[Laser surgery in esthetic surgery. Review]. / Laserchirurgische Verfahren in der ästhetischen Chirurgie. Ubersicht.

Since the introduction of laser therapy was developed continuously. New indications are possible in the aesthetic surgery. The laser is used for the treatment of naevi, hemangiomas, wide port-wine-stains, teleangiectasias, tattoos, epilations and skin resurfacing. To fulfill the expectations of the patients and the remands of a plastic aesthetic surgeon it is important to find the correct indication and choose the right laser. Vascular and pigmental disorders can be successfully treated with the flash lamp pumped pulsed dye laser. Laser containing different wave lengths are available. For the treatment of the aged skin the Ultrapuls-CO2-Laser offers advantages in comparison with the Erbium-YAG-Laser. However these lasers can not replace a facelift or blepharoplasty.

[Neurologic complications in mid-face fractures]. / Neurologische Komplikationen bei Mittelgesichtsfrakturen.

The aim of this study was to discuss the various neurological complications after middle face fractures. The study is based on 186 patients with injuries of the middle face region, admitted to the ENT Department for clinical diagnosis and treatment. Only patients with apparently minor head injury (SHT I. degree) were included in this study. The neurological complications are divided into extracranial and intracranial neurological impairments. It was evident that extracranial neurological complications are frequent and that they decisively influence the surgical treatment (decompression of the N. infraorbitalis or N. opticus). The intracranial neurological complications, however, are rare, but most important for the prognosis quoad vitam, because a small number of patients with middle face fractures can develop a life-threatening intracranial haematoma that must be rapidly detected and removed.

[Immunological studies on patients with tonsillar carcinoma: progress?]. / Immunologische Untersuchungen an Patienten mit Tonsillenkarzinom: ein Fortschritt?

Of 101 consecutive cases of tonsillar carcinoma, 76 were finally selected as fulfilling the statistical requirement of the study. 25 of the cases were excluded because of deficiency of follow-up information. Actuarial survival time up to five years was compared with tumor staging and grading as well as with immunological parameters measured. Autologous and allogeneic anti-tumor antibodies were used for diagnostic purposes. Lymphocyte subpopulations, their distinction and in vitro function as suppressor cells was measured during the course of the disease. Actuarial five years survival time was 55%. Males contributed with 76% of the patients usually showing more progressed disease than females. Antibodies directed against tumor cells were found in all patients but not in healthy volunteers. A mean of 15% of immunofluorescence positive tumor cells revealed the best sensitivity, specificity and progressive value in terms of recurrencies. 5.8 months after reappearance of positive cells in the former operation area recurrencies could be proven histologically. 6.8 months later on the patients had died. Neither course of disease nor staging or grading of tumors showed a significant influence on lymphocyte subpopulations. In later stages in less differentiated tumors T-suppressor phenotypes showed an increase in numbers as compared to T-helper-cells. In parallel a significant rise of in-vitro suppressor activity of peripheral and lymph node lymphocytes could be detected. It is suggested that the rather good survival time is due to an intensive postoperative care and multiple hints from various immunological tests in addition to clinical signs. They allow to intensify directly the therapeutic and hygienic measures needed.

[Current remarks on functional esthetic rhinosurgery]. / Aktuelle Bemerkungen zur funktionell-ästhetischen Rhinochirurgie.

We report over 600 functional esthetic rhinoplasties carried out between 1980 and 1986 and discuss the following points: the indications for profilplasty, intra-operative selection of the implant (autologous, ceramic), extra-nasal technic and injections of collagen to correct irregularities of the nasal dorsum.

[A new procedure for covering septum defects]. / Ein neues Verfahren zur Deckung von Septumdefekten.

In 15 cases of nasal septal defects a new technique was used to close perforations up to 3 cm in diameter with a mucoperiosteal flap. The flap was rotated from the end of the inferior turbinate into the nasal septal defect. This method is easy and has a high rate of successful closure.

[Therapy of tracheal stenoses]. / Zur Problematik der Therapie von Trachealstenosen.

We report the aetiology management and results of 40 cases of laryngeal or tracheal stenoses. In 77.5% the stenoses were due to trauma or iatrogenic causes: nearly all of the stenoses caused by translaryngeal intubation affected the cricoid cartilage or the cricotracheal area. Two kinds of treatment were usually used: segmental resection with end to end anastomosis was successful in all cases and had the advantage of a short treatment and a low complication rate. Treatment by temporary open gutter with subsequent reconstruction of the trachea was successful in 16 patients but duration of the management was longer.

[Acute viral infections in association with idiopathic peripheral facial paralysis]. / Akute virale Infektionen in Zusammenhang mit der idiopathischen peripheren Fazialisparese.

The possible association of some viral infections with the onset of Bell's palsy was examined in a study of 29 patients. The results were compared with a sex- and age-matched control group. The number of probable recent viral infections, as judged by a fourfold increase in antibody titers or the presence of specific IgM antibodies, differed statistically from that found in the control group. In seven patients with Bell's palsy the enzyme-linked-immunosorbent assay (ELISA) indicated an acute viral infection (herpes simplex 4; varicella zoster 2; cytomegalovirus 1). All these infections were due to viruses belonging to the herpesvirus group. Clinical evidence of herpesvirus infection was found in three cases (Herpetic eruption). The aetiological relationship between the virological findings and Bell's palsy is discussed. Reactivated herpes simplex virus and transient demyelination of the facial nerve could be one cause of an idiopathic facial palsy.

[Support of an unusual orbital fracture by 2 balloons]. / Die Abstützung einer ungewöhnlichen Orbitafraktur durch zwei Ballons.

Six weeks after a traffic accident a patient presented with enophthalmos of 6 mm on the right side, a marked divergent squint, and double vision in all directions of gaze. CT scans showed a posterior medial, and inferior fracture of the orbit with tissue prolapse. In the course of surgery it became clear that an antral balloon alone would not be sufficient to push back the prolapsed tissue in the ethmoidal region. For this reason an additional, smaller (Lincoff-Kreissig) balloon was inflated in this region. The procedure was successful.

[Traumatology of the midface--diagnostic and therapeutic guidelines for the practicing ENT physician from the viewpoint of the otorhinolaryngologist]. / Traumatologie des Mittelgesichts--Diagnostische und therapeutische Leitlinien für den praktizierenden HNO-Arzt aus der Sicht des Oto-Rhino-Laryngologen.

Middle face fractures are classified as follows: fractures of the nose, maxillary fractures (vertical and transverse, Le Fort I-III), lateral middle face fractures, isolated orbital floor fractures (blow out fractures), isolated zygoma fractures and combined multiple fractures. Rhinosurgical indications are discussed with emphasis on osteosynthesis using wire and miniplates.

[Instructions for the documentation of neoplasms in the area of the head and neck following the TNM system. Contribution to the validation of the TNM system]. / Anleitungen zur Dokumentation von Malignomen im Kopf-Hals-Bereich nach dem TNM-System. Ein Beitrag zur Validierung des TNM-Systems.

As the only international classification scheme the TNM-system allows classification of practically all tumours of all organs according to uniform rules. In the interest of international comparison of findings and results the TNM-system alone can be recommended for classification. Checklists are used for extension of the basic documentation for the head and neck. Directions for initial and follow up analysis are given. The TNM-system in this proposed practice allows clear determination of the pre-therapeutic findings, recurrences to be taken into account, the course of the disease to be recorded, and the survival rate to be calculated. The data are suitable for recording on a computer. Finally uniform recommendations for treatment may be deduced.

[Ultrasound diagnosis of the paranasal sinuses: progress in ENT practice?]. / Ultraschalldiagnostik der Nasennebenhöhlen: Ein Fortschritt in der HNO-Praxis?

A-Scan-ultrasound cannot be left out as a routine way of examination of the paranasal sinuses in the practice of an ENT-doctor. This method is not a substitution for X-rays but gives important additional information in case of pathologic contents of the paranasal sinuses. Ultrasound diagnosis plays its main role in diagnosing decreases of the paranasal sinuses in children and pregnant females and in controlling acute sinusitis. B-Scan-ultrasound has no important advantages in diagnosing paranasal sinus diseases compared to A-Scan-ultrasound. But B-Scan-ultrasound is an ideal additional means to examine the soft parts of the head and neck. Tumours can be differentiated as solid or cystic and their relation to different tissue structures can be defined. At the moment, however, a recommendation for the routine use of the B-Scan-ultrasound in the ENT-practice cannot be given.

[Squamous cell carcinoma of the palatine tonsils. Effect on the immune system in man]. / Das Plattenepithelkarzinom der Tonsilla palatina. Auswirkungen auf das immunologische System beim Menschen.

Immunological monitoring was applied to 56 patients suffering from squamous cell carcinoma of the tonsils. The Immunofluorescence of oral swabs and measurements of unspecific suppressive activity of peripheral lymphocytes were tested. Autologous IgG antibodies directed against antigens of the tumor cells as well as higher levels of suppressor cells could be found in patients with carcinomas. These antibodies reacted similarly with allogeneic tonsillar carcinomas; cross reaction with other allogeneic tumor cells (bladder-kidney carcinoma) could not be detected. The findings indicate therapeutical consequences for the patients with high suppressor activity and immunofluorescence.

[What is new in plastic surgery of the head and neck for the practicing otorhinolaryngologist?]. / Was gibt es Neues in der plastischen Chirurgie im Kopf-Hals-Bereich für den praktizierenden Hals-Nasen-Ohren-Arzt?

On examples the plastic facial surgery is shown as an multidisciplinary territory, whereby main points are set. Most important for the oto-rhino-laryngology is the ear and nose correction as whereas the possibility to use collagen injections, the problems of secondary Rhinoplastics, the esthetic corrections in the area of the throat and head (dermabrasio, eye lid corrections, face lifting, hair transplantation) and considerations about education and advanced training. The maxillo facial surgery puts out the dento-alveolic dysgnathies, the ophthalmology the eye lid corrections. The experimental surgery can contribute to the still open questions, whether in the future in plastic operations allogene transplantates can fill the place of autogenous material or not.

[The value of computer tomography in frontobasal brain injuries]. / Zur Wertigkeit der Computer-Tomographie bei frontobasalen Schädeltraumen.

This paper deals with the value of the cranial computerised tomography by the reconstruction of 64 frontobasal skull traumas. The advantages of computerised tomography as compared to conventional x-ray diagnosis of frontobasal skull traumas are the eminent saving of time for determining operation and the possibility to supply quickly and precisely the diagnosis of intracranial complications by patients who are seriously injured. By the help of computerised tomography we can trace single fragments more accurately whereby one cannot renounce the conventional x-ray diagnosis by the pre- and postoperative diagnosis.

[Endoscopically controlled ultrasound diagnosis of the paranasal sinuses]. / Endoskopisch kontrollierte Ultraschalldiagnostik der Kieferhöhlen.

261 patients with diseases of the paranasal sinuses were examined by ultrasound (A-Scan). Sinuscopy or surgery was performed on these patients. Samples for histologic examination were taken. The correlation between ultrasound, endoscopy and x-ray was 80-90%. In endoscopic histologic normal maxillary sinuses, however, x-ray examination led to wrong positive results five times as often as ultrasound examination did. X-ray examination was more accurate only in cases where the process was separated from the anterior wall of the maxillary sinus by a layer of air.

[Artificial bone (tricalcium phosphate) in facial surgery (author's transl)]. / Künstlicher Knochen (Tricalciumphosphat) in der Gesichtschirurgie.

In recent years, the medical profession has shown increased interest in using ceramics in the field of head and neck surgery. Among the materials available, artificial bone (tricalcium phosphate) is being used more and more frequently in plastic surgery of the face on account of the good biocompatibility and bioactivity. We have been using this material in 194 patients for the last 3 years for augmentation of facial defects without experiencing any noticeable complications. This paper describes the various possible uses of artificial bones in facial surgery. Nevertheless, several further years of close observation will be necessary.