Search

Objectives: Donor site morbidity, including pneumothorax, can be a considerable problem when harvesting cartilage grafts for laryngotracheal reconstruction (LTR). Tissue-engineered cartilage may offer a solution to this problem. This study investigated the feasibility of using Hyalograft C combined with autologous chondrocytes to tissue engineer cartilage grafts for LTR in rabbits.Study Design: Animal study.Methods: Eighteen New Zealand white rabbits underwent LTR: 12 rabbits received autologous tissue-engineered cartilage grafts and 6 animals, serving as a positive control group, native auricular cartilage. To determine any differences in response to the site of implantation and any potential immune response to the scaffold, a second piece of engineered neocartilage and a non-cell-loaded scaffold were inserted paralaryngeally into a subset of the rabbits. The rabbits were sacrificed 3, 6, 8, 10, and 12 weeks after the LTR and their larynx examined.Results: None of the 18 rabbits showed signs of respiratory distress. A smooth, noninflammatory scar was visible intraluminally. Histologically, the native auricular cartilage implants showed excellent integration without any signs of inflammation or cartilage degradation. In contrast, all tissue-engineered grafts and empty scaffolds revealed marked signs of an unspecific foreign body reaction, leading to a complete degradation of the neocartilage, whether implanted para- or intralaryngeally.Conclusion: In contrast to the success with which Hyalograft C has been applied in articular defect repair, our results indicate that, in rabbits, Hyalograft C initiates a foreign body reaction if implanted intra- or paralaryngeally, leading to cartilage degradation and possible graft failure. These findings suggest limitations on the environment in which Hyalograft C can be applied. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Between 1979 and 1997, a total of 92 patients with primary nasopharyngeal carcinoma were treated at the Hospitals of the University of Erlangen. Until 1988, radiotherapy alone was the treatment of choice and simultaneous radiochemotherapy was consistently applied thereafter. This retrospective analysis was performed to evaluate the influence of concurrent radiochemotherapy on survival and to identify possible prognostic factors on cause-specific survival-, locoregional tumor control- and distant-metastases-free survival rates.Patients and Methods: Fifty-three patients (58%) received treatment by radiotherapy alone and 39 (42%) underwent primary radiochemotherapy with 2 courses of 5-FU and cisplatin. Median total dose to the bilateral neck region was 60 Gy (range, 50 to 62 Gy), and 74 Gy (range, 56 to 88 Gy) to the primary tumor. Median follow-up of the surviving patients was 8 years.Results: Following radiochemotherapy and radiotherapy alone, the 5-year-survival rates were 67% and 48%, respectively (p = 0.06). Female patients had a survival advantage as compared to male patients (5-year-survival rate 77% vs 44%, p = 0.01). Patients with and without cranial nerve palsy at presentation had survival rates of 0% and 61%, respectively, at 5 years (p = 0.01). Distant-metastases-free survival was influenced by the following factors: lymph-node involvement (NO: 82% vs N1 to N3: 68%, p = 0.04), gender (female: 88% vs male: 64%, p = 0.01), type of treatment (radiochemotherapy: 86% vs radiotherapy: 63%, p = 0.02) and cranial nerve involvement (76% without and 42% with involvement, p = 0.04).Conclusions: In primary nasopharyngeal carcinoma simultaneous radiochemotherapy can significantly reduce distant metastases and improve survival as compared to radiotherapy alone. Since late toxicity rates were similar in both treatment groups and the slightly increased acute side effects following radiochemotherapy were effectively compensated by standard supportive care, patients with advanced nasopharyngeal carcinoma may benefit from simultaneous radiochemotherapy. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The results of a combined neuro-rhinosurgical procedure in eight cases of aesthesioneuroblastoma are presented. All patients were suffering from tumours in the advanced stage (stage C according to Kadish). Diagnosis was established by the clinical history, neuroradiological imaging and by endoscopic endonasal biopsy. Contrary to most reports in the literature the authors performed a one step operative removal of the whole tumour mass by a combined transcranial-transbasal approach alone. A second transfacial operation was unnecessary in all our cases. To the best of our knowledge only Loew (see Jakumeit 1971) already in the 1960ties used a comparable one step transcranial approach for tumour removal. The long-term survival rate in our patients is 50%, a result comparable to reported series in the literature. Mortality is due to early recurrences and metastases within a few months after the initial treatment including post-operative irradiation. Four patients are living without evidence of tumour recurrence 1.5 to 5 years after treatment. The authors surgical technique is presented in detail and compared with the results of other treatment modalities. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Oto-rhino-laryngology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The reconstruction of the posterior wall of the external acoustic meatus destroyed by surgery or a cholesteatoma is necessary for the complete restoration of function. For this purpose, allogen cartilage preserved in thiomersalate has been transplanted on the anterior wall of the air-containing mastoid bone in 160 clinical cases. The histomorphological reaction of the recipient to unilaterally uncovered transplant material has previously been unknown. In 10 guinea pigs, 15 fenestrated bullae (hypotympanum equivalents) were closed with cartilage transplants fixed in place with tissue adhesive. After a period varying between 7 1/2 and 11 months, the walls of the bullae with the transplant were then examined histomorphologically. Despite the variations in the period in situ, the avital cartilage transplant, which remained largely constant in volume and shape, was always to be found. It was tolerated without reaction and was 'enveloped' - also on the primarily uncovered surface - by a capsule of bone and connective tissue. In no case was rejection observed. Marked foreign-body reaction was, however, found in the vicinity of the tissue adhesive, which was absorbed only slowly. The clinically well-known tissue-compatible and complicationfree behaviour of the allogenic cartilage transplant preserved in thiomersalate, is thus explained by the histomorphological findings. In contrast, the fact that marked foreign-body reaction was demonstrable even after almost one year, suggests that tissue adhesive should not be used. [ABSTRACT FROM AUTHOR]

Cosmetic and functional disturbances are the result of any mandibular defect. Therefore the bone should not be resected, if not absolutely necessary. Out of 118 patients with tumours of the floor of the mouth and the tonsil, 24 patients with carcinoma very close to the mandible or attached to the periosteum, the tumour and bone were resected en bloc and histologically examined. According to our findings, the periosteum is a barrier, so that the tumor infiltrates the bone comparatively late. The histological results were in agreement with our surgical concept, which includes the following rules: [ABSTRACT FROM AUTHOR]

The reconstruction of a posterior canal wall was performed in radical cavities. Two series of operations were studied, using either autologous bone grafts or homologous cartilage. Details of the procedure and preliminary results are given. In conclusion the use of bank cartilage is favored, but long range results should be respected. [ABSTRACT FROM AUTHOR]

Depending on size and location, the management of the congenital cystic hygroma may have severe problems. Watchful waiting for spontanous improvement is indicated, if there is no rapid growth of the tumor, or no acute danger like dyspnoe for the child. Surgical excision is usually difficult in large and invasive growing angiomas. The removal of these infiltrating tumors is often not possible without sacrifying important structures of the neck. Out of 24 lymphangiomas, treated by surgical excision, nine children showed extensive infiltration into adjacent anatomical areas. In order not to sacrifice important nerves and muscles, these nine children were treated by incomplete removal of the tumor. A follow up from 3 to 8 years showed in all cases no recurrence of the lymphatic tissue, which was left at the first operation. A subtotal excision of the lymphangioma is therefore justified, if important structures are a barrier against a complete removal, because subsequent regression can be expected. [ABSTRACT FROM AUTHOR]

In our series of 140 carcinomas of the oro-pharyngeal region smoking, alcohol abusus and diminished care of oral hygiene were obvious cofactors of cancer etiology. Most tumours were found in the lower social class. In contrast to other findings in the literature chronic mechanic trauma was frequent in our patients, resulting from sharp rests of teeth, insufficient conservation, or malfitting prosthesises. The epithelial lining showed, according to the clinical findings, histological inflammation, hyperkeratosis, carcinoma in situ or even growth of carcinoma. Therefore, optimal prosthesises and oral hygiene are important factors in the prevention of carcinomas of this region. [ABSTRACT FROM AUTHOR]

The covering of defects in oral surgery is associated with particular problems since, in order to avoid the formation of salvatory fistulas, a primary closure should be aimed at. Between 1973 and 1975 73 carcinomas of the floor of the mouth, the tongue and the oropharynx were treated by block dissection. In 28 cases the forehead flap and in 20 cases the tongue flap were employed. While the forehead flap necessitates the preservation of the A. carotis externa, the tongue flap can be used even if the ipsilateral lingual artery is sacrifled. The tongue flap has functional and cosmetic advantages in comparison with the forehead flap. [ABSTRACT FROM AUTHOR]

In 200 patients with uni- or bilateral neck dissection the long range cosmetic results, subjective complaints, and the neurologic status were studied at postoperative time intervals between 3 months and 10 years. The main disorders were related to both the absence of resected, tumorinvolved structures and to hyperesthesia of the lateral neck skin. The function of the muscle portions of the shoulder was less disturbed than being expected, and recovered with some time. Cases with bilateral neck dissections showed postoperative edema of the head, being resorbed, with a little persisting submental edema. Postoperative irradiation gave rise to an increasing number of neuralgiform symptoms. [ABSTRACT FROM AUTHOR]

For the immediate reconstruction of a nutritional pathway after pharyngo-laryngeal resektion, the preservation of a small vertical strip of pharyngeal mucosa membran, resected at least 15 mm to the tumormargin, is recommended. A minimum of 10 mm width of mucosa, which is intraoperatively controlled by frozen section,, is necessary, and sutured over a nasal gastric tube of 18 or 16 Ch. This reconstruction is of shorter operationtime, avoids a pharyngo- and oesophagostoma, and gives a fast rehabilitation. A full course of radiation is recommended. [ABSTRACT FROM AUTHOR]

Based on the experience of more than 50 cases the use of muscle-flaps for reconstructive purposes in ablative head and neck surgery is recommended. With respect to topography, surgical technique and viability of three outstanding muscles the indications for muscle rotations are described. [ABSTRACT FROM AUTHOR]

The atresia auris congenita includes in some cases a complete or incomplete paralysis of the facial nerv and sometimes an abnormal course of its tympanal segment. Pregnant Wistarrats received a high dose of Vitamin A and Thalidomid the 8th, 9th, 10th, 11th day of gestation. The temporal bone and the medulla oblongata of the fetus and the adult rats were examined histologically and microsurgically. In contrast to the literature no extremely abnormal tympanal course of the nerv was found, which corresponds with 62 endaural operated human malformations of the ear (Wigand). The paralysis of the nerv seems due to a reduced diameter and not to the malformation of his nucleus. [ABSTRACT FROM AUTHOR]

The tissue reactions in and about homologous cartilage, preserved in thiomersalate and transplanted by a half-open inlay technique were studied in 15 bullae of adult guinea pigs. After a period of 7 1/2-11 months, the area of the transplant was examined histomorphologically. The cartilage, transplanted with one side uncovered to the pneumatized bulla, was tolerated by the host organism without reaction and was 'enveloped' by fibrous connective tissue or bone. The clinically successful application of this homologous preserved cartilage for the reconstruction of middle ear walls was thus confirmed by the histomorphological findings. The use of tissue adhesive (Histoacryl) be confined to selected cases. [ABSTRACT FROM AUTHOR]

Disorders of the immune system have been discussed as a possible cause of chronic sinusitis, but have up to date not been adequately substantiated. After the establishment of detailed case histories and clinical findings, samples of mucous membrane obtained by surgery from 50 patients with polyposis nasi et sinuum were examined histomorphologioally with respect to the intensity of edema, and the nature and extent of cellular infiltration. Parallel to this, the humoral immune reaction was determined by quantitative determination of the antibody-producing cells and the level of immunoglobulins in the tissue and serum. Histologically, all the preparations revealed a variety of marked stages of inflammation. The individual regions of mucosa manifested varying degrees of cellular infiltrations by lymphocytes and plasma cells. An immunological disorder in the form of an immune defect or a hypersensitivity reaction, corresponding to the histomorphological and clinical findings, was demonstrable only in a few individual cases. [ABSTRACT FROM AUTHOR]