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In newborns, the main supporting structure of the nose is the dorsoseptal cartilage, a T-bar-formed complex of septum and upper lateral cartilages, which is essentially an external extension of the cartilage of the anterior cranial base. Later the anatomic situation gradually changes -- a potential pitfall for surgeons and radiologists. The vulnerability of various processes underlying postnatal development of the facial skeleton is discussed. The cartilaginous septum is the dominant growth center. Loss of septal cartilage at different ages leads to different facial syndromes involving nose, maxilla, and orbita. The septal cartilage in children demonstrates thinner fracture-prone areas next to thicker growth zones. Septum fractures have a preference for the thinner regions, corresponding with the most frequent septum deviations observed in growing children. The essential problem in pediatric rhinosurgery is not the age-specific anatomy but the poor wound-healing capacity: fractured or transected septum cartilage will not heal, and disconnected ends tend to overlap, resulting in increasing or recurrent deviations. Based on clinical and experimental evidence, indications and "safe" and "unsafe" techniques of rhinosurgery are presented for children of various age groups.

Objectives Telemedicine applications carry the potential to enhance the quality of life of patients, but studies evaluating telemedicine applications are still scarce. The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive. This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients. Design and Measurements Between 1999 and 2002, we conducted a prospective controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck, using quality of life questionnaires that covered 22 quality of life parameters. All patients had undergone surgery for head and neck cancer at the Erasmus MC, a tertiary university hospital in The Netherlands. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks, starting at discharge from the hospital. Results In total, we included 145 patients in the control group and 39 in the intervention group. At 6 weeks, the end of the intervention, the intervention group had significantly improved QoL in 5 of the 22 studied parameters. Only one of these five quality of life parameters remained significantly different at 12 weeks. Conclusions This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients.

Objectifs: Identifier les patients susceptibles d'avoir une mauvaise qualite de vie lors des trois premiers mois suivant leur depart l'hopital suite a chirurgie oncologique cervico-faciale. Devis: Evaluation des patients ayant subi une chirurgie pour un cancer tete et cou avec un questionnaire a remplir au depart de l'hopital, 6 semaines et trois mois plus tard. Organisation: Le departement d'Oto-Rhino-Laryngologie et de chirurgie cervico-faciale du Centre Medical Universitaire d'Erasmus, un centre de soins tertiaires a Rotterdam, Pays-Bas. Participants: Quatre-vingt-dix patients souffrant d'un cancer de la region tete et cou qui ont subi une laryngectomie total, un curage ganglionnaire, ou une resection bucco-mandibulaire complexe. Variables evaluees: La qualite de vie de patients pour vingt-deux domaines differents. Resultats: Nous avons decouvert trois caracteristiques des patients qui risquent de souffrir d'une mauvaise qualite de vie dans les trois mois suivant leur depart de l'hopital: laryngectomie, un niveau d'education inferieur et etre celibataire. La qualite de vie s'ameliorera durnat les trois premiers mois dans huit des domaines de qualite de vie apres leur depart de l'hopital, mais la qualite de vie dans la dimensions « perte de controle » et « l'autonomie physique » se deteriore dans la meme periode. Conclusions: II est possible d'identifier les groupes de patients qui sont les plus susceptibles d'avoir une mauvaise qualite de vie durant les trois premiers mois suivant leur depart de l'hopital suite a chirurgie oncologique cervico-faciale. Les resultats de cette etude peuvent aider a offir des soins plus personnalises a la personne qui a subi une chirurgie pour un cancer cervico-faciale.

Summary Objective: An anterior cricoid split (ACS) causes an immediate distortion of the cricoid cartilage resulting in an anterior gap due to retraction of the cut ends. The objective of this animal study is to investigate: (1) to what extent the distortion after ACS is influenced by non-cartilaginous structures like tunica elastica, membranes, ligaments and muscles, which are connected to the cricoid; (2) how distortion is changing with further development; (3) in what way the distortion is affected by scoring of the internal surface of the cricoid; and (4) whether an immediate or late injury-induced distortion is related to age. Methods: Surgical interventions were performed in 20 young (8 weeks of age, 1300–1600 g) and 5 adult (28 weeks of age, 3500–4000 g) New Zealand White rabbits. The immediate effects were measured, and then the animals were followed for 20 weeks to study the long-term effects of the various procedures. Results: (1) The gap, immediately following an ACS, increased after additional transection of the cricothyroid ligament and the cricotracheal membrane, and even more when the cricovocal membrane was elevated from the inner surface of the cricoid arch. (2) The degree of distortion after various interventions in young animals appeared to increase substantially during further growth. (3) When the above-mentioned successive surgical steps were combined with scoring of the internal surface of the cricoid arch, a marked malformation of the split cricoid did develop with warping of the cut ends in lateral direction and a latero-cephalic rotation, the latter due to the action of the cricothyroid muscles. (4) The immediate distortion appeared to be similar in young and adult animals. During a follow-up of 20 weeks, a progressive distortion of the split cricoid ring was observed in the young growing rabbits. In adult animals, no significant progression of the distortion was found. Conclusions: The immediate and long-term distortion of the split cricoid is determined by the release of intrinsic forces of the cartilage, and extrinsic forces from non-cartilaginous structures like ligaments, muscles, membranes and tunica elastica.

Cartilage can be shaped by scoring. In an exploratory study in living adult animals, this phenomenon was demonstrated in cartilage of the nasal septum. Bending was observed immediately after superficial scoring of the cartilage surface, and the cartilage always warped in the direction away from the scored side. The scored piece of cartilage still showed its initially distorted shape 10 weeks after primary surgery. In ex vivo experiments, a clear relation between incision depth and bending of septal cartilage was observed. Under these controlled conditions, the variation between different septa was small. Deformation of the septal specimens was increased by introducing single superficial incisions deepening to half the thickness of the cartilage. A positive correlation between incision depth and bending was demonstrated. A model was used to accurately predict the degree of bending of the cartilage after making an incision of a particular depth. Hence, the effect of cartilage scoring can be predicted. Because the results of this controlled study showed excellent reproducibility for different septa, it is expected that this model can be extrapolated to human nasal septum cartilage. This would enable the surgeon to better predict the result of cartilage scoring, either preoperatively or perioperatively.

Cartilage structures from the head and neck possess a certain but limited capacity to heal after injury. This capacity is accredited to the perichondrium. In this study, the role of the inner (cambium) and the outer (fibrous) layers of the perichondrium in cartilage wound healing in vitro is investigated. For the first time, the possibility of selectively removing the outer perichondrium layer is presented. Using rabbit ears, three different conditions were created: cartilage explants with both perichondrium layers intact, cartilage explants with only the outer perichondrium layer dissected, and cartilage explants with both perichondrium layers removed. The explants were studied after 0, 3, 7, 14, and 21 days of in vitro culturing using histochemistry and immunohistochemistry for Ki-67, collagen type II, transforming growth factor beta 1 (TGFbeta1), and fibroblast growth factor 2 (FGF2). When both perichondrium layers were not disturbed, fibrous cells grew over the cut edges of the explants from day 3 of culture on. New cartilage formation was never observed in this condition. When only the outer perichondrium layer was dissected from the cartilage explants, new cartilage formation was observed around the whole explant at day 21. When both perichondrium layers were removed, no alterations were observed at the wound surfaces. The growth factors TGFbeta1 and FGF2 were expressed in the entire perichondrium immediately after explantation. The expression gradually decreased with time in culture. However, the expression of TGFbeta1 remained high in the outer perichondrium layer and the layer of cells growing over the explant. This indicates a role for TGFbeta1 in the enhancement of fibrous overgrowth during the cartilage wound-healing process. The results of this experimental in vitro study demonstrate the dual role of perichondrium in cartilage wound healing. On the one hand, the inner layer of the perichondrium, adjacent to the cartilage, provides (in time) cells for new cartilage formation. On the other hand, the outer layer rapidly produces fibrous overgrowth, preventing the good cartilage-to-cartilage connection necessary to restore the mechanical function of the structure.

A pedicled auricular perichondrial flap wrapped around trabecular demineralized bovine bone matrix can generate an autologous cartilage graft. In earlier experimental studies, it was demonstrated that this graft could be used for nasal and cricoid reconstruction. It was assumed that the vascularization of the perichondrial flap was obligatory, but it was never proven that the flap should be pedicled. Moreover, for clinical use, the dimensions of the auricle would set restrictions to the size of the graft generated. Therefore, the possibility to generate cartilage with a composite graft of a free perichondrial flap wrapped around demineralized bovine bone matrix, by using young New Zealand White rabbits, was studied. This composite graft was implanted at poorly (subcutaneously in the abdominal wall; n = 12), fairly (subcutaneously in the pinna; n = 12), and well-vascularized sites (quadriceps muscle; n = 12). As a control, trabecular demineralized bovine bone matrix was implanted without perichondrial cover. Half of these grafts (n = 6) were harvested after 3 weeks, and the remaining grafts (n = 6) after 6 weeks of implantation. In histologic sections of these grafts, the incidence of cartilage formation was scored. Furthermore, the amount of newly formed cartilage was calculated by computerized histomorphometry. Trabecular demineralized bovine bone matrix without perichondrial cover demonstrated early resorption; no cartilage or bone was formed. In demineralized bovine bone matrix wrapped in perichondrium, early cartilage formed after 3 weeks at well- and fairly vascularized sites. No cartilage could be detected in grafts placed at a poorly vascularized site after 3 weeks; minimal cartilage formed after 6 weeks. In summary, the highest incidence of cartilage formed when trabecular demineralized bovine bone matrix was wrapped either in a pedicled auricular perichondrial flap or in a free perichondrial flap, which was placed at a well-vascularized site. Second, a significantly higher percentage of the total area of the graft was cartilaginized at well-vascularized sites after 3 weeks. The newly generated cartilage contained collagen type II and proteoglycans with hyaluronic acid binding regions, whereas collagen type I was absent, indicating the presence of hyaline cartilage. This study demonstrates that new cartilage suitable for a graft can be generated by free perichondrial flaps, provided that the site of implantation is well vascularized. Consequently, the size of such a graft is no longer limited to the dimensions of the auricle.

This study was performed to determine the various processes involved in the behaviour of hyaline cartilage during the wound healing period after trauma or surgery of vulnerable structures like the nasal septal cartilage and the cricoid. The results of different procedures (perpendicular and parallel to the cartilage surface) in young and young-adult animals were analyzed: septal incision at different locations (young-old), cricoid split (young-old), suturing cartilage, closing defects with autologous cartilage (young), biomaterials (young) and newly engineered cartilage in 4- and 24-week-old rabbits (series of ten animals). Cartilage of the young rabbit and child have similar hyaline cartilage with a varying distribution in thickness. Thinner areas are more susceptible to malformations. Incisions through younger cartilage give rise to some new cartilage formation covered by a new layer of perichondrium: through older, differentiated cartilage the incision causes superficial but permanent necrosis. Edges of cut cartilage mostly do heal by formation of fibrous junctions. This forms a weak spot, sensitive to deviations. The same fate goes for the healing between the autologous graft and the surrounding pre-existent cartilage. Trauma parallel to the surface, leads to inconsistent quantity of neocartilage. With ageing the wound healing and regenerative capacities decrease. In general, biomaterials are less accepted by the surrounding tissues and would impede further growth. Only newly engineered, and thus less differentiated (younger) cartilage of hyaline nature, appeared to be well accepted at the interface with the edges of a cartilage defect. There are indications that the release of growth factors might play a role in cartilage wound healing. In the child as well as the adult, wound healing of hyaline cartilage structures is incomplete, and surgery remains 'experimental' surgery. The clinical implications of gradual loss of the regenerative capacity of hyaline cartilage should be further investigated.

Ultrasound (US) of cervical tuberculous adenitis (CTA) was demonstrated to produce a characteristic pattern of the affected nodes in the majority of the patients in this study. The contribution of US to the diagnosis and assessment of CTA is evaluated. It is concluded that, since the other diagnostic tests for CTA are not reliable and/or time-consuming, the demonstration of nodal calcifications, conglomerate nodal masses and spread into the subcutaneous tissues at US in patients with elusive cervical masses may result in earlier recognition of CTA.

Earlier studies in young growing rabbits have suggested that post-traumatic developmental deformities of the cricoid might play a role in failing treatment in children with similar injuries. Specific patterns of malformations in the animals occurred preferentially at the anterior side of the cricoid ring. In this study, the growth dynamics of the cricoid were studied by histometry and autoradiography. Results indicated that (1) the cell/matrix ratio remains unchanged from 4 to 24 weeks of age, with both tissue components thus contributing equally to growth of the cricoid; (2) mitoses occur in cartilage and perichondrium, indicating interstitial as well as appositional growth; (3) mitotic activity is mainly restricted to the first 4 weeks of life, while cell hypertrophy is thereafter the dominant feature; (4) the highest degree of mitotic activity and cell hypertrophy is found in the anterior half of the cricoid ring which therefore can be considered as a growth center. This center might play a role in the development of trauma-induced deformation in the anterior part of the cricoid ring.

The outcome of surgical interventions is largely depending on the quality of wound healing of the tissues. In children, a second aspect of paramount importance is the effects on further growth.

Background. Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. Methods. To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a selfreport questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. Results. Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 Iarynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. Conclusions. This study indicates that T1 Iarynx patients report many physical complaints even though several years had elapsed since treatment. Also, Iaryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.

We studied the effects of superficial and deep endolaryngeal trauma of the subglottic airway in young and adult rabbits. In both age groups a soft stenosis was formed as long as the cartilaginous cricoid ring is not involved. This stenosis comprised a thickened subepithelial zone of scar tissue, separated from the cricoid cartilage by a layer of fatty tissue. Injury of the internal side of the cricoid cartilage induced a compact mass of scar tissue with local differentiation into fibrocartilage. In young animals only, injury of the cartilage led to remodelling of the cricoid ring (indentation or collapse of the traumatized sectors). On the basis of the differentiating effects of age and depth of the lesion, three histopatholog-ical types of subglottic stenosis were distinguished. The experimental results provide an explanation for the variability in the histopathological features of the wall of the stenotic subglottic airway, as observed in biopsies and postmortem specimens.

The effects of a Rethi procedure upon the cricoid is investigated in young rabbits. An anterior and posterior cricoid split carried out upon the larynx of a young rabbit was demonstrated to result in an enlarged cricoid lumen in the adult stage due to an enhancement of both the anterior and posterior transversal diameter of the ring. These changes are ascribed to a release of interlocked stresses in the cricoid cartilage and the action of the cricopharyngeal and cricothyroid muscle.

In this study the feasibility to reconstruct the anterior laryngeal wall in adult rabbits with a composite graft of demineralized bovine bone matrix and autogenous perichondrium was investigated. It is demonstrated that demineralized bovine bone, which is a porous biomaterial, is completely transformed into autologous cartilage, once it is implanted in a vascularized perichondrial pocket. It appeared to be possible to reconstruct the anterior laryngeal wall in adult rabbits with this newly formed cartilage. As the biomaterial has been transformed into autologous tissue it is entirely incorporated at the recipient site giving rise to solid connections (cartilaginous and/or fibrous) with the surrounding tissues.

With modern diagnostic imaging techniques, the head and neck oncologist is faced with increasing information on the status of neck nodes of patients with head and neck cancer. It is often difficult to include this new diagnostic information in clinical management because strategies of neck treatment date from times when only clinical examination was available. Computed tomography, magnetic resonance imaging, and ultrasonography (US) may provide information on the status of neck nodes. In the University Hospital Leiden and the University Hospital Rotterdam, US of the neck, when combined with ultrasonographic fine-needle aspiration biopsy (US-UGF-NAB), has proved to be an accurate diagnostic test for nodal disease. The combined procedure is characterized by high sensitivity and specificity. Therefore, this technique is suited for detecting, demonstrating, and excluding nodal metastases. This article will discuss how to interpret the new diagnostic information supplied by US-UGFNAB. A different approach in the clinical management of the neck, based on techniques from the field of clinical decision analysis, will be presented. It is concluded that US-UGFNAB is a promising concept of methodic use of both cytologic examination and an imaging technique in the examination of patients with squamous cell carcinoma of the upper aerodigestive tract. Application of the test may produce an accurate classification of patients with a head and neck tumor and change indications for elective and therapeutic neck treatment.

Ultrasound of the neck is, when combined with ultrasound-guided fine-needle aspiration biopsy (UGFNAB), an accurate test for nodal disease in patients with head and neck squamous cell cancer (HNSCC). The combined procedure is characterized by high sensitivity and specificity. Therefore, the technique is suited for demonstrating, detecting and excluding cervical metastatic disease. This paper will discuss how to interpret the diagnostic information supplied by US-UGFNAB. It is concluded that US-UGFNAB is a promising concept of methodic use of both an imaging technique and cytopathologic examination in the evaluation of patients with HNSCC. Application of the combined procedure may produce a more accurate classification of these patients and may change indications for therapeutic and elective neck treatment. In addition, US-UGFNAB may prove to be valuable during follow-up of patients with HNSCC, in the accurate preoperative assessment of the carotid artery in patients with metastatic neck disease, and the detection of lymph nodes in patients with malignancies other than HNSCC.

Ultrasound and palpation findings of 17 patients with branchiogenic cysts were studied. Results were compared with operative and histopathologic findings in 13 patients, and to fistulography, cytologic examination and/or CT in 4 patients. Ultrasound findings (appearance, location and extension) were characteristic in 15 of 17 cases. Palpation proved to be incorrect or inconclusive in more than half of the patients. It is concluded that ultrasound examination of the neck may contribute to the correct presurgery diagnosis of branchiogenic cysts.

The purpose of this study was to determine the value of ultrasound examination in the diagnosis of thyroglossal duct anomalies. The ultrasound and palpation findings in 24 patients with a thyroglossal duct anomaly were reviewed. Cysts, tracts and ectopic thyroid tissue appeared to produce a characteristic ultrasound pattern in most cases. This study includes 5 patients with non-symptomatic lesions which were detected at ultrasound examination. The necessity of performing a radionuclide scan prior to surgery for a thyroglossal duct anomaly is reconsidered in view of the diagnostic power of ultrasound in thyroid disease.

In young and adult rabbits the effects of one anterior or two bilateral splits of the cricoid were studied. Interruption of the cricoid ring elicits wound healing of the cut edges and induces changes in form and size of the separated parts of the cricoid (indirect effect). It was demonstrated that with increasing age i) the wound healing capacities of the hyaline cartilage is highly diminished or lost and ii) the induced remodelling, involving the total ring in young animals, is in the adult stage confined to the posterior part. Moreover, the observations suggest that dividing the cricoid ring in an anterior and posterior part at a young age can result in a stimulation of growth of the anterior part, in comparison with unoperated control animals.

Background Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors' knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients. Methods A total of 133 consecutive head and neck carcinoma patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. Results During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment. Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who were more physically self-efficacious (i.e., higher perceived physical abilities) were more likely to survive and less likely to develop a recurrence. In addition, patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings. Conclusions The current findings linking physical self-efficacy and prognosis are promising, but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence. Also, the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients.

The Union Europeen des Medecins Specialistes (UEMS) has been promoting harmonization of specialist training programs in Europe. Anticipating a future contribution to a European standard for training specialists for tertiary care of children with otorhinolaryngology (ORL)-related problems this Round Table was organized by ESPO. The presentations refer to six European countries. The number of ORL specialists (including pediatric ORL specialists) appeared to vary from +/- 8 to +/- 1 per 100,000 inhabitants, suggesting significant differences as far as their contribution to health care is concemed. Numbers for pediatricians vary from 12 to 3 and for family doctors from 50 to 100 per 100,000. In two countries pediatric ORL has the status of an official sub-specialty for tertiary care, requiring at least 2 years of additional training for qualified ORL specialists. In three other countries specific centers for pediatric ORL are present, although the sub-specialty has no official status. In the last a center for pediatric otorhinolaryngology has not yet been established and facilities for training in pediatric ORL are not available. For each country various aspects of current practice of tertiary ORL care for children are presented. It is concluded that a European standard for pediatric ORL could be most useful, if it would not only refer to current diagnostic and therapeutic skills but also to relevant scientific knowledge and skills. However, it should be recognized that the relevance of today's standards is restricted, as medicine and medical technology are rapidly developing. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

The effects of elevation of the perichondrium of the nasal septum, whether or not followed by resection of the cartilage, was histologically studied in young rabbits. The perichondrium has proved to be a highly reactive tissue. The degree of reaction varied from a transient oedema to the production of large quantities of cells, differentiating into new cartilage. The type of reaction appeared to depend on the conditions at the inner surface of the elevated perichondrium. The new cartilage differs from the original septal cartilage in morphology and growth potential. The data described above can contribute to the interpretation of previous observations in children.

Investigations of wound healing of the cricoid cartilage, its epithelium and subepithelial layer were performed in an experimental model. Each experiment comprised 10 young rabbits at the age of 4 weeks with a standard follow-up period of 20 weeks (to adulthood). Endolaryngeal lesions could be restricted to the soft tissue lining (epithelium + subepithelial layer), or they could also involve the perichondrium and the inner side of the cartilage. Splits were performed at different sites: anteriorly, bilaterally or antero-posteriorly, along with additional combinations. Assessment was performed by endoscopy and histopathology. The latter comprised 5-J1m sectioning in the horizontal and sagittal planes. The structure of the larynx of rabbits remarkably corresponds with that of man: the organization of the different cartilaginous parts and their interrelation, the structure of the respiratory epithelium and the subep­ ithelium with vessels, glands, and most important, the elastic system (1). An endolaryngeal injury with traumatization of the epithelium, the subepithelial layer, and the internal side of the cricoid can lead to major anomalies just I week after surgery. The epithelium has already regenerated, but in disorderly fashion with thick, multilayered parts next to thin parts with cubic cells. Enormous thickening of the subepithelial region demonstrates a large quantity of blood vessels and a loose netting of fibrous tissue. Even the cartilage demonstrates important deformations, of which inconsistent thickness is the most conspicuous. The lumen has narrowed, sometimes to a degree incompatible with life. Twenty weeks after intervention, the oval cricoid ring is transformed into a deformed, sometimes pear­ shaped ring with sideward or anterior collapse; the lumen has been decreased

To assess the impact of lateral nasal wall surgery on sinonasal growthTwenty young New Zealand White rabbits, 6 weeks of age, were included in this experimental study. Surgery was performed on two groups of ten animals each (series I and II). Entrance to the left nasal cavity is achieved through the nasal dorsum via mobilization and rotation of the left nasal bone. Series I: partial resection of the lateral nasal wall (including the ostium to the maxillary sinus) on the left side. Series II: partial resection of the lateral nasal wall and anterior ethmoid. Follow-up period was 20 weeks. Twenty rabbits served as controls.In series I, all skulls have grown normally. In series II the nasal dorsum has also developed symmetrically. Snout length and growth of upper jaw are normal; there is no malocclusion. Three skulls show a slight deviation of the nasal dorsum (two to the left, one to the right). Morphometric measurements of 20 points on the skulls show no significant difference between the control group and the experimental series I and II.This experimental study demonstrates that visually controlled partial resection of the bony sinonasal wall, with or without resection of the anterior ethmoid does not affect later development of nose and upper jaw on condition that eventually underlying cartilage is preserved. Contradictory results from other experimental studies, previously published and concerning negative effects of sinus surgery, might be attributed to surgical traumatization of intranasal cartilage structures, in particular, the upper lateral cartilages.

The potential of Information and communication technology (ICT) as a method to improve care is widely acknowledged. However, before ICT can be used in a specific patient population, the needs of that population must first be made explicit. In this paper we aim to explore the feasibility and functionality of an electronic information system to support head and neck (H&N) cancer care. We describe communication and information bottlenecks in supportive care for H&N cancer patients. These bottlenecks were used to determine the functionality of an electronic health information support system. We discern three perspectives of problems in H&N cancer care: lacking communication among professionals, lacking information about the disease and its treatment, and lacking supportive measures to reduce uncertainty and fear in patients. To support care, an information support system can facilitate (1) communication among all professionals involved and between professionals and patients, (2) professionals' and patients' access to information, (3) contact with fellow sufferers, and (4) early detection of patient problems by means of monitoring. Based on these analyses we subsequently built such a system and established a setting for evaluation. Information and communication technology can be tailored to address the communication and information bottlenecks in supportive H&N cancer care. As we aim to investigate whether care for H&N cancer patients may benefit from ICT, we are currently performing a clinical evaluation study.

Objective: to study the histopathology of subglottic stenosis in children of different ages after treatment during different periods of time, with or without laser application. Partial resection of the anterior cricoid with adhering stenotic subglottic area in the live young patient provides unique material for studying wound healing and scarring processes. Methods: 25 specimens obtained from partial cricotracheal resection (PCTR) in children, were histologically processed and stained with Haematoxylin and Eosin, Resorcin and Fuchsin (for elastic fibers), and immunohistochemical staining (for the presence of macrophages). Results: all specimens were found to have severe and sclerotic scarring with squamous metaplasia of the epithelium, loss of glands and elastic mantle fibers (tunica elastica), and dilation of the remaining glands with formation of cysts. Also, the cricoid cartilage was affected on the internal and external side, with irreversible loss of perichondrium on the inside and resorption by macrophages of cartilage on both sides. Detrimental effects of laser therapy were demonstrated in four cases. The normal intercellular matrix was completely destroyed and the number of chondrocytes in the cartilage structure diminished. Conclusion: wound healing after laryngeal injury is a process of intense restoration and reorganization of the various tissues involved. This process, however, does not guarantee complete repair. In the severe cases irreversible scarring has replaced normal tissues. There seems to be no direct relationship between the length of the post-lesional period, the age of the patient and the severity of the stenosis. When subglottic stenosis has developed and the majority of the tissues is replaced by dense fibrous tissue, PCTR is strongly indicated to achieve renewed patency of the airway.

In this study an animal model was developed for evaluation of the feasibility of cartilage grafts. In the cartilage of the external ear of the rabbit multiple holes, 6 mm in diameter, were punched, leaving the adherent skin intact. Different experimental groups were evaluated. First, the punch-hole model was validated under various conditions to study spontaneous or perichondrial initiated regeneration of the cartilage defect. When both cartilage and perichondrium was excised no spontaneous repair of the cartilage defect was observed. When perichondrium is present, variable patch-like closure of the punch hole was found. As 'golden standard' a punched out piece of cartilage was reimplanted directly. This condition showed adequate closure of the punch hole, however, no perfect integration of graft and surrounding cartilage was observed. Secondly, to evaluate the 'punch-hole model' a biomaterial, trabecular demineralized bovine bone matrix (DBM), was implanted and tested as a scaffold for tissue engineering techniques in vivo and in vitro. Direct implantation of DBM did not lead to any cartilage formation to close the defect. In vivo engineered cartilage, generated by enveloping DBM in perichondrium for 3 weeks, could adequately close the punch hole. When DBM was seeded with isolated chondrocytes in vitro before implantation in the defect, a highly fragmented graft, with some islets of viable cells was seen. To promote an efficient and reliable evaluation of cartilage grafts a semi-quantitative grading system was developed. Items such as quality, quantity and integrity of the cartilage graft were included in a histomorphological grading system to provide information about the properties of a specific cartilage graft. To validate the grading system, all conditions were scored by two independent observers. An excellent reliability (R = 0.96) was seen between the observers. In summary, the rabbit pinna punch-hole model is a reliable and efficient method for first evaluation of cartilage grafts. The results can be easily analyzed using a semi-quantitative grading system.

Nowadays Europe encompasses more than 30 countries. These countries differ in climate, in culture, in population density, in history, in socio-economic system and in the organization of medical care. Despite these differences there is a general trend of unification in politics, in industry and in science. In the field of medicine, medical faculties and professional organizations try to harmonize medical curricula and training programmes for medical specialists.

Thirty young patients with acquired laryngeal stenosis were treated by means of a laryngofissure and stenting. The age distribution suggested two subgroups: infants aged 0-2 years (n = 24), and children aged 6-16 years (n = 6). The causes of the stenosis and the treatment results were different in these subgroups. Treatment resulted in successful decannulation in 22 of 24 infants, and in 5 of 6 children. Treatment included a re-operation in two patients. In 1 patient the therapy failed, and 2 patients died after fatal complications. Decannulation rate, duration of the tracheotomy, and the number of re-operations compare favorably to the results of other centers. The longer duration of stenting, and the high mortality rate may be considered disadvantages.

Surgeons and orthodontists are still challenged to achieve 'better' noses for children with a unilateral cleft or lip, alveoulus and palate (UCLP). Various aspects are discussed: infant anatomy and later changes, developmental mechanics, cleft syndrome in animals with surgically produced facial clefts, untreated patients with congenital clefts, the radical primary correction of the UCLP nose, the unsolved problems in secondary rhinoplasty and suggestions for scientific communication.

For the first time it was observed in a boy that a xenogenic implant of demineralized bovine bone matrix, enfolded in a pedicled flap of autogenic ear perichondrium, was transformed into autogenic cartilage. This new cartilage could be adequately used as a graft to bridge the cartilaginous defect of a nasal septum perforation. The defect was successfully closed by a technique employing four bipedicled mucosal advancement flaps of the septum and the nasal floor. The result of this pilot study, which is based on experiments in growing rabbits, appears to open the possibility to create de novo young and growing autogenic cartilage of substantial quantity in children, without the loss of the cartilage present.

The failure to extubate a preterm infant after prolonged intubation is often caused by laryngotracheal injury. This condition is treated by tracheotomy, anterior cricoid split, or often, by reintubation and subsequent extubation attempts in a later stage. To assess the value of reintubation as treatment of post-intubation injury, we retrospectively studied a group of preterm infants from the neonatal intensive care unit in the Sophia Children's Hospital. Three categories of injury were distinguished according to the findings at laryngobronchoscopy: (a) edema or superficial lesions, (b) ulcerations and edema and (c) granulations. Twenty-three infants were therapeutically reintubated after post-intubation injury was diagnosed, for a mean period of 17 days. The therapy was successful in 22 patients, and a failure in one. The follow-up period was a mean 34 months. The result and the duration of the treatment vary with the category of the injury and the condition of the patient. Therapeutic reintubation is compared with alternatives such as anterior cricoid split and tracheotomy. We conclude that reintubation is a valuable therapy that should precede the decision for surgery.

Clinical and anatomical features of laryngoceles are reviewed. Furthermore, the ultrasound characteristics of 8 patients with laryngoceles are outlined. Internal laryngoceles appeared to be echo-free, well-defined structures inside the thyroid cartilage. Combined laryngoceles had an additional cystic mass outside the laryngeal skeleton, at the thyrohyoid membrane. Characteristically, this cystic mass was connected through the thyrohyoid membrane to the intra-laryngeal mass. Finally, the value of ultrasound examination in the diagnostic work-up of patients with laryngoceles is appreciated and compared to the respective values of ENT examination, conventional tomography and CT.

Using the nose of growing rabbits as an experimental model, the effects on nasal growth of various Killian-type partial resections of the cartilaginous septum were studied. Larger resections in young animals caused decreased height and length of the nose in the adult stage. Partial resection of the basal rim of the cartilaginous nasal septum demonstrated no effects on the postnatal growth of the nasal dorsum. This is in agreement with the hypothesis that the growth of the nasal dorsum is mainly the result of expansion of an area of thick cartilage within the nasal septum extending from the sphenoid to the nasal dorsum.

In growing rabbits, the feasibility of a new type of composite graft for the reconstruction of defects in the cricoid ring is studied. This graft consists of Demineralized Bovine Bone matrix (DBBM) enfolded in a perichondrial flap. The cartilage formed in the DBBM by cells, derived from the perichondrium, is demonstrated to provide a valuable substitute for resected parts of the cricoid. A specific feature of this reconstruction is that it allows further growth and does not result in a secondary stenosis during later development.

In an experimental study in growing rabbits an endolaryngeal injury to the subglottis resulted in the development of a stenosis due to the formation of scar tissue containing ectopic cartilage. For comparison, biopsies taken from the subglottic stenosis in 8 children were studied histologically. In 6 cases ectopic cartilage was observed; all patients had a history of endotracheal intubation. In 3 children the diagnosis hamartoma was made. In the remaining 3 cases the formation of ectopic cartilage might have been a direct reaction to the endolaryngeal intubation. The observations suggest that the formation of ectopic cartilage in acquired subglottic stenosis is not always due to a developmental aberration such as a hamartoma.

• The assessment of nodal involvement in patients with squamous cell carcinoma of the head and neck is still a major diagnostic problem. Although the sensitivity of imaging techniques for detection of neck nodes is gradually improving, the specificity for metastases remains low. Cytologic examination could, theoretically, supply additive information. Computed tomographic—and magnetic resonance—guided aspiration techniques have been described, but these were not efficacious and laborious. In 1984, we developed a technique for ultrasound-guided (UG) fine-needle aspiration biopsy (FNAB). This technique is described herein, and the value of UGFNAB is compared with conventional FNAB. All statistical characteristics of UGFNAB appeared to be superior to conventional FNAB (sensitivity, 98% vs 88%; specificity, 95% vs 82%; positive predictive value, 98% vs 93%; negative predictive value, 95% vs 74%; and accuracy, 97% vs 87%). Furthermore, UGFNAB was characterized by less nondiagnostic aspirations. It is concluded that UGFNAB is a reliable technique for differentiation between benign nodes and cervical lymph node metastases and it may, therefore, contribute to a more accurate assessment of the neck in squamous cell carcinoma of the head and neck. ( Arch Otolaryngol Head Neck Surg . 1991;117:402-404)

In young rabbits the effects were studied of an anterior midline and a bilateral split with and without traumatisation of the perichondrium and subperichondrial cartilage on the inner side of the ring. Various interventions produced specific patterns of distortions. It is concluded that release of interlocked stress in the cartilage is of paramount importance for the development of deformities. A specific feature of the circular cartilaginous structure seems to be that the tensile forces on the outer side of the ring exceed those on the inner side.

Deep neck abscesses may still result in significant morbidity and mortality. Surgical therapy carries the risk of damage to cranial nerves and arteries. Excellent results of ultrasound-guided percutaneous catheter drainage of abdominal abscesses led us to apply this technique to the management of deep neck abscesses. Five patients were treated with ultrasound-guided catheter drainage and antibiotics. All patients were cured without complications or recurrences. We consider this cheap and highly effective treatment as a valuable alternative to conventional therapy.

Introduction. The objective was to study the complex interactions among psychosocial, medical, behavioural and demographic variables as they relate to survival and relapse in this type of patient.1 Methods. A total of 133 consecutive patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. Results. During the observation period, 57 patients died whereas 76 were still alive 6 years after treatment. Results of the multivariate survival analysis indicate that patients without neck metastases had a better prognosis than patients with positive neck nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who are more physically fit were more likely to survive and less likely to suffer a relapse. Also, patients who expressed a high intensity of psychosocial complaints prior to the treatment had a better prognosis than had those who did not express such negative feelings. Conclusion. The current findings linking physical fitness and prognosis are suggestive, but clinical trials are necessary to examine the direct and indirect pathways of the variables that underlie physical fitness and influence survival and relapse. The finding of the poor prognostic value associated with an inability to express negative feelings is consistent with a growing body of research knowledge.