[Orbital decompression : Indications, technique, results]. / Orbitadekompression : Indikationen, Operationstechnik, Ergebnisse.

Orbital decompression is an effective surgical procedure to reduce intraorbital pressure. Causes may diseases leading to rapid pressure increases, e. g., bleedings, and those causing slower, progressive pressure increases, e. g., tumors or Graves' orbitopathy. During fat tissue decompression, peri- and retrobulbar adipose tissue is removed; in bony decompression, one or more bony orbital walls are removed (one-, two-, or three-wall decompression). In many cases the procedures are combined. Recent developments are the transconjunctival approaches for removing parts of bony orbital walls. Complications include double vision, which occurs in up to 30% of cases depending on the approach, hemorrhage, infections, development of chronic sinusitis, and iatrogenic skull base lesions with consecutive meningitis. In the hands of an experienced rhino- and head and neck surgeon, the intervention has low complication rates.

[Lateral Sinus Thrombosis--A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma]. / Die Sinusvenenthrombose--eine seltene Komplikation der akuten Mastoiditis und des Cholesteatoms.

BACKGROUND: Lateral sinus thrombosis (LST) is a rare but threatening complication of an acute mastoiditis or infected cholesteatoma. Currently only very few papers are available in the literature dealing with the systematic investigation of patients with suspected LST. The purpose of the present study was to evaluate the clinical, intraoperative and therapeutic findings of patients with particular disease. PATIENTS AND METHODS: For this retrospective study the clinical records of 7 patients which were admitted for a suspected LST were evaluated. All patients underwent mastoidectomy with exposition of the lateral sinus and investigating of its blood flow. RESULTS: A LST was confirmed in 4 patients, 3 patients had a phlebitis. Patients with a LST presented additional symptoms beside otalgia, i. e., dizziness, cephalgia, meningism, deafness of the affected ear, and facial nerve paresis. Postoperative MRI scans revealed a recanalization of the sinus in all cases. Although immediate surgery, 2 patients developed a 2-staged brain abscess in the cerebellum. CONCLUSION: Clinical symptoms of the SVT are unspecific. In cases of an acute mastoiditis, neurological signs might be pathognomonic and can direct to a LST. Therapeutic concepts comprise intravenous antibiotics and operative elimination of disease. The exposition of the lateral sinus should be performed in any mastoidectomy for a LST in order to scrutinize its blood flow. In case of a thrombosis additional anticoagulative therapy might be indicated. To exclude a 2-staged brain abscess control MRI scans 7 through 14 days postoperatively are recommended.

[Pilomatrixoma - an important differential diagnosis of facial masses]. / Das Pilomatrixom - eine wichtige Differenzialdiagnose von Raumforderungen der Kopf- und Gesichtshaut.

BACKGROUND: Pilomatrixoma are rare tumors usually arising from the sebaceous glands in the subcutaneous tissue. They are the most frequent superficially localized tumors of the cheek and parotid region in children. About 20% of all tumors in this area in children are pilomatrixoma. Currently there are only a few studies in the literature which describe characteristic findings in these tumors. The purpose of the present study was to describe clinical, sonographical and morphological characteristics of these rare tumors. PATIENTS AND METHODS: Clinical records of 6 patients which were operated on for a pilomatrixoma were retrospectively analyzed. All tumors were completely excised followed by an histopathological examination on H&E stained specimens. RESULTS: All patients reported about a slowly growing painless mass in the parotid area or nuchal. Sonographically tumors displayed as hyperechoic masses with a dorsal sound extinction, due to hypercalcification. Histopathologically all tumors were characterized by typical basaloid and ghost cells, accompanied by a foreign-body reaction. CONCLUSION: Pilomatrixoma are an important differential diagnosis of unclear masses in the head and neck especially in children. The sonographical characteristics are variable and unspecific. A fine-needle aspiration biopsy is not recommended, since false malignant cytologic findings occur quite often. Therapeutically complete excision is required. Usually no adjuvant therapy is necessary, and the prognosis is good.