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During the treatment of head and neck cancer (HNC), salivary problems may impair a patient's healing process. Botulinum toxin (BoNT) is accepted as an effective treatment option for reducing salivary flow. We aimed to describe the features of patients treated with BoNT to determine the effects of BoNT.Twenty-five patients over a five-year period were retrospectively included. The patients suffered at different stages of oncologic treatment. The cohort primarily had larger primary tumors that required complex oncological treatment.The condition improved in more than three quarters of the 19 patients with functional hypersalivation. Four of six cases suffering from a salivary fistula demonstrated an obvious reduction in symptoms.Injection of BoNT, to temporarily reduce saliva flow, is a safe tool in the treatment of HNC even in situations involving repeated therapy or high dosage. The main clinical side-effect of BoNT is insufficient reduction of the salivary problem.

Drooling is both a clinical sign for the diminished control of saliva and oral motor function and a heavy social burden for patients. We report a case in which drooling deteriorated after radiotherapy of the head and neck region as the primary treatment for hypopharyngeal cancer, although radiotherapy of the salivary glands is known to be an effective treatment option for drooling. In this particular case, injection of botulinum toxin in the parotid and submandibular glands significantly reduced drooling. The excellent response to botulinum toxin is of great clinical interest for similar RT non-responders.

Central sleep apnea (CSA) is characterized by the inability to generate regular breathing patterns as a result of the loss of metabolic drive and failure of respiratory muscle control. We present the case of a 54-year-old woman with a severe CSA strictly dependent upon REM-sleep. Extensive diagnostic workup excluded typical underlying causes and serological analysis revealed acute borreliosis infection. The severity of sleep apnea decreased after repeated polysomnographic studies without a specific therapy. CSA is usually associated with non-REM stages of slow-wave-sleep. This report illustrates the clinical presentation and diagnostic implications of an unusual case of a CSA strictly associated with REM-sleep. Anecdotally reports of severe respiratory failure in borreliosis indicate the potential of this infection to destabilize breathing control but the precise impact of the infection remains controversial. In our case, a relevant neuroborreliosis was not proven, since there were no other neurologic impairments and the patient refused studies of liquor fluid.

Silicone gel is one therapeutic approach in the treatment and prevention of excessive scarring. The likely mechanism of action is the hydration of the tissue. This should lead to reduced angiogenesis and capillary blood flow. The efficacy is still controversial and the evidence base, insufficient. The aim of this prospective and standardized study is to investigate silicone gel in the preventive treatment of scars.Included in the study were 20 patients with costal cartilage harvest. Half of a standard chest scar was treated for three months with a silicone gel. The other half served as an internal control. After three months both scar sides were compared subjectively by visual analog scale and objectively by elasticity, moisture and color measurements.Of 19 patients 8 had a better subjective result in the treated half. In one subject, no difference was seen. A worse subjective result in the treated half was seen in 10 out of 19. The objective measurements showed no significant difference. A correlation between the different results was not seen.The use of silicone gel caused subjective differences within the same scar (worsening as well as improvement of the appearance). Positive effects were not detectable in the investigated parameters.

Infection with Pseudomonas aeruginosa (PA) induces mucus hypersecretion in airways. Therapeutic options to attenuate excessive mucus expression are sparse.To investigate the effect of steroids and N-acetyl-cysteine (NAC) on PA-induced mucus expression.Calu-3 cells and explanted human mucosa from the upper airways were stimulated with either PA, lipopolysaccharide from alginate producing PA (smooth, sPA-LPS) or non-alginate producing PA (rough, rPA-LPS). Dexamethasone (DEX) and NAC were added in different concentrations. Expression of mucin (MUC5AC) gene and mucin protein expression was quantified using PAS (periodic acids Schiff) staining and real time PCR.PA, sPA-LPS or rPA-LPS significantly induced mucin protein and MUC5AC gene expression in Calu-3 cells and explanted mucosal tissue (P0.05). Both DEX and NAC significantly decreased PA-, sPA-LPS- and rPA-LPS-induced mucin protein expression both in vitro and ex vivo (P0.05). A significant reduction was also observed for MUC5AC gene expression with the two agents (P0.05) except for sPA-LPS-induced mucin gene expression in vitro (P0.05).Our data show that both an anti-inflammatory drug (DEX) and an anti-oxidative agent (NAC) can attenuate PA-induced mucus expression in human airways. These results support the use of steroids and NAC in clinical practice to treat PA-induced mucus hypersecretion.

The prevalence of sleep apnoea among patients following treatment of head and neck carcinomas seems to be slightly higher than in the normal population. The possible importance of tumour treatment features, especially transient tracheostoma, needs further assessment.The epidemiology of sleep apnoea in patients following the treatment of head and neck cancer remains unclear. This study was undertaken to assess the prevalence of sleep apnoea in head and neck cancer patients by characterizing their clinical, anatomical and tumour treatment features.Our study examined 31 patients in a prospective non-controlled study using a standardized questionnaire that included the Epworth Sleepiness Scale (ESS) and a polygraph.Six of the 31 patients showed a pathologic AHIor = 20/h. Subjects positive for sleep apnoea more often had a tumour of the hypopharynx or larynx and more often had a transient tracheostoma during cancer therapy. Radiotherapy had no clear impact on the prevalence of sleep apnoea.

The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.

Little is known about the psychosocial improvement of microtic patients following reconstruction with rib cartilage. Furthermore, no data exist on detailed follow-ups of patients who refused ear repair. To the best of our knowledge, this is the first report of a prospective evaluation of psychosocial outcomes with a validated instrument in ear reconstruction with rib cartilage. Twenty-one patients, who had undergone rib-cartilage reconstruction to treat a congenital auricular defect, were evaluated prospectively for psychosocial changes using a clinically validated questionnaire. In addition, patients were asked to judge the new auricle and thoracic scar. Twenty-three patients, who decided against an ear reconstruction following consultation, were analysed for the reasons behind their refusal. Almost 66% of the treated patients were able to integrate the new ear into their body concept. If faced with the same surgery decision again, 88% would still choose to undergo ear reconstruction with rib cartilage. There were strong postoperative improvements in psychosocial attitude (p=0.02). In our sample, patients who declined ear repair showed higher values of psychosocial attitude (p=0.006) compared with the preoperative results in treated patients. Our study shows that the clinically known improvement of psychosocial aspects can be documented by a validated psychological test. The patient's expectations and surgical limits of the reconstruction with rib cartilage need detailed discussion prior to surgery to prevent dissatisfaction despite surgical success. Our data help to accept a child's denial as these patients have a good psychosocial standing even with an unrepaired microtia.

Mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx is a rare but well-documented entity which may arise from chronic inflammatory process. Supraglottic left regions are predominant due to unknown reason.We present the case of a 62-year-old man with a dry cough, stridor and developing exertional dyspnea. This subglottic almost circumferential MALT lymphoma showed a temporary distinct disappearance after cortisone administration during the diagnostic process. Bronchoscopy confirmed the diagnosis of a primary MALT lymphoma of the larynx. The patient received chemotherapy according to CHOP scheme plus rituximab. A reliable post-treatment care period of 15 months showed no sign of recurrence.MALT lymphoma of the larynx are believed to arise from preexisting or acquired lymphoid tissue of the upper airway. Acquired lymphoid tissue is documented in the supraglottic region and may be associated with a chronic inflammatory process. However, in subglottic cases it is unclear whether the chronic inflammation arises from a local or systemic process.

Background: There are few data focusing on the improvement of psychosocial functioning and self-esteem in patients with congenital or acquired severe auricular defects. Objective: We investigated the satisfaction of patients following auricular reconstruction with rib cartilage. Methods: One hundred patients treated for reconstruction with rib cartilage for congenital or traumatic auricular defects have been evaluated retrospectively for changes in self-esteem, performance ability, and psychosocial attitude using a clinically established questionnaire, Frankfurter Selbstkonzeptskalen (FSKN). In addition, patients were asked to judge the new auricle and the thoracic scar using a new questionnaire. Results: Of 68 patients who took part in this study, almost 90% could integrate the new ear into their body concept. If faced with the same decision for surgery again, 75% would again choose a reconstruction with rib cartilage. More than three-quarters rated the thoracic scar as acceptable in relation to the benefits of the new ear, although one-third felt uncomfortable with the pain and cosmetic appearance of the thoracic scar. According to the results of the FSKN questionnaire, values in psychosocial abilities improved postoperatively. There was no clear change in either self-esteem or performance ability. Conclusions: Ear reconstruction with rib cartilage remains, under most circumstances, the procedure of choice for repairing auricular defects. There is a high acceptance of this method among patients, although the impact of the thoracic scar needs to be discussed extensively before surgery. The importance of the surgeon's experience cannot be underestimated, because it determines the aesthetic results and the patient's satisfaction in this challenging area of plastic surgery.

Background: A failed ear reattachment tends to complicate subsequent reconstruction with autogenous rib cartilage. The various reattachment methods differ in technical demand, in the secondary damage of periauricular tissue, and in aesthetic outcome. In the past 25 years, the microsurgical method has proven to be especially successful. The aim of this work was to assess case reports of auricular trauma since the first microsurgical ear replantation by Pennington. Methods: An extensive review of the literature of acute ear trauma published between 1980 and 2004 was performed. For a better comparison, the type of damage, the reattachment technique, and the final outcome were categorized. Representative cases of traumatic auricular lesions, which were reconstructed with rib or conchal cartilage at the authors' hospital, were included. Results: Seventy-four cases in 56 publications were analyzed. The microsurgical replantation showed excellent aesthetic results but demanded an intensive perioperative and postoperative treatment. Pocket methods were used mainly in partial amputations. Repairs with periauricular tissue flaps made a quite inconsistent impression. Direct reattachments, such as composite grafts, were indicated only in extended lacerations. Conclusions: To replant an avulsed auricle is still a challenge for surgeons. Microsurgically reanastomosed ear replantation appears to be the best method because a superior outcome can be achieved without jeopardizing a subsequent ear reconstruction with rib cartilage in case of failure. The pocket method and periauricular skin or fascia flaps should be abandoned. They rarely achieve such a consistently good aesthetic outcome as a secondary reconstruction with rib cartilage.

Hypersalivation bezeichnet einen ubermasigen Speichelfluss, der durch insuffiziente oromotorische Fahigkeiten, verminderte zentralnervose Kontrolle und Koordination oder gestorte Schluckablaufe zu einem Benassen des Betroffenen und seiner Umgebung fuhren kann. Dieses reduziert die sozialen Interaktionsmoglichkeiten und erhoht den Pflegeaufwand. Die Diagnostik und Therapie sollten fruhzeitig multidisziplinar erfolgen, weshalb eine S2k-Leitlinie zur Hypersalivationstherapie erarbeitet wurde. Schwerpunkte sind die Abklarung von Schluckstorungen mit Speichelaspiration und von orofazialen motorischen Defiziten. Die endoskopische Schluckdiagnostik und die Videofluoroskopie konnen wichtige Informationen zur Therapiekontrolle liefern. Insbesondere bei traumatischen oder tumortherapeutischen Defektstorungen sind schlucktherapeutische Ubungsmasnahmen zur Aktivierung von Kompensationsmechanismen zweckmasig. Vor allem bei Kindern mit hypotoner perioraler Muskulatur konnen Stimulationsplatten uber einen vermehrten Lippenschluss zur Symptomreduktion fuhren. Sinnvolle medikamentose Therapien bei akuter Hypersalivation sind insbesondere Glycopyrrolat und Scopolamin, jedoch ist die Langzeitanwendung kritisch zu betrachten. Zuletzt hat sich die Injektion von Botulinumtoxin in die Speicheldrusen als effektive und sichere Behandlungsform mit einer lang anhaltenden Speichelreduktion erwiesen. Chirurgische Eingriffe der Speicheldrusen bleiben zunehmend Einzelfallen vorbehalten. Die externe Bestrahlung der Speicheldrusen gilt als ultima ratio. In der Nachsorge sind Therapieeffekte zu erfassen; insbesondere bei neurodegenerativen Erkrankungen ist die individuelle Dynamik der Symptomverschlechterung zu berucksichtigen. Der Einfluss der resultierenden relativen Mundtrockenheit soll vom behandelnden Arzt in Hinblick auf die Mund- und Zahnhygiene evaluiert werden.