Julian Künzel

Juvenile recurrent parotitis: A retrospective comparison of sialendoscopy versus conservative therapy

There are several therapeutic approaches to treat juvenile recurrent parotitis. The aim of this study was to compare sialendoscopy, including prophylactic cortisone irrigation, with observation and a conservative approach of antibiotic therapy alone.

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.

Long‐term results and subjective outcome after gland‐preserving treatment in parotid duct stenosis

To assess the objective long‐term results and subjective outcome after treatment of Stensens duct stenosis.

Evaluation of the Different Transcervical Approaches for Zenker Diverticulum

Objective. The aim of this study was to evaluate the results of open surgical techniques in the treatment of Zenker diverticulum. Study Design. Case series with chart review. Setting. Academic tertiary referral center. Subjects and Methods. Fifty-four patients with Zenker diverticulum were treated using a transcervical approach. Three with a Brombart I diverticulum underwent a simple myotomy of the cricopharyngeal muscle. Myotomy was combined with a diverticulum inversion in 14 patients and myotomy with diverticulectomy was performed in 37 patients. The surgical procedures were compared with regard to mean anesthesia time, duration of hospitalization, overall complication rate and rate of serious complications, recurrence rate, and follow-up results. Results. Hospitalization times were significantly shorter in the inversion group (P = .024). No statistically significant differences were observed between the transcervical modalities for any of the other variables investigated. Conclusions. Inversion is an effective modality and is by definition less traumatic than traditional diverticulectomy. Although the size of the diverticulum appeared to be a helpful criterion, careful intraoperative evaluation is the key element in deciding which transcervical procedure should be used. In the authors’ view, inversion always should be considered if the individual anatomy of the diverticulum sac (in terms of pharyngeal pouch size and intactness of the mucosa) allows it.

Diagnosis and gland-preserving minimally invasive therapy for wharton's duct stenoses†

The management of stenoses of Whartons duct has so far been little investigated or systematized. The development of minimally invasive treatment methods, including sialendoscopy, has made preservation of gland function possible.

Early Stage Oropharyngeal Carcinomas: Comparing Quality of Life for Different Treatment Modalities

Objective. To compare long-term quality of life outcomes after treating early stage oropharyngeal carcinoma either with surgery, surgery combined with radiotherapy, or surgery combined with chemoradiotherapy. Methods. Questionnaire based method: 111 eligible patients agreed to fill out a quality of life questionnaire. Results. Of the 32 scales contained in the EORTCs combined QLQ-C30 and HN35, 11 scales show significantly better results for the surgery-only treatment group when compared to either surgery combined with radiotherapy or surgery combined with any type of adjuvant therapy. These eleven scales are role function (P = 0.019/0.008), social function (P = 0.01/0.034), nausea (P = 0.017/0.025), pain (P = 0.014/0.023), financial problems (P = 0.030/0.012), speech (P = 0.02/0.015), social eating (P = 0.003/<0.001), mouth opening (P = 0.033/0.016), sticky saliva (P = 0.001/<0.001), swallowing (P < 0.001/<0.001), and dry mouth (P < 0.001/0.001). Conclusion. Treatment of early stage oropharyngeal carcinoma with surgery alone has definite advantages over treatments including any form of adjuvant therapy when considering quality of life. Advantages manifest themselves especially in functional aspects of the head and neck realm; however general health aspects as well as psychosocial aspects show improvements as well. This study does not show any indication of QOL-related drawbacks of surgery-only treatment approaches.

Treatment of cervical paragangliomas: Is surgery the only way?

PURPOSE To analyze the results after surgery or stereotactic radiotherapy (SRT) in the treatment of cervical paragangliomas. Against this background, the decision-making algorithm used in the treatment of carotid body tumors (CBTs) and vagal paragangliomas (VPs) was reevaluated relative to the existing literature on the topic. MATERIALS AND METHODS Retrospective study between 2000 and 2012. A total of 27 CBTs and nine VPs in 32 patients were treated. Shamblin class I: 59.3% (n=16); class II: 29.6% (n=8); class III: 11.1% (n=3). Treatment modalities were surgery, radiotherapy, or observation. The end points for analysis were long-term tumor control and integrity of the cranial nerves. RESULTS 21 CBTs and seven VPs underwent surgery; SRT was performed in three CBTs and two VPs. Three CBTs were clinically observed. Permanent nerve paresis followed after surgery for CBTs in five patients (20%) and in all patients with VPs. No impaired cranial nerve function resulted after SRT. The median follow-up period was 4.7 years. The tumor control rate after therapy for CBTs and VPs was 100%. One CBT that received clinical observation showed slow tumor progression. CONCLUSIONS A surgical procedure should be regarded as the treatment of choice in patients with small CBTs. In larger CBTs, particularly in elderly patients with unimpaired cranial nerves, radical surgery should be regarded critically. As surgery for VPs caused regularly impairment of cranial nerves with functional disturbances of various degrees a comprehensive consultation with the patient is mandatory and nonsurgical strategies should be discussed.

Lymph node ratio as a valuable additional predictor of outcome in selected patients with oral cavity cancer

OBJECTIVE This study aimed to evaluate the utility of lymph node ratio (LNR) as a potential prognostic predictor in selected patients with oral squamous cell carcinoma (OSCC). STUDY DESIGN This was a retrospective study that identified 374 patients with OSCC who underwent primary surgery from 1980 to 2010. Of these patients, 148 were identified with regionally metastasized cancer. LNR was calculated as the ratio of positive nodes to the total number of nodes removed during neck dissection. Multivariate analysis was carried out. RESULTS The global median LNR was 0.07. Cutoff values of LNR 0.05 and LNR 0.07 divided the patients into low- and high-risk groups. Patients with an LNR >0.05 had a hazard ratio of 3.665 for a disease-specific survival event, in comparison to LNR <0.05. The mean follow-up period was 5.25 years. CONCLUSIONS Alongside established prognostic factors for predicting the outcome in patients with OSCC, the LNR appears to be another valuable prognostic factor for risk stratification.

Paraganglioma of the facial nerve, a rare differential diagnosis for facial nerve paralysis: case report and review of the literature

This report describes a rare case of histopathologically confirmed glomus faciale tumor. The role of imaging in the differential diagnosis is discussed and therapeutic options are evaluated, along with a review of the previous literature on glomus faciale tumors. A 39-year-old male patient presented with total peripheral facial nerve paralysis. He underwent radical tumor resection and facial nerve grafting for a histopathologically confirmed paraganglioma of the facial nerve. He is now tumor-free after a 4-year follow-up period, and the functional outcome after primary nerve grafting is satisfactory. Facial nerve paragangliomas are a rare cause of facial nerve paralysis. Early imaging using computed tomography and magnetic resonance imaging is essential to clarify the differential diagnosis and assess the location and extent of the tumor. Precise pathological diagnosis requires additional targeted immunohistochemical examinations. The treatment of choice in patients with preoperative facial nerve paralysis is radical tumor resection with nerve reconstruction.

First experience with the fiber-enabled CO2 laser in stapes surgery and a comparison with the "one-shot" technique.

Objective To compare bone conduction after fiber-enabled CO2 laser perforation of the stapes footplate with conduction after the “one-shot” technique during stapedotomy in patients with otosclerosis. Study Design Retrospective clinical study. Setting Tertiary reference center. Materials and Methods We evaluated data from 178 patients who had undergone primary stapedotomy for suspected stapedial ankylosis. The stapes footplate was perforated using a fiber-enabled CO2 laser in 89 patients and the “one-shot” technique in the other 89. Only consecutive surgery was considered. Bone conduction thresholds were determined at 0.5, 1, 2, and 4 kHz on the first and third postoperative days in all patients; 172 patients were followed up after 1 month. Audiograms were compared with preoperative bone conduction. Results The postoperative bone conduction threshold on Day 1 was significantly worse at almost all frequencies. At 0.5 and 2 kHz, it improved within a month and was significantly different from the preoperative value. Bone conduction threshold at 4 kHz showed the greatest deterioration immediately after surgery, improving considerably in 1 month but remaining worse than at baseline. Only at 1 kHz was there no significant immediate hearing loss. Direct comparison of the fiber-enabled CO2 laser and the “one-shot” technique showed no statistically significant differences. Conclusion Compared with the “one-shot” technique, the fiber-enabled CO2 laser can be used safely in stapes surgery, without great risk to the patient. In our opinion, it has practical advantages, especially in difficult anatomic conditions.