[Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery-a review. German version]. / Kontinuierliches intraoperatives Neuromonitoring (cIONM) in der Kopf-Hals-Chirurgie ­ eine Übersicht.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.

Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery-a review.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects.

BACKGROUND AND OBJECTIVE: Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF. MATERIAL AND METHODS: Using a split-mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF-BPBM combination. Re-entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill. RESULTS: Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF-BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF-BPBM group (4.47±0.78 mm on buccal and 4.29±0.82 mm on lingual sites) when compared with the PRF group (3.35±0.68 mm on buccal and 3.24±0.73 mm on lingual sites). The PRF-BPBM group presented with significantly greater attachment gain (3.82±0.78 mm on buccal and 3.71±0.75 mm on lingual sites) than the PRF group (2.24±0.73 mm on buccal and 2.12±0.68 mm on lingual sites). Defect fill was also greater in the PRF-BPBM group (4.06±0.87 mm on buccal and 3.94±0.73 mm on lingual sites) than in the PRF group (2.21±0.68 mm on buccal and 2.06±0.64 mm on lingual sites). CONCLUSION: The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.

Primary surgical treatment for carcinoma of the larynx: influence of the local invasion.

In the period from 1976 to 1988, 417 patients with supraglottic carcinoma of the larynx were treated by primary surgery. Infiltration of the pre-epiglottic space was found in 11.99 per cent (50/417) of the patients. Carcinomas of the infrahyoid epiglottis spread to this space more frequently--14.24 per cent (44/309), than those of suprahyoid localization--5.55 per cent (6/108). Tumour invasion of the pre-epiglottic space is a relative contra-indication for reconstructive surgery. Partial conservation operations were performed on 32 per cent (16/50) of patients with invasion of the pre-epiglottic space. The remaining patients had a total laryngectomy. Infiltration of the paraglottic space intra-operatively was found in 2.4 per cent (10/417) of patients and all of these tumours were from the infrahyoid localization. Spread of tumours to this site is an indication for radical surgery and laryngectomy was performed on 80 per cent (8/10) of patients.

[Surgical management of fractures of the proximal end of the radius]. / Uber die operative Versorgung von Frakturen des proximalen Radiusendes.

The problems of dislocated proximal radial fractures are discussed by presentation of 47 cases treated operatively. After operation, 74,6% of these patients had good results with complete elbow function. Special attention is paid to indication and possibilities of operative treatment as well as to intra- and postoperative complications.

[Experience with the Ender hooked plate in the management of 42 scaphoid pseudarthroses]. / Erfahrungen mit der Ender-Hakenplatte bei der Versorgung von 42 Skaphoid-Pseudarthrosen.

To treat the pseudarthrosis of scaphoid, there exist many operative procedures. We describe the method of H. G. Ender: A hook plate fixes the main bone fragments and exerts a pressure on the in-between lying bone transplant. We report on 42 patients operated on using the Ender-plate. In 39 cases a follow-up was possible. 95% of the patients had a consolidation of the bone, in two cases a further operation was required. 36 patients complained preoperatively of pain during exercise and only seven patients had the same complaints after the operation. In some cases, a minor reduction of the motion had to be taken into account to achieve painfree movement.

[Treatment of bites to the hand and wrist--is the primary antibiotic prophylaxis necessary?]. / Die Therapie von Bissverletzungen der Hand und des Handgelenkes - Ist eine Antibiotika-Prophylaxe in jedem Fall notwendig?1.

Animal bites make up a large proportion of the injuries treated in an emergency department. Due to the type of injury, the variety of wounds and the contamination with aerobic and anaerobic organisms, they deserve special attention. In this study, we reviewed 98 patients (55 male/43 female) with bite wounds to the hand and wrist treated between 1995 and 2000. They were either treated conservatively (n = 65) or surgically (n = 33) depending on the clinical findings. In 18 of 33 cases, the reason for surgical treatment was an infection. A primary antibiotic prophylaxis, usually with cephalosporines, was administered in 47 of 98 cases. Results were analysed retrospectively. An infection developed in 32 patients. In six of these patients, an infection developed despite primary antibiotic prophylaxis. Operative treatment became necessary in four of these six cases. Twenty-six of 32 patients were treated without primary antibiotic prophylaxis. Surgical treatment was required in around half (n = 14) of these patients, while the other 12 patients were treated conservatively with antibiotic therapy.Twenty-one of 26 patients presented with bite wounds that were already infected. Microbiological examination revealed a variety of microbes, usually a mixed infection with Pasteurella multocida was found. All organisms were susceptible to treatment with second or third generation cephalosporines.A total of 15 patients had to be operated due to deeper injuries to the bone, extensive soft-tissue injury, or because of injury to a tendon and the tendon sheath. In most patients, a good to acceptable functional result was achieved. Primary antibiotic prophylaxis does not prevent the development of infection. Nevertheless, because of the inherently high infection risk associated with bite wounds to the hand and wrist, prophylaxis should be carried out. In case of severe damage to the soft tissue or signs of infection, early surgical therapy should be considered.

[Initial experiences with interposition of a silicon sheet in reconstruction of the wrist joint]. / Die ersten Erfahrungen mit der Interposition einer Silikonfolie bei der Wiederherstellung des Handgelenkes.

We report about the possibility to improve the condition of incongruent joint surfaces by temporary interposition of silicon sheet in the radiocarpal joint. The implant was used in 18 patients with damaged joint surfaces, either for the primary operation or for revision. It was removed four to six weeks after having started physiotherapy. Our results show that this procedure can improve the condition of joint surfaces. Silicon-induced granulation tissue can even uprough parts of the joint surface and thus reduce chondral friction. We did not see any complications.

[Corrective interventions for malunited fractures of the distal end of the forearm. Indications, choice of procedure, results]. / Korrektureingriffe nach in Fehlstellung verheilten Brüchen am distalen Unterarmende. Indikation, Verfahrenswahl, Ergebnisse.

Malunion, non-union, as well as painful ligamentous joint instability following fractures to the distal forearm may seriously compromise the function of a hand. Forty-seven surgically treated cases, thirty-nine of which were followed up, are presented in order to point out the problems of such lesions. Retrospective evaluation of the lesion is absolutely mandatory, as it often dates back to childhood. Management should take clinical findings as well as the patient's functional demands on his hands into consideration, but without overestimating therapeutic potentials.

[Treatment of Galeazzi's fracture - is the surgical revision of the distal radioulnar joint necessary?]. / Die Therapie der Galeazzifraktur - Ist die Revision des distalen Radioulnargelenkes zwingend notwendig?

PURPOSE: Fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ) are termed as Galeazzi-fractures. In Galeazzi's fracture, the aim of treatment is restoring the congruency of the joint and the stability of the DRUJ, thus preventing a loss of pronation or supination. PATIENTS AND METHOD: In this study, we included 24 patients (m = 22, f = 2) with 25 Galeazzi fractures treated between 1980 and 1998. Surgical treatment and the duration of therapy were analyzed retrospectively. The clinical and radiological results of 15 patients were followed up. Two children were treated conservatively with immobilization in an above-the-elbow plaster. 19 patients were treated surgically by rigid internal fixation with a plate approximately one week after the accident. Four patients were treated initially in a different way. In 13 cases, the distal radioulnar joint was immobilized by pinning with Kirschner wires. In ten patients, the DRUJ showed no instability. Patients with DRUJ pinning received an above the elbow plaster for six weeks, the other patients received a forearm cast for the time of wound healing. RESULTS: Two patients developed a pseudarthrosis following Kirschner-wire or rush-pin osteosynthesis. The consolidation of remaining fractures was regular. In two patients, the DRUJ was not completely stable after temporary fixation. The remaining patients revealed a stable DRUJ. Eight patients showed a limited pro- or supination after temporary Kirschner wire fixation of the DRUJ. The other patients did not reveal a decrease in range of motion. CONCLUSION: A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.

[Results of angled plated osteosynthesis in per- and subtrochanteric fractures in the elderly]. / Ergebnisse nach Winkelplattenosteosynthese der per- und subtrochantären Brüche beim alten Menschen.

From 1/86 to 12/89 62 old patients (average age: 82.6) with intertrochanteric and subtrochanteric fractures underwent surgery by using angeled plates. The postoperative course showed complications in 32.2%, while only 1 patient died. In 3 of 5 cases with dislocation of the angeled plate re-osteosynthesis was performed. 4 other complications (2x haematoma, 2x wound dehiscence) needed further surgery. During the first three months 3 other dislocations occurred. In two cases re-osteosynthesis was carried out. Due to these results and the high rate of complications we are of the opinion that the indication for the use of the angeled plate osteosynthesis in old patients has to be limited in favor of other methods like the dynamic hip screw or total hip replacement.

[The value of digital luminescence radiography within the scope of traumatologic follow-up examinations]. / Der Stellenwert der digitalen Lumineszenzradiographie im Rahmen traumatologischer Kontrolluntersuchungen.

At the present time we cannot unhesitatingly recommend the general use of digital luminescence radiography in traumatological follow-up examinations. Marked drawbacks of this method are, for example, sudden changes in contrast in the marginal areas of osteosynthesis material, occasional limitations in the detailed assessment of spongious structures and problems in respect of imaging geometry. By modifying the image processing parameters, increasing the image matrix and enlarging the format spectrum, however, these problems should be capable of being resolved in the future. Positive features, on the other hand, are even now the possibility of reducing the dosage to a marked degree in many traumatological follow-up examinations, especially in children and adolescents, and in case of conservatively treated fractures. In the long run we can foresee the routine use of digitalised examination methods on traumatology coupled with the possibility of storage in an image filing and communication system, although this is at present not yet feasible due to lack of requisite experience and the cost of the necessary equipment.

Severe dyspnea as atypical presenting symptom of Madelung's disease.

Madelung's disease (benign symmetrical lipomatosis) is a rare disease of unknown etiology manifesting as symmetric abnormal deposits of adipose tissue in the head, neck and upper trunk. We report a case of a 58-year-old man with a long lasting Madelungs disease in whom progressive fatty tissue accumulation caused a severe inspiratory dyspnea as atypical presenting symptom. The etiopathogenetic, clinico-diagnostic and therapeutic aspects of this rare disease are discussed. Due to its progressive but not so easily predictable enlarging behavior Madelung's disease has not only aesthetic but also functional and sometimes life threatening consequences which need to be treated.