[Guideline: Treatment of obstructive sleep apnea in adults]. / Leitlinie: Therapie der obstruktiven Schlafapnoe des Erwachsenen.

The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.

Risk factors and dose-effect relationship for osteoradionecrosis after hyperfractionated and conventionally fractionated radiotherapy for oral cancer.

A high frequency of osteoradionecrosis after hyperfractionated radiotherapy (RT) of head and neck tumours led to a detailed analysis of risk factors in the dental, surgical, and radiotherapeutic areas. 168 patients with oral cancer were analysed retrospectively. 19% of them had been irradiated primarily and 81% postoperatively. 116 patients received a total dose mostly ranging from 60 Gy to 70 Gy to the ICRU 29 reference point (daily single dose 2 Gy). 52 patients were treated hyperfractionally with two daily fractions of 1.2 Gy per day, 4 h minimum apart and a total dose 82.8 Gy. Dental findings could be evaluated in 126 patients. Factors were checked for prognostic significance for osteoradionecrosis (ORN). Dose dependency was computed using a PROBIT analysis. Dental status before radiotherapy was generally poor (mean 11/32 teeth present, of these 1 was dead, 2.4 carious, 2.4 loose, 0.3 destroyed). On average, six teeth (range 0-27 teeth) had to be extracted. In one-third of the patients bone surgery was necessary. ORN occurred in 8.6% of the patients treated conventionally but in 22.9% of those treated hyperfractionally (p = 0.029). Biologically effective dose (p = 0.032) and deep paradontitis (p = 0.034) proved to be significant risk factors for ORN. PROBIT analysis showed a steadily rising dose dependency of the ORN frequency after conventional radiotherapy. Using total doses up to 70 Gy the frequency of ORN was 8.6%. Dose escalation using hyperfractionation led to an intolerable ORN frequency (22.9%) where a short interfraction interval was a significant factor. The use of this dose fractionation was therefore discontinued in 1992.

[Retrospective and prospective studies of patients with Cogan I syndrome]. / Retrospektive und prospektive Untersuchungen an Patienten mit Cogan-I-Syndrom.

Since August 1987 we documented the course of three patients with Cogan-I-Syndrome (CS) (interstitial keratitis and audio vestibular disorder). The patients (2 female, 1 male) received oral protease therapy in addition to the corticosteroids. Under oral treatment with proteases the corticosteroid therapy could be discontinued. Regression of inflammatory reaction and improvement of hearing was encountered in all patients. In two cases alpha-1-antitrypsin (AAT) serum levels were profoundly reduced, reaching normal range during therapy. Concomitant to the raise of this parameter improvement of hearing and general status could be encountered. In all 3 cases pathological leukocytosis normalized under treatment with proteases. All patients had increased IgA-levels against varicella zoster virus (VZV) indicating a reactivation.

[Combined surgical flaps for simultaneous reconstruction of the tongue, mouth floor and pharynx in expanded glossectomy within the scope of multi-modal treatment of squamous epithelial cancers of UICC stage IV]. / Kombinierte Lappenplastiken zur simultanen Rekonstruktion von Zunge, Mundboden und Pharynx bei erweiterter Glossektomie im Rahmen einer multimodalen Behandlung von Plattenepithelkarzinomen des UICC-Stadium IV.

Multimodal approach and improved surgical techniques enable the head and neck surgeon to operate even far advanced tumours of the head and neck under curative intention. Microanastomosed distant flaps and intestinal grafts expanded the operative spectrum while having the disadvantages of being time-consuming and in most cases the necessity to call for the specialist (e.g. the abdominal, vascular surgeon). In 6 cases of total glossectomy combined with hemipharyngectomy and hemimandibulectomy the possibilities of closing large defects by combined regional and pedicled flaps in the head and neck area are shown. In all of our cases surgical therapy had been placed at the end of therapeutic interventions in a multimodal treatment protocol. Treatment started with induction chemotherapy with a regimen including cisplatin, bleomycin and vindesin sulfate and was followed by a subsequent radiotherapy reaching a total reference dose of 60 to 70 Gy. After radiotherapy 5 patients received adjuvant chemotherapy of 1-4 cycles. Despite the aggressive presurgical treatment, the postoperative complications were minor. In a median survival of 37.5 months there were 3 recurrences, 2 patients died of tumour progression. All of our patients benefited from of the "salvage-operation" especially with regard to tumour pain. Quality of the patients' life could be improved upon by percutaneous endoscopic gatrostomy (PEG) and as well good functional and cosmetic results of the surgical reconstructions. The results justify the discussion about a palliative indication of extended surgical procedures and reconstructive surgery in far advanced head and neck cancer in the course of a multimodal treatment regimen.