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Biomedical subjects

W Hosemann

Publications and source records attributed to W Hosemann.

At least 19 recordsLinked to original sources
PubMed1997

[Anatomic terminology and nomenclature for paranasal sinus surgery].

A consensus on the preferred modern usage of potentially confusing or ambiguous terms in sinus anatomy and nomenclature is described. These terms are intended to provide clear communication among otorhinolaryngologists worldwide and serve as a basis for discussion among anatomists. Terminology is based on Latin nomenclature. An attempt has been made to reconcile or eliminate duplication, redundancy, and overlap in terminology that have arisen over the past century. A key concept is that the ethmoid complex is divided into anterior and posterior sections by the basal lamella of the middle turbinate.

Ethmoid Sinus↗
PubMed1997

[Endonasal frontal sinus surgery with permanent implantation of a place holder].

BACKGROUND: Endonasal frontal sinus surgery is well established. It is not yet clear what degree of enlargement of the frontal sinus neoostium is required to achieve permanent drainage or whether stenting improves the results. PATIENTS AND METHODS: Prospective survey with two groups: Group 1. included 10 patients (15 operations) who underwent endonasal sinus surgery because of chronic polypoid sinusitis with stenting of the frontal sinus neoostium for 6 months. Group 2. included 11 patients (21 operations) without stenting. INTERVENTION: Endonasal frontal sinus surgery with extended drainage Draf Type II (NFA II according to May) with (group 1) and without (group 2) long-term stenting of the neoostium for 5 months using a silicone stent. MAIN OUTCOME MEASURE: 12-16 months postoperatively: flexible endoscopy of nose and frontal sinus; computed tomography; magnetic resonance tomography; Wilcoxon-Mann Withney-Test. RESULTS: With stenting: neoostium endoscopically patent in 80% (including 20% with edematous swelling only at the opening to the frontal sinus), occluded by scar tissue in 6.7%, occluded by polyps in 13.3%. Endoscopy and CT/MRT together: normal mucosa and aeration in 93.3%, complete opacification in 6.7%. Without stenting: neoostium endoscopically patent in 33%, occluded by scar tissue in 48%, occluded by polyps in 19%. Endoscopy and CT together: normal mucosa and aeration in 71.4%, aeration and mucosal swelling in 14.3%, complete opacification in 14.3%. With stenting of the frontal sinus neoostium for six months endoscopic evaluation of the frontal sinus was possible in a significantly higher proportion of cases (p = 0.0416). CONCLUSION: Long-term stenting of the frontal sinus significantly reduces the rate of recurrent stenosis of the frontal neoostium and is recommended in all cases where an extended frontal sinus drainage is necessary. The optimal design for such a stent has not yet been clearly defined.

Adult↗
PubMed1996

[Exposure of operating room personnel to anesthetic gases during ENT interventions].

During ENT surgical procedures under general anesthesia contamination of the operating room air through waste anesthetic gases seems unavoidable. A resulting chronic low-level exposure to anesthetic gases in subanesthetic concentrations (m1/m3 = ppm) may cause various negative health effects. The aim of this study was to quantify possible side effects on operating room personnel. By using a highly sensitive, direct reading instrument for determining contamination leakage from a patient's mouth and resulting concentrations in the breathing zone of the surgeon and anesthetist, levels of isoflurane and nitrous oxide were measured at 2-min intervals during 20 ENT surgical procedures performed under usual workplace conditions. Despite high concentrations of anesthetic at the mouth of each patient, personnel-related mean values remained under recommended threshold values (TLV) of 10 ppm isoflurane. A TLV of 100 ppm nitrous oxide was exceeded in 20% of the operations. Furthermore, a safe TLV for pregnant staff was 25 ppm nitrous oxide. This value was exceeded during nearly all operations (93%) for the group "surgeon". High leakages at the patient's mouth led to an undesirably high contamination of operating room personnel by nitrous oxide. Although threshold values were mostly not exceeded in available working conditions (i.e., adequate air conditioning and intubation cuff pressure control), present health and safety regulations concerning pregnant women showed that the values of nitrous oxide were still too high to allow such women to work safely in operating rooms during surgery. However, exposure to isoflurane was too slight to classify.

Adult↗
PubMed1996

[How traumatising is mechanical mucous membrane care after interventions on paranasal sinuses? A histological immunohistochemical study].

OBJECTIVE: Endonasal sinus surgery lead to more or less circumscribed mucosa defects exposing the underlying bone. Healing of these wounds is accompanied by crust formation, which may be subjected to mechanical debridement. It is not known whether this wound care impaires or facilitates wound healing. METHODS: Following sinus surgery, 72 crusts were removed from the operative site after having taken endoscopic photographs choosing different postoperative intervals. Mucosal biopsies were taken from beneath the crusts. All specimen were submitted to routine histological serial sections as well as immunohistochemical staining of epithelium. RESULTS: Local debridement of crusts avulsed parts of epithelium in 23% of cases during the first postoperative week. There was no histological evidence of avulsed epithelium with crusts removed the second week. This figure later increased to 16%. Possible trauma to regenerating mucosa cannot be predicted solely by the appearance of crusts. CONCLUSION: In principle, large crusts may disturb ventilation and drainage, causing secondary mucositis. Local care is mandatory in these cases. According to our examinations, mechanical debridement of wounds must respect the time-dependent irritability of the healing wound. There is little risk of impairing epithelization during the second week after surgery and the chance of sustaining the healing process is best.

Biopsy↗
PubMed1996

Endonasal endoscopic surgery for rhinogen intraorbital abscess: a report of six cases.

Intraorbital abscess is a serious complication of sinusitis with the danger of permanent loss of vision and even the danger of life-threatening progress. The recommended surgical procedure in the literature for drainage of an intraorbital abscess is the external approach. We report on successful functional endonasal endoscopic surgery in a series of six sequential cases with intraorbital abscesses following sinusitis. The main advantages of this approach are the simultaneous treatment of causative disorders with surgery following the pathogenic route of the abscess formation and lack of trauma to further structures. The endoscope with 25- or 70-degree angled axis of vision enables the surgeon to explore and drain the abscess cavity, which often is located behind the bulbus, with minimal trauma. For the trained surgeon the field of vision is favorable as compared with the external approach when the abscess is located right in the axis of vision and one has to cut through healthy tissue and the intact skin, which, especially in children, can lead to long-lasting visible scars.

Abscess↗
PubMed1996

Eicosanoids from biopsy of normal and polypous nasal mucosa.

In order to clarify the influence of inflammatory mediators of the arachidonic acid cascade in the mechanism of nasal polyp growth, peptido-leukotriene (pLT), prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) synthesis was investigated. In addition to several stimuli, functionally intact human biopsy specimens of polypous and normal tissue were incubated. Especially remarkable was the significantly increased release of pLT by polypous tissue upon arachidonic acid stimulation, in contrast to only slightly elevated PGE2 release compared to normal tissue. Basic release of pLT and PGE2 was similar for polypous and normal tissue. Examining TXB2 release, no significant difference was observed with regard to the origin of tissues. These data support an altered pattern of the lipoxygenase and cyclo-oxygenase pathways when tissue becomes irritated and suggest their involvement in the aetiopathogenesis of nasal polyps.

Biopsy↗
PubMed1994

Endoscopic endonasal dacryocystorhinostomy: results in 56 patients.

Fifty-six patients with a complete stenosis of the nasolacrimal duct were treated by endoscopically controlled intranasal dacryocystorhinostomy according to West. Forty-four patients had idiopathic stenosis and 12 had posttraumatic scarring. Revision surgery was done in 11 of these 56 cases (8 patients with a previous external Toti procedure, and 3 patients with previous endonasal surgery). Altogether, 95% of the patients were symptom-free (86%) or felt improved (9%) postoperatively. Surgical revision was successful in 82%. Of patients with an "idiopathic" stenosis, 84% were healed and an additional 11% were improved. The success rate in the 12 patients with posttraumatic stenosis was 92%. Endoscopic duct surgery is a highly successful procedure with a low complication rate, the worst complication being persistence of symptoms.

Aged↗
PubMed1993

Minimally invasive surgery in otorhinolaryngology.

Otorhinolaryngology has always strived to improve the diagnostic and therapeutic possibilities of managing afflicted organs by developing technically and conceptually new and advanced treatment techniques. The endeavor to develop methods with minimized patient discomfort during interventional surgery in the head and neck region was an essential motive which gave rise to the discipline of ENT medicine. Since fairly recently, the term "minimally invasive surgery" has become firmly established in the domain of general surgery. The possibility for replacing a substantial number of routine operations by endoscopic procedures with low levels of discomfort for the patient and shorter periods of hospitalization has given the term "minimally invasive" even further wide-ranging significance. The present review endeavors to provide an assessment of the current state-of-the-art in otorhinolaryngology, giving special attention to the historical development and pathophysiological fundamentals of this field.

Endoscopy↗
PubMed1993

[Fracture healing of the ethmoid bone--a contribution to rhinologic management of naso-ethmoid injuries].

Severe maxillofacial trauma accompanied by a dislocated ethmoidal bone fracture was confirmed by CT imaging in 15 adult patients. Routine surgical management included reduction of fractures, miniplate fixation and/or intermaxillary fixation with interosseous wiring. The fractured ethmoidal cell system was left to heal spontaneously. A follow-up examination including endoscopy of the nasal cavity as well as active anterior rhinomanometry and computed tomography was carried out approximately 24 months after surgery. The fractured ethmoidal cell system showed a clear tendency to spontaneously reventilate and drain. However, in 8 of 30 sides a traumatic obstruction of the anterior ethmoid led to secondary frontal sinus mucositis. 12 out of 30 maxillary sinuses ranged from marked mucosal swelling to the development of a traumatic mucocele. Altogether, 9 of the 15 patients suffered from paranasal sinusitis. Routine debridement of every fractured ethmoidal cell system does not appear to be necessary. In case of fractures of the anterior ethmoid with probable obstruction of the nasofrontal duct and/or maxillary sinus ostium, endonasal endoscopic surgery is recommended for minimally invasive reconstruction of the ventilation and drainage of the frontal and maxillary sinus during primary surgical management. Furthermore, patients with severe naso-orbito-ethmoidal fractures should undergo rhinological follow-up examination including CT-imaging approximately 3 months after surgery.

Adolescent↗
PubMed1993

Indications, technique and results of endonasal endoscopic ethmoidectomy.

Endoscopic ethmoid sinus surgery was introduced in Erlangen in 1976. Posterior-to-anterior ethmoidectomy under the optical control of a 70 degrees telescope with a suction-irrigation handpiece was established for treatment of chronic-diffuse hyperplastic paranasal sinusitis. This technique complements partial resections of the ethmoid. The different procedures are applied depending upon the extent of the disease. The indication for endonasal endoscopic surgery was expanded with practical experience. Diseases of the nasolacrimal duct and the frontal sinus, the frontal skull base as well as the orbita often proved to be accessible for endonasal surgery. A survey of the technical aspects of endoscopic ethmoid surgery and an introduction of the extended range of indications are presented together with the results of each procedure.

Adolescent↗
PubMed1992

[Intranasal endoscopy-controlled surgery of the frontal sinus in mucopyocele and empyema].

Twenty-six patients diagnosed as having mucopyoceles or empyemas of the frontal sinus were submitted to endoscopy-aided endonasal surgery of the anterior ethmoid and the adjacent frontal sinus between April 1989 and July 1991. Eighteen patients followed-up for a period exceeding the 3 months normally required for wound healing are presented (follow-up 3-22 months, mean 11 months). The subjective assessment of the patient was good to excellent in 16 cases. Two of these patients refused endoscopic follow-up, since they felt so well that they saw no need for it. At endoscopy, the frontal sinus was highly accessible in 5 patients, while in another 8 patients with a smaller frontal ostium it was possible to explore it adequately. Two patients in whom symptoms persisted had to be submitted to transfacial revisional surgery. An increasing percentage of patients with inflammatory frontal sinus disease can be treated by endoscopic endonasal surgery followed by thorough endoscopic aftercare.

Adult↗
PubMed1992

Selective resection of the semicircular canals of rabbits with preservation of hearing.

The goal of this investigation was to develop a method of surgical removal of the semicircular canals of the rabbit without induction of auditory impairment. Four different surgical techniques were utilized: i) fenestration of the lateral semicircular canal; ii) fibrin glue perfusion of the canal following fenestration; iii) removal of the lateral semicircular canal by drilling after fenestration and fibrin glue perfusion, and iv) removal of all three canals after fenestration and fibrin gluing. Brainstem auditory potentials were recorded repeatedly for up to 3 months after operation and demonstrated preservation of hearing in all rabbits in the first group and in 78% of the second group. In the third group the potentials could be recorded in 67% of the animals and showed a 20 dB deterioration of hearing. After removal of all three semicircular canals residual hearing could be recorded in 50% of the rabbits. These animals regularly showed a 30-40 dB deterioration of hearing. A precise microsurgical technique using fibrin glue and bone chips for interruption of the peri- and endolymph flow proved crucial for hearing preservation.

Animals↗
PubMed1992

[Resection of the semicircular canal system with preserved hearing--an animal experiment study].

In a previous investigation we selectively resected the lateral semicircular canal of the rabbit, preserving the hearing in 67% of the animals. We now report an attempt to remove all three canals in one step with a microsurgical technique using fibrin glue and bone chips. Brain-stem auditory potentials were recorded at intervals up to 3 months after operation. Residual hearing could be recorded in 50% of rabbits. These animals regularly showed a 30-40 dB deterioration of hearing.

Animals↗
PubMed1991

Normal wound healing of the paranasal sinuses: clinical and experimental investigations.

Twenty-two patients underwent partial or complete ethmoidectomies and were subjected to standardized postoperative follow-ups including endoscopic photography of healing tissues. Sequential biopsies were also taken from the regenerating mucosa and compared with endoscopic findings. On this basis wound healing could be divided into four different phases, allowing for the diagnosis of healing disturbances and clinical planning of stage-dependent therapy. Additionally, a model of wound healing in the maxillary antrum of the rabbit was developed for better understanding the clinical observations. Regeneration of standardized mucosal defects was studied with three-dimensional histomorphological analysis. Circular wounds were found to regenerate concentrically, with wound closure starting by epithelial migration. Within 120 h, granulation tissue covering the wound surface started to become hyperplastic and bone apposition occurred with the formation of osteoid. The systemic application of prednisolone (2 mg/kg per day i.m.) and topical 5% dexpanthenol ointment resulted in an acceleration of late epithelial wound closure together with a reduction in hyperplastic granulation tissue. Local applications of "epidermal growth factor" had no significant effect.

Animals↗
PubMed1991

[Endonasal, endoscopically controlled repair of dura defects of the anterior skull base].

18 patients presenting a circumscribed cerebrospinal fluid (CSF-) leak in the region of the ethmoidal roof, the olfactory cleft or the sphenoidal sinus, were operated on via the endonasal route. Dural laceration could be attributed to paranasal sinus surgery (iatrogenic CSF-leak, N = 11) and to other traumas (N = 6). In one case, no obvious cause was detectable (spontaneous CSF-leak). Using the 70-degree angular optical device, the dural lacerations were closed by autogenous grafts of conchal mucosa with the help of fibrin glue. The average time of postoperative observation was 17 months. No liquorrhoea, meningitis or cerebral abscess was observed postoperatively.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1991

[Selective resection of the lateral semicircular canal with hearing preservation--an animal experiment study].

The goal of our investigation was to develop a method for removing parts of the vestibular labyrinth by surgery without inducing a loss of auditory function. Three different surgical lesions were created in the lateral semicircular canal of the rabbit: (1) fenestration; (2) fibrin glue perfusion of the canal following fenestration; and (3) destruction of the semicircular canal by drilling after fenestration and fibrin glue perfusion. Brain-stem auditory potentials were recorded repeatedly up to 3 months after operation. They demonstrated preservation of hearing in all rabbits in the first group, in 78% of the second and 67% of the third group. In the last group a 20 dB deterioration of hearing was regularly noticed. Histological study revealed the utmost importance of the fibrin glue perfusion of the perilymph space of the semicircular canal inducing an interruption of the peri- and endolymph flow. A precise microsurgical technique was crucial for hearing preservation.

Animals↗