Claus Gerstenberger

Intraoperative medialization of medial rectus muscle as a new endoscopic technique for approaching intraconal lesions.

Background Intraconal tumors of the orbit are rare entities and surgical treatment is challenging. Endoscopic transnasal approaches to the orbit offer a new perspective for surgery, although only few reports exist in literature. This study displays the Graz experience with endoscopic approaches to intraorbital tumors between 2006 and 2010 introducing a novel endoscopic technique for temporary medialization of the medial rectus muscle facilitating access to the orbital cone. Methods A retrospective analysis of patients’ charts was performed. Results For approaches to intraconal lesions a special endoscopic temporary medialization technique of the medial rectus muscle through applying transseptal sutures was developed. Six patients (four male and two female patients) have been included in this study presenting with intraconal/intraorbital tumors. Three patients underwent endoscopic surgery for two hemangiomas and one Schwannoma, respectively, and three patients were successfully biopsied endoscopically revealing one malignant melanoma, one malignant lymphoma, and one optic glioma each. Both hemangiomas were completely resected without any deterioration of vision. The Schwannoma was partially resected with postoperative imaging showing no tumor progression within 3 months. No intraoperative complications occurred. Five cases were performed with computer assisted surgery using CT/MR fusion navigation. Conclusion Although technically challenging, the endoscopic approach to the orbit, even for intraconal lesions with medialization of the medial rectus muscle, can be safe and promising for well-selected cases. Good postoperative results and sufficient material acquisition for proper histological examination can be obtained. Advantages are good visualization of the surgical field and avoidance of external scars. Limitations to endoscopic techniques are tumors in the lateral superior and lateral inferior quadrant of the orbit.

The unsolved chapter of vocal fold scars and how tissue engineering could help us solve the problem

Vocal fold scarring is a relatively small field in scar research with prerequisites found nowhere else. The deterioration of the delicate tri-layered micro-structure of the epithelium of the vocal folds leads to impaired vibration characteristics resulting in a permanent hoarse and breathy voice. Tissue engineering approaches could help to restore the pre-injury status. Despite a considerable progress in this field during the last years, routine clinical applications are not available so far. One reason might be that vocal fold fibroblasts, as the responsible cell type for fibrogenesis, have very particular properties that are only poorly characterized. Moreover, in vivo trials are costly and time consuming and a representative in vitro model does not exist so far. These particular circumstances lead to innovative in vitro strategies and concepts such as macro-molecular crowding that can also be applied in adjacent fields.

A Transthyroidal Method for Arytenoid Adduction: A Basic Anatomical Study

INTRODUCTION Arytenoid adduction is a very effective procedure for medializing the posterior part of the vocal fold in vocal fold paralysis. Major drawback of the method is the technically sometimes-difficult access to the arytenoid with increased postoperative morbidity. Aim of this study was to provide basic anatomical data regarding the accessibility of the arytenoid cartilage through a thyroplasty window. Furthermore, to investigate the feasibility of an arytenoid adduction by fixation of a surgical screw to the arytenoid cartilage by using this approach. MATERIALS AND METHODS 10 cadaver larynges, six female and four male, were dissected and measured for our points of interest. A standard manufacture-made surgical screw attached to a suture was anchored to the fovea oblonga of the arytenoid cartilage. RESULTS Our anatomical measurements proved a mean distance from the posterior edge of the thyroid window to the arytenoid of about 8-9 mm in male larynges and 7-8 mm in female larynges. The distances did not differ significantly between the sexes. Pulling the anchored surgical screw medializes the posterior part of the vocal fold. DISCUSSION Our data showed that there is a very constant morphometric relation between the thyroplasty window and the arytenoid cartilage. It is known that gender-related differences result in a veritable laryngeal dimorphism in nearly all absolute laryngeal dimensions. These differences appear to a much lesser extend in the distances from the surface to the depth, as was confirmed in our series. Using these findings led us to identification of the fovea oblonga near the muscular process as the most favorable point for fixation of a surgical screw through a conventional thyroplasty window. Pulling the attached suture medializes the arytenoid cartilage.

Subjective and objective vocal parameters in women with polycystic ovary syndrome.

INTRODUCTION Despite the relatively high prevalence of the polycystic ovary syndrome (PCOS) affecting up to 15% of all women of reproductive age, only little is known about vocal changes related to this endocrinologic disorder that is characterized by biochemical or clinical hyperandrogenism, impaired cycles, and/or polycystic ovaries. The aim of our study was to describe objective and subjective vocal changes in women with a diagnosed PCOS compared with a control group. MATERIALS AND METHODS Our study group comprised 34 women-24 cases with confirmed PCOS and 10 controls in whom PCOS was excluded. A complete endocrinologic laboratory status was obtained by all participants; study procedures included a videolaryngostroboscopy, voice recording, and completion of the German version of the Voice Handicap Index. RESULTS A trend toward lower mean fundamental frequency was detectable, but this failed statistical significance. No differences were found in the objective and subjective voice parameters. CONCLUSION Elevated serum levels of androgens, as found in women with PCOS, were shown not to have an impact on the subjective and objective voice parameters.

Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve

Age related atrophy of the laryngeal muscles -mainly the thyroarytenoid muscle (TAM)- leads to a glottal gap and consequently to a hoarse and dysphonic voice that significantly affects quality of life. The aim of our study was to reverse this atrophy by inducing muscular hypertrophy by unilateral functional electrical stimulation (FES) of the recurrent laryngeal nerve (RLN) in a large animal model using aged sheep (n = 5). Suitable stimulation parameters were determined by fatiguing experiments of the thyroarytenoid muscle in an acute trial. For the chronic trial an electrode was placed around the right RLN and stimulation was delivered once daily for 29 days. We chose a very conservative stimulation pattern, total stimulation time was two minutes per day, or 0.14% of total time. Overall, the mean muscle fiber diameter of the stimulated right TAM was significantly larger than the non-stimulated left TAM (30μm±1.1μm vs. 28μm±1.1 μm, p<0.001). There was no significant shift in fiber type distribution as judged by immunohistochemistry. The changes of fiber diameter could not be observed in the posterior cricoarytenoid muscle (PCAM). FES is a possible new treatment option for reversing the effects of age related laryngeal muscle atrophy.

Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study. Methods. On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2. Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures. Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap.

Influence of Topical Antifungal Drugs on Ciliary Beat Frequency of Human Nasal Mucosa: An In Vitro Study

Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions.

A piezoelectric device for bone work in endoscopic anterior skull base surgery ‐ a feasibility study in 15 patients

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.12760 This article is protected by copyright. All rights reserved. Received Date : 07-Jun-2016 Revised Date : 04-Sep-2016 Accepted Date : 23-Sep-2016 Article type : Our Experience

Phonatory characteristics of ex-vivo aged sheep models

For humans, voice quality reduces with age. Due to the increasing life span and the increase of the older population, it is necessary to develop new strategies to treat people concerned. Since potential new treatment technologies as functional electrical stimulation have to be first established in animal models, we investigated phonatory characteristics in aged sheep larynges. Ex-vivo dynamic experiments were performed on nine aged sheep larynges providing normative phonatory data. The larynges were analyzed at sustained phonation for varying subglottal pressure levels. Additionally, three different weights were successively attached to the thyroid cartilage to induce pre-stress forces towards the thyroarytenoid muscle and to therefore simulate longitudinal tension of the vocal folds. Laryngeal vibrations, airflow and acoustics were recorded. Afterwards, larynges were analyzed for tissue damage using histological standard methods. Overall, the larynges showed rather asymmetric vibrations and exhibited ver...

Erste klinische Erfahrungen mit einem gebogenen Laryngoskopierohr für die endolaryngeale Chirurgie@@@First clinical experience with a moderately bent laryngoscope for endolaryngeal surgery

INTRODUCTION In this article we describe the successful use of a moderately bent laryngoscope in two different patient cases. MATERIALS We developed a prototype of a 20 degrees bent laryngoscope. The moderate curvature allows insertion of the laryngoscope without using any optical device. The operation is performed via a laterally attached 30 degrees nasal endoscope and a monitor, with slightly bent instruments. Previous work by our group showed that when a bent laryngoscope was used, the forces on the oropharyngeal tissues were significantly reduced. Furthermore, the use of these laryngoscopes significantly improves the exposure of the endolarynx. RESULTS We present two cases in which insertion of a conventional straight laryngoscope was not possible due to anatomical reasons. However, the operations could be performed successfully with the bent laryngoscope.ZusammenfassungEinleitungWir präsentieren anhand zweier Kasuistiken den Gebrauch eines moderat gebogenen Laryngoskopierohres.MaterialWir entwickelten einen Prototyp eines um 20° gebogenen Laryngoskopierohres. Diese geringe Krümmung erlaubt eine Einstellung des Operationsgebietes ohne zu Hilfenahme von optischen Geräten. Die Operation selbst erfolgt über ein seitlich in das Rohr eingeführtes 30° Nasenendoskop via Monitor, mit einem Satz entsprechend gebogener Instrumente. In vorausgehenden Publikationen konnten wir zeigen, dass es unter experimentellen Bedingungen durch Verwendung eines gebogenen Laryngoskopierohres zu einer signifikanten Reduktion der auf die oropharyngealen Gewebe auftretenden Kräfte kommt und dadurch die Einstellung des Endolarynx signifikant erleichtert wird.ErgebnisseIn der vorliegenden Arbeit konnten wir anhand von zwei Patienten, die mit konventionellen, geraden Laryngoskopierohren nicht einstellbar waren zeigen, dass es mit dem von uns entwickelten gebogenen Laryngoskopierohr möglich ist, endolaryngeale Operationen komplikationslos durchzuführen. Gebogene Laryngoskopierohre in Verbindung mit Videoendoskopen könnten in speziellen Fällen eine wertvolle Ergänzung zu konventionellen Instrumenten darstellen.AbstractIntroductionIn this article we describe the successful use of a moderately bent laryngoscope in two different patient cases.MaterialsWe developed a prototype of a 20° bent laryngoscope. The moderate curvature allows insertion of the laryngoscope without using any optical device. The operation is performed via a laterally attached 30° nasal endoscope and a monitor, with slightly bent instruments. Previous work by our group showed that when a bent laryngoscope was used, the forces on the oropharyngeal tissues were significantly reduced. Furthermore, the use of these laryngoscopes significantly improves the exposure of the endolarynx.ResultsWe present two cases in which insertion of a conventional straight laryngoscope was not possible due to anatomical reasons. However, the operations could be performed successfully with the bent laryngoscope.