[Reconstruction of the nose in tumor defects].
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Biomedical subjects
Publications and source records attributed to V Jahnke.
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Reliable methods are presented for the reconstruction of various nasal defects following trauma or tumour surgery; they fulfill both functional and esthetic requirements. Pedicle flaps from the immediate surrounding of the defect and particularly from the forehead play a major role. Particularly satisfactory are the fronto-temporal flap for minor defects (mainly for substitution of the ala) and the scalp flap for subtotal or total reconstruction of the nose.
Most carcinomas of the oral tongue and floor of the mouth are presently treated surgically, often combined with pre- or postopervative irradiation. The treatment plan is mainly determined by the primary site and the local and regional extension, desirable are general rules on the basis of the TNM classification. The indications and principles of the most important operative procedures are discussed: Local excision, partial glossectomy, excision of the floor of the mouth with marginal mandibulectomy, composite resection. Operations for removal of the primary and radical neck dissection with preservation of the mandible (e.g. the pull-through procedure) are rarely advised. A radical neck dissection is indicated in each carcinoma of the oral tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection is advised in view of the high frequency of clinically occult lymph node metastases (between 23 and 43%). Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining a motility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible.
In longstanding recurrent laryngeal nerve paresis with parmedian fixation of the vocal cord the fine structure of the vocal muscle is surprisingly well preserved. Though there are in part bundles of atrophic muscle fibers and increased connective tissue, the normal ultrastructure of the remaining muscle and of the myelinated nerves remains always intact. It is assumed that the vocal cord is prevented from regaining its motility both by the increased connective tissue which misdirects the nerve fibers and by irreverisble changes of the cricoarytaenoid joint. The results are discussed in relation to attempts of reconstructive surgery of the recurrent laryngeal nerve as well as various problems in the neurophysiology of the laryngeal muscles.
The hypothesis that denervation of the motor nerves of the larynx regularly results in hyposmia, has been examined by measuring the olfactory acuity in patients with bilateral recurrent laryngeal nerve paralysis. Hyposmia occurred in 28% of the patients who were decannulated following successful endolaryngeal artytenoidectomy (Thornell procedure).
First known case report of the a single large varicosity formation in the parotid gland. Assuming a benign tumer, a parotidectomy was performed and the diagnosis made histologically.
Report of two cases with "acute mastoiditis" which was due to secondary malignant disease in the mastoid as shown postoperatively. One was the metastisis of an embryonic lung tumor previously diagnosed as histologically benign, the other one was the first sign of acute myeloid leukemia.
Using human temporal bone specimens the patency of the reuniting duct was studied. The endolymph was marked by various dyes and fluorescent substance, during the application the cochlea remained closed. It is shown that the substances in the endolymph flow from the first turn of the cochlear duct via the reuniting duct into the saccule. The patency of the reuniting duct is confirmed by histological serial sections, and the clinical significance of these findings is discussed.
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