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Klotz LV, Ingrisch M, Eichhorn ME, Niemoeller O, Siedek V, Gürkov R, Clevert DA. Monitoring parotid gland tumors with a new perfusion software for contrast-enhanced ultrasound. Clin Hemorheol Microcirc 2015; 58:261-9. [PMID: 25339101 DOI: 10.3233/ch-141895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/15/2022]
Abstract
PURPOSE Contrast enhanced ultrasound (CE-US) is a promising imaging modality for non-invasive analysis of functional vascularisation. Lesions of the parotid gland are associated with a vascularisation that differs from normal gland tissue. The aim of this clinical study was to further analyse the perfusion in parotid gland lesions with CE-US. The new quantification software VueBox (Bracco, Italy) was used to assess the perfusion, based on DICOM datasets of CE-US examination. MATERIALS AND METHODS CE-US measurements were performed by intravenous application of a contrast agent (SonoVue, Bracco, Italy) before surgical tumor resection. From the analysis of a time sequence of 2D DICOM contrast images, area under time intensity curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in-perfusion-index (WiPI) were calculated using VueBox. These were correlated with the histological analyses of the tumor tissue. RESULTS Significant difference of area below intensity time curve (AUC), peak enhancement (PE), wash-in-rate (WiR) and wash-in perfusion index (WiPI) were observed in the malign lesions compared to benign tumors (p < 0,05) and in pleomorphic adenoma compared to cystadenolymphoma (p < 0,05). CONCLUSION CE-US seems to be a quantitative and independent method for discriminating between malign and benign parotid gland tumors.
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Affiliation(s)
- Laura V Klotz
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Munich, Germany
| | - Michael Ingrisch
- Institut of Clinical Radiology, University of Munich, Munich, Germany
| | - Martin E Eichhorn
- Department of Radiation Oncology, University of Munich, Munich, Germany
| | | | - Vanessa Siedek
- Department of Otorhinolaryngology, University of Munich, Munich, Germany
| | - Robert Gürkov
- Department of Otorhinolaryngology, University of Munich, Munich, Germany
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Klotz LV, Gürkov R, Eichhorn ME, Siedek V, Krause E, Jauch KW, Reiser MF, Clevert DA. Perfusion characteristics of parotid gland tumors evaluated by contrast-enhanced ultrasound. Eur J Radiol 2013; 82:2227-32. [DOI: 10.1016/j.ejrad.2013.08.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/19/2013] [Accepted: 08/20/2013] [Indexed: 11/29/2022]
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Siedek V, Nehls K, Zur Nieden K, Leunig A, Sroka R. Influence of laser light on bioimplants used in otorhinolaryngology. Lasers Med Sci 2013; 29:965-72. [PMID: 24026111 DOI: 10.1007/s10103-013-1425-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/15/2013] [Indexed: 11/26/2022]
Abstract
In otorhinolaryngology, dermatology and reconstructive surgery biomaterials as implants and a variety of lasers are used. Laser light applied near to an implant could have the risk to damage these materials. Therefore, their resistance exposed to laser light is of interest. A diode laser emitting at 940 nm and a CO2 laser were used to investigate its effects to the biomaterials Bioverit®, Medpor® and Palacos®, and in addition, an excised implant containing Medpor® and nasal turbinate tissue, excised and fixed in formalin. The macro- and microscopic changes of the material, temperature development during laser energy application in dependency to distance of fibre and material, time of exposure and applied power were investigated. Interaction of diode laser light with Bioverit® (0 mm distance, 360 s, 10 W, 3,600 J) resulted in minimal microscopic effects in direct contact of with the fibre. Using Medpor® (1 mm, 10s, 10 W, 100 J) resulted in melting and perforation. In the case of Palacos® (0.6 mm, 10s, 10 W, 100 J), melting occurred creating a flat excavation. The effect to Medpor® in nasal turbinate (1-2 mm, 10s, 10 W, 100 J) showed tissue denaturation and carbonisation and creation of a hole. The interaction of the CO2 laser with Bioverit® (3 cm, 0.5, 1 and 5 s, 2, 10 or 20 W) induced melting and discolouring resulting finally in a perforating hole. Depending on the material, first damage starts 10 s after an impact of 100 J (threshold value). So interaction between laser energy and biomaterials occurs. This should be carefully considered during clinical laser treatments especially nearby implants.
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Affiliation(s)
- Vanessa Siedek
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany,
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Siedek V, Clevert DA, Rytvina M, Ihrler S, Klotz LV, Berghaus A, Strieth S. Contrast-enhanced ultrasound for monitoring effects of extracorporeal shock wave sialolithotripsy in sialolithiasis. Laryngoscope 2012; 122:1301-5. [PMID: 22522958 DOI: 10.1002/lary.23281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/03/2012] [Accepted: 02/13/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Contrast-enhanced ultrasound (CE-US) can be used for noninvasive analysis of functional vascularization. Chronically recurrent sialadenitis due to sialolithiasis of the submandibular gland is associated with increased vascularity. The aim of this investigator-initiated clinical trial was the evaluation of CE-US as a quantitative monitoring technique during gland-preserving extracorporeal shock wave sialolithotripsy (ESWL). STUDY DESIGN In this prospective clinical evidence level 2c study, perfusion in patients (n = 10) with unilateral sialolithiasis of the submandibular gland was quantitatively analyzed using CE-US before and after ESWL, comparing with the respective contralateral gland. METHODS Before CE-US measurements, a subjective clinical score of complaints (range, 1-10) was documented. The contrast agent SonoVue was injected into a cubital vein. The intensity-time curve gradients (ITGs) were calculated from CE-US data. RESULTS The ITGs derived from CE-US measurements revealed higher perfusion in the affected submandibular gland compared to the contralateral side. In parallel to clinical complaints, parametric CE-US data were significantly reduced after ESWL in chronic sialolithiasis-associated sialadenitis. CONCLUSIONS CE-US-derived ITGs appear to be an independent and quantitative marker for treatment effects of ESWL. Clinical experience and further studies will have to validate this method as a diagnostic tool to decide especially whether to proceed to sialoadenectomy in therapy-refractory cases.
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Affiliation(s)
- Vanessa Siedek
- Department of Otorhinolaryngology, University of Munich, Munich, Germany.
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Stelter K, Ertl-Wagner B, Luz M, Muller S, Ledderose G, Siedek V, Berghaus A, Arpe S, Leunig A. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology 2012; 49:429-37. [PMID: 21991568 DOI: 10.4193/rhino11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Many sinus surgeons report improved spatial orientation after using a navigation system. This study investigates the surgical, ergonomic and economic aspects of using a navigation system in training and teaching. MATERIALS AND METHODS Eight rhino-surgeons in training and 32 patients with bilateral diseases of the paranasal sinus system were included. After randomisation, one patient`s side was operated on with a navigation system while the other side was operated on without navigation. It was monitored how often the surgeon used the navigation pointer and then changed the procedures. A standardised and validated interview recorded the cognitive load when using the navigation system and the application efficiency. RESULTS The operations lasted on average 16 minutes longer with the navigation. Five paranasal sinuses could not be found in the control group without navigation. In only 10-13% of cases did the surgical procedure change after the use of the pointer. Most of the surgeons admitted that particular steps of the operation were more reliable and safer to carry out with the navigation system. The general trust in the system rose in proportion to intraoperative accuracy and repeated use. CONCLUSION Overall, there was an overwhelming level of trust in the navigation system. Trainee sinus surgeons seeing their more experienced colleagues using a navigation device tend to overestimate the possibilities of the system and to underestimate the risks. The assistance system was used particularly effectively in the group of slightly more experienced surgeons. In this group, the additional expenditure of time was less and the navigation substantially contributed to reinforcing the anatomical sense of direction.
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Affiliation(s)
- K Stelter
- Department of Otorhinolaryngology, Ludwig Maximilian University, Munich, Germany.
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Stelter K, Ertl-Wagner B, Luz M, Muller S, Ledderose G, Siedek V, Berghaus A, Arpe S, Leunig A. Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. A prospective, randomised clinical study. Rhinology 2011. [DOI: 10.4193/rhin11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stelter K, Ihrler S, Siedek V, Patscheider M, Braun T, Ledderose G. 1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study. Eur Arch Otorhinolaryngol 2011; 269:679-84. [PMID: 21792687 DOI: 10.1007/s00405-011-1681-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/17/2011] [Indexed: 11/28/2022]
Abstract
In the last decade, tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. In a previous study, the tonsillotomy with laser or radiofrequency therapy proved as a safe and effective procedure with minimal pain and hemorrhage. This follow-up study determines which method is more effective with respect to long-term outcome, recurrence of tonsillar hyperplasia and recurrence of tonsillitis. A prospective, randomised, double-blinded controlled clinical study was conducted at the Department of Otorhinolaryngology of the Ludwig-Maximilians-University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Tonsillotomy was performed on one side with monopolar radiofrequency and on the other side with a carbon dioxide laser. Exactly 1 year after the procedure, all 26 patients were documented by digital photography to define a possible recurrence of tonsillar hyperplasia. All parents were asked for occurring tonsillitis and fulfilled the Glasgow Children's Benefit Inventory (GCBI) for health-related quality of life after surgical procedures. In seven children, a slightly visible recurrence of the tonsillar hyperplasia occurred, without any symptoms or correlation to the different methods and sides. One child with recurrent tonsillitis and hyperplasia had to be tonsillectomized 8 months after the initial tonsillotomy procedure. The specimen showed open crypts with bacterial infection in the deep. The GCBI resulted in highly significant benefits of the surgery in all categories and subcategories. In conclusion, both methods, the laser tonsillotomy and the radiofrequency method, were equal concerning the effectiveness and safety after 1 year. Further investigations have to aim at the long-term outcome after tonsillotomy in patients with recurrent infections.
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Affiliation(s)
- Klaus Stelter
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre of Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany.
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Zengel P, Siedek V, Berghaus A, Clevert DA. Intraductally applied contrast-enhanced ultrasound (IA-CEUS) for improved visualization of obstructive diseases of the salivary glands, primary results. Clin Hemorheol Microcirc 2010; 45:193-205. [PMID: 20675900 DOI: 10.3233/ch-2010-1298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Obstructive diseases of the salivary glands are often based on Sialolithiasis; however, conventional radiological imaging or ultrasound does not provide a diagnosis in 5-10% of all cases. It was the aim of our study to examine the effectiveness and viability of an intraductal applied contrast-enhanced ultrasound (IA-CEUS) to improve the visualization of obstructive diseases of the salivary glands in comparison to conventional ultrasound and clinical symptoms. MATERIALS AND METHODS The study included fifteen patients with swelling of indeterminate cause and/or pain of one or more salivary glands. A high-end ultrasound machine (Siemens, ACUSON, S 2000, Germany) with a multi-frequency linear 9 MHz transducer was used to carry out contrast-enhanced ultrasound with SonoVue. RESULTS All patients were examined using all diagnostic ultrasound tools of the study. The results show that the procedure is easy and convenient to perform, as well as efficient, but more significantly, that the intraductal contrast agent improved the diagnostic assessment capabilities of ultrasound for patients with obstructive salivary gland diseases, thereby helping to identify the best treatment. CONCLUSION In comparison to conventional ultrasound, the use of an intraductal applied contract-enhanced ultrasound not only improved the visualization of the glandular duct system as a whole, but was less time-consuming as well as more reproducible. Thus, IA-CEUS with an intraductal applied contrast agent (IA-CEUS) is a promising tool that provides additional helpful information and an improvement for cases involving patients with unclear symptoms.
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Affiliation(s)
- P Zengel
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Siedek V, Kremer A, Betz CS, Tschiesner U, Berghaus A, Leunig A. Management of orbital complications due to rhinosinusitis. Eur Arch Otorhinolaryngol 2010; 267:1881-6. [DOI: 10.1007/s00405-010-1266-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 04/22/2010] [Indexed: 11/30/2022]
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Braun T, Siedek V, Assmann G, Ihrler S, Kirchhoff S, Vielhauer V, de la Chaux R. Lymphknotensarkoidose der Submandibularisloge. HNO 2010; 58:371-3. [DOI: 10.1007/s00106-009-1947-7] [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: 10/20/2022]
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Zengel P, Siedek V. [Salivary stone]. MMW Fortschr Med 2009; 151:37. [PMID: 19739522 DOI: 10.1007/bf03365796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P Zengel
- Klinik für Hals-Nasen-Ohren-Heilkunde, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 München.
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Kastl KG, Betz CS, Siedek V, Leunig A. Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery. Am J Rhinol Allergy 2009; 23:80-4. [PMID: 19379618 DOI: 10.2500/ajra.2009.23.3267] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis. Nasal packing is usually placed after the surgery to support wound healing and prevent adhesions. The purpose of this study was to investigate the effect of carboxy-methylated cellulose (CMC) nasal packing on wound healing after FESS compared with no nasal packing. METHODS Twenty-six patients underwent bilateral FESS. The patients were randomized to receive CMC mesh or gel packing on one side and no packing on the opposite side. The patients were followed at 2, 4, and 12 weeks after surgery. Endoscopically visible CMC, crusting, mucosal integrity, synechia formation, granulation tissue formation, and adverse side effects were assessed and documented. RESULTS No adverse side effects were observed. No significant differences were found between the CMC-packed side and the unpacked side with respect to the outcome measure of wound healing. No difference was found between two different forms of CMC in terms of wound healing. Two weeks after surgery, endoscopically visible CMC was detected in four patients of the CMC mesh group, whereas none of the patients in the CMC gel group had endoscopically visible CMC (p = 0.040). CONCLUSION As we were unable to establish an effect, we must question the efficacy of this packing material and the necessity of its use after FESS based on the technique of the Graz University Medical School. The mesh form of CMC could be potentially useful as a vehicle for extended drug delivery owing to its longer retention time in the nose.
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Affiliation(s)
- Konrad G Kastl
- Department of Otorhinolaryngology, University Hospital Ulm, Ulm, Germany.
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Siedek V, Stelter K, Betz CS, Berghaus A, Leunig A. Functional endoscopic sinus surgery--a retrospective analysis of 115 children and adolescents with chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol 2009; 73:741-5. [PMID: 19269044 DOI: 10.1016/j.ijporl.2009.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/20/2009] [Accepted: 01/26/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Functional endoscopic sinus surgery (FESS) is not frequently performed in children. The aim of our retrospective analysis was to determine symptoms, surgical extent, complications and outcome of operated children. METHODS For a period from 1994 to 2004 the clinical records of the Department of Otorhinolaryngology, LMU Munich, Germany, were screened for pediatric FESS procedures. Subsequently, a retrospective chart review was performed in all cases. For assessment of outcome, symptom- and quality of life-related questionnaires were sent out to all patients. RESULTS 115 children had a FESS procedure due to CRS, 77 were boys and 38 girls. The response rate of the questionnaires was 64% (73 of 115); the mean follow up of these was 5.4 (+/-1.8) years. 76% of the patients reported an improvement of their chief symptoms and 71% of their general quality of life. The overall quality of life had improved significantly (p<0.01) on VAS. In CRS patients nasal obstruction was completely relieved in 62.3%, facial pain in 65.5% and postnasal drip in 72.5%. Improvement of primary nasal symptoms (PNS) of CRS in patients with CF, asthma or allergies as well as in youngsters who had started or continued to smoke 35 out of 73 (48%) was significantly less. CONCLUSIONS Self-assessment after FESS showed in 76% improvement of chief symptoms in children with CRS. Besides known negative prognostic factors for long-term outcome as CF, asthma, nasal polyps, allergies and previous surgery, smoking was correlated with less favourable improvement.
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Affiliation(s)
- Vanessa Siedek
- Ludwig Maximilians-University, Department of Otorhinolaryngology, Head and Neck Surgery, Munich, Germany.
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Canis M, Siedek V. [Infections of the external ear canal]. MMW Fortschr Med 2009; 151:38-39. [PMID: 19728681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Martin Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum Grosshadern, Universität München.
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Tschiesner U, Linseisen E, Baumann S, Siedek V, Stelter K, Berghaus A, Cieza A. Assessment of functioning in patients with head and neck cancer according to the International Classification of Functioning, Disability, and Health (ICF): A multicenter study. Laryngoscope 2009; 119:915-23. [DOI: 10.1002/lary.20211] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Leunig A, Betz CS, Siedek V, Kastl KG. CMC packing in functional endoscopic sinus surgery: does it affect patient comfort? Rhinology 2009; 47:36-40. [PMID: 19382492] [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: 05/27/2023]
Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis (CRS and nasal polyposis). Nasal packing is usually placed after the surgery to minimize mucosal bleeding and support the wound healing process. Both the packing itself and its removal are often associated with pain and discomfort. OBJECTIVE To evaluate the effect of carboxymethylcellulose (CMC) nasal packing on patient comfort following FESS. METHODS Forty consecutive patients underwent bilateral FESS. One side of the nasal cavity was packed with CMC (mesh or gel) and the opposite side was not packed, the sides having been randomly selected. Postoperatively, patients were given visual analog scales to rate nasal airway obstruction and headache/pressure separately for the right and left sides. They also rated sleep disturbance and general well-being. RESULTS No significant differences were found between the CMC-packed side and the unpacked side with regard to patient comfort. No significant differences were found between CMC mesh and CMC gel. CONCLUSION Based on the presented data concerning patient comfort, CMC appears to be an ideal packing material following FESS. However, there is no other study revealing an identical study design focusing on other resorbable packing material. As a consequence, other available resorbable packing material should be investigated to find the ideal packing material following FESS, if packing is required.
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Affiliation(s)
- Andreas Leunig
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Betz CS, Zhorzel S, Schachenmayr H, Stepp H, Havel M, Siedek V, Leunig A, Matthias C, Hopper C, Harreus U. Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited Indocyanine Green: preliminary results. J Plast Reconstr Aesthet Surg 2008; 62:1602-8. [PMID: 19036663 DOI: 10.1016/j.bjps.2008.07.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/28/2008] [Accepted: 07/24/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Free-tissue transfer has become a standard procedure for reconstructive surgery in the head and neck area. Flap failures are relatively rare (<or=5%), and a high percentage can be salvaged if detected early. Indocyanine Green (ICG) angiography might be able to improve the detection of flap malperfusion at an early stage. METHODS So far, 11 patients with free-flap reconstructions of the upper aerodigestive tract (UADT) have participated in this study. Each participant underwent three endoscopic ICG angiographies (24h intra-operatively and 72h postoperatively). The data obtained were evaluated online as well as offline on a personal computer (PC), and the results compared to the clinical outcome. RESULTS There were no partial or complete flap losses. One flap was successfully salvaged following initial arterial kinking with impeded perfusion. The ICG fluorescence angiography was tolerated well in all patients. The free flaps showed a delayed yet equal ICG fluorescence as compared to the surrounding tissue. The timing and slope of fluorescence build-up were dependent on circulatory factors. The relative fluorescence maxima of flap versus surrounding were 33% in the initially failing flap and >or=64% for all other examinations. CONCLUSIONS It was possible to prove the feasibility of endoscopic ICG fluorescence angiography in patients undergoing free-flap transfer to the UADT. The method provides instant information about the perfusion state of the tissue and is easily performed without greater patient discomfort or risk of side effects. Due to the endoscopic approach, the method seems highly promising for this indication and merits further evaluation.
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Affiliation(s)
- C S Betz
- Department of Otorhinolaryngology, Head & Neck Surgery, Ludwig Maximilian University, Grosshadern Medical Campus, Marchioninistr 15, D-81377 Munich, Germany.
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Siedek V, Schuh T, Wollenberg A. Leser–Trelat sign in metastasized malignant melanoma. Eur Arch Otorhinolaryngol 2008; 266:297-9. [DOI: 10.1007/s00405-008-0636-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Accepted: 09/27/2007] [Indexed: 11/30/2022]
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Staindl O, Siedek V. Complications of auricular correction. GMS Curr Top Otorhinolaryngol Head Neck Surg 2008; 6:Doc03. [PMID: 22073079 PMCID: PMC3199843] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction.
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Affiliation(s)
- Otto Staindl
- University Clinic for Ear, Nose and Throat Medicine and Head and Neck Surgery, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Vanessa Siedek
- Clinic for Ear, Nose and Throat Medicine, Ludwig Maximilians University, Großhadern Clinic, Munich, Germany
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Affiliation(s)
- V Siedek
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU München.
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Siedek V, Zengel P, Berghaus A. [Causes and diagnostics of chronic xerostomia]. MMW Fortschr Med 2008; 150:27-30. [PMID: 18300550 DOI: 10.1007/bf03365315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- V Siedek
- Klinik für Hals-, Nasen- und Ohrenheilkunde der LMU München.
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Siedek V, Betz CS, Hecht V, Blagova R, Vogeser M, Zengel P, Berghaus A, Leunig A, Sroka R. Laser induced fragmentation of salivary stones: An in vitro comparison of two different, clinically approved laser systems. Lasers Surg Med 2008; 40:257-64. [DOI: 10.1002/lsm.20624] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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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Affiliation(s)
- O Staindl
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Paracelsus Medizinische Privatuniversität Salzburg
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Leunig A, Kastl K, Siedek V, Betz C. A Comparison of Carboxy-Methylated-Cellulose (Rapid Rhinor-Sinu-Knit) and “No Nasal Packing” following Functional Endoscopic Sinus Surgery. Skull Base 2007. [DOI: 10.1055/s-2006-958590] [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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Siedek V, Betz CS, Leunig A. [Cervical skin emphysema: a rare complication following tonsillectomy]. HNO 2006; 55:121-4. [PMID: 16528501 DOI: 10.1007/s00106-006-1389-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emphysema of the subcutis or interstitial compartments of the neck or around the naso- oro- or hypopharynx is caused by a perforation. In most cases, it occurs after surgery in this area; spontaneous emphysema is very rare. The characteristic symptom is crepitation; the extension is best seen on a CT scan. Endoscopic control of the surgical area for other lesions is necessary. An anaerobic, gas producing infection must be ruled out. Antibiotics should be given prophylactically.
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Affiliation(s)
- V Siedek
- Klinik und Poliklinik für Hals-Nasen- Ohren-Heilkunde der Ludwig-Maximilians-Universität München, Klinikum Grosshadern, 81366, München.
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Eckstein F, Siedek V, Glaser C, Al-Ali D, Englmeier KH, Reiser M, Graichen H. Correlation and sex differences between ankle and knee cartilage morphology determined by quantitative magnetic resonance imaging. Ann Rheum Dis 2004; 63:1490-5. [PMID: 15479900 PMCID: PMC1754795 DOI: 10.1136/ard.2003.018226] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [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: 11/04/2022]
Abstract
OBJECTIVE To study the correlation between ankle and knee cartilage morphology to test the hypothesis that knee joint cartilage loss in gonarthritis can be estimated retrospectively using quantitative MRI analysis of the knee and ankle and established regression equations; and to test the hypothesis that sex differences in joint surface area are larger in the knee than the ankle, which may explain the greater incidence of knee osteoarthritis in elderly women than in elderly men. METHODS Sagittal MR images (3D FLASH WE) of the knee and hind foot were acquired in 29 healthy subjects (14 women, 15 men; mean (SD) age, 25 (3) years), with no signs joint disease. Cartilage volume, thickness, and joint surface area were determined in the knee, ankle, and subtalar joint. RESULTS Knee cartilage volumes and joint surface areas showed only moderate correlations with those of the ankle and subtalar joint (r = 0.33 to 0.81). The correlations of cartilage thickness between the two joints were weaker still (r = -0.05 to 0.53). Sex differences in cartilage morphology at the knee and the ankle were similar, with surface areas being -17.5% to -23.5% lower in women than in men. CONCLUSIONS Only moderate correlations in cartilage morphology of healthy subjects were found between knee and ankle. It is therefore impractical to estimate knee joint cartilage loss a posteriori in cross sectional studies by measuring the hind foot and then applying a scaling factor. Sex differences in cartilage morphology do not explain differences in osteoarthritis incidence between men and women in the knee and ankle.
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Affiliation(s)
- F Eckstein
- Institute of Anatomy, Paracelsus Medizinische Privatuniversität, A5020 Salzburg, Austria.
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