Nasalance in patients with maxillary defects - Reconstruction versus obturation.

BACKGROUND: An important question remains on how to obtain good quality of speech for patients needing maxillectomy. Oral and nasal spaces must be separated either by surgical means or by using an obturator-prosthesis. An objective measure of oronasal closure is nasalance. Different rehabilitative strategies should be compared. METHODS: Between 1990 and 2000, 88 patients underwent maxillectomy of which 28 (32%) were available for examination. Ten patients had obturators (group l) and in 18 patients the maxilla was biologically reconstructed with different techniques (group 2). Sound pressure of nasal and oral airways were assessed seperately using a computerized sampling system (NasalView) and standardized German texts. Nasalance was calculated and compared with an uncompromised sample of patients. RESULTS: There were no significant differences between group 1 and group 2 concerning nasalance. Furthermore, the achieved values of nasalance were similar to healthy individuals. CONCLUSION: Nasalance after maxillectomy can be normal after sufficient rehabilitation.

Treatment of gustatory sweating (Frey's syndrome) with botulinum toxin A.

BACKGROUND: Gustatory sweating is a common complication of parotid surgery. Injection of botulinum toxin A has been reported as a safe and effective treatment option for patients with Frey's syndrome. PATIENTS AND METHODS: A total of 69 patients who had undergone superficial parotidectomy because of adenoma were evaluated with respect to the incidence of Frey's syndrome and treatment interest. Minor's iodine starch test was used to detect the affected skin area. Affected skin areas were documented using a digital camera; skin areas were evaluated morphometrically. A single injection of Botox per 1 cm(2) skin field was administered to those patients interested in treatment. RESULTS: Of 43 patients (62%) with gustatory sweating, 33 patients requested treatment. The affected skin area varied from 16 cm(2) to 81 cm(2). The individual Botox dosage ranged from 16 to 80 IU. All relevant clinical symptoms of sweating disappeared within 1 week after a single injection. Treatment was well tolerated with no side effects. CONCLUSION: Botox A injection is a safe and effective treatment with long-lasting effects for patients with extensive gustatory sweating.

Lateral Transmandibular Approach to the Skull Base in Children: Three Case Reports.

The choice of surgical approach to tumors of the cranial base in children is determined by strict criteria. The criteria include optimal visibility for the surgeon, minimal possible impairment of facial skull growth, and the preservation of motor and sensory nerve integrity. From 1993 to 1996, three children (6 years old, 22 months old, 6 months old, respectively) underwent surgery to resect cranial base tumors through a modified lateral transmandibular approach. In all three patients a preauricular incision with temporal and submandibular extensions was performed. After the mandible was prepared, an osteotomy was conducted cranially to the mandibular foramen. When the capitulum was temporarily disarticulated, wide access to the cranial base was provided and the tumors were resected. Two of these children were available for follow-up, and we continue to observe their development. Given the severity of their conditions, treatment yielded good results. Growth impairment of the mandible was corrected by the distraction osteogenesis technique.