[Autologous composite grafts from the cavum conchae for reconstruction of multilayer nasal defects]. / Das autologe Haut-Knorpel-Transplantat aus dem Cavum conchae zur Rekonstruktion mehrschichtiger nasaler Defekte.

BACKGROUND: Autologous transplants comprising skin and cartilage, so-called composite grafts (cgs), are an important reconstructive tool for multilayered defects of the nose. A cg from the auricular cavum conchae needs to fulfill both functional and esthetic demands. OBJECTIVE: This article illustrates the indications for and requirements of cgs, and also investigates graft healing and functional-aesthetic results. The current publication is a review article; the original data were published with the award of the 2014 APKO prize under the title "The auricle's cavum conchae composite graft in nasal reconstruction". MATERIALS AND METHODS: At the ENT department of Ulm University Medical School, multilayered defects of different nasal esthetic subunits are reconstructed with cgs. Based on these experiences, the authors report on long-term functional and esthetic results in the areas of the donor and recipient sites. CONCLUSION: Auricular cgs are versatile and reliable autologous transplants. The ease of harvesting, minimal donor site morbidity, and stable convex shape of these grafts render them ideal for reconstruction of multilayered nasal defects. Septal splints and custom-made prosthesis promote healing and prevent stenotic scarring.

[Functional and aesthetic outcome after surgery on cleft lip nasal deformities]. / Funktionelle und ästhetische Ergebnisse nach Spaltnasenoperationen.

OBJECTIVE: Patients with cleft lip nasal deformities suffer not only from aesthetic stigmatization but also from functional problems. Many different techniques to operate on this deformity have been described. METHODS: 24 patients (16 male and 8 female, aged 20-56 years) have been enrolled in this study. A subjective value of the postoperative result of aesthetics and function was measured by a visual analogue scale ranging from - 5 (significant aggravation) to +5 (significant improvement) including 0 (no change). Additionally the primary nasal symptoms (PNS) of the SNOT-20 GAV were collected. RESULTS: 10 primary surgeries and 14 revisions were performed with 20 open and 4 endonasal approaches. In 11 cases a composite graft from the concha was used. 75% of the patients looked up to both features aesthetic and function favorably. The mean evaluation was +3.4 for aesthetics and +2.6 for function. 91% of the patients who received a composite graft looked up to the result favorably. The mean PNS were 14. CONCLUSIONS: Altogether good results especially concerning the subjective aesthetics can be achieved by precise preoperative evaluation and the described operative algorithm. In our sample of patients better results could be accomplished by using composite grafts. Nevertheless it seems to be more difficult to improve the function of cleft lip nasal deformities than the aesthetics. More innovations and objective measurements are needed to come up to the still unsolved problems of the challenging surgery of cleft lip nasal deformities.

[Trigeminal autonomic cephalgias. After initial diagnosis, consider secondary causes]. / Trigeminoautonome Zephalgien. Bei Erstdiagnose auf sekundäre Formen achten.

Trigeminal autonomic cephalgias (TAC) are classified as primary headache syndromes. The use of instrumental procedures including neuroimaging in the diagnostic workup of the TACs is controversially discussed in the literature. Several case reports have been previously published, reporting trigeminal autonomic cephalgias related to structural lesions. We contribute two of our own cases of symptomatic TACs and demonstrate that a "classic" clinical presentation does not preclude a symptomatic etiology. Thus, we advocate a systematic diagnostic evaluation including neuroimaging in every patient presenting with symptoms indicative of TAC for the first time.

[Basedow's disease in an adolescent with histiocytosis X]. / Maladie de Basedow chez un adolescent porteur d'une histiocytose X.

BACKGROUND: Immunological dysfunction is known to be present in Langerhans cell histiocytosis; some autoimmune diseases with autoantibodies associated with this condition have already been described. This immunological dysfunction could play a role in the Langerhans cell histiocytosis pathogenesis. CASE REPORT: A 13 year-old boy presented a multifocal bone Langerhans cell histiocytosis associated with Graves' syndrome. This last condition was successfully treated with carbimazole while the focal lesions of histiocytosis did not require any treatment. CONCLUSION: This unique association could be explained by the immunological dysfunction seen in Langerhans cell histiocytosis with secondary appearance of thyreo-stimulating antibodies.