[Methods for surgical closure of pharyngo-cutaneous fistulas after laryngectomy].

Salivary fistulas after laryngectomy and radiotherapy can be treated with different reconstructive procedures if spontaneous closure fails to occur. In small fistulas local supraclavicular flaps are useful if not altered by radiotherapy. Larger fistulas can be closed with pectoralis major flaps.

[Pedicled and microvascular reanastomosed transplants for reconstruction in the head-neck area].

The introduction of the pectoralis major myocutaneous flap has opened up new dimensions for reconstruction following radical resection of advanced oral and pharyngeal malignancies. We report our 12-year experience with 89 patients in whom reconstruction with a pectoralis major flap was performed. The advantage of this technique is that it involves a single-stage reconstruction; moreover, the carotid artery is protected after neck dissection and soft tissue defects can be remodelled with the added bulk of the myocutaneous flap.

Computed tomography (CT) and magnetic resonance imaging (MRI) in T-stage evaluation of oral and oropharyngeal carcinomas.

174 CT and 32 MRI investigations were carried out on patients with carcinomas of the mouth and oropharynx. The methods were compared and their value in predicting the pre-therapeutic T-staging studied. The combination of CT and clinical examination was able to improve the T-staging considerably compared with clinical examination alone.

[Mucociliary activity of free transplanted respiratory epithelium].

The function of free grafted respiratory epithelium was investigated in inbred rats. In nine of ten animals it could be shown that the respiratory epithelium not only regenerated as an epithelial surface lining but also regained mucociliary activity. The grafted epithelium was able to secrete mucus, which was equal in protein fragmentation to the secretion of normal nasal mucosa.

[Reconstructions in the head and neck area using a free latissimus dorsi flap].

Deep defects of the head and neck involving different layers require plastic reconstruction with bulky flaps. We present our experience in the use of the free latissimus dorsi flap in head and neck reconstruction and point out its advantages to the pedicled latissimus dorsi flap. The latissimus dorsi flap not only is useful for conturing the head and neck but also to fill out large cavities due to operation.

[Wegener's granulomatosis: otologic and clinico-immunologic aspects].

Clinical, audiometric and immunological data of 26 patients with histological proven Wegener's granulomatosis are presented. In 21 patients the middle ear was involved with serous otitis media, adhesive process or subacute otitis media. 28 of 36 audiometric examinations showed a mild to moderate sensorineural hearing loss.

Regeneration of free grafted respiratory epithelium on severely altered lamina propria.

The lamina propria of nasal mucosa has been thought to play a key role in function and metabolism of respiratory epithelia by allowing exchange of various substances and migratory cells from blood vessels into the epithelium. Here we show that the lamina propria of mucosa transplanted to rat rectus abdominis muscle looses its typical structure and becomes vascularized connective tissue. In the subepithelial space of free grafted respiratory epithelia nasal glands, ducts and nerves degenerate and are no more detectable 3 weeks after transplantation.

Direct observation of living laryngeal carcinoma cells during invasion of healthy cell formation.

After cloning of laryngeal carcinoma cells from tumor fragments obtained during surgery, the behavior of pure tumor cells was investigated under the inverted microscope. In tissue culture flasks, separately grown tumor cell layers and fibroblast layers were cocultured to visualize the invasion of malignant cells into healthy tissue. Using a time-lapse camera, the cells were recorded.

Regeneration of respiratory epithelia in the rat after free grafting.

Following free grafting of septal mucosa from the rat to the rectus abdominis muscle, the mucosal membrane was found to degenerate into a flat squamous epithelium with loss of the majority of differentiated epithelial cells. Both the goblet cells and ciliated cells regenerated from stem cells, which appear in large numbers 2 days after transplantation. Microvilli were found initially on the surfaces of developing ciliated cells and were replaced 21 days post-grafting by cilia.

[Life saving glance diagnosis in type IIb multiple endocrine neoplasia].

Medullary carcinoma of the thyroid gland is a feature of multiple endocrine neoplasia, type IIb (MEN IIb). The cancer frequently gives rise to metastases in early life. Marfanoid habitus and virtually pathognomic mucosal ganglioneuromas, often situated on the tongue, enable early diagnosis.

Reduction of complication rate at radial forearm flap donor sites.

The radial forearm flap has become a versatile tissue transfer in head and neck surgery, especially in the reconstruction of the pharynx and oral cavity. Still, many surgeons avoid its application because of the possible donor site complications. In 29 of 51 patients who were operated between July 1987 and April 1990 at the Department of Otorhinolaryngology in Tübingen, we evaluated the function and aesthetic appearance of the radial forearm donor site after surgery.

Cellular differentiation after free grafting of respiratory epithelia.

Since there have been few investigations on the free grafting of respiratory epithelia, the aim of our present experiments was to establish whether it was possible to carry out such grafting in an animal model. Purebred strains of Lewis blood group rats were used to avoid host-versus-graft rejections of mucous membrane transferred from a donor to a recipient animal. Respiratory epithelia from the nasal septum were transplanted to the rectus abdominis muscle.

Repair of salivary fistulae after laryngectomy.

A new surgical technique is described for the repair of salivary fistulae. It has been used in three patients. The fistulae occurred after laryngectomy and had been unsuccessfully treated with local and regional flaps.

[Computerized tomography imaging of laryngocele. Its importance in the differential diagnosis of tumors of the larynx and pharynx].

The laryngocele is a dilatation of the laryngeal ventricle and represents a rare condition. In most cases there is a typical history. Patients with an internal laryngocele usually complain of hoarseness, dyspnea and cough.

Ploidy as a prognostic indicator in end stage squamous cell carcinoma of the head and neck region treated with cisplatinum.

We measured tumour cellular DNA in 102 patients entered into two phase III trials of chemotherapy for end stage squamous carcinoma of the head and neck. The median survival of untreated patients with aneuploid tumours was 55 days compared with 224 days for patients treated with cisplatinum. This difference was highly significant.

[Radial forearm flap. Its versatile application in plastic surgery reconstruction of the head and neck].

The radial forearm flap is a versatile tissue transfer in the head and neck. It can be raised either from the distal or the proximal aspect of the volar forearm, and can also include the whole volar forearm skin. The flap is ideal for reconstruction of superficial defects in the head and neck, for the pharynx and oral cavity, as well as for skin defects of the face and the neck.

[Plastic reconstruction of small defects of the soft palate using the tonsil].

The tonsil is suitable for reconstruction of small defects of the soft palate after tumour resection if pedicled at the upper pole. It can be easily sutured into the defect and yields a satisfactory functional result.

[Postoperative monitoring of a free jejunum transplant].

For postoperative monitoring of free jejunal transplants, a small hole in the skin right above the small bowel in the neck is used. The colour of the serosa yields information on the blood supply of the loop.

[The free forearm flap in covering defects of the pharynx and oral cavity].

The radial forearm flap is a versatile method for reconstruction of the pharynx and the oral cavity after tumour resection. We prefer the distal volar forearm since the flap is thin, with little subcutaneous fat. The vascular pedicle is rather long.

[Microvascular tissue transplantation of the ear, nose and throat].

Free tissue transfers are a versatile method of reconstruction in head and neck surgery. In the pharynx and oral cavity the functional result dictates the choice of flap. For these sites thin and pliant fasciocutaneous flaps are ideal tissue transfers, and we favour the radial forearm flap which is raised from the distal volar forearm.

[Chemodectoma of the larynx (2 case reports)].

We report two cases of chemodectoma of the larynx. A 70-year-old man underwent a laryngectomy in April 1984 for a tumor diagnosed as a squamous cell carcinoma but which postoperatively proved to be a chemodectoma. Ipsilateral cervical metastases appeared 2 years later and were removed by local excision.

[Radiation-induced damage to the large arteries].

The extracranial arteries of 28 irradiated patients with malignant tumors of the head and neck were examined by continous wave (CW) Dopplersonography and duplex-scan. The results were compared with those obtained from 556 healthy people of the same average age. The mean period between irradiation and examination was 7.

Early stabilization of human posture after a sudden disturbance: influence of rate and amplitude of displacement.

The functional role of short-, medium- and long-latency responses for the maintenance of upright posture was investigated in twenty healthy subjects standing on a platform which could be rotated in pitch around the subject's ankle joints. Tilting the platform toe-up evokes a stretch reflex in the triceps surae muscle (TS, latency 55-65 ms) and at higher speeds and amplitudes of platform displacement a medium-latency response (latency 108-123 ms). Both responses functionally destabilize posture, since they enforce the induced backward displacement of the body.