Joachim Hornung

Potential of ultrasound diagnosis for parotid tumors: Analysis of qualitative and quantitative parameters

Objective Histology of parotid tumors determines the extent of surgery. The aim was to test ultrasound (US) contrast enhancer-kinetics to identify histologic entities, possibly being superior to qualitative morphological parameters. Study Design In a cross-sectional assessment of ultrasound diagnosis, the subjective US-classification was compared with contrast analysis with histology as gold standard. Subjects and Methods A total of 64 male and 61 female patients with a mean age of 54 years were included, with 13 malignant tumors. These were classified with US morphology, then time-dependent contrast medium analysis. Results A total of 92.8% of tumors were classified correctly as malignant or benign. The sensitivity, specificity, positive- and negative-predictive values were 66.7%, 86.3%, 60.6%, and 89.1% for differentiating Warthin tumors, but only 46.2%, 98.2%, 75%, and 94% for malignant lesions. Contrast parameters yielded significant parameters for benign tumors, not for malignant entities. Conclusion Although contrast medium analysis provided statistical criteria, these, however, do not possess the ability to improve the diagnostic prediction of tumor histology. Neither the morphologic classification nor contrast medium analysis was able to identify a malignant lesion sufficiently.

Comparison among different available surgical approaches in T1 glottic cancer

This study aims to assess the oncologic results of open and transoral surgical techniques in T1a and T1b category glottic carcinomas.

T1 and T2 hypopharyngeal cancer treatment with laser microsurgery.

To assess the oncologic results and functional outcomes of CO2 laser microsurgery in T1 and T2 hypopharyngeal cancer.

Imaging of cochlear implant electrode array with flat-detector CT and conventional multislice CT: comparison of image quality and radiation dose

Conclusion: Cochlear implantation assessment is possible using commercially available standard flat-detector computed tomography (FD-CT) protocols. Image quality is superior to multislice CT (MSCT). The radiation dose of FD-CT is lower in comparison with MSCT standard protocols and may therefore overcome the limitations of MSCT in the evaluation of cochlear implants. Objective: FD-CT offers higher spatial resolution than MSCT. Our objective was to compare the image quality of FD-CT to conventional MSCT in the visualization of a cochlear implant electrode array with respect to radiation exposure. Methods: An isolated temporal bone specimen was scanned using a commercially available FD-CT system and a 4 and 64 row MSCT scanner. Different scanning protocols were used. Image quality was assessed by four independent readers using a scoring system with different criteria describing delineation of the cochlea and the electrode array, image noise and spatial resolution. Radiation dose was measured using the CT dose index (CTDI) and a 16 cm acrylic phantom. Results: Image quality was rated superior for FD-CT for all criteria by all readers. Single electrode contacts were only visible in FD-CT and assessment of implant position was improved by FD-CT. The radiation dose of FD-CT was half that of MSCT standard protocols.

Function-preserving therapy for jugulotympanic paragangliomas: A retrospective analysis from 2000 to 2010†

Treatment for jugulotympanic paragangliomas (JTPs) is shifting from radical toward function‐preserving surgery. Alternative primary treatments are available, such as stereotactic radiotherapy (SRT) and radiosurgery. The aim of this study was to analyze the results after primary function‐preserving surgery with or without adjuvant radiotherapy, or primary SRT, in the treatment of JTPs.

Evaluation of available surgical management options for early supraglottic cancer

This study was undertaken to evaluate the oncologic results of endoscopic and open surgical techniques in early supraglottic cancer.

Localization and infliction pattern of iatrogenic skull base defects following endoscopic sinus surgery at a teaching hospital

OBJECTIVE Aim of this study is to evaluate the incidence, infliction patterns and management of dural injuries with cerebrospinal fluid (CSF) rhinorrhea following endoscopic sinus surgery at a teaching hospital. We present our results of over 14 years of experience from endoscopic repair of CSF rhinorrhea with long-term follow-up. METHODS A retrospective study was performed by screening 14 years of sinus surgeries for iatrogenically inflicted CSF leaks of the anterior skull base. Obtained data were analyzed to determine the infliction pattern and location of CSF leaks, surgical closure techniques and outcomes. All incidences were further evaluated with regards to the surgeons training status. RESULTS 144 patients out of 6908 sinus surgeries were diagnosed with CSF rhinorrhea and underwent subsequent surgical repair. 52 patients had iatrogenic CSF leaks with 32 of the defects inflicted by the departments physician personnel. Average follow-up was 62 months, with a range of 10-168 months. The side distribution was 56.3% to the patients right side and in 40.6% to the patients left side. 68.7% became apparent during the initial surgery whereas 31.3% only after surgery. The most common defect location was the anterior ethmoid at the attachment of the medial concha base with 43.7%, followed by the junction between the ethmoid and sphenoid sinus with 21.9%, the frontal sinus aditus with 18.7% and the medial ethmoid region with 9.4%. With increasing training status, surgeons were more prone to cause defects at the frontal sinus aditus whereas surgeons with lesser training status caused more defects at the anterior ethmoid at the medial concha base. The posterior ethmoid and sphenoid sinus was equally prone to defects over all stages of surgical training. Initial endoscopic repair was successful in 87.5% of patients and 95% after revision surgery. CONCLUSION The obtained data confirm the safety of the endonasal sinus surgery according to Wigands technique. The incidence of iatrogenic CSF leaks at a teaching hospital is not higher than at specialized rhinology departments. We observed a distinct pattern of inflicted skull base defects with different hot-spot areas, prone to damage in various stages of the surgeons status of expertise.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas.

This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions.

Effect of repeated laser microsurgical operations on laryngeal cancer prognosis

The aim of this study was to evaluate whether repeated sessions of transoral CO2 laser microsurgery (TLM) aiming to achieve clear histologic margins carry a negative effect on the prognosis of laryngeal cancer.

First experience with a new titanium clip stapes prosthesis and a comparison with the earlier model used in stapes surgery

The aim of the study was to gain the first clinical experience with a new titanium clip prosthesis in stapes surgery, and to compare this model with its predecessor. We placed particular emphasis on the practicability of fixing the prosthesis to the long process of the incus and on the postoperative improvement in hearing.