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Biomedical subjects

F Bootz

Publications and source records attributed to F Bootz.

At least 19 recordsLinked to original sources
PubMed1998

[Objective methods for simulated detection of unilateral deafness with special reference to DPOAE (distortion-product otoacoustic emissions) exemplified by a case report].

The simulation of unilateral deafness is very rare. Objective findings are of special interest if it happens. A patient with alleged deafness on the left-hand side due to commotio cerebri was treated in our hospital. Pure tone audiometry showed deafness on the left-hand side and normal hearing on the right-hand side. However, stapedius reflexes were found ipsilaterally left as well as contralaterally right, at 0.5 to 2 kHz with a stimulation of approximately 90 dB SPL. Transiently evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) were measured. The TEOAE had the same reproducibility but a very low response on both sides, such that inner ear function could not be evaluated. In comparison, the DP gram showed clear DP amplitudes over the whole frequency range on both sides. Nonphysiological DPs could be excluded by assessing the DP growth rate at three different frequencies. By means of brainstem electric response audiometry (BERA), with which the IV/V complex was detectable up to stimulation with 20 dB SPL clicks, and the Stenger test, a neural or central hearing loss could be excluded. Normal hearing on the left-hand side was thus confirmed. In cases of simulated deafness it is possible to prove a normal inner ear function by DPOAE. DPOAE therefore complements the list of potential audiological simulation tests.

Adult↗
PubMed1996

[Free transplanted, microvascular reanastomosed forearm flap for reconstruction of the mouth cavity and oropharynx. Clinical and morphologic findings with special reference to reinnervation].

It remains a controversial question whether or not the anastomosis of sensory nerves is necessary in free transplants of microvascularly reanastomosed radial forearm flaps in the oral cavity and oropharynx. Some authors perform this routinely because they expect fewer complications in a skin with a sensory nerve supply. We carried out clinical and morphological examinations in 20 patients in order to determine the sensory innervation of the transplanted tissue. All patients received free transplants of microvasculary reanastomosed radial forearm flaps during a tumor operation in the oral cavity or oropharynx. Postoperative wound healing proceeded without complications in all but three cases, but these disturbances were insufficient to explain any deficit in sensation in the operated areas. Following surgery, sensation was determined clinically by two-point discrimination. Morphological studies of 20 flap biopsies using conventional colored light microscopy demonstrated nerve fibers in 14 of the biopsies. Immunohistochemical investigations also showed the presence of small nerve fibers by proving S-100 positive Schwann cells. We could not find a correlation between the demonstration of nerve fibers and the use of radiation (or an increased radiation dosage) following surgery. These findings suggest that nerve regeneration was completed just before the 6th postoperative month, which was the earliest time recorded in this study. Perivascular (vegetative) nerves showed a delayed regeneration and could be demonstrated only 36 months after operation. Histological investigations of the transplanted tissue showed a decrease in keratin with a partial increase in parakeratosis, a loss of skin structures and nearly always chronic inflammation. Our findings verify that a sensory innervation is possible in free transplanted radial forearm flaps by the regeneration of nerves coming from the transplantation bed and/or adjacent (oral) mucosa. This leads to a sensation comparable to that of healthy mucosa. These findings also indicate that there is no need for the anastomosis of sensory nerves during transplant surgery.

Adult↗
PubMed1995

Repair of anterior base of skull with free latissimus dorsi flap.

After craniofacial resection for ethmoid and nasal cancer the resulting defect in the anterior base of skull often is a problem because of liquorrhoea, followed by meningitis and brain herniation. Two approaches were used for surgery of ethmoid and nasal cancer involving the anterior base of skull-the transfrontal and the transethmoidal. The neurosurgeon performs the transfrontal approach, an additional lateral rhinotomy and ethmoidectomy is made by the ENT-surgeon. Seven patients underwent radical operation with immediate repair of the skull base defect performed in four and delayed repair in three cases with a microvascular latissimus dorsi muscle flap. The flap was tailored as a pure muscle transplant if only the base of skull had to be repaired and the surgical cavity had to be obliterated. In three cases a skin paddle was left on the muscle to perform closure of the orbit and of the hard palate. The aim of reconstruction is a good functional and cosmetic result and reduction of postoperative problems-such as brain herniation, CSF-leakage and meningitis-by obliteration of surgical cavities. Furthermore crusting of large cavities and disorders of phonation are reduced. The disadvantage of limited direct postoperative tumour control by nasal endoscopy however is justified by an increase of quality of life.

Adult↗
PubMed1995

[Tinnitus models for use in tinnitus counselling therapy of chronic tinnitus patients].

Tinnitus models are an integral part of tinnitus counselling. In cases with compensated tinnitus, counselling represents the only therapeutic measure necessary. In contrast, patients with uncompensated tinnitus require further therapy in the form of medication, tinnitus-maskers or psychotherapy. Sound processing along the peripheral and central auditory pathways is achieved by functional loops that direct mechanical, electrical or chemical information to various points in the pathway. Minor damage to a loop can cause destabilization of this finely balanced system and can induce tinnitus. Current peripheral tinnitus models are reviewed and discussed with respect to in vitro data from isolated outer hair cells of the guinea pig cochlea. Audiological findings of a patient with central tinnitus after brainstem surgery are discussed in view of central tinnitus models. Specific models for common hearing disorders, such as tinnitus with normal hearing, noise trauma, sudden hearing loss, toxic cochlear lesions, presbyacusis, acoustic neurinoma and Menière's disease are presented for the ENT-surgeon involved with tinnitus-counselling.

Adult↗
PubMed1994

Influence of static middle ear pressure on transiently evoked otoacoustic emissions and distortion products.

Otoacoustic emissions (OAE) are influenced in their amplitude and frequency spectra by the middle ear. The effects of changes in the middle ear transmission mechanisms on transiently evoked OAE (TEOAE) and distortion product emissions (DPOAE) were investigated as a function of static ear canal pressure in 25 normal-hearing test persons aged 18-35 years. The ear canal pressure was varied stepwise between positive and negative values of 200 daPa. TEOAE and DPOAE amplitudes were attenuated significantly with changes of the static ear canal pressure, with greatest changes at low frequencies (< 2 kHz). The alterations of OAE amplitude were slightly dependent on the polarity of the pressure, with positive pressure producing a greater attenuation (0.6 dB). The results demonstrate that changes in middle ear impedance can cause a misinterpretation of OAE. To avoid this problem, tympanometry should always precede OAE measurements. Alternatively, both methods can be combined using one acoustic probe, so that the emissions can be evoked at the peak of middle ear compliance.

Acoustic Impedance Tests↗
PubMed1994

[Microvascular tissue transplantation in plastic reconstruction of the external head-neck area].

Free tissue transfer is under certain circumstances an ideal reconstructive method for skin and soft tissue defects of the head and neck region. These are multilayer, large defects, recurrences after previous reconstructive methods, in cases of aesthetic disturbances due to local flaps, in difficult reconstructive areas due to chronic infection and radiotherapy and if local tissue is not available. From 1987 to 1993 we performed 30 reconstructions of the surface of the head and neck region with free flaps, mainly the forearm flap and the scapular flap. But also the latissimus dorsi flap and in one case the rectus abdominis flap were used. There was no flap failure. In only one case of a forearm flap we saw a delayed healing of the donor defect. There was no functional impairment of the donor defect. All cosmetical results were acceptable. Flaps from the trunk mainly showed considerable differences in colour and texture to the surrounding skin.

Adult↗
PubMed1994

[Melanoma metastasis in the oropharynx].

Malignant melanomas of the upper respiratory tract are rare tumors but even rarer are their metastases in this region. Between 2% and 3.6% of malignant melanomas of the head and neck occur in the upper respiratory tract. We report a case history of a 48-year-old patient who underwent excision of a superficial spreading melanoma (tumor-thickness, 2 mm) from his trunk and later radical dissections of metastases in his axilla and groin. Chemotherapy with DTIC, an alpha-interferon, was performed. During follow-up, CT-scan demonstrated a 1 cm asymptomatic metastasis in the nasopharynx. Nasal endoscopy confirmed the CT finding as a dark tumor mass in the mucosa of the roof of the nasopharynx, close to Rosenmüller's fossa. Tumor was excised by a temporary split of the soft palate.

Chemotherapy, Adjuvant↗
PubMed1993

[Differential indications of free and pedicled transplants in reconstructive surgery in the head and neck area].

Since the microvascular tissue transfer has been introduced in the reconstructive surgery of the head and neck the question arises repeatedly which free transplant should be favoured and which advantages exist to pedicled flaps. Based on our experiences in 243 reconstructions we discuss the advantages and disadvantages of different operative techniques and their differential indications. Using free as well as pedicled flaps, reconstructions can be performed individually and the decision for a transplant depends on localisation, size and depth of the defect. In contrast to conventional techniques, like the deltopectoral flap, which we performed a decade ago, both new principles allow a one-stage procedure, which reduces the period of hospitalisation and improves the quality of life for the patients. The advantages of free tissue transfer can be seen especially in the reconstruction of the upper digestive tract after laryngopharyngectomy. The existing form of the jejunum segment like a tube allows an easy one-stage reconstruction, as well as better functional and aesthetic results. The radial forearm flap is a nearly ideal transplant in the anterior oral cavity because of the mechanical stability. In contrast the jejunum patch is more vulnerable and less qualified especially when fitting a prosthesis. In the posterior oral cavity we prefer the jejunum patch because it allows more mobility of the tongue. Deep defects, for instance after glossectomy, should be reconstructed with a free latissimus-dorsi-flap or a pedicled myocutaneous pectoralis major flap. In contrast to free tissue transfer, pedicled flaps have the advantage that the difficult technique of microanastomosis is avoided, which reduces the complication rate and the operation time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Immediate management of rupture and soft tissue injuries in the area of the head-neck].

Most injuries to the head and neck region are accompanied by trauma to the soft tissue. The management of the wound depends on whether it is a superficial or a penetrating trauma. Penetrating traumas may injure bloodvessels, nerve structures and the upper aerodigestive tract. The initial evaluation of a patient with a neck wound should proceed with the basic rules of trauma management (Airway, Bleeding, Circulation). It is suggested, that all wounds deep to the platysma should be explored. Penetrating injuries through the airway should be considered in cases of hoarsness, dyspnea or direct visualization of the airway. In case of dyspnoe the patient should be intubated. In an unstable airway a tracheotomy must be considered. Injuries to the airway demand special care and immediate reconstruction since otherwise it can lead to permanent damage. Hemorrhage and hematoma are the most common symptoms of penetrating neck injuries. Poor initial control of bleeding is the most common cause of death. Uncontrolled clamping of vessels in the neck should be avoided since it can lead to damage of uninvolved structures especially nerves. The neck is divided into 3 zones. Zone I is the area below the sternal notch, Zone II lies between the sternal notch and the angle of the mandible. Zone III is the area above the angle of the mandible. Zone I and III injuries are evaluated with angiography. Zone II injuries are evaluated by surgery. Therapy of Zone I and III is difficult and needs mandibulotomy or resection of the clavicle to gain exposure to the vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Craniocerebral Trauma↗
PubMed1993

[Methods for surgical closure of pharyngo-cutaneous fistulas after laryngectomy].

Salivary fistulas after laryngectomy and radiotherapy can be treated with different reconstructive procedures if spontaneous closure fails to occur. In small fistulas local supraclavicular flaps are useful if not altered by radiotherapy. Larger fistulas can be closed with pectoralis major flaps. If these methods fail and there is a large defect in the pharynx, free tissue transplants can be used. For this purpose the "single" or "double" jejunal patch can be recommended. The double patch is used for fistulas with large skin defects, since the outer patch from which the mucosa is removed will take split skin. If there is severe infection and tissue alteration by radiotherapy, free omentum transplantation is an excellent method for closure of a fistulas, since in addition to immunological reactivity it easily takes split skin. the vanous methods mentioned are not equal in their applications and are used depending on the size of defect present. In particular, the use of intestinal grafts depends on the general health of the patient affected.

Fistula↗