Biomedical subjects
Publications and source records attributed to H Masing.
In 20 adult cleft patients, the influence of a Le-Fort-I-osteotomy and ventral-caudal advancement of the maxilla on nasal breathing was studied. An increase of nasal air flow in the majority of patients is due to an increase in the volume of nasal skeleton and/or in the nasolabial angle and alar nasal base. Rhinomanometric measurements and X-ray examination confirm the results.
A unilateral mucosal flap from the septum with a wide pedicle and an axial blood supply was used for closure of septal perforations. In special cases this procedure was combined with a labial-buccal flap. 18 patients with perforations of different sizes were treated resulting in a permanent and complete closure in 12 cases. Relief of complaints was also noticed in the six patients with residual perforations. We therefore conclude that diminution and shifting of the perforation may be sufficient to relieve symptoms. The technique proved to be a safe and physiological procedure for the patients with septal perforations.
In the great majority of patients with hypoplasia of the middle third of the face, the surgical advancement or displacement of the maxilla results in a subjective improvement in nasal breathing, which can also be verified. This is due to an increase in the volume of the nasal skeleton and/or in the nasolabial angle, which improves nasal ventilation. These operations have virtually no effect on endonasal obstructions to flow, which, in order further to improve nasal breathing, should be dealt with separately.
17 unilateral and 6 bilateral choanal atresias in children were observed in the ENT-Dept. of the University Hospital Erlangen during 1975-1982. Bilateral choanal atresia requires immediate trepanation by using the CO2 or Argon laser technique. The surgical procedure in unilateral choanal atresia is postponed until the age of 4 years. Transnasal microsurgical approach is preferred in these cases because it involves minimal damage to the developing structures. The satisfying results are reported.
The function of the nasal muscles in rhinoplasty has not been investigated sufficiently. On this reason electromyographical and neuromyographical investigations were done in a group of rhinoplastics before and immediately after surgery but also at least 8 weeks later on. By performing a conservative technique the initial disturbance of the muscles immediately after surgery disappears in a high percentage and voluntarily movements of the nasal muscles can be observed. Different results are discussed.
There are various causes for collapsed ala nasi. In elder people especially, the lateral crus of the alar cartilage is frequently deformed in shape and position. Model experiments show that by rotation of the lateral crus outwards and upwards, the vestibulum is expanded and the tip of the nose raised. On the basis of these experiments, in 19 patients with collapsed ala nasi, the lateral crus of the alar cartilage was rotated dorsally. The longterm results showed a satisfactory functional and aesthetic outcome.
In 49 rabbits the mucoperichondrium of their nasal septa was strictly unilaterally separated according to the Cottle procedure. In addition, in some rabbits only the surface of the septal cartilage was incised and in others the cartilage was cut vertically or horizontally. Four months after the operation the following alterations of the septa were seen: The separation of the mucoperichondrium from the cartilage or superficial incision of the cartilage led to a deviation to the operated left side. If in addition parts of the cartilage septum were mobilized, thus swinging horizontally or vertically, a deviation to the other nonoperated side was seen. Similarly, if two parallel vertical stripes of cartilage were excised, the ends of the remaining cartilage plate bent and the cartilage plate itself deviated to the nonoperated side. The postoperative deviations are due to released unbalanced forces of the cartilage itself and to the disequilibrium of scar tension resulting from the unilateral separation of the mucoperichondrium. To avoid these postoperative deviations the bilateral tunneling of the mucoperichondrium is required.
In 35 test persons with normal nasal condition the newly developed imidazole derivative 2-(2-imidazolin-2-yl)-N-(4-indanyl)amine hydrochloride (indanazoline E-VA-16, active principle of Farial) was tested for its decongesting influence on nasal mucosa and for its tolerability using anterior rhinomanometric techniques and comparing the results with those of xylometazoline. 10 min after application of either drug the stream volume increased significantly thus evidencing decongestion of the nasal mucosa. There was no substantial difference between the two substances. 8 h after application the initial values were virtually reached again in both treated groups. Since indanazoline showed little effect in conditions of minor respiratory resistance but was highly effective against increased initial respiratory resistance it is concluded that its therapeutic safety margin might be larger. The reactive hyperemia observed after both drugs should not be overvalued. Blood pressure and pulse rate were not appreciably influenced at any time. Both drugs were well tolerated.
There are still some problems of the surgical treatment of septal perforations (s.p.). Only patients with s.p. having complaints i.e. bleeding, crusting, whistling and headache should be treated. More than 60% of 61 operated patients had an iatrogenic perforation. The complete closure of the s.p. is not abosulutely necessary. More important seems to be the protection of the posterior circumference of the s.p. In small perforations (up to 5 mm) an interposition of fascia combined with a rotating mucosa flap is a safe technique. In middle size s. p. (up to 15 mm) a two stage technique is recommended by using a vestibular-conchal flap which gives satisfactory results in 80% of the operated patients. In great s. p. (more than 15 mm) a septal button is preferred.
The histological findings following transplantation of crushed septal cartilage into the nasal septums of seven rabbits during septoplasties are reported. Living and devitalized chondrocytes were found together with loss of cartilage substance, its replacement by granulation tissue, and new cartilage and to a lesser extent new bone formation.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The diagnosis and treatment of nasal cysts and fistulas are reviewed on the basis of a material of 16 cases. Definite evidence of cyst size is often unobtainable. Surgery of nasal cysts and fistulas should be done as early as possible to assure unimpaired nasal growth. In secondary fistulas re-operations may be quite problematic. Bifid noses vary substantially in terms of severity. Severity, in fact, will dictate the surgical techniques to be employed, i.e. decortication or external incisions. Saddling, which is a consistent finding can be corrected by preserved cartilage. The results thus obtainable are satisfactory by follow-up evidence. Congenital flat nose is a rare anomaly. Eight cases were encountered in the past 10 years. The techniques of columellar lengthening and strutting of the nasal tip are reviewed.
The Häring endoprosthesis was originally designed for re-establishing an esophageal passage in patients with tumor stenosis of the esophagus. We have successfully used this prosthesis in two patients for closure of large pharyngeal fistulae following laryngectomy. The prosthesis provides a watertight closure of the pharynx and allows immediate natural feeding by the patient.
Explore the source record for details and available documents.
A histological study is presented on 18 cartilage grafts, conserved in Merthiolat TM, which had been implanted for reconstruction of the caudal border of the nose for time periods of 1 month up to 11 years. These cartilage graft preparations were compared to non graft cartilage from patients died in an age of 37, 51 and 53 years respectively. Our findings show that cartilage grafts are eroded from the edge by resorption granulations of the host. Besides resorption one case showed purulent chondritis and another one osteoneogenesis. The extent of the erosion and the resorption rate seem to depend strongly on the original quality of the cartilage graft. This is possibly due to degenerative focuses which could be found in all of the natural cartilage preparations. After our opinion these focuses regarded like "loci minoris resistentiae". Therefore cartilage material to be used for rhinoplasty ought to be checked for such degenerative focuses.
The submucous resection of septum by Killian is not appropriate as a primary correcting treatment, especially in case of traumatical septum deformities. Due do the loss of cartilage often form and function of the nose deteriorates in a typical way. These complaints demand an operative correction under complicated circumstances. Based on the patient clietele of the Univ.-HNO-Klinik Erlangen it is demonstrated how secondary operations with the special technique of displacement of the remaining cartilage a satisfying result finally can be achieved.
Long term experience of nasal surgery using cartilage homografts preserved in merthiolate shows the implants to have the following properties: 1. They heal without complications and are well tolerated. 2. Rate of resorption varies according to the quality of the recipient site and the stresses on it from outside. 3. Very suitable for support to replace resected or destroyed cartilage. 4. Limited use in reconstructing weight bearing areas because of unduly high resorption rate in 50% of implanted struts. 5. No clinical evidence of resorption in areas not subject to stress. 6. Resorption in areas of stress varies from a virtual absence to a rapid process.