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Biomedical subjects

W Thumfart

Publications and source records attributed to W Thumfart.

At least 19 recordsLinked to original sources
PubMed2000

Transoral laser surgery for early glottic carcinoma.

This prospective study evaluates the oncological results of transoral laser surgery (TLS) for glottic carcinoma categorized Tis, T1 and T2 in a large, unselected group of 285 consecutive patients from a university-based referral center that uses transoral laser surgery as the standard approach to these tumors. Patients were treated between 1 January 1987 and 31 December 1996. Thirty-three patients had Tis disease, 174 T1 tumors and 113 T2. Main outcome measures were local control with initial therapy, ultimate local control, regional control, organ preservation, overall survival and cause-specific survival. The 5-year uncorrected actuarial survival for all 285 patients was 71.1%, and cause-specific actuarial survival was 98.7%. Local control with initial treatment was 85.9%, ultimate local control with salvage for local treatment failures 98.5%, and regional control 98.4%. In all, 94.3% had their larynges preserved after 5 years. Although favorable oncological results for early laryngeal carcinoma treated with laser surgery are supported this study, no definitive recommendations can be given for the best single treatment. Partial laryngectomies lead to the highest local control rates reported so far, radiotherapy is believed to preserve voice best and laser surgery is associated with time- and cost-effectiveness, low morbidity, fair local control rates and excellent re-treatment options in case of local failure. All specialists dealing with the treatment of early glottic carcinoma should be able to offer these different treatment modalities to their patients and to deal specifically with each patient's individual needs and preferences.

Carcinoma, Squamous Cell↗
PubMed2000

Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society.

The European Laryngological Society is proposing a classification of different laryngeal endoscopic cordectomies in order to ensure better definitions of post-operative results. We chose to keep the word "cordectomy" even for partial resections because it is the term most often used in the surgical literature. The classification comprises eight types of cordectomies: a subepithelial cordectomy (type I), which is resection of the epithelium; a subligamental cordectomy (type II), which is a resection of the epithelium, Reinke's space and vocal ligament; transmuscular cordectomy (type III), which proceeds through the vocalis muscle; total cordectomy (type IV); extended cordectomy, which encompasses the contralateral vocal fold and the anterior commissure (type Va); extended cordectomy, which includes the arytenoid (type Vb); extended cordectomy, which encompasses the subglottis (type Vc); and extended cordectomy, which includes the ventricle (type Vd). Indications for performing those cordectomies may vary from surgeon to surgeon. The operations are classified according to the surgical approach used and the degree of resection in order to facilitate use of the classification in daily practice. Each surgical procedure ensures that a specimen is available for histopathological examination.

Glottis↗
PubMed1999

One-stage reconstruction of defects in the hypopharyngeal region with free flaps.

Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula formations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive oncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lining, a satisfactory covering of cervical soft-tissue, and adequate functional rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flaps in the reconstruction of combined hypopharyngeal, cervico-oesophageal, and cervical skin defects.

Adult↗
PubMed1997

[Indications, technic and results following Sedlacek-Kambic-Tucker reconstructive partial resection of the larynx].

Management of laryngeal carcinoma located at the anterior commissure remains controversial. Local control rates with radiotherapy or surgery are not as good as those seen after treatment of midcord lesions. The vertical partial laryngectomy with epiglottic reconstruction (VPLER) may be a more successful approach to such lesions. The charts of all patients treated for larynx carcinoma between 1991 and 1996 at the authors' institutions were reviewed to identify those patients treated with VPLER as described by Sedlacek in 1965, Kambic in 1976 and Tucker in 1979. Indications for performing surgery and outcome data of patients were collected and analyzed according to the indications for surgery, surgical technique, perioperative complications, oncological outcomes and functional results. Twelve patients were identified that had been treated with VPLER. Indications for surgery included five patients with local recurrences following endoscopic laser partial laryngectomies, four cases with previously untreated primary tumors at the anterior commissure (T2 N0-2 M0), two with local recurrences following radiotherapy, and one with recurrence following frontolateral partial laryngectomy. There were no postoperative complications except for one laryngocutaneous fistula that required secondary repair. All patients were able to swallow at the tenth postoperative day. All had their tracheostomies closed after completion of wound healing, (a mean of 17 days after surgery). Phonatory results were usually poor. Two local recurrences occurred during the follow-up period. However, both patients were salvaged with total laryngectomies and have since been free from disease. All other patients are alive and well. Our findings show that VPLER is an effective surgical approach for carcinoma at the anterior commissure of the larynx that cannot be adequately managed with transoral laser surgery or simple frontolateral partial laryngectomy. This study demonstrates that the procedure can be successfully applied to the treatment of local recurrences following initial radiotherapy or surgery. No major complications occurred in our study.

Adult↗
PubMed1995

Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma.

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.

Adult↗
PubMed1993

Radical removal of a large glossopharyngeal neurinoma with preservation of cranial nerve functions.

A 51-year-old man is reported who was suffering from an extensive right-sided glossopharyngeal neurinoma (4.6 x 3.4 cm). The patient was admitted with a history of headache for six to seven years and vomiting for two years accompanied by a progressive hearing loss, tinnitus and dizziness during the last year. Audiometry indicated a perceptive deafness in the whole frequency range up to 70 dB HL, while electronystagmography (ENG) showed a loss of vestibular function of the right side, but there were no signs of a jugular foramen syndrome. Magnetic resonance imaging (MRI) revealed a large tumor portion in the right cerebello-pontine angle with only a small part in the jugular foramen. The neurinoma was completely removed by microsurgery through a suboccipital approach with preservation of nerves VII-XII. The postoperative course was uneventful and normal function of facial and caudal cranial nerves (Nn IX-XII) were proven by electromyography and magnetic stimulation, with exception of a transitory hypesthesia in the palatine region which completely normalized within a few months. The right-sided hearing loss was unchanged, but vertigo improved. In comparison with literature review the lack of temporary or permanent postoperative dysfunctions of caudal cranial nerves as well as of the facial nerve was extraordinary in the reported case.

Audiometry, Pure-Tone↗
PubMed1986

[Penetration behavior of mezlocillin in chronic polypous inflamed mucosa of the paranasal sinuses].

Recent investigations have shown that conservative treatment of chronic sinusitis, especially with polypi in the nasal cavity and in the paranasal sinuses, is not as successful as in acute inflammation. Surgical intervention to remove the diseased mucosa is necessary. The newly developed more conservative endonasal techniques may nevertheless allow spread of the pathogenic bacteria during surgery. Mezlocillin has a broad spectrum against both aerobic and anaerobic micro-organisms: its penetration into the hyperplastic mucosa of the chronically diseased maxillary sinus was therefore investigated. In 15 patients with chronic sinusitis a 5 g bolus injection of mezlocillin was given half an hour before the operation. Two more doses of the antibiotic were given 6 and 12 h afterwards. The specimens investigated were blood taken before the injection of mezlocillin, and blood and tissue taken by the endoscopic endonasal techniques innovated by Wigand (1977) between 30 and 120 min after the start of the operation. The concentration of mezlocillin was determined by bioassay using Bacillus subtilis ATCC 6633 as indicator organisms. The results were compared with the minimal inhibitory concentration of bacteria usually found in chronic maxillary sinusitis. The results showed that mezlocillin may be of value in chronic paranasal infections in the conservative treatment of complications of sinus infections, especially if surgery is contraindicated because the patient is a high anaesthetic risk.

Humans↗
PubMed1984

[Electrodiagnosis of caudal cranial nerve disorders in infants and small children].

The endoscopic application of electrodes for electromyography of laryngeal and pharyngeal muscles is routinely performed in adults and very helpful in electrodiagnosis of voice and speech disturbances. Dysfunctions of the lower cranial nerves in infancy and childhood are congenital diseases in most of the cases. Up to now the most helpful diagnostic tool has been direct laryngoscopy which, however, could not classify the type of peripheral or central neural or even muscular disease. It is only by electrophysiological methods that the laryngologist can answer these questions. Electromyography and neuromyography as well as reflex myography of the lower cranial nerves have been performed in ten children since 1979, enabling diagnosis and classification of congenital and acquired lesions in the muscles of tongue, soft palate, pharynx and larynx. In particular accurate diagnosis of laryngeal malacia with intact peripheral innervation and voluntary activity during electromyography is always possible. In addition, the method is helpful in the planning of therapy which consists in either conservative or surgical treatment.

Adolescent↗
PubMed1983

Electromyography in rhinoplasty.

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.

Electric Stimulation↗