[Laryngopyocele. Rare cause of relapsing cervical infections]. / Laryngopyozele. Seltene Ursache rezidivierender zervikaler Abszesse.

A laryngopyocele forms when a laryngocele, as a dilatation of the laryngeal ventricle, becomes infected and fills with mucopus. Laryngopyoceles are rare, as only few cases have been previously reported in the literature. The case of a 75-year-old woman who was treated twice because of a deep cervical infection is described. First of all the cause remained unknown but 3 years after the first manifestation air could be aspirated from a now non-infected neck swelling. A laryngocele was revealed as the cause of the relapsing infection. The surgical resection led to a final healing and the patient remained free from disease. When dealing with a clinical picture of an unknown deep cervical infection, an external or mixed laryngocele should be considered in the differential diagnosis as a rare cause.

[Use of a chlorhexidine-fuchsin solution for ear, nose and throat diseases]. / Anwendung einer Chlorhexidin-Fuchsin-Lösung in der HNO-Heilkunde.

Castellani's solution can no longer be used for medication due to the critical status of its ingredients. A solution of chlorhexidine and fuchsin is proposed as an alternative. This has good antimicrobial effectiveness and can be used in difficult cases of otitis externa solution for the treatment of cavities after mastoidectomy. The literature indicates that the use of this solution is admissible for selected cases in the field of ear, nose and throat diseases.

Ultrasound guided lithotripsy of salivary calculi using an electromagnetic lithotriptor.

Sialolithiasis is a common disease of the major salivary glands. A supplement to the traditional therapies is extracorporeal shock wave lithotripsy of the calculus. This method has been adopted from the therapy of renal or bladder calculi. Patients with a solitary calculus of parotid or submandibular gland were treated with a specially designed lithotriptor. In a retrospective study the results of this therapy were analysed. The success rate was far better for parotid gland calculi than for submandibular calculi. We could not find better results than those published in literature with other devices. In our therapeutic concept, sialolithotripsy is the therapy of first choice for single parotid gland calculi. For submandibular gland calculus this method is advisable in selected cases only.

[The monthly interesting case -- case no. 64. Cavernous hemangioma]. / Der interessante Fall Nr. 64. Kavernoses Hemangiom.

An 89 year old female patient presented with severe epistaxis and nasal congestion on the right side. On endoscopic examination of the nasal cavity a reddish-bluish tumor has been seen that almost completely filled the posterior part of the cavity. In the MRI a highly vasculated tumor was shown. Performing transnasal endoscopic surgery the tumor was completely removed from the nasal cavity. On histopathologic examination the tumor turned out to be a cavernous haemangioma affecting the posterior end of the right turbinate. Cavernous haemangiomas in this region are very rare.

[Otosialorrhoea - a rare case of a spontaneous salivary fistula of the external auditory canal]. / Otosialorrhoe Uber den seltenen Fall einer primären Speichelfistel im äusseren Gehörgang.

Spontaneous salivary fistulas are rare. Extremely rare are spontaneous salivary fistulas of the external auditory canal. We report a case of otorrhoea caused by such a fistula in connection with defects of the cartilagenous and the osseous external auditory canal (Fissures of Santorini, foramen of Huschke) and its successful surgical treatment.

[Anomalies of muscles in the parotid area--a contribution to parotid surgery]. / Uber Muskelanomalien in der Regio parotidea - ein Beitrag zur Parotischirurgie.

A Contribution to Parotid Surgery. Anomalous muscles in the parotid area may be derived from platysma fibres migrating to ventral or dorsal. We describe a M. occipito-parotideus with its origin in the back of the neck crossing the upper part of the M. sternocleidomastoideus and inserting the fascia parotidea. This muscle may irritate the surgeon preparing the muscular landmarks of parotid and facial nerve surgery.

Cytologic diagnosis of adenoid cystic carcinoma of salivary glands.

The cytomorphologic features in fine-needle aspiration (FNA) biopsies from 31 primary and 33 recurrent adenoid cystic carcinomas (ACC) were investigated. The correct FNA diagnosis was established in 24 of 31 primary ACC (77%). The diagnostic clue in aspirates from ACC are large globules of extracellular matrix, partially surrounded by basaloid tumor cells. In FNAs with predominance of basaloid tumor cells, but lacking characteristic globules, all other benign and malignant salivary gland tumors of epithelial-myoepithelial differentiation should be considered in the cytologic diagnosis. Pleomorphic adenoma is most frequently confused with ACC, and therefore, the cytologic findings in FNAs from 50 pleomorphic adenomas were compared with those diagnosed as ACC. Furthermore, rare neoplasms of salivary glands with epithelial-myoepithelial cell differentiation, including basal-cell adenoma and carcinoma, epithelial-myoepithelial carcinoma, and polymorphous low-grade adenocarcinoma, as well as some nonsalivary gland neoplasms presenting an adenoid cystic pattern, must be considered. The cytologic features of these entities are discussed in detail with respect to the cytologic diagnostic criteria of ACC.

Pleomorphic adenomas of the salivary glands: absence of HMGIY rearrangements.

Rearrangements of chromosome region 12q14-15 affecting the HMGIC gene are a frequent finding in benign solid tumors. Another non-random chromosomal alteration observed in subgroups of several of the tumor entities with 12q14-15 changes are rearrangements of 6p21 resulting in alterations of the HMGIY gene, which have so far not been documented in pleomorphic adenomas of the salivary glands. In our series of 335 pleomorphic adenomas, karyotypic changes affecting chromosomal region 6p21-23 were observed in five tumors all showing either a simple or complex t(6;8)(p21-p23;q12). Molecular cytogenetic studies of two of these tumors revealed that the 6p-breakpoint of this translocation maps distal to HMGIY, not affecting the gene or its closer vicinity. The results strongly suggest that pleomorphic adenomas are the only exception to the rule that entities of benign tumors with HMGIC rearrangements also have subtypes with HMGIY rearrangements. The difference from the other tumors is discussed in terms of tissue specificity of both HMG protein genes.

[Hypopharyngeal carcinomas and radical operation--can one refrain from total laryngeal excision?]. / Hypopharynxkarzinome und Radikaloperation--kann man auf die Kehlkopftotalexstirpation verzichten?

BACKGROUND: Patients with hypopharyngeal carcinoma have a poor prognosis. In reviewing patients treated at our clinic from 1977 to 1990, we wanted to find out how this prognosis is influenced by the degree of surgical radicality (total vs. partial laryngectomy). METHODS: From 1984 to 1990, 46 patients with carcinoma of the hypopharynx were treated at the ENT department of ZKH St.-Jürgen-Strasse in Bremen and followed up for 5 years. All patients had been treated by radiotherapy and all, except 3 patients, had had additional surgery of the lymph nodes. In 14 patients the primary tumor had been only irradiated (group 1), and in 32 patients it had been removed by surgery (groups 2 and 3). Surgical removal of the primary tumor had been combined with partial resection of the hypopharynx and of the larynx only (group 2) or with total laryngectomy (group 3). There were no differences in tumor stages between groups 1 and 3, which comprised mainly stages III and IV. Stages I and II were overrepresented in group 2. RESULTS: The 5-year survival rate was 37% for all patients, and for groups 1, 2 + 3, 2 and 3, 31%, 40%, 58%, and 28%, respectively. DISCUSSION: These results are superior to those obtained between 1977 and 1983 for 49 patients who had been treated either by excision of the primary tumor combined with laryngectomy, or by irradiation alone, without neck dissection. The respective 5-year survival rates were 19% for all patients, 11% for the group of radiotherapy alone, and 33% for patients undergoing additional surgery. CONCLUSION: In our opinion less radical surgical procedures are justified for the treatment of hypopharyngeal cancer.

Cytologic diagnosis of acinic-cell carcinoma of salivary glands.

The cytologic findings in fine-needle aspiration (FNA) biopsies obtained from 40 primary and 18 recurrent acinic-cell carcinomas (ACC) were retrospectively analyzed. Cytomorphologically, ACC is characterized by acinar differentiated tumor cells. In addition to these diagnostic clue cells, other types of neoplastic cells including vacuolated cells, cells resembling oncocytes, and nonspecific glandular cells are encountered. A pronounced lymphocytic reaction is a hallmark in 10% of ACC aspirates. Both the variety of tumor cell differentiation and the pronounced lymphocytic reaction observed in ACC aspirates may result in confusion with other salivary gland lesions. The differential diagnosis of ACC encompasses adenocarcinoma, mucoepidermoid carcinoma, pleomorphic adenoma, Warthin tumor, sebaceous lymphadenoma, benign lymphoepithelial lesion, sialoadenosis, sialadenitis caused by radiotherapy, and lymphadenitis. Primary ACCs were correctly diagnosed in 68%; additionally, ACC was suspected or included in the differential diagnosis in 15%. Increased familiarity with the spectrum of cytomorphologic findings and the potential diagnostic pitfalls in ACC will improve the cytodiagnosis of this neoplasm.

Giant cell tumor of the temporal bone (osteoclastoma).

A 49-year-old white female patient was referred to the ENT Department, Zentralkrankenhaus, Bremen, because of conductive hearing loss. Widespread tumor formation was found in the left temporal bone and was identified by biopsy to be an osteoclastoma. The tumor was extirpated surgically and reconstruction was performed. Periodic clinical follow-ups during a 36-month period after surgery have included control computed tomographic scans and have shown no evidence for recurrent disease. The specific pathology of the osteoclastoma is presented and different ways for treatment are discussed.

[Cervical lymph node metastases in unknown primary tumor. Follow-up of 58 patients]. / Halsymphknotenmetastasen bei unbekanntem Primärtumor. Verlaufsbeobachtung an 58 Patienten.

Fifty-eight patients presenting with lymph node metastases of the head and neck were treated at the Bremen ENT Clinic from 1970 to 1988. In none of the patients could a primary tumor be detected despite extensive diagnostic procedures. The 5-year survival rate was 26.3%. During the further course of the disease, six primary tumors were detected in the following areas: nasopharynx (2 cases), soft palate, oesophagus, bronchi and kidney. Prognosis decreased with increasing tumor stages, although histological grading had no influence on prognosis. Supraclavicular localization and male sex were high risk factors. Prognosis was also not improved when ampiric irradiation also included the pharynx as a possible site of the primary tumor.

[Paralysis of the facial nerve caused by "low-grade" adenocarcinoma of the parotid gland--a contribution to the differential diagnosis of Bell's palsy]. / Paresen des N. facialis durch "Low-grade"-Adenokarzinome der Ohrspeicheldrüse--Ein Beitrag zur Differentialdiagnose der Bellschen Parese.

Facial paresis is the only clinical symptom of two deep-seated, moderately malignant salivary duct carcinomas. The unusual course of the pareses (recurrences, varying degrees of severity) prompts the diagnosis of Bell's palsy. The final, exact diagnosis of a epithelial-myoepithelial intercalated duct carcinoma, respectively of a polymorphic low-grade adenocarcinoma, is made as late as six, respectively three, years after onset of the paresis.

[Voice rehabilitation from the viewpoint of the laryngectomized patient. Results of a patient survey]. / Die Stimmrehabilitation aus der Sicht der Laryngektomierten. Ergebnisse einer Patientenbefragung.

105 of 292 patients who had been laryngectomised at the Zentralkrankenhaus Bremen, between 1975 and 1990, were asked retrospectively by questionnaires concerning the state of their voice rehabilitation. 66.6% of them had learnt oesophageal speech, 36.2% used an external vibrator, and 9.4% a voice prosthesis (since 1985). 82.8% used only one kind of substitute (non-laryngeal) speech. If patients used more than one non-laryngeal speech pattern, the most frequent combination was oesophageal speech and an external vibrator. The most rapid voice rehabilitation was achieved by patients using a voice prosthesis (71.3% within six weeks). In the same period of time, 45.5% of the patients learnt to use the electronic voice aid, and only 16.1% learnt oesophageal speech. It took a whole year before all patient who eventually used oesophageal speech, had learned to handle it. Ambulant speech therapy was the predominant treatment leading to voice rehabilitation, followed by the support given by self-aid groups. A comparison of the various non-laryngeal speech patterns with regard to daily communication problems, and of the general satisfaction achieved with the type of non-laryngeal speech used, showed quantitative predominance of oesophageal speech as a positively rated method for voice restoration, even though a clear trend towards increased use of the voice prosthesis since its introduction is noticeable.

[Infected cystadenolymphoma. A possible reason for clinical and cytologic diagnostic error "carcinoma"]. / Das infizierte Zystadenolymphom. Ein möglicher Anlass zur klinischen und zytologischen Fehldiagnose "Karzinom".

Inflamed cystadenolymphomas may mimic malignancies both clinically and cytologically. Inflammation-induced facial nerve paralysis, as a clinical sign, and atypical epithelial cells (arising from the inflamed cystic portion of the tumour), as a cytological marker of malignancy, are responsible for this false diagnosis. The diagnostic problems encountered are demonstrated by two case reports.