Colgajo "en tiburón" para la reconstrucción de defectos de la región alar nasal / Shark Island Flap for Reconstruction of Nasal Ala-Perinasal Defects

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[Assessment of functioning in patients with head and neck cancer based on the international classification of functioning, disability and health (ICF)]. / Beurteilung von Funktionsfähigkeit bei Patienten mit Kopf-Hals-Tumoren, auf Basis der Internationalen Klassifikation für Funktionsfähigkeit, Behinderung und Gesundheit (ICF).

The article approaches with the question how preservation of function after treatment of head and neck cancer (HNC) can be defined and measured across treatment approaches. On the basis of the "International Classification of Functioning, Disability and Health (ICF)" a series of efforts are summarized how all relevant aspects of the interdisciplinary team can be integrated into a common concept.Different efforts on the development, validation and implementation of ICF Core Sets for head and neck cancer (ICF-HNC) are discussed. The ICF-HNC covers organ-based problems with food ingestion, breathing, and speech, as well as psychosocial difficulties.Relationships between the ICF-HNC and well-established outcome measures are illustrated. This enables the user to integrate different aspects of functional outcome into a consolidated approach towards preservation/rehabilitation of functioning after HNC - applicable for a variety of treatment-approaches and health-professions.

ICF Core Set for head and neck cancer: do the categories discriminate among clinically relevant subgroups of patients?

The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the ICF Core Set for Head and Neck Cancer (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was to test whether categories of the ICF-HNC can discriminate among clinically relevant differences in patients. This was a cross-sectional multicentre study in which 267 patients with HNC from 11 different countries participated. All categories were tested within a cumulative logit model to identify which ICF-categories show differences in tumour location, staging, treatment modalities and time since treatment. In the comprehensive ICF-HNC, 84 of the tested categories (76%) reflect differences in at least one of the given parameters. In the Brief ICF Core Sets for HNC (ICF-HNC), all 19 categories (100%) reflect differences. Two categories (social relationships and economic self-sufficiency) showed significant differences among all tested criteria. Most categories of the ICF-HNC are sensitive to clinically relevant differences in the study population. Especially, the ICF component 'activities and participation' holds categories with high discriminative ability for clinically relevant differences. These aspects should be carefully included into rehabilitation plans for HNC.

Preoperative vestibular ablation with gentamicin and vestibular 'prehab' enhance postoperative recovery after surgery for pontine angle tumours--first report.

CONCLUSIONS: Preoperative gentamicin in combination with vestibular 'prehab' offers a possibility to reduce postoperative malaise and speed up recovery and may be used for patients undergoing such surgery when there is remaining vestibular function. OBJECTIVES: Removal of pontine angle tumours in a patient with remaining vestibular function causes symptoms of acute vestibular loss. A simultaneous cerebellar lesion can cause a combined vestibule-cerebellar lesion. PATIENTS AND METHODS: Twelve patients with pontine angle tumours but with near normal vestibular function were treated with intratympanic gentamicin in combination with vestibular 'prehab' to achieve preoperative vestibular ablation and compensation. After work-up patients started with a home-based vestibular training programme for 14 days. They then received a total of 1.2 ml of 30 mg/ml buffered gentamicin in four intratympanic installations over 2 days. They continued training and returned 6-16 weeks later. All patients were tested with calorics, vestibular video-impulse testing of all six canals, VEMP, subjective visual vertical and horizontal, posturography and pure tone and speech audiometry. RESULTS: There was a loss of caloric reactions and loss of impulses. In two patients the hearing deteriorated and in one hearing improved. All subjects were vestibulary compensated before surgery and no patient complained of dizziness or vertigo after surgery.

Functional swallowing therapy after treatment for head and neck cancer can outcome be predicted?

Possible prognostic factors for swallowing after curative treatment of head and neck cancer were investigated by retrospectively analyzing the records of 82 consecutively treated patients. All of them had an exhaustive assessment of swallowing after the oncological treatment, and all had an adequate follow-up. In general, a major improvement in swallowing quality was obser-ved after rehabilitation, although some patients (9/82) still had major problems. Patients with transport problems have a significantly better prognosis than patients with aspiration. No single parameter was strongly correlated with the outcome of swallowing. A weighted score (presence/absence of pharyngeal reflexes combined with the quality of laryngeal sphincter function) was of satisfactory prognostic value for improvement in the quality of swallowing.

[Research in psychosocial aspects of ENT tumor surgery (excluding laryngectomy): 4-part analysis of the literature. 3: Results of research]. / Erforschung der psychosozialen Aspekte der HNO-Tumorchirurgie (exklusiv Laryngektomie): 4teilige Analyse der Literatur. Teil 3: Forschungsergebnisse.

The available literature on psychosocial aspects of head and neck cancer surgery from 1950 to 1995 was reviewed in four parts. Part 3 is a detailed description of the findings looked at from four different points of view: 1. Restrictions by illness and treatment (dysfunction, mutilation, emotional and social reactions); 2. Coping; 3. Course of illness and treatment (treatment delay, preoperative phase, hospitalization, early and later rehabilitation, tumor recurrences, terminal disease); 4. Relationships between patients and professionals (doctor-patient relationships, countertransference).

[Surveillance and rehabilitation of cancers of upper respiratory and digestive tracts]. / Surveillance et réhabilitation des cancers des voies aéro-digestives supérieures.

Follow-up of head and neck cancers after treatment is usually done by specialists every 2 to 3 month during an indeterminate period. The aim of this follow up is to detect a recurrence or a complication due to the treatment. Xerostomia, endolaryngeal and cutaneous modifications are the most frequent sequelae of irradiation. Major surgery of the larynx require a speech rehabilitation which gives correct results in 70% of the cases. Professional rehabilitation is possible for few patients: only 50% of the patients who had jobs before treatment were able to go back to work. The return to work was more often seen among civil servants, and workers than among craftsmen. Laryngectomised people resume their work less often than other head and neck cancer patients. There is no problem with social rehabilitation.

[Exercise and sports therapy for patients with head and neck tumors]. / Bewegungs- und Sporttherapie für Patienten mit Kopf-Hals-Tumoren.

Important aspects in the aftercare of patients with cancer of head and neck can be realized by physical training in a sports group. The aftermath of operative therapy, e.g. loss of motion, imbalances of muscular activity or respiratory movements, can be reduced. The main importance of physical training in a group is the patient's reintegration in a social environment. Evaluating the quality of life of the individual patient we found that this method of psychosocial aftercare can improve subjective quality of life. Therefore, this conception of rehabilitation should not be missing in the aftercare of patients with malignant cancer.