[Therapy of hypopharyngeal cancer. Part IV: Long-term results of transoral laser microsurgery of hypopharyngeal cancer]. / Therapie des Hypopharynxkarzinoms. Teil IV: Langzeitergebnisse der transoralen Lasermikrochirurgie von Hypopharynxkarzinomen.

Between 1979 and 1986, 74 patients with hypopharyngeal carcinomas were operated using transoral laser microsurgery by the first author. 32 of the patients were subdivided into 5 subgroups and considered separately because of pretreatment for head and neck tumors, simultaneous multiple tumors etc. (excluding criterias). Survival times were not significantly prolonged and lasted 1-27 months (median, 11 months), but the quality of life was improved due to preservation or restoration of natural laryngopharyngeal functions. Forty-two patients were operated with curative intention. This group primarily underwent transoral laser microsurgery, aiming at complete locoregional tumor resection with function preservation (pT1, 5; pT2, 31; pT3, 4; pT4, 2). In 29 patients 31 necks were operated, mostly as a regionally limited functional neck dissection (or "selective" neck dissection). In 90% of the cases neck metastases (pN+) were found, mostly in levels II and III; pN1, 6; pN2a, 1; pN2b, 18; pN2c, 1. Altogether, stages III and IV were found in 71.4% of the patients. A temporary tracheotomy was required in four patients. There was no secondary laryngectomy, even though it was indicated in one case. Post-treatment oncological followup (median observation time, 104 months) demonstrated loco-regional recurrences (n = 1), late or recurrent metastases (n = 4), persisting metastases in the neck with cerebral metastasis (n = 1), distant metastases (n = 4), secondary tumors (n = 9, 5 of which occurred in the head and neck). Through March 1993, 24 patients (57%) have died. Causes were TNM-related (7), second primary tumor with or without distant metastases (8) and intercurrent disease with no evidence of disease (9). Within 5 years 17% of the patients died of TNM-related tumors, 9.5% due to a second primary with or without distant metastases, as well as 9.5% with intercurrent disease. The 5-year overall survival rate was 64% and was 83% (adjusted survival rate) if only TNM-related deaths were considered.

[Fracture healing of the ethmoid bone--a contribution to rhinologic management of naso-ethmoid injuries]. / Untersuchungen zur Frakturheilung im Siebbein--Ein Beitrag zur rhinologischen Versorgung nasoethmoidaler Verletzungen.

Severe maxillofacial trauma accompanied by a dislocated ethmoidal bone fracture was confirmed by CT imaging in 15 adult patients. Routine surgical management included reduction of fractures, miniplate fixation and/or intermaxillary fixation with interosseous wiring. The fractured ethmoidal cell system was left to heal spontaneously. A follow-up examination including endoscopy of the nasal cavity as well as active anterior rhinomanometry and computed tomography was carried out approximately 24 months after surgery. The fractured ethmoidal cell system showed a clear tendency to spontaneously reventilate and drain. However, in 8 of 30 sides a traumatic obstruction of the anterior ethmoid led to secondary frontal sinus mucositis. 12 out of 30 maxillary sinuses ranged from marked mucosal swelling to the development of a traumatic mucocele. Altogether, 9 of the 15 patients suffered from paranasal sinusitis. Routine debridement of every fractured ethmoidal cell system does not appear to be necessary. In case of fractures of the anterior ethmoid with probable obstruction of the nasofrontal duct and/or maxillary sinus ostium, endonasal endoscopic surgery is recommended for minimally invasive reconstruction of the ventilation and drainage of the frontal and maxillary sinus during primary surgical management. Furthermore, patients with severe naso-orbito-ethmoidal fractures should undergo rhinological follow-up examination including CT-imaging approximately 3 months after surgery.

[Magnetic resonance angiography: diagnosis of pulsatile tinnitus]. / MR-Angiographie: Diagnostik des pulsatilen Tinnitus.

Vertigo, sensorineural hearing loss and tinnitus are common symptoms in clinical otology. After exclusion of an acoustic neuroma in patients with sensorineural hearing loss and vestibular dysfunction, a vascular malformation can be responsible for pulsatile tinnitus. The two cases now reported with pulsatile tinnitus involved a dural arteriovenous malformation and a diverticulum of the jugular bulb and were diagnosed by non-invasive MR angiography. The techniques of diagnostic imaging using MR tomography, MR angiography, high-resolution computed tomography and digital subtraction angiography are demonstrated in the two cases presented.

[Scintigraphic imaging of head and neck cancers with 99m technetium (v) dimercaptosuccinic acid. A prospective clinical study]. / Szintigraphische Darstellung von Kopf-Hals-Karzinomen mit 99mTechnetium (v) Dimercaptosuccinic acid. Eine prospektive klinische Studie.

In patients with cervical metastases conventional examination by ultrasound, CT or MRI imaging often fails to identify an unknown primary tumor. Also the retrieval of a recurrent malignancy may be difficult. Scintigraphy, utilizing technetium-99m (v) dimercaptosuccinic acid was chosen for a prospective study in 17 patients to evaluate its properties for imaging metastasizing squamous cell carcinoma of the head and neck. Scintigraphic findings were correlated with the results of clinical examination and conventional imaging techniques. In all cases the primary tumor revealed good uptake of 99mTc(v)DMSA. Manifest cervical metastases could only be imaged in some cases. In future, therefore, 99mTc(v)DMSA scanning may be used for the detection of unknown primary tumors. However, it does not appear helpful in the evaluation of cervical nodes.

[Neurovascular contacts in the inner ear canal and cerebellopontile angle. A methodologic comparison between CT with pneumocisternomeatography and MR angiography]. / Neurovaskuläre Kontakte im inneren Gehörgang und Kleinhirnbrückenwinkel. Ein methodischer Vergleich zwischen CT mit Luftzisternomeatographie und MR-Angiographie.

The interaction between arterial loops and the vestibulocochlear nerve is considered to be responsible for such clinical symptoms as progressive sensorineural hearing loss, tinnitus and vestibular dysfunction. Previously, neurovascular relationships were best demonstrated with invasive Gas-CT-cisternography, although this technique resulted in a low detection rate of 38%. Magnetic resonance angiography offers a non-invasive method for imaging vessel loops in the cerebellopontine angle without contrast medium in more than 90% of cases. A comparison between gas-CT-cisternography and magnetic resonance angiography in 9 patients revealed a superior simultaneous depiction of both anterior inferior cerebellar arteries with magnetic resonance angiography.

[A new procedure for covering septum defects]. / Ein neues Verfahren zur Deckung von Septumdefekten.

In 15 cases of nasal septal defects a new technique was used to close perforations up to 3 cm in diameter with a mucoperiosteal flap. The flap was rotated from the end of the inferior turbinate into the nasal septal defect. This method is easy and has a high rate of successful closure.