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Surgery of the paranasal sinuses is one of the most frequently performed surgical interventions in otorhinolaryngology today. The potential for surgical complications with damage to paranasal structures in the close vicinity (orbit, endocranium, vital arteries) is still significant despite very elaborate, minimally invasive endoscopic and microscopic techniques. Reviewing the wide range of surgical complications of paranasal sinus surgery in a systematic and topographical fashion, elucidated by typical clinical case reports, we discuss the therapeutic management of such surgical sequelae. In addition, medicolegal aspects of informed patient consent as well as general recommendations to possibly avoid such complications are given.

BACKGROUND: Injuries of the head and neck with suicidal intention might create serious situations that require rapid and interdisciplinary treatment. METHODS AND PATIENTS: Twenty-seven patients with suicidal head and neck injuries were treated at the Department of oto-rhino-laryngology, head and neck surgery, University of Wurzburg/Germany, between 1991 and 2002. The medical histories were analyzed retrospectively. RESULTS: Twenty-three of them were male, 4 female. Mean age at time of attempted suicidal was 48 years (18 - 90). One patient was already treated for a psychiatric disorder. None of the patients had a suicidal attempt in the history. Nine patients suffered from a pharynx or larynx trauma after strangulation. Four out of seven patients with cutting or stabbing injuries showed a perforation of the upper airways. Nine patients had gunshot traumas, one of them with perforation of the pharynx. Thirteen patients underwent immediate endoscopy under general anaesthesia followed by a neck exploration in 3 patients. Six patients received a temporary tracheotomy. All patients were considered suicidal for the duration of stay in the ENT-department resulting in a permanent supervision. All patients were transferred to a psychiatric unit as soon as possible for further treatment. A statistically significant accumulation was observed during the last third of a year. Over the period of 11 years, suicidal injuries of the head and neck tend to occur more frequently. CONCLUSIONS: The presented study emphasizes the need of immediate surgical and intensive care treatment of patients with head and neck injuries due to suicide attempts as well as an adequate psychiatric supervision during as well as after the surgical treatment. German language)

Background: Second primary tumors are of great importance for diagnostics, therapy and prognosis in patients suffering from squamous cell carcinomas of the upper aerodigestive tract. The clinical observation of an increase of second primaries was the reason for analyzing all patients with head and neck cancer treated for a certain period of time at our institution. Methods: The hospital charts of 576 patients treated for squamous cell carcinoma of the oral cavity, the oropharynx, the hypopharynx and larynx treated from 1993 till 1996 at the Department of Otolaryngology, Head and Neck Surgery of the University of Wurzburg were reviewed retrospectively. Results: 10.1 % of all patients developed a second primary tumor. The rate was highest for patients with carcinoma of the oral cavity (17.5%), followed by tumors of the hypo- and oropharynx (11.7% and 11.5%) and the larynx (6.4%). Besides the location, younger age was detected as a risk factor for the formation of second malignancies. The latency between first and second primary tumor was 2.9 years in average. 31 % of the second primaries were detected synchronous, 39% metachronous. Conclusion: The results demonstrate that younger patients and patients with carcinomas of the upper digestive tract need a consequent follow-up. The development of second primaries even years after the first malignoma demonstrates the necessity of lifelong follow-up and oncological care.

Einleitung: Angiosarkome sind seltene, hochmaligne Gefäßtumoren, die bevorzugt an Kopf und Hals lokalisiert sind. Therapie der Wahl ist die weite Exzision mit anschließender Radiotherapie. Darüber hinaus befinden sich chemotherapeutische Behandlungsansätze in der Diskussion. Patient: Ein 83 Jahre alter Mann stellte sich mit einer schmerzlosen, lividen, infiltrativen Läsion der Nase vor, die sich innerhalb von 6 Wochen manifestiert hatte. Während sich das Weichgewebe über dem knorpeligen Nasenskelett bei Ödem und sekundärer Einblutung aufgetrieben zeigte, reichte die Läsion endonasal nur bis an die Nasenklappenregion heran. In der Computertomographie fand sich keine Infiltration in die Gesichtsweichteile. Die histologische Aufarbeitung von entnommenen Hautbiopsien ergab die Diagnose eines Angiosarkoms. Im Staging zeigte sich keine weitere Tumormanifestation. Ergebnis: Die chirurgische Therapie einer totalen Ablatio nasi wurde nach umfassender Aufklärung vom Patienten abgelehnt, insb. wegen befürchteter Stigmatisierung durch die zu erwartende Verstümmelung mit Epithesenversorgung. Daher wurde eine primäre Radiatio mit einer Kumulativdosis von insgesamt 70 Gy fraktioniert über 7 Wochen durchgeführt. Nach Abschluss der Therapie zeigte sich klinisch eine komplette Remission. Diskussion: Durch das diffus infiltrative, häufig multifokale Wachstum des Angiosarkoms ist die Prognose unabhängig von der Art des Therapieregimes zumeist schlecht. In o.g. Fall sprach der Tumor trotz des Verzichts auf die in der Literatur empfohlene, radikale Chirurgie gut auf eine alleinige strahlentherapeutische Behandlung an., GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery; 6:Doc24; ISSN 1865-1038

Ag receptor triggering in B cells stimulates the activity of receptor-associated tyrosine protein kinases (TPK), leading to tyrosine phosphorylation of several cellular substrates, one of which is the Vav proto-oncogene product. We have recently determined that Vav is a TPK-regulated guanine nucleotide exchange factor for Ras in T cells. Here, we show that B cell extracts or Vav immunoprecipitates contain a Ras GDP/GTP exchange activity that is stimulated upon surface Ig (slg) triggering. The receptor-mediated stimulation of Vav exchange activity was blocked by the TPK antagonist, herbimycin A. Furthermore, immunodepletion of Vav from the B cell extracts removed approximately 80% of the Ras GDP/GTP exchange activity. These findings indicate, first, that B cell-derived Vav possesses GDP/GTP exchange activity for Ras; second, that the exchange activity of Vav is accelerated by a slg-triggered, herbimycin A-sensitive TPK and, third, that Vav accounts for most of the receptor-stimulated Ras GDP/GTP exchange activity. Thus, Vav may serve as a critical component in slg-mediated signal transduction pathways by coupling receptor-associated TPK to the activation of Ras proteins.