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The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation.

To address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (B.A.) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure.A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure.Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery.Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis.Therapeutic, IV.

Objectives/Hypothesis To characterize the histologic and biochemical properties of auricular and septal cartilage and analyze age-related changes in middle-aged to older adults. Study Design Cross-sectional study of auricular and septal cartilage from 33 fresh cadavers. Methods Auricular and septal cartilage specimens were stained using Safranin O for glycosaminoglycans, Verhoeff's stain for elastin, and Masson's trichrome for collagen. Percentage of tissue stained, cell density and size were quantified. Relationships between donor characteristics and histologic properties were evaluated using mixed model analyses. Results The average donor age was 75 years (standard deviation = 11 years; range, 55–93 years). In auricular cartilage, each 1-year increase in age was associated with a 0.97% decrease in glycosaminoglycans (P < .001) and a 0.98% decrease in elastin (P < .001). In septal cartilage, glycosaminoglycans decreased 2.4% per year (P < .001). Age did not affect collagen content significantly in auricular (P = .417) or septal cartilage (P = .284). Cell density and cell size declined with age in auricular (both P < .001) and septal cartilage (P = .044, P = .032, respectively). Compared to septal cartilage in patients of all ages, auricular cartilage had more glycosaminoglycans, less collagen, higher cell density, and smaller cells. Conclusions In auricular and septal cartilage, glycosaminoglycans, elastin, cell density, and cell size decrease significantly with age in patients over 55 years of age. Glycosaminoglycan content declines faster with age in septal cartilage than auricular cartilage. These age-related changes may affect biomechanical properties and tissue viability, and thereby have implications for graft choice in functional, aesthetic, and reconstructive nasal surgery. Level of Evidence NA. Laryngoscope, 127:E399–E407, 2017

Es sind jetzt genau 107 Jahre her, seit Kraske [3] die Rectotomia posterior superior vorgestellt hat, die nach ihm benannt wurde. Bis zu diesem Zeitpunkt konnten die Chirurgen den Mastdarmtumor entweder nur peranal entfernen, wenn die Geschwulst entsprechend tief unten wuchs, oder durch Laparotomie, wenn der Tumor hoch genug lag. Alle Patienten mit einem Tumor im mittleren Rektumdrittel, der peranal oder vom Abdomen her entfernt wurde, verstarben. Die Low-anterior-Resektion nach Dixon [1] war ja noch nicht bekannt, auch nicht die abdominoperineale Rektumexstirpation nach Miles [5] oder das Durchzugsverfahren nach Hochenegg [2]. Kraske hatte nun die Idee, diese nicht operablen Tumoren im mittleren Rektumdrittel von hinten — also von der Kreuz-Steisbein-Seite aus — operabel zu machen, da ihm dieser Zugang als der einzig richtige Weg erschien. Er entfernte unter Schonung des 3. Sakralnervs den linken unteren Teil des Kreuzbeinflugels, um so besser an den in der Kleinbeckenhohle linksseitig liegenden Mastdarm heranzukommen. Der Patient wurde in Rechtsseitenlagerung bei angezogener linker Hufte gebracht. Der Schnitt erfolgte von der Mitte des Kreuzbeins bis knapp zum After hin. Kraske war uberrascht, wie gunstig dieser Zugang von hinten war und wie gut man das Rektum aus der Kreuzbeinhohle mobilisieren konnte. Er versuchte dabei, das Peritoneum nicht zu eroffnen. Die Anastomose nahte er am oberen Analrand. Erstaunlicherweise trat keine anorektale Kontinenzstorung auf.

Es wird uber einen Patienten mit bronchobiliarer Fistel, deren Ursache ein unspezifischer Leberabsces war, berichtet. Die kausale Therapie bestand in der Drainage des Leberabscesses, die Fistel heilte dann auch spontan ab. Eine primar thorakale Fistelsanierung ist in solchen Fallen nicht angezeigt.

Problems of 39 patients with permanent colostomies/ileostomies are investigated one up to seven years after having got the anus praeternaturalis. The postoperative problems of everyday life are various and often serious, they are the more severe, the less patients had been informed preoperatively and the older the patients are. Younger and more intelligent patients integrate the colostomy easier and more quickly in their everyday life. Very useful for rehabilitation is the close contact between patient and the surgeon, respectively special colostomy-consulting hours.

Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.

Transanal tumorectomy is an operation with continuing anal continence. With necessary indications give, this operation is justified both curatively and palliatively. Sphincter-stretching in combination with a lateral sphincterotomy of the Musculus sphincter internus and externus to two thirds their height is performed. This technique allows the resection of tumors in the rectum up to 12 cm from the anocutaneous line, a height that cannot be reached by dilatation only. The results from the First Surgery Department of Innsbruck University show that in more than 50% of patients submitted to transanal tumorectomy, this expansion of the operational angle was necessary to remove tumors.

An Hand von 8 eigenen Fallen wird die Problematik der Relaxatio diaphragmatica besprochen. Die Ursache war 4mal eine geburtstraumatische, 2mal eine iatrogene Phrenikusparese und 1mal eine angeborene Muskelhypoplasie des Zwerchfells. 4 Kinder konnten konservativ behandelt werden, 4 Neugeborene musten wegen Entwicklung eines schweren Atemnotsyndroms operiert werden.

Es wird uber die Haufigkeit von Rezidiven nach vorderer tiefer Rektumresektion und nach Resektion hoherer Dickdarmabschnitte wegen bosartiger Tumoren berichtet.

Es wird uber 2 Falle eines primaren malignen peritonealen Mesothelioms berichtet, die in den vergangenen 10 Jahren an der Chirurgischen Universitatsklinik Innsbruck behandelt wurden. An Hand der Fallberichte wird auf die Pathologie, klinische Symptomatik sowie auf die diagnostischen Moglichkeiten eingegangen und zur Therapie Stellung genommen.

In 32 patients with colorectal carcinomas, the immunoreactivity of carcinoembryonic antigen (CEA) was measured on section preparations of the tumours by means of a computer controlled microdensitometric method. By measuring numerous single points, the intensity of the immunohistochemical staining reaction of CEA was evaluated. This method is superior to the commonly used semiquantitative method (+, ++, ) for the assessment of various degrees of staining intensity whenever the antigen to be measured is not homogeneously dispersed in the tissue. The results show that highly differentiated colorectal carcinomas of stage A according to Dukes classification have a lower CEA immunoreactivity than highly differentiated carcinomas of stage B. A correlation between CEA immunoreactivity and degree of malignancy could only be found in patients in stage B. Stage C carcinomas of all degrees of differentiation appeared with a very low CEA immunoreactivity. CEA follow-up controls in our study were of little value for detecting local recurrences; metastases, however, almost always caused an increase in serum CEA titers. Prognostically, a preoperatively increased serum CEA level seems to be as unfavourable as a low CEA immunoreactivity in the tumour.

Es wird uber 3 Patienten mit einer ausgedehnten Zerstorung des anorektalen Sphinkterapparates berichtet, die zwischen 1964 und 1981 an der I. Universitatsklinik fur Chirurgie in Innsbruck versorgt wurden. Diagnostik und Therapie werden angegeben. Besonderer Wert wird auf eine genaue anamnestische, klinische, radiologische und neurologische Beurteilung des Sphinkters vor der Ruckoperation der Schutzkolostomie gelegt.

Es wird erstmals uber das Auftreten eines lokalisierten gutartigen Perikard- und Peritonealmesothelioms bei ein und demselben Patienten berichtet. Die bei der Behandlung gemachten Erfahrungen, sowie die diagnostischen Schwierigkeiten, Symptomatik, Histologie und Prognose werden dargelegt.

In the years 1971-1976 five patients with Dieulafoy's ulcer were operated upon succfully in the Innsbruck University Surgical Clinic. A high consumption of alcohol and tobacco was an outstanding feature in the history of all these patients. Gastroscopy is the diagnostic procedure of choice in this disease; it should be done during the acute phase of hemorrhage since the rather minor morphological changes often cannot be detected when they are not bleeding. Occluding the bleeding vessel by stitches is the therapy of choice. Procedure including resections, especially a socalled "blind" resection, do not seem to be justified. If the bleeding vessel cannot be found during endoscopy a large gastrotomy ought to be done with careful inspection especially of the upper third of the stomach. Our patients were followed up to 64 months; they all are well and without complaints. Prognosis thus seems to be very good if a correct diagnosis is established quickly and if surgery is done adequately.

A case of “bowenoid” leukoplakia in the anal region of a 31-year-old woman is presented to our knowledge for the first time in the literature. Clinically the lesion appeared as a “simple” leukoplakia. Although excision of the lesion was performed as histologically shown in toto, three recurrences followed. Both retinoid therapy and local treatment with 5-fluorouracil were unsuccessful, whereas radiation therapy apparently cured the patient.

We report 3 patients with traumatic renal artery thrombosis treated successfully with revascularization. The diagnosis was made preoperatively in 2 cases and intraoperatively in 1. Treatment consisted of reanastomosis with a saphenous vein patch on the side of the arteriotomy in case 1, an aortorenal artery saphenous vein bypass in case 2 and a bypass graft from the aorta to the distal renal artery in case 3. Two patients had functioning kidneys and normal blood pressure, and 1 patient died 24 hours after reconstruction.

The simultaneous appearance of a gastric ulcer with a duodenal ulcer or postulcerous changes is primarily caused by a duodenal ulcer. A gastric ulcer may occur secondarily; the possible causes of this development are discussed.

Etiology, pathophysiology, and clinical picture of local frost-injuries are described. By aid of literature, and by proper experiences in 49 patients, who had been treated at the University-Hospital of Innsbruck during the year of 1966 to 1973, therapy of local frost-injuries is discussed. Moreover the advantage of surgical therapy on the sympathicus over conservative treatment is pointed out.

Carcinoma arising in Zenker's diverticulum have to be thought of, if it has been present for long time, if there is blood mixed the food regurgitated, and if there are irregularities of the wall of the diverticulum to be detected radiologically. In most cases resection is the method of choice. A case of a 70 year old patient is reported, who harbored a microcarcinoma in the mucosa of a resected Zenker's diverticulum. Surgery was done 10 years ago and no recurrence or mestastases have been observed since.

An analysis of the complications occurring in permanent colostomies at Surgery Departments of Innsbruck University during the period between January 1969 and December 1977 showed that approximately 72% of all complications were primarily caused by operative shortcomings. It was therefore right and proper to investigate the causes of these operative shortcomings by means of physical considerations with the model and the preternatural anus and to analyse its most frequent complications in order to develop a colostomy technique which has so far turned out to be clinically successful in 32 controlled patients.

For the first time appearance of a localized benign pericardial mesothelioma and peritoneal mesothelioma in one and the same patient is described. The experiences made in the course of the treatment, the diagnostic difficulties, symptomatology, histology and prognosis are discussed.

Post-operative complications after colonic surgery because of malignant tumours were analysed in 412 patients from 1961 to 1974 at the Surgical-Clinic of Innsbruck University. 42% of the patients had postoperative complications. 60% of these complications were directly due to surgery, 40% indirectly. Attention should be paid to the fact that colonic surgery in particular has a high rate of complications, i.e. 76% of these cases seen in relation to 38% of routinely operated patients. With reference to all patients 18 different complications were observed. Causes of these complications and prophylactic treatment, likely to decrease the rate of lethality and complications are discussed.

Between 1961 and 1974 at the University Hospital Surgical Clinic at Innsbruck, 991 cases of malignant tumors of the colon have been treated. Statistically a significant increase is proved in the number of these patients above the age of fifty in the Tyrolean population during this period. On the other hand the percentage of colon-tumors is decreasing with the age in patients younger than fifty. 412 out of these 991 cases could be analysed very carefully. The malignant tumors have been studied, among other respects, in relation to the localisation in the particular part of the colon, the frequency in the different ages and sexes. Specially the symptoms due to the particular localisation of the tumor are stressed. It is also noticed that the long case history, mainly because of the patients' own negligence, plays a decisive part in the unsatisfactoring number of cured. Some measures are mentioned, which with the so far got knowledge and science can improve the final therapeutic results.

At the First University Clinic for Surgery Innsbruck a benign, scarred stenosis in the anal canal was found in 14 patients between 1975 and 1981. This stenosis turned out to be the cause of an anorectal incontinence. This stenosis results in a hampering of important organs in the anal canal that are conducive to continence. Therapy, therefore, aims at a restoration of continence. Within this therapy, removal of the stenosis is the first and most important step.

The effects of the main lipoprotein density classes on the human adipose tissue lipoprotein lipase activity were studied. A dose-dependent stimulation of lipoprotein lipase activity was obtained for HDL and, to a lesser extent, for VLDL on a constant weight basis. LDL exerted virtually no effect. At higher concentrations, HDL as well as VLDL inhibited the stimulated lipolytic activity. In type V hyperlipoproteinemia, the stimulating effect of VLDL and of HDL was significantly lower, whereas the inhibiting action of HDL was markedly increased.

The course of treatment with polychemotherapy for the progressed and metastasized breast-carcinoma is discussed. The therapy with cytostatics must be continued for the patients entire life. A sample of 27 patients from the Chir; Univ.-Klinik Innsbruck with a course of treatment lasting from 15 to 29 months (October 1973 resp; December 1974 to February 1976) showed a success rate of 81%.

The operative results of 115 patients with pilonidal sinus are described. The patients were controlled in 1977, 2 to 11 years after surgery. Only small, non-infected pilonidal sinuses should be radically excised followed by primary suture and Redon-drainage. For extended sinuses and for recurrences the best results are obtained when the wound is left open or marsupialisation is applied. Pilonidal sinus-abscesses should be incised. This simple procedure resulted in primary healing in 23% of our patients.

Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.