[Operative therapy of deglutition paralysis]. / Zur operativen Therapie der Schlucklähmung.

Disorder of deglutition is one of the severest signs in postoperative or posttraumatic paresis of the caudal cranial nerves. The main problem in these cases is aspiration. It is a serious disorder with potentially life-threatening pulmonary sequelae. In cases with unilateral paresis of the vagus and glossopharyngeal nerve we can consider the problem of surgical rehabilitation of swallowing as to be solved very well, as described in the present paper. However, in cases with bilateral vagus paresis we are faced with many more problems especially in the high-grade aspiration syndrome. The surgical procedures are described.

[Potentials of reconstructive plastic surgery in the area of the nose]. / Möglichkeiten der plastisch-rekonstruktiven Chirurgie im Bereich der Nase.

Reconstruction of defects in the nasal area is described. There are basic principles to be considered, especially the cause of the defect, which may be traumatical or due to a tumour. It makes a difference whether the defect is placed on the bridge of the nose or on the lobule, or if the columella or the alar areas are affected. Another point of view is the extent of the defect, especially if it is a penetrating defect. We have also to consider the side issues, such as recurrence of the tumour, or the condition after radiotherapy. There are four principal techniques for reconstructive surgery in the nose area: Local flaps, regional transpositional flaps, distant flaps, and free transplantation of tissue. The clinical application of the different possibilities of reconstructive surgery in the nasal area is discussed.

[Orbital involvement in frontobasal injuries]. / Mitbeteiligung der Orbita bei frontobasalen Traumen.

In the mechanism of fracturing in the region of the frontobasis and of the midface there is the possibility of an orbital involvement. If the traumatic forces affect directly the frontal zone we may find a latero-orbitalfrontobasilar fracture--the socalled type IV according to the classification of frontobasilar fractures by Escher. If the middle face is more affected, the type III will result with tearing off the midface bones from the skull at the frontobasis. In a few cases there are indirect blow-out fractures of the orbital roof in communication with frontobasilar fractures especially in the ethmoidal or frontal sinus region. Penetration of foreign bodies through the orbital roof and through the lamina cribriformis cause an open frontobasal cerebral trauma. The problem of the penetrating fronto-orbital traumata is to find the foreign body and to remove it. The danger is the infection with possible development of meningitis or brain abscess. The quota of lesions of the optic nerve in frontobasilar fractures seems to be relatively high. The pathogenesis of optic nerve injury is rather unknown. Mechanisms to be considered are discussed as well as indications and contraindications for a rhinosurgical decompression operation in the optic canal.

[Incision- and suture-techniques in plastic surgery of the face (author's transl)]. / Schnittführungen und Nahttechniken im Gesichtsbereich.

In plastic and reconstructive surgery of the face it is very important to consider the RSTL (1, 3) for getting satisfactory scar postoperatively. Sometimes it is necessary to regard the so-called esthetic units of the face (2) especially in free grafting. Unsatisfactory scars will be improved by using the Z- and W-plasty techniques. The incision should always be perpendicular to the surface of the skin, assuming that the skin has been made tense by the left hand of the surgeon or by the hand of the assistant. The subcutaneous dissection and mobilization is performed with a scalpel with the blade held flat, parallel to the surface of te skin using a hook rather than a tissue forceps. The haemostasis should be as perfect as possible. The infiltration of a local analgesic solution with epinephrin greatly facilitates the haemostasis, careful coagulation by fine bipolar tissue forceps is possible. The principal types of transcutaneous, subcutaneous and intradermal interrupted and continuous sutures are described.