[Epidemiology of auricular trauma]. / Zur Epidemiologie von Ohrmuschelverletzungen.

BACKGROUND: Auricular trauma is rare but can seriously reduce self-acceptance and function. Epidemiologic data on the causes of trauma causes and patient characteristics are limited. PATIENTS AND METHODS: The case notes of 141 from 197 patients with ear injuries have been reviewed retrospectively according to trauma cause and to the distribution of age and gender. RESULTS: Two thirds of the documented cases occurred between the age of 11 and 40 years. Men outnumbered women at a ratio of 2 to 1. The most frequent causes for ear trauma were traffic accidents (43 %), accidents at home (33 %), and fights (14 %). CONCLUSIONS: Mainly younger and active groups of the population are affected by ear trauma. Therefore, it is of particular concern in the acute setting to select those therapeutic options that have turned out good aesthetic and functional results in the long-term perspective.

[Comparison of 2 endoscopic surgery techniques for reliable therapy of Zenker diverticulum]. / Vergleich zweier endoskopischer Operationstechniken für eine sichere Therapie des Zenkerschen Divertikels.

BACKGROUND: A mediastinitis or intraoperative bleeding are the most feared complications of the transoral laser assisted diverticulotomy of Zenker's diverticulum. To reduce these complications we developed a new endoscopic surgical technique and compared the results of this new method with the results of patients who we treated earlier. PATIENTS AND METHODS: At the department of Otorhinolaryngology, Head and Neck Surgery, University of Luebeck 68 patients suffering from a hypopharyngeal diverticulum have been treated since 1987. In 64 patients we performed an endoscopic diverticulotomy using a CO2-Laser and the Weerda distending diverticuloscope. Four of the Zenker's diverticulua had to be removed by an external approach. From 1987 to 1994 a five millimeter bar between pouch and hypopharynx after diverticulotomy was left and sealed with fibrin glue in the first 38 patients. From 1995 to 1999 the spur of the hypopharyngeal pouch of the other 26 patients was completely separated. Afterwards we sutured the mucosa between the pouch and the hypopharynx to close the opened mediastinal space and sealed the former spur with fibrin glue. RESULTS: Comparing both endoscopic methods we had to observe concerning our first method one mediastinitis, a rise of body temperature in 29 patients (76%) and we had to perform a revision diverticulotomy in three patients (8%). Our modified technique didn't cause any mediastinitis, a rise of body temperature did only occur in five patients (18%) and no patient had to undergo revision surgery. CONCLUSIONS: The transoral complete separation of the spur of the hypopharyngeal pouch with suturing the mucosa of the pouch and the hypopharynx causes good functional results and means a further reduction of complications and a further improvement of the endoscopic diverticulotomy. Our new instruments (Fa. K. Storz, Tuttlingen) will be demonstrated.

Two-step external ear canal construction in atresia as part of auricular reconstruction.

OBJECTIVES: One of the common complications of atresia surgery is restenosis of the surgically constructed external ear canal. To avoid this complication, a new two-step technique of creating an external ear canal was developed and evaluated. STUDY DESIGN: Prospective clinical evaluation. PATIENTS AND METHODS: Thirty-six patients with third-degree microtia and aural atresia have been treated this way. In the first step, the canal is drilled into the petrous bone, a Silastic cylinder is inserted and wrapped into pieces of cartilage and bone dust. In the second step several months later, the implant is removed and a slightly smaller tube covered with a split thickness skin graft is inserted. RESULTS: Except the first three patients operated with a slightly different technique, none of the following 33 patients showed a severe restenosis. Instead, all had a nice, smooth external ear canal. CONCLUSION: With this two-step technique of creating a new external ear canal in atresia, we could avoid one of the major complications of this kind of surgery. The external ear canal is either necessary for the reconstructed middle ear or it can be used to adapt a (behind or in the ear) hearing aid. By integrating this technique into a three-step concept for auricular reconstruction, the patient does not need any additional operation, and his or her rehabilitation from ear malformation can be enhanced.

The effect of tissue expansion on the expression of collagen type I and type III mRNA in distinct areas of skin in the dog as an animal model.

To evaluate the transcriptional response of skin to tissue expansion in the dog, the expression of procollagen alpha 1(I) mRNA and procollagen alpha 1(III) mRNA were analyzed by in situ hybridization. This expression was evaluated in distinct skin areas (subepidermal zone, dermis, capsular zone) after 4-85 days of expansion. Within the first 4 days of expansion expression of procollagen alpha 1(I) and alpha 1(III) mRNA was not affected in the subepidermal and dermal zone. Only a slightly elevated level of type III procollagen mRNA was demonstrated in tissue surrounding the implanted silicone expander. After 7 days of expansion an enhanced level of procollagen alpha 1(III) mRNA was observed in the dermis and capsular zone. A slightly enhanced type I collagen mRNA level occurred in all zones of the dermis that was even stronger in the capsular zone after 9 days of expansion. Concurrently, the number of transcriptionally active cells was significantly higher. Return to the basal level of procollagen alpha 1(I) mRNA was attained after 40 days. At this time a significant expression of procollagenase mRNA was observed. Procollagen III mRNA expression reached its basal level on day 85.

Effects of transforming growth factor-beta1 and basic fibroblast growth factor on proliferation of cell cultures derived from human vestibular nerve schwannoma.

The influence of transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) on growth of cell cultures derived from unilateral vestibular nerve schwannomas was investigated. Cell cultures were initiated from 9 schwannomas and characterized immunocytochemically with antibodies against S-100 and type IV collagen. The effects of TGF-beta1 and bFGF on DNA synthesis in chemically defined serum-free medium were assessed by measuring the incorporation of 5-bromo-2'-deoxy-uridine (BRDU) into cellular DNA. Cell proliferation was evaluated with an electronic cell counter. Reverse transcription polymerase chain reaction (RT-PCR) was performed using oligonucleotide primers specific for TGF-beta1 and TGF-beta2. TGF-beta1 stimulated DNA synthesis in a dose dependent manner. Maximal stimulation was observed at a concentration of 1 ng/ml, which induced a nearly 2-fold increase in DNA content. This effect was not seen when TGF-beta1 was added in the presence of neutralizing antibodies. In addition, antibodies against TGF-beta1 significantly reduced DNA synthesis in control cultures without supplemented exogenous growth factors. bFGF alone had no significant effects on DNA synthesis. In contrast, when TGF-beta1 and bFGF were added together, the mitogenic response was much greater than produced by TGF-beta1 alone. RT-PCR showed that the cultured cells expressed mRNA for both TGF-beta1 and TGF-beta2. We hypothesize that TGF-beta1 is an autocrine growth factor for human vestibular nerve schwannomas in culture. A similar mechanism might be involved in the growth of these tumors in situ.

[Postoperative pain therapy using on-demand analgesia after external ear reconstruction with rib cartilage harvesting]. / Postoperative Schmerztherapie mittels on-demand-Analgesie nach Ohrmuschelaufbau mit Rippenknorpelentnahme.

BACKGROUND: The individual experience of postoperative pain values considerably. It is the patient who can best evaluate the intensity of pain and the effect of a given analgesic substance. Patient-controlled analgesia (PCA) enables the patient to self-administer an i.v. analgesic bolus by pressing a button of an electronic pump device within a previously set range. If needed. The resection of rib cartilage to be used for ear reconstructions is associated with intense postoperative pain. This could result in unfavorable stress responses such as impaired cough and clearance of lung secretions carrying a greater risk of bronchitis or pneumonia, prolonged mobilization, and complications of wound healing. Therefore, individually adapted pain therapy is of great importance and technically feasible with modern PCA devices. METHOD: Informed and cooperative children aged five years and older and adults without severe health risks are suitable for PCA. Management, handling, monitoring and documentation of the PCA device are discussed. A 24-hour counselling service is maintained for occurring problems. RESULTS: Almost all patients expressed their great satisfaction with the means of pain therapy. Few patients were apprehensive. The initial scepticism of the involved personnel concerning opioid abuse, over-dosage, or technical problems gave way for a support of the PCA once the great satisfaction of the patients in absence of side effects was witnessed. No patient had to be antagonized for respiratory depression. Nausea and vomiting were rare events. CONCLUSION: Patient-controlled analgesia proved to be an excellent answer to postoperative pain after resections of rib cartilage.

The neurovascular infrahyoid muscle flap: a new method for tongue reconstruction.

OBJECTIVE: Description of a new neurovascular island flap derived from the infrahyoid muscles to reconstruct a total tongue or large defects of the tongue base. The surgical technique, anatomic findings, and the postoperative function tests with the patients' outcome are described. Eleven patients had tongue cancer, 5 at a T2 stage, 3 at a T3 stage, and 3 at a T4 stage. Four patients underwent total glossectomy, 3 patients underwent hemiglossectomy, and in 2 patients a half and in another 2 patients a quarter of the tongue base were resected. The tongue of the patients who underwent total glossectomy has been reconstructed with the infrahyoid myofascial neurovascular flap from both sides of the neck; in all the other patients this new flap has only been taken from one side of the neck. In one patient a glossectomy had to be combined with a laryngectomy. In 10 patients the tracheostoma could be closed in 4 weeks after the operation, and all patients could eat an oral diet. Electromyography showed voluntary innervation of the reconstructed tongues. With the neurovascular infrahyoid flap, defects of the tongue base can be reconstructed successfully after partial resections or total glossectomies. The main advantage is the voluntary innervation of this flap by means of the ansa cervicalis and the prevention of scarring and atrophy of the reconstructed tongue.

Histopathology of laryngeal changes after long-term chondrosynthesis.

Two patients treated for laryngeal tumors at the University of Lübeck are presented. Both underwent laryngeal reconstructions with plate and screw fixation systems immediately following partial laryngectomies. Recurrent disease was found at 14 and 55 months, respectively, and was subsequently managed by total laryngectomy. The laryngectomy specimens with the plate and screws in situ were evaluated histopathologically, paying special attention to the reaction of local tissue to the implants. Findings showed that the metallic plates were fixed with screws in the bony trabeculae of the laryngeal skeleton. The histological response showed primary wound healing without evidence of sequestration or implant loosening, as often associated with excess mechanical stress. Furthermore, there were no signs of tissue necrosis or widespread chronic inflammation. In both patients, a small discrete area of chronic inflammation and soft tissue fibrosis was noted adjacent to the screw heads. This study supports our previously documented clinical experience that the use of chondrosynthetic techniques is almost complication-free and is an ideal system for performing precise anatomical reconstruction of the laryngeal skeleton.

High-resolution CT of the temporal bone in dysplasia of the auricle and external auditory canal.

PURPOSE: To determine CT findings in the external, middle, and inner ear of patients with microtia and external auditory canal dysplasia. METHODS: We used high-resolution CT, with multiplanar or axial 1-mm continuous sections, coronal or sagittal reformations, or low-dose spiral acquisitions, to examine 184 temporal bones of children with microtia. RESULTS: In cases of minor microtia, auditory canal stenosis was the most common associated abnormality; in those with major microtia, atresia was predominant. Middle ear malformations depended on the severity of the auricular anomalies. Inner ear changes could also be noted. Ossicle dysplasias occurred in 98% of patients (stapes, 72%), absence of the oval window in 36%, labyrinthine malformations in 13%, closed round window in 6%, facial canal displacement in up to 75%, and aberrations of the vascular canal in 38% of patients with third-grade auricular deformity. CONCLUSION: A variety of external, middle, and, less frequently, inner ear changes were detected in connection with microtia.

[Bone conduction hearing aids with fluid medium]. / Knochenleitungshörgeräte mit Flüssigkeitsankopplung.

In patients with chronic otorrhoea or middle ear pathology, traditional hearing aids which depend on air conduction are of little use. In these situations a bone conduction hearing aid is preferable. Such devices by-pass the middle ear cleft and ossicular chain by conducting sound waves through bone to the cochlea. To date, bone conduction hearing aids have transmitted sound via a vibrating transducer applied either to skin (transcutaneous) or to bone (percutaneous). Unfortunately, these hearing aids possess a number of disadvantages, which include: cost, aesthetic appeal, a general anaesthetic for percutaneous aids, and most notably pressure discomfort to the side of the head. To overcome some of these problems a new bone conducting hearing aid is being developed which differs from conventional aids in that sound transmission is through a liquid medium. This has been tentatively named the "Hydro-Hearing Aid" and a prototype is now being tested.

[Orbital and intracranial complications of acute sinusitis in childhood--status of endoscopic paranasal sinus surgery based on case examples]. / Orbitale und endokranielle Komplikationen akuter Sinusitiden im Kindesalter--Stand der endoskopischen NNH-Chirurgie anhand von Fallbeispielen.

BACKGROUND: Orbital or endocranial complications of sinusitis are rare clinical syndromes in infancy. METHODS: We retrospectively examined the complications that occurred and the role of functional endoscopic sinus surgery (FES). RESULTS: Most of the complications were caused by acute inflammation of the ethmoid or sphenoid cells with direct extension through dehiscent areas (flat bone) or neurovascular foramina. MRT had the highest sensitivity in detecting acute inflammatory foci. Early elimination of the cause of inflammation by FESS prevents spread of the complication. Advantages of FESS included better orientation and surgical access to the paranasal system of infants. The orbital complications were treated by surgical exploration of the communication pathways by a new endoscopic speculum. CONCLUSION: Early elimination of acute inflammatory foci by FESS prevents spread of infection in complications of paranasal sinusitis in infancy.