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Adenoid cystic carcinoma (AdCC) of the head and neck is a well-recognized pathologic entity that rarely occurs in the larynx. Although the 5-year locoregional control rates are high, distant metastasis has a tendency to appear more than 5 years post treatment. Because AdCC of the larynx is uncommon, it is difficult to standardize a treatment protocol. One of the controversial points is the decision whether or not to perform an elective neck dissection on these patients. Because there is contradictory information about this issue, we have critically reviewed the literature from 1912 to 2015 on all reported cases of AdCC of the larynx in order to clarify this issue. During the most recent period of our review (1991-2015) with a more exact diagnosis of the tumor histology, 142 cases were observed of AdCC of the larynx, of which 91 patients had data pertaining to lymph node status. Eleven of the 91 patients (12.1%) had nodal metastasis and, based on this low proportion of patients, routine elective neck dissection is therefore not recommended. ispartof: Advances in Therapy vol:33 issue:4 pages:553-579 ispartof: location:United States status: published

Congenital unilateral agenesis of the parotid gland is a rare condition with only few cases reported in the literature. A review of 21 cases in the available literature is presented in this article. We report on a further case of a 34-year-old woman with agenesis of the left parotid gland and lipoma of the right cheek. Clinicopathological characteristics of described cases in the literature were discussed.

Objective:To review reports of adenoid cystic carcinomas arising in the head and neck area outside of the major salivary glands, in order to enhance the care of patients with these unusual neoplasms.Methods:An international team of head and neck surgeons, pathologists, oncologists and radiation oncologists was assembled to explore the published experience and their own working experience of the diagnosis and treatment of adenoid cystic carcinomas arising in the vicinity of the sinonasal tract, nasopharynx, lacrimal glands and external auditory canal.Results:The behaviour of adenoid cystic carcinoma arising in head and neck sites exclusive of the major salivary glands parallels that of tumours with a similar histology arising in the major salivary glands – these are relentless, progressive tumours, associated with high rates of mortality. Of 774 patients reviewed, at least 41 (5.3 per cent) developed documented regional node metastases.Conclusion:The relatively low overall incidence of nodal metastases in adenoid cystic carcinomas arising in the head and neck region outside of the major salivary glands suggests that routine elective regional lymph node dissection might not be indicated in most patients with these tumours.

Objective Imaging of the anterior skull base and paranasal sinuses is essential before surgery of the nose and paranasal sinuses. It is important to know individual anatomical variations to define a “dangerous ethmoid” to prevent complications such as considerable bleeding or injury to the brain. This study aimed to analyze the relevant parameters with special regard to age-dependent differences. Methods This was a retrospective, single center study of 865 patients. Data from cone beam computed tomography (CBCT) of 116 patients less than 18 years of age and 749 adult patients were analyzed. Keros type, the course of the anterior ethmoid artery, the course of the uncinate process and the angle between the lateral lamella and the cribriform of the olfactory fossa were evaluated. Results Different frequencies of the course of the uncinate process between young and adult persons could be shown: onset at the lamina papyracea 67% vs. 64%; onset at the skull base, 22% vs. 26%; and onset at the middle turbinate, 11% vs. 10%. Differences in the course of the anterior ethmoid artery could be evaluated in the same way: course at the skull base, 49% vs. 44%; free course with a distance to the skull base of less than 3 mm, 11% vs. 19%; and free course with a distance to the skull base more than 3 mm, 40% vs. 37%. Significant differences could be found in the frequencies of the height of the olfactory fossa: Keros type I, 28% vs. 16%; Keros type II, 51% vs. 60%; and Keros type III, 21% vs. 24%. The angle between the lateral lamella and the cribriform plate showed significant differences dependent on the course of the anterior ethmoid artery (skull base = 123° vs. distance 3 mm = 110°) and dependent on the height of the olfactory fossa (Keros type I = 135° vs. Keros type II = 117° vs. Keros type III = 104°). Analysis of the angle as a factor of age and Keros type showed a significant difference in Keros type I (125° vs. 132°) and Keros type II (105° vs. 110°). Conclusion Cone beam computed tomography (CBCT) of the anterior skull base allows the assessment of individual anatomical-radiological risk profiles and the identification of a “dangerous ethmoid”. Significant age-dependent differences in the frequencies of anatomic landmarks and the angles of the ethmoid roof could be evaluated and led to significantly different risk profiles between children and adults.

Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.

In a recent original article published in New England Journal of Medicine D’Cruz et al., reported about the value of elective versus therapeutic neck dissection in node-negative oral cancer [1]. In a prospective, randomized, controlled trial the effect on survival of elective neck dissection (ipsilateral neck dissection at the time of the primary surgery) versus therapeutic node dissection (watchful waiting followed by neck dissection for nodal relapse) in patients with stage T1 or T2 oral squamous cell carcinomas was evaluated. In their article the authors suggested that elective neck dissection improves overall and disease-free survival compared to therapeutic neck dissection after nodal relapse. The results of this study should be discussed critically.

This immunohistochemical study of estrogen and progesterone receptors could not confirm a significant expression in nasal telangiectasias. Thus, a specific effect of these hormones or anti-hormone therapy on malformed nasal vessels has to be questioned and only offered under strict clinical control.The efforts to control recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT) using alternative methods are very intense. Hormone or anti-hormone therapy has frequently been postulated and the reported results are controversial. Therefore it was important to find an explanation regarding a possible impact of hormonal therapies by immunohistochemical evaluation of progesterone and estrogen receptor expression on nasal telangiectasias of affected patients.Tissue samples of nasal mucosa with evidence of telangiectasias from 14 patients with HHT were analyzed for the expression of progesterone and estrogen receptors on the nuclei of endothelial cells of the malformed vessels using immunohistochemistry.Progesterone receptors were not detected in any of the cases and only two cases showed a weak expression of estrogen receptors with an immunoreactive score of 2/12.

Background The surgical closure of nasal septal perforation is still an unsolved clinical problem. In this study the experiences with a novel surgical technique for closure of large perforations of the nasal septum are presented. Methods A total of 55 patients with symptomatic nasal septal perforation measuring 23 ± 3 mm (range, 11–38 mm) at the widest point were enrolled in the study. The closure of the nasal septal perforation was performed with a new and simple surgical technique using a nasal mucosal flap consisting of the defect-corresponding mucosa of the floor of the nose, inferior nasal meatus, and inferior turbinate. Results A symptomatic improvement of nasal symptoms was noted in all treated patients. In only 3 of 55 cases was the perforation closing incomplete. Conclusion Our experience with this flap shows its reliability and safety in repairing large nasal septal perforations, with many advantages compared with other techniques for septal perforation repair.

Objective Hemangiomas of the nasal tip (HNT) are commonly described as “Cyrano” or “Pinocchio nose”. They may cause significant aesthetic and functional impairment. It is still controversial how and when HNT should be treated. The risk of severe complications like irreversible contour deformities, growth disturbance, ulcerations, and nasal obstruction may obligate a therapeutic intervention. The aim of this study is to overview and to analyze different therapeutic approaches which were practiced over the last decade in two specialized centers. Methods This is a retrospective study which includes the analysis of demographic parameters, extent of the lesion, therapeutic interventions, outcome, and follow-up interventions. The analysis includes a blinded evaluation of photographic series for evaluation of the extension at the time of presentation and of the final outcome. Results Twenty-three children with HNT were analyzed who presented from 04/01/1998 to 03/31/2009. The age at presentation ranged from 1 to 63 months. On 6 patients (26%) conventional surgery was performed, 6 (26%) were treated with Nd:YAG laser, 6 (26%) were only observed, in 3 cases (13%) cryotherapy and in 2 patients (9%) treatment with Propranolol was performed. The results were evaluated between 9 months and 10.5 years after treatment (mean: 35.5 months). Limited lesions which were only observed showed a good tendency of regression. Significant wound healing disturbance and scar formation was observed after Nd:YAG laser therapy. Secondary rhinoplasty in adulthood was recommended to two patients. Conclusion Limited lesions do not require therapy. The results with Propranolol are encouraging. Laser- and cryo-therapy have to be critically reevaluated. Treatment of choice for lesions that are not suitable for beta blockers and residual disease is conventional surgery.

The clinical presentation of low flow vascular malformations of the head and neck (LFVM) can range from a birthmark to severe disfigurement, functional impairment or relevant hemorrhage. The values of Brightness mode (B-mode) ultrasound and Doppler sonography in the investigation, identifying and differentiating of these lesions has been sparingly documented in the literature. This study evaluates the sonografic features of different morphological subtypes of LFVM. This is a 2-year retrospective study of 51 patients who presented with LFVM based on routine ultrasound exam in the context of their clinical consultation. Diagnosis was based on the clinical and histological findings. B-mode, color coded duplex and spectral Doppler measurements were performed for venous, lymphatic, capillary, and mixed venous-lymphatic lesions of the head and neck. The echogenicity of the majority of venous malformations was heterogenic, of most lymphatic malformations hypoechoic, and of all capillary malformations isoechoic. Blood flow was detected in only 11 cases (36.7%) of venous malformations with a monophasic pattern. There was a statistical significant difference in the mean minimum and maximum Doppler shifts between venous and lymphatic malformation for cases when the blood flow was evident. No statistical significant difference in Doppler parameters existed between capillary and lymphatic, neither between venous and capillary nor mixed malformations. Phleboliths were present in eight cases (26.7%) of venous malformations and were not detectable in any other subtype of LFVM. The detection of flow in ultrasound was only possible in a small portion of LFVM. When considering differentiating among LFVM, features such as the echogenecity, spectral Doppler wave forms, and the evidence of phleboliths contribute to establish the correct diagnosis.

Objectives/Hypothesis: Although selective neck dissection (SND) is an oncologically efficient procedure for the N0 neck, its functional results are discussed controversially. The aim of the present study was to analyze the frequency of morbidity related to SND. Study Design: Retrospective single-institution series. Methods: The clinical data of 98 patients who had undergone unilateral SND of different dimensions and neck levels were analyzed. Radiotherapy was carried out in 37 (37.8%) patients. Functional and aesthetic results were evaluated in the context of aftercare consultation in 52 patients. The contralateral side of each patient served as the control. The mean follow-up period was 2.6 (0.5–9.1) years. Results: SND-related complications arose in two out of 50 patients (4%) with dissection of level IV in terms of an injury of the thoracic duct. Ten (19.2%) patients showed persistent slight lymph edema, and 34 (65.4%) patients noticed cervical incision sensibility disturbances after at least 6 months. Concerning head, neck, and shoulder function, no significant side differences were noticed by 31 (82%) patients for arm abduction, 32 (84%) for head rotation, and 30 (79%) for lateral head inclination. Subjectively, 50 (96.2%) patients had no restriction in head, neck, and shoulder movement after SND. Concerning the aesthetic results, only one (2%) patient was subjectively not satisfied. Conclusions: SND of different dimensions and neck levels shows low incidence of surgical complications and acceptable functional and aesthetic results. Laryngoscope, 2010

We examined the clinical appearance of mucosal venous malformations of the upper aerodigestive tract with regard to their accessibility to laser therapy and further assessed the value of treatment of these lesions with the Nd:YAG and CO(2) lasers. A retrospective study was performed in 50 patients who had undergone laser treatment for mucosal low-flow vascular malformations of the upper aerodigestive tract. Records were reviewed for demographic data, extent of the lesion, treatment modality, required number of therapy sessions and the therapeutic outcome. Follow-up was performed by postinterventional clinical examination and additional interview by phone for current status. Between 1 July 2001 and 30 September 2008 32 women and 18 men received laser treatment and were followed up until 30 June 2009. The lesions were classified into three grades according to their extent and clinical presentation, as follows: grade 12 cm, asymptomatic or mild symptoms; grade 2 2-4 cm, asymptomatic or mild symptoms; and grade 3or =4 cm or multiple locations (more than two) or severe symptoms such as dyspnoea, pain or dysphagia. Of the 50 patients, 13 (26%) were classified as having grade 1 disease, 22 (44%) grade 2 disease, and 15 (30%) grade 3 disease. Treatment in 39 patients was solely with the Nd:YAG laser using the noncontact or interstitial technique. Resection using the CO(2) laser was performed in six patients, and combined conventional surgery and Nd:YAG laser therapy in five patients. The applied grading reflects the extent of laser therapy and also the number of therapy sessions performed in patients treated with the Nd:YAG laser. Resection with the CO(2) laser is suitable for grade 1 lesions. In advanced lesions a combined therapeutic approach and multiple sessions are necessary. The Nd:YAG laser is still a valuable therapeutic tool for the treatment of venous malformations of the mucosa.

Conclusion: Preoperative imaging is important, because of the small size of the cribriform plate, different anatomical variants of the olfactory fossa in varied patients and unequal width of the cribriform plate in the anterior and posterior third. Objective: Digital volume tomography (DVT) is a rather new imaging technique for the diagnosis of diseases of paranasal sinuses. This technology is dedicated to the evaluation of the distinctive structures of the anterior skull base due to the high resolution of the DVT. Based on the Keros classification this anatomic area was analyzed radiologically and also in relation to the uncinate process. Methods: The investigation was performed on 111 patients. The Accu-I-tomo F17 was used. Patients with total nasal polyposis and patients who had undergone sinus surgery were excluded from the study. Results: Keros type I was found in 11.25% of the patients, type II in 68.05% and type III in 20.7%. Significant asymmetry of the olfactory fossa was identified in nine patients (8.1%). The width of the olfactory cleft varied from 0 to 3.25 mm. No relation between Keros type and a particular onset of the uncinate process to orbit, skull base or middle turbinate could be detected.

For managing dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy in the acute postoperative period, reversible vocal cord lateralisation is performed at the authors' departments. However, in the later postoperative period of thyroidectomy when there is no chance for recovery of the recurrent laryngeal nerves, they perform irreversible procedure. Applying these operative techniques satisfactory breathing can be achieved in about 95% of cases avoiding tracheostomy. In 5% of cases there are other comorbidities in the background of unsuccessful operative results which can cause potential dyspnea as well. From these complications the authors emphasize the role of laryngeal obstruction and myxedema as a consequence of hypothyroidism developed after thyroidectomy. Management of severe dyspnea caused by association of these two complications of thyroidectomy means a great therapeutic challenge. Between 01 Jan 1989 and 30 Nov 2008 the authors performed 161 reversible and 135 irreversible vocal cord lateralisations to manage dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy. From these cases four patients had further obstruction due to laryngeal myxedema. By performing endoscopic laryngeal surgeries and applying levothyroxine replacement therapy sufficiently wide glottic chink has been achieved in all the cases. According to the experience of the authors dyspnea caused by bilateral vocal cord paralysis after thyroidectomy needs complex, interdisciplinary therapeutic approach beside glottis widening operations.

Nasal septal perforation may cause recurrent epistaxis, nasal obstruction, discharge, crusting, dryness, pain and whistling. Many surgical approaches for the repair of septal perforations have been reported in the literature, however most of the available closure techniques are technically difficult, require experienced surgeons and have a high rate of re-perforations. A new and simple surgical technique for the treatment of nasal septal perforations is described in the present study. A total of 13 patients with symptomatic nasal septal perforation measuring 17+/-3mm (range 5-26 mm) at the widest point were enrolled in the present study. All patients were treated with a unilateral inferior meatal mucosal flap and had their septal defects closed. Complete symptomatic resolution was documented among all of these patients. This technique provides a new method with many advantages compared to other techniques for closure of septal perforations. Our first experiences with this flap show its reliability in repairing septal perforations.

A small part of patients suffering from cutaneous squamous cell carcinomas of the head develop locoregional metastases. Those metastases are very aggressive tumors that worsen the prognosis of the patient significantly. Especially elder and immunosuppressed patients with a cutaneous squamous cell carcinoma measuring more than 1.5 cm in diameter represent the main risk group for developing parotid metastases. Thus a sonographic control of the lymph nodes of the parotid gland and the neck is required in narrow intervals in order to early detect those metastases, in particular within the first two years after diagnosis of the cutaneous carcinoma.

Background and purpose: Intraglandular injection of botulinum toxin (BoNT) leads to a transient denervation of the submandibular gland and this is associated with reduced salivary secretion. The purpose of the present study was to verify whether temporary acinar atrophy occurs simultaneously with chemical denervation of the glands. Experimental approach: Tissue specimens of the right submandibular gland taken from 18 Wistar rats after intraglandular injection of BoNT A, BoNT B, or a combination of both were examined. As a sham control, an equivalent volume of saline was injected into the left submandibular gland. Morphometric measurements, immunohistochemistry, electron microscopy and western blot analysis were used to analyse the morphological and functional changes of the denervated glands. Key results: Morphological and ultrastructural analyses of the cell organelles and secretory granula showed a clear atrophy of the acini, which was more prominent in glands injected with the combination of BoNT/A and B. Morphometric measurements of the glandular acini revealed a significant reduction of the area of the acinar cells after injection of BoNT (P=0.031). The expression of amylase was significantly reduced in BoNT treated glands. Conclusions and implications: Intraglandular application of BoNT induces structural and functional changes of the salivary glands indicated by glandular atrophy. These effects may be due to glandular denervation induced by the inhibition of the soluble N-ethylmaleimide-sensitive fusion protein attachment protein receptors (SNAREs) involved in acetylcholine release at the neuroglandular junction and also specially inhibition of those involved in exocytosis of the granula of the acinar cells. British Journal of Pharmacology (2007) 152, 161–167; doi:10.1038/sj.bjp.0707375

Erkrankungen des N. laryngeus superior (NLS) treten viel haufiger auf als angenommen. Die Parese des NLS stellt eine der haufigsten Ursachen fur eine Dysfunktion dieses Nervs dar, die v. a. im Rahmen der Schilddrusenchirurgie auftreten kann. Die Voraussetzung zur Vermeidung einer iatrogenen Schadigung des NLS ist die genaue topographische Kenntnis des Nervenverlaufs. Eine Lasion des NLS kann mit einer belastenden Stimmanderung sowie mit einer Schluckstorung mit Aspirationsneigung einhergehen. Die Diagnostik dieser Erkrankungen stellt vielfach eine besondere klinische Herausforderung dar, da deren klinische Symptomatik haufig geringgradig ausgepragt ist und zu ihrer Diagnostik neben der Laryngoskopie in der Regel Stroboskopie und Elektromyographie erforderlich sind.

Ziel der Untersuchung war die Charakterisierung der Patienten mit parotidealer Metastase eines Plattenepithelkarzinoms der Kopfhaut. Klinische, radiologische und pathologische Daten zu 16 Patienten mit parotidealer Metastase eines zuvor behandelten Plattenepithelkarzinoms der Haut wurden retrospektiv untersucht. In der vorliegenden Untersuchung boten uber 70-jahrige Patienten mit einem Karzinom von uber 1,5 cm Durchmesser das hochste Risikoprofil fur parotideale Metastasen. Das Zeitintervall zwischen der Therapie des Hautkarzinoms und der Diagnose der parotidealen Metastase betrug im Durchschnitt 9,8 Monate. Bei der Erstdiagnose betrug der maximale Durchmesser der parotidealen Metastase im Durchschnitt 3,2 cm. Zu diesem Zeitpunkt zeigten 9 Patienten zervikale Lymphknotenmetastasen, 2 Patienten eine pulmonale Metastasierung. Samtliche Patienten waren nach einer durchschnittlichen Uberlebenszeit von 11,7 Monaten tumorbedingt gestorben. Der fruhzeitigen Diagnose und Therapie der lokoregionaren Metastasen bei Plattenepithelkarzinomen der Kopfhaut kommt eine hohe prognostische Bedeutung zu, weshalb eine engmaschige sonographische Kontrolle der parotidealen und zervikalen Lymphknoten bei Risikopatienten wichtig ist.

Background The presence of heterotopic salivary gland tissue in intra-, periparotideal and cervical lymph nodes is not an uncommen finding. In some rare cases the salivary gland inclusions in lymph nodes may undergo neoplastic transformation. Patient and methods An isolated and indolent tumor was detected in level III in the right cervical area in a 60 year-old male patient. The histological assessment of the extirpated node seemed to indicate lymph node metastasis of an adenoid cystic carcinoma. The radiological and endoscopic findings did not reveal a primary tumor. Results Due to the fact of missing of a primary tumor, the diagnosis of an adenoid cystic carcinoma in heterotopic salivary gland tissue of the cervical lymph node was established after long-term observation. Conclusion After exclusion of an occult carcinoma of the salivary glands, the possibility of malignant transformation of heterotopic intranodal salivary gland inclusions should be considered in patients suffering from salivary gland carcinoma in the area of the cervical lymph nodes.

The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control.

Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach. United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) (P30CA008748) United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) (P30 CA008748)

The purpose of this study was to evaluate the effect of training on the performance outcome with the da Vinci Skills Simulator.Forty novices were enrolled in a prospective training curriculum. Participants were separated into 2 groups. Group 1 performed 4 training sessions and group 2 had 2 training sessions over a 4-week period. Five exercises were performed 3 times consecutively. On the last training day, a new exercise was added.A significant skills gain from the first to the final practice day in overall performance, time to complete, and economy of motion was seen for both groups. Group 1 had a significantly better outcome in overall performance, time to complete, and economy of motion in all exercises. There was no significant difference found regarding the new exercise in group 1 versus group 2 in nearly all parameters.Longer time distances between training sessions are assumed to play a secondary role, whereas total repetition frequency is crucial for improvement of technical performance. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1762-E1769, 2016.

Einleitung: Die Anzahl der Patienten mit Kopf-Hals-Karzinomen im fortgeschrittenen Lebensalter steigt. Es gibt jedoch nur wenige valide Daten über den postoperativen Verlauf nach chirurgischer Therapie von Kopf-Hals-Karzinomen bei Patienten dieser Altersgruppe. Das Ziel der vorliegenden Untersuchung war es, die chirurgischen und onkologischen Resultate nach Laryngektomie im fortgeschrittenen Lebensalter zu untersuchen. Material und Methoden: Es wurden die klinischen Daten von insgesamt 67 Patienten retrospektiv untersucht, welche sich im Rahmen eines Hypopharynx- oder Larynxkarzinoms einer Laryngektomie unterzogen haben. Es erfolgte eine Einteilung der Patienten in zwei Altersgruppen (65 Jahre: n=32). Es wurden das Gesamtüberleben und das rezidivfreie Überleben analysiert. Weiterhin erfolgte eine vergleichende Analyse der Komorbiditäten sowie der perioperativen Komplikationsrate der beiden Patientengruppen. Ergebnisse: Der Vergleich unterschiedlicher klinischer und histopathologischer Daten ergab keinen signifikanten Unterschied zwischen den beiden Altersgruppen. Operationsbedingte Komplikationen konnten bei insgesamt 31 (46,3%) Patienten im perioperativen Verlauf festgestellt werden, wobei in 14 Fällen die jüngere Patientengruppe betroffen war. Das rezidivfreie Überleben war ohne signifikanten Unterschied in den beiden Altersgruppen in der Kaplan-Meier-Analyse (p=0,07). Ein signifikanter Einfluss des Alters auf das Gesamtüberleben konnte weder in einer uni- noch einer multivariaten Analyse festgestellt werden (p=0,24 vs. 0,15). Schlussfolgerung: Laryngektomie in Kombination mit Neck dissection kann bei Patienten im fortgeschrittenen Lebensalter mit Hypopharynx- und Larynxkarzinomen zu befriedigenden onkologischen und chirurgischen Ergebnissen führen. Der Erstautor gibt keinen Interessenkonflikt an., GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery; 11:Doc349; ISSN 1865-1038

Einleitung: Infektionen mit MRSA stellen weiterhin ein klinisches als auch ökonomisches Problem bei stationären Patienten dar. Ziel dieser retrospektiven Untersuchung ist die Identifikation der Auswirkungen die aus der Infektion resultieren. Material und Methoden: In einem Zeitraum von[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Das invertierte Papillom der Nasenhaupt- und Nasennebenhöhlen ist gekennzeichnet durch ein lokal destruierendes Wachstum, die Möglichkeit einer malignen Transformation sowie eine hohe Rezidivneigung bei geringer Prävalenz. Ziel war klinische und histopathologische Charakteristika sowie den perioperativen Verlauf von Patienten mit invertierten Papillomen der Nasenhaupt- und Nasennebenhöhlen zu analysieren. Methoden: Es wurden retrospektiv die klinischen sowie histopathologischen Daten von insgesamt 47 Patienten untersucht, welche sich in einem Zeitraum von 14 Jahren einer operativen Behandlung eines invertierten Papilloms der Nasenhaupt- oder Nasennebenhöhlen unterzogen haben. Ergebnisse: Bei 45 Patienten zeigte sich eine uni- und bei 2 Patienten eine bilaterale Manifestation des invertierten Papilloms. Das Hauptsymptom war eine Nasenatmungsbehinderung. In 42 Fällen erfolgte ein endonasal-endoskopischer, in 4 Fällen ein endo- und extranasaler sowie bei einem Patienten ein rein extranasaler operativer Zugang. Hierdurch konnte bei allen Patienten der Tumor komplett entfernt werden. Es traten keine relevanten perioperativen Komplikationen auf. Der immunhistochemische Nachweis von p16 gelang in 1/47 Fällen. Bei drei Patienten konnte in der histologischen Untersuchung eine maligne Transformation des Tumors nachgewiesen werden. Schlussfolgerung: Eine endonasal-endoskopische Resektion invertierter Papillome der Nasenhaupt- und Nasennebenhöhlen ist in der überwiegenden Mehrzahl der Fälle möglich und scheint mit einer geringen Morbidität für die Patienten verbunden zu sein. Ein ursächlicher Zusammenhang mit einer möglichen HPV-Infektion oder anderen klinischen Risikofaktoren konnte nicht nachgewiesen werden. Der Erstautor gibt keinen Interessenkonflikt an., GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery; 11:Doc232; ISSN 1865-1038

Einleitung: Bei einem kleinen Teil der Patienten mit einem Kopf-Hals-Karzinom kann eine Infiltration der A. carotis durch eine Lymphknotenmetastase festgestellt werden. Die genaue Beurteilung einer möglichen Gefäßinfiltration ist jedoch mittels Bildgebung oft nur eingeschränkt möglich.[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Neben lokoregionären Rezidiven können Fernmetastasen das Überleben von Patienten mit Kopf-Hals-Karzinomen limitieren. Ziel der Studie war, das Überleben nach Fernmetastasierung von Kopf-Hals-Karzinomen zu analysieren und mögliche Prädiktoren für die Länge des Überlebens zu identifizieren. Methoden: Patienten mit Plattenepithelkarzinomen des oberen Aerodigestivtraktes mit initialem M0-Status, die 2005-2012 mit kurativer Absicht behandelt wurden und im Verlauf der Erkrankung Fernmetastasen ohne gleichzeitiges lokoregionäres Rezidiv entwickelten, wurden analysiert. Prädiktoren für die Dauer des Überlebens wurden mittels Cox-Regressionsanalyse ausgewertet. Ergebnisse: 46 Patienten entwickelten Fernmetastasen, am häufigsten traten Lungen- (59%) und Knochenmetastasen (24%) auf. Die Zeit von der Erstdiagnose bis zur Fernmetastasierung betrug im Durchschnitt 16 Monate. Die häufigste Therapie bei Fernmetastasierung war eine palliative Chemotherapie, bei 21% der Patienten erfolgte aufgrund des schlechten Allgemeinzustands nur ein Best-Supportive-Care. Die mittlere Überlebenszeit nach Diagnose der Fernmetastasen betrug 7,5 Monate, die Gesamtüberlebensraten 1 und 2 Jahre nach Fernmetastasierung betrugen 40,4% und 26,2%. In der Regressionsanalyse zeigten sich keine signifikanten Prädiktoren für ein verlängertes Überleben, wobei bei den einzigen drei zum Zeitpunkt der Datenerhebung überlebenden Patienten jeweils eine operative Resektion solitärer Fernmetastasen erfolgt war. Schlussfolgerung: Bei Vorliegen von Fernmetastasen sollte aufgrund der schlechten Prognose die Palliation im Vordergrund stehen und das Therapiekonzept unter Berücksichtigung des Allgemeinzustandes des Patienten gewählt werden. Im Einzelfall kann eine Resektion von solitären Metastasen sinnvoll sein. Der Erstautor gibt keinen Interessenkonflikt an., GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery; 11:Doc016; ISSN 1865-1038

Parapharyngealraum ist in der Tiefe der Halsweichteile zwischen Unterkiefer und Pharynxschlauch lokalisiert. Zur Diagnostik und Therapie der Tumore des Parapharyngealraums sind genaue Kenntnisse zur topographischen Anatomie dieser Region erforderlich. Die Lokalisation und Begrenzung des Parapharyngealraums[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Bei der hereditären hämorrhagischen Teleangiektasie (HHT) handelt es sich um eine autosomal dominant vererbbare systemische Erkrankung der Gefäße, welche sich oft initial durch rezidivierende Epistaxis und Teleangiektasien im Bereich der Schleimhäute bemerkbar macht.[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Bei der Carotis-Sinus-Cavernosus-Fistel handelt es sich um einen arterio-venösen Kurzschluss der A. carotis interna mit dem sie umgebenden Sinus-Cavernosus an der Schädelbasis. Hier wird der Fall einer spontan aufgetretenen Fistel dargestellt, welche retrograd transvenös über die V. ophthalmica superior verschlossen wurde. Patient und Methoden: Eine 73-jährige Patientin stellte sich bei einer akut aufgetretenen Visusminderung links, Doppelbildern sowie Chemosis der Bindehaut und Stauung und Hyperämie der episkleralen Gefäße beidseits vor. Die Patientin gab gleichzeitig pulsatile Cephalgien linksseitig an.Angiographisch zeigte sich eine indirekte Carotis-Sinus-Cavernosus-Fistel links mit Drainage über Sinus intercavernosus anterior und posterior und über die V. ophthalmica beidseits. Es erfolgte die transorbitale Darstellung und Punktion der V. ophthalmica superior rechts zur Coil-Embolisation des Sinus-Cavernosus links. Nach transvenöser Embolisation konnte die Fistel erfolgreich verschlossen werden. Ergebnisse: Postoperativ kam es zu einer vollständigen und raschen Beschwerdebesserung. Schlussfolgerungen: Die Direktpunktion der dilatierten V. ophthalmica superior stellt einen alternativen Zugangsweg zur interdisziplinären Behandlung der Carotis-Sinus-Cavernosus-Fistel dar. Der Erstautor gibt keinen Interessenkonflikt an., GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery; 11:Doc246; ISSN 1865-1038

The details of the etiopathogenesis of cystadenolymphoma (Warthin's tumor) are still unclear. To explore the possible risk factors for the development of this tumor, medical records of 81 patients with 96 Warthin's tumors of the parotid glands were compared retrospectively with those of 91 patients with pleomorphic adenoma. The medical history and clinical tumor characteristics of all patients were similar. There were no significant differences between these two patient groups with respect to concomitant diseases, regular medications, and preoperative laboratory findings. However, a significant male predominance of patients with Warthin's tumor could be noted (P

Aims : Irradiation-induced sialadenitis is a significant cause of morbidity in head and neck cancer patients receiving radiotherapy. Neither the exact aetiopathology of chronic irradiation-induced sialadenitis nor the mechanisms leading to atrophy of the glandular cells associated with an increase in extracellular matrix are understood. The aim of our study was to determine the phenotype of the inflammatory infiltrate and to study its distribution in the affected submandibular glands. Methods and results : Paraffin-embedded submandibular glands from a homogeneous group of 19 patients with advanced oropharyngeal cancer who received conventional radiotherapy to the primary site and upper neck were analysed. In all patients the radiation dose and field were approximately equal. The submandibular glands were obtained during neck dissection. To characterize the lymphoid infiltrate, all tissue sections were immunostained for T cells (CD3, CD4, CD8), cytotoxic T cells (granzyme B), B cells (CD20), and macrophages (Ki-M1p). A histopathological classification into four grades was established based on the degree of glandular atrophy, fibrosis and lymphocytic infiltration. Phenotypic analysis of submandibular gland sections revealed that the great majority of lymphocytic infiltrates were cytotoxic T cells associated with acinar cell destruction. Conclusions : The significantly elevated frequencies of cytotoxic cells in the submandibular glands of patients with irradiation-induced sialadenitis suggest that cell-mediated immune mechanisms may play a part in the pathogenesis of this disease.

Introduction In the industrialized nations of the Western hemisphere the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. With regard to these expectations 40 patients, beyond the age of 75 and who were first diagnosed to suffer from squamous cell carcinoma of the upper aerodigestive tract, were analysed. Material and methods Forty patients diagnosed and treated between 1998 and 2003 for head and neck squamous cell carcinoma (HNSCC) were analysed. Results Laryngeal carcinoma was noted in 80% of the patients. All types of treatment were tolerated well. Patient compliance was generally good and the rate of complications was low. Conclusion The results of the present study show that HNSCC in elderly patients should be treated with curative intention. Age itself should never be a sole factor in deciding which curative therapy should be undertaken. Exceptions could be made in patients with severe general comorbidity.