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Wyburn-Mason syndrome is a rare disease associated with multiple arteriovenous malformations of the brain, orbit, and face resulting from an insult occurring during embryonic development.We present the clinical and radiological features of a 47-year-old-man with Wyburn-Mason syndrome who suffered from recurrent bleeding episodes primarily at the nasal corner of the left orbit. After radiotherapy and several angioembolisations, surgical reduction with exenteration of the left orbit was performed and resulted in reduced bleeding. Two years later the patient presented with maxillary sinus empyema. Due to massive endonasal bleeding, endoscopy could not be performed and the maxillary empyema was treated via a transorbital approach.Although close observation represents the standard of care in Wyburn-Mason syndrome, patient-specific management decisions are required in the presence of symptoms or complications. In the presented case, surgical intervention proved to be successful.

In order to evaluate the potential of matrix metalloproteinase 2 (MMP-2) as a prognostic factor for glottic laryngeal cancer. One hundred and two surgical specimens from patients with glottic laryngeal cancer who underwent laryngectomy for their disease in the University Hospital of Patras, Greece from 1998 to 2005 were reviewed retrospectively regarding MMP-2 expression via immunohistochemistry. Immunostaining was performed using a streptavidin–biotin peroxidase complex technique (LSAB). Results revealed that 54 of 102 patients (52.9%) had positive cytoplasmic staining for MMP-2. Kaplan–Meier analysis demonstrated statistically significant difference (p = 0.037) for the 5-year overall survival rate between the groups with positive and negative MMP-2 expression, and marginal statistical significance for the disease free survival rate (p = 0.048). The capsule rupture of metastatic lymph nodes and MMP-2 expression in primary tumor site also seems to be related (p = 0.047). Statistical significance could not be established between MMP-2 expression and the clinicopathological features of the disease (T stage, N stage, clinical stage, differentiation). In conclusion, MMP-2 expression was related with worse overall and disease-free survival and could be considered as a potential marker of poor prognosis.

Radiological evaluation of the position of cochlear implant (CI) devices is an upcoming method for quality control after CI surgery. First, results of imaging of the middle and inner ear with digital volume tomography (DVT) show considerable advantages such as exceptional image quality, thin slice thickness, and low radiation dose. The aim of this study was to evaluate whether DVT is an appropriate method for postoperative imaging of CI patients and to identify the exact position of the implant array within the cochlear by multiple measurements.Thirteen formalin-fixed temporal bone specimens were implanted with a CI array and scanned in DVT. To determine the exact electrode position, these specimens were ground and stained for microscopic measurements. The measurements on grindings acted as a referee and were compared with the measurements in DVT scans. The statistical analysis between the two measurement protocols was performed using the Bland-Altman method.Best achievable agreement between DVT scans and histological reference was shown. Mean differences between DVT and grindings from -1.55 to -65.40 microm were calculated. All means are within the region of accuracy. General positioning of the implant into the cochlea could be verified in all specimens. The exact position of the implanted array within the cochlear scalae could be recognized correctly in 11 of 13 cases in DVT. It was possible to identify shiftings between the tympanic and vestibular scalae in all cases.DVT seems to be a convenient technique for postoperative position control after cochlear implantation.

Einleitung: Fortgeschrittene lymphatische Malformationen im Kopf-Hals-Bereich stellen ein komplexes Krankheitsbild dar. Das Wissen um die exakte Morphologie und die Möglichkeit kurativer Interventionen sind weitgehend begrenzt. Andererseits gewinnen endoskopische Zugänge auch im Bereich der[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Das Vorliegen von Lymphknotenmetastasen bei Patienten mit einem Karzinom der oberen Luft- und Speisewege ist von hoher prognostischer Relevanz. Ziel der vorliegenden Untersuchung war es, die onkologische Sicherheit der cervikalen Tumorkontrolle bei Patienten mit klinischem und pathologischem[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Intraduktale Papillome sind seltene Speicheldrüsentumore, die insbesondere im Bereich der kleinen Speicheldrüsen vorkommen. Der Fall eines Patienten mit einem intraduktalen Papillom der Gl. submandibularis wird dargstellt und die Diagnostik und Therapie dieses Tumors diskutiert.[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Die Speicheldrüsen-Szintigraphie ist ein gut geeignetes Untersuchungs-Verfahren zur Beurteilung der Speicheldrüsen-Funktion bei Menschen. Unser Ziel ist die Etablierung eines Modells an der Wistar-Ratte zur Evaluierung der Speicheldrüsen-Funktion. Methoden: Nach entsprechenden[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Die Mini-Plattenosteosynthese ist der Goldstandard für die Versorgung von Mittelgesichtsfrakturen. Diese bestehen in der Regel aus Titan oder aus resorbierbaren Materialien, wie z.B. Lactosorb®. Im Vergleich zu den weit verbreiteten Titanplatten ist insbesondere für die neuste[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

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.Retrospective single-institution series.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.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.SND of different dimensions and neck levels shows low incidence of surgical complications and acceptable functional and aesthetic results.

A correct and universally accepted terminology based on the biologic behavior of orbital vascular anomalies is essential to avoid misleading diagnoses, to choose an adequate therapy regimen, and to compare different therapeutic approaches. The management of these diseases is multi-modal and an interdisciplinary challenge.There is persisting terminological and clinical confusion about vascular anomalies involving the orbit. Review of the literature reveals a diverse or misleading terminology and a lack of consensus for the treatment of vascular malformations or vascular tumors of the orbit.This study comprised a detailed analysis of cases presenting with orbital vascular anomalies followed by an extensive review of the literature.Thirty-six patients were analyzed, among them 19 patients with peri- and/or intraorbital hemangiomas, 3 with intraorbital and 2 with periorbital venous malformations, 2 with orbital involvement of complex vascular malformations, and 10 with lymphatic malformations involving the orbit.

Einleitung: Die genaue Ätiopathogenese der Zystadenolymphome der Glandula parotis ist noch nicht in allen Einzelheiten bekannt; es wird jedoch die so genannte Heterotopie-Hypothese diskutiert. Nach dieser Theorie nehmen diese Tumoren ihren Ursprung aus den epithelialen Speicheldrüsen-Einschlüssen[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Introduction: Sinc e the description of the anatomy of the inferior turbinate by Zuckerkandl other descriptions are rare and mostly based on cadaveric specimen. The dimensions of the inferior turbinate are analysed using the DVT data of the anterior skull base. Patients and methods: The data of 100[for full text, please go to the a.m. URL], 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

Zielsetzung: Unilaterale Agenesie der großen Speicheldrüsen, insbesondere der Gl. parotis, wird sehr selten beobachtet. Der Fall einer unilateraler Agenesie der Gl. parotis wird vorgestellt und mit den in der Literatur beschriebenen Fällen verglichen. Methode: Eine 34-jährige[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einführung: Seit Zuckerkandl die Anatomie der unteren Nasenmuschel beschrieb, befassten sich nur wenige Arbeiten gezielt mit der Größe der unteren Nasenmuschel. Die dabei ermittelten Daten basierten v.a. auf Kadaversektionen. Es gilt, die radiologischen Dimensionen der unteren Nasenmuschel[for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Patienten mit einer Septumperforation klagen häufig über Nasenatmungsbehinderung, rezidivierende Epistaxis, Verkrustung und Trockenheit der Nasenschleimhäute. Konservative Therapie sowie der Einsatz von Septumknöpfen führen in der Regel zu keiner signifikanten Besserung der [for full text, please go to the a.m. URL], 81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

The aim of the present study was to analyze the diagnostic value of some temporal bone structures, e.g., ossicular chain, with digital volume tomography (DVT) compared with computed tomography (CT).Radiological imaging for presentation structures of the temporal bone were performed by DVT and CT. Axial and coronal scans in vitro examinations were performed in 38 human temporal bones. 43 structures were defined. The frequency of visualization of these anatomic structures were studied and statistically analyzed.In the present study there was a higher significance of identified structures in DVT. In 15 (34.9%) temporal bone specimens defined structures were found equally in DVT and CT scans of axial images and 12 (27.9%) of coronal images. However, 9 structures (20.1%) of axial scans and 5 structures (11.6%) of coronal scans could be identified statistically significantly (P 0.05) more often in DVT than in CT.Anatomical structures of the temporal bone can be identified in higher significance in DVT than in CT scans.

Purpose. The purpose of this study was to describe the sonographic (US) features of parotid gland involvement in patients with sarcoidosis. Methods. The US findings of the parotid gland of 6 patients with histologically proven sarcoidosis of the parotid gland were reviewed. Results. The sonographic features ranged from nodal enlargement to diffuse or partial involvement of the parotid gland with various degrees of echogenicity and vascularity. Conclusions. Because of the lack of specificity of US findings in sarcoidosis involvement of the parotid gland, sarcoidosis should be considered in the differential diagnosis of parotid gland lesions in the proper clinical setting. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Einleitung: Lagekontrolle nach Cochlear Implantation (CI) spielt zunehmend eine wichtige Rolle in der Otochirurgie. Die Digitale Volumentomographie (DVT) ist ein Rotationstomographie-System, das unter anderem als neue Methode zur bildgebenden CI-Diagnostik vorgestellt wurde. Es vereinigt Vorteile im[for full text, please go to the a.m. URL], 80. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Orbital lymphatic malformations are benign cystic malformations of the lymphatic system. The present report shows two cases with symptoms of orbital complications of acute rhinosinusitis with proptosis, compressive optic neuropathy, loss of vision and cellulites in children. Magnetic resonance imaging (MRI) revealed a well-demarcated intraorbital mass with heterogeneous signal conformable with lymphatic malformation in both cases. A tumor extirpation was performed via lateral orbitotomy in both cases. Postoperatively the symptoms and especially the loss of vision improved completely. Histological analysis of the surgical specimens verified lymphatic malformations of the orbit. Orbital lymphatic malformations can mimic the symptoms of orbital complications of acute rhinosinusitis. The existence of lymphatic malformation should be considered in every orbital complication of rhinosinusitis in children.

Einleitung: Das sonographische Erscheinungsbild der Speicheldrüsensarkoidose wurde nur selten untersucht. Das Ziel der vorliegenden Untersuchungen war die Beschreibung der sonographischen Eigenschaften der Sarkoidose der Gl. parotis und Bestimmung der Bedeutung der Sonographie in der Diagnostik[for full text, please go to the a.m. URL], 80. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Einleitung: Der Strahlentherapie kommt eine zentrale Bedeutung im Behandlungskonzept von Karzinomen der oberen Luft- und Speisewege zu. Xerostomie bleibt als Spätfolge der radiogenen Schädigung der Speicheldrüsen nach Abschluss der Strahlentherapie lebenslang bestehen und führt [for full text, please go to the a.m. URL], 80. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Conclusion. Relapse-free survival (RFS) of patients suffering from cancers located in the oro- and hypopharynx (COH) is strongly related to the localization and initial tumor stage; 25% of relapses remain undetected by the patients themselves. To detect relapse at an early stage oncologic follow-up should be performed at close intervals during the first 3 years. For confirmation imaging procedures should be indicated generously as well as control endoscopy under general anesthesia. Objectives. COH are often characterized by a rapid progression of disease in case of relapse. Most of these relapses are already incurable at the time of diagnosis. The aim of the present study was the assessment of time intervals between initial diagnosis of the primary tumor and its relapse. Patients and methods. The course of disease of 280 patients was analyzed. RFS was evaluated statistically. Results. RFS was strongly related to the location of the primary tumor. The median RFS of patients suffering from oropharyngeal cancer was longer (86 months) than that of patients with hypopharyngeal carcinomas (45 months). Patients with COH revealed an accumulation of recurrent disease within the first 33 months after initial diagnosis. Within the first 2 years more than 60% of COH recurred. After 3 years 80% had developed a relapse.

The objective of this study was to describe end-stage disease in patients suffering from advanced head and neck cancer (hnc). It is one of the most unpleasant and agonizing way a person may die and is a challenging problem for all involved with its treatment. Until today, only few detailed information about the final phase of life of hnc patients in a hospice setting are available. The design of this study was a cohort sample. The course of disease until death was thoroughly analyzed. In addition, hospice staff was interviewed. The study was conducted in a hospice setting (University Hospital). The charts of 16 patients suffering from end-stage hnc were evaluated. The median survival time in the hospice was 19.5 days. There, a more or less rapid deterioration of disease was evident. Several nurses sometimes felt extremely distressed after confrontation with the advanced disease stages. Partially, the situations for the nursing staff were unbearable because of visible, odorous, and fungating tumors or metastasis. The final days were characterized by restlessness followed by somnolence and resulting in an irreversible coma. The goal of palliative treatment of terminal hnc patients is offering the most convenient way to "live" the final days of their lives in dignity. The short survival time in hospice indicates that incurable patients may be referred to terminal care institutions too late in their dying trajectory. Physicians should be encouraged to talk to their terminally ill patients about the status and incurability of the disease as early as possible to facilitate patient and family decision making on how to prepare for the impending end of life.

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.

Diseases of the superior laryngeal nerve occur more often than thought. Paresis of the superior laryngeal nerve is one of the most frequent causes of dysfunction of this nerve, mainly occurring in the context of thyroid surgery.To avoid iatrogenic damage of the superior laryngeal nerve, knowledge of the exact topography of the course of this nerve is necessary. A lesion of the superior laryngeal nerve may be associated with changes in the voice as well as with swallowing disorders with aspiration. Diagnosis of this disease is clinically challenging because the clinical symptoms are frequently not pronounced. Besides laryngoscopy, stroboscopy and electromyography are required for exact diagnosis.

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.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.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.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.

The surgical procedure for patients with otosclerosis routinely is incus stapedotomy. In case of otosclerosis with incus necrosis or a bony fixation of the malleus and incus, malleostapedotomy is performed.Between May 2002 and September 2003, malleostapedotomy was performed in 6 out of 34 patients with otosclerosis. In 2 primary cases, a middle ear dysplasia was found. The malleus was fixed in 2 further primary cases. Two revision surgeries were performed with incus necrosis present. A titanium piston was used, which was fixed at the malleus handle and introduced into an opening of the footplate.The preoperative air-bone gap was reduced from 36 dB(A) to 13 dB(A) after surgery for an average checkup time of 3 months. The length of the prostheses varied from 6.3 to 7.5 mm. No patient showed a hearing loss or vertigo after surgery.Malleostapedotomy is the technique of choice in case of an additional pathology of the ossicular chain in patients with otosclerosis. Larger numbers of patients and long-term investigations need to compare the results of malleostapedotomy with those of a conventional incus stapedotomy.

The aim of the study was the characterization of patients with metastatic cutaneous squamous cell carcinoma involving the parotid gland.The clinical, radiological and pathological tumor data of 16 patients with parotid metastasis of a previously treated squamous cell carcinoma of the skin were analyzed retrospectively.Patients over 70 years of age with a primary skin cancer of at least 1.5 centimeter in diameter were defined as the high risk group for development of regional metastasis involving the parotid gland. The time interval between therapy of the skin cancer and detection of the metastatic involvement of the parotid gland was 9.8 (2-24) months on average. The average maximal diameter of the parotid metastasis was 3.2 (1.5-4.9) centimeter at diagnosis. Metastatic infiltration of cervical lymph nodes could be shown in 9 patients and in 2 patients pulmonary metastases were detected. The average survival after parotid metastasis was 11.7 (3-31) months.The early diagnosis and therapy of locoregional metastasis from cutaneous squamous cell carcinoma of the scalp have a high prognostic value. High-risk patients with cutaneous squamous cell carcinoma should be followed up sonographically in narrow intervals for detection of parotid and cervical lymph node metastasis.

Background: The surgical procedure for patients with otosclerosis routinely is incus stapedotomy. In case of otosclerosis with incus necrosis or a bony fixation of the malleus and incus, malleostape