[Preserving the accessory nerve in neck dissection].

A total of 104 patients who had undergone neck dissection were examined with respect to disturbance of shoulder function on the operated side. The accessory nerve had been severed in half the patients and preserved in the other half. A dynamo-meter was used to measure the force a patient standing upright could exert in pulling upward with his arm outstretched.

[Juvenile ossifying fibroma of the facial skull. Computerized tomography and nuclear magnetic resonance tomography].

The clinical and radiological features in a case of a juvenile ossifying fibroma of the skull were studied with CT and MRI. The combination of both imaging modalities allows a precise prediction of tumor components and extension.

[Experiences with the augmentation of vocal cords].

Augmentation of a vocal fold serves to improve glottic closure and may be indicated for paresis of the recurrent nerve and after tumor resection. Methods include injection of viscous fluids (paraffin, liquid silicone, polyvinyl alcohol, gelatin, sesame oil, collagen and particularly teflon paste) and operations to tighten the vocal cord or displace it medially. The disadvantages of the former include the danger of overcorrection, tissue irritation and possible systemic absorption of the material.

Complications of frontal defects. Immobilization of the eye.

A case where the severe course of an orbital phlegmon led to a functionally and cosmetically poor condition is presented. Thirty-five years later, it was possible to achieve a satisfactory result through several operations performed with interdisciplinary cooperation. The orbit and forehead were reconstructed with porous polyethylene, thus ensuring a cosmetically good result.

Surgical concepts for reconstruction of the auricle. History and current state of the art.

We compiled and evaluated the world literature on auricular reconstruction, for a total of over 400 publications, more than 200 authors, and over 3,300 reported cases. We found that partial reconstructions were already performed as early as 600 BC; total reconstructions were still considered impracticable in 1830. But since 1891, more than 40 different cartilaginous, osseous, and alloplastic frame materials have been described.

Porous polyethylene in reconstructive head and neck surgery.

Porous polyethylene is a thermoplastic synthetic with a pore size ranging from about 100 micron to 200 micron. In addition to other materials, it is used for alloplastic replacement of auditory ossicles. Experimental and clinical experience in our department in recent years has shown that porous polyethylene, due to its good formability, tissue tolerance, and stability is suitable for use in reconstruction of other cartilaginous and bony structures.

[Our concept of the formation and closure of a tracheostoma].

Better functional and cosmetic results are achieved after the closure of an epithelialized tracheostomy if a method suited to the closure technique is selected when the stoma is first created. We choose a horizontal skin incision which also allows an incision running along the tension lines of the neck to be used when closing the tracheostomy. The flap from the anterior tracheal wall reported by Björk is of functional value and for closure of the stoma also.

Porous polyethylene and proplast: their behavior in a bony implant bed.

A comparative animal study showed that, after implantation in skull defects in guinea pigs, porous high-density polyethylene (PHDPE) was substantially better anchored in the bone than Proplast, and had greater stability of form and structure. In Proplast, ingrowth of fibrous tissue caused partial structural dilatation and fragmentation, which could limit its suitability for use in reconstructive surgery.

[Porous synthetic materials in external ear reconstruction].

An investigation was done on the suitability of four porous synthetic materials--Dacron, porous polyethylene, Proplast II and Teflon--for use as a framework in external ear reconstruction. For this purpose, folded implants up to 1,8 mm thick were implanted under the abdominal skin of rats to create a standing skin fold. The fibrin glue proved useful.

Closure of perforations of the septum including a single-session method for large defects.

It is the impression of the authors that, although the overall frequency of septal perforations has decreased, the proportion of large defects has increased. Therefore, in addition to the methods for surgical treatment of small perforations, a particular description is given of a new procedure in which an extramucosal technique is used, which permits closure of even large perforations in a single session. Very large defects of more than about 2 cm in diameter can be closed most reliably with a three-step procedure using a pedicled flap from the oral vestibule.