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Morand J, McClellan P, Isali I, Dikici Y, Fan D, Li L, Shoffstall AJ, Akkus O, Weidenbecher M. Dexamethasone eluting polydopaminated polycaprolactone-poly (lactic-co-glycolic) acid for treatment of tracheal stenosis. J Biomed Mater Res A 2024; 112:781-792. [PMID: 38204293 DOI: 10.1002/jbm.a.37659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
Tracheal stenosis is commonly caused by injury, resulting in inflammation and fibrosis. Inhibiting inflammation and promoting epithelization can reduce recurrence after initial successful treatment of tracheal stenosis. Steroids play an important role in tracheal stenosis management. This study in vitro evaluated effectiveness of a polydopaminated polycaprolactone stent coated with dexamethasone-eluting poly(lactic-co-glycolic) acid microparticles (μPLGA) for tracheal stenosis management. Polydopamination was characterized by Raman spectroscopy and promoted epithelialization while dexamethasone delivery reduced macrophage activity, assessed by individual cell area measurements and immunofluorescent staining for inducible nitric oxide synthase (iNOS). Dexamethasone release was quantified by high-performance liquid chromatography over 30 days. Activation-related increase in cell area and iNOS production by RAW 264.7 were both reduced significantly (p < .05) through dexamethasone release. Epithelial cell spreading was higher on polydopaminated polycaprolactone (PCL) than PCL-alone (p < .05). Force required for stent migration was measured by pullout tests of PCL-μPLGA stents from cadaveric rabbit and porcine tracheas (0.425 ± 0.068 N and 1.082 ± 0.064 N, respectively) were above forces estimated to occur during forced respiration. Biomechanical support provided by stents to prevent airway collapse was assessed by comparing compressive circumferential stiffness, and stiffness of the stent was about 1/10th of the rabbit trachea (0.156 ± 0.023 N/mm vs. 1.420 ± 0.194 N/mm, respectively). A dexamethasone-loaded PCL-μPLGA stent platform can deliver dexamethasone and exhibits sufficient mechanical properties to anchor within the trachea and polydopamination of PCL is conducive to epithelial layer formation. Therefore, a polydopaminated PCL-μPLGA stent is a promising candidate for in vivo evaluation for treatment of tracheal restenosis.
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Affiliation(s)
- Jacob Morand
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
| | - Phillip McClellan
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yusuf Dikici
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Di Fan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Longshun Li
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew J Shoffstall
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mark Weidenbecher
- Advanced Platform Center, Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology, Case Western Reserve University, Cleveland, Ohio, USA
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Muller RG, Weidenbecher M, Ludlow D. PET/CT versus triple endoscopy in initial workup of HPV+ oropharyngeal squamous cell carcinoma. Head Neck 2022; 44:1164-1171. [PMID: 35212072 DOI: 10.1002/hed.27016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Synchronous primary tumors (SPTs) are detected via triple endoscopy or positron emission tomography/computed tomography (PET/CT). Patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) lack risk factors for SPTs. METHODS We performed a single institution retrospective review of the efficacy of triple endoscopy and PET/CT in HPV+ OPSCC patients. RESULTS Sixty-five HPV+ OPSCC patients underwent triple endoscopy and PET/CT. Patients were white (n = 48, 72.7%), male (n = 53, 81.5%), mean 58.7 ± 8.1 years old. SPT was detected in 1 (1.5%) patient via PET/CT. No SPTs were detected on triple endoscopy. PET/CT had 100% and 95.3% sensitivity and specificity, respectively. PET/CT positive predictive value (PPV) and negative predictive value (NPV) were 25.0% and 100%, respectively. Triple endoscopy specificity and NPV was 90.2% and 93.2%, respectively. CONCLUSIONS PET/CT is superior to triple endoscopy in ruling out SPTs. With negative PET/CT, only direct laryngoscopy with biopsy may be necessary.
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Affiliation(s)
- Richard Grant Muller
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - David Ludlow
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
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Kent DT, Chio EG, Weiner JS, Heiser C, Suurna MV, Weidenbecher M. A Noninferiority Analysis of 3- vs 2-Incision Techniques for Hypoglossal Nerve Stimulator Implantation. Otolaryngol Head Neck Surg 2021; 167:197-202. [PMID: 34846979 DOI: 10.1177/01945998211062150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The only hypoglossal nerve stimulation (HNS) device available for US clinical use is implanted through 3 incisions. A recently proposed 2-incision modification moved the respiratory sensing lead from the fifth to the second intercostal space to eliminate the third lower chest incision. This study compared perioperative data and therapeutic outcomes between the techniques. STUDY DESIGN Noninferiority cohort analysis of a retrospective and prospective registry study. SETTING Tertiary care and community surgical centers. METHODS Patients with obstructive sleep apnea underwent HNS implantation via a modified 2-incision technique (I2). A cohort previously implanted via the standard 3-incision technique (I3) were 1:1 propensity score matched for a noninferiority analysis of postoperative outcomes. RESULTS There were 404 I3 patients and 223 I2 patients across 6 participating centers. Operative time decreased from 128.7 minutes (95% CI, 124.5-132.9) in I3 patients to 86.6 minutes (95% CI, 83.7-97.6) in I2 patients (P < .001). Postoperative sleep study data were available for 76 I2 patients who were matched to I3 patients. The change in apnea-hypopnea index between the cohorts was statistically noninferior (a priori noninferiority margin: 7.5 events/h; mean difference, 1.51 [97.5% CI upper bound, 5.86]). There were no significant differences between the cohorts for baseline characteristics, perioperative adverse event rates, or change in Epworth Sleepiness Score (P > .05). CONCLUSION In a multicenter registry, a 2-incision implant technique for a commercially available HNS device had a statistically noninferior therapeutic efficacy profile when compared with the standard 3-incision approach. The 2-incision technique is safe and effective for HNS implantation.
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Affiliation(s)
- David T Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eugene G Chio
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Clemens Heiser
- Department of Otorhinolaryngology-Head and Neck Surgery, Technische Universität München, Munich, Germany
| | - Maria V Suurna
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
Superior laryngeal nerve neuralgia (SLNN) is an anterior neck pain syndrome that is underrecognized and, as a result, is often misdiagnosed. We present a series of patients who were diagnosed with and subsequently treated for SLNN. Nineteen patients were treated with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and/or a therapeutic neck injection with 2% lidocaine and 40% triamcinolone acetonide. All patients completed a visual analog scale (VAS) to rate the level of pain before and after treatment. Four patients rated their pain as mild, 14 as moderate, and 1 as severe according to the VAS. Of the 19 patients, 8 chose to proceed with a 2-week course of NSAIDs and only 1 of them had complete resolution of their symptoms. A total of 18 patients underwent therapeutic neck injections, with a complete response to injection therapy in 10 patients. Five patients described a minimal residual foreign body sensation and 3 patients complained of mild residual pain. In this study, we found that therapeutic neck injections are effective not only in confirming the diagnosis but also in treating pain.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Weidenbecher
- Department of Otolaryngology- Head and Neck Surgery, MetroHealth Hospital, Cleveland, OH, USA
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Affiliation(s)
- Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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Weidenbecher M, Tamaki A, Cabrera C, Strohl K. Improved exposure of the hypoglossal branches during hypoglossal nerve stimulator implantation: Clinical outcomes of twenty patients at a single institution. Clin Otolaryngol 2018; 44:72-76. [PMID: 30207417 DOI: 10.1111/coa.13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Hospital, Cleveland, Ohio
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Claudia Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Boon M, Huntley C, Steffen A, Maurer JT, Sommer JU, Schwab R, Thaler E, Soose R, Chou C, Strollo P, Kezirian EJ, Chia S, Withrow K, Weidenbecher M, Strohl K, Doghramji K, Hofauer B, Heiser C. Upper Airway Stimulation for Obstructive Sleep Apnea: Results from the ADHERE Registry. Otolaryngol Head Neck Surg 2018; 159:379-385. [DOI: 10.1177/0194599818764896] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Upper airway stimulation (UAS) is an alternative treatment option for patients unable to tolerate continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Studies support the safety and efficacy of this therapy. The aim of this registry is to collect retrospective and prospective objective and subjective outcome measures across multiple institutions in the United States and Germany. To date, it represents the largest cohort of patients studied with this therapy. Study Design Retrospective and prospective registry study. Setting Ten tertiary care hospitals in the United States and Germany. Subjects and Methods Patients were included who had moderate to severe OSA, were intolerant to CPAP, and were undergoing UAS implantation. Baseline demographic and sleep study data were collected. Objective and subjective treatment outcomes, adverse events, and patient and physician satisfaction were reviewed. Results The registry enrolled 301 patients between October 2016 and September 2017. Mean ± SD AHI decreased from 35.6 ± 15.3 to 10.2 ± 12.9 events per hour ( P < .0001), and Epworth Sleepiness Scale scores decreased from 11.9 ± 5.5 to 7.5 ± 4.7 ( P < .0001) from baseline to the posttitration visit. Patients utilized therapy for 6.5 hours per night. There were low rates of procedure- and device-related complications. Clinical global impression scores demonstrated that the majority of physicians (94%) saw improvement in their patients’ symptoms with therapy. The majority of patients (90%) were more satisfied with UAS than CPAP. Conclusions Across a multi-institutional registry, UAS therapy demonstrates significant improvement in subjective and objective OSA outcomes, good therapy adherence, and high patient satisfaction.
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Affiliation(s)
- Maurits Boon
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin Huntley
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | - Richard Schwab
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Courtney Chou
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Eric J. Kezirian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Stanley Chia
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | | | - Karl Doghramji
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Weidenbecher M. Repair of high-grade posterior glottic stenosis: A novel criocarytenoid joint release technique. Laryngoscope 2018; 128:1639-1642. [DOI: 10.1002/lary.27092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery; University Hospitals Cleveland Medical Center; Cleveland Ohio U.S.A
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Tamaki A, Wasman J, Weidenbecher M. Laryngeal alveolar soft part sarcoma: A case report of a rare malignancy in an atypical location. Am J Otolaryngol 2017; 38:260-262. [PMID: 28131550 DOI: 10.1016/j.amjoto.2017.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/17/2017] [Indexed: 11/26/2022]
Abstract
Laryngeal sarcoma is a rare and potentially aggressive malignancy. In this case report, we present a 23year-old-male with four-years of progressive hoarseness who was found to have a large left paraglottic mass. A partial laryngectomy was successful at completely excising the lesion. Final pathology returned as alveolar soft part sarcoma. Alveolar soft part sarcomas of the larynx are extremely rare with only five cases published in the current literature. This article provides a case presentation with literature review of alveolar soft part sarcoma of the head and neck.
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Abstract
Histiocytic disorders can be classified according to the distribution pattern of the lesions and the organs involved. Non-Langerhans-cell histiocytosis is a rare group of diseases that have varied clinical presentations ranging from isolated masses to diffuse systemic eruptions. We discuss a patient who initially presented with a vocal cord lesion and was ultimately diagnosed with adult onset xanthogranuloma.
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Whitney GA, Mera H, Weidenbecher M, Awadallah A, Mansour JM, Dennis JE. Methods for producing scaffold-free engineered cartilage sheets from auricular and articular chondrocyte cell sources and attachment to porous tantalum. Biores Open Access 2013; 1:157-65. [PMID: 23514898 PMCID: PMC3559237 DOI: 10.1089/biores.2012.0231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Scaffold-free cartilage engineering techniques may provide a simple alternative to traditional methods employing scaffolds. We previously reported auricular chondrocyte-derived constructs for use in an engineered trachea model; however, the construct generation methods were not reported in detail. In this study, methods for cartilage construct generation from auricular and articular cell sources are described in detail, and the resulting constructs are compared for use in a joint resurfacing model. Attachment of cartilage sheets to porous tantalum is also investigated as a potential vehicle for future attachment to subchondral bone. Large scaffold-free cartilage constructs were produced from culture-expanded chondrocytes from skeletally mature rabbits, and redifferentiated in a chemically-defined culture medium. Auricular constructs contained more glycosaminoglycan (39.6±12.7 vs. 9.7±1.9 μg/mg wet weight, mean and standard deviation) and collagen (2.7±0.45 vs. 1.1±0.2 μg/mg wet weight, mean and standard deviation) than articular constructs. Aggregate modulus was also higher for auricular constructs vs. articular constructs (0.23±0.07 vs. 0.12±0.03 MPa, mean and standard deviation). Attachment of constructs to porous tantalum was achieved by neocartilage ingrowth into tantalum pores. These results demonstrate that large scaffold-free neocartilage constructs can be produced from mature culture-expanded chondrocytes in a chemically-defined medium, and that these constructs can be attached to porous tantalum.
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Affiliation(s)
- G Adam Whitney
- Department of Biomedical Engineering, Case Western Reserve University , Cleveland, Ohio. ; Department of Orthopaedics, Case Western Reserve University , Cleveland, Ohio. ; Hope Heart Matrix Biology Program, Benaroya Research Institute , Seattle, Washington
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Manjila S, Weidenbecher M, Semaan MT, Megerian CA, Bambakidis NC. Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma. J Neurosurg 2013; 119:113-20. [PMID: 23350781 DOI: 10.3171/2012.11.jns121365] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN. METHODS The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection. RESULTS Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively. CONCLUSIONS The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.
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Affiliation(s)
- Sunil Manjila
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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Abstract
OBJECTIVES/HYPOTHESIS Scaffold-free cartilage has been used to engineer biocompatible and mechanically stable neotracheas in vivo. The purpose of this animal study was to determine if neotracheal constructs, implanted paratracheally, could successfully be used for segmental tracheal reconstruction. STUDY DESIGN Animal study. METHODS Culture-expanded auricular rabbit chondrocytes were used to engineer scaffold-free cartilage sheets. Cartilage and a strap muscle flap were wrapped around a tube and implanted paratracheally. At 12 to 14 weeks postimplantation neotracheas were used to reconstruct 20 mm tracheal defects. Surgical technique was modified several times in an attempt to decrease the amount of neotracheal obstruction and fibrosis. In one of the six rabbits, neotrachea with its intact strap muscle flap was dropped into the defect followed by an end-to-end anastomosis; in two animals the muscle flap was partially, and in one rabbit completely removed. In two animals the muscle flap was partially removed, the tube reinserted, and the construct reimplanted for 5 weeks to allow formation of a fibrous lining over the exposed cartilage followed by tracheal reconstruction. RESULTS All implants developed into vascularized and mechanically sound neotracheas. Following reconstruction, none of the animals showed immediate signs of respiratory distress; however, one died after 24 hours due to extensive endotracheal muscle flap edema, whereas rabbits who had undergone partial or complete muscle flap removal survived up to 39 days before developing cicatricial stenosis. CONCLUSIONS Tissue-engineered neotracheas proved to have excellent biocompatibility and stability to function under physiologic conditions, but lacked adequate endotracheal lining resulting in neotracheal stenosis.
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Affiliation(s)
- Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Medical Center, University Hospitals of Cleveland, Cleveland, Ohio, USA.
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Hummel T, Rissom K, Reden J, Hähner A, Weidenbecher M, Hüttenbrink KB. Effects of olfactory training in patients with olfactory loss. Laryngoscope 2009; 119:496-9. [DOI: 10.1002/lary.20101] [Citation(s) in RCA: 306] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Weidenbecher M, Tucker HM, Gilpin DA, Dennis JE. Tissue Engineered Trachea for Airway Reconstruction. Laryngoscope 2009. [DOI: 10.1002/lary.21534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Iro H, Waldfahrer F, Weidenbecher M, Wigand ME. Behandlung von Malignomen der Nase und der Nasennebenhöhlen mit Beteiligung der Orbita*. Laryngorhinootologie 2008. [DOI: 10.1055/s-2007-997040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Iro H, Kachlik HG, Weidenbecher M, Brandl M, Kolb S. Bedeutung der perkutanen endoskopisch kontrollierten Gastrostomie zur Prophylaxe und Therapie der Ösophagotrachealfistel nach Langzeitintubation. Anasthesiol Intensivmed Notfallmed Schmerzther 2008. [DOI: 10.1055/s-2007-1002552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weidenbecher M, Henderson JH, Tucker HM, Baskin JZ, Awadallah A, Dennis JE. Hyaluronan-based scaffolds to tissue-engineer cartilage implants for laryngotracheal reconstruction. Laryngoscope 2007; 117:1745-9. [PMID: 17690606 PMCID: PMC2504717 DOI: 10.1097/mlg.0b013e31811434ae] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Donor site morbidity, including pneumothorax, can be a considerable problem when harvesting cartilage grafts for laryngotracheal reconstruction (LTR). Tissue-engineered cartilage may offer a solution to this problem. This study investigated the feasibility of using Hyalograft C combined with autologous chondrocytes to tissue engineer cartilage grafts for LTR in rabbits. STUDY DESIGN Animal study. METHODS Eighteen New Zealand white rabbits underwent LTR: 12 rabbits received autologous tissue-engineered cartilage grafts and 6 animals, serving as a positive control group, native auricular cartilage. To determine any differences in response to the site of implantation and any potential immune response to the scaffold, a second piece of engineered neocartilage and a non-cell-loaded scaffold were inserted paralaryngeally into a subset of the rabbits. The rabbits were sacrificed 3, 6, 8, 10, and 12 weeks after the LTR and their larynx examined. RESULTS None of the 18 rabbits showed signs of respiratory distress. A smooth, noninflammatory scar was visible intraluminally. Histologically, the native auricular cartilage implants showed excellent integration without any signs of inflammation or cartilage degradation. In contrast, all tissue-engineered grafts and empty scaffolds revealed marked signs of an unspecific foreign body reaction, leading to a complete degradation of the neocartilage, whether implanted para- or intralaryngeally. CONCLUSION In contrast to the success with which Hyalograft C has been applied in articular defect repair, our results indicate that, in rabbits, Hyalograft C initiates a foreign body reaction if implanted intra- or paralaryngeally, leading to cartilage degradation and possible graft failure. These findings suggest limitations on the environment in which Hyalograft C can be applied.
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Affiliation(s)
- Mark Weidenbecher
- Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Abstract
BACKGROUND Segmental tracheal resection is considered to be the standard treatment of tracheal stenoses. MATERIALS/METHODS During the time period 1985-2002, segmental tracheal resection with a primary end-to-end anastomosis was performed in 117 patients with a cervical or upper thoracal stenosis of the trachea. The age distribution of the patients was between 7 and 77 years. Of the patients with a benign tracheal stenosis, sufficient data for a retrospective analysis were available in 101 patients. The length of the resected tracheal segments varied between 2 and 6 cm which required mobilisation of the trachea and the larynx and, if necessary, incision of the pulmonary ligament. RESULTS In 5 patients a permanent damage of the recurrent laryngeal nerve was seen, of which 4 had undergone revision surgery and 10 months after surgery 93% presented with a large and stable tracheal lumen without any relevant restenosis. Due to a restenosis of 70-80% causing dyspnea at rest, 3% of the 101 patients had to undergo revision surgery. In 4% a mild and asymptomatic restenosis of 30-40% was seen which did not require any further treatment. CONCLUSION These results demonstrate that segmental tracheal resection can safely and effectively remove stenotic tracheal segments of up to 6 cm and is therefore the treatment of choice.
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Affiliation(s)
- M Weidenbecher
- Klinik mit Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universität, 91054, Erlangen
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Schick B, Weidenbecher M, Miller R, Iro H. [Experience with laryngotracheal reconstruction in subglottic stenosis in a 30 years time period]. Laryngorhinootologie 2007; 86:358-64. [PMID: 17226434 DOI: 10.1055/s-2006-945002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe subglottic stenosis is a difficult condition to manage. It can be treated by laryngotracheal reconstruction or cricotracheal resection. PATIENTS AND METHODS In this retrospective study the experiences for treatment of isolated subglottic stenosis in 37 patients (age: 3-78 years; stenosis grading: 20 x grade II, 13 x grade III, and 4 x grade IV) by laryngotracheal reconstruction in a 30-years experience are presented. RESULTS In 33 out of 37 patients (89.2 %) a sufficient subglottic patency (postoperative endoscopic finding: stenosis less than 30 %) was achieved by laryngotracheal reconstruction. However, 5 patients of this series had required revision of laryngotracheal recontruction and in 22 patients endoscopic removal of granulation tissue had been performed. Sufficient widening of the subglottic space had been possible in all grade II stenosis (20/20), in 11 out of 13 patients with grade III stenosis, and in 3 out of 4 patients with grade IV stenosis. In one child an accidental decannulation occurred and due to asphyxia an apallic syndrome developed. CONCLUSIONS Even through laryngotracheal reconstruction is a demanding surgical technique requiring great experience it is an effective option for treatment of subglottic stenosis less than 90 %. For severe subglottic stenosis (> 90 %) treatment by laryngotracheal reconstruction is possible and should be considered if mobilisation of the trachea by scar tissue is suited to be worse or to extended cricotracheal stenosis is present, both being not good candidates for cricotracheal resection.
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Affiliation(s)
- B Schick
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie der Friedrich-Alexander-Universität Erlangen-Nürnberg
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22
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Abstract
BACKGROUND An elongation of the styloid process or an ossification of the stylohyoid ligament can be the cause for a styloid syndrome and may lead to craniocervical pain, globus sensation and dysphagia. Pathophysiologically, the styloid syndrome is related to an irritation of the surrounding nerves, the carotid artery or the pharyngeal mucosa. There are various alternatives for its treatment. PATIENTS AND METHODS This study analyzed retrospectively the data of eleven patients, who were treated for a styloid syndrome. All patients were placed on a stepwise therapy plan, which began with a medicamentous treatment, followed by a surgical treatment, if the problems persisted. The surgical approach included a transoral styloid fracture and/ or a surgical styloid shortening, which was carried out either transorally or transcervically. RESULTS Three of the eleven patients presented no complaints after the medical treatment and did not require any further therapy. In two out of five patients, transoral fracturing of the styloid was successful. Six patients underwent surgical resection of the styloid process. In five cases a transoral route was used and in one cases a transcervical route. Postoperatively, four patients were free of symptoms and did not present any functional deficit. Two patients experienced severe complications with an ipsilateral medial cerebral artery infarction. These were related to a dissection of the internal carotid artery (ICA) in one case, and an arrosion bleeding of the ICA after the formation of an abscess of the parapharyngeal space in the other case. CONCLUSION A stepwise therapy of the styloid syndrome including medicamentous treatment, transoral styloid fracture and resection of the styloid process has proven to be of value. If the styloid process can be palpated submucosally, a transoral resection may be chosen. However, using this route, the possibility of severe complications has to be taken into consideration, such as injury of the internal carotid artery.
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Affiliation(s)
- M Weidenbecher
- Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
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Weidenbecher M, Huk WJ, Iro H. Internal carotid artery injury during functional endoscopic sinus surgery and its management. Eur Arch Otorhinolaryngol 2005; 262:640-5. [PMID: 15657746 DOI: 10.1007/s00405-004-0888-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 10/18/2004] [Indexed: 10/25/2022]
Abstract
Rupture of the internal carotid artery (ICA) during functional endoscopic sinus surgery (FESS) is a rare complication, which can potentially result in death. Only a few cases have been reported in the literature thus far. We present four cases with an ICA bleeding during sphenoidotomy. The treatment is discussed and an emergency plan to manage the heavy arterial bleeding is presented.
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Affiliation(s)
- Mark Weidenbecher
- Department of Otolaryngology and Head and Neck Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
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24
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Weidenbecher M, Winter M. Das Styloidsyndrom – mögliche Komplikationen der chirurgischen Therapie. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Sobiegalla M, von Hintzenstern U, Weidenbecher M, Rupprecht H. [Tracheal rupture--a rare and dramatic emergency]. Anaesthesiol Reanim 2004; 28:79-81. [PMID: 12872541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A tracheal tear requires fast and proper treatment. A 55-year-old man working in a sewage pipe slipped and hit his neck on the edge of a concrete ring. The patient showed the following symptoms: cervical bruising, neck emphysema and increasing dyspnea. After several unsuccessful attempts to intubate the patient, a necklace incision was made immediately at the scene, under the suspected diagnosis of a torn trachea. A finger was used to look for the lower tracheal stump lying in the mediastinum. The lower stump was then intubated. In the hospital, an end-to-end anastomosis of the trachea as well as tracheotomy were performed on the patient. Because of the fracture of the larynx, an endolaryngeal stent was used to stabilize the lumen. Due to an injury to both laryngeal nerves, the patient suffered from dysphagea, whispered speech and dyspnea on minimal exertion as long-term side-effects. A lateralization of the vocal cord was made eight months later. Because of the quick assessment of the situation and proper treatment of the patient at the site of the accident, the patient was able to survive the injury.
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Affiliation(s)
- M Sobiegalla
- Abteilung für Anästhesie und perioperative Medizin, Krankenhauses Forchheim.
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26
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Weidenbecher M, Amann K, Iro H. Laryngotracheal growth following cricotracheal resection combined with laminotomy. An experimental study on rabbits. Ann Otol Rhinol Laryngol 2003; 112:697-703. [PMID: 12940668 DOI: 10.1177/000348940311200809] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cricotracheal resection (CTR) has been shown to be successful in the treatment of pediatric subglottic stenosis. Whether CTR combined with posterior midline division or partial resection of the cricoid plate affects the stability and growth of the larynx is still questionable. The study included 24 infant female New Zealand White rabbits that were divided into 4 groups of 6 animals each. Group 1 was the unoperated control group. Group 2 underwent removal of three quarters of the anterior cricoid circumference, followed by a primary anastomosis (CTR). In addition to CTR, the rabbits in group 3 underwent a laminotomy by splitting of the cricoid plate midline. Group 4 underwent both CTR and partial resection of the lamina. No stents were used in this study. After 6 months, the experiment was terminated, and the following observations were made. Groups 2 and 3 presented a large and stable subglottic lumen, comparable to that of the control group. After partial cricoid plate resection, 4 of the rabbits in group 4 suffered from a subglottic collapse that caused an airway obstruction and resulted in death. These results support the conclusion that CTR alone, as well as combined with laminotomy, can be performed in a relatively safe and effective manner without interfering with the development of the larynx in young rabbits. Cricotracheal resection together with partial resection of the cricoid plate, however, leads to an unstable situation with an impaired airway.
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Affiliation(s)
- Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, University of of Erlangen-Nuremberg, Erlangen, Germany
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27
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Grabenbauer GG, Mühlfriedel C, Rödel F, Niedobitek G, Hornung J, Rödel C, Martus P, Iro H, Kirchner T, Steininger H, Sauer R, Weidenbecher M, Distel L. Squamous cell carcinoma of the oropharynx: Ki-67 and p53 can identify patients at high risk for local recurrence after surgery and postoperative radiotherapy. Int J Radiat Oncol Biol Phys 2000; 48:1041-50. [PMID: 11072161 DOI: 10.1016/s0360-3016(00)00737-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the prognostic value of biologic (p53, Ki-67) and clinical factors in squamous cell carcinoma of the oropharynx after radical surgery and postoperative radiotherapy (RT). METHODS AND MATERIALS Between 1985 and 1995, a total of 102 patients with 104 tumor sites were entered onto the study. Fifty-five primary tumors (53%) involved the tonsils, 26 (25%) the soft palate, and 23 (22%) the base of the tongue. Median age was 53 years (range 36-80 years). The clinical T- and N-categories (UICC 1997) were: T1 (30), T2 (47), T3 (22), T4 (5), N0 (33), N1 (28), N2 (42), and N3 (1). Histologically-clear margins were achieved in all patients by initial surgery. Postoperative RT to the primary and regional lymphatics was given, to a total of 60 Gy in 6 weeks, and single daily fractions of 2 Gy. The expression of the nuclear p53- and Ki-67-labeling index (LI) was investigated by immunostaining using the monoclonal antibodies DO-7 and MIB 1. The nuclear p53-intensity (p53-I) was graded into 4 categories (0/+/++/) by densitometry. Median follow-up was 43 months (range 14-132 months). RESULTS Cancer-specific survival, disease-free survival, and locoregional tumor control rates were 74%, 69%, and 75%, respectively, at 5 years. Significant prognostic factors for disease-free survival were: T-category (T1/2: 77% vs. T3/4: 53%, p = 0.02), tumor site (tonsils: 79% vs. soft palate: 70% vs. base of tongue: 45%, p = 0.05), duration of RT (< or = 46 days: 80% vs. > 46 days: 60%, p = 0.04), Ki-67 LI (< or = 20%: 84% vs. > 20%: 49%, p = 0.006) and p53-I (0/+: 56% vs. ++/ : 79%, p = 0.008). A significant prognostic impact on locoregional control was noted for the duration of RT (< or = 46 days: 86% vs. > 46 days: 68%, p = 0.01), tumor site (tonsils: 88% vs. soft palate: 67% vs. base of tongue: 51%, p = 0.02), Ki-67 LI (< or = 20% LI: 87% vs. > 20% LI: 56%, p = 0.018), and the p53-I (0/+: 58% vs. ++/ : 88%, p = 0.0006). On multivariate analysis, the p53 nuclear intensity (p = 0.002) and the Ki-67 index (p = 0.01) remained the only significant factors for locoregional control. CONCLUSION Ki-67 labeling index above 20% and a weak p53 nuclear intensity (0/+) are both able to identify patients with squamous cell carcinoma of the oropharynx being at high risk for local recurrence after surgery and postoperative RT. Consequently, in this subgroup an intensification of treatment may be contemplated in prospective trials.
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Affiliation(s)
- G G Grabenbauer
- Department of Radiation Oncology, University Hospital, Erlangen, Germany.
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Grüner A, Grabenbauer GG, Rödel C, Weidenbecher M, Martus P, Iro H, Sauer R. [Nasopharyngeal carcinoma: only irradiation or simultaneous radiochemotherapy?]. Strahlenther Onkol 1999; 175:591-6. [PMID: 10633784 DOI: 10.1007/s000660050045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Between 1979 and 1997, a total of 92 patients with primary nasopharyngeal carcinoma were treated at the Hospitals of the University of Erlangen. Until 1988, radiotherapy alone was the treatment of choice and simultaneous radiochemotherapy was consistently applied thereafter. This retrospective analysis was performed to evaluate the influence of concurrent radiochemotherapy on survival and to identify possible prognostic factors on cause-specific survival-, locoregional tumor control- and distant-metastases-free survival rates. PATIENTS AND METHODS Fifty-three patients (58%) received treatment by radiotherapy alone and 39 (42%) underwent primary radiochemotherapy with 2 courses of 5-FU and cisplatin. Median total dose to the bilateral neck region was 60 Gy (range, 50 to 62 Gy), and 74 Gy (range, 56 to 88 Gy) to the primary tumor. Median follow-up of the surviving patients was 8 years. RESULTS Following radiochemotherapy and radiotherapy alone, the 5-year-survival rates were 67% and 48%, respectively (p = 0.06). Female patients had a survival advantage as compared to male patients (5-year-survival rate 77% vs 44%, p = 0.01). Patients with and without cranial nerve palsy at presentation had survival rates of 0% and 61%, respectively, at 5 years (p = 0.01). Distant-metastases-free survival was influenced by the following factors: lymph-node involvement (NO: 82% vs N1 to N3: 68%, p = 0.04), gender (female: 88% vs male: 64%, p = 0.01), type of treatment (radiochemotherapy: 86% vs radiotherapy: 63%, p = 0.02) and cranial nerve involvement (76% without and 42% with involvement, p = 0.04). CONCLUSIONS In primary nasopharyngeal carcinoma simultaneous radiochemotherapy can significantly reduce distant metastases and improve survival as compared to radiotherapy alone. Since late toxicity rates were similar in both treatment groups and the slightly increased acute side effects following radiochemotherapy were effectively compensated by standard supportive care, patients with advanced nasopharyngeal carcinoma may benefit from simultaneous radiochemotherapy.
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Affiliation(s)
- A Grüner
- Strahlentherapeutische Klinik, Universität Erlangen-Nürnberg
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Abstract
Neurothekeomas are benign tumours mostly arising in the face and upper limbs predominantly in young women. Histologically they can be classified as cellular or myxoid, and complete surgical resection is the treatment of choice. In this case of a neurothekeoma located in the anterior tongue of a child, cryotherapy was used as the treatment modality, in order to avoid a greater loss of tongue function.
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Affiliation(s)
- T Breuer
- Otolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
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30
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Abstract
Middle ear adenocarcinoma is a very rare, locally invasive neoplasm assumed to arise from the middle ear mucosa. Although endolymphatic sac tumor (aggressive papillary middle ear tumor) and jugulotympanic paraganglioma may show brain invasion, intracranial extension of histologically confirmed middle ear adenocarcinoma has not been previously reported. The authors describe a 53-year-old man who suffered from otalgia and tinnitus for more than 10 years and from neurological deficits for 1 year due to a large temporal bone tumor that invaded the temporal lobe. A combined neurosurgical and otolaryngological resection was performed. Pathological analysis revealed a low-grade adenocarcinoma of a mixed epithelial-neuroendocrine phenotype, which showed a close histological similarity to, and topographical relationship with, middle ear epithelium. The authors conclude that middle ear adenocarcinoma belongs to the spectrum of extracranial tumors that have possible local extension to the brain.
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Affiliation(s)
- W Paulus
- Department of Neuropathology, University of Erlangen Medical School, Germany.
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31
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Iro H, Waldfahrer F, Altendorf-Hofmann A, Weidenbecher M, Sauer R, Steiner W. Transoral laser surgery of supraglottic cancer: follow-up of 141 patients. Arch Otolaryngol Head Neck Surg 1998; 124:1245-50. [PMID: 9821928 DOI: 10.1001/archotol.124.11.1245] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the role of transoral laser resection of supraglottic carcinomas. DESIGN Retrospective unicenter study of the oncologic results of transoral carbon dioxide laser microsurgery for supraglottic carcinomas performed between February 1979 and December 1993. Median follow-up was 37 months. SETTING University hospital academic tertiary referral center. PATIENTS We reviewed the medical records of 141 patients (a consecutive sample of 131 men and 10 women; mean age, 60 years) with histologically proven supraglottic carcinomas undergoing transoral laser surgery, possibly in combination with neck dissection or radiotherapy. Stage distribution of patients was as follows: stage I, 23.4%; stage II, 25.5%; stage III, 16.3%; and stage IV, 34.8% (according to the Union Internationale Contre le Cancer staging system). MAIN OUTCOME MEASURES Recurrence-free survival rates and local and regional recurrence rates. RESULTS Five-year recurrence-free survival rates were as follows: the whole case load, 65.7%; stage I, 85.0%; stage II, 62.6%; stage III, 74.2%; and stage IV, 45.3%, according to the Union Internationale Contre le Cancer staging system. The local and regional recurrence rates were 16.3% and 9.9%, respectively. CONCLUSIONS The oncologic results of transoral carbon dioxide laser surgery are satisfying if clean surgical margins (R0 resection) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resection) and transoral revision is not possible, transcervical procedures (partial or total laryngectomy) should be performed. The indication for transoral supraglottic laryngectomy in T3 lesions should be considered with restraint.
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Affiliation(s)
- H Iro
- Department of Otorhinolaryngology-Head and Neck Surgery, Saarland University, Homburg, Germany.
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Abstract
In this retrospective study, oncologic and functional results of 24 patients treated for glomus jugulare tumor stages C and D are reported. The surgical approach used was a combined transmastoid-transcervical approach, which was modified according to individual tumor growth. As needed, this was combined with a transtemporal or retrosigmoid approach. Complete tumor removal resulted in a cure rate of 100%. Surgically induced cranial nerve palsies developed in 38% of the patients. In 54% of cases it was possible to retain middle ear function. Seven patients had incomplete tumor removal requiring postoperative irradiation, with tumor progression occurring in 2 patients. Radical tumor removal was modified by efforts to reduce mutilating resections. These results show that individually tailored and combined multidirectional surgical approaches can allow total tumor removal to be performed with lower morbidity.
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Affiliation(s)
- M Gjuric
- Klinik und Poliklinik für Hals-Nasen-Ohrenkranke, Universität Erlangen-Nürnberg
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33
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Grabenbauer G, Fietkau R, Keilholz L, Weidenbecher M, Spitzer W, Müller R, Meyer M, Sauer R. Iridium-192 brachytherapy (BT) in head & neck cancer (H&NSCC). Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)85520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gjuric M, Rüdiger Wolf S, Wigand ME, Weidenbecher M. Cranial nerve and hearing function after combined-approach surgery for glomus jugulare tumors. Ann Otol Rhinol Laryngol 1996; 105:949-54. [PMID: 8973281 DOI: 10.1177/000348949610501204] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce multilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.
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Affiliation(s)
- M Gjuric
- Department of Otorhinolaryngology, University of Erlangen-Nuremberg, Germany
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35
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Fietkau R, Grabenbauer G, Keilholz L, Seegenschmiedt M, Weidenbecher M, Spitzer W, Meyer M, Sauer R. 80 Iridium-192 brachytherapy in the management of recurrent or secondary tumors of the head and neck region. Radiother Oncol 1996. [DOI: 10.1016/0167-8140(96)87882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fietkau R, Grabenbauer G, Keilholz L, Weidenbecher M, Spitzer W, Meyer M, Sauer R. 79 Interstitial and external beam radiotherapy combined with surgery for carcinomas of the head and neck region. Radiother Oncol 1996. [DOI: 10.1016/0167-8140(96)87879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Plaßwilm L, Kirschner M, Grabenbauer G, Fietkau R, Weidenbecher M, Spitzer W, Sauer R. 51 Accelerated split-course radiation (RT) with and without chemotherapy (ChT) for inoperable head and neck cancer (SCC H&N). Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Fifty-six patients with a complete stenosis of the nasolacrimal duct were treated by endoscopically controlled intranasal dacryocystorhinostomy according to West. Forty-four patients had idiopathic stenosis and 12 had posttraumatic scarring. Revision surgery was done in 11 of these 56 cases (8 patients with a previous external Toti procedure, and 3 patients with previous endonasal surgery). Altogether, 95% of the patients were symptom-free (86%) or felt improved (9%) postoperatively. Surgical revision was successful in 82%. Of patients with an "idiopathic" stenosis, 84% were healed and an additional 11% were improved. The success rate in the 12 patients with posttraumatic stenosis was 92%. Endoscopic duct surgery is a highly successful procedure with a low complication rate, the worst complication being persistence of symptoms.
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Affiliation(s)
- M Weidenbecher
- Department of Otorhinolaryngology, University of Erlangen-Nuremberg, Germany
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39
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Abstract
Malignant tumors of the anterior cranial skull base are still a challenge for radical surgical treatment. Several different techniques and approaches have been developed over the years and the results, with mortality rates over 50%, are still not encouraging. Here we present our results of an interdisciplinary, one-stage, neurohino transfronto-transbasal surgical approach in twelve patients with such tumors. The long-term survival rate in our patients is now 83% with a mean postoperative follow-up of 19.3 months. Two patients died due to early recurrencies and metastasis after 10 and 13 months after initial treatment and postoperative irradiation. Another five patients with a follow-up of 34.2 months have had tumor recurrencies diagnosed at 19.5 months postoperatively. These patients have survived their recurrent tumor for 14.7 months. Five patients, 41% of the whole group, have been living without evidence of tumor recurrence for between 2 and 35 months.
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Affiliation(s)
- U Neubauer
- Neurosurgical Clinic, University Clinic Erlangen-Nürnberg, Fed. Rep. of Germany
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40
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Thiel HJ, Fietkau R, Sauer R, Rüppel W, Müller RG, Herbst M, Weidenbecher M, Spitzer W. [Results of temporary interstitial iridium 192 implantation in head and neck tumors]. Strahlenther Onkol 1989; 165:791-6. [PMID: 2480652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In order to improve local tumor control in advanced head and neck tumors, a temporary interstitial iridium-192 implantation (40 to 50 cGy/h) was performed as a boost therapy (20 to 30 Gy at the surface of the target volume). This treatment was part of a multimodal therapy conception for primary tumors (N = 55) as well as for recurrences (N = 22). Local control was achieved in 89% (49/55) of patients treated for primary tumors. Complications appeared in the form of soft tissue necroses in 55% (30/55) and in the form of osteoradionecrosis of the mandible in 7% (4/55) of the patients. The authors discuss as possible reasons for this high complication rate: implantation volume too large or total activity too high, activities of the individual iridium-192 seeds to high, setting of radiation sources too close together, total dose too high, disturbed reparation capacity of sound tissues due to preceding operation and chemotherapy, premature test biopsies in the area of implantation, lacking oral hygiene and dental care by uncooperative patients. A local control rate of 50% was achieved by the treatment of recurrences, but this has no importance for the course of this tumor disease which is fatefully determined by the formation of remote metastases.
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Affiliation(s)
- H J Thiel
- Strahlentherapeutische Klinik und Poliklinik, Universität Erlangen-Nürnberg
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41
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Fahlbusch R, Neubauer U, Wigand M, Weidenbecher M, Röckelein G, Thierauf P, Sauer R. Neuro-rhinosurgical treatment of aesthesioneuroblastoma. Acta Neurochir (Wien) 1989; 100:93-100. [PMID: 2589125 DOI: 10.1007/bf01403592] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The results of a combined neuro-rhinosurgical procedure in eight cases of aesthesioneuroblastoma are presented. All patients were suffering from tumours in the advanced stage (stage C according to Kadish). Diagnosis was established by the clinical history, neuro-radiological imaging and by endoscopic endonasal biopsy. Contrary to most reports in the literature the authors performed a one step operative removal of the whole tumour mass by a combined transcranial-transbasal approach alone. A second transfacial operation was unnecessary in all our cases. To the best of our knowledge only Loew (see Jakumeit 1971) already in the 1960ties used a comparable one step transcranial approach for tumour removal. The long-term survival rate in our patients is 50%, a result comparable to reported series in the literature. Mortality is due to early recurrences and metastases within a few months after the initial treatment including post-operative irradiation. Four patients are living without evidence of tumour recurrence 1.5 to 5 years after treatment. The authors surgical technique is presented in detail and compared with the results of other treatment modalities.
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Affiliation(s)
- R Fahlbusch
- Neurochirurgische Universitätsklinik, Universität Erlangen-Nürnberg, Federal Republic of Germany
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von Glass W, Weidenbecher M. [Early and long-term results following tracheal segment resection]. HNO 1989; 37:259-63. [PMID: 2745171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We analysed the medical records of 41 patients who had undergone sleeve resection of the trachea for cicatricial stenosis of the airway at least 1 year previously. An attempt was made with the aid of a questionnaire and follow-up examination to determine the long-term results of these patients. Thirty-two of the patients were available for review. In 22 patients, respiration at rest and during exertion was adequate. Six patients had dyspnoea under stress due to a medical cause, or it was not possible to assess respiration under conditions of exertion. In 2 patients in whom a very long segment of the trachea had been resected, a recurrent tracheal stenosis had led to dyspnoea on exertion, although respiration at rest was adequate. Two patients had to undergo further surgery for dyspnoea at rest. In both patients, in addition to the stenosis of the trachea, narrowing of the glottis caused by paralysis of the vocal cords in the paramedian position was also present. Overall the results of tracheal sleeve resection were good. The great advantage of this method in comparison with other procedures is the fact that a stenosis of the trachea can be eliminated in a single operation with a high chance of success.
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Dunst J, Sauer R, Weidenbecher M. [Cervical lymph node metastases from an unknown primary tumor]. Strahlenther Onkol 1988; 164:129-35. [PMID: 3353851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
From 1978 through August 1986, 32 patients with lymph node metastases of the neck and unknown primary tumor were treated at the Radiotherapeutic Hospital of the University Erlangen-Nürnberg. Most of the cases were large metastases from squamous cell carcinomas or anaplastic carcinomas. The patients were treated by surgery and postsurgical radiotherapy or radiotherapy alone. In nearly all patients the target volume comprised both sides of the neck including the median structures as well as the base of the tongue and the nasopharynx. A dose of at least 50 Gy was aimed at, which was given within five weeks by individual doses of 2 Gy each. The survival at three years is 70% and at five years 52%. Out of twenty patients irradiated with more than 50 Gy following lymph node extirpation or radical excision of the lymph nodes of the neck, sixteen are tumor-free. The five year survival of this group is 80%. The results of radiotherapy alone are unsatisfactory, because only two out of nine patients are alive with follow-up periods of less than one year. Two primary tumors were found after the end of treatment. Both were situated within the ORL areas beyond the ancient irradiation fields, and both were developed by patients who at first had only been treated by local irradiation. Half of the patients with lymph node metastases of the neck and unknown primary tumors can be cured by complete tumor excision and postsurgical irradiation. The target volume of radiotherapy comprises both sides of the lymph drainage area of the neck as well as the mucous membranes of the ORL region including nasopharynx and base of the tongue. The dose is at least 50 Gy which is given after surgery with conventional fractionation.
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Affiliation(s)
- J Dunst
- Strahlenklinik, Universität Erlangen-Nürnberg
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Iro H, Kachlik HG, Weidenbecher M, Brandl M, Kolb S. [Significance of percutaneous endoscopically controlled gastrostomy in the prevention and therapy of esophagotracheal fistula following long-term intubation]. Anasth Intensivther Notfallmed 1987; 22:283-6. [PMID: 3125758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An esophago-tracheal fistula, which developed during long-term artificial ventilation, is a vital threat to the life of a patient. The esophago-tracheal fistula is caused by pressure lesion of the mucosa of the posterior tracheal and anterior esophageal wall. The adverse mechanic factors are the blocked tube cuff on the one hand and the nasogastric tube being usually required for enteral nutrition on the other hand. Replacement of a nasogastric tube through a percutaneous, endoscopically controlled gastrostomy relieves the esophagus and thus prevents pressure lesion of the anterior esophageal wall. A percutaneous endoscopic gastrostomy, if performed in time, is suggested to reduce the incidence of an esophago-tracheal fistula, which develops in the course of long-term artificial ventilation.
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Affiliation(s)
- H Iro
- Hals-Nasen-Ohren-Klinik, Universität Erlangen-Nürnberg
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von Glass W, Weidenbecher M, Fürstberger W. [Development of the larynx and trachea following division of the cricoid cartilage and segmental resection of the trachea in the growth stage. An animal experiment study]. HNO 1987; 35:393-8. [PMID: 3667348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Laminotomy as described by Réthi, and segmental tracheal resection with end-to-end anastomosis have proved useful in the adult for the treatment of stenoses of the larynx. In children, the question arises why these may interfere with the growth of the larynx and trachea. A vertical split of the cricoid cartilage followed by stabilization of the larynx by the temporary introduction of a Montgomery silicone T-tube was carried out on four kittens aged four to six weeks. A segmental tracheal resection with end-to-end anastomosis was performed on other animals of the same age. When the animals had stopped growing, the larynx and trachea were investigated both endoscopically and histologically. Following laminotomy the larynx underwent remodelling, resulting in an oval shape, the lumen being wide and the function of the vocal cords normal. Following segmental resection of the trachea, a circular stenosis was found, as a result of irregular growth of the sutured tracheal cartilages. In none of the animals, however were either functional disorders or respiratory distress to be observed. Thus, laminotomy or segmental resection of the trachea can be employed during the formative years without fear of clinically relevant growth disorders.
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Weidenbecher M. Das juvenile Nasenrachenfibrom. Laryngorhinootologie 1984. [DOI: 10.1055/s-2007-1008271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weidenbecher M. [Juvenile nasopharyngeal fibroma. Report of experiences]. Laryngol Rhinol Otol (Stuttg) 1984; 63:184-8. [PMID: 6727499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The juvenile nasopharyngeal angiofibroma is a rare and histologically benign tumour of the adolescent male. The aetiology and site of origin are unknown. The diagnosis can easily be made by the symptoms, the typical angiographic pattern and the endoscopic picture. Complete surgical extirpation is superior to all other modalities such as radiotherapy and hormonal treatment. To reduce the enormous blood flow into the tumour, the ligation of the external carotid artery, or the embolisation of the feeding vessels are the best presurgical methods. The technique of tumour removal differs according to the size of the tumour. A great therapeutic problem are those tumours which grow through the skull base and invade the sella, the optic nerve or the cavernous sinus. These tumours should be removed as radically as possible. Small areas of intracranial tumour could remain in order to preserve the optic nerve or the pituitary. These small areas respond very well to 4000 rads. Of 14 patients treated between 1972 and 1981, 12 tumours (types I and II) could be removed completely (recurrence rate 0%), 2 neoplasms ( typ III and IV) which were removed incompletely, received 4000 rads directed at the intracranial remnant, and showed no tumour progression within 4 and 6 years. The preoperative use of hormones (2 cases) showed no effect on the tumour size, especially not on intraoperative loss of blood.
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Weidenbecher M, Busch R. [Therapy of lymphangioma in the head and neck region]. Fortschr Med 1983; 101:1953-7. [PMID: 6654295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
20 patients with a lymphangioma of the head and neck were observed after surgery over follow-up intervals of 3 to 13 years. In six children the tumor removal had to be subtotal in order to preserve vital organs. Though small areas of tumor were left no recurrent tumor growth was observed in this group. In 14 patients the tumor was surrounded by a capsule, in six newborns and children the tumor showed an infiltrating growth, which led to difficulties in breathing and swallowing. Out of the 14 radically operated patients, three had a recurrence after 1-2 years. In the six function conservating and not radical operated children, in whom small areas of tumor were left, no recurrence was noticed within 3-13 years.
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Weidenbecher M, Pesch HJ. [General partial resection of the mandible in para-osteal cancers of the mouth and oropharynx]. HNO 1982; 30:453-6. [PMID: 7161159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The mandibles of 24 patients with a squamous cell carcinoma of the floor of the mouth or the tongue or the tonsils (all were T2N1b and T3N1b), were histologically examined. It could histologically be shown, that the bone will be destroyed by 2 modalities: 1. Atrophy of the mandible, caused by the pressure of the tumor, leaving the periosteum intact 2. Infiltration of the tumor into the bone. Tumor cells could not be found in the lymphatic system of the periosteum. Since the periosteum is a barrier against tumor growth, the indicator for the resection of the mandible was made after shaved off the periosteum. Resulting from our findings we propose the following concept: 1. If the tumor reaches the mandible (distance tumor to bone = 0 mm) or is fixed to the periosteum and the compacta shows no errosion, after shaving off the periosteum, the mandible can be preserved. 2. If the tumor grows through the periosteum, a marginal resection of the mandible is necessary. 3. If the bone shows errosion, a partial resection of the anterior part of the mandible or a hemimandibulectomy is indicated.
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Weidenbecher M. Die Behandlung des infiltrierend wachsenden Lymphangioms im Kindesalter. Eur Arch Otorhinolaryngol 1982. [DOI: 10.1007/bf00459984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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