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The German S3 guideline on diagnosis, treatment, and follow-up of laryngeal cancer was developed in 2019 as part of the oncology guideline program of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG) and German Cancer Aid (Deutsche Krebshilfe, DKH), published under the leadership of the German Society for Otorhinolaryngology, Head and Neck Surgery. The guideline was funded by DKH as part of the oncology guideline program. Since guidelines are an important tool for quality assurance and quality management in oncology, they should be incorporated into everyday care in a targeted and sustainable manner. The guideline should generally fulfil the interdisciplinary character of early diagnosis, diagnostics, treatment, rehabilitation, and follow-up, with the aim of developing evidence- and consensus-based recommendations and statements for treatment of laryngeal cancer with the aim of organ preservation, but also show their limits. The main recommendations of the original text are summarized. The guideline is available as a long and a short version in the guideline program of the DKG ( https://www.leitlinienprogramm-onkologie.de/leitlinien/larynxkarzinom/ ) and also as an app ( https://www.leitlinienprogramm-onkologie.de/app/ ).

Surgical therapy, regardless of the procedure, remains of great importance for today's treatment of oropharyngeal carcinomas, despite advances in radiation and immunotherapy. The individual treatment plan should be defined in discussion with the patient and in an interdisciplinary tumor conference, taking into account the likelihood of achieving of tumor-free resection margins and an acceptable postoperative quality of life. With regard to conventional and possibly also open surgical procedures, a good overview of the surgical site-particularly in the case of more extensive carcinomas and challenging patient anatomy-and simplified reconstructability of the defect region are decisive aspects. Endoscopically, microsurgically, or even robot-assisted minimally invasive procedures have the advantage of precise and gentle removal of tumor tissue with improved maintenance of function. Overall, selection of the appropriate surgical procedure remains an individual decision based on tumor size, the facilities at the tumor center, and the surgeon's experience. The extent of surgical intervention, also with regard to simultaneous neck dissection, depends on tumor stage. In the case of oropharyngeal carcinomas, there will be an increasing distinction between human papillomavirus (HPV)-negative and HPV-positive tumors in the future; however, the therapeutic strategy is currently identical. Upcoming clinical trials will show whether treatment de-escalation is appropriate depending on HPV infection status.

Prognostic and predictive biomarkers for personalized treatment management in head and neck squamous cell carcinoma (HNSCC) are of great clinical interest.DNA methylation is an epigenetic process involved in gene regulation and could be a source of potential prognostic and predictive biomarkers.This study comprises literature research in PubMed and own studies.Gene methylation, e.g. of PITX2, is a strong, human papillomavirus (HPV)-independent prognostic biomarker. SHOX2 and SEPT9 methylation in circulating cell-free DNA within blood plasma correlates with tumor stage and prognosis. Methylation of diverse immune checkpoints, e.g., PD‑1, PD-L1, and CTLA4, is also prognostic and correlates with gene expression.DNA methylation is a source of efficient prognostic blood plasma- and tissue-based biomarkers. However, prior to clinical implementation, studies must prove that biomarker-guided treatment selection can lead to better outcomes or reduced toxicity. The applicability of DNA methylation as a predictive biomarker for targeted drug-based cancer therapy seems promising, although further validation is needed.HINTERGRUND: Prognostische und prädiktive Biomarker sind für eine personalisierte Therapiesteuerung beim Plattenepithelkarzinom des Kopf- und Halsbereichs (HNSCC) von klinischem Interesse.Die DNA-Methylierung als epigenetischer Mechanismus der Genregulation könnte eine Quelle geeigneter prognostischer und prädiktiver Biomarker sein.PubMed-Literaturrecherche und eigene Arbeiten.Methylierung von Genen, wie PITX2, ist ein starker, Human Papillomvirus(HPV)-unabhängiger prognostischer Biomarker. Die Methylierung von im Plasma zirkulierender zellfreier DNA von SHOX2 und SEPT9 korreliert mit dem Tumorstadium und der Prognose. Die Methylierung verschiedener Immuncheckpoints, beispielsweise von PD‑1, PD-L1 und CTLA4, ist ebenfalls prognostisch und mit der Genexpression korreliert.Die DNA-Methylierung ist eine Quelle leistungsstarker prognostischer Plasma- und Gewebe-Biomarker, jedoch muss vor einem klinischen Einsatz noch in Studien gezeigt werden, dass eine anhand von Biomarkern gesteuerte Therapiewahl zu einem verbesserten Überleben oder einer Reduzierung der Nebenwirkungen führt. Eine Eignung der DNA-Methylierung als prädiktiver Biomarker für eine zielgerichtete medikamentöse Tumortherapie erscheint vielversprechend, ist jedoch noch nicht ausreichend belegt.

Nowadays, social projects are usually oriented in such a way that after a given period of time, they can either support themselves independently or even allow a pecuniary reimbursement. In the latter case, experts speak of a profit-oriented reimbursement. On the other hand, there is so-called social reimbursement, which in contrast to the abovementioned form is not profit oriented, but, for example, considers its task fulfilled by the fact of successful knowledge transfer. The Spanish-German Society for ENT Medicine and Head and Neck Surgery (SDGHNO) launched the Latin America project in 2001 under the patronage of the then President Prof. Dr. Wolfgang Draf (Fulda). The goal of the SDGHNO was and is to create a professional as well as cultural platform for Spanish- and German-speaking ENT doctors. This platform can and should be used for professional purposes, e.g., for knowledge transfer. Since the beginning of its existence, the Latin America project has thus brought numerous scientific events into being and created specific contacts which have lasted until today or have even been continued and further developed. Particularly successful examples are Chile, Colombia, and Peru. This is a vivid example of social reimbursement, because the participating German-speaking members/speakers carried out their tasks on an entirely voluntary basis. Thus, the SDGHNO did not bear any travel, catering, or accommodation costs. The activities of the SDGHNO within the framework of the Latin America project are explained.

Aspiration (Larynx, Trachea oder Bronchien) bzw. Ingestion von Fremdkorpern (Hypopharynx, Osophagus, Magen oder Dunndarm) gehoren zu den relativ haufigen Verdachtsdiagnosen in der padiatrischen Akutmedizin. Sie sind mit einer relevanten pra- und innerklinischen Morbiditat und Mortalitat verbunden. Betroffen sind meist Kinder im Alter zwischen 6 Monaten und 4 Jahren. Ziel der vorgestellten S2k-Leitlinie gemas der AWMF – Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften ist die strukturierte Beschreibung der wesentlichen organisatorischen, diagnostischen und therapeutischen Aspekte fur die sichere, interdisziplinare Versorgung von Kindern nach Fremdkorperaspiration und -ingestion. Hierbei sind folgende 3 Aspekte essenziell: daran denken (Anamnese, Reevaluation), im Zweifel endoskopieren und das Vorgehen interdisziplinar absprechen.

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In interventional neuroradiology, endovascular embolization represents an important and helpful tool in the treatment of multiple head and neck diseases. These interventional procedures may be performed with curative intent, to reduce the surgical risk within a multimodal treatment concept, or to improve or at least maintain a good quality of life within a palliative therapy concept. In addition to a good understanding of disease pathology, knowledge of vascular anatomy, including collateral vessels and dangerous extracranial-intracranial anastomoses, is essential for successful treatment, as is implementation of an established technique using appropriate material. Indications for endovascular embolization are i. otherwise unmanageable bleeding (caused by e. g., trauma, vascular malformation, or tumor), ii. reduction of perioperative bleeding by preoperative embolization in case of a hypervascularized tumor, iii. selective induction of tumor necrosis by palliative embolization to enhance local tumor control. Major complications such as stroke, loss of vision, and cranial nerve palsy are mostly due to a lack of preinterventional evaluation. Regarding neurological deficits, interventions within the supply region of the external carotid artery have a complication rate below 1%.

Alongside clinical investigation, imaging is an important diagnostic modality for guiding treatment decisions and particularly for surgical planning in head and neck cancer. The significance and type of imaging depends on localization of the primary tumor. Beside the primary tumor, each imaging procedure must also include the lymph nodes, in order to develop an overall concept of surgical treatment. In addition to the superficial growth of a tumor, it is of utmost importance that its infiltration also be detected by imaging, in order to define the extent of tumor resection and identify potentially necessary reconstructive procedures. The type of imaging needed to understand tumor localization and size, e.g., CT or MRI, depends on the region. In some cases the methods are complementary.

The parapharyngeal space extends from the nasopharynx to the oropharynx. It is bordered medially by the pharyngeal wall and the constrictor pharyngis muscles, and laterally by the mandible. One distinguishes between a pre- and a poststyloid space. Tumors of the parapharyngeal space are rare and represent less than 1 % of all head and neck neoplasms. Benign (70-80 %) as well as malignant (20-30 %) tumors arise from different structures of the parapharyngeal space, mainly from salivary glands and nerve structures. Concerning salivary gland tumors, most are pleomorphic adenomas typically appearing in the prestyloid space, whereas the schwannomas that may also arise are located in the poststyloid space. The main symptom is dysphagia, with the tumor generally presenting as a visible bulking of the pharyngeal wall, in rare cases also as an externally visible cervical mass. Treatment is generally surgical resection, particularly in benign tumors, preferably via transcervical access. If R0 resection of malignancies is possible, this should be performed. In malignant lymphomas and nonresectable tumors, primary chemo-, radio-, or combination therapy should be considered after histologic confirmation. For neurogenic tumors, particularly vagal nerve schwannoma and especially in older patients, a wait-and-scan strategy is most favorable, since postoperative vagal palsy is unavoidable with surgical resection. Treatment planning for parapharyngeal space tumors requires good knowledge of topographic anatomy and careful evaluation of imaging findings.

Recurrence rate, time to progression, and facial nerve function were analysed by comparing patients with complete and near total tumor removal after suboccipital craniotomy for vestibular schwannoma surgery.From 1996 to 2004, 118 patients with vestibular schwannoma were operated with an interdisciplinary approach. Fifty patients fulfilled the inclusion criteria and were included in the study. Progression was defined as an increase of ⩾2 mm in the largest diameter in the magnetic resonance imaging. Preoperative tumor size, facial nerve function estimated using the House-Brackmann score (HBS), time to progression, and recurrence rate were analysed and related to the extent of resection.In 28 cases (group I), a capsular remnant was left. In 22 cases (group II), tumor removal was complete. In group I, nine patients (32·1%) showed progression. In group II, two patients (9·1%) developed a recurrent tumor, no significance (P = 0·085). In groups I and II, 53·6 and 59·6% had a good function of the facial nerve (HBS I+II), 28·6% in group I and 13·5% in group II had a moderate disturbance (HBS III+IV), and 17·9% in group I and 27·7% in group II had a poor function (HBS V+VI). There was no significant difference between median preoperative tumor size and facial nerve function within patients with HBS III and IV.Complete tumor removal may be associated with a risk of functional loss, whereas near total tumor removal may be associated with a higher risk of progression.

Die bei Kleinkindern sehr haufige akute Otitis media (AOM) entsteht meist durch tubogene Infektionen des Mittelohrraums mit Streptococcus pneumoniae, Haemophilus influenzae, Staphylokokken oder Pneumokokken, seltener auch hamatogen bei Virus- und bakteriellen Infektionskrankheiten. Mit der Verbesserung der Tubenfunktion beim Heranwachsen werden AOM seltener. Meist handelt es sich um eine ausgepragte Entzundung mit starken Ohrenschmerzen, Fieber, Rotung und Vorwolbung des Trommelfells, das spontan perforieren kann. Die AOM kann sehr unterschiedlich verlaufen, heilt aber meist folgenlos aus. Die Diagnose wird anhand des otoskopischen Befunds gestellt. Wichtig ist die rechtzeitige Erkennung der seltenen, aber bedrohlichen Komplikationen wie Mastoiditis, Sinusthrombose und Hirnabszess. Die Behandlung kann durch Nasentropfen oder -spray, Analgetika, Antipyretika, evtl. Parazentese und Adenotomie sowie eine antimikrobielle Therapie erfolgen. Bei Komplikationen ist eine Operation meist unausweichlich. In wenigen Fallen bleibt eine Trommelfellperforation zuruck (chronische Otitis media). Selten entwickelt sich uber diese ein Cholesteatom.

Early detection of cancerous lesions is still crucial for a patient's prognosis. Although diagnostic access to the oral cavity and oropharynx is comparably easy, the incidence of resulting disease remains high. This is due to the fact that in many cases, malignity is recognized too late on a purely visual basis. Previously, we discussed the application of hyperspectral imaging for early detection of precancerous and cancerous lesions of the larynx. This time, we evaluate the method in the oral cavity and oropharynx.In 85 patients scheduled for endoscopy, hyperspectral imaging was performed. We used a rigid 0-degree endoscope, a light-adjustable monochromator, and a hyperspectral camera. For evaluation of the method, 3 patients were chosen exemplarily. Training sites from physiological and cancerous tissues were marked. Hyperspectral data from 1 patient were used to train a classifier, which was then used for automatic detection of precancerous and cancerous lesions in another 2 patients.Intraoperative hyperspectral imaging was performed without any problems. Classification showed sensitivities of 61 and 43%, and a specificity of 100%.This proof-of-concept study underscores the high potential of hyperspectral imaging for early recognition of cancer in the mouth and oropharynx. Besides a better prognosis for cancer patients, this approach could lead to higher cost efficiency in the health system.

INDRODUCTION: The regular application of transit time flow measurement in microvascular anastomoses during heart surgery has lead to improvements of the outcome of coronary artery bypass grafts. Our study was meant to discover whether this measurement method was also applicable for evaluation and optimization of microvascular arterial anastomoses of radial forearm flaps.In this prospective examination a combining ultrasound imaging and transit time flow measurement device (VeriQ, MediStim) was used during surgery to assess anastomotic quality of 15 radial forearm flaps. Pulsatility index (PI) and mean blood flow were measured immediately after opening the arterial anastomosis as well as 15 min afterwards. Furthermore, application time and description of handling were recorded seperately for every assessment.Mean blood flow immediately after opening the anastomosis and 15 min later were 3.9 and 3.4 ml/min resepectively showing no statistically significant difference (p=0.96). There was no significance in the increase of pulsatility index from 22.1 to 27.2 (p=0.09) during the same time range, either. Due to measurement results showing atypical pulse curves in 2 cases decision for surgical revision of the anastomoses was made. All forearm flaps showed good vascularisation during follow-up. Time for device set up, probe placement and measurements was about 20 min. Handling was described to be uncomplicated without exception. There were no noteworthy problems.Transit time flow measurement contributes to the improvement of anastomotic quality and therefore to the overall outcome of radial forearm flaps. The examined measurement method provides objective results and is useful for documentation purposes.

Carcinomas of the mouth and pharynx rank sixth of all malignant tumours worldwide. They are responsible for 10% of the newly diagnosed malignant tumours. The median five year survival rate is 50%, depending on tumour localisation and size, but mainly determined by lymph node metastases. Carcinomas of the mouth and pharynx cause symptoms that resemble those of common harmless diseases of the head and neck such as pharyngitis. This can lead to misinterpretation by both, the patient and the doctor. Since the initial delay by the patient is difficult to influence it is very important that the doctor is aware of a possible malignant disease. Persistent common symptoms such as swallowing impairment or hoarseness, mucosal lesions, such as leukoplakia, a persistent cervical lymph node and unresponsiveness to initial treatment, must prompt the doctor to initialise appropriate diagnostic steps (incisional biopsy, e.g.). Only early diagnosis can help to improve the prognosis of patients with carcinomas of the mouth and pharynx.

Bacteria and viruses may be transmitted to laboratory rodents by contaminated biological materials such as transplantable tumours, cell lines, sera or other biological materials. Biological materials are currently being screened using the mouse or rat antibody production (MAP/RAP) test (serological testing). We decided to test and validate an alternative assay using polymerase chain reaction (PCR/realtime PCR) technology to detect viral contamination directly in biological material. The aim of this study therefore is the validation of our new PCR assays and the comparison of PCR and the MAP test. For 8/14 viruses, conventional PCR was more sensitive and more specific than the MAP test in detecting murine viruses. For 12/14 viruses, the realtime PCR was more sensitive than the MAP test. In 2/14 cases, all three detection methods had the same sensitivity. Furthermore, PCR screening clearly conforms to the principles of the 3Rs as a replacement technique because it eliminates the need for using animals to screen for murine viruses in biological material.

Ziel. Die peri- und postoperative Komplikationshaufigkeit der translaryngealen Tracheotomie (TLT) nach Fantoni sollte prospektiv ermittelt werden.

Taste dysfunction is a common side effect during irradiation of head and neck. Our aim was to determine the time-dependent course and a possible dependency of this side effect to the radiation-dose during irradiation with helical tomotherapy.31 patients with malignant tumours in the region of head and neck received an IG-/IM-radiotherapy (helical tomotherapy).The median total dose was 63 Gy (range 30-66 Gy). For all patients the subjective taste dysfunction was documented and correlated to the median (D50) tongue dose.A subjective taste dysfunction was registered by the patients themselves after 9 BT (days of radiotherapy) (median). This correlates to a mean dose (D50) of 15.3 Gy (back third of tongue (back ZD)), 11.3 Gy (middle ZD), 8.2 Gy (front ZD). A subjective ageusia occurred after 15 BT (median) (28.9 Gy (back ZD), 22.2 Gy (middle ZD), 17.7 Gy (front ZD)). A starting recovery was registered by 77% of the patients in the first 6-8 weeks after the end of radiotherapy.The time-dependent course of taste dysfunction during radiotherapy and the following recovery is predictable. A dependency of taste dysfunction to radiation-dose exists. Based on the collected data a targeted dose reduction to the tongue with a view to minimize the taste dysfunction is thinkable and aim of further studies.

Atypical mycobacteriosis is a rare cause of cervical lymphadenitis that most frequently affects immunoincompetent children between the ages of 12 months and 5 years. The typical clinical manifestation is a painless unilateral cervical mass. The nonspecific clinical symptoms and laboratory parameters complicate diagnosis and, therefore, therapeutic management. Various therapeutic options, including surgery, antimycobacterial drug therapy and wait-and-scan approaches are discussed in the literature. Complete surgical excision has become the established treatment of choice. However, controlled randomized studies that clearly demonstrate the benefits of a particular type of therapy are lacking.

Summary. A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. Magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. Aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin B (1 mg kg−1 body weight) plus itraconazole (Sempera®, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin B and 5-fluorocytosine. Neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1 : 2, Pastorex®) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis. Zusammenfassung. Bei einem 74jahrigen Mann mit insulinabhangigem Diabetes mellitus Typ II mit Retinopathie und Polyneuropathie kam es zur Entstehung eines Exophthalmus, auserdem traten Ptosis sowie Doppelbilder auf. Die Magnetresonanz-und Computertomographie deckten einen raumfordernden Prozes im rechten Orbitatrichter auf. Daraufhin wurde dieser unter gleichzeitiger Orbitotomie extranasal operativ ausgeraumt. Im exzidierten Gewebe aus dem Sinus ethmoidalis waren septierte Hyphen nachweisbar, in der Pilzkultur wuchs Aspergillus fumigatus. Die Pilzmassen wurden chirurgisch entfernt mit nachfolgender Therapie mit Amphotericin B (1 mg kg−1 Korpergewicht) plus Itraconazol (Sempera®, 200 mg pro Tag) uber sechs Wochen. Funf Monate spater verschlechterte sich der Zustand des Patienten mit folgenden Symptomen : Ubelkeit, Erbrechen und Schmerzen hinter dem rechten Auge sowie ein Exophthalmus. Erneut wurde Amphotericin B und 5-Flucytosin verabreicht. Eine Neutropenie bestand zu keinem Zeitpunkt. Es entwickelte sich ein somnolenter Zustand, so dass eine Meningitis vermutet wurde. Aspergillus-Antigen (Titer 1 : 2, Pastorex®) war im Liquor nachweisbar, dagegen keine Anti-Aspergillus-Antikorper. Sowohl das rechte Auge als auch die retrobulbaren Pilzmassen wurden eradiziert mittels Exenteratio bulbi et orbitae. Der Patient verstarb dennoch an einer sich entwickelnden Niereninsuffizienz sowie apallischem Syndrom. Die Autopsie zeigte ein mykotisches Aneurysma der Arteria carotis interna dextra mit Ruptur des Gefases und nachfolgender massiver Subarachnoidalblutung. Daruber hinaus wurde eine schwere mykotische Sinusitis sphenoidalis und Aspergillose der rechten Orbita nachgewiesen, die letztlich zu einer bifrontalen Meningitis gefuhrt hatte.

Das vertikal offene MRT-System mit supraleitenden 0,5-Tesla-Magnetspulen (Signa SP, General Electric) ist in besonderem Mase fur die interventionelle Diagnostik und Therapie geeignet. Wir sehen die Indikation bei der Biopsie schwer zuganglicher Tumore wie z.B. der Felsenbeinspitze, des Parapharyngealraums und der Orbita. Ferner ist das offene MRT bei der Beurteilung des Operationsablaufs und zur Navigation bei Eingriffen an den Nasennebenhohlen geeignet. In diesen Fallen kann intraoperativ das Ausmas der Gewebeentfernung beurteilt werden. Daneben erlaubt es eine genaue Einschatzung der anatomischen Strukturen, was sowohl an der Felsenbeinspitze (A. carotis interna) als auch im Bereich der Nasennebenhohlen (Schadelbasis, Orbita) von besonderer Bedeutung ist. Im offenen MRT integrierte virtuelle Pointer erlauben ein Navigieren. Der Vorteil gegenuber herkommlichen Navigationssystemen liegt in der Moglichkeit der annahernden Real-time-Darstellung, bei der auch Gewebeveranderungen, die wahrend des Eingriffs auftreten berucksichtigt werden konnen. Im Zeitraum von August 1996 bis Marz 1999 fuhrten wir im offenen MRT 10 Biopsien der petroklivalen Region und 2 Biopsien des parapharyngealen Raums bzw. nuchalen Bereichs, die Einlage von Afterloadingsonden in Tumormetastasen in 3 Fallen und 5 mikroskopgestutzte Nasennebenhohlenoperationen durch. Bei allen operativen Eingriffen zeigte sich die ausgesprochen gute raumliche Auflosung vor allem von Weichteilstrukturen. Mit Hilfe von speziellen Pointern oder Ausloschartefakten eingesetzter Instrumente konnten in allen Fallen sowohl die anatomische Strukturen als auch pathologisch verandertes Gewebe genau lokalisiert werden, so das das offene MRT als nutzliche Unterstutzung bei diesen Eingriffen angesehen werden kann.

PURPOSE Development of an helpful instrument for a better planning and orientation during MR guided interventions. MATERIAL AND METHODS We developed a reusable, sterilizable instrument that can be filled both with a solution of Gd-DTPA (1%) and with a sodium chloride solution (0.9%). The pointer has a diameter of 3 and 5 mm resp. and its length is 100-150 mm. The instrument can be combined with an interactive stereotactic tracking device. RESULTS The MR-Track-Pointer can be fixed to the two handpieces of the integrated interactive tracking system without problems. The pointer can be seen both on T1w and T2w sequences inside and outside of the tissue. This new instrument can be interactively used for reliable planning the biopsy trajectory, planning craniotomies and identifying structures which are only visible on MR images. CONCLUSIONS The MR-Track-Pointer is an ideal supplement for the integrated virtual tracking system. It permits a minimal invasive orientation and facilitates the exact localisation of suspect lesions in sensible regions during MR guided interventions, e.g. diagnostic biopsies and tumour resections.

Die tuberose Sklerose ist eine autosomal-dominant vererbte Phakomatose, die die klassische Trias viszerale Hamartome, Epilepsie und geistige Retardierung beinhaltet und sich im HNO-Gebiet mit ausgedehnten perinasalen Angiofibromen manifestiert. Letztere konnen ein mechanisches, blutendes und stigmatisierendes Atemhindernis bedeuten. Fur die Therapieplanung muss die Entartungstendenz der Lasionen und die Patienten-Compliance berucksichtigt werden. Vorgestellt wird eine 34-jahrige Patientin, die mit einer Kombination aus CO2-Laser-Behandlung und Fibrinversiegelung rasch und asthetisch sehr ansprechend behandelt wurde.

The degree of pain following different types of ear-nose-throat surgery varies greatly and must be adjusted on an individual basis. Post-operative pain therapy can be classified into basic pain therapy and additive pain therapy (as needed). Effective pain therapy can lead to lower morbidity and to considerable economic advantages. The subjective pain intensity experienced by patient should be the basis for the dose adaptation and is essential for rapid recovery.

Oropharyngeal cancer surgery often does not allow primary wound closure; furthermore, surgery of tumors in the base of the tongue, the soft palate and the lateral pharyngeal wall often lead to swallowing disorders and nasal twang which severely impair quality of life. Secondary scarring may also result in fixation of the tongue or stenosis of the pharynx. Therefor reconstructive techniques with free or pedicled flaps are essential to reduce functional impairment. In addition, after trauma or due to malformations, reconstructive surgery using flap techniques is sometimes indicated.