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W Hosemann

Publications and source records attributed to W Hosemann.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Interdisciplinary endoscopic outpatient management of connatal dacryocystoceles].

Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.

Ambulatory Surgical Procedures↗
PubMed2001

Clinical anatomy of the nasal process of the frontal bone (spina nasalis interna).

OBJECTIVES: During endonasal frontal sinusotomy with the sharp spoon, a solid piece of bone is frequently encountered anterior to the neo-ostium. This bone may be referred to as the nasal process of the frontal bone or internal nasal spine (spina nasalis interna). A prominent spina may render an extended sinusotomy difficult and may call for use of the drill. A series of anatomic measurements is presented to illustrate the 3-dimensional anatomy of the spina nasalis and the regional anatomy. METHODS: A maximum endonasal frontal sinusotomy (Draf type I-II procedure, nasofrontal approach type II) was performed on 36 anatomic specimens by means of a sharp spoon. The dimensions of the remaining nasal spine were measured subsequently together with the anterior-posterior diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neo-ostium to the anterior ethmoidal artery. RESULTS: The individual microanatomy of the medial floor of the frontal sinus showed a wide range of variation. The average height of the individual spine was 10 mm, the maximum depth 6 mm. A correlation was found between the nasofrontal angle of the specimen and the anterior-posterior dimension of the spine: the more acute the angle, the thicker the spine. In three quarters of the cases, the neo-ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery. CONCLUSIONS: The presented investigations provide the surgeon with quantitative data on the individual anatomy of the nasal spine and offer additional information for selecting the appropriate surgical procedure in the individual patient.

Cadaver↗
PubMed2001

Modern concepts of frontal sinus surgery.

OBJECTIVES/HYPOTHESIS: To validate the endonasal surgical approach to frontal sinus in inflammatory sinus disease, trauma, and selective tumor surgery, and to define the role of external approaches to the frontal sinus. Endonasal frontal sinusotomy can range from endoscopic removal of obstructing frontal recess cells or uncinate process to the more complex unilateral or bilateral removal of the frontal sinus floor as described in the Draf II-III drainage procedures. In contrast, the osteoplastic frontal sinusotomy remains the "gold standard" for external approaches to frontal sinus disease. METHODS: A retrospective review of 1286 patients undergoing either endonasal or external frontal sinusotomy by the authors at four university teaching programs from 1977. Prior author reports were updated and previously unreported patient series were combined. RESULTS: Six hundred thirty-five patients underwent type I frontal sinusotomy, 312 type II sinusotomy, and 156 type III sinusotomy. A successful result was seen in these groups, 85.2% to 99.3%, 79% to 93.3%, and 91.5% to 95%, respectively. External frontal sinusotomy or osteoplastic frontal sinusotomy was successfully performed in 187 of 194 patients. Clinical symptoms, endoscopic findings, computed tomography, and magnetic resonance image scanning, and reoperation rate measured postoperative success. CONCLUSIONS: A stepwise approach to the surgical treatment of frontal sinusitis, trauma, and selective benign tumors yields successful results as defined by specific criteria which vary from 79% to 97.8%. The details of specific techniques are discussed, essential points emphasized, and author variations noted.

Chronic Disease↗
PubMed2001

Evaluation of powered instrumentation in out-patient revisional sinus surgery.

A feasibility study was carried out to prove the benefits of powered instrumentation, i.e. microdebrider in revisional surgery under local anaesthesia of chronic sinusitis in out-patients. Acceptance by the patients was investigated by questionnaire. Out-patient surgery is well tolerated by the majority (79.2%) of patients. Ninety-four percent would undergo the treatment again if necessary. An operation under general anaesthesia could be avoided in the cases we submitted to investigation. The cost-effectiveness of the method is thus an important consideration, despite calculating high prime costs and rather expensive, expendable instrumentation. Special consideration is attributed to a new feature added to the debrider device. To improve out-patient care, we developed an integrated electrocoagulation unit which supplements the microdebrider. It proved to be effective and easy to use. Bleeding was reduced to a minimum. Hence, nasal packing could be avoided in all out-patient cases. The possibility of causing severe complications using the microdebrider-technique is not eliminated as was shown in the anatomical specimens. Based on our experience, reduction of strong bony structures is subject to limitations at present. We therefore recommend the use of microdebriders for soft tissue manipulations, especially in revisional surgery. The microdebrider proved to be a significant advantage in out-patient surgery for recurrent sinusitis.

Adolescent↗
PubMed2000

The success of 6-month stenting in endonasal frontal sinus surgery.

The ultimate success or failure of frontal sinus surgical procedures, whether they be endonasal or external, is determined essentially by the rate of restenosis of the frontal sinus outflow tract or neo-ostium postoperatively. Long-term stenting for a period of several months significantly reduces the rate of restenosis, particularly in difficult cases. We retrospectively reviewed the cases of 12 patients who received 21 frontal nasal stents, which were left in place for 6 months. Based on outcomes measures that included endoscopy or radiologic findings and patients' self-evaluations, we conclude that frontal nasal stents that are left in place for 6 months are more effective than stents that are removed earlier. We recommend that this type of management be considered in difficult revision cases and before performing an external operation.

Adult↗
PubMed1999

Surgical experience and complications during endonasal sinus surgery.

OBJECTIVE/HYPOTHESIS: The introduction of optical aids for endonasal sinus surgery has not produced the expected drop in the rate of serious intraoperative complications. STUDY DESIGN/METHODS: 1. Retrospectively, consecutive procedures of different surgeons were analyzed in regard to major complications (periorbital injury, orbital lesion, dural injury, endocranial lesion, damage to the internal carotid artery). The chronological distribution was transformed into a personal learning curve. 2. From our own experience and as surveyors, we analyzed the experiences of surgeons having encountered severe complications and compared them with the above-mentioned learning curve. RESULT: In total, 1,500 operations carried out by five surgeons with 16 serious complications were assessed. For the learning curve, the following stages were defined. stage I: greatest risk of complication, with dural injury (1st to 30th operation); stage II, slighter risk of complication, with frequent periorbital injuries (31st to 180th operation); and stage III, least risk, corresponding to an experienced surgeon. Serious complications occur most frequently among experienced surgeons. CONCLUSION: The beginner enjoys the most effective type of assistance, in the form of personal guidance of an experienced surgeon who is constantly present during the first 30 operations, and who should then be readily available during the next 70 operative procedures. The use of multimedia software appears to be helpful, though its actual value still remains to be determined. The experienced surgeon in particular must be willing to exercise repeated self-criticism to keep his or her rate of complications to a minimum.

Dura Mater↗
PubMed1999

Wound healing of mucosal autografts for frontal cerebrospinal fluid leaks--clinical and experimental investigations.

Wigand introduced in 1981 the concept of applying autogenous free mucosal grafts for small to middle-sized cerebrospinal fluid (CSF) leaks of the frontal skull base. This operative technique has proved to be successful in clinical use. However, the details of wound healing of the free graft and the host area of the skull base are largely unknown. We conducted a series of animal experiments using 21 rabbits. Standardized CSF leaks of the frontal skull base were created and then closed using free autogenous grafts from the nasal septum. Twenty specimens could be evaluated after different postoperative time intervals by means of conventional microscopy of histological serial sections. In addition, we carried out a small series of special clinical postoperative observations following routine sinus surgery for polypoid mucositis on our patients, applying free mucosal autografts to the intact frontal skull base. The autogenous free mucosal transplants underwent a rapid process of histological remodelling. All grafts showed a reduction in size of about 1/5. The respiratory epithelia mostly disappeared postoperatively. The main histological feature consisted of a fibrous transformation of the graft, starting 8 days postoperatively. The presented experiments and observations lay the foundation for optimizing the operative technique and the postoperative care of our patients suffering from CSF leaks.

Animals↗
PubMed1998

Influence of endoscopic sinus surgery on voice quality.

Twenty-one patients with documented chronic paranasal sinusitis and in need of endoscopic endonasal sinus surgery were subjected to voice analysis. Tape recordings of different sustained vowels were performed pre- and postoperatively. All voice samples were examined with a sound spectrographic analysis system. Patients having known nasal obstruction detected by active anterior rhinomanometry were excluded from further study. Analysis of pre- and postoperative spectrograms focused on changes in center frequency or bandwidth of the first four formants, as well as variations in specific differences of the formant frequencies and amplitudes. The different subgroups of patients revealed a series of significant changes in the parameters studied. The vowels [a:] and [i:] showed inverse changes in measured values, while evaluation of the vowel [u:] was restricted due to artifactual scattering of individual values. In general, band-width diminished and energy peaks of formants increased postoperatively. In 6 of 21 patients (approximately one-third of the cases), patients or other individuals detected perceptual changes of speech postoperatively. Based on our data, we recommend informing all patients, and voice professionals in particular, about the possible effects of endonasal sinus surgery on altering speech.

Adult↗
PubMed1998

[Complications with permanent damage in endonasal paranasal sinus operations--more frequent in experienced surgeons?].

BACKGROUND: The rate of serious complications in endonasal sinus surgery has not gone down although optical aids are widely used nowadays. Are serious complications caused more often by unexperienced or experienced surgeons using a microscope and/or endoscope? METHODS: We defined serious complications as follows: death, persistent neurological deficits or permanent loss of vision, and injury to the internal carotid artery. Two different studies were made: the first consecutive 300 interventions of 6 sinus surgeons were evaluated. Sixteen malpractice cases were analysed regarding the experience of the surgeon. RESULTS: In 9 out of 16 malpractice cases serious complications were attributable to experienced surgeons, five to moderately experienced surgeons, and only two to an inexperienced surgeon (although he had extensive experience in external sinus surgery). There were 6 deaths, 6 neurologic defects, 2 visual disorders, and 2 injuries to the internal carotid artery without any sequelae. In 9 cases the serious complications were related to injury of the internal carotid artery, in five cases to perforation of the skull base. Twice the orbital wall was penetrated. In 1800 procedures performed by 6 surgeons, no serious complications were encountered. There were only lesions of the periorbit (n = 33) or CSF leaks (n = 8) without any permanent damage to the patient. CONCLUSIONS: Even an experienced surgeon must always keep in mind that serious complications can occur in sinus surgery. One must constantly be alert to the possibility of anatomical variants or specific pathologic findings.

Cause of Death↗
PubMed1998

[Clinico-anatomic study of the spina nasalis ossis frontalis and its role within the scope of frontal sinus surgical approach].

BACKGROUND: During endonasal frontal sinusotomy using the sharp spoon (endonasal frontal sinus surgery type II according to Draf or May and Schaitkin) a solid piece of bone is frequently encountered anterior to the neo-ostium. This bone may be referred to as a "nasal spine". A prominent spine may render a sinusotomy difficult or even impossible. METHODS: A maximum endonasal frontal sinusotomy was performed on 36 anatomical specimens by means of a sharp spoon producing neo-ostia of 7 x 5 mm on average. The dimensions of the remaining nasal spine were measured subsequently together with the diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neoostium to the anterior ethmoidal artery. RESULTS: Almost every specimen (97%) showed a relevant nasal spine. The average height of the spine was 10 mm. The anterior-posterior dimension was 6 mm on average. A correlation was found between the nasofrontal angle and the a.-p. dimension of the spine: the more acute the angle, the thicker the spine was. In three out of four specimens the neo-ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery. CONCLUSIONS: In the majority of the specimens a sufficient endonasal approach to the frontal sinus could be obtained by enlarging the natural ostium as described by Draf or May and Schaitkin. The anterior ethmoidal artery is a valuable landmark for locating the ostium. The maximum diameter of the frontal sinus approach in frontal direction can be estimated by measuring of the nasofrontal angle.

Endoscopes↗
PubMed1998

Delayed facial palsy following uneventful middle ear surgery: a herpes simplex virus type 1 reactivation?

In rare cases, a facial palsy appears a few days after uneventful middle ear surgery. The reason for this delayed palsy is unclear. One hypothesis is that it results from a reactivation of herpes simplex virus type 1 (HSV-1) in the geniculate ganglion of the facial nerve. From 1987 to 1996, in the course of over 1,800 middle ear operations, we observed 7 ipsilateral delayed facial palsies and investigated 5 of them using immunologic and virologic methods, including the polymerase chain reaction (PCR). We could detect HSV-1 genome with the nested primer PCR in the tongue swabs of 4 of the 5 examined patients with delayed facial palsy. The immunologic changes in these palsies are also compatible with a reactivation of HSV-1. We conclude that minimal stimulation of the facial nerve during middle ear surgery could result in a reactivation of HSV-1 in the geniculate ganglion, which may in turn lead to a facial palsy.

Adult↗
PubMed1998

Histochemical detection of lymphatic drainage pathways in the middle nasal meatus.

Following extensive middle meatal antrostomy, even without manipulation inside the maxillary sinus, a reactive edema of the maxillary sinus mucosa may be subsequently detected. A presumptive correlation has been established between this particular mucosal reaction and insufficient maxillary lymphatic drainage. Histochemical examination of the lymphatic drainage pathways was carried out on surgical specimens. During the performance of surgical maxillary fenestrations, 80 surgical specimens of the middle nasal meatus were obtained including adjacent parts of the medial maxillary wall. The specimens were subjected to visualization of lymphatic vessels based on the histochemical detection of 5'-nucleotidase according to Werner (1993). Both the nasal and the maxillary sinus mucosa showed a distinct superficial and deep longitudinal lymphatic capillary network (15-200 mu phi) with an orientation towards the natural maxillary sinus ostium. The density of the network increased from cranial to caudal, from dorsal to ventral and reached maximum density at the natural maxillary ostium. Lymphatic vessels of the maxillary sinus mucosa were thin but numerous in comparison to nasal vessels. The maxillary lymphatic capillary network showed direct connections to the nasal vessels, not only along the mucosal folds of the primary maxillary sinus ostium, but also in most cases (57%) transmurally through the natural bony gaps of the uncinate process. Grünwald's theory (1910) which states that lymphatic drainage of the maxillary sinus is established exclusively along the mucosal pane through the natural ostium was disproved. Maxillary mucosal congestion subsequent to extensive middle meatal antrostomy may be explained by ablation of the intramural and transmural lymphatic drainage pathways.

5'-Nucleotidase↗