[Traditional transcutaneous approaches in head & neck surgery]. / Grundlagen und klinische Bedeutung der klassischen transzervikalen Chirurgie von Kopf-Hals-Tumoren - Teilresektionen, Laryngektomie, Rekonstruktionstechniken, Rettungschirurgie.

The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing. In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool. In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.

[New strategies for tissue replacement in the head and neck region]. / Neue Strategien zum Gewebeersatz im Kopf-Hals-Bereich.

In recent years there has been an increase in the need for tissue replacement in the head and neck region. The disadvantages of classical reconstructive procedures are donor site morbidity for autologous transplants and the immunogenity of allogenous transplants. Tissue engineering is a promising method for the generation of autologous cartilagenous transplants for plastic and reconstructive surgery for closure of large defects by the use of minimal amounts of material for reconstruction. For this purpose harvested material must be cultivated in suitable culture/carrier systems. One obstacle is the loss of phenotype and function once the cells are detached from their environment (dedifferentiation). Adult mesenchymal stem cells are a valuable cell source for tissue engineering. The underlying strategy of using stem cells is the replacement of functionally compromised cells either by in vitro expanded stem cells or activation of stem cells in the tissue. However, there are still problems regarding valuable markers for cellular differentiation and the controlled differentiation towards a specific phenotype.