients explained.

[Ischemic preconditioning in a rat adipocutaneous flap model]. / Der epigastrisch adipokutane Lappen am Tiermodell zur Evaluierung der ischämischen Präkonditionierung.

INTRODUCTION: Flap necrosis in ear, nose, and throat surgery, especially in high-risk groups, is not rare, but not all of the individual pathophysiological processes are known. The objective of this study was to establish an animal model to determine whether acute ischemic preconditioning, which has been reported to be successful in organ transplantation, will result in enhanced flap survival. METHODS AND MATERIALS: Forty-two Wistar rats were divided into three experimental groups. An epigastric adipocutaneous flap, based on both superficial epigastric arteries and veins, was raised. The flap was either raised (control), clamped for 2 h (ischemic), or subjected to ischemia of 30 min, followed by 30 min of reperfusion and another 2 h of induced ischemia (IP). The mean flap necrosis area was assessed in all groups on the 5th postoperative day. RESULTS: All animals were doing well on the final day. The average necrosis in the ischemic group was significantly greater than in the control group. No significant superiority in the IP group was demonstrated. CONCLUSION: The data show that the experimental animal model is practicable and that additional approaches to ischemic preconditioning should be verified.

[Monitoring and conditioning in plastic and reconstructive ENT-surgery]. / Monitoring und Konditionierung beim Gewebetransfer in der rekonstruktiven HNO-Chirurgie.

Plastic and reconstructive ENT surgery serves for reconstruction of form and function. Frequent indications in ENT surgery are the covering of large tissue defects after tumor operations, firing and/or explosion injuries, accidents, burns or massive infections. A high revision rate of up to 20 % in selective patient groups show that more knowledge of both monitoring and ischemia-/reperfusion mechanisms is necessary. Besides improved monitor proceedings biochemical cell procedures in pedicled and free flaps are getting more focused. In the last years certain physical and medical factors appear, which have influence on the long-term surviving of a pedicled or free flap, e. g. pre- and/or postconditioning. The increasing knowledge of changes in perfusion and oxygenation, which prevail in the flap, as well as different options of physical and pharmacological therapies permit a promising view into the future, in order to achieve an improved surviving of a pedicled or free flap in combination with improved monitor proceedings.

[Functional outcome after midcarpal arthrodesis in the treatment of advanced carpal collapse (SNAC-/SLAC-wrist)]. / Funktionelle Ergebnisse nach mediokarpaler Teilarthrodese als Behandlungskonzept bei fortgeschrittenem karpalem Kollaps (SNAC-/SLAC-Wrist).

PURPOSE: The purpose of this retrospective study was the evaluation of the functional outcome of midcarpal arthrodesis, its results in the treatment of SNAC/SLAC stage II and III and patients' satisfaction. METHODS: 49 patients that were treated with a midcarpal arthrodesis were re-examined at a mean follow-up time of 47 months. Range of motion was verified and grip strength was measured with a Jamar-Dynamometer II and a pinch-grip. Pain was evaluated by a visual analogue scale (VAS 0 to 100) for stress and under resting conditions. Patients' daily activities and general quality of life were estimated with the DASH questionnaire. Radiographic evaluation was done by conventional X-ray. RESULTS: Active range of motion was 56 % and grip strength was 76 % of the non-operated wrist. The DASH score was 29 points. Pain relief was 34 % during resting conditions and 31 % after stress respectively. 45 patients demonstrated bony consolidation in X-ray control. Six patients needed further treatment with a total arthrodesis because of pain or absence of bony consolidation. 77 % of the patients returned to their original occupation and 80 % were satisfied with the final result. CONCLUSION: Our data demonstrate that midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed.

[The reconstruction of scaphoid pseudoarthroses with the operation of Matti-Russe. A retrospective follow-up analysis of 84 patients]. / Die Rekonstruktion von Skaphoidpseudarthrosen durch die Operation nach Matti-Russe. Eine retrospektive Analyse von 84 nachuntersuchten Patienten.

BACKGROUND: In a retrospective study 84 patients were examined who were treated with a Matti-Russe procedure between 1985 and 1997 due to scaphoid non-union. The purpose of this study was to evaluate the long term results after scaphoid reconstruction and to get impressions about subjective feeling of the patients. PATIENTS AND METHODS: 79 patients were male, 5 were female. The average follow-up period was 88 months. Measured parameters were: grip strength and range of motion, pain was evaluated with a visual analog scale (VAS) from 0 to 100. The functional and subjective outcome was evaluated with the DASH-questionnaire. RESULTS: A bony consolidation could be verified in 82% of the patients. The mean postoperative pain score was 3 (non-stress) and 33 (stress) in patients with scaphoid union. The DASH-score reached 15. Active range of motion and grip strength were 82% and 92% compared to the contralateral side. 81% of the patients have been working in strenuous jobs. CONCLUSION: The results show the reliability of the Matti-Russe procedure in non-union of fractures of the scaphoid. Alternative treatment options have no advantages in bony union.

[Orbital floor reconstruction. Comparison of a new perforated 0.15 mm thick PDS layer with established titanium dynamic mesh]. / Orbitabodenrekonstruktion. Vergleich einer neuen perforierten 0,15 mm dicken PDS-Folie mit etabliertem Titanium-Dynamic-Mesh.

INTRODUCTION: For surgical reconstruction of the orbital floor after blow-out fractures, a new perforated PDS (poly-p-dioxanon) foil (0.15 mm thickness) has recently become available. The main target of this prospective and randomized interdisciplinary clinical study was to compare this new PDS foil with the proven titanium dynamic mesh (0.3 mm thickness). PATIENTS/METHODS: Aside from the common diagnostic procedures, an extensive ophthalmologic examination was performed and documented preoperatively (U1), 4 days (U3), 1 month (U4), and 6 months (U5) postoperatively. RESULTS: In both groups the surgical procedure was tolerated well. The new perforated PDS foil turned out to be easier to handle intraoperatively because of smooth and clean cutting edges. The surgical treatment was well tolerated in all randomized groups. In contrast to the control group, the PDS and TD groups showed postoperatively a slight increase of the preoperative exophthalmos (mean 0.5 mm). CONCLUSION: The new perforated PDS foil is comparable concerning cosmetic and functional aspects. Especially with regard to stability after blow-out fractures, the new perforated PDS foil is equal to titanium dynamic mesh up to 20 mm in diameter. PDS foil is felt to be superior regarding bioresorption and due to the more convenient handling.

Effectiveness of a new perforated 0.15 mm poly-p-dioxanon-foil versus titanium-dynamic mesh in reconstruction of the orbital floor.

INTRODUCTION: In recent years a new perforated PDS (poly-p-dioxanon) foil (0.15 mm) has become available and has not yet been proven to be successful in reconstruction of the orbital floor after blow-out-fractures in randomized studies. The main aim of this clinical trial is to compare this new PDS foil with titanium dynamic mesh (0.3 mm) (TD), which is well established in reconstruction of the orbital floor. PATIENTS AND METHODS: In a prospective multicentre randomized trial, conducted between 1997 and 1998, out of 42 patients with fractures of the orbital floor, 28 patients needing material for reconstruction were randomized to receive either PDS foil or TD. In a comprehensive preoperative and postoperative protocol patients were monitored by the surgeon, radiologist and ophthalmologist with a postoperative follow-up of least 6 months. RESULTS: Maximum defects of the orbital floor were comparable in both groups (PDS group: 13.3 mm, TD group: 13.9 mm). In both groups the surgical procedure was well tolerated, and functional and cosmetic results were evaluated as satisfactory by all patients. Ophthalmological evaluation, performed up to 6 months postoperatively, revealed double vision or vertical strabismus in nine patients (five PDS group, four titanium group). This was not confirmed subjectively in each single patient. Also ex- or enophthalmos, registered in seven patients of the PDS and four of the TD group (mainly + /- 1 mm) were not considered as relevant by the patients. CONCLUSION: The new 0.15 mm perforated PDS foil was comparable to 0.3 mm titanium mesh concerning functional and cosmetic outcome. Obviously, persisting ophthalmometric disorders were compensated very well in both groups. PDS foil is felt to be the preferred material since it is bioresorbable and more convenient to handle.