[Current practice of tumour endoscopy in German ENT-clinics]. / Praxis der Tumorendoskopie an deutschen HNO-Kliniken.

BACKGROUND: Second primary carcinomas (SPC) essentially influence therapy and the outcome in head and neck cancer. This study presents the current status of tumour endoscopy in German ENT-clinics. MATERIAL AND METHODS: A standardised questionnaire regarding indication, time of event, examined anatomical region and technique of tumour endoscopy was compiled, sent to all German ENT-clinics (n=159) and subsequently analysed. RESULTS: In 94-100% of the clinics, tumour endoscopy is being conducted when primary carcinoma lies within oral cavity, pharynx, larynx or is a CUP-syndrome. In 80%, 2-stage surgical procedure is preferred. Nasal cavity and tracheobronchial system (47%, 74%) are often not included in the examination. When primary cancer is seen, in 7% of the clinics a standardised biopsy of unsuspicious anatomic areas is conducted. In CUP-syndrome, unsuspicious surfaces within the pharynx do not undergo routine biopsy in 10-20% of the clinics. In tracheobronchoscopy (63.0%) and esophagoscopy (93.3%) rigid scopes are mainly used. 65% of the clinics conduct endoscopy as follow-up care. CONCLUSION: Practice of tumour endoscopy in German ENT-clinics is widespread but does not follow standardised mechanisms. Current international literature shows that there is no common consensus on value and techniques of tumour endoscopy, however, due to highly developed radiological diagnostics, risks of rigid endoscopies and unknown incidence of second primary tumours it is discussed more and more negative. To establish future guidelines, controlled studies or analysis of large populations seem to be necessary.

Improvement and long-term stability of neuromuscular adaptation in implant-supported overdentures.

OBJECTIVES: In edentulous patients, implant-supported overdentures can improve chewing efficiency and patient satisfaction, and even a positive impact on bone tissue preservation has been observed. The objective of this long-term study was to investigate whether kinesiographic and electromyographic (EMG) parameters would also benefit from implant placement and whether the status achieved would remain consistent over time. MATERIAL AND METHODS: The functional adaptability of the neuromuscular system in edentulous patients has been recorded in four different states of restoration: (1) insufficient old dentures, (2) new complete dentures, (3) implant-supported overdentures, and (4) implant-supported overdentures 10 years in use. In each state of restoration, the neuromuscular adaptation was assessed during masticatory activity on the basis of myodynamic parameters such as vertical opening, frontal extension and closing velocity. EMG parameters, i.e. Musculus masseter and Musculus temporalis activities were recorded simultaneously. RESULTS: The results revealed a general increase in the myodynamic and EMG-parameters. All of them clearly approached the values for normal dentate subjects and maintained this level over a period of 10 years. The significant changes between states 2 and 3 indicate that implant stabilization of dentures is accompanied by an immediate increase of the neuromuscular parameters. CONCLUSIONS: In elderly edentulous patients, the treatment with two interforaminal implants provides evidence of neuromuscular adaptation towards values of healthy dentate. Thus, the known benefits of implant placement such as tissue perseverance and improved function are complemented by improved neuromuscular adaptation.

Stress and inflammation as a detrimental combination for peri-implant bone loss.

The causes of peri-implant bone loss continue to be controversial. To determine the impact of biomechanical stress and inflammation, we investigated a total of 80 interforaminal implants in situ for more than 10 years. Two stress groups, with 14 patients each, were established: a low-stress situation with single-standing implants, and an increased-stress situation with splinted implants. To categorize inflammation, we introduced a Composite Inflammation Score using 4 inflammatory parameters. Peri-implant bone loss was calculated from digital panoramic radiographs. To differentiate between the effects of stress and inflammation, we compared bone loss in both stress groups at equivalent levels of inflammation. With greater Composite Inflammation Score values, a clear discrepancy between single-standing and splinted implants was evident (p = 0.117/0.000, regression analysis; p = 0.135/0.000, analysis of variance; p = 0.002, t tests). While stress and inflammation alone may not necessarily be detrimental factors, the presence of stress heightens peri-implant bone loss significantly as inflammation increases.