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O Kleinsasser

Publications and source records attributed to O Kleinsasser.

At least 19 recordsLinked to original sources
PubMed1999

Malignant transformation in non-irradiated juvenile laryngeal papillomatosis.

A spontaneous cancer transformation of non-irradiated juvenile papillomas has been observed in a very small number of cases. We report on six more patients with juvenile laryngeal papillomatosis developing into a squamous-cell carcinoma. Three patients had childhood papillomatosis and three patients adult onsets of their papillomas. The average duration between onset of papillomatosis and cancer diagnosis was 33 years, while the average age at time of diagnosis of a laryngeal cancer was 50 years. All patients were cigarette smokers, but none of them had received prior irradiation. The typical histological picture of tumors showed an infiltrating keratinizing squamous carcinoma besides remaining benign papillomas within the larynx. Our study again illustrates the risk of malignant transformation of juvenile papillomatosis in long-lasting cases. Therefore, regular extensive biopsies and careful histopathological examination are required. The role of smoking as a co-factor in the development of carcinoma ex-papilloma is still not clear.

Adolescent↗
PubMed1998

[Surgery in benign parotid tumors: individually adapted or standardized radical interventions?].

BACKGROUND: Several authors demand emphatically that the minimal operative procedure in benign parotid gland tumors has to be a superficial parotidectomy. MATERIAL: Of a consecutive series of 372 patients with benign parotid tumors treated in our department between 1973-1996 81% of the patients could be followed up 1-24 years. in 10.9% a total parotidectomy was performed, in 16% a lateral parotidectomy and in 73.1% a simple extirpation of the tumor (often taking away a small margin of surrounding parotid parenchyma). The operating microscope and microsurgical techniques were used in all of these operations. RESULTS: Of all the followed-up patients 2.3% developed a recurrence. There were no recurrences of cystadenolymphomas or of rare types of adenomas. Recurrences of primary treated pleomorphic adenomas occurred in 3.0%. In recurrent pleomorphic adenomas a further recurrence could be seen in 7.4% of the cases. The over-all incidence of permanent facial nerve weakness was 2.1%: 0.7% after extirpation, 3.3% after lateral parotidectomy and 9.7% after total parotidectomy. we observed in 6.3% a gustatory sweating. CONCLUSION: Our data prove that with simple extirpation similar results compared to lateral parotidectomy can be achieved concerning recurrence, function of the facial nerve and the Frey's syndrome. We suggest a surgical management adapted to the extent, the size and the location of the parotid gland tumors. In our opinion lateral or total parotidectomy should be reserved for tumors of larger amount or deep located tumors.

Adolescent↗
PubMed1997

Clinical and morphological aspects of laryngeal cysts.

To our knowledge only a few defined studies have been carried out on laryngeal cysts. These cysts represent a mixed group of benign laryngeal lesions that can cause diagnostic and therapeutic difficulties. The aim of this study was to characterize their histological structure and localizations in the larynx as well as to discuss theories about their genesis. Between 1973 and 1996, 342 laryngeal cysts were treated at Phillips University of Marburg, while from 1990 to 1996, 74 were treated at Justus Liebig University of Giessen. In all, 416 laryngeal cysts were treated by endolaryngeal microsurgery. All clinical charts were reviewed retrospectively and surgical specimens examined histomorphologically. Findings showed that 58.2% of the laryngeal cysts were located in the glottic area and 18.3% in the ventricular folds. The remainder were located on the aryepiglottic fold (2.2%) and interarythenoid region (0.7%). Two congenital cysts were also treated. Approximately 56% of the laryngeal cysts were lined by squamous cell epithelium, 37% by respiratory epithelium and 7% by oncocytic epithelium. In general, the laryngeal cysts were found to be a collection of inhomogenous lesions from different histogenetic origins with diverse symptoms related to their site and size. On the basis of our investigations, a new classification was established concerning the genesis and development of laryngeal cysts by subdividing cysts into congenital cysts, retention cysts, and inclusion cysts.

Adolescent↗
PubMed1996

Preformation of microvascular composite free flaps in the rat as an animal model.

For optimal reconstruction of large defects after tumor surgery of the head and neck, composite flaps may be necessary. We describe the design of microsurgically reanastomosed composite skin flaps, using porous polyethylene or titanium implants as a "back side" in an animal model. The epigastric skin of 48 healthy adult Wistar rats was prepared for the subdermal insertion of porous polyethylene implants (pore size: 100-200 microns) and titanium mesh implants having different forms and sizes. Two to 6 weeks after this procedure the flaps were lifted, transposed to the other side and the epigastric vessels were reanastomosed microsurgically. Eighty-three per cent of the skin flaps containing the titanium implants survived when the transplantation occurred 2 weeks after insertion of the implants. Concurrently all flaps with the implanted porous polyethylene (1 mm thick) showed signs of skin necrosis. Survival of the polyethylene loaded flaps improved to 50% when the flaps were left 4 weeks at the donor site. The influence of the implant form on the survival of the flaps was investigated with different implant shapes with flap necrosis being greatest when concave implants were used. Histopathological evaluation of the titanium flaps showed a thin capsule around the implants and a minimal inflammatory reaction. All porous polyethylene implants resulted in a pronounced chronic infection. Transplantation of flaps containing perforated metals (such as the titanium mesh) was possible 2 weeks after insertion of the implant, whereas neovascularization of flaps with porous material required more than 4 weeks growth in situ to ensure at least a 50% viability of the skin. An advantage of the metal implants is the possibility of its use in correcting form by modelling.

Animals↗
PubMed1996

[Intubation damage to the larynx. Manifestations, comments on pathogenesis, treatment and prevention].

BACKGROUND: A variety of lesions can be seen in the larynx subsequent to an intubation anaesthesia or treatment with a respirator. The larynx may already be injured by introducing an endotracheal tube. The inserted tube must necessarily chafe the laryngeal mucosa. Many studies are concerned with individual manifestations [5-10,14,16,17,20]. The following article gives an overview of the intubation lesions of the larynx observed by us and offers comments on pathogenesis and prevention. PATIENTS: 161 patients with severe lesions subsequent to an intubation or treatment with a respirator were seen at the ENT Department of the University of Marburg Hospital from 1973 to 1995. TYPES OF LESIONS CAUSED BY INTUBATION: Basing on the pathomechanisms, we can classify the lesions as follows: inflammatory reactions, lesions of the larynx caused during intubation, lesions caused by chafing by the tube or by the sealing sleeve. CONCLUSIONS: Considering the large number of performed intubations, lesions of the larynx occur rarely. However, in view of the possible sequels, it would be advisable if an experienced laryngologist would perform a careful endoscopic examination of the larynx and trachea at least after every forced or prolonged intubation and especially after every treatment with a respirator.

Adolescent↗
PubMed1996

[The pT-classification of primary vocal cord carcinomas and its significance for T-classification].

Since the pretherapeutic T and pT classification of vocal cord cancer according to the UICC has often been found to fail in a high percentage of cases, frequently resulting in an insufficient separation of the different T categories, the pT classification proposed by Glanz was applied in order to obtain a more exact and better reproducible pretreatment system. In a histopathological investigation of 223 previously untreated carcinomas of the vocal cord dating from 1978 to 1988, specimens from total and partial laryngectomies were examined by subserial sectionings. The extension of each lesion was ascertained by measuring tumor in three dimensions per millimeter and determining affected histopathological structures. Neck lymph nodes were also examined for metastases. The different tumor stages were then evaluated with the UICC T/pT classification of Glanz's pT classification. The survival rates and recurrence-free rates of both classification systems were compared. Our evaluation showed that 24% of all the vocal cord cancers studied had to be classified to a higher tumor stage. The pT classification developed by Glanz was better able to separate the different tumor categories than the UICC T/pT classification. Glanz's pT classification system, staging a glottic cancer according to its exact size and laryngeal structures involved, is a significant improvement on the UICC T and pT classification used to date.

Adult↗
PubMed1994

[Prognostic significance of extra-capsular invasion in cervical lymph node metastases of squamous epithelial carcinoma].

In a retrospective study we evaluated the clinical and histological datas of patients with squamous cell carcinomas of the head and neck to determine the influence of extranodal spread in metastases for the prognosis. Lymph nodes were dissected from the neck dissection specimens and investigated histologically with special regard to extranodal spread. 304 patients (58%) showed positive lymph nodes and 212 of this patients had additionally extranodal spread (70%). Hence, the rate of extranodal spread in the whole investigated group (522 patients) was 40%. For the patients with carcinomas of the hypopharynx the rate of extranodal spread was especially high (70%). Most extranodal spread could be found at levels 2, 3 and 4. We found a correlation between the appearance of extranodal spread and increasing T-stage. 5-year survival rates were greatly different for patients with no metastases (77%) and patients with extranodal spread (28%). We discuss the use of the criteria extranodal spread for the planning of adjuvant chemotherapy.

Carcinoma, Squamous Cell↗
PubMed1993

Benign keratoma of the vocal cords.

Benign keratomas are true benign tumors of the vocal cords that are to be differentiated clinically and histologically from malignant, inflammatory and reactive lesions which may also result in superficial keratinization. Clinically, keratomas present as flat, warty or papillary lesions with varying keratinization surrounded by a normal-appearing ("healthy") epithelium. They are usually unilateral, with their extents varying from 2 to 3 mm in diameter to tumors occupying the entire vocal cord. Histology shows grade I or grade II epithelial hyperplasia without any signs of inflammation. In the present study 61 patients with benign keratomas were treated by excisional biopsies alone. Fifty-seven patients were followed for a minimum of 7 months and a maximum of 16.5 years. Two patients developed recurrent keratomas. To date none of the patients has developed an invasive vocal cord carcinoma or a carcinoma in situ.

Adult↗
PubMed1993

Growth and spread of squamous cell carcinoma of the floor of the mouth.

Forty-eight specimens of carcinoma of the floor of the mouth were analyzed histologically by step serial sections. Five tumors were so-called superficial spreading carcinomas with large fields of cancerous mucosa, while 43 specimens showed advanced vertical growth into adjacent structures. Three different routes of invasion could be defined. The region of the sublingual gland was the main pathway in 23 cases. The space between the intrinsic muscles of the tongue and the genioglossus muscle was the main direction of infiltration for 14 tumors. Only 6 specimens showed direct invasion into the intrinsic tongue muscles. There was a good correlation between tumor thickness and the occurrence of metastases. Twenty-six patients (54%) showed metastases in regional lymph nodes and 13 patients with submandibular metastases already had developed metastases along the jugular vein. Unilateral or bilateral functional neck dissections remained the standard treatment procedure for all cases with depths of invasion over 5 mm. To avoid local tumor recurrences, patterns of invasion have to be considered. Soft tissue structures like the sublingual gland, intrinsic tongue muscles, genioglossus muscle and geniohyoid muscle have to be resected routinely. Management of the mandible should be conservative if radiological and clinical investigations are negative.

Carcinoma, Squamous Cell↗
PubMed1993

[Temporary sagittal mandibulotomy as an approach to the pterygopalatine fossa, the parapharyngeal space and the oropharynx].

Standard procedures for temporary mandibulotomy are medial or the lateral osteotomy. Median mandibulotomy is associated with destruction of anatomical structures in the floor of the mouth and with lateral osteotomy no preservation of the nervus alveolaris inferior is possible. Therefore, a modification of mandibulotomy is described with wide-field exposure, minimal functional defects and reduction of osteotomy-related complications. The first osteotomy is carried out vertically before the foramen mentale on the buccal compacta of the mandible. A second vertical osteotomy is placed on the lingual compacta posterior to the musculus myohyoideus. Horizontal osteotomies on the alveolar ridge and the basal ridge of the mandible are connected with the vertical osteotomies. Using a chisel, the lingual and the buccal part of the mandible are split sagittally with preservation of the nervus alveolaris inferior located in the buccal fragment of the mandible. The two parts of the mandible are divided to provide access to the oropharynx. Surgical approach to the fossa pterygopalatina and the parapharyngeal space is reached with dissection of the mucosa along the ascending mandible, subluxation in the mandibular joint and reflection of the mandible cranially and posteriorly. The wide access offers a lot of advantages especially in combination with a microvascular flap reconstruction. Fixation of the mandible is carried out with two titanium miniplates at the anterior vertical osteotomy. The wide areas of the split bone marrow, resulting from sagittal splitting, achieved an exact adaptation of the mandibular parts and an easy and sure fixation via miniplates. Therefore, post-operative radiation therapy can be started two weeks after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗
PubMed1993

[Further development in TNM classification of laryngeal cancers].

To prepare an improved TN classification of laryngeal carcinomas, a great number of serial sections of laryngeal cancers and neck dissection specimens has been investigated and corresponding studies of clinical relevance were performed. Our proposals have been accepted in the 1993 supplement of the TNM-UICC classification and will be tested within the frame of so-called ramification studies. The authors propose that the T-category of laryngeal carcinomas should no longer be determined by anatomical areas of different sizes, but by millimetres only (up to 15 mm T1, 15-25 mm T2 a, 25 mm and more without impaired mobility T2 b, to impaired mobility or fixation of vocal cords T3, or T4 if the tumour extends beyond the larynx. The pT categories correspond to the T categories. A histological depth of or less than 5 mm is pT 1 or 2. It is proposed that the differentiation into glottic and subglottic tumours of the larynx should be abandoned. In lymph node metastases, the size, number, level and extranodular spread are considered. N1 and N2 are metastases in the upper two thirds of the neck without fixation (extranodal spread). N1 are one or two ipsilateral metastases of 2 cm or less in diameter, N2 are metastases of more than 2 cm diameter or bilateral metastases. N3 are fixed metastases or metastases in the lower third of the neck. Our proposals are presented in tables, ramification tables, conversion tables and a documentation sheet.

Humans↗
PubMed1992

Revision of classification of laryngeal cancer, is it long overdue? (Proposals for an improved TN-classification).

The TNM-classification of laryngeal carcinomas of the UICC contains a number of weaknesses which diminish their prognostic relevance. Based on clinical observations and microscopic investigations of surgical specimens, several changes are proposed to improve the existing TN-classification. The larynx is subdivided by the UICC into the supraglottic, the glottic and the subglottic main area and their tumours. There are embryological, anatomical, functional and oncological reasons to divide the larynx into two main areas only--the supraglottis and the glottis (vocal folds) without any further subsites and to abandon a separate group of subglottic tumours. The T size of a tumour should not be assessed according to the extent of an ill-defined anatomical region, but measured in millimetres of greatest surface extent only. The T2 category of vocal fold tumours should not contain those which lead to an inhibited mobility of the fold. All tumours with reduced vocal fold mobility or fixation should be classified as T3 or T4 according to the dimension of invasion. Post-operative pathological examinations (pT/pN) allow an assessment of the true extent of a tumour in three dimensions. A validation study using a 'metric' TpT-classification shows very distinct groups of tumours with a significantly different prognosis from Tis 1 to T4. Studies of lymph node metastases in the neck have shown that, number, size, site of metastasis and the presence of extracapsular tumour spread have a significant influence on the prognosis. An improved N/pN-classification taking these factors in consideration is proposed.

Carcinoma in Situ↗
PubMed1992

[Treatment and treatment results of mouth floor cancers].

The records of 68 patients with cancer of the floor of the mouth were reviewed. 56 patients underwent surgical management, 51 of them got additionally postoperative radiation. The tumour-specific five years' survival for patients with operation was 46%, 57% of treatment failures developed from local recurrence of the tumour. In 52% of all cases there was a spread to the lymphatic system in the histological evaluation. There was high incidence of false negative clinical examinations of the neck. Conservative neck dissection was the procedure of choice for clinically positive lymph nodes and for the elective management of the neck. Only advanced tumours showed involvement of the mandibular bone. Therefore a conservative management of mandibular resection was preferred. Radical tumour extirpation and histological controlling with serial sectioned specimens are methods of avoiding local tumour recurrence.

Carcinoma, Squamous Cell↗
PubMed1991

Preinvasive stages of adenocarcinoma of the nose after exposure to wood dust.

The early stages of adenocarcinoma of the nose due to exposure to beech and oak wood dust show superficial preinvasive growth. The papillary and tubular structures of this "adenocarcinoma in situ" are identical with those of invasive adenocarcinomas. There are no indications that cuboid or squamous metaplasia precedes the development of this type of carcinoma.

Adenocarcinoma↗