RESUMEN
BACKGROUND: Oropharyngeal cancer is a diagnosis which means a change in life and even after successful treatment a tremendous reduction in the quality of life. Aim of this study is to analyse the health-related quality of life in patients with oropharyngeal cancer dependent on different treatment options. METHODS AND PATIENTS: Charts of 256 patients treated for oropharyngeal cancer between 1997 and 2007 were analysed in a retrospective study. Inclusion criteria for this study has been fulfilled by 98 patients, 82 of these completed the study. Therefore, standardised questionnaires (EORTC QLQ-C30 und EORTC QLQ-H&N35) have been used and 2 groups were compared: patients with primary radiochemotherapy (pRCT) vs. patients treated by an operation and adjuvant radiation. RESULTS: Most of the health-related quality of life domains in our patients were significantly reduced compared to the general population. There have been just very few significant differences in the quality of life domains in between the 2 groups. CONCLUSIONS: Health-related quality of life after treatment of oropharyngeal cancer is significantly compromised for these patients compared to the general population, but there have been no obvious differences depending on the compared treatment options. Only regarding the items "physical and cognitive functioning" patients after primary radiochemotherapy showed significantly better results and thus a better quality of life, despite the fact, that this group has a significantly advanced cancer stadium.
Asunto(s)
Carcinoma de Células Escamosas/psicología , Carcinoma de Células Escamosas/terapia , Neoplasias Orofaríngeas/psicología , Neoplasias Orofaríngeas/terapia , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/patología , Quimioradioterapia Adyuvante , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Orofaringe/cirugía , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA® and the active partially implantable device Vibrant Soundbridge® could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of -these implantable hearing aids.
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Enfermedades del Oído/diagnóstico , Enfermedades del Oído/cirugía , Oído Medio , Niño , Colesteatoma del Oído Medio/diagnóstico , Colesteatoma del Oído Medio/cirugía , Implantación Coclear , Oído Medio/cirugía , Audífonos , Humanos , Mastoiditis/diagnóstico , Mastoiditis/cirugía , Otitis Media/diagnóstico , Otitis Media/cirugía , Implantación de Prótesis , Anclas para SuturaRESUMEN
Cholesteatomas can be subclassified into genuine and acquired forms. Whilst epidermoid formations are the generally accepted cause of genuine cholesteatomas, metaplasia, immigration, proliferation and retraction pocket theories have all been proposed to explain the development of acquired cholesteatomas. Clinically, paediatric cholesteatomas exhibit more extensive and aggressive growth than those arising in adulthood. Molecular biological differences in terms of angiogenesis, cytokine expression and particularly the more marked inflammatory responses of the perimatrix could potentially explain these clinical differences. The surgical therapy of paediatric cholesteatomas should be adapted to the individual pathological findings, although where possible a canal wall up procedure is preferred during initial surgery. The "inside-out" mastoidectomy tracking-technique combines the benefits of a good surgical overview with those of a physiological postoperative auditory canal.
Asunto(s)
Colesteatoma del Oído Medio/diagnóstico , Colesteatoma del Oído Medio/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Niño , Medicina Basada en la Evidencia , HumanosRESUMEN
BACKGROUND: The objectives of this study were to compare a German version of the Glasgow Benefit Inventory (GBI) with the original English version and to describe quality of life following stapes surgery. PATIENTS AND METHODS: Audiometry and a questionnaire on handicap in various listening situations were used to assess 36 patients with otosclerosis before and 6 months after stapes surgery. The GBI was used to estimate the change in quality of life following surgery. RESULTS: Postoperative air-bone gap closure was <10 dB in 71% of patients. The postoperative air conduction threshold was <30 dB in 48% of patients. Using the GBI, the mean benefit score was 28 and the general benefit score 42. The social support and physical health scores were both zero. Where the postoperative improvement in air conduction was >15 dB, a significant reduction in handicap in everyday life, watching TV, listening to the radio and making telephone calls was seen. CONCLUSIONS: The German version of the GBI showed an improvement in quality of life in various everyday situations following stapes surgery.
Asunto(s)
Pérdida Auditiva Conductiva/psicología , Pérdida Auditiva Conductiva/cirugía , Psicometría/métodos , Psicometría/estadística & datos numéricos , Calidad de Vida/psicología , Cirugía del Estribo/psicología , Cirugía del Estribo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Alemania/epidemiología , Pérdida Auditiva Conductiva/epidemiología , Humanos , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento , Adulto JovenRESUMEN
Sweetness signals the nutritional value of food and may moreover be accompanied by a sensory suppression that leads to higher pain tolerance. This effect is well documented in infant rats and humans. However, it is still debated whether sensory suppression is also present in adult humans. Thus, we investigated the effects of sweet taste on the perception of the painful trigeminal stimulus capsaicin in two groups of healthy adult human subjects. A solution of 100 µM capsaicin was applied to the tip of the subject's tongues in order to stimulate trigeminal Aδ- and C-fiber nociceptors. When swallowed, 1M sucrose reduced the capsaicin-induced burning sensation by 29% (p ≤ 0.05) whereas a solution of similar taste intensity containing 1 µM quinine did not. Similarly, sucrose application to the frontal hemitongue suppressed the perception of the burning sensation induced by contralaterally applied capsaicin by 25% (p ≤ 0.01). We furthermore investigated the effects of documented unilateral transection of the chorda tympani nerve on capsaicin perception. In accordance with the ipsi-to-contralateral effect of sucrose on capsaicin perception in healthy subjects, hemiageusic subjects were more sensitive for capsaicin on the tongue contralateral to the taste nerve lesion (+38%; p ≤ 0.01). Taken together, these results argue I) for the existence of food intake-induced sensory suppression, if not analgesia, in adult humans and II) a centrally mediated suppression of trigeminal sensation by taste inputs that III) becomes disinhibited upon peripheral taste nerve lesion.
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Capsaicina/farmacología , Nervio de la Cuerda del Tímpano/fisiología , Percepción del Dolor/efectos de los fármacos , Fármacos del Sistema Sensorial/farmacología , Gusto/fisiología , Lengua/inervación , Adulto , Anciano , Nervio de la Cuerda del Tímpano/lesiones , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Sacarosa/administración & dosificación , Edulcorantes/farmacología , Gusto/efectos de los fármacos , Lengua/efectos de los fármacos , Adulto JovenRESUMEN
In addition to injuries to the pinna otologic traumatology comprises in particular injuries of the tympanic membrane and ossicular chain, temporal bone fractures together with accompanying impairment of the labyrinth and facial nerve as well as acoustic trauma and barotrauma. Depending on the mechanism of injury and typical symptoms, such as hemorrhagic otorrhoea, hearing loss, vertigo, tinnitus, facial nerve palsy, otoliquorrhea or pseudorhinoliquorrhea, further investigations should be planned. The present article provides an overview of the necessary further diagnostic measures as well as the therapeutic options currently available for all forms of injury mentioned here.
Asunto(s)
Oído/lesiones , Fracturas Óseas/diagnóstico , Fracturas Óseas/terapia , Trastornos de la Audición/etiología , Hueso Temporal/lesiones , Perforación de la Membrana Timpánica/diagnóstico , Perforación de la Membrana Timpánica/terapia , Fracturas Óseas/complicaciones , Trastornos de la Audición/diagnóstico , Trastornos de la Audición/prevención & control , Humanos , Hueso Temporal/cirugía , Perforación de la Membrana Timpánica/complicacionesRESUMEN
The presented article shows the current scientific concept including diagnostics and therapy of otosclerosis with an emphasis on surgical treatment options. The three main proposed causes for otosclerosis are viral and hormonal origin as well as a genetic predisposition. In 25 to 50% a familiar accumulation can be seen. Usually patients become aware of clinical problems by a progressive middle ear hearing loss in the young adulthood. In up to 80% of cases both ear become affected during lifetime. Surgical options of therapy are the stapedotomy, stapedectomy and the laser-assisted stapedotomy. In every case the alternative use of a hearing aid must be offered during the consultation. Typical surgical complications are rare but can be persistent vertigo, secondary facial palsy and a sensorineural hearing loss up to complete single-sided deafness in up to 1% of the cases. The most common finding which necessitates stapes revision surgery is the necrosis of the long incus process with dislocation of the stapes piston.
Asunto(s)
Otosclerosis/diagnóstico , Otosclerosis/cirugía , Otoscopía/métodos , Cirugía del Estribo/métodos , Trompa Auditiva/fisiopatología , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Sensorineural/cirugía , Humanos , Otosclerosis/etiología , Otosclerosis/fisiopatología , Complicaciones PosoperatoriasRESUMEN
The external auditory canal is vulnerable to bacterial infections, but little is known about thechemical compositions of ear wax regarding antimicrobial peptides. We, therefore, studied the proteinconcentrations of ten well-known human antimicrobial peptides from ear wax.Twenty ear wax samples from healthy individuals were analysed using enzyme-linked immunosorbent assay (ELISA) to determine theprotein concentrations of the antimicrobial peptides hBD1-3, lactoferrin, LL-37, BPI, hSLPI and HNP1-3. All ten antimicrobial peptides are present in ear wax. Some of these proteins seem to be merelycell-bound in ear wax. Antimicrobial peptides in ear wax prevent bacteria and fungi from causing infections inthe external auditory canal. The role and importance of these proteins for the blind-ending ear externalcanal is discussed. If this local defence system fails, infections of the external auditory canal may result.The knowledge about the presence of antimicrobial peptides in cerumen may lead to new concepts ofthe local treatment of external auditory canal diseases in the future.
Asunto(s)
Péptidos Catiónicos Antimicrobianos/análisis , Cerumen/química , Adulto , Bacterias/efectos de los fármacos , Bacterias/crecimiento & desarrollo , Ensayo de Inmunoadsorción Enzimática , Hongos/efectos de los fármacos , Hongos/crecimiento & desarrollo , HumanosRESUMEN
INTRODUCTION: The therapy of choice in nasoseptal defects is reconstruction with vital respiratory mucosa; in particular, three-layer repair using the bridge-flap technique according to Schultz-Coulon is the most promising. Cases exceeding operative limitations can be treated with silastic buttons. Our aim was to overcome the disadvantages of prefabricated silastic obturators by using custom-made prostheses. METHODS: A customised silastic prosthesis was made according to an endonasal cast taken under general anesthesia and then inserted either under general or local anesthesia, depending on the size of the prosthesis. Patients were asked to attend a re-examination and to retrospectively answer a questionnaire (Sinu-nasal Outcome Test-20 German adapted Version [SNOT-20 GAV]), in addition to a number of questions typical for nasoseptal defects. RESULTS: Of the 14 patients, 12 answered the questionnaire and eight could be re-examined after a mean of 12 months. One patient had died, while in another patient the prosthesis had been removed due to pain prior to follow-up. A total of 11 patients had subjectively benefitted from the prosthesis. Symptom-intensity grades according to the SNOT-20 GAV increased by one grade and by two grades for the additional items typical for nasoseptal defects. DISCUSSION: The insertion of a custom-made silastic prosthesis represents an effective and safe supplement in the therapy of inoperable nasoseptal defects. The SNOT-20 GAV is only of limited value for the assessment of outcome of therapy for nasoseptal defects.
Asunto(s)
Dimetilpolisiloxanos , Tabique Nasal/anomalías , Tabique Nasal/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Prótesis e Implantes , Colgajos Quirúrgicos , Análisis de Falla de Equipo , Humanos , Diseño de PrótesisRESUMEN
BACKGROUND: Dissection-courses have become an important element in ENT-education. They are offered covering different subjects. Until now no study exists that verifies the acceptance and efficiency of those courses. METHODS: We consulted the trainees of three surgical anatomical courses with a multiple choice form for their opinion on courses visited in the past. The acquired data was analyzed quantitatively and examined for statistically significant correlation between age, gender and professional experience. RESULTS: In our study 73 participants filled in our questionnaire. The average age was 32 years. The satisfaction concerning the currently offered courses is high. The dissection-exercises were rated as 'good' and 'very good' by 72%. The strongest point of criticism (49%) related to the price of the dissection-courses. The improvement of surgical skills showed to be the main motivation for visiting anatomical dissection-courses (46%). Most respondents had registered for dissection-courses of the temporal bone and the paranasal sinuses. A correlation between professional experience and the type of courses visited could be found for the courses on nerval- and blood vessel reconstruction. DISCUSSION: The courses offered currently in ENT are appreciated as beneficial and effective. The fact that these courses are visited frequently and that the benefit in daily practice is highly appreciated indicate a well thought out educational concept. It seems unlikely that fees for these courses can be reduced as hoped for by many participants. The economic pressure on the organizational team is very high. Surprisingly the interest in CME-points is relatively low.
Asunto(s)
Anatomía Regional/educación , Actitud del Personal de Salud , Educación de Postgrado en Medicina , Otolaringología/educación , Senos Paranasales/anatomía & histología , Hueso Petroso/anatomía & histología , Adulto , Factores de Edad , Curriculum , Femenino , Alemania , Humanos , Masculino , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Factores Sexuales , Encuestas y CuestionariosRESUMEN
Otosclerosis can be of viral origin and in 25-50% of cases a familiar accumulation can be seen. Typically patients develop a progressive middle ear hearing loss which starts in young adulthood and which can affect one as well as both ears in up to 80% of cases. The surgical procedures of choice are stapedotomy and stapedectomy. Complications of surgery are persistent vertigo, secondary facial nerve palsy and the most severe complication is deafness in up to 1% of the cases. Even if the operation risks are low, the alternative use of a hearing aid must be offered in the initial consultation. A new technique of stapes surgery is laser-assisted stapedotomy. Necrosis of the incus process with dislocation of the prosthesis is the most common finding which necessitates stapes revision surgery. The aim of this article is to present the current scientific concept, diagnostics and therapy of otosclerosis with an emphasis on surgical treatment options.
Asunto(s)
Pérdida Auditiva/diagnóstico , Pérdida Auditiva/cirugía , Otosclerosis/diagnóstico , Otosclerosis/cirugía , Cirugía del Estribo/métodos , Cirugía del Estribo/tendencias , Pérdida Auditiva/etiología , Humanos , Otosclerosis/complicaciones , Cirugía del Estribo/instrumentaciónRESUMEN
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a growth factor of the transforming growth factor-beta superfamily. Members of this protein family are involved in the development of various mammalian tissues, including the inner ear. As their notations indicate, they also have well-known effects on bone formation and regeneration. In this study, we examined the influence of rhBMP-2 on spiral ganglion (SG) neurite growth in vitro and showed the presence of its most preferred receptor BMPR-IB in spiral ganglion cells both in vitro and in vivo. SG explants of postnatal day 4 rats were analysed for neurite length and number after organotypical cell culture for 72 h, fixation and immunolabeling. Different concentrations of rhBMP-2 were used in a serum-free culture media. Neurite growth was compared with control groups that lacked stimulative effects; with neutrophin-3 (NT-3), which is a well-established positive stimulus on neurite length and number; and with combinations of these parameters. The results display that neurite number and total neurite length per explant in particular concentrations of rhBMP-2 increased by a maximum factor of two, while the mean neurite length was not affected. NT-3 demonstrated a much more potent effect, delivering a maximum increase of a factor of five. Furthermore, a combination of both growth factors shows a predominant effect on NT-3. Immunohistological detection of BMPR-IB was successful both in cell culture explants and in paraffin-embedded sections of animals of different ages. The results show that rhBMP-2 is, among other growth factors, a positive stimulus for SG neurite growth in vitro. Most growth factors are unstable and cannot be attached to surfaces without loss of their biological function. In contrast, rhBMP-2 can be attached to metal surfaces without loss of activity. Our findings suggest in vivo studies and a future clinical application of rhBMP-2 in cochlear implant technology to improve the tissue/electrode interface.
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Proteínas Morfogenéticas Óseas/farmacología , Neuritas/fisiología , Neurogénesis/efectos de los fármacos , Proteínas Recombinantes/farmacología , Ganglio Espiral de la Cóclea/fisiología , Factor de Crecimiento Transformador beta/farmacología , Animales , Proteína Morfogenética Ósea 2 , Receptores de Proteínas Morfogenéticas Óseas de Tipo 1/metabolismo , Medio de Cultivo Libre de Suero , Neuritas/efectos de los fármacos , Neurotrofina 3/farmacología , Técnicas de Cultivo de Órganos , Ratas , Ratas Sprague-Dawley , Ganglio Espiral de la Cóclea/efectos de los fármacos , Ganglio Espiral de la Cóclea/metabolismoRESUMEN
BACKGROUND: This study was designed to assess the postoperative quality of life (QoL) of 30 patients successfully treated with a laryngectomy. METHODS: QoL was evaluated with two validated questionnaires (EORTC-QLQ-C30 and EORTC-QLQ-H&N35) during the regular outpatient follow-up. To analyse the long-term quality of life, we divided our collective into two groups of patients; one consisting of patients whose treatment had been completed less than five years ago and one whose therapy had been finished more than five years ago. RESULTS: The collective consisted of 24 men (80 %) and 6 (20 %) women with a mean age of 58.8 +/- 8.7 years. Mean follow-up was 53 months (range: 12 - 110). Most patients (n = 15, 50 %) had a tumor stadium IV after UICC. Voice rehabilitation was achieved in all patients with a Provoxreg voice prosthesis. The global QoL was rated as satisfying with a mean value of 62. The analysis of the specific questionnaire showed mostly a limitation of smell. Patients, whose treatment was longer than five years ago, showed a slight improvement in the global QoL. Overall we could not find a significant difference concerning the QoL between the two groups. CONCLUSIONS: In our study the QoL of laryngectomized patients was satisfying. The most common symptoms were problems with smell, cough and dyspnoea.
Asunto(s)
Neoplasias Laríngeas/cirugía , Laringectomía/psicología , Laringe Artificial/psicología , Calidad de Vida/psicología , Sobrevivientes/psicología , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/psicología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Satisfacción del PacienteRESUMEN
Nasal surgery is frequently performed. Predictors of surgical outcome in terms of chemosensory function are not clear. A total of 64 patients were included in this prospective study (41 men, 23 women; age range 22-67 years). Prior to surgery, patients received a detailed otorhinolaryngological examination including nasal endoscopy, and CT scans used to establish the Lund-Mackay score. Olfactory function was analyzed using a custom-built odor identification test which allowed separation of chemosensory function into "olfactory" and "trigeminal" portions. Retest was performed 6 months after surgery. In terms of the sense of smell, nasal surgery produced the highest success rates in women, high degree of polyposis, and aspirin-intolerance. Neither age, presence of asthma, nor the number of preoperative surgical interventions had a significant impact on the outcome of surgery in terms of chemosensory function. Although "trigeminal scores" changed to a lesser degree than "olfactory scores", the present results indicated that nasal surgery may also improve trigeminal function, although this needs further corroboration. Improvement of olfactory function following nasal surgery appears to last, on average, for at least 6 months. While the present results may be seen as an encouraging step towards the description of more detailed prognostic factors related to nasal surgery, results from the present investigation also point towards the idea that nasal polyposis is due to a multifactorial process that, so far, is not adequately addressed by current research. Future work is needed to identify further predictors of postoperative outcome in terms of olfactory function.
Asunto(s)
Seno Frontal/cirugía , Nariz/cirugía , Complicaciones Posoperatorias , Olfato , Adulto , Anciano , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/patología , Trastornos del Olfato/diagnóstico , Trastornos del Olfato/etiología , Percepción OlfatoriaRESUMEN
OBJECTIVE: To demonstrate the functional long-term results after reconstruction of the lower lip with the tongue flap. METHODS: We describe the surgical technique and long-term results of lower lip reconstruction with the tongue flap and review five cases in which this technique was used to reconstruct defects of the lower lip, particularly the lip vermilion. RESULTS: Between 1993 and 2003 we performed reconstruction of the lower lip using the tongue flap in five patients. All patients were followed for 2 to 10 years (mean 3.4 years). The procedure achieved good functional and aesthetic results, with no major complications, in particular no flap necrosis. One patient complained of paresthesias of the tongue which resolved within 24 months. Speech was unaffected by use of the tongue flap, although eating and drinking were temporarily impaired prior to the flap separation at the second and final stage of surgery. CONCLUSION: The tongue flap is a simple and reliable technique for reconstruction of part or all of the lip vermilion. The technique is easy to perform and provides good aesthetic and functional results.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de los Labios/cirugía , Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Lengua/trasplante , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Satisfacción del Paciente , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: The goal of this study was to assess the potentials and limitations of endonasal micro-endoscopic surgery in the treatment of sinonasal inverted papilloma (IP) and to demonstrate long-term results. PATIENTS AND METHODS: From 1989 to 2005, 64 patients underwent resection of IP via an endonasal approach using either the endoscope or microscope. Charts were reviewed retrospectively for presenting symptoms, radiological and intraoperative data. All patients were followed by endoscopic and MRI control during a period of up to 174 months, median follow-up was 78 months. RESULTS: Our study group consisted of 26 male and 38 female patients with an average age of 54.3 years. The majority of the patients (67 %) complained of unilateral nasal obstruction. 52 patients (81 %) were referred for primary surgery. In 12 cases (19 %) recurrent tumors were operated. According to the Krouse classification for IP the tumors were staged as T1 = 11 (17 %) cases, T2 = 37 (58 %) and T3 = 14 (22 %). In two patients a squamous cell carcinoma was associated with an IP ( = T4 stage). Most tumors were localized within the nasal cavity (72 %) or the anterior ethmoid (62 %). In 10 patients an infiltration of the bony skull base was present. During the follow-up period 6 patients developed recurrencies corresponding to an overall recurrence rate of 9.4 %. CONCLUSIONS: The advances in endonasal micro-endoscopic surgery allow both safe and effective removal of IP with low morbidity, and therefore it should be the approach of the first choice. The osteoplastic approach combined with endonasal surgery is suitable in far lateral located IP. Close follow-up is mandatory to ensure the surgical success.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Endoscopía , Microcirugia , Neoplasias Nasales/cirugía , Papiloma Invertido/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adolescente , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Senos Etmoidales/patología , Senos Etmoidales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias Nasales/patología , Papiloma Invertido/patología , Neoplasias de los Senos Paranasales/patología , Reoperación , Estudios Retrospectivos , Base del Cráneo/patología , Base del Cráneo/cirugíaRESUMEN
BACKGROUND: Surgical therapy for paragangliomas (PG) of the head and neck is, due to the alternatives of radiation therapy and wait-and-scan strategy and because of postoperative morbidity, under ongoing discussion. MATERIAL AND METHODS: Between 1981 and 2004, 79 patients with 94 PG of the head and neck were treated at our department. These patients had follow-up examination within a clinical trial considering tumor control, functional results and for the first time neuropsychologically evaluated postoperative quality of life. Mean follow-up time was 65 months (1 to 228 months). RESULTS: Among the 94 PG there were 19 carotid body (GCP), 12 vagal nerve (GVP) and 63 jugular-tympanal paragangliomas (JTP). Of these, 87 tumors underwent surgery. In 68 patients (78.1 %), the tumor could be removed completely. In particular, complete resection of GCP was achieved in 100 %, of GVP in 90.9 %, of JTP type A in 100 %, of JTP type B in 83.3 %, of JTP type C in 66.6 % and of JTP type D in 61.5 %. During the follow-up period, residual or recurrent tumors were diagnosed in 17 patients (19.5 %). Six of the seven residual PG were observed by magnetic resonance tomography and did not show growth. One residual PG and 6 recurrencies were resected completely. One recurrent tumor was radiated and 3 others are under observation without showing growth tendencies. Two patients died postoperatively due to borderline operations of extended tumors. The quality of life after PG surgery showed a SIP of 4.8, which is comparably much better than after acoustic neuroma surgery (SIP 10.3). CONCLUSION: Whereas complete tumor resection of GCP and JTP types A and B is almost ever possible without cranial nerve palsies, surgery of GVP and advanced JTP causes often severe functional deficits. However, postoperative quality of life is mostly good. Nevertheless, advanced PG require an individualized therapeutic regime also including radiation and observation of tumor growth.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Paraganglioma/cirugía , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Tumor del Cuerpo Carotídeo/cirugía , Terapia Combinada , Neoplasias de los Nervios Craneales/cirugía , Femenino , Estudios de Seguimiento , Tumor del Glomo Yugular/cirugía , Tumor del Glomo Timpánico/cirugía , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Paraganglioma/radioterapia , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Enfermedades del Nervio Vago/cirugíaRESUMEN
BACKGROUND: The aim of the present study was to establish the efficacy of endonasal micro-endoscopic surgery for removal of benign and malignant neoplastic lesions of the paranasal sinuses and the anterior skull base. MATERIAL AND METHODS: This retrospective study evaluated 350 patients with tumors of the paranasal sinuses and the anterior skull base (215 benign and 135 malignant tumors) that were treated surgically at the ENT-Department of the Hospital Fulda gAG between 1993 and 2003. Median follow-up was 65 months. RESULTS: Most frequent entities of benign tumors were osteomas, inverted papillomas and juvenile angiofibromas. Adenocarcinomas, squamous cell carcinomas and esthesioneuroblastomas were most frequently treated in the group of malignomas. 54 % of the benign (n = 118) and 41 % of the malignant tumors (n = 54) were resected exclusively via the endonasal micro-endoscopic approach. Within the follow-up period 3 recurrencies were observed, two inverted papillomas (one was operated endonasally) and one juvenile angiofibroma. In the malignoma group 34 patients died because of tumor disease (16 cases due to recurrencies, 18 cases due to metastases formation). The 5 year survival rate was 66.4 % with respect to the disease-specific survival. The Kaplan-Meier analysis revealed statistically significant differences for the pT stage: pT2 and pT3 tumors have had a 5-year disease-specific survival of 92.3 % and 83.8 %, respectively, compared to 61.5 % of the pT4 tumors. Disease-specific survival also showed differences dependent on histology, tumor site and occurrence, but was without proven significancy. In the patient subgroup who suffered from adenocarcinoma, squamous cell carcinoma or esthesioneuroblastoma the 5-year disease-specific survival was 78.4 % of 29 patients after endonasal resection compared to 66.4 % in 51 patients operated via an external approach. CONCLUSION: The advances in endonasal micro-endoscopic surgery also allow a safe and effective removal of benign and malignant anterior skull base tumors with low morbidity. Thereby, indication is dependent on tumor site and size as well as histology.
Asunto(s)
Endoscopía , Microcirugia , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de la Base del Cráneo/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/mortalidad , Neoplasias de los Senos Paranasales/patología , Reoperación , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/diagnóstico , Neoplasias de la Base del Cráneo/mortalidad , Neoplasias de la Base del Cráneo/patología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: In latero-basal, central or spheno-fronto-orbital skull base fractures the internal carotid artery is more frequently involved in severe lesions than expected. PATIENTS AND METHODS: Between 1996 and 2003 we examined 684 patients with Glasgow Coma Scales (GCS) between 2 and 15, median 7.2, using computed tomography (CT). In suspicion of a latero-basal, central or spheno-fronto-orbital fractur they got an additional high resolution skull base CT. If the bony canal of the internal carotid artery (ICA) was involved the patient underwent digital subtraction angiography (DSA). The ICA lesion was treated either interventional neuroradiologically, by surgery or only conservatively. RESULTS: Of the 684 patients 33 (4.8 %) had fractures of the ICA bony canal and therefore underwent DSA. Among them were 25 men and 8 women (mean age 35.3 years). Lesions of the ICA were seen in 1.9 % of the patients. A traumatic cavernous-carotid fistula was found in 7 patients (1 %) and in 6 patients (0.9 %) a dissection and/or an aneurysm of the ICA was diagnosed. Six of the patients had clinical symptoms. The lesions were treated primarily interventional neuroradiologically (n = 5) as well as surgically in two cases by clipping the aneurysm and closing the sphenoid sinus, respectively. CONCLUSIONS: Vessel lesions of the ICA in skull base fractures and involvement of the bony carotid canal are more frequent than mentioned in current literature. A solid diagnosis can only be achieved by DSA. Early diagnosis and treatment is important for improving the prognosis of these often multiply injured patients.
Asunto(s)
Angiografía de Substracción Digital , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Angiografía Cerebral , Fracturas Orbitales/diagnóstico por imagen , Base del Cráneo/lesiones , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Disección de la Arteria Carótida Interna/cirugía , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/lesiones , Seno Cavernoso/cirugía , Femenino , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Masculino , Fracturas Orbitales/cirugía , Base del Cráneo/cirugía , Fracturas Craneales/cirugíaRESUMEN
BACKGROUND: The aim of the study was to evaluate postoperative hearing, facial nerve function, quality of life (QOL), affective status and neuropsychological performance after trans-temporal removal of acoustic neuromas (AN). PATIENTS AND METHODS: A retrospective analysis was carried out in 89 patients with AN who were operated at the ENT-Department of the Hospital Fulda between 1988 and 2004. Median follow up was 57 months. Of these 41 patients were additionally examined by a psychologist for evaluation of QOL, neuropsychological functions and affective disorders using several questionnaires. RESULTS: The AN were classified as follows: Type A = 53 %, type B = 35 % and type C = 12 %. One year postoperatively facial nerve function was excellent in 93.3 % of the patients (grade I and II). In 53 % of cases hearing could be preserved. The subjective QOL was expressed through depression and social withdrawal associated with deafness. However, facial nerve dysfunction did not lead to QOL effect. Objective QOL (functional level) was reduced because of verbal memory disturbances and symptoms like dizziness. In 47.5 % of the patients affective and/or neuropsychological dysfunctions were diagnosed. Subsequent MRI evaluation showed lesions of the temporal lobe in 40.5 % of the cases. Of these 80 % suffered from cognitive and/or affective disturbances. CONCLUSIONS: The cognitive and affective disturbances after trans-temporal removal of AN could be to a certain degree due to the elevation of the temporal lobe during surgery. Further research, especially pre- and postoperative examination of QOL and psychological state as well as the comparison between different approaches, particularly trans-temporal vs suboccipital have to clear up specific morbidity of the different approaches.