Jochen Wurm

Determination of facial symmetry in unilateral cleft lip and palate patients from three-dimensional data: technical report and assessment of measurement errors.

Objective To assess measurement errors of a novel technique for the three-dimensional determination of the degree of facial symmetry in patients suffering from unilateral cleft lip and palate malformations. Design Technical report, reliability study. Setting Cleft Lip and Palate Center of the University of Erlangen-Nuremberg, Erlangen, Germany. Patients The three-dimensional facial surface data of five 10-year-old unilateral cleft lip and palate patients were subjected to the analysis. Distances, angles, surface areas, and volumes were assessed twice. Main Outcome Measures Calculations were made for method error, intraclass correlation coefficient, and repeatability of the measurements of distances, angles, surface areas, and volumes. Results The method errors were less than 1 mm for distances and less than 1.5° for angles. The intraclass correlation coefficients showed values greater than .90 for all parameters. The repeatability values were comparable for cleft and noncleft sides. Conclusion The small method errors, high intraclass correlation coefficients, and comparable repeatability values for cleft and noncleft sides reveal that the new technique is appropriate for clinical use.

Surgical Application of a New Robotic System for Paranasal Sinus Surgery

The applicability of a robotic system for fully automated surgical procedures approaching the sphenoid sinus is evaluated. An integrated robotic system, A73, for computer navigation-guided, fully automated, and telemanipulation robotic performance is described. Details of the system comprising newly designed surgical instruments for robotic operations and preoperative planning protocols are provided. Experiments with an operational accuracy of less than 1 mm were followed by surgical tests, in which the results of fully automated and telemanipulation performances on 5 cadaveric heads are seen. The A73 system has been successfully used for a reproducible and accurate resection of the anterior wall of the sphenoid sinus. Therefore, we conclude that this system is suited for further testing toward approaching fully automated and more complex procedures of paranasal surgery.

Komplikationen bei entzündlichen Erkrankungen der Nasennebenhöhlen

ZusammenfassungDie anatomische Nähe der Nasennebenhöhlen zum Gehirn und zur Orbita erklärt das Auftreten von auch heute noch schweren und lebensbedrohlichen entzündlichen Komplikationen bei Sinusitis. Zwar treten diese schweren Fälle insgesamt selten auf, sollten aber wegen ihrer Letalität von 5–10% rechtzeitig erkannt und behandelt werden. Im vorliegenden Beitrag werden Diagnostik und Therapie bei akuten Komplikationen infolge von Entzündungen sowie bei Mukozelen der Nasennebenhöhlen nach aktuellem Stand dargestellt.AbstractThe close localization of the paranasal sinuses both to the brain and the orbit can even today lead to severe and potentially lethal complications in patients with sinusitis. These incidents are rare, however, they should be duly diagnosed and treated since fatal outcome is described in 5–10% of cases. Current diagnosis and therapy for acute inflammatory complications and mucoceles of paranasal sinuses are presented in this article.

Complications with inflammatory diseases of the nasal sinuses

ZusammenfassungDie anatomische Nähe der Nasennebenhöhlen zum Gehirn und zur Orbita erklärt das Auftreten von auch heute noch schweren und lebensbedrohlichen entzündlichen Komplikationen bei Sinusitis. Zwar treten diese schweren Fälle insgesamt selten auf, sollten aber wegen ihrer Letalität von 5–10% rechtzeitig erkannt und behandelt werden. Im vorliegenden Beitrag werden Diagnostik und Therapie bei akuten Komplikationen infolge von Entzündungen sowie bei Mukozelen der Nasennebenhöhlen nach aktuellem Stand dargestellt.AbstractThe close localization of the paranasal sinuses both to the brain and the orbit can even today lead to severe and potentially lethal complications in patients with sinusitis. These incidents are rare, however, they should be duly diagnosed and treated since fatal outcome is described in 5–10% of cases. Current diagnosis and therapy for acute inflammatory complications and mucoceles of paranasal sinuses are presented in this article.

New endoscopic instruments for paranasal sinus surgery

BACKGROUND: Minimally invasive endoscopic and microscopic procedures represent state of the art paranasal sinus surgery techniques in both diagnostic and surgical fields. To combine favorable aspects of both techniques, we evaluated the clinical applicability and effectiveness of multifunctional microendoscopes, providing multiple features to ensure highest accuracy and surveillance when performing crucial steps in paranasal sinus surgery. METHODS: The study included both anatomic experiments on cadaveric heads and clinical tests on patients undergoing routine paranasal surgery. The systems applicability was evaluated in procedures approaching the frontal and sphenoid sinus. Three different endoscopes, 2 straight and the other 1 with a 90° angle, were tested. They integrate canals for flushing and suction and a working canal for either drilling or obtaining biopsies with a miniaturized forceps. For stereotactic feedback, the applicability in combination with a computer-navigation system was evaluated. RESULTS: Anatomic tests were performed to optimize illumination and to test drilling features and forceps biopsies. In all cases, the frontal sinus ostium and the sphenoid sinus anterior wall was easily identified and enlarged by drilling under visual and stereotactic control. Continuous suction and irrigation ensured a constant visual surveillance by removing drilling debris and blood. Best suited for multifunctional endoscopic surgery were drill heads with a cylinder shape, for placing bore holes along the Z axis, and spherical drill heads, for furbishing and enlarging drill holes. CONCLUSION: These new instruments have proven their applicability in paranasal sinus surgery. Multifunctional endoscopic procedures were deemed best suited for maneuvers requiring highest precision, such as the surgery of the frontal and sphenoid sinus.

Prophylaktische und notfallmäßige Unterbindungen der Aa. carotides bei Patienten mit malignen Tumoren im Kopf-Hals-Gebiet

ZusammenfassungLebensbedrohliche Blutungen bei Patienten mit malignen Tumoren im Kopf-Hals-Gebiet sind aufgrund von Faktoren wie Tumorausdehnung, anatomischen Veränderungen nach Operation, Infektionen und Radionekrosen häufig schwierig zu kontrollieren. Eine Möglichkeit zur Prophylaxe und Therapie von Tumorblutungen besteht in der Unterbindung der A. carotis externa (ACE), A. carotis communis (ACC) sowie der A. thyroidea superior (ATS). Zur Abschätzung der Risiken und des therapeutischen Nutzes derartiger Gefäßunterbindungen wurden 52 Patienten retrospektiv untersucht. Bei 25 Patienten wurde die ACE im Rahmen der primären Tumorresektion und Neck dissection prophylaktisch unterbunden. In 27 Fällen erfolgte die Unterbindung der ACE, ACC oder ACE und ATS notfallmäßig wegen akut aufgetretener Blutungen nach abgeschlossener Therapie (Operation, primäre oder postoperative Radiatio bzw. Radio-Chemo-Therapie). Nach prophylaktischer Unterbindung der ACE trat keine postoperative Nachblutung auf. Ein Patient mit multiplen kardiovaskulären Vorerkrankungen erlitt nach 1 Jahr einen ipsilateralen Hirninfarkt. Bei 6 von 9 Patienten mit notfallmäßiger Unterbindung der ACC und bei allen 3 Patienten Patienten mit notfallmäßiger Unterbindung der ACE und ATS kam es zu erheblichen neurologischen Komplikationen bis zum apallischen Syndrom. Die Anzahl der Todesfälle, die durch eine Tumorblutung verursacht wurde, war unter den Patienten, bei denen im Rahmen der primären Tumorresektion und Neck dissection eine prophylaktische Unterbindung der ACE erfolgte, deutlich geringer. Ferner kam es in der Folge nach prophylaktischer Ligatur der ACE erheblich seltener zu ungünstigen Verläufen, wie sie nach notfallmäßiger Unterbindung der ACC oder ACE und ATS zu beobachten waren.SummaryLife threatening hemorrhage in patients with malignant tumours of the head and neck area are often, as a result of tumour infiltration, postoperative anatomical changes, infection and radiological necrosis, difficult to control. One option for prophylaxis and treatment is the ligature of the external (ECA) or common carotid artery (CCA) and superior thyroid artery (STA). 52 patients were examined in a retrospective study to determine both the hazards and the therapeutic use of the procedure. The external carotid artery (ECA) was ligated prophylactically during the operative procedure of tumour resection and neck dissection in 25 patients. In 27 cases closure of the ECA, CCA or ECA and STA was carried out as an emergency procedure for acute hemorrhage following completed primary treatment (operation, primary or postoperative radiation or radiochemotherapy). There was no postoperative hemorrhage after prophylactic ligature of the ECA. One patient with multiple cardiovascular diseases suffered from an ipsilateral cerebral infarction 1 year after operation. In 6 of 9 patients and in all 3 patients, in whom ligature of the CCA or ECA and STA respectively was carried out as an emergency procedure, severe neurological complications up to an apallic syndrome occured. The number of deaths due to acute hemorrhage was considerably smaller among those patients with prophylactic ligature of the ECA performed during operative procedure of tumor resection and neck dissection. In addition there were much less unfavourable courses in the sequence of prophylactic closure of the ECA than observed after ligating the CCA or ECA and STA in an emergency situation.

Endonasale Entfernung eines ausgedehnten Kraniopharyngeomrezidivs mit Hilfe der intraoperativen Navigation

In recent years computer-navigation systems have been commonly used in the field of otorhinolaryngology. Taking its limitations and possible failures into account, this technology is considered reasonable and helpful in routine paranasal sinus surgery, particularly in revision cases and complex approaches to the lateral skull base. We report on a patient with a large recurrent craniopharyngioma, and show that the use of intraoperative navigation might even be necessary to accomplish the desired postoperative outcome in certain cases. Future developments will demonstrate whether computer assisted surgery can extend the indications for operative procedures in complex anatomical regions.ZusammenfassungAuf dem Gebiet der Hals-Nasen-Ohren-Heilkunde werden computergestützte Navigationssysteme seit einigen Jahren verbreitet eingesetzt. In Kenntnis der Fehlermöglichkeiten und Störfaktoren gilt diese Technologie als sinnvoll und hilfreich in der routinemäßigen Nasennebenhöhlenchirurgie, insbesondere aber auch bei Revisionseingriffen und komplexen Zugangswegen im Bereich der lateralen Schädelbasis. Der hier geschilderte Fall einer kompletten Enfernung eines ausgedehnten Kraniopharyngeomrezidivs mit Hilfe der intraoperativen Navigation zeigt, dass zum Erreichen eines gewünschten postoperativen Ergebnisses die Verwendung eines solches Systems sogar notwendig sein kann. Zukünftige Entwicklungen werden zeigen, ob sich durch die computergestützte Navigation die Indikationen für operative Eingriffe in komplexen anatomischen Regionen erweitern lassen.AbstractIn recent years computer-navigation systems have been commonly used in the field of otorhinolaryngology. Taking its limitations and possible failures into account, this technology is considered reasonable and helpful in routine paranasal sinus surgery, particularly in revision cases and complex approaches to the lateral skull base. We report on a patient with a large recurrent craniopharyngioma, and show that the use of intraoperative navigation might even be necessary to accomplish the desired postoperative outcome in certain cases. Future developments will demonstrate whether computer assisted surgery can extend the indications for operative procedures in complex anatomical regions.

Intra‐operative image update: first experiences with new software in computer‐assisted sinus surgery

So far, conventional navigation systems do not provide the opportunity for any modification of acquired image datasets. In particular, the surgical progress in the operating field cannot be visualized unless new imaging scans are performed.

Weichteilnavigation im Kopf- Hals-Bereich und navigierte Fremdkörperentfernung

BACKGROUND Soft tissue navigation has traditionally been neglected in computer-aided surgery (CAS) because of unpredictable margins of error. In our study, we examined clinical cases in which standard CAS was applied in soft tissue surgery in the head and neck region. Its extended applicability, margins of error, and general performance are described and discussed. MATERIALS AND METHODS CAS was applied in surgical procedures for six patients. Five patients had foreign bodies in the head and neck region, and one patient displayed uncertain cervical lymph node enlargement. An optoelectrical navigation system (VectorVision(2), BrainLAB) was used in all cases. RESULTS Using CAS, 10 out of 11 total foreign bodies were identified. Only one glass splinter attached to the eyeball could not be detected by the navigation system. One glass splinter that was deeply buried within the sphenoid bone was easily found but was left untouched. The parapharyngeal lymph node was identified and extracted in a minimally invasive transpalatinal approach. CONCLUSIONS Soft tissue navigation was successfully applied in all but one case; the success was due to the altered demands in soft tissue navigation as opposed to skull-base surgery. Easy identification of foreign bodies and lymph nodes was possible in the soft tissues of the head and neck, with an acceptable margin of error.

Endonasal removal of a large recurrent craniopharyngioma using intraoperative navigation

In recent years computer-navigation systems have been commonly used in the field of otorhinolaryngology. Taking its limitations and possible failures into account, this technology is considered reasonable and helpful in routine paranasal sinus surgery, particularly in revision cases and complex approaches to the lateral skull base. We report on a patient with a large recurrent craniopharyngioma, and show that the use of intraoperative navigation might even be necessary to accomplish the desired postoperative outcome in certain cases. Future developments will demonstrate whether computer assisted surgery can extend the indications for operative procedures in complex anatomical regions.ZusammenfassungAuf dem Gebiet der Hals-Nasen-Ohren-Heilkunde werden computergestützte Navigationssysteme seit einigen Jahren verbreitet eingesetzt. In Kenntnis der Fehlermöglichkeiten und Störfaktoren gilt diese Technologie als sinnvoll und hilfreich in der routinemäßigen Nasennebenhöhlenchirurgie, insbesondere aber auch bei Revisionseingriffen und komplexen Zugangswegen im Bereich der lateralen Schädelbasis. Der hier geschilderte Fall einer kompletten Enfernung eines ausgedehnten Kraniopharyngeomrezidivs mit Hilfe der intraoperativen Navigation zeigt, dass zum Erreichen eines gewünschten postoperativen Ergebnisses die Verwendung eines solches Systems sogar notwendig sein kann. Zukünftige Entwicklungen werden zeigen, ob sich durch die computergestützte Navigation die Indikationen für operative Eingriffe in komplexen anatomischen Regionen erweitern lassen.AbstractIn recent years computer-navigation systems have been commonly used in the field of otorhinolaryngology. Taking its limitations and possible failures into account, this technology is considered reasonable and helpful in routine paranasal sinus surgery, particularly in revision cases and complex approaches to the lateral skull base. We report on a patient with a large recurrent craniopharyngioma, and show that the use of intraoperative navigation might even be necessary to accomplish the desired postoperative outcome in certain cases. Future developments will demonstrate whether computer assisted surgery can extend the indications for operative procedures in complex anatomical regions.