[Disfiguring neurinoma of the nose tip and the columella-rhinosurgical aspects]. / Dysfigurierendes Neurinom der Nasenspitze und der Columella ­ rhinochirurgische Aspekte.

Neurinomas in the nose and the nasal sinuses are rare. In the present work, we present an exceedingly rare case of a disfiguring neurinoma involving the nasal columella. Treatment of choice is complete resection of the tumor. For an optimal view for tumor resection and esthetic and functional reconstruction, we recommend an open surgical approach.

Validity of sentinel node biopsy in early oral and oropharyngeal carcinoma.

PURPOSE: This study investigates the possibility and sensibility of using sentinel node biopsy (SNB) during surgery for oropharyngeal carcinomas with clinically and radiographically unremarkable cervical lymph nodes. MATERIALS AND METHODS: A total of 36 patients who were treated for early oral and oropharyngeal carcinoma and unremarkable cervical lymph nodes were included in this study. After lymphoscintigraphy for detecting sentinel lymph nodes (SLN), the SLN were excised first. Thereafter elective neck dissection was performed. Histopathological and immunochemical examinations were used to examine the SLN and all other lymph nodes. RESULTS: The preoperative SLN detection rate was 97.2% (35 of 36). SLN in level V were detected in four patients (11.1%). Metastases were found in 33.3% of the patients (12 of 36). All metastases were in the marked SLN. No skip metastases could be detected. A specificity of 100% and a sensitivity of 94.4% were identified for the SNB. CONCLUSION: The study confirms that SNB is a precise diagnostic procedure for assessing the nodal status of cervical lymph nodes. Further studies are needed to determine whether SNB without elective neck dissection for clinically and radiologically unremarkable cervical lymph nodes can become a reliable course of treatment for carcinomas of the head and neck region.

Implementation of a miniaturised navigation system in head and neck surgery for the detection and removal of foreign bodies.

The removal of embedded blast-generated fragments from soft tissue is very difficult, especially in the head and neck regions. First, because many retained foreign materials are non-metallic and can, therefore, not be detected by fluoroscopy, and second, because a broad exploration of the soft tissue is not possible in the facial area for functional and cosmetic reasons. Intraoperative navigation computer-assisted surgery (CAS) may facilitate the retrieval of foreign bodies and reduce exploration trauma. In a blind trial, five test specimens of different materials (glass, metal, wood, plastic, and stone) were inserted on the left and right sides of the head and neck of ten body donors through an intraoral incision. A second physician then detected and removed the foreign bodies from one side of the body without and from the other side of the body with navigation. We measured the duration of surgery, the extent of tissue trauma caused during surgery, the time it took to remove the foreign bodies, and the subjective evaluation of the usefulness of navigation. With the aid of the navigation system, the various foreign bodies were detected after an average of 26.7 (±35.1) s (p < 0.0001) and removed after an average of 79.1 (±66.2) s (p = 0.0239), with an average incision length of 10.0 (±3.5) mm. Without the navigation system, the foreign bodies were located after an average of 86.5 (±77.7) s and removed after an average of 74.1 (±45.9) s, with an average incision length of 13.0 mm (±3.6) mm (=0.0007). Intraoperative navigation systems are a valuable tool for removing foreign bodies from the soft tissue of the face and neck. Both the duration of surgery and the incision length can be reduced using navigation systems. Depending on the material of the foreign bodies and the signal intensity in the CT/MRI scanner, however, the detection reliability varies. All in all, navigation is considered to be a useful tool.

[Solving problems after rehabilitation with voice prostheses : Two rare cases of fistula-related complications]. / Problemlösung bei Stimmrehabilitation mittels Stimmprothesen : Zwei seltene fistelassoziierte Komplikationen.

During the past three decades, the use of voice prostheses has developed worldwide into the gold standard for voice rehabilitation after total laryngectomy. Insertion of a voice prosthesis is a simple and rapid surgical procedure, which is associated with a low rate of complications. The current article describes the cases of 2 patients showing a rapid development of granulation tissue around the voice fistula, leading to complete incarceration of the prosthesis and subtotal/total stenosis of the neopharynx.

[Voice rehabilitation after total laryngectomy: A chronological review of medical history]. / Stimmrehabilitation nach totaler Laryngektomie: Ein chronologischer, medizinhistorischer Überblick.

BACKGROUND: Loss of voice is the consequence of laryngectomy most disturbing for the patient. As such, the notion of performing a laryngectomy has always been directly linked to the possibility of voice rehabilitation. The multitude of different technical and surgical approaches pays testimony to the problems associated with rehabilitation of speech and swallowing after laryngectomy. METHODS: Scientific online search engines and library facilities were used to search for recent publications and historical medical documents. Important works were identified and summarized. RESULTS: Four different categories of voice rehabilitation can be identified: external (electrical) devices, esophageal speech, and tracheoesophageal shunts either with or without fistula valves/voice prosthesis. During the past three decades, fistula valves/voice prostheses have become the state of the art, with some patients still using esophageal speech or external devices as a back-up method in case of prosthesis failure.

[Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation]. / Bedeutung zellulärer Tight-junction-Komplexe bei der Entwicklung einer periprothetischen Leckage bei stimmprothetischer Versorgung.

BACKGROUND: The use of voice prostheses is currently the gold standard in voice rehabilitation after total laryngectomy. This method combines low complication rates and excellent rehabilitation results; however, approximately 30% of patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration within the first 4 years. The development of this enlargement is controversially discussed in the literature but recently published studies have shown that high esophageal reflux plays a key role in this process, which leads to an inflammatory reaction and disturbs the intercellular tight junctions in the sense of an epithelial mesenchymal transition (EMT). MATERIAL AND METHODS: A total of 44 patients underwent 24 h pH monitoring, a sample biopsy from the region of the fistula and a subsequent biomolecular examination for intracellular junction proteins as well as a correlation between the severity of reflux and tracheoesophageal fistula problems before and after antireflux therapy with proton pump inhibitors (PPI). RESULTS: Immunohistochemical staining revealed decreases in membrane E-cadherin and ß-catenin and a significant increase in the cytoplasmic fraction, depending on the severity of inflammation in the fistula tissue. In patients with an improvement of clinical fistula problems under oral PPI treatment an increase of membrane E-cadherin could be shown, whereas patients with persisting fistula enlargement demonstrated a further decrease of E-cadherin. CONCLUSION: The data indicate a central role of EMT in the development of fistula enlargement after total laryngectomy. Patients with periprosthetic leakage showed a loss of membrane bound E-cadherin and ß-catenin with an up-regulation of vimentin expression. In patients with mild or no leakage problems EMT could be resolved by aggressive antireflux treatment, whereas patients without any effect of PPI treatment on the fistula showed no reversal of EMT. These data contribute to the understanding of treatment resistant fistula enlargement after total laryngectomy.

[Voice rehabilitation after laryngectomy]. / Stimmrehabilitation nach Laryngektomie.

Laryngeal and hypopharyngeal carcinomas are among the most common malignant tumours of the head and neck region, accounting for about 3,000 new cases per year. Despite enormous advances in organ preservation surgery and chemoradiotherapy, total laryngectomy is still necessary in approximately one quarter of affected patients. The removal of the larynx results in the loss of 3 important functions, i. e., voice production, the air conditioning mechanism of the nose, and the ability to smell. Whereas voice rehabilitation has been a mainstay of treatment from the very beginning of laryngeal surgery, pulmonary and olfactory rehabilitation has received increasing attention only in the past 2 decades. Today every head and neck surgical oncologist should be familiar with the various methods of voice rehabilitation and the use of heat and moisture exchangers for air conditioning. The objective of this article is to provide an overview of current methods of rehabilitation after total laryngectomy and to introduce young surgeons with an interest in voice rehabilitation to available techniques.

[Human papillomavirus in squamous cell cancer of the head and neck. A study at the Ulm Military Hospital, Germany]. / Humane Papillomavirusinfektionen bei Plattenepithelkarzinomen des Kopf- und Halsbereichs. Eine Untersuchung am Krankengut des Bundeswehrkrankenhauses Ulm.

There is increasing evidence worldwide that human papillomavirus is a major risk factor for head and neck cancer. Only few studies on this association have been performed in Germany to date. For the purposes of the present study, tumor specimens from 223 patients with squamous cell cancer of the oral cavity, oropharynx, hypopharynx and larynx were analyzed for HPV DNA and p16INK4a expression. The prevalence of HPV genotype 16 (HPV16) DNA in the study population was 17.5%. Further high-risk HPV types were not detected. All HPV16-positive tumors showed intense p16INK4a expression. HPV16 prevalence was highest in tonsillar carcinoma (37.5%) and lowest in laryngeal cancer (2.8%). We observed a significantly higher incidence of cervical lymph node metastases in patients with HPV16-positive tonsillar carcinoma in comparison to HPV-negative tumors (p < 0.016). Tobacco and/or alcohol consumption was significantly lower in patients with HPV-positive tumors (p < 0.0001).

[A novel puncture instrument: the Provox-Vega® puncture set. Its use in voice prosthesis insertion following laryngectomy]. / Neues Punktionsinstrumentarium: Provox-Vega®-Punktionsset. Anwendung beim Einbringen einer Stimmprothese nach Laryngektomie.

BACKGROUND: The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a guidewire and anatomic hemostatic forceps. The use of these instruments requires a certain level of experience on the one hand, while on the other use of a trocar and subsequent manipulation with the hemostatic forceps can lead to tissue trauma around the membranous wall or damage to the voice prosthesis. We present the results of a phase I/II study using a novel atraumatic puncture set for primary and secondary insertion of voice prostheses. PATIENTS AND METHODS: Once patients had been fully informed and given their consent, the Provox-Vega® puncture set was used in 21 patients in either a primary (16) or a secondary (5) procedure. All procedures were documented on video, while approach, complications and surgical success were recorded using a questionnaire. RESULTS: The average surgical time was 83.5 (± 19.12) s for primary voice prosthesis insertion and 212.57 (± 93.03) s in secondary procedures. The prosthesis could be inserted without complication in 19 patients, while a longer prosthesis needed to be selected intraoperatively in two patients due to a thick membranous wall. No serious complications were observed. One patient incurred a discrete injury to the mucosa of the esophageal posterior wall. CONCLUSION: The Provox-Vega® puncture set proved itself to be a safe aid in the insertion of voice prostheses. It is significantly easier to use than other systems and tissue trauma is minimal. In most cases, no further instruments were required.

[Microdebrider-assisted inferior turbinoplasty. Minimally invasive technique for the treatment of nasal airway obstruction caused by enlarged turbinates]. / Shaver-turbinoplastik. Minimalinvasives verfahren zur therapie der behinderten nasenatmung bei vergrösserten nasenmuscheln.

BACKGROUND: Various methods are available for the surgical treatment of nasal airway obstruction caused by enlarged turbinates. These methods include partial turbinectomy, submucosal electrocautery, radiofrequency surgery, and laser turbinoplasty, all of which can have adverse effects such as defects of the mucous lining of the turbinates, prolonged postoperative healing, and bleeding. The purpose of this study was to analyse the effectiveness and potential adverse effects of microdebrider-assisted inferior turbinoplasty (MAIT), which is a less commonly used treatment option. MATERIALS AND METHODS: In a prospective randomized study, 35 patients underwent microdebrider-assisted inferior turbinoplasty. Two control groups (35 patients each) underwent conventional partial turbinectomy or submucosal electrocautery. Endoscopic and functional studies (active anterior rhinomanometry, saccharin test) were performed before surgery and 2, 4, and 24 weeks after surgery. Pain and other postoperative problems were assessed using analogue scales. RESULTS: After 2 weeks, MAIT patients, unlike the other patients, showed almost no more mucosal lesions. After 4 weeks, mean saccharin clearance time was 11.1 min in the MAIT group, 15.9 min in the partial turbinectomy group, and 13.7 min in the electrocautery group. When the patients were asked to rate their symptoms on a scale of 0-10, the mean score in the fourth postoperative week was 6.1 in the MAIT group, 7.7 in the partial turbinectomy group, and 7.8 in the electrocautery group. Rhinomanometry showed a mean flow rate increase from 178 ml/s to 574 ml/s after MAIT (401 ml/s after partial turbinectomy, 361 ml/s after electrocautery). CONCLUSION: Microdebrider-assisted inferior turbinoplasty is a minimally invasive method for reducing inferior turbinate size and maintaining mucosal integrity. It has the advantages of a short healing time, only a mild decrease in mucociliary clearance, only minor postoperative problems, and a good functional outcome.

[Diagnosis and treatment of injuries to the frontal skull base]. / Diagnostik und Therapie von Verletzungen der Frontobasis.

The role of ENT surgery in the management of anterior skull base defects has become increasingly important in recent years. Transnasal endoscopic surgical techniques and intraoperative navigation enable a minimally invasive approach in a large proportion of patients, thus helping to avoid morbidity typically associated with neurosurgical subfrontal approaches. Whereas traffic accidents and sport injuries are the main causes of anterior skull base trauma in the civilian setting, penetrating injuries caused by gunshots and improvised explosive devices (IEDs) play an increasing role in the military arena and terroristic attacks. Minor injuries to the anterior skull base are usually managed by ENT surgeons. Major injuries, involving the midface or neurocranium, require an interdisciplinary approach including maxillofacial surgeons and neurosurgeons. A centre for head and neck medicine and surgery is an ideal setting for such interdisciplinary teams to provide appropriate care for patients with complex skull base trauma in cooperation with ophthalmologists and interventional neuoradiologists. The present article describes concepts for the treatment of anterior skull base trauma established at the head, neck and skull base center at the Ulm military hospital in Germany.

[Penetrating injuries in the face and neck region. Diagnosis and treatment]. / Penetrierende Gesichts- und Halsverletzungen. Diagnostik und Therapie.

Penetrating head and neck injuries often present with vascular lesions and airway compromise and may be life-threatening. Thus controlling bleeding and airway stabilisation take priority in emergency treatment. High-velocity projectiles, fragmentations from improvised explosive devices (IEDs) and shrapnel can cause severe tissue injury, representing a challenge for the head and neck surgeon. Since several organ structures, such as the eyes, midface, pharynx, larynx, trachea, esophagus, nerves, vessels and vertebral spine can be injured at the same time, patients should be referred to a specialized trauma center for interdisciplinary treatment following emergency treatment. High-speed ballistic injuries were once confined to the battle field and have been uncommon in Europe since World War II. For this reason, experience among civilian head and neck surgeons is at present limited. With the increased incidence of terrorism and the use of IEDs as the preferred weapon in terrorism it has become important for civilian head and neck surgeons to understand the role of ballistic injuries in mass casualty events. The present paper discusses current viewpoints in the diagnosis and treatment of penetrating head and neck injuries.

[Laryngectomised patients with voice prostheses: influence of supra-esophageal reflux on voice quality and quality of life]. / Laryngektomierte Stimmprothesenträger: Einfluss eines supraösophagealen Refluxes auf Stimm- und Lebensqualität.

INTRODUCTION: We conducted a prospective study to assess the influence of supra-esophageal reflux on voice quality and quality of life in patients who had undergone laryngectomy and prosthetic voice rehabilitation. PATIENTS AND METHODS: We investigated 60 laryngectomised patients using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30. Voice quality was quantified using the voice handicap index (VHI10). Quality of life and voice quality parameters were then correlated with the severity of reflux disease. RESULTS: Patients with physiological reflux area index (RAI) scores had a mean VHI10 score of 46.4 (±11.4). VHI scores were found to increase to up to 64.1 (±9.6) with reflux severity (p=0.025). Total quality of life scores ranged from 115.8 (±24.7) in patients with physiological RAI scores to 131.0 (±33.1) in patients with highly pathological RAI scores (p=0.007). After 6 months of treatment with PPIs, VHI scores improved to a total score of 57.5 (±20.6, p=0.003). Quality of life scores improved to 123.3 (±29.0, p=0.045). CONCLUSION: Supra-esophageal reflux influences voice quality and quality of life in laryngectomised patients with voice prostheses. This can be explained, for example, by an increased incidence of periprosthetic leakage, the presence of edema in the pharyngo-esophageal segment (where speech is produced), and general reflux symptoms. Rigorous treatment with anti-reflux medications leads to an improvement in reflux parameters that can be assessed objectively (RAI) and in correlated quality of life and voice quality parameters. For this reason, we recommend rigorous oral treatment with PPIs in laryngectomised patients with a confirmed diagnosis of supra-esophageal reflux.

[Voice rehabilitation after laryngectomy. Initial clinical experience with the Provox-Vega® voice prosthesis and the SmartInserter® system]. / Stimmrehabilitation nach Laryngektomie. Erste klinische Erfahrungen mit der Provox-VEGA®-Stimmprothese und dem SmartInserter®-System.

BACKGROUND: Voice prostheses have considerably improved the success of voice rehabilitation after total laryngectomy and are the treatment of choice in many hospitals. Provox® voice prostheses are the most commonly used devices for voice restoration in Europe. Their benefits in terms of voice quality and ease of use are well documented in the literature. In March 2009, the third generation of Provox voice prostheses became available under the name of Provox-Vega®. This prosthesis features major changes in design and is supplied with the new SmartInserter® insertion device. MATERIAL AND PATIENTS: Nineteen patients who were receiving follow-up care at our department and had been using voice prostheses for an extended period of time were treated with Provox-Vega® prostheses after they gave their written informed consent. The patients completed a structured questionnaire covering the subjective evaluation of voice quality, phonation times and dynamic ranges. We also asked our patients whether they felt uncomfortable during prosthesis replacement procedures. In addition, we asked our medical professionals to evaluate the ease of use of the new insertion device. RESULTS: The Provox-Vega® prosthesis was found to be superior to other prostheses in terms of voice quality, loudness and pitch modulation. It helped patients improve mean phonation time from 11.3 to 15.3 seconds and increase the dynamic range by 4.7 dB. Our medical professionals reported that the insertion device was easier to use and quicker to replace. CONCLUSIONS: Provox-Vega® prostheses were found to improve voice quality and phonation times. Patients do not feel uncomfortable during replacement procedures. Following an appropriate period of familiarisation with the SmartInserter®, we found that the Vega system is quick and easy to use.

[Laryngeal and pharyngeal actinomycosis]. / Aktinomykose im Bereich von Pharynx und Larynx.

Cervicofacial actinomycosis is an uncommon infection and in most cases odontogenic in origin. Pharyngeal and/or laryngeal lesions, usually occurring secondary to mucosal trauma, are very rare and may mimic a malignant tumor. In such cases, which represent less than 1% of all cases, the differential diagnosis with upper aerodigestive tract malignancy remains challenging. We report a case of actinomycosis in a 56-year-old male patient who presented with an extensive, centrally necrotic mass in the oropharynx, hypopharynx and larynx region suspected to be a tumor. The lesion was diagnosed 6 months following accidental ingestion of an ear of corn and ultimately proved to be cervicofacial actinomycosis. The clinical and pathological features and current aspects of the diagnosis and treatment of cervicofacial actinomycosis are discussed.

[Prosthetic voice restoration after laryngectomy: the management of fistula complications with anti-reflux medications]. / Stimmprothetisch versorgte Patienten nach Laryngektomie: Medikamentöse Antirefluxtherapie von Stimmfistelkomplikationen.

INTRODUCTION: Approximately 30% of all patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration. In a prospective study, we investigated the role of aggressive anti-reflux therapy in fistula complications. PATIENTS AND METHODS: A total of 48 patients were assigned to one of two groups. Group A consisted of 16 patients with recurrent periprosthetic leakage. Group B comprised 32 patients without periprosthetic leakage. The presence of reflux was objectively assessed using 24-h dual-probe pH monitoring. All patients with pathological reflux underwent proton pump inhibitor (PPI) therapy. After 6 months, patients were re-evaluated for fistula complications and objective reflux parameters. RESULTS: The mean absolute number of reflux events was 202.8 (+/-44) before and 74.5 (+/-22.9) after PPI therapy (p=0.025). The reflux area index decreased from 419.5 (+/-112.5) before treatment to 105.8 (+/-54.7) after treatment (p=0.0005). The mean DeMeester score was 104.4 (+/-21.3) without PPIs and 43.5 (+/-9.3) after 6 months with PPIs (p=0.028). A risk analysis for patients with both periprosthetic leakage and pathological reflux (15 patients at the beginning of the study, four patients after therapy) showed that the relative risk of periprosthetic leakage decreased to 0.3 (p=0.0054) with PPI therapy. CONCLUSION: Patients with recurrent periprosthetic leakage in the region of the fistula showed a significantly higher number of supra-oesophageal reflux episodes. Rigorous anti-reflux treatment can help manage or prevent leakage problems in a large proportion of patients.

[Surgical treatment of enlarged trachoesophageal puncture with and without supraesophageal reflux : case report and review of literature]. / Chirurgische Therapie von Stimmshunt-Komplikationen unter besonderer Berücksichtigung eines supraösophagealen Refluxes : Fallbericht und Literaturübersicht.

Approximately a quarter of all patients who undergo prosthetic voice restoration develop periprosthetic leakage with aspiration symptoms within 1 to 4 years following surgery. Depending on the severity of fistula enlargement, treatment ranges from conservative approaches to surgical procedures. In some cases, however, these measures prove unsuccessful. The causes of treatment failure and fistula enlargement are not fully understood. There is growing evidence, however, that the presence of coexisting supraesophageal reflux can contribute to fistula complications. We report the case of two patients with voice prostheses and simultaneous severe reflux disease who underwent multiple failed attempts at fistula closure. After effective reflux therapy, the fistulas could eventually be closed successfully.

[Coincidence of fistula enlargement and supra-oesophageal reflux in patients after laryngectomy and prosthetic voice restoration]. / Koinzidenz von Stimmfistelerweiterungen und supraösophagealem Reflux nach stimmprothetischer Versorgung bei Laryngektomie.

INTRODUCTION: In a prospective study on patients who developed recurrent periprosthetic leakage in the region of the fistula after laryngectomy and prosthetic voice restoration, we investigated whether there was an increased incidence of supra-oesophageal reflux. PATIENTS AND METHODS: A total of 48 patients included 16 patients with recurrent periprosthetic leakage (group A) and 32 patients without periprosthetic leakage (group B). The presence of reflux was objectively assessed using 24-hour dual-probe pH monitoring. The number of supra-oesophageal reflux events, the reflux area index (RAI 4) and the DeMeester score were determined as well as the relative risk of fistula enlargement in relation to the presence of reflux and postoperative radiotherapy. RESULTS: In group A pathological reflux events were detected in 100% of the cases. The mean number of supra-oesophageal reflux episodes was 414.8, the RAI was 419.5 (+/-212.45) and the DeMeester score was 104.4 (+/-21.3). In group B pathological reflux events were found in only 50% of the cases. The mean number of supra-oesophageal reflux episodes was 11.8, the RAI was 146.9 (+/-40.4) and the DeMeester score was 42.9 (+/-11.8). All reflux parameter results for group A patients were significantly higher than those obtained for group B patients. The relative risk of fistula enlargement was 1.8-2.3 times higher in the presence of reflux. Postoperative radiotherapy did not increase the risk of fistula enlargement (relative risk 0.75-0.93). CONCLUSIONS: A significantly higher number of supra-oesophageal reflux episodes occurred in patients with recurrent periprosthetic leakage in the region of the fistula. As reflux events may cause problems in the region of the fistula, prophylactic treatment with proton pump inhibitors is recommended.

[Pulmonary rehabilitation after total laryngectomy using a heat and moisture exchanger (HME)]. / Pulmonale Rehabilitation nach totaler Laryngektomie durch die Verwendung von HME (Heat Moisture Exchanger).

A complete removal of the larynx has profound consequences for a patient. Since laryngectomy involves the separation of the upper airway from the lower airway, it not only implies a loss of the voice organ but also leads to chronic lung problems such as increased coughing, mucus production and expectoration. In addition, laryngectomees complain of fatigue, sleeping problems, a reduced sense of smell and taste, and a loss of social contact. A heat and moisture exchanger (HME) cassette can replace a function of the upper airway which consists in conditioning inspired air. It can improve pulmonary symptoms in three ways. 1. An HME cassette heats and moisturises inhaled air and thus creates nearly physiological conditions in the region of the deep airway. 2. The use of an HME cassette leads to an increase in breathing resistance, thereby reducing dynamic airway compression and improving lung ventilation. 3. An HME cassette acts as a filter and removes larger particles from incoming air. This review examines the current understanding of lung physiology after laryngectomy and assesses the effects of HME cassettes on the conditioning of respiratory air, lung function and psychosocial problems.

[Penetrating gunshot wound in the neck. Case report and review of the literature]. / Penetrierende Schussverletzung im Halsbereich. Fallbericht und Literaturübersicht.

Penetrating gunshot neck injuries present a serious challenge for the primary attending surgeon. By means of a case treated in the German Field Hospital in Mazar-e-Sharif (northern Afghanistan) and a review of the literature, the principles of diagnosis and treatment of penetrating zone II neck injuries due to gunshots or shrapnel are presented.