Duplication of the external auditory canal: a report of three cases.

OBJECTIVE: Malformations of the first branchial cleft are uncommon and only sporadically reported in the literature. They may present as inflammatory openings on the neck, bland cysts or fistula associated with the external auditory canal. In this retrospective study, clinical features and anatomical relationships are described in three pediatric cases. Therapeutical guidelines for surgical management of first branchial cleft anomalies are discussed. PATIENTS: Between 1997 and 1999 three patients aged 9 months, 2 and 7 years with first branchial cleft anomalies were included in this study. All patients were treated surgically, wide exposure and superficial parotidectomy was necessary for complete removal in two of three cases. RESULTS: Exploring patients histories revealed previous infections with repeated incision and drainage procedures as well as inadequate operative resections. Clinically, purulent drainage from the ear, swelling in the parotid area and abscess formation with persistent drainage after incision in the neck or parotid area were noted. CONCLUSIONS: From our case series two of three patients underwent inadequate incision and drainage procedures to combat infection followed by scar tissue formation. Because of the variable relation to the facial nerve this led to difficulties in identifying and protecting the nerve during definite surgery. Management of first branchial cleft anomalies must include the facilities to achieve ear surgery and superficial parotidectomy including facial nerve exposure.

[Infection of deep soft tissues of the neck in intravenous drug abuse]. / Infektion der tiefen Halsweichteile bei i.v. Drogenabusus.

BACKGROUND: Despite the availability of antibiotics deep neck space infections with anaerobic germs (Ludwig's angina) still carry the potential for significant morbidity and mortality with delayed treatment. Usually, odontogenic infections with involvement of the submandibular space are the source of deep neck space infections in adults, whereas in the pediatric population the most common cause is acute tonsillitis with involvement of the peritonsillar space. During the second half of this century intravenous drug abusers appeared as a new group of patients at risk for deep neck space infections. When peripheral veins sclerosis the addicts feel it necessary to either inject subcutaneously or use the major vessels of the neck and groin. Intravenous drug abusers injecting the major vessels of the neck risk delayed diagnosis because of dissimulation of their injection practices. Dangerous complications of deep neck space infections may be the result. CASE: We report a clinical case with delayed diagnosis and fatal outcome. CONCLUSION: Intravenous drug abuse is a rare cause for deep neck space infections but should be considered when swelling of the neck soft tissue of uncertain cause is presented. The search for the diagnose should not keep from taking quick therapeutic steps.

[Occurrence of harmful pollutants in fattened pigs]. / Zhodnocení výskytu rizikových polutantu u výkrmových prasat.

Fourteen fattened pigs (age of 240-250 days, live weight 110-120 kg) were examined on three farms (D., M. and T.) in Hodonin district in 1994 for the content of some harmful pollutants (mercury, cadmium, lead, lindane, DDT sum, DDT isomers, lower and higher chlorinated biphenyls, PCB congeners) in the muscle, liver, kidneys and subcutaneous fat. Maximum allowable quantities (MAQ) of extraneous matters were slightly exceeded in mercury only, in 5 samples of the muscle (0.012-0.022 mg/kg). In comparison with the average contents of extraneous matters in pigs in the Czech Republic in 1994, higher concentrations of mercury (0.009 mg/kg), lead (0.124 mg/kg), lindane (0.060 mg/kg fat) and DDT sum (0.083 mg/kg) were observed in the muscle of pigs from Hodonín district. The liver of the pigs contained the highest average concentrations of lead (0.141 mg/kg), lindane (0.280 mg/kg fat), DDT sum (0.323 mg/kg fat), p,p'-DDE (0.106 mg/kg fat), p,p'-DDT (0.057 mg/kg fat). PCB-Delor 103 (0.415 mg/kg fat), PCB-Delor 106 (0.561 mg/kg fat) and PCB 118 congener (0.029 mg/kg fat). The highest average values of mercury (0.014 mg/kg) and cadmium (0.147 mg/kg) were determined in the kidneys of pigs. The ratio of lower-chlorinated biphenyls (Delor 103) to higher-chlorinated biphenyls (Delor 106) was approximately 1 : 3 in the muscle, 1 : 1 in the liver and 1 : 2 in subcutaneous fat. The per cent share of three PCB congeners, 101, 138 and 153, was highest in the muscle, liver and subcutaneous fat of pigs. The pigs from Hodonín district exhibited in 1994 the greater load of mercury, lead, lindane and DDT than in other regions of the Czech Republic, but these values did not mostly exceed the hygienic limits in force. It is desirable to observe the spectrum of indicator PCB congeners for objective evaluation of PCB load in pigs, as they indicate the contamination level with lower- and higher-chlorinated biphenyls (Delor 103 to Delor 106). Greater attention should be paid to the congener PCB 118, which is the most toxic out of the indicator congeners concerned.

[Indications for silastic and gelation film in tympanoplasty. Analysis of 624 cases using EDP (author's transl)]. / Indikationen zur Silikonfolien- und Gelfilmpaukeneinlage bei der Tympanoplastik. Eine Auswertung von 624 Spätresultaten mittels EDV.

Statistical analysis shows that the regular use of silastic sheet in all cases of extensive defects of the middle-ear mucosa (ensuring a mucosa-lined space) or advanced inflammatory changes (draining the cavity and tube) can eliminate negative influences of pathological conditions of the middle-ear on the long-term functional results, provided the sheet is removed when the remaining air-bone gap within the main speech range exceeds 10 dB after the ear has healed. Resorbable gelatin film implants should be used in minor inflammatory changes, less extensive mucosal defects, and subtotal perforations of the drum.

[Regenerative capacity of the tympanic mucosa following tympanoplasty (author's transl)]. / Reaktionsformen der Paukenschleimhaut am Beispiel ihrer chronischen Entzündung und Heilung nach Tympanoplastik.

From adult temporal bones with clinically normal ears mucous lining specimens were taken and investigated microscopically. Comparing these specimens with biopsies from the tympanon of patients following tympanoplasty, we could detect an over-all correspondence of epithelial and subepithelial cell structures of normal tympanic mucosa and of ears operated upon because of chronic inflammation. These findings suggest that the middle ear epithelium is an only partial developed mucociliar - and not an pluripotential - epithelium, arising by ingrowth of respiratory mucosa of the nasopharynx. It reacts upon every exogenic or endogenic irritation always in direction to complete differentiation. This differentiation is caused by stimulation of the O2-metabolism following such various proceedings as traumatisation, inflammation, otospongiosis activity, experimental tympanoplasty or explanation into tissue culture. The generally reversible process should not be defined as metaplasia.

[The influence of the stapes prosthesis on the long-term results of stapedectomy (author's transl)]. / Der Einfluss des Prothesentyps auf das Langzeitergebnis der Stapedektomie. Ein Vergleich der Drahtprothese mit der Stahlpistonprothese nach Robinson.

In comparing two groups of patients following stapedectomies, significantly better long-term results were obtained by using the Robinson steel piston prosthesis (n = 85) as opposed to the wire prosthesis (n = 74). By so doing, the impairment of sound transmission was reduced and the Carhart depression counterbalanced. This improvement is thought to result from the increased mass and stability of the steel prosthesis as well as from its more correct anatomical positioning.

[Diagnosis and treatment of rare tumors in the laryngeal-pharyngeal area (author's transl)]. / Diagnostik und Therapie seltener Tumoren im Larynx-Pharynx-Bereich.

From 1968 to 1979, 11 patients with rare tumors in the laryngeal-pharyngeal area have been treated by the Department of otolaryngology at the University hospital Homburg-Saar. These 11 cases consist of 6 benign and 5 malignant tumors. The malignant tumors were irradiated postoperatively by the Department of Radiology. There was found in the pharyngeal area 1 malignant despeciated leiomyoma, 2 malignant synovialomas and in the laryngeal area 4 local nongeneralised amyloidosis, 1 hamartoma, 1 chemodectoma, 1 pleomorphic rhabdomyosarcoma of the larynx and 1 primary "oat-cell" carcinoma. The initial exploratory excisions often led to an incorrect diagnosis: The final one was made postopertively. The large number of preoperative wrong diagnoses leads to the demand to only operate after extensive exploratory excisions.

[Falk's technic of extranasal dacryocystorhinostomy in cases of tear duct stenoses (author's transl)]. / Die extranasale Dakryozystorhinostomie nach Falk bei Stenosen der ableitenden Tränenwege.

The lacrimal sac is totally sacrificed and rebuilt into an accessory nasal sinus using the extranasal dacryocystorhinostomy in the treatment of nasolacrimal duct stenosis as described by Falk in 1961. Using this method, 62 patients with tear duct stenoses were operated in our clinic since 1959. According to etiology, the stenoses were in 5 cases connatal, in 17 traumatic, in 32 inflammatory and in 8 iatrogenic. In only 4 cases (6,4%) failures were reported. - the operative indication has at present been expanded to include stenosis of the lower tear ducts (presaccal stenosis) or in cases where the lacrimal sac has been obliterated (saccal stenosis). In these cases the stenosis is dissected and a silicon tube (introduced via the tear point into the inferior lacrimal duct and drained into the nose) is left in position.

[Experiences in the treatment of children with pseudocroup (author's transl)]. / Erfahrungen in der Behandlung von Kindern mit Pseudocroup.

In most of the own 93 cases the paediatrician could manage the syndrome conservatively. In 14 children of them the question of an active procedure was discussed in cooperation of paediatricians, laryngologists and anaesthesiologists. In most of the cases this was necessary in the first 2 to 3 hours after admission. Recommendations for the active procedure are given in detail, generally spoken a balanced manner with confined prolonged orotracheal intubation.

[Synovial sarcoma of the neck (author's transl)]. / Maligne Synovialome im Halsbereich

Two cases of synovial sarcoma of the neck are reported. As it is already known from comparable literature, the extraoridinary localisation and the unusual histological pattern showing sarcomatous and synovial elements may cause major difficulties in diagnosis. In both cases the treatment consisted of radical surgical removal.

[Falk's lacrimal sac surgical technique for stenosis (author's transl)]. / Die Technik der Tränensackoperation nach Falk bei saccalen und präsaccalen Stenosen

The lacrimal sac as such is sacrificed in Falk's extra-nasal dacrocystorhinostomy. It is opened along its entire extent and embedded in toto into the lateral nasal wall. This procedure proved to be successful in most kinds of lacrimal duct stenosis. Its indications have now been extended to include those with obliteration of the lacrimal canaliculi and where the sac is itself obliterated. In such cases a thin silicone tube passed into the lower lacrimal punctum through the inferion lacrimal canaliculus and into the nose.