[A 28-year-old patient with hepatitis, parotid gland swelling, facial paralysis and conjunctivitis].
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Adult↗
Biomedical subjects
W Draf
Publications and source records attributed to W Draf.
[Simultaneous occurrence of an acoustic neurinoma and a glomus tympanicum tumor in a patient. An unusual constellation and problematic surgical task].
We present the case of a 65-year-old woman who was found to have a concurrent ipsilateral acoustic neuroma and glomus tympanicum tumor. Both tumors were removed in one operation. The acoustic neuroma was removed via the translabyrinthine approach because of preoperative deafness while the glomus tumor was found only during the operation to remove the neuroma. A preoperative biopsy was not associated with significant bleeding while microscopic examination of the biopsy tissue indicated only chronic infection.
Aged↗
Surgical management of midfacial fractures.
A brief overview has been given about types, diagnostics and therapy of midfacial fractures. The ENT-surgeon should play an important and active role in the treatment. In extended cases interdisciplinary cooperation will give better results.
Frontal Sinus↗
[Esophagotracheal fistula of the cervico-thoracic area--problem solution using a combined trans-cervical and transthoracic approach].
Closure of oesophagotracheal fistulae in the cervicothoracic region using a cervical approach often fails. We report a patient with carcinoma of the larynx who underwent pharyngolaryngectomy, postoperative radiotherapy and several operations for reconstruction of the hypopharynx and cervical oesophagus elsewhere. Finally we were asked to close an oesophagotracheal fistula in the cervicothoracic region. We were successful using a pectoralis major muscle flap via a combined transcervical-transthoracal approach. This interdisciplinary procedure seems to be the method of choice in difficult cases of achieving safe closure of fistulae in this region.
Humans↗
[Bilateral Gradenigo syndrome--on the value of an integrated therapy concept including hyperbaric oxygenation and chronic destructive inflammation of the skull base].
The case of a 30-year-old female with bilateral Gradenigo's syndrome is presented in order to detail commonly applied therapy. In particular, the importance of a comprehensive therapeutic approach is emphasized that includes such adjuvant therapeutic options as hyperbaric oxygenation and the administration of specific immunoglobulins. Indications, therapeutic benefits and limitations of treatment modalities are discussed in relationship to current concepts of therapy.
Adult↗
[Complications of endonasal micro-endoscopic ethmoid bone operation].
We examined the frequency and site of major complications after intranasal micro-endoscopic ethmoidectomy. Injury of the orbital periostium was significantly more frequent on the right than on the left side, but there was no side predominance for damage to the dura mater. Surgery on the lamina papyracea and the lateral wall of the sphenoid sinus is more dangerous on the side on which the surgeon stands during the operation. The use of the microscope, the endoscope and preoperative CT scan of the paranasal sinuses helps to avoid major complications.
Carotid Artery Injuries↗
[Parotidectomy: functional and esthetic results].
We report a retrospective study of 154 patients after parotidectomy. The patients were examined immediately and on average about 40 months after the operation. The emphasis of the examination was to assess both functional as well as aesthetic results. The function of the facial nerve was evaluated by Stennert's score. We found a median score of 20% 3.3 days after operation. The late postoperative results (34.3 months after operation) indicated that 91% of the patients had no paresis. There was no significant difference between superficial parotidectomy and total parotidectomy in regard to the aesthetic result. The decision for partial or total parotidectomy should be based exclusively on pathological and oncological considerations.
Aged↗
[Synopsis of TNM classifications in the head and neck area].
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Head and Neck Neoplasms↗
[Systematic indications of various free transfer flaps in the area of the head and neck].
Many microsurgical free flaps have been described to tackle various problems in the head and neck. The authors present a system of indications which has proved to be suitable as judged by the functional and cosmetic results obtained. The harvesting of these flaps requires versatile training in surgical techniques for the different anatomical areas. This system of indications comprises the free fasciocutaneous forearm flap, jejunal loops, the fasciocutaneous parascapular flap, iliac crest flaps with vascularized bone and the parascapular cutaneous, latissimus dorsi osteomyocutaneous double flap.
Bone Transplantation↗
Lip reconstruction with Meyer-plasty: a universal procedure?
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Carcinoma, Squamous Cell↗
[Facial injuries caused by dog bites in childhood. Clinical staging, therapy and prevention].
Dog bite injuries are a frequent cause of facial injuries in childhood. Between 1986 and 1990 we treated 16 children with facial dog bite injuries. Based on these experiences we suggest a clinical classification, corresponding therapeutic rules and prophylactic possibilities, summarized according to the literature. It is our aim to establish guidelines for the physician concerned with the therapy of these injuries, and advice to involved families.
Animals↗
[Surgical treatment of malignant tumors of the paranasal sinuses with involvement of the base of the skull].
After 18 years of close cooperation between ORL and neurosurgery in the treatment of the base of the skull, the authors present their surgical conception and technique for the treatment of malignant tumors of the paranasal sinuses involving the base of the skull. Three basically different surgical procedures are possible: 1. Extracranial partial resection of the anterior base of the skull sparing the contents of the orbit. 2. Radical revision of superior maxilla, ethmoid bone, and base of the skull including exenteratio orbitae. 3. Combined intra-extracranial approach. An interdisciplinary cooperation and the combination of macro- and microsurgery will be more successful with respect to survival chances, functional and esthetic results.
Adenocarcinoma↗
Surgical rehabilitation of facial nerve.
The management of facial nerve lesions using microsurgical techniques should be part of the armamentarium of surgeons managing head and neck problems. One has to differentiate between techniques for repair of the nerve itself and secondary reconstructive operations. Direct nerve reconstruction, indirect nerve reconstruction and combined procedures are discussed in detail. Secondary reconstructive methods are indicated if repair of the nerve itself is not possible. The results of 31 cases of facial nerve rehabilitation are presented.
Adolescent↗
[Yaws: a rare case of an "invasively growing" tumor of the maxillary sinus].
Yaws is a treponematosis which is rare in Europe. Tertiary stages may present with tumor-like lesions predominantly in the face. These manifestations are called rhinopharyngitis mutilans and goundou. A 40-year-old woman with goundou is presented.
Adult↗
[Surgical treatment of the lacrimal apparatus--technics and results].
After a short review of anatomy the clinical and radiological diagnosis of stenoses of the lacrimal duct system are discussed in detail. Microcatheterdacryocystography and high resolution CT are very important in determining the indications for surgery. Microsurgical endonasal dacryocystorhinostomy is preferred for treatment of postsaccal stenoses. It is also the method of choice for one stage definitive therapy of acute lacrimal sac empyema. Surgical reconstruction in cases of presaccal stenoses is difficult and should be handled individually. For intubation of the canaliculi we have developed a special modified pigtail-hollow-probe (Draf-Haag 1981), which reduces damage to the epithelium. If reconstruction of the natural lacrimal duct system is not possible, a conjunctivorhinostomy by Walter's technique is indicated. The different surgical concepts and results are discussed.
Catheters, Indwelling↗
[Laterocaudal approaches to the clivus].
The different lateral approaches to the skull base (including the clivus) are subsumed under the term infero-lateral approaches, and include: 1. The cervical approach. 2. The direct lateral approach. 3. The postero-inferior approach. Indications and technical details are discussed, and a few examples are demonstrated. The inclusion of microsurgery improves the results as regards survival, function and esthetics. Reconstructive surgery must be included in the rehabilitation of these difficult surgical problems. In special cases this problem can be better solved by co-operation between ENT and neurosurgeons.
Adult↗
[Oncosurgical treatment principles in basalioma and spinocellular carcinoma of the facial skin].
The concept for surgical removal of facial skin neoplasms consists of three components: Sufficient preoperative clinical diagnosis; complete tumor removal; Adequate functional and esthetic reconstruction. For achieving proper diagnosis the collaboration with the dermatologist is highly recommended. The ENT examining microscope allows for better visualisation of structural characteristics. Excisional biopsy should be preferred whenever possible. Out of 97 basal cell carcinomas 25% secondary or thirdly neoplasms have been found. In 81 basal cell carcinomas the visible extent, the real tumor extent in the specimen after fixation and the total excisional area are compared. According to these measurements the following safety margins seem to be recommendable: For small solid or solid-cystic superficial basal cell carcinomas 3-5 mm, for the sclerodermiform or partially undifferentiated basal cell carcinoma 10-20 mm and for basal cell carcinomas involving the bone more than 20 mm. Excising a spinocellular carcinoma a safety margin of at least half of the maximal diameter has proved to be sufficient. The close collaboration with the histopathologist resulted in our department in a simplified economic and safe microscopically controlled excision. The rate of recurrences of 97 basal cell carcinomas was 6.6%. The question of prophylactic lymph-node dissection in combination with the excision of spinocellular carcinomas is discussed.
Carcinoma in Situ↗
[Tuberculosis of the head, neck and ear--a rare disease?].
Between 1980 and 1984 we treated 9 patients with tuberculosis of the lymph nodes, middle ear, parotid gland, larynx and sphenoid sinus. Diagnosis is difficult because of the unusual courses of the disease, the special pathways of infection and because tuberculosis is rarely suspected as the diagnosis. The importance of a combined conservative-surgical therapy is stressed.
Adolescent↗