[Standardized risk-based antibiotic prophylaxis and adhesive film dressing for the prevention of wound infection following cochlear implantation]. / Standardisierte risikobasierte Antibiotikaprophylaxe und adhäsiver Filmverband zur Prävention von Wundinfektion bei Cochleaimplantation.

BACKGROUND: There is no consensus in the pertinent literature regarding the optimal antibiotic prophylaxis (AP) for cochlear implantation (CI). This study evaluates the implementation of standardized risk-based AP combined with application of an adhesive film dressing. MATERIALS AND METHODS: All CI cases since September 2019 were retrospectively reviewed for postoperative wound complications. While all patients received preoperative AP with ceftriaxone, postoperative AP after CI in patients older than 7 years was no longer routinely performed in our clinic. Exceptions were made according to predefined criteria for an increased risk of infection. The wound was covered with a transparent adhesive polyurethane film. RESULTS: In 72% of the 219 cases, we did not perform postoperative AP. The overall wound complication rate was 2.7% (in the groups with and without postoperative AP, 4.9% and 1.9%, respectively). Wound infection did not occur in any of the patients without postoperative AP older than 70 years (n = 32), with controlled diabetes mellitus (n = 19), or with reimplantation due to technical defect (n = 19). The film did not need to be changed until the suture material was removed. CONCLUSION: Standardized risk-based AP can avoid prolonged administration of antibiotics in selected patients. The film dressing permits continual examination and sufficient wound protection.

Piezoelectric ear surgery: a systematic review.

BACKGROUND: The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill. MATERIALS AND METHODS: We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection. RESULTS: The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill. CONCLUSION: Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery.

[Piezoelectric ear surgery: a systematic review. German version]. / Piezoelektrische Ohrchirurgie: systematische Literaturübersicht.

BACKGROUND: The piezoelectric instrument (PEI) offers a novel technique for bone removal in ear surgery with a combination of micro-oscillation and cavitation. The aim of this review is to explore the advantages, disadvantages, and limitations of this instrument in comparison to the drill. MATERIALS AND METHODS: We conducted a search of PubMed/MEDLINE and Google Scholar in accordance with the PRISMA recommendations. The primary selection included all studies reporting on the use of PEI in ear surgery or its effect on the inner ear. Only studies with a control group were included in the secondary selection. RESULTS: The first search identified 49 studies between 2003 and 2022. These reported on a total of 1162 ear operations, during which PEI was used for various indications. Most data were based on uncontrolled retrospective studies or case reports (76%). Only one of the five controlled clinical studies was prospective and randomized. The advantages of PEI weighed against its limitations and disadvantages were critically analyzed in comparison to the drill. CONCLUSION: Piezoelectric surgery is an innovative and promising surgical technique in the temporal bone. PEI appears to enable safer and more precise bone removal in close proximity to soft tissue when compared to the drill. The slower bone removal and cost factors represent current limitations to its wider use in ear surgery.

The Heterogenicity of Parotid Gland Squamous Cell Carcinoma: A Study of 49 Patients.

BACKGROUND/AIM: The aim of this study was to critically evaluate diagnostic workup, treatment and outcome of parotid gland squamous cell carcinoma (SCC). PATIENTS AND METHODS: We retrospectively examined 844 consecutive cases of parotid surgery in a German teaching hospital between 1975 and 2017. RESULTS: A total of 748 patients had parotid surgery. A total of 118 patients (15.7%) had a malignant tumour. Of those 49 patients had SCC accounting for 6.6% of all cases, and 41.5% of all malignant tumours. SCC typically affected males (79.6%) of advanced age. A total of 86% of patients had metastatic disease; three cases were primary SCC. Most primary carcinomas were skin (n=26) or pharynx (n=10). Four cases were carcinomas of unknown primary. We performed radical parotidectomy in 47 cases, neck dissections in 42 cases and adjuvant chemo-radiotherapy in 44 cases. CONCLUSION: The majority of parotid SCC are metastases. In cases without known primary lesion and lack of infiltrative tumour growth, a carcinoma with unknown primary should be considered.

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure.

OBJECTIVE: To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series. METHODS: We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017. RESULTS: We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis. CONCLUSION: Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.

Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

AIM: To evaluate the frequency of Warthin tumours among parotid neoplasms over the past 42 years in a population in rural Germany and to identify potential risk factors. METHODS: We conducted a retrospective case note evaluation from all patients who underwent parotid surgery between 1975 and 2017. The 42-year time period was evenly split into four quartiles. RESULTS: A Warthin tumour was diagnosed in 265 out of 806 patients (32.9%). The frequency of Warthin tumour increased steadily from 20.6% in the first decade between 1975 and 1986 to 44.9% in the fourth decade between 2008 and 2017. The age of the patients decreased from 68 years in the first to 62 years in the fourth decade. The male-to-female ratio in Warthin tumour was reduced from 1:5.3 in the first to 1:2.1 in the fourth decade. CONCLUSION: A Warthin tumour was the most common histological tumour type in the period from 1997 to 2017. We also found a high incidence of multiple tumours, a growing incidence in women and a decreasing age of patients. We propose a re-evaluation of the existing view of the epidemiology of benign parotid tumours, which proposes that pleomorphic adenoma is the most common benign parotid tumour.

Correction to: Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

In the original publication, in Table 2, the last value of third column, referring to `Number of cases' has been misprint. It should read "265" instead of the "235". The corrected table 2 is given below.

Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients

ABSTRACT Purpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients.

PURPOSE: Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. PATIENTS AND METHODS: We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. RESULTS: Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. DISCUSSION AND CONCLUSION: Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

Parotid gland metastases of distant primary tumours: A diagnostic challenge.

OBJECTIVE: Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours. METHODS: We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%). RESULTS: Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma. CONCLUSION: The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10-20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.

Photodynamic therapy for recurrent respiratory papillomatosis.

BACKGROUND: Recurrent respiratory papillomatosis (RRP) is a benign condition of the mucosa of the upper aerodigestive tract. It is characterised by recurrent papillomatous lesions and is associated with human papillomavirus (HPV). Frequent recurrence and rapid papilloma growth are common and in part responsible for the onset of potentially life-threatening symptoms. Most patients afflicted by the condition will require repeated surgical treatments to maintain their airway, and these may result in scarring and voice problems. Photodynamic therapy introduces a light-sensitising agent, which is administered either orally or by injection. This substance (called a photo-sensitiser) is selectively retained in hyperplastic and neoplastic tissue, including papilloma. It is then activated by light of a specific wavelength and may be used as a sole or adjuvant treatment for RRP. OBJECTIVES: To assess the effects of photodynamic therapy in the management of recurrent respiratory papillomatosis (RRP) in children and adults. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 January 2014. SELECTION CRITERIA: Randomised controlled trials utilising photodynamic therapy as sole or adjuvant therapy in participants of any age with proven RRP versus control intervention. Primary outcome measures were symptom improvement (respiratory distress/dyspnoea and voice quality), quality of life improvement and recurrence-free interval. Secondary outcomes included reduction in the frequency of surgical intervention, reduction in disease volume and adverse effects of treatment.   DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. Meta-analysis was not possible and results are presented descriptively. MAIN RESULTS: We included one trial with a total of 23 participants. This study was at high risk of bias. None of our primary outcomes and only one of our secondary outcomes (reduction in volume of disease, assessed endoscopically) was measured in the study. There was no significant difference between the groups (very low-quality evidence). Adverse effects reported included airway swelling requiring intubation in a child with severe RRP a few hours after photodynamic therapy. AUTHORS' CONCLUSIONS: There is insufficient evidence from high-quality randomised controlled trials to determine whether photodynamic therapy alters the course of disease or provides an added benefit to surgery in patients with recurrent respiratory papillomatosis. Multicentre randomised controlled trials with appropriate sample sizes and long-term follow-up are required to evaluate whether photodynamic therapy is of benefit. Outcomes such as improvement in symptoms (respiratory function and voice quality) and quality of life should be measured in future trials.

Hearing benefit in allograft tympanoplasty using tutoplast processed malleus.

Objectives. Tutoplast processed human cadaveric ossicular allografts are a safe alternative for ossicular reconstruction where there is insufficient material suitable for autograft ossiculoplasty. We present a series of 7 consecutive cases showing excellent air-bone gap closure following canal-wall-down mastoidectomy for cholesteatoma and reconstruction of the middle ear using Tutoplast processed malleus. Patients and Methods. Tympanoplasty with Tutoplast processed malleus was performed in seven patients to reconstruct the middle ear following canal-wall-down mastoidectomy in a tertiary ENT centre. Main Outcome Measures. Hearing improvement and recurrence-free period were assessed. Pre-and postoperative audiograms were performed. Results. The average pre operative hearing loss was 50 ± 13 dB, with an air-bone gap of 33 ± 7 dB. Post operative audiograms at 25 months demonstrated hearing thresholds of 29 ± 10 dB, with an air-bone gap of 14 ± 6 dB. No prosthesis extrusion was observed, which compares favourably to other commercially available prostheses. Conclusions. Tutoplast processed allografts restore conductive hearing loss in patients undergoing mastoidectomy and provide an excellent alternative when there is insufficient material suitable for autograft ossiculoplasty.

Plasma cell mucositis of Oro- and hypopharynx: a case report.

Objective. To raise awareness of plasma cell mucositis as a rare differential diagnosis for oral mucosal ulceration and its macroscopic similarity to malignancy. Method. We report a patient who presented with oral features suggestive of malignancy. A biopsy revealed plasma cell mucositis. Results. The patient successfully had a full excision of one lesion and a spontaneous resolution of the other. Conclusion. With the increasing incidence of oral mucosal pathology, physicians should be aware of this differential diagnosis.

The relevance of adhesion molecules in the classification of squamous cell carcinoma of the head and neck.

BACKGROUND: Clinical studies have demonstrated increased serum levels of E-selectin, P-selectin and VCAM-1 in patients with squamous cell carcinomas, which correlate with expression in the primary tumour. For this reason, selectin expression may also support the diagnosis and be of prognostic value in squamous cell carcinoma of the head and neck (SCCHN). MATERIALS AND METHODS: Using immunohistochemistry, the expressions of E- and P-selectin and VCAM-1 in SCCHN were characterised and analysed. RESULTS: The expressions of E-selectin and VCAM-1 were increased. The magnitude of expression was unrelated to the location or size of the primary tumour. With increasing de-differentiation, the expression of E-selectin increased, whereas the number of cells expressing VCAM-1 was highly variable. In contrast, E-selectin and VCAM-1 expressions decreased with progressive metastatic disease. CONCLUSIONS: These data demonstrate that the expression patterns of E-selectin and VCAM-1 may depend on differentiation and lymphogenic metastatic disease in SCCHN, and suggest that these molecules may have a dual role, depending on the stage of tumour development. These findings support the hypothesis that expression of E-selectin and VCAM-1 may be initiated by the release of tumour necrosis factor-alpha (TNF-alpha) at an early stage of tumour development. In contrast, the decrease in selectin expression, observed as the metastatic disease progresses, may serve as a protective mechanism to prevent an influx of effector cells.

Comparison of surface HLA class I levels in squamous cell carcinoma cell lines of the head and neck.

BACKGROUND: Squamous cell carcinomas of the head and neck (SCCHN) are the most frequent malignancies in this region. Down-regulation of human leukocyte antigen (HLA) class I was found to be implicated in the immune escape of these tumors. MATERIALS AND METHODS: Cell surface expression levels of several HLA class I antigens were evaluated in 21 SCCHN cell lines utilizing FACS analysis. RESULTS: Expression levels of HLA-antigens varied significantly between the investigated cell lines. On average higher HLA-B27 expression levels were observed in cell lines from younger and female patients. CONCLUSION: Our data confirms down-regulation of HLA class I to be an important event in SCCHN. However, since several SCCHN cell lines also exhibited high HLA levels, other mechanisms than HLA down-regulation also need to be considered as a cause for disease progression. Further studies will be required to elucidate the potential role of HLA-B27 in SCCHN.