Benedikt J. Folz

Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery.

Objectives/Hypothesis Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. New short‐acting anesthetics such as propofol and remifentanil allow exact control of intraoperative blood pressure and thus might be valuable tools to improve intraoperative conditions for the otorhinolaryngological surgeon. Intravenous anesthesia was compared with traditional balanced anesthesia by subjective assessment of surgical conditions made by two experienced otorhinolaryngological surgeons.

Ultrasound-guided interstitial Nd:YAG laser treatment of voluminous hemangiomas and vascular malformations in 92 patients

In many cases voluminous vascular anomalies of the head and neck region are still treated with conventional surgery, although neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser therapy offers a valuable treatment alternative. Ninety‐two patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy (power density, 1300 to 3300 W/cm2), partly complemented by a noncontact‐mode Nd:YAG laser light application (energy density, 1000 to 2500 J/cm2). The vascular tumors had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients (n = 55) showed a complete clinical regression. Thirty‐three patients (35.8%) had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser, and three of them subsequently underwent conventional surgery. Only nine of the 92 patients (9.8%) showed cosmetic or functional impairments. The results of this first consecutive series study with a retrospective clinical evaluation of the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrate a high effectiveness of this novel therapy modality.

p53 serum antibodies as prognostic indicator in head and neck cancer

Abstract p53 antibodies are a new serological parameter of unknown potential in patients with malignancies. Their occurrence has been described in various types of cancer patients. The mechanism underlying the immunization process is still unclear. We investigated the incidence of p53 serum antibodies in 143 head and neck cancer patients with an enzyme-linked immunosorbent assay. The post-therapy course of two matched study groups (n = 38 each), one p53-antibody-seropositive and one p53-antibody-seronegative, was followed up for 24 months. Thirty-nine head and neck cancer patients (27.3%) were seropositive for p53 antibodies. During the follow-up, the p53-antibody-seropositive patients accounted for more local tumor recurrences (n = 12 versus n = 8) and more tumor-related deaths (n = 11 versus n = 5) than did seronegative patients, and second primary tumors (n = 9 versus n = 0) occurred exclusively in seropositive patients. In total, therapy failures (recurrences, tumor-related deaths, second primaries) were observed in 17/38 cases (44.7%) in the p53-antibody-seropositive group and in 8/38 cases (21.1%) in the p53-antibody-seronegative group. These results, after a follow-up of 2 years, seem to indicate a prognostic value of p53 serum antibodies for therapy failure in patients with head and neck cancer.

Anti‐emetic prophylaxis with oral tropisetron and/or dexamethasone

Background  The corticosteroid dexamethasone and the serotonine3‐antagonist tropisetron are both effective drugs for the prophylaxis of post‐operative nausea and vomiting (PONV) when given intravenously. The aim of this trial was to evaluate the oral use of both drugs as part of a routine oral premedication and to compare their single and combined effectiveness.

Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser.

The hypopharyngeal (Zenkers) diverticulum is a herniation of mucosa and submucosa on the posterior wall of the pharynx. The only treatment is surgical.

Differentially Expressed Genes in Head and Neck Cancer

Carcinogenesis is considered a multistep process. To further elucidate involved genetic changes, the differential display method was applied to compare gene expression of head and neck carcinoma cells and normal keratinocytes from the upper aerodigestive tract. Total RNA was extracted from cultured squamous carcinoma cells and keratinocytes. mRNA was reverse transcribed into cDNA, amplified by PCR, and separated on a gel. Currently three DNA transcripts were identified with a length of 191 to 336 base pairs (bp) that were either expressed only by the keratinocytes or by the malignant cells. Differentially expressed DNA fragments of the carcinoma cells and the keratinocytes were cloned and sequenced. A gene bank database search identified one fragment expressed by the carcinoma cells as an unknown gene, another one found in the keratinocytes as probably a part of the human cell attachment domain, and the third one with homology to the mRNA of the human epidermal growth factor receptor (EGFR). Northern blot analysis confirmed the differential expression in the malignant cells or the keratinocytes. Differential display seems to confirm the well‐known overexpression and up‐regulation of the EGFR, the differential expression of the cell attachment domain may play a role as a cofactor in carcinogenesis of head and neck cancer, and the third unknown fragment is still under investigation to elucidate the role in carcinogenesis.

First experiences with the interstitial Nd:YAG laser therapy in the treatment of upper-aerodigestive-tract carcinoma

The laser-induced interstitial thermotherapy (LITT) is a new treatment modality for advanced recurrent malignancies of the upper aerodigestive tract. Since 1993 26 patients with an incurable tumor recurrence of the head and neck region were treated at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Kiel. In nine patients tumor progression was stopped or a partial regression was observed. Eight patients showed slowed down tumor growth and nine patients displayed an unchanged tumor progression. No severe complications were noted. These preliminary results show that the LITT is a suitable method for the palliative treatment of advanced tumor recurrences of the head and neck region. Through optimization and standardization of radiation parameters and application of the laser fibers the success rate could be improved.

Real-time ultrasonography as a monitoring technique for interstitial Nd:YAG laser treatment of voluminous hemangiomas and vascular malformations

Voluminous vascular anomalies of the head and neck region are still treated with conventional surgery although Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser therapy is an effective treatment method. One hundred thirty give patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy, partly complemented by a non-contact mode Nd:YAG laser light application. The vascular tumors had a diameter of more than 3 cm in two or all three dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients showed a complete clinical regression of the vascular tumor, a third of the patients had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser and three of them subsequently underwent conventional surgery. Only 10 patients showed cosmetic and functional deficits. These results on the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrated the high effectiveness of this novel and innovative therapy modality.

Nd:YAG laser treatment of tumors of the oropharynx

The laser surgical treatment of carcinomas of the upper aerodigestive tract has become an established treatment modality at many otolaryngology departments throughout the laser years. The oncologic results that can be achieved with this surgical technique are quite as good as the results that can be achieved by conventional surgery, the functional results on the other hand often seem to be superior to conventional surgery. The Nd:YAG laser has so far rarely been used as a cutting device in the head and neck region. The fibertom mode is a new technique, which has been developed to make the employment of the Nd:YAG laser as a laser scalpel feasible. Between December 1995 and May 1997 thirty-five patients with squamous cell carinomas of the oral cavity were treated at the Department of Otolaryngology, Head and Neck Surgery of the University of Kiel with the Nd:YAG laser in fibertom mode (30 - 50 Watt, cw-mode, 600 m bare fiber). The operative approach, intra- and postoperative complications, duration of the operation and of the healing process, as well as functional and oncologic results were documented and compared to the retrospectively raised data of a group of patients (n equals 25), that was treated by CO2 laser surgery. When working with the Nd:YAG laser in fibertom mode fewer hemorrhages during the actual dissection could be observed as opposed to dissection with the CO2 laser. By laser dissection with the Nd:YAG laser in fibertom mode the operation had to be interrupted to a much lesser extent for bipolar cautery, thus resulting in a reduced operation time. Until a complete reepithelialization of the laser wound was achieved an interval of 3 - 4 weeks went by. Following Nd:YAG laser excision the healing process was 7 - 10 days delayed when compared to CO2 laser surgery. The functional and oncologic results were quite satisfactory in both groups and no major difference between the two laser systems could be observed. The fibertom mode renders the use of the Nd:YAG laser for the excision of tumors in highly vascularized regions like e.g. the tongue, the floor of the mouth and the oropharynx. The functional and oncologic results which were achieved with this method in the treatment of carcinomas of the tongue are so convincing that the CO2 laser has been replaced in our department by the Nd:YAG laser for the indications mentioned above. Tumors of the larynx and hypopharynx on the other hand remain to stay a domain of CO2 laser surgery.

Therapy of Oral Cavity Malignomas with the Nd:YAG Laser Compared to the C02 Laser

The laser surgical treatment of carcinomas of the upper aerodigestive tract (UADT) has become an established treatment modality at many otolaryngology departments throughout the last years. The oncologic results that can be achieved with this surgical technique are quite as good as the results that can be achieved by conventional surgery, the functional results on the other hand often seem to be superior to conventional surgery [7, 8].