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T Lenarz

Publications and source records attributed to T Lenarz.

At least 145 records · Page 8Linked to original sources
PubMed1996

[Tooth discoloration as a rare complication of septorhinoplasty].

BACKGROUND: Surgeons should thoroughly consider the clinical implications of elective surgery such as septorhinoplasty for functional and cosmetic improvement of the appearance of the nose. Complications may jeopardize the intended result of this surgery. CASE REPORT: We report on the rare complication of devitalization of two incisors in the maxilla with disturbing discoloration after performing a septorhinoplasty in a 23-year-old woman. The patient underwent a serial hydrogen peroxide bleaching and a root canal procedure. CONCLUSION: The osteotomy of a huge basal crista that compromised neurovascular dental supply could be a possible mechanism of this event. Even though such a complication after septorhinoplasty is extremely rare, patients should be informed of this eventually prior to surgery, if only for legal reasons.

Adult↗
PubMed1996

[Distant metastasis of renal cell carcinomas to the head-neck area].

BACKGROUND: Metastases of hypernephroma to the head and neck, especially to the larynx, are rare occurrences. PATIENTS: We report on two cases with solitary spread in the head and neck. A 73-year-old woman who underwent nephrectomy because of a hypernephroma six years ago had a manifestation in the right false vocal cord, which was resected by laser surgery. The specimen of the strumectomy in the other patient revealed a metastasis of an asymptomatic hypernephroma to the thyroid gland and finally led to correct diagnosis of the primary tumor. RESULTS: The female patient refused any further treatment and died of cachexia with tumor dissemination four months later. The other patient is still living with a local recurrence after palliative irradiation and administration of interleukin-2 and alpha-interferon. CONCLUSIONS: In absence of other tumor manifestations, choosing an adequate therapy can be difficult because of the long survival rates in some patients even after hematogenous spread and the unpredictable behavior of this malignancy.

Aged↗
PubMed1996

[Cochlear implant in inner ear abnormalities and footplate malformation].

BACKGROUND: Malformations of the cochlea can cause deafness and otogenic meningitis. Cochlear implantation in children with such malformations, which are sometimes quite complex, require special attention before, during and after surgery. PATIENT: The concept developed for these patients at Hannover Medical School is illustrated in a patient with severe bilateral inner ear malformation and bilateral stapes defect. Implantation of a cochlear implant was performed in this 2-year-old girl. A large endostal sack originating from the inner ear, which had caused meningitis twice, was observed in the right middle ear. Both ears had to be obliterated to prevent recurrent meningitis. RESULTS: The child had no post-operative problems and the initial rehabilitation efforts have been successful. The immediate and differentiated reactions to stimulation are very encouraging. This article briefly summaries all diagnostic and therapeutic procedures established over the last three years at Hannover Medical School in cases of implantation into a malformated cochlea. In particular, we describe perioperative radiology (CT scans, MRI and plain radiographs), facial nerve monitoring and intraoperative screening for "hearing sensations", details of surgical technique, and possible postoperative complications. CONCLUSIONS: Based on experience with 13 of these cases, we discuss the different aspects of implantation into a malformated cochlea. Given certain preconditions implantation into a malformated cochlea may be recommended.

Child, Preschool↗
PubMed1996

[Ionomer cement in cochlear implant surgery--applications and long-term outcome].

Over the last ten years about 850 cochlear implant operations were performed at the ENT department of Hannover Medizinische Hochschule. In most cases, intracochlear nucleus implants were used. For about two years the intracochlear Clarion device has also been used in 150 adults and children. For several years we have used ionomeric cement (lonocap, supplied by lonos, Seefeld/Germany) to fix the electrode array in the region of the posterior wall and the facial recess. Previously, the implant package was fixed by ionomeric cement. To evaluate the outcome of cement application, we conducted a prospective study of our implant patients during the period from 1991 to 1993. During regular reexamination over a period of two years postoperatively in 244 patients (122 male and 122 female patients, average age 17.6 years), we did not observe any complication related to the cement. Nearly all revision cases (n = 8) showed a stable contact between electrode array, bone, and cement. With increasing experience, we reduced the cement application and fixed the package with vicryl sutures in a precisely drilled bony bed. Contact of the cement with neural and cerebral structures should be avoided. In our experience ionomeric cement is a helpful tool in cochlear implant surgery with long-term stability and no rejection reactions.

Adolescent↗
PubMed1996

[Reconstructive surgery in the head-neck area with regional and free tissue transfer].

BACKGROUND: Operative treatment of head and neck cancer requires radical resection of the tumor with not only severe impairment of important functions like swallowing speech, and respiration but also aesthetic mutilation because of the exposed character of the head and neck region. Therefore the rehabilitation from a functional and cosmetic standpoint is an essential goal of treatment in addition to control of the malignant disease. Fortunately regional plastic surgery offers a variety of options for reconstruction of the defects to receive a solution tailored to each individual patient. PATIENTS: Between the years 1986 and 1996, 107 patients with advanced head and neck cancer were treated surgically by radical resection of the tumor and plastic reconstruction. In this study we made a retrospective analysis of the functional and aesthetic outcome of the techniques of reconstructive surgery we used for rehabilitation. The sex ratio was 79 males to 28 females. Average age was 59.4 years (ranging from 39 to 78 years). Most of the patients suffered from squamous cell carcinoma of the upper digestive tract (97 cases). The others included an adenocarcinoma of the paranasal sinuses (three cases), adenoid cystic cancer of the palate (two cases), squamous cell carcinoma of the temporal bone (two cases), two deep infiltrating basaliomas in the area of the nose and forehead and one chondrosarcoma of the neck. Our oncological concept includes a radical resection of the tumor and a onestep reconstruction of the defect, if the patient's general condition enables this approach. The surgical techniques we used include the approved pedicled myocutaneous flaps like the pectoralis major flap, latissimus dorsi flap (which can be also applied as a free microvascular tissue graft), temporalis muscle flap, and the free radial forearm flap. RESULTS: In previous years, the pedicled myocutaneous pectoralis-major- and latissimus-dorsi-flaps were used for reconstruction (n = 67), but the arc of rotation and the huge bulk of the graft are limiting factors for the indication of these techniques. The free forearm flap has increasingly been used to provide an excellent closure of large pharyngeal defects (n = 16), whereas the temporalis flap is useful for restoration after limited resection of the palate (n = 18). Beside these rather invasive procedures, aesthetic rehabilitation may be achieved with bone-anchored epithesis especially after exenteration of the orbit and ablation of the external ear in case of elderly patients with multiple morbidities (n = 5). In most cases, sufficient rehabilitation from the anatomical and functional point of view was possible even after large tumor resections. A main problem can be longstanding aspiration after resection of large areas of the pharyngeal mucosa (n = 8). Complications included eight cases of necrosis of the flaps and seven patients who developed significant seromas at the donor site. CONCLUSIONS: The potential of modern regional reconstructive surgery enables the surgeon to achieve anatomically and functionally rehabilitation in a one-step procedure in most cases, even after extended resection for head and neck cancer. One should be aware of the fact that these techniques do not offer a significant improvement of prognosis. As such, the aggressiveness of surgical therapy should remain in reasonable relation to the prognosis of the malignant disease.

Adenocarcinoma↗
PubMed1996

[Cochlear implant management of young children].

INTRODUCTION: Since 1988, more than 450 children have received cochlear implants at the Department of Otolaryngology of the Medizinische Hochschule Hannover. Among them are 38 children who underwent surgery before the age of two. Due to increasing experience with this technique, the mean age at implantation has decreased over time so that most children nowadays receive implants between the ages of two and five. In terms of the critical periods of both development of the auditory system and the acquisition of language, it is advantageous for even younger children to receive implants soon after detection of deafness. However, the present diagnostic tools do not allow proper estimation of residual hearing and additional handicaps. Therefore longer periods of hearing aid use and audioverbal training are mandatory before implantation. Additional objections against early implantation are biosafety problems such as head growth, the high incidence of otitis media, and the specific surgical anatomy. This paper outlines criteria for patient selection, the surgical concept, postoperative rehabilitation, and complications. PATIENTS: Twenty-six children suffered from postmeningitic deafness and beginning obliteration of the cochlea as shown by repeated high resolution CT scans. Nine children had congenital deafness which was detected early in life and showed no improvement after proper hearing aid fitting and audioverbal training for speech development. Three children had severe inner ear malformations detected by CT scans. All children had no ABR or CAP responses in ECoG. Their developmental, language, and neuropaediatric status was examined. SURGERY: Thirty-five children received the Nucleus Mini 22 cochlear implant; three children received the Clarion 1.2 device. The surgery was not different from adult surgery. Special care was given to proper fixation and placement of the electrode in the drilled out mastoid to compensate for head growth. POSTOPERATIVE RESULTS: All children wear the speech processor regularly. They are able to detect everyday sounds and suprasegmental features of speech after a few months. After one year, the child begins to understand and produce speech; after two years speech understanding has been achieved and normal language development starts with small sentences. The complication rate was not higher than in other age groups of patients. Fitting and tune-up of the speech processor required a broad range of experience and a specialized team working at the children's implant center. CONCLUSION: Early implantation in children is both possible and effective in selected cases. Due to an improved early detection of deafness, it should be possible to increase the percentage of children with early cochlear implantation.

Child↗
PubMed1996

[Indications for middle ear obliteration within the scope of cochlear implant management].

BACKGROUND: Cochlear implants have gained worldwide acceptance as a reliable method of rehabilitation of profoundly hearing-impaired patients. Due to thorough patient selection major postoperative complications rarely occur and are flap related in most cases. Deafness can develop during chronic suppurative otitis media, either coincidentally or secondary to the medical treatment; normally this condition is regarded as a contraindication for cochlear implantation. In cases with a mastoid cavity after surgical treatment for cholesteatoma, the electrode covered only by the epithelial lining will likely become exposed or extruded. Therefore we suggest the obliteration of the middle ear cleft with abdominal fat and the blindsac closure of the external ear canal before cochlear implantation in these conditions. PATIENTS: The average age of our 12 patients was 48 years, whereas the youngest was 2 1/2 years of age. Due to chronic inflammatory ear disease. 11 patients had a mastoid cavity on both ears. Eight patients had a cholesteatoma, the chronic bone destroying process in the temporal bone of two female patients was considered as a fibroinflammatory pseudotumor. The child had a congenital deafness in both ears with a Mondini dysplasia in CT scan. She had already developed two episodes of pneumococcal meningitis which was caused by a defect in the stapes footplate through which a liquor-filled cystic sac herniated in the middle ear. Because of a massive liquorrhoea after opening of the sac, we decided to obliterate the middle ear cleft after successful insertion of the electrode array. RESULTS: All active electrodes of 10 Nucleus implants (Cochlear) and two Clarion devices (Advanced Bionics Corp.) were successfully inserted in the cochlea of the 12 patients. After an average follow-up of 15 months, a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a fibroinflammatory pseudotumor developed a massive inflammatory reaction in the implanted ear two months after cochlear implantation, which could not be controlled by conservative treatment. The implant had to be removed and local conditions settled after administration of immunosuppressive treatment with cyclophosphamide. The patient received a new implant seven months ago. CONCLUSIONS: Implantation of a foreign body in a potentially infected space which communicates intracranially means a surgical challenge which can be managed by obliteration of the middle ear after subtotal petrosectomy with abdominal wall fat combined with a reliable closure of the external ear canal. In case of massive inflammation we would prefer a two-stage procedure.

Adipose Tissue↗
PubMed1996

Expression of matrix-metalloproteinases and their inhibitors in human cholesteatomas.

The proteolytic erosion of the temporal bone is the key event in the pathognomonic course of cholesteatoma progression. The molecular mechanisms of bone resorption, endangering the ossicles, the inner ear, the facial nerve, large vessels or the brain, are not understood. Recently, a new family of proteolytic enzymes, the matrix-metalloproteinases (MMP's) has been described and identified, which seems to play a pivotal role in matrix- and bone homeostasis and inflammatory osteolytic diseases, e.g. osteoarthritis and periodontitis. These enzymes are sophisticatedly controlled by specific inhibitors and activation cascades. We investigated whether human cholesteatoma tissue expresses MMP's and MMP-inhibitors. By immunocytochemistry of cholesteatoma-cryosections, the expression of MMP-2 (72 kD collagenase), MMP-9 (92 kD collagenase), and MMP-3 (stromelysin-1) could be seen to be strictly confined to the basal and suprabasal cell layer of the cholesteatoma epithelium. The neutrophil collagenase (MMP-8) showed a more disseminated expression in the epithelium and the granulation tissue as well. The tissue inhibitor of metalloproteases, TIMP-1, could be detected only in very limited areas of the granulation tissue in a quite randomized manner. Therefore, a derailment in favor of proteolysis of the normally tightly controlled MMP-system might be postulated. The results indicate that members of the MMP-family could play an active role in the molecular mechanisms of cholesteatoma invasion into the temporal bone. This offers new insights into the pathophysiology of the disease and of potential therapeutic approaches.

Adolescent↗
PubMed1995

[Progressive hearing loss--pathophysiology, differential diagnosis, therapy].

Progressive sensorineural hearing loss (SNHL) is still a challenge to the otorhinolaryngologist. It can be solved only by a systematic and interdisciplinary approach to the patient and his disease. Most often an acute onset is observed with a non-linear, sometimes dramatic progress to chronicity and complete deafness. Cardiovascular and rheologic diseases, hereditary disorders, immunological phenomena, hormonal and metabolic derailments, infections, environmental causes like noise, ototoxic drugs and industrial substances and systemic maladies must be included in the diagnostic reflections. Otopathy is an idiopathic hearing loss which cannot be classed with the above mentioned disorders. Wherever possible a causal therapy should be carried out. Symptomatic therapeutic concepts include rheologic medications, corticosteroids or, with all reservation, cytotoxic drugs. Hearing aids should be prescribed in close relation to the dynamic deterioration of the hearing. The timely cochlear implant operation stands at the end of the therapeutic scale.

Cochlear Implants↗
PubMed1995

[Noninvasive assessment of intracochlear pressure. III. Case reports of patients with intracochlear hyper- and hypotension].

It was the scope of two previous papers to outline the basics and possible neurotological applications of the tympanic membrane displacement technique (TMD). The present paper is aimed at briefly reviewing five distinct cases where a sudden sensorineural hearing loss with/without tinnitus could be monitored by the TMD technique. These features include a sudden hearing loss upon lumbar puncture, the audiological manifestation of an internal hydrocephalus, stapes gusher and the round window rupture. All symptoms are based on a change in intracranial and intracochlear pressure which in turn leads to the manifestation of the previously unknown sensorineural hearing loss and/or tinnitus.

Adult↗
PubMed1995

[Standardization and quality assurance exemplified by tinnitus].

Quality management will become another discipline for intensive care and research for the physician. Therefore, the first step in this process will be the need for standardised evaluation criteria and case record forms for documentation, leading to effective quality assessment and control. Only this approach may promote our attempts to improve the quality of patient care. Tinnitus is, due to the lack of objective measurable parameters and a missing rational basis of therapy, up to now a "crux medicorum" for every involved person. In this paper we reproduce a case record form and a patient's questionnaire for patients suffering from tinnitus. The presented forms are based on a consensus conference concerning the evaluation of treatment regimens held at the Fourth International Tinnitus Seminar in Bordeaux in August 1991. Epidemiological data, collected with this questionnaire, are presented and analysed. In conclusion, the presented case record form will lead to a standardised evaluation of symptoms according to tinnitus and improve our understanding of concomitant disturbances in tinnitus sufferers. Furthermore, this form of evaluation and documentation will produce comparable data in different centres allowing a pooling of patients data and history. A comparison of clinical trials in which the items are collected by the procedure shown here will be facilitated and lead us to a new understanding in determining the causes of the disease and the outcome of different therapeutic regimens.

Adolescent↗
PubMed1995

[Carcinoma of the temporal bone--current diagnostic and therapeutic aspects].

BACKGROUND: Carcinoma of the external ear canal and the middle ear is a rather rare event and is especially seen in patients with chronic inflammatory ear disease. PATIENTS: Between 1993 and 1994, we treated seven patients with such a tumor, of which six proved to be a squamous cell carcinoma and one presumably adenocarcinoma. In three patients, the malignoma developed in a radical cavity of the ear and caused a facial palsy. Only two patients were without any discharge of the ear. Beside facial palsy, hemorrhagic otorrhea and otalgia were the leading symptoms. One patient presented with a bilateral painless swelling of the neck due to lymph node metastasis. Diagnosis was made by means of biopsy in only three patients and on the basis of a resected specimen after mastoidectomy in four patients. Angiography and computed tomography and magnetic resonance imaging studies were performed prior to treatment to determine the extent of the tumor. RESULTS: The tumor was resected by petrosectomy, parotidectomy, and neck dissection in 5 patients. Three times the margins of the histological specimen were free of tumor. Lymph node metastasis in the neck were seen in 5 cases, while distant metastasis did not occur. Two patients underwent primary irradiation, but a postoperative radiation therapy was performed five times. To date, three patients died after one year follow-up. CONCLUSIONS: Carcinoma of the temporal bone is a rare tumor, which can be treated only in case of early diagnosis.

Adenocarcinoma↗
PubMed1995

[Langerhans cell histiocytosis of the temporal bone].

BACKGROUND: The localized form of the Langerhans cell histiocytosis was referred to earlier as eosinophilic granuloma, which has the best prognosis of all histiocytosis syndromes concerning survival. The non-malignant proliferative disorder of the histiocytic system is still of unknown etiology. Characteristic radiographic signs are osteolytic lesions. PATIENT: We report on an otologic manifestation of a 20-year-old man's temporal bone, which developed three years after a successful treatment of an eosinophilic granuloma of the mandible. RESULTS: Surgery and low-dose irradiation led to a complete remission of the disease. Other manifestations of the disease were not detected until now. CONCLUSIONS: In the presence of chronic aural discharge, Langerhans cell histiocytosis must bei considered in differential diagnosis and a histopathological examination should be performed.

Adult↗