Risk of lymph node metastases after en bloc cold steel, en bloc laser-, and piecemeal laser surgical resection of auricular VX2 carcinoma.

There is some controversy in the literature if lymph vessels are enduring sealed during piecemeal CO2 laser surgery of squamous cell carcinomas of the head and neck or a propagation of tumor cells into the lymphatics occurs. The aim of the present study was to analyze the incidence of lymph node and distant metastases after different methods of resection of a VX2 carcinoma in an animal model. A solid auricular VX2 carcinoma was induced in 200 rabbits. Seven days later, an en bloc cold steel (group A), en bloc laser surgical resection with CO2 laser in continuous wave mode with 2 W (group B), or piecemeal laser surgical resection after transection of the tumor with CO2 laser in continuous wave mode with 2 W (group C) or 20 W (group D) was performed. The animals were killed and the incidence of lymph node and distant metastases was compared between the different groups. Of the rabbits, 21.1 % developed lymph node metastases and 10 % pulmonary metastases. The incidence of lymph node metastases was 17.4 % in group A, 20.4 % in group B, 26 % in group C, and 20 % in group D. These differences were not statistically significant. En bloc cold steel, en bloc laser-, or piecemeal laser surgical resections include similar risk of postoperative metastases. Propagation of tumor cells cannot be excluded with certainty by any of these methods.

Temporal bone imaging using digital volume tomography and computed tomography: a comparative cadaveric radiological study.

PURPOSE: The aim of the present study was to analyze the diagnostic value of some temporal bone structures, e.g., ossicular chain, with digital volume tomography (DVT) compared with computed tomography (CT). METHODS: Radiological imaging for presentation structures of the temporal bone were performed by DVT and CT. Axial and coronal scans in vitro examinations were performed in 38 human temporal bones. 43 structures were defined. The frequency of visualization of these anatomic structures were studied and statistically analyzed. RESULTS: In the present study there was a higher significance of identified structures in DVT. In 15 (34.9%) temporal bone specimens defined structures were found equally in DVT and CT scans of axial images and 12 (27.9%) of coronal images. However, 9 structures (20.1%) of axial scans and 5 structures (11.6%) of coronal scans could be identified statistically significantly (P < 0.05) more often in DVT than in CT. CONCLUSION: Anatomical structures of the temporal bone can be identified in higher significance in DVT than in CT scans.

Digital volume tomography (DVT) measurements of the olfactory cleft and olfactory fossa.

CONCLUSION: Preoperative imaging is important, because of the small size of the cribriform plate, different anatomical variants of the olfactory fossa in varied patients and unequal width of the cribriform plate in the anterior and posterior third. OBJECTIVE: Digital volume tomography (DVT) is a rather new imaging technique for the diagnosis of diseases of paranasal sinuses. This technology is dedicated to the evaluation of the distinctive structures of the anterior skull base due to the high resolution of the DVT. Based on the Keros classification this anatomic area was analyzed radiologically and also in relation to the uncinate process. METHODS: The investigation was performed on 111 patients. The Accu-I-tomo F17 was used. Patients with total nasal polyposis and patients who had undergone sinus surgery were excluded from the study. RESULTS: Keros type I was found in 11.25% of the patients, type II in 68.05% and type III in 20.7%. Significant asymmetry of the olfactory fossa was identified in nine patients (8.1%). The width of the olfactory cleft varied from 0 to 3.25 mm. No relation between Keros type and a particular onset of the uncinate process to orbit, skull base or middle turbinate could be detected.

Digital volume tomography (DVT) as a diagnostic modality of the anterior skull base.

CONCLUSION: Because of high resolution and the relatively lower costs in comparison with modern helical CT scanners, digital volume tomography (DVT) can be recommended in the diagnosis of the nasal cavity and paranasal sinuses. OBJECTIVES: DVT is an advancement of panoramic tomography and is based on the principles of rotational tomography. It enables high resolution visualization of osseous structures. The slices can be displayed in three orthogonal planes that can be changed in angle arbitrarily. Data volumes of up to 12×17 cm can be examined with a new generation of the DVT. The aim of this study was to point out the potential of DVT in the anterior skull base. SUBJECTS AND METHODS: DVT scans with a cylindrical size of 10 cm in diameter and 10 cm in height were performed in 23 patients. The identification of surgical key landmarks (uncinate process, middle turbinate, ethmoidal bulla, agger nasi cells, Haller cells, frontal recess, anterior ethmoidal artery in its relationship to the skull base, the cribiform plate of the sphenoidal sinus in relation to the optic nerve, and the internal carotid artery) was evaluated. RESULTS: Display of the essential surgical key landmarks was possible in all patients.

Which tinnitus patients benefit from transcranial magnetic stimulation?

OBJECTIVES: Chronic tinnitus is associated with hyperactivity of the central auditory system. Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has been proposed as a treatment for chronic tinnitus. This study determined the factors that predict a beneficial outcome with rTMS treatment. STUDY DESIGN: Forty-five patients with chronic tinnitus underwent 10 sessions of low-frequency rTMS to their left auditory cortex. The treatment outcome was assessed with a tinnitus questionnaire. Therapeutic success was related to the patients' clinical characteristics. RESULTS: A significant reduction in tinnitus complaints occurred after rTMS. In the questionnaire, 40% of the patients improved by five points or more. Treatment responders were characterized by shorter duration of tinnitus complaints and no hearing impairment. CONCLUSION: Tinnitus-related neuroplastic changes might be less pronounced in patients with normal hearing and a short history of complaints. This could explain why those patients benefitted more from rTMS treatment.