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Sühs KW, Koestner W, Schütze M, Bronzlik P, Hermann EJ, Durisin M, Polemikos M, Krauss JK, Höglinger GU. Recurrent infarcts from thyroid cartilage compression of an aberrant vertebral artery: rare, easily overlooked, but treatable. J Neurol 2023; 270:6146-6150. [PMID: 37548680 PMCID: PMC10632289 DOI: 10.1007/s00415-023-11896-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Affiliation(s)
- K W Sühs
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - W Koestner
- Department of Radiology and Neuroradiology, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany.
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany.
| | - M Schütze
- Department of Radiology and Neuroradiology, St. Bernward Hospital, Treibestraße 9, 31134, Hildesheim, Germany
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - P Bronzlik
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - E J Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - M Durisin
- Department of Otolaryngology, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - M Polemikos
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - J K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - G U Höglinger
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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Eifler R, Seitz JM, Weber CM, Grundke S, Reifenrath J, Kietzmann M, Lenarz TH, Maier HJ, Klose C, Durisin M. MgNd2 alloy in contact with nasal mucosa: an in vivo and in vitro approach. J Mater Sci Mater Med 2016; 27:25. [PMID: 26704542 DOI: 10.1007/s10856-015-5636-7] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
Biodegradable and biocompatible magnesium alloys appear to be very promising not only for temporary clinical application but also for developing deformable and degradable medical implants. This study analyzes the in vivo degradation behavior and the impact on the paranasal sinuses of the highly ductile Mg-2 wt%Nd alloy (MgNd2) in order to provide a basis for a satisfying stent system for the therapy of a chronic sinusitis. Moreover, in vitro tests were carried out on primary porcine nasal epithelial cells (PNEC). For the in vivo tests, cylindrical MgNd2 specimens were implanted into the sinus' mucosa of minipigs. During and after a total period of 180 days the long-term biodegradation and biocompatibility properties after direct contact with the physiological tissue were analyzed. Biodegradation was investigated by measuring the mass and volume losses of the MgNd2 specimens as well as by performing element analyses to obtain information about the degradation layer. The influence on the surrounding tissue of paranasal sinuses was evaluated by endoscopic and histopathological examinations of the mucosa. Here, only a locally unspecific chronic infection was found. The degradation rate showed a maximum after 45 days postsurgery and was determined to decrease subsequently. In vitro experiments using PNEC showed adequate biocompatibility of MgNd2. This study demonstrates a good in vivo biocompatibility for MgNd2 in the system of paranasal sinuses and underlines the promising properties of alloy MgNd2 for biodegradable nasal stent applications.
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Affiliation(s)
- R Eifler
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany.
| | - J-M Seitz
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
- Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend, Dr., Houghton, MI, 49931, USA
| | - C M Weber
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - S Grundke
- Institute of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hanover, Foundation, Bünteweg 17, 30559, Hanover, Germany
| | - J Reifenrath
- Small Animal Clinic, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
- Department of Orthopedic Surgery, CrossBIT - Center for Biocompatibility and Implant-Immunology, Hannover Medical School, Feodor-Lynen-Straße 31, 30625, Hannover, Germany
| | - M Kietzmann
- Institute of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hanover, Foundation, Bünteweg 17, 30559, Hanover, Germany
| | - T H Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - H J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - C Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - M Durisin
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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Durisin M, Seitz JM, Reifenrath J, Weber CM, Eifler R, Maier HJ, Lenarz T, Klose C. A novel biodegradable frontal sinus stent (MgNd2): a long-term animal study. Eur Arch Otorhinolaryngol 2015; 273:1455-67. [PMID: 26341887 DOI: 10.1007/s00405-015-3774-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022]
Abstract
The frontal sinus recess consists of anatomically narrow passages that are prone to stenosis in endonasal frontal sinus surgery for chronic sinus disease. Over the past 100 years, diverse frontal sinus stents have been developed and evaluated in clinical and animal studies. However, superinfection, formation of granulations tissue, stent dislocation and late stenosis of the duct have remained challenges and subject of debate in the literature. Currently developed biodegradable materials, including rare earth-containing magnesium alloys are promising candidates for application as temporary implant materials. The Mg 2 % wt Nd alloy (MgNd2) was used to design a nasal stent that fit the porcine anatomy. In the current study, we evaluate biocompatibility, biodegradation and functionality of a frontal sinus stent in 16 minipigs over 6 months. Intraoperative endoscopy revealed free stent lumen in all cases. Blood examination and clinical examinations indicated no systematic or local inflammation signs. The histopathology and elements analysis showed a very good biocompatibility. The μ-computed tomography-based volumetric analysis showed substantial stent degradation within 6 months. Our MgNd2 based stent appears to be a promising, solid basis for the development of a frontal sinus stent for clinical use.
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Affiliation(s)
- M Durisin
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - J M Seitz
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany.,Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
| | - J Reifenrath
- Department of Orthopedic Surgery, CrossBIT, Center of Biocompatibility and Implant-Immunology, Hannover Medical School, Feodor-Lynen-Straßee 31, 30625, Hannover, Germany
| | - C M Weber
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - R Eifler
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
| | - H J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
| | - T Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - C Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
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Helmstaedter V, Tellkamp R, Majdani O, Warnecke A, Lenarz T, Durisin M. High-frequency jet ventilation for endolaryngotracheal surgery - chart review and procedure analysis from the surgeon's and the anaesthesiologist's point of view. Clin Otolaryngol 2015; 40:341-8. [DOI: 10.1111/coa.12376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- V. Helmstaedter
- Department of Otorhinolaryngology/Head and Neck Surgery; Medical University of Hannover; Hannover Germany
| | - R. Tellkamp
- Department of Anaesthesiology and Intensive Care Medicine; Medical University of Hannover; Hannover Germany
| | - O. Majdani
- Department of Otorhinolaryngology/Head and Neck Surgery; Medical University of Hannover; Hannover Germany
| | - A. Warnecke
- Department of Otorhinolaryngology/Head and Neck Surgery; Medical University of Hannover; Hannover Germany
| | - T. Lenarz
- Department of Otorhinolaryngology/Head and Neck Surgery; Medical University of Hannover; Hannover Germany
| | - M. Durisin
- Department of Otorhinolaryngology/Head and Neck Surgery; Medical University of Hannover; Hannover Germany
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Lyutenski S, Länger F, Lenarz T, Durisin M. [A Rare Tumor of the Tongue]. Laryngorhinootologie 2015; 94:459-60. [PMID: 25739070 DOI: 10.1055/s-0034-1396858] [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: 10/23/2022]
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Seitz JM, Eifler R, Weber C, Lenarz TH, Maier HJ, Durisin M. In vivo degradation effects of alloy MgNd2 in contact with mucous tissue. J Biomed Mater Res A 2014; 103:2427-40. [PMID: 25537491 DOI: 10.1002/jbm.a.35382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/13/2014] [Revised: 11/17/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022]
Abstract
Magnesium alloys are currently being investigated for use as resorbable biomaterials. Various applications for magnesium based implant materials have already been presented. Currently, stents and structures that sustain diseased or narrowed vessels seem to be the most promising areas. This study focuses on the use of a magnesium fluoride (MgF2 ) coated magnesium neodymium based alloy (MgNd2 ) and its use as a postsurgery stent material to avoid proliferation in the sinus region. Simple cylindrical shaped specimens were sown to the sinus' mucosa of pigs and left in place for different periods of time to investigate the long-term corrosion resistance of the alloy and its coating during direct contact with physiological tissue. Investigations made within this study explicitly focused on the corrosive behavior of the alloy in the region of a physiological sinus. Thus, losses in mass and volume, and element analyses were considered to obtain information about the specimens' corrosion performance over time. Furthermore, micrographs support the alloy specific corrosion type analyses which focus on grain boundary effects. This study demonstrates the general in vivo applicability of fluoride coated MgNd2 . The progress of corrosion was determined to be adequate and homogeneous over a total period of 180 days.
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Affiliation(s)
- J-M Seitz
- Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, Michigan, 49931.,Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany.,Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, Michigan, 49931
| | - R Eifler
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - C Weber
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - T H Lenarz
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - H J Maier
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - M Durisin
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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Helmstaedter V, Tellkamp R, Schwab B, Lenarz T, Durisin M. [High-frequency jet ventilation in otorhinolaryngology - surgical and anaesthesiologic issues]. Laryngorhinootologie 2014; 93:455-60. [PMID: 24676871 DOI: 10.1055/s-0034-1370925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND High-frequency jet ventilation (HFJV) through thin catheters creates more room for surgical procedures in laryngotracheal surgery, while few contraindications exist. In contrast, the anaesthesiologist has to cope with reduced monitoring and numerous contraindications. Therefore, every participating discipline has to thoroughly know the method. We report our experiences with HFJV and focus on relevant points, which contribute to a safe and cooperative procedure. MATERIAL AND METHODS We performed a retrospective chart review for patients, who were operated for benign laryngotracheal lesions using HFJV at the Hannover Medical School, Department of Otorhino-Laryngology between June 2012 and February 2013. We analyze patient characteristics, complications and important anaesthesiologic and operative steps. RESULTS A total of 46 cases of microlaryngoscopies and tracheoscopies were included in this study. The median body mass index was 27 kg/m(2). According to the ASA-classification, 24% of patients were categorized class I, 54% class II and 22% class III. In 2 cases we had reversible, peripheral desaturations down to 70%. In one case, emergent re-intubation with an endotracheal tube was inevitable due to rapid desaturation below 50%. Further complications were not observed. CONCLUSION HFJV represents a safe ventilation approach in laryngotracheal surgery, when patients are thoroughly selected. Especially the surgeon benefits from more room in the operating field. Obesity, reflux and cardiopulmonary diseases have to be evaluated well, as these can represent relative contraindications. Individual decisions can be made under consideration of all comorbidities.
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Affiliation(s)
- V Helmstaedter
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
| | - R Tellkamp
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover
| | - B Schwab
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
| | - T Lenarz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
| | - M Durisin
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
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Durisin M, Weber C, Seitz J, Bach FW, Kietzmann M, Schumacher S, Lenarz T. The Biodegradable Magnesium Stent as an Alternative Treatment in Cases of Chronic Ventilation Disorders of the Paranasal Sinuses. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-C/bmt-2013-4049/bmt-2013-4049.xml. [DOI: 10.1515/bmt-2013-4049] [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: 11/15/2022]
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Arnoldner C, Stöver T, Bartling SH, Windhagen A, Durisin M, Averbeck T, Lenarz T. [Exostosis of the internal auditory canal in a patient with myotonic dystrophy]. Laryngorhinootologie 2006; 85:755-9. [PMID: 17031763 DOI: 10.1055/s-2005-921214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
A 53-year-old patient with myotonic dystrophy presented to our clinic with progressive bilateral hearing loss. The ENT status and particularly the otological examination were without pathological signs. Pure tone audiograms showed a bilateral moderate to severe sensorineural hearing loss. Routinely performed computed tomography of the temporal bones revealed the rare picture of exostosis of the internal auditory canals and the medial surface of the petrous bones. To our knowledge, this is the first report describing exostosis of the internal auditory canal in a patient with myotonic dystrophy, although at present it remains unclear in how far there is a causal connection between these two pathologies.
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Affiliation(s)
- C Arnoldner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover
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Teschner M, Durisin M, Mangold A, Lenarz T, Stöver T. [Peripheral facial palsy as the first symptom of a metastatic bronchogenic carcinoma]. Laryngorhinootologie 2006; 85:512-6. [PMID: 16791767 DOI: 10.1055/s-2005-870515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
BACKGROUND We present a case of a facial palsy as the initial symptom of a bronchogenic carcinoma. METHODS Case-report. A 56-year-old patient presented with a peripheral facial palsy. The clinical picture as well as the temporal bone CT were without pathological findings. A 10-day rheologic therapy as well as anti-viral medication were not successful. Five days after rheological therapy had been completed, the patient presented a swelling of the neck. In the computer tomography we found a bilateral thrombosis of the internal jugular vein. In addition, the clinical picture of a left-sided glossopharyngeal palsy appeared. The following thorax CT as well as the diagnostic extirpation of an enlarged cervical lymph node lead to the diagnosis of a metastasized smallcell neuro-endocrine bronchogenic carcinoma with a compression of the right primary bronchus and the vena cava superior as well as an upper inflow congestion. In the cMRT we furthermore found a metastasis in the area of the foramen stylomastoideum. The patient underwent emergency radiation and chemotherapy. RESULTS According to the present findings, this metastasis lead to the facial palsy as the initial symptom of the bronchogenic carcinoma. CONCLUSION Therefore, therapy resistant facial palsy should be further diagnosed in detail, especially examined by imaging procedures.
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Affiliation(s)
- M Teschner
- Hals-Nasen-Ohrenklinik der Medizinischen Hochschule Hannover.
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Durisin M, Mengel M, Beilken A, Donnerstag F, Lenarz T, Stöver T. [Embryonal rhabdomyosarcoma of the orbita]. Laryngorhinootologie 2006; 85:124-7. [PMID: 16498541 DOI: 10.1055/s-2005-861431] [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: 10/25/2022]
Abstract
A 2(1/2) year old girl was presented with an acute, painless orbital swelling without signs of local or systemic inflammation. CT and MRT scanning revealed a tumor which by open biopsy disclosed embryonal rhabdomyosarcoma. By means of this case we present the current diagnostic and therapeutic approaches for childhood soft tissue sarcomas. At present our patient receives a poly-chemotherapy which has already shown a good response. For local tumor control, a complete surgical resection as well as radiotherapy may be indicated and have to be considered carefully with respect to the possible late effects. This case demonstrates that in a child with a unilateral, progressive orbital tumor, the differential diagnosis of a soft tissue sarcoma has to be ruled out.
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Affiliation(s)
- M Durisin
- HNO-Klinik der Medizinischen Hochschule Hannover
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Abstract
Bilateral Osteomyelitis following frontal sinusitis is a rare complication in the antibiotic era. The main risk of a progredient course is mainly the formation of external subperiostal, epidural, subdural abscesses or brain abscesses with potentially life-threatening complications. This is a report on a patient who presented in our department with progredient cephalgia and swelling in the area around the glabella and frontal sinus. Macroscopical examination revealed septum deviation to the right side and nasal polyposis of the right nasal passage. A computed tomography of the paranasal sinuses showed subtotal soft tissue obstruction of all sinuses with the exception of the sphenoidal sinus. Bilateral osteolysis of the ventral osseous borders of the frontal sinus with accompanying osteosclerosis was also observed. The therapy consisted of radical frontal sinus surgery via Unterberger approach. This case demonstrates a rare case of bilateral frontal osteomyelitis together with the necessary diagnostic and therapeutic measures. The management consisted of the removal of all osteomyelitic bone and antibiotic therapy. Differential diagnostic procedures must be carried out in order to exclude orbital and intracranial complications. Regular follow-up examinations and a CT scan of the paranasal sinuses are part of the standard therapy.
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Affiliation(s)
- M Durisin
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover
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