[Surgical possibilities for improving paralytic dysphagia].
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Cranial Nerve Diseases↗
Biomedical subjects
W Draf
Publications and source records attributed to W Draf.
[Current aspects of frontal sinus surgery. I: Endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses].
Most conditions of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. According to Draf, 3 types of frontal sinus drainage occur. Surgical techniques and indications are described. In a retrospective study we evaluated 132/648 patients who were on average 5 years postoperative. Forty-two patients had type 1, 43 patients had type 2 and 47 patients had type 3 drainage. Endoscopy revealed a normal mucosa in 56-67%, whole polyps were found in 9-15%. There was no recurrence of an orbital or endocranial complication. According to our definition of surgical success, there was a success rate of 83.4% with type 1 drainage, 83.7% with type 2 drainage and 89.4% with type 3 drainage. If there was only little chance for successful endonasal surgery with type 3 drainage, an external osteoplastic frontal sinus operation was performed for definitive therapy.
Drainage↗
[Current aspects of frontal sinus surgery. II: External frontal sinus operation--osteoplastic approach].
Most inflammatory diseases of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. There remain, however, a number of problematic cases in which optimal exposure of the entire frontal sinus is required with possible complete removal of the mucous membrane and sinus obliteration. These remain indications for osteoplastic frontal sinus surgery. Depending on the individual situation, incisions can be chosen that are bicoronal, placed in a frontal crease or positioned below the eye-brow. Surgical techniques are described in detail. Osteoplastic surgery of the frontal sinus with fat obliteration is a reliable and safe method, particularly for management of so-called "difficult" frontal sinuses.
Adipose Tissue↗
[Aspects of frontal sinus surgery. III: Indications and results of osteoplastic frontal sinus operation].
The osteoplastic approach is indicated for frontal sinus surgery if optimal exposure of the entire frontal sinus is required for possibly complete removal of the mucous membrane and sinus obliteration. In a retrospective study we evaluated 75 patients whose osteoplastic frontal sinus operations were performed in Fulda between 1979 and 1992 and examined indications for surgery, complications and outcome. All patients were examined clinically and subjective complaints were recorded. Indications for surgery were trauma (43), acute and chronic infections (19), tumors (11) and sinus pneumatoceles (2). The overall aesthetic and functional outcome was excellent. Revision was necessary in one only patient, who had forced air into his frontal sinus by nose-blowing too early to create a threat of infection. No serious complications occurred, such as surgery-related meningeal injury or impaired or double vision. One patient needed a blood transfusion because of hemorrhage due to operation (1.3%). The main advantage of the coronal incision used was preservation of the supraorbital nerve bundle without subsequent nerve dysfunctions. Besides optimal exposure of the whole frontal sinus, precise replacement of the osteoplastic flap and choice of incision also lead to a good aesthetic result.
Abscess↗
[Frontal sinus impression fracture as a collision sequelae in football].
4 soccer accidents, causing the rare case of impression fracture of the frontal sinus, are introduced as soccer-specific lesions, which are caused by head-to-head collisions, being due to heading-maneuvers. Mostly the right frontal sinus was hurt. The indication for an operation is the obvious dislocation of the osseous fragments. Primary intentions for an intervention are the precise reconstruction of the anterior wall of the frontal sinus because of esthetic reasons and a permanent drainage in order to avoid late complications as for instance mucopyoceles, if the infundibulum has been damaged. The therapy of choice is the osteoplastic frontal sinus operation, using a bicoronary incision.
Adult↗
Temporary unilateral amaurosis with pneumosinus dilatans of the sphenoid sinus.
Pneumosinus dilatans (PSD), first described by Meyes in 1898, is an abnormal dilatation of one or more of the paranasal sinuses without bony erosion. The term sinus pneumocele indicates the presence of bony erosion. Review of the literature from 1968 to 1992 revealed 24 cases of idiopathic PSD and 17 cases of pneumocele of various paranasal sinuses. PSD occurred most commonly in the frontal sinus. Males were more often affected than females. The average age for males ranged from 16.5 for the maxillary sinus to 35.5 years for the sphenoid sinus. Pneumoceles occurred most commonly in the maxillary sinus. The average age for males ranged from 29 years for the frontal sinus and 47 years for the ethmoid sinus. Two patients (1 pneumocele and 1 PSD) had a temporary loss of vision. We report the case of a 37-year-old mountain climber who experienced temporary loss of vision in his left eye above 3000 m. Vision returned below 2000 m. High resolution computed tomography scan revealed pneumosinus dilatans of the sphenoid sinus with dehiscence of the optic canal on the left side. Endonasal microendoscopic resection of the anterior wall of the left sphenoid sinus was performed. The patient has remained symptom-free after 2 years of follow-up. Pneumosinus dilatans should always be considered in the differential diagnosis of sudden visual loss associated with atmospheric pressure changes.
Case Reports↗
[Reconstruction of lacrimal ducts].
For reconstruction of lacrimal drainage after injury of tumour resection indications, surgical technique and results of five surgical procedures are presented: primary suture with splinting, conjunctivorhinostomy, endonasal dacryocystorhinostomy, Heermann tube and mobilisation of nasolacrimal duct. Performing these techniques, solitary or in combination, one achieves almost a good lacrimal drainage. The results of our retrospective study are based upon a combination of subjective and objective findings. Success rate was 96% for direct suturing of the tear ducts with intubation, 100% for conjunctivorhinostomy, 96% for endonasal dacryocystorhinostomy in case of postsaccal stenosis, 83% for Heermann/Jones tube and 100% for relocation of the nasolacrimal duct.
Dacryocystorhinostomy↗
[Foreign bodies of the esophagus and upper gastrointestinal tract in childhood].
In a retrospective study we evaluated 49 endoscopies performed under suspicion of a foreign body in the oesophagus or upper gastrointestinal tract. In 27 cases a foreign body was easily removed. One child had to undergo a cervical oesophagotomy as a result of a chronically incarcerated foreign body. Because of the very low complication rate of endoscopy and a much higher risk of complications due to unknown foreign bodies, early endoscopic diagnosis is recommended even if the foreign body is only suspected.
Child, Preschool↗
Temporal bone fractures: high resolution CT.
Apart from midfacial traumas, laterobasal fractures are the most common skull base injuries the ENT surgeon has to deal with. These fractures often appear in combination with more or less extensive further skull or brain injuries. In these cases interdisciplinary co-operation with the neurosurgeon is necessary. Today, development of high resolution computed tomography makes it possible to define priorities in treatment of these patients exactly.
Adult↗
[Aneurysmal bone cyst of the petrous bone. A rare cause of recurrent bacterial meningitis].
Occult malformations of the skull base are very rare disorders which cannot initially be diagnosed clinically. They become first symptomatic, if complications arise. The most frequent clinical manifestation is a recurrent bacterial meningitis. Based on the unique case of a presumably congenital aneurysmal bone cyst of the petrosal bone, which imposed clinically as hearing loss and recurrent bacterial meningitis, we have evaluated the extensive literature on this theme. Considering mostly atypical clinical findings, solely coronal thin-section computed tomographic scans of the skull base allow a reliable diagnosis. The possible risks of this investigation (necessary sedation up to insufflation anesthesia and the radiation exposure of the child's lens) are justifiable and subordinate to the diagnostic importance.
Adolescent↗
[Tumors and pseudotumors ("tumor-like lesions") of the frontal cranial base, originating in the nose, the paranasal sinuses and the nasopharynx (including surgical approach)].
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Combined Modality Therapy↗
[Endonasal microsurgical treatment of lacrimal duct stenoses. Indications, technique and results].
In a retrospective study we examined the indications, results and complications of endonasal microscopic dacryocystorhinostomy. Eighty-five operations were evaluated. Surgical success was proven in 83% for all indications using a combination of subjective judgement and objective findings. For the so-called classic indications--postsaccal stenosis, functional stenosis dacryolith and acute empyema--the operation was successful in 91% of cases. There were no permanent side effects.
Adolescent↗
[Results, complications and efficacy of micromediastinoscopy].
In a retrospective study we examined all 72 patients who underwent a mediastinoscopy using the surgical microscope described by Meuser in 1968. A total of 74 operations was performed. In only 3 cases was there a false-negative result. Test sensitivity was 95%, specificity 100% and effectiveness 96%. Complications involved 2 cases of pneumothorax (for which no further therapy was necessary), 1 case of bleeding from a branch of the brachiocephalic trunk and 1 case of persistent lymphorrhagia with chylothorax, which was stopped by repeat mediastinoscopy. Preconditions for mediastinoscopy to minimize complications and false-negative results are: preoperative CT of the thorax, good cooperation with an anaesthesiologist, use of a microscopic and other special instruments and intraoperative frozen sections of tissue biopsies.
Adolescent↗
[Personal experience with Ionocem in head- and neck surgery].
Ionomeric bone bond cement (Ionocem) is a new alloplastic bone replacement material, which was used by us for functional and aesthetic purposes in surgery of the head and neck. We have used the cement 44 times (in 43 patients) for repair of skull and mid-face trauma, reconstruction of defects after tumor removal and for aesthetic augmentation. Ionocem was distinguished by its ready shaping on existing bony structures, its adaptation of bone fragments and bone implants without gaps and its help in avoiding ancillary procedures requiring autogenous grafts. Complications occurred in 22 patients, with most involving swelling, seromas, granulation, fistulas and sequestration which occurred after unsuitable indications or application.
Adolescent↗
[A 28-year-old patient with hepatitis, parotid gland swelling, facial paralysis and conjunctivitis].
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Adult↗
[Simultaneous occurrence of an acoustic neurinoma and a glomus tympanicum tumor in a patient. An unusual constellation and problematic surgical task].
We present the case of a 65-year-old woman who was found to have a concurrent ipsilateral acoustic neuroma and glomus tympanicum tumor. Both tumors were removed in one operation. The acoustic neuroma was removed via the translabyrinthine approach because of preoperative deafness while the glomus tumor was found only during the operation to remove the neuroma. A preoperative biopsy was not associated with significant bleeding while microscopic examination of the biopsy tissue indicated only chronic infection.
Aged↗
Surgical management of midfacial fractures.
A brief overview has been given about types, diagnostics and therapy of midfacial fractures. The ENT-surgeon should play an important and active role in the treatment. In extended cases interdisciplinary cooperation will give better results.
Frontal Sinus↗
[Esophagotracheal fistula of the cervico-thoracic area--problem solution using a combined trans-cervical and transthoracic approach].
Closure of oesophagotracheal fistulae in the cervicothoracic region using a cervical approach often fails. We report a patient with carcinoma of the larynx who underwent pharyngolaryngectomy, postoperative radiotherapy and several operations for reconstruction of the hypopharynx and cervical oesophagus elsewhere. Finally we were asked to close an oesophagotracheal fistula in the cervicothoracic region. We were successful using a pectoralis major muscle flap via a combined transcervical-transthoracal approach. This interdisciplinary procedure seems to be the method of choice in difficult cases of achieving safe closure of fistulae in this region.
Humans↗