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Biomedical subjects

H Stammberger

Publications and source records attributed to H Stammberger.

At least 73 records · Page 4Linked to original sources
PubMed1990

Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique.

The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory disease of the paranasal sinuses. In so doing, diseases and lesions that otherwise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.

Endoscopy↗
PubMed1989

History of rhinology: anatomy of the paranasal sinuses.

The knowledge of the presence of the paranasal sinuses dates back to early mankind as well as attempts to treat their diseases. Apart from the sensory function of smell, however, little has been known about the function and especially the anatomy of the system till the end of the last century. Until the late middle ages sometimes obscure functions were attributed to the sinuses, like holding the "grease" for the movement of the eyeballs, or allowing the brain to "drain its bad spirits" to the outer world, bringing about names like "la cloaca del cerebro" by Sansovino in the 16th century. The old French expression of "rhume de cerveau" demonstrates these ideas having passed on into modern man's vocabulary. During the 17th and 18th century discussion was mainly about the function or purpose of the sinuses, and the rare anatomical studies were meant to support or prove one or the other "philosophies". Today's knowledge of the anatomy to a great deal goes back to the basic work of Emil Zuckerkandl of Austria, who starting from the 1870s described in subtile studies the anatomical and development details of the nose and the sinuses, opening an entire new field for scientific and surgical approach to the area. The decades around the turn of the century boost with studies on sectional and surgical anatomy, creating the specialty of rhinology and leading into our modern concepts of diagnosis and therapy of nasal and paranasal sinus diseases. Names like Grünwald, Onodi, Hajek and many others are closely linked with this creative period. Radiology, especially the development of conventional and computed tomography during the last two decades helped to "rediscover" the fascinating details and complex connections of the paranasal sinus system. Together with the development of the operating microscope and the endoscope this helped to open new ways for functional approaches and less radical microsurgery.

History, 17th Century↗
PubMed1988

Special radiologic imaging of paranasal sinuses. A prerequisite for functional endoscopic sinus surgery.

Endoscopic diagnosis and surgery of inflammatory diseases of the lateral nasal wall and the paranasal sinuses require a very detailed preoperative knowledge of the individual anatomical conditions and pathological changes. Pluridirectional tomography and computed tomography are used best to visualize this region. The complicated radiologic anatomy of the lateral nasal wall together with the most important anatomical variations are demonstrated and the underlying pathophysiologic principles of chronic recurrent sinusitis are discussed.

Endoscopy↗
PubMed1988

[The roof of the anterior ethmoid: a locus minoris resistentiae in the skull base].

Because of its special anatomic features, the roof of the anterior ethmoid is a preferred area for frontobasal fractures as well as an area of hazard during ethmoid surgery. As clinical experience proves, the most critical area for lesions to occur is the vicinity of the anterior ethmoidal artery, especially where this leaves the dome of the ethmoid medially to reach the ethmoidal sulcus in the olfactory fossa. Complete ethmoidal specimen were investigated by the means of serial histological sections in the frontal plane. 40 anterior ethmoidal arteries were anatomically prepared and the special features of their topography like connection with the dura, fixation of the dura to the bone of the skull base and the variations of the thickness of the surrounding bony wall studied with regard to their surgical relevance. Not the dome of the ethmoidal roof proves to be the most critical point for lesions to occur, but the area where the anterior ethmoidal artery leaves the ethmoid medially, to enter the olfactory fossa. Here, the bone is tenfold thinner than at the very roof of the ethmoid.

Arteries↗
PubMed1987

Paranasal sinuses: CT imaging requirements for endoscopic surgery.

Recent advances in the understanding of mucociliary activity and the pathophysiology of the nasal cavity and paranasal sinuses have revolutionized the surgical management of chronic and/or recurrent sinusitis. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology. This information has led to more focused endoscopic surgical procedures, which have dramatically reduced patient morbidity. As a consequence, there is now worldwide interest among otolaryngologists in the radiologic definition of paranasal regional anatomy. For effective interactions between radiologist and otolaryngologist, the former must be prepared to render interpretations that address these "microanatomic" locales. This communication is directed at familiarizing the radiologist with these observations and concepts, considering both normal and disturbed anatomy with their attendant pathophysiologic and therapeutic implications.

Endoscopy↗
PubMed1987

[Surgical treatment of chronic recurrent sinusitis--the Caldwell-Luc versus a functional endoscopic technic].

More than 50 patients who underwent intranasal or radical (Caldwell-Luc) antrostomy for chronic recurring sinusitis and who had still the same symptoms as before the operation, were examined by endoscopy and polytomography/CT. More than 50% still had polypoid changes of the maxillary sinus mucosa. No correlation was found between the degree of the patient's symptoms and the degree of the maxillary sinus pathology or the patency of the naso-antral window. CT demonstrated anterior ethmoid disease in all of the patients, correlating well with the endoscopic findings and the patient's symptoms. This again proves that the anterior ethmoid holds the key position for re-infection or cure of the larger dependent sinuses. Functional endoscopic sinus surgery therefore aims at the primary infective foci in the anterior ethmoid and usually cures disease in the larger sinuses without an attack upon the latter sinuses.

Chronic Disease↗
PubMed1986

An endoscopic study of tubal function and the diseased ethmoid sinus.

Diseases of the paranasal sinuses--especially of the anterior ethmoid sinus--may affect tubal function. Acute and chronic sinus inflammations cause alterations in the normal pathways for secretions out of the sinus system. The normal secretion pathways usually bypass the orifice of the eustachian tube in the nasopharynx. Excessive or infected mucus can then be transported directly over the tubal orifice to cause its obstruction and promote ascending infections into the middle ear. We have found that nasal endoscopy proves to be very helpful in detecting even "hidden" pathologies due to sinus disease in key areas in the middle meatus, and furthermore allows a direct visualization of the tubal orifice. Functional endoscopic surgery has also enabled us to clear diseased and stenotic areas involving the sinus ostia with minimal procedures. Normal drainage and ventilation are reestablished via the physiologic sinus ostia and thus help to normalize tubal function.

Acute Disease↗
PubMed1986

Nasal and paranasal sinus endoscopy. A diagnostic and surgical approach to recurrent sinusitis.

Our endoscopic concept of the diagnosis and surgical treatment of recurrent sinusitis is based on Messerklinger's finding that almost all infections of the frontal and maxillary sinuses are rhinogenic. They are secondary to infection foci in their prechambers in the anterior ethmoid, especially in the ethmoidal infundibulum and the frontal recess, spreading from there to the dependent larger sinuses. Consequently, our functional endoscopic sinus surgery is aimed at these infection foci in the ethmoid, clearing mucosal contact areas, stenotic clefts and diseased cells. Ventilation and drainage of frontal and maxillary sinuses are re-established via their natural routes. There is no need for fenestration via the inferior meatus. Disease in the larger sinuses then usually heals without the mucosa having actually been touched. In our experience, this leaves hardly any indication for external or more radical procedures. The technique of endoscopic diagnosis and surgery are described in detail.

Endoscopy↗
PubMed1986

Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations.

Many years of endoscopic investigation and observation proved that most infections of the paranasal sinus are rhinogenic, spreading from the nose into the sinuses. The common focus of infection in cases of recurring sinusitis is the stenotic areas of the anterior ethmoid, with infection recurring in the larger sinuses. The anterior ethmoid, especially its infundibulum, is thus a key location for infection or cure, and maxillary as well as frontal sinuses are fully dependent on the pathophysiologic conditions there. Histologic examination demonstrates that massive changes of the nasal glands are the reason for permanent mucosal thickening. Retention cysts, highly viscous mucus, mucus extravasations, and metaplastic epithelial changes add to the vicious cycle of blockage of the ostium-meatus unit.

Cilia↗
PubMed1986

Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique.

Our endoscopic endonasal surgery, under the guidance of rigid endoscopes, aims at the primary focuses in the anterior ethmoid, clearing stenotic clefts and infected ethmoidal cells of diseased mucosa. The maxillary ostium is enlarged into the anterior nasal fontanelle to provide drainage and ventilation. There is no need for any fenestration into the inferior nasal meatus. Once the ethmoidal focus is cleared, the dependent larger sinuses usually heal without having been touched--even if their mucosal pathologies seemed almost irreversible. The endoscopic procedure, which except in children is carried out under local and surface anesthesia, is described in detail. Excellent results with this method, developed by Messerklinger, indicate that there is seldom need for a Caldwell-Luc operation as the state-of-the-art procedure in chronic recurring sinusitis.

Child↗
PubMed1986

Radiological aspects of aspergillosis in the paranasal sinuses.

A retrospective radiographic study was performed on 142 proven cases of Aspergillosis in the paranasal sinuses. In all but two cases the mycosis was unilateral and in all cases the maxillary sinus was infected. A common radiographic presentation was a homogeneous opacity of the infected maxillary sinus, while about 50% of the cases showed nonspecific infectious changes of other paranasal sinuses additionally. Earlier stages of the disease showed an intraluminal soft tissue mass, representing the mycelium conglomerate. Bone destruction due to Aspergillosis could not be proven. 58% of the cases presented with intraluminal structures of metallic density. Histochemical studies proved these to consist mainly of tertiary Calciumphosphate. These concrements are considered to be pathognomonic of Aspergillosis.

Adult↗
PubMed1985

[Jugulotympanic paraganglioma].

A case is described of a jugulotympanic paraganglioma in a 64-year-old woman with extentions down the jugular vein to the clavicle and penetration of the cerebellar fossa. The symptoms, differential diagnosis, therapy and prognosis are discussed on the basis of this case report and compared with the literature. The importance of radiological investigation (e.g. selective angiography and computed tomography) in respect to diagnosis and determination of tumour size is emphasized. The diagnostic value of the immunohistochemical detection of neuron-specific enolase, a neuroendocrine cell marker and S-100 protein is stressed. The most favourable therapy, depending on tumour extension, seems to comprise preoperative embolisation, radical resection and postoperative radiotherapy.

Diagnosis, Differential↗
PubMed1985

[Metal-dense structures in the paranasal sinuses--a reliable indication of aspergillosis?].

The significance of mycotic concretions of 'metal density' in the diagnosis of aspergillosis of the paranasal sinuses has been analysed in 47 patients with this diagnosis. The incidence, types, radiological appearances and chemical composition of these very dense calcifications are discussed. Demonstration of these concretions, if metal foreign bodies and displaced dental fillings are excluded, are evidence for a mycosis of the paranasal sinuses. Absence of these dense structures does not exclude aspergillosis and was present in our clinical material in only 50% of cases.

Adult↗
PubMed1985

Aspergillosis of the paranasal sinuses.

The authors examined 105 proved cases of aspergillosis involving the paranasal sinuses or nasal fossa. Mycosis was always unilateral, and the maxillary sinus was infected in all cases. Early stages were manifested by an intraluminal soft-tissue mass representing the mass of mycelia. Fifty-nine patients (56%) demonstrated very dense intraluminal calcifications. Such dense concretions suggest the diagnosis of aspergillosis.

Adult↗
PubMed1985

[1st report on the use of an autogenous tissue adhesive in otorhinolaryngology].

An autogenous tissue glue has been developed at the ENT Department of the University Clinic Graz. It is prepared from the patient's own plasma, and has the following advantages: There is no danger of transmitting infectious diseases, there are no problems with storage, temperature and expiration date. The glue is produced at room temperature and is cheap. The production and application of this autologous tissue glue are described and a first report is given on initial experiences.

Drug Combinations↗