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Biomedical subjects

W Draf

Publications and source records attributed to W Draf.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Jugulotympanic paraganglioma: therapy concepts under development].

BACKGROUND: The operative treatment and radiation therapy of jugulotympanic paragangliomas (JTP) are still a matter of controversial discussion. In spite of various improvements during the last 50 years, selecting the appropriate treatment modality (surgery, radiation, or observation) is still a challenge. PATIENTS: During a 16-year period, 44 patients with 45 JTP (10 at level A/B and 35 at level C/D according to Fisch) were seen at the ENT-department in Fulda. Forty-one cases were treated surgically. RESULTS: Complete resection was possible for level A/B in 100% of the patients (n = 10). Residual tumor was demonstrated for level C in 23% of the patients (5/22) and for level D in 40% (4/10) with a median follow-up time of 69 months. In two cases residual tumor was treated by radiation. Six patients with residual paraganglioma tissue were maintained under observation without any evidence of tumor progression (median follow-up time 39 months). We report one death after the attempt to resect a large residual paraganglioma that had already caused brain stem compression. A sufficient duraplasty could not be achieved following radiation therapy. CONCLUSIONS: Complete tumor resection of jugulotympanic paragangliomas of levels A and B is often possible without injury to the cranial nerves. Extensive tumors present difficulties in complete tumor resection and increase the risk of cranial nerve injuries. Advanced paragangliomas therefore require an individualized therapeutic regime including surgery, radiation therapy, and observation of tumor growth.

Adult↗
PubMed1998

[Reconstruction of the forehead region with tabula externa of the skull].

BACKGROUND: Calvarial bone graft is often used in reconstructive cranio-facial surgery. As most common three different forms can be distinguished: outer-table bone, full thickness grafts and composite flaps (bone with a periostal or muscular pedicle). PATIENT AND METHOD: An extensive fibrous dysplasia of the frontal region was removed in a 26 years old patient. Reconstruction was carried out with alloplastic material achieving a good esthetic result. Recurrent seroma and occurrence of a fistula demanded removal of the alloplastic material and en-bloc reconstruction of the forehead region was accomplished with a parietal outer-table graft. Within a follow-up time of one year a good esthetic and stable reconstruction has been achieved. CONCLUSION: Split-thickness calvarial bone is still a versatile graft in reconstruction of the forehead region. Although a low rate of side effects in harvesting calvarial bone grafts are in general expected, one has to be aware of dural lesions occuring in the donor site during craniotomy.

Adult↗
PubMed1998

[Regional muscle flap-plasty and adjuvant measures for rehabilitation of the paralyzed face].

BACKGROUND: The loss of facial nerve activity reduces the quality of life in regard to functional disturbances and to the appearance of the patient. As far as possible a reconstruction of the facial nerve should be advocated. Only this procedure allows the natural variety of differentiated facial expression. If reconstruction of the facial nerve is not indicated or turns out to be unsatisfactory, a dynamic muscle transposition should be considered. PATIENTS AND METHODS: The patient records of the ENT-Departments in Fulda for the period from 1988 to 1995 and in Mönchengladbach from 1993 to 1995 were reviewed to survey the experience of secondary plastic rehabilitation of the paralysed face. Our special interest focussed on the oral region with dynamic muscle transfer. The techniques leading to rehabilitation of the lid region were included in this study. RESULTS: Transfer of the temporalis muscle was performed 12 times and a masseter muscle flap 4 times to rehabilitate the oral region. Static rehabilitation (canthoplasty, tarsorrhaphy) of the lid was performed 8 times, implantation of a gold weight in the upper lid 5 times and dynamic rehabilitation of the lid region with a temporalis muscle transposition once. CONCLUSIONS: Rehabilitation of the oral region is best managed with a temporalis muscle flap because of its favourable vector of tension and its broad, flat form. Masseter muscle transposition is particularly indicated if a temporalis muscle transfer is not possible or if resection of the facial nerve because of malignancy of the parotid gland has to be performed and nerve reconstruction is not advisable.

Adult↗
PubMed1998

[Is chronic laryngitis associated with Helicobacter pylori? Results of a prospective study].

H. pylori is found in the stomach of patients with chronic gastritis. The infection is usually transmitted by the gastro-oral route and bacteria could be identified in saliva and dental plaque. An essential cause of chronic laryngitis is gastroesophageal reflux. The aim of the study was to evaluate if a H.pylori-associated chronic laryngitis exists. 38 patients with chronic laryngitis underwent gastroscopy. Biopsies were taken from the gastric antrum and body, lower, middle and upper esophagus. H. pylori was diagnosed by rapid urease test and histology. 14 of the patients (36.8%) were H.pylori-positive, but the bacteria could not be identified between stomach and larynx. 24 patients were H. pylori-negative. Seven patients (18.4%) suffered from esophagitis, six of these patients were H. pylori-negative. The H. pylori-infected patients received triple therapy for one week, in case of esophogitis Omeprazole 20 mg BID was prescribed. Six weeks later a follow-up endoscopy was performed. The eradication rate was 12/14 (85.7%), in all patients with reflux the esophagitis was cured. The laryngitis was clinically and endoscopically unchanged in ten of the twelve (83.3%) patients after successful treatment for H. pylori; in the remaining two patients as well as in the two H. pylori-positive patients the laryngitis was improved. In six out of the seven patients with esophagitis the laryngitis had healed completely and was improved in the remaining patient. It may be concluded that there is no evidence for the existence of H. pylori-associated laryngitis, suggesting that acid reflux is the underlying etiology.

Adult↗
PubMed1997

Extranasopharyngeal angiofibroma in a 15-month-old child.

Angiofibromas are usually characterized by typical location with involvement of the posterior nasal cavity and nasopharynx. They are most commonly found in adolescent males. Despite these facts, a case of an angiofibroma presented in a 15-month-old boy at an atypical site anterior and medial to the lacrimal sac. The tumor was resected via an endonasal, micro-endoscopic approach avoiding an external incision.

Angiofibroma↗
PubMed1997

Occult malformations of the skull base.

Occult malformations of the skull base are rare anomalies. They are often not detected until they give rise to complications such as meningitis or cerebrospinal fluid rhinorrhea. We used high-resolution computed tomography, fluorescein endoscopy, cisternography, magnetic resonance imaging, and duraplasty to diagnose occult malformations of the skull base in 4 patients. The four patients had had between 4 and 6 attacks of meningitis. Cerebrospinal fluid rhinorrhea was confirmed in 3 cases. The following occult malformations were found: (1) an encephalocele of the glabella/cribriform plate and a meningocele at the petrous bone apex, (2) a meningoencephalocele at the petrous bone apex, (3) dural lesions in the regions foramen rotundum/sphenoid sinus and frontal sinus/cribriform plate, and (4) a dural lesion of the sphenoid sinus. In patients presenting with recurrent meningitis, meningitis with isolation of upper airway pathogens, or cerebrospinal fluid rhinorrhea, modern diagnostic methods should be used to search for dural lesions. Diagnosis of an occult malformation makes it possible to perform the necessary surgical repair and thus prevent the further occurrence of potentially fatal episodes of meningitis.

Adolescent↗
PubMed1997

[Long-term follow-up of fronto-basal dura-plasty].

A safe closure of a dura lesion is necessary on account of the risk of potentially fatal (late) meningitis. 161 duraplasties of the frontal skull base carried out from 1979 to 1994 at the ENT-department Fulda were evaluated in a retrospective study in regard to etiology, operative techniques and results. Duraplasty of the rhinobasis was indicated in 70 cases of rhinobasal trauma, 47 cases after paranasal sinus surgery, 36 cases of tumors and 8 malformations. After an average follow-up time of 6 years the patients were interviewed for postoperative liquorrhea, sinusitis treated with antibiotics and meningitis. As an objective measure to verify the tight closure of the treated CSF-leaks a fluorescein test was performed in 50.9% 6 to 8 weeks after the operation. Duraplasty was successful in more than 96%. The approach and technique to perform a duraplasty have to be chosen individually considering size, location and etiology of the dural defect. In the majority of dural defects in the area of the frontal skull base reconstruction can be carried out now a days via an endonasal approach. By use of allogenic tissue, a mucosal flap from the surrounding area to cover the graft and fibrin clue good results were obtained.

Adolescent↗
PubMed1997

[Early childhood angiofibroma in an unusual site].

Angiofibromas are usually characterized by their occurrences in adolescent males with a typical localization and involvement of the posterior nasal cavity and nasopharynx. Even the suspicion of an extranasopharyngeal angiofibroma or an angiofibroma in young children must be viewed in general with skepticism, although reports of angiofibromas with atypical localizations and manifestations in young children have appeared in the literature. Three cases of this fibro-vascular neoplasm with manifestations in the first decade of life and atypical localizations are presented: (1) an angiofibroma medial to the left lacrimal sac in a 15-month old boy, (2) a right paranasal localization in a 9-year-old boy and (3) an angiofibroma limited to the right sphenoid sinus in a 6-year old boy. In all three cases the neoplasm was resected via an endonasal, micro-endoscopic approach that avoided an external incision. According to the literature and based on our own experiences with typical histological findings in all three cases, the clinician has to be aware that the rare angiofibroma can occur in preadolescent children with atypical localizations. The endonasal surgical approach is without any doubt the least traumatic one and in selected cases allows resection of a circumscribed tumor considering functional and aesthetic aspects.

Angiofibroma↗
PubMed1997

[Malignant degeneration of juvenile laryngeal papillomatosis?].

BACKGROUND: Spontaneous malignant transformation of laryngeal papillomatosis was in the past mostly negated, or the discussion in literature was rather toned down and reserved. Therefore, from a biological and prognostic point of view, HPV infection of the larynx seems to carry a different weight than a viral infection in genital region. According to general consensus, secondary, malignant transformation in juvenile papillomatosis occurs in irradiated patients and leads to the conclusion that radiation therapy of this disease is presently contraindicated. Because there is as yet no causal and curative treatment, repeated and frequent removal of papillomatous tissue by microlaryngoscopy may often be necessary to keep the airway patent. PATIENT, METHOD AND RESULTS: We diagnosed and treated an advanced laryngeal squamous cell carcinoma with lymphatic metastasis in a 50-year old male. Juvenile papillomatosis had been diagnosed already at the age of five, and at the patient's last presentation 5 years ago (age 45), typical clinical and histological features of laryngeal papillomatosis had been observed. Furthermore, virus infection of the papillomatous tissue (HPV-6/11) was proved by using the technique of in-situ hybridisation. Risk factors for malignant transformation, such as smoking, alcohol or radiation, were denied by the patient. CONCLUSIONS: From these aspects, a spontaneous, malignant transformation of laryngeal papillomatosis must be considered with regard to six similar observations in the German and English literature. In the reported case, a tumoural origin in the flat laryngeal mucosa in close neighbourhood to the former site of papillomas, is less probable, albeit not ruled out completely, since continuous changes from benign squamous papilloma to atypical, invasive tumour and a HPV-infection in the carcinomatous tissue could not be proved by in-situ hybridisation.

Carcinoma in Situ↗
PubMed1997

[Possible indications for temporalis muscle flaps in plastic-reconstructive surgery of the head and neck].

BACKGROUND: In reconstructive plastic surgery, the temporalis muscle has proven to be a reliable and versatile flap for a wide field of indications. The temporalis muscle is a flat, fanshaped muscle with a generous blood supply and innervation from the trigeminal nerve. METHODS AND RESULTS: Based on our own experiences in a total of 25 cases (12 cases involving muscle transposition for mouth reanimation, six cases involving stabilisation of a duraplasty including protecting the internal carotid artery in one case, four cases involving reconstruction of the orbital floor or the base of the skull, and three cases involving recontouring the lateral face) and a review of the literature we give an up-to-date overview of the different indications for the temporalis muscle flap. These include: a) treatment of facial nerve paralysis, b) recontouring of the lateral face, c) reconstruction of skull base, orbita, and oropharynx, d) stabilization of duraplasty, e) protection of internal carotid artery, f) in temporomandibular joint surgery, and g) for obliteration in ear surgery. CONCLUSION: Because of the wide range of indications, the temporalis muscle flap remains a versatile and important tool in plastic reconstructive surgery.

Adolescent↗
PubMed1997

[Anatomic terminology and nomenclature for paranasal sinus surgery].

A consensus on the preferred modern usage of potentially confusing or ambiguous terms in sinus anatomy and nomenclature is described. These terms are intended to provide clear communication among otorhinolaryngologists worldwide and serve as a basis for discussion among anatomists. Terminology is based on Latin nomenclature. An attempt has been made to reconcile or eliminate duplication, redundancy, and overlap in terminology that have arisen over the past century. A key concept is that the ethmoid complex is divided into anterior and posterior sections by the basal lamella of the middle turbinate.

Ethmoid Sinus↗
PubMed1997

[Endonasal frontal sinus surgery with permanent implantation of a place holder].

BACKGROUND: Endonasal frontal sinus surgery is well established. It is not yet clear what degree of enlargement of the frontal sinus neoostium is required to achieve permanent drainage or whether stenting improves the results. PATIENTS AND METHODS: Prospective survey with two groups: Group 1. included 10 patients (15 operations) who underwent endonasal sinus surgery because of chronic polypoid sinusitis with stenting of the frontal sinus neoostium for 6 months. Group 2. included 11 patients (21 operations) without stenting. INTERVENTION: Endonasal frontal sinus surgery with extended drainage Draf Type II (NFA II according to May) with (group 1) and without (group 2) long-term stenting of the neoostium for 5 months using a silicone stent. MAIN OUTCOME MEASURE: 12-16 months postoperatively: flexible endoscopy of nose and frontal sinus; computed tomography; magnetic resonance tomography; Wilcoxon-Mann Withney-Test. RESULTS: With stenting: neoostium endoscopically patent in 80% (including 20% with edematous swelling only at the opening to the frontal sinus), occluded by scar tissue in 6.7%, occluded by polyps in 13.3%. Endoscopy and CT/MRT together: normal mucosa and aeration in 93.3%, complete opacification in 6.7%. Without stenting: neoostium endoscopically patent in 33%, occluded by scar tissue in 48%, occluded by polyps in 19%. Endoscopy and CT together: normal mucosa and aeration in 71.4%, aeration and mucosal swelling in 14.3%, complete opacification in 14.3%. With stenting of the frontal sinus neoostium for six months endoscopic evaluation of the frontal sinus was possible in a significantly higher proportion of cases (p = 0.0416). CONCLUSION: Long-term stenting of the frontal sinus significantly reduces the rate of recurrent stenosis of the frontal neoostium and is recommended in all cases where an extended frontal sinus drainage is necessary. The optimal design for such a stent has not yet been clearly defined.

Adult↗
PubMed1997

[Osteoplastic surgery of the frontal sinus: indications, procedures and results apropos of 75 cases].

In a retrospective study we have evaluated 75 osteoplastic frontal sinus operations performed in Fulda (Germany) between 1979 and 1993. Fractures, infections, tumors and pneumatosinus represent the indications for surgery. The frontal sinuses were obliterated in 31 cases. The average duration of follow up was 3.8 years. The overall results were very good and without serious complications. Only one revision was necessary.

Frontal Sinus↗
PubMed1996

Management of dural lesions occurring during endonasal sinus surgery.

BACKGROUND: Dural lesions incurred during endonasal sinus surgery must be repaired surgically because of the risk of potentially fatal late meningitis. DESIGN: Retrospective survey. SETTING: Ear, nose, and throat department of a university teaching hospital. PATIENTS: Consecutive sample of 47 patients who had undergone duraplasty for repair of a dural lesion that occurred as a complication of endonasal sinus surgery. Forty-two patients were interviewed after an average postoperative period of more than 5 years. INTERVENTION: Endonasal duraplasty, external duraplasty (fronto-orbital or transfrontal extradural approach) by underlay or onlay technique. MAIN OUTCOME MEASURES: Fluorescein test (intrathecal administration of fluorescein sodium and subsequent nasal endoscopy), subjective complaints, history of meningitis, cerebrospinal fluid rhinorrhea, or hyposmia. RESULTS: There were 44 endonasal and 3 external duraplasties (2 by the fronto-orbital and 1 by the transfrontal extradural approach); the underlay technique was used in 25 and the onlay technique in 22. The fluorescein test, performed in 43% (20/47) of the patients was negative in all cases. Twenty-six percent of the patients had had 1 or more episodes of bacterial sinusitis without meningitis. Duraplasty was clinically intact in 100%. Postoperative olfactory disturbances were reported in 17%. CONCLUSIONS: Duraplasty can be performed satisfactorily by the endonasal route, thus avoiding the disadvantages of the fronto-orbital approach (visible scar, risk of damage to the supraorbital nerve, and removal of bone from the floor of the frontal sinus with a tendency to stenosis of the nasofrontal duct and subsequent mucocele). Allogeneic connective tissue in combination with fibrin glue has proved suitable as a graft material.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1996

Effect of omeprazole on the course of associated esophagitis and laryngitis.

Esophagitis has increasingly been implicated as a cause of chronic laryngitis and there is some evidence that gastro-esophageal reflux disease (GERD) is more common in patients with laryngitis. The aim of this study was to evaluate whether patients with esophagitis and laryngitis responded to treatment with omeprazole. Of 74 consecutive patients with endoscopically proven GERD, 21 had laryngitis. These 21 patients with associated esophagitis and chronic laryngitis were treated for 4 weeks with omeprazole 40 mg per day. After 2 weeks of treatment and at the conclusion of the study, 2 weeks later, esophagoscopy and laryngoscopy were performed and the patients responded to a questionnaire on their symptoms. The follow-up period was 1 year. Twenty-one of the 74 patients (28.4%) had esophagitis (grade I, n = 12; grade II, n = 9) and associated laryngitis (grade I, n = 14; grade II, n = 7). The severity of the esophagitis accorded with the severity of the laryngitis. After 2 weeks' treatment with omeprazole, both the esophageal and the laryngeal symptoms had improved in all 21 patients. Endoscopically, the healing rates were 62% for esophagitis and 33.3% for laryngitis. At the end of the study period, at 4 weeks, all patients were symptom-free and the esophagitis and laryngitis had healed completely. No patient suffered from drug-induced side effects. Patients with associated laryngitis and esophagitis should be given adequate anti-reflux therapy. Both the laryngeal and esophageal symptoms improved with the omeprazole treatment, suggesting that reflux was the underlying etiology.

Adult↗
PubMed1996

[Long-term results of endonasal frontal sinus surgery].

Most conditions of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. To date there has been no clear position regarding indications and results of different types of endonasal frontal sinus drainage. In a retrospective study we evaluated long-term results of Draf's type II and III endonasal frontal sinus drainages using endoscopy and computed tomography. Twelve to 98 months following type II drainage, 58% of 83 frontal sinuses were ventilated and normal. A ventilated frontal sinus but with hyperplastic mucosa was seen in 12%. Scarred occlusion with total opacification on CT occurred in 14%. Furthermore, total opacification in 16% was due to recurrent polyposis. Patients were free of symptoms or had only minor problems in 79%. Twelve to 89 months following type III drainage, 59% of 81 frontal sinuses were ventilated and normal. A ventilated frontal sinus with hyperplastic mucosa was seen in 17%. Scarred occlusion with total opacification on CT was present in 7%. Furthermore, total opacification in 16% was due to recurrent polyposis. In all, 95% of the patients were free of symptoms or had only minor problems. Combining our results with those of other authors and utilizing the physiology of wound healing after sinus surgery, we developed a protocol of differential indications for endonasal frontal sinus drainage.

Adolescent↗