[Hyperostosis of the internal auditory canal : An incidental finding?]. / Hyperostose des Meatus acusticus internus : Ein Zufallsbefund?

In contrast to the fairly common exostoses in the external auditory canal, hyperostoses and osteomas of the internal auditory canal are extremely rare. In this case report we present a patient with sudden right-sided sensorineural hearing loss, in whom imaging revealed hyperostosis with bilateral stenosis of the internal auditory canal. Whether the connection of such radiological findings with dysfunction of cranial nerves VII and VIII be causal or coincidental is controversially discussed in the literature. Therefore, the indication for surgical intervention should be considered with extreme caution. Despite examination of our radiology database comprising almost 1000 MRI/CT temporal bone investigations, we could find no other cases of hyperostosis of the petrous bone. This case thus represents a rare disease, which should be considered a differential diagnosis.

[Dysphonia and dysphagia after anterior cervical spine surgery]. / Dysphonie und Dysphagie nach anterioren Zugängen zur Halswirbelsäule.

BACKGROUND: Anterior cervical spine surgery is a common procedure for fusions and/or discectomies. Postoperative dysphonia and dysphagia are known complications. In this study, we examined the frequency and outcomes of these complications in this patient population. MATERIALS AND METHODS: Patients planned to receive anterior cervical spine surgery between 01.03.2010 and 28.02.2011 at the Department of Neurosurgery, St. Gallen were prospectively included. Patients were evaluated using laryngoscopy, fiberoptic endoscopic evaluation of swallowing (FEES), voice field measurements and validated questionnaires. RESULTS: From the 53 patients included in the study, 40 had at least one complete follow-up examination. The frequency of postoperative dysphonia due to recurrent nerve palsy was 4/40 (10 %), although this was temporary in 3 patients. FEES revealed a pathological result in 18.9 % of patients. Postoperative Swallowing Quality of Life Questionnaire (Swal-QoL) scores were significantly lower. CONCLUSION: At a frequency of 10 %, dysphonia due to recurrent nerve palsy is a relevant complication in cervical spine surgery, albeit temporary in most cases. Postoperative dysphagia is common and should be evaluated and treated during follow-up.

[Purulent lymphadenitis after peritonsillar abscess under immunosuppression. An often forgotten differential diagnosis]. / Eitrige Lymphadenitis nach Abszesstonsillektomie bei Immunsuppression. Eine oft vergessene Differenzialdiagnose.

In the present case study, a 75-year-old, immunosuppressed man presented with recurrent cervical abscesses after a peritonsillar abscess. In the cervical region, an ulcer developed with persistent wound healing deficit. Subsequently, the patient's general condition deteriorated, showing symptoms of a Landouzy sepsis. In the course of the examination, Mycobacteria tuberculosis was detected in the cervical ulcer. He suffered from latent tuberculosis, which was reactivated by a combination of his disease, immunosuppressive therapy and the preceding peritonsillar abscess. Upon treatment with tuberculostatics, the patient fully recovered.

[A rare cause of a cervical lymphadenopathy]. / Eine seltene Differentialdiagnose der zervikalen Lymphadenopathie.

We report on a 15-year-old female patient with a slow-growing, mildly painful swelling on her neck, without any signs of inflammation or any general symptoms. Sonographic findings included two enlarged lymph nodes with hilar markings evident. Based on the histology, Castleman's disease of the hyaline vascular type was ultimately diagnosed. The differential diagnosis of the swelling on the neck is described along with the clinical, diagnostic, pathogenic and therapeutic aspects of Castleman's disease. Castleman's disease is a rare differential diagnosis of non-infectious cervical lymphadenopathy. Unicentric Castleman's is treated by surgical resection. In patients with contraindications, radiotherapy should be discussed as an alternative. Multicentric forms manifest as systemic diseases with poor prognosis and must be managed by an interdisciplinary team.

[Pustules from the cow barn]. / Pusteln aus dem Kuhstall.

A 54-year-old cattle farmer presented with crusty purulent plaques in the neck area. The clinical picture and microscopical proof of hyphae in the skin smear combined with Wood's lamp testing led to the diagnosis of Tinea barbae, a mycological infection of the skin transmitted by cattle (typically Trichophyton verrucosum). Therapy with itraconazole 200 mg q.d. p.o. and miconazole ointment 1×/day over 2 weeks was successful. This case report and its image are designed to bring attention to this rarely diagnosed pathology.

Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study.

Our study group recently evaluated an ED(95) local anaesthetic volume of 0.11 ml.mm(-2) cross-sectional nerve area for the ulnar nerve. This prospective, randomised, double-blind crossover study investigated whether this volume is sufficient for brachial plexus blocks at the axillary level. Ten volunteers received an ultrasonographic guided axillary brachial plexus block either with 0.11 ('low' volume) or 0.4 ('high' volume) ml.mm(-2) cross-sectional nerve area with mepivacaine 1%. The mean (SD) volume was in the low volume group 4.0 (1.0) and 14.8 (3.8) ml in the high volume group. The success rate for the individual nerve blocks was 27 out of 30 in the low volume group (90%) and 30 out of 30 in the high volume group (100%), resulting in 8 out of 10 (80%) vs 10 out of 10 (100%) complete blocks in the low vs the high volume groups, respectively (NS). The mean (SD) sensory onset time was 25.0 (14.8) min in the low volume group and 15.8 (6.8) min in the high volume group (p < 0.01). The mean (SD) duration of sensory block was 125 (38) min in the low volume group and 152 (70) min in the high volume group (NS). This study confirms our previous published ED(95) volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time.

[Zenker's diverticulum]. / Das Zenkersche Divertikel.

The first case of posterior pharyngooesophageal diverticulum was published in 1764 by Ludlow. Zenker's name has been attributed to the diverticulum since his description of a series of patients in 1878. The aetiology and pathogenesis of Zenker's diverticulum are not well understood. Research has mainly focused on the role of the upper oesophageal sphincter, but numerous manometric studies have produced controversial results. Also, the influence of gastrooesophageal reflux on the upper oesophageal sphincter and the development of a diverticulum is unclear. Patients with a Zenker's diverticulum typically present with a long history of slowly progressive dysphagia for solid consistencies and regurgitation of undigested food. Weight loss and nocturnal attacks of coughing may bother the patient. The diagnosis of a diverticulum needs to be confirmed by radiologic examination. The only definite therapy is surgery. The classical extramucosal cricopharyngeal myotomy by transcervical approach, with or without removal of the diverticular sac, is increasingly giving way to transmucosal myotomy through a transoral endoscopic approach. Compared to the transcervical approach the endoscopic technique avoids the risk of injuring the recurrent laryngeal nerve, substantially lowers the number of pharyngeal fistulas and, in large series, showed an equivalent outcome as far as relief of symptoms is concerned. In the light of the literature and our own experience diverticulooesophagostomy with the Endo-GIA stapler by a transoral endoscopic approach has become the therapy of choice at the ENT-Department of the University Hospital of Zurich, Switzerland. In an operating time of only 10-15 minutes the stapler cuts the wall between the diverticular sac and the oesophagus, and in the same manoeuvre closes the mucosal wound edges with tiny staples. Oral feeding is possible from the first postoperative day. With the technique described this elderly population of patients obtains rapid and safe relief of symptoms.

[Value of panendoscopy in assessment of mouth cavity, pharyngeal and laryngeal cancers]. / Wertigkeit der Panendoskopie in der Abklärung von Mundhöhlen-, Pharynx- und Larynxkarzinomen.

The concept of multiple squamous cell carcinoma in the region of the upper aerodigestive tract was first described over 100 years ago by Billroth. The aim of our study was to assess the incidence of synchronous and metachronous second primary tumours and refine the role of panendoscopy in diagnosing them. The charts of 358 patients presenting for initial treatment of primary squamous cell carcinoma of the upper aerodigestive tract between January 1990 and December 1995 were reviewed. The incidence of second primary tumours was 16.2%, 6.4% being synchronous and 9.8% metachronous. In only 3.1% of all patients was a synchronous tumour clinically silent and only revealed by panendoscopy. Synchronous tumours were most likely to be located in the oral cavity, pharynx or larynx (61%), whereas metachronous second primary tumours were most likely to be located in the lung (57%). Though the incidence of synchronous second primary tumours revealed by routine panendoscopy is low (3%), we still recommend this investigation because it is often necessary for exact assessment of the first primary tumour. Further, it is ideal for training in the use of rigid endoscopy. In our opinion panendoscopy involves minimal time, cost and morbidity.

[Salvage surgery in laryngeal and hypopharyngeal carcinoma]. / Salvage-Chirurgie beim Larynx- und Hypopharynxkarzinom.

INTRODUCTION: The aim of this study was to analyse survival and complications in patients undergoing surgery for squamous cell carcinoma of the larynx and hypopharynx as a salvage procedure for recurrent tumours after radiotherapy. METHODS: Between January 1990 and December 1998, 166 patients with previously untreated squamous cell carcinoma of the larynx and hypopharynx were primarily treated by radiotherapy. Local failure occurred in 77 patients (46%). 57 (34%) underwent salvage surgery. RESULTS: 5-year survival for the 42 patients with carcinoma of the larynx was 60% and for the 15 patients with carcinoma of the hypopharynx 20%. The overall rate of postsurgical complications was 33% in patients with laryngeal and 47% in patients with hypopharyngeal cancer. DISCUSSION: There are few data in the literature regarding the clinical outcome in patients whose tumours are not controlled by initial radiotherapy. Our results indicate that only in carefully selected cases is salvage surgery successful in treating radiation failure in hypopharyngeal cancer. In patients with carcinoma of the larynx salvage surgery is successful and the rate of postoperative complications acceptable.

[Quality of life after treatment of laryngeal carcinoma: surgery versus radiotherapy]. / Lebensqualität nach Behandlung eines Larynxkarzinoms: Chirurgie versus Radiotherapie.

Radiotherapy and surgery for laryngeal cancer achieve comparable results in patient survival. Therefore, the expected quality of life is increasingly influencing the choice of treatment. The aim of this study was to compare the quality of life of patients after surgery or radiotherapy for laryngeal carcinoma. To evaluate quality of life, we used the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC Head and Neck module (EORTC QLQ-H&N35). 65 patients who were treated with either radiotherapy or surgery for laryngeal cancer between January 1990 and December 1995, and who were alive and free of tumour in January 1999, were included in this study. In the first group with small tumours (T1/T2), 40 patients were treated by CO2-laser surgery and 16 by primary radiotherapy. In the second group with more advanced tumours (T3/T4), 5 patients underwent total laryngectomy and 4 primary radiotherapy. In the first group there was good global quality of life with no significant difference between the two treatment modalities. Surgically treated patients scored significantly better than the irradiated patients in questions about swallowing of solid food, xerostomia and dental problems. No other significant differences were found: hoarseness in particular was rated equally after both treatments. In the second group there was also good global quality of life with no significant difference between the two treatment modalities. The laryngectomized patients scored equally on questions about voice function, talking on the phone and social behaviour. As far as quality of life is concerned we can recommend both treatment modalities for patients with laryngeal cancer of all stages.