M. Scheithauer

Impact of menthol inhalation on nasal mucosal temperature and nasal patency.

Background Menthol is a natural herbal compound. Its isomer L-menthol presents the characteristic peppermint scent and is also responsible for the cooling sensation when applied to nasal mucosal surfaces because of stimulation of trigeminal cold receptors. The aim of this study was to assess the effect of menthol inhalation on end-inspiratory nasal mucosa temperature and nasal patency. Methods Eighteen healthy volunteers with a mean age of 30 years were enrolled in this study. Objective measurements included the septal mucosal temperature within the nasal valve area by using a miniaturized thermocouple as well as active anterior rhinomanometry before and after inhalation of l-menthol vapor. All subjects completed a visual analog scale (VAS; range, 1–10) evaluating nasal patency before and after menthol. Results The mean end-inspiratory mucosal temperature ranged from 27.7°C (±4.0) before menthol inhalation to 28.5°C (±3.5) after menthol inhalation. There were no statistically significant differences between the temperature values before and after menthol inhalation (p > 0.05). In addition, no statistically significant differences between the rhinomanometric values before and after menthol inhalation were observed. Sixteen of the 18 subjects reported an improvement of nasal breathing after menthol inhalation by means of the VAS. Conclusion Menthol inhalation does not have an effect on nasal mucosal temperature and nasal airflow. The subjective impression of an improved nasal airflow supports the fact that menthol leads to a direct stimulation of cold receptors modulating the cool sensation, entailing the subjective feeling of a clear and wide nose.

Empty Nose Syndrome: Limbic System Activation Observed by Functional Magnetic Resonance Imaging

Empty nose syndrome (ENS) patients have a persistent sense of impaired nasal patency despite radical resection of nasal turbinates. The aim of this study was to elucidate differences in cerebral activation during free breathing and after inhalation of a fragrance (lemonene) and a pseudodecongestant (menthol) over a nasofacial mask. Our hypothesis was that menthol would be perceived as beneficial and that cerebral activation would show differences in areas corresponding to emotional suffering and air hunger in ENS patients.

A european multicenter study evaluating the flex robotic system in transoral robotic surgery.

To evaluate the application of the Flex Robotic System in transoral robotic surgery (TORS).

First use of a computer-assisted operator-controlled flexible endoscope for transoral surgery.

Transoral robotic surgery (TORS) has become an accepted treatment option for head and neck cancer. However, anatomical limitations and a relevant financial burden require alternative developments in this field. To this end, a patient presenting with a T2 squamous cell carcinoma of the lower lateral oropharyngeal wall was effectively treated with a new Conformité Européene–certified, computer‐assisted, operator‐controlled flexible endoscope (Flex). Intraoperative visualization and tissue handling were acceptable and safe. Transoral surgery with the flexible endoscope was safely conducted in a clinical setting. The introduction of alternative TORS systems will increase competition, drive scientific improvement, and reduce financial expenses. Laryngoscope, 125:645–648, 2015

Nasal mucosal temperature in relation to nasal airflow as measured by rhinomanometry.

Background The aim of this study was to measure in vivo nasal mucosal temperature and assess its relationship to nasal patency. Methods Nasal mucosal temperature of 30 nasal cavities was measured by means of a miniaturized thermocouple within the anterior turbinate area during respiration. Temperature values were compared with corresponding rhinomanometrical data. Results The median mucosal temperature ranged from 30.2°C (range, 28.9–31.7°C) after inspiration to 32.2°C (range, 31.0–33.9°C) after expiration. The end-inspiratory (r = -0.85) and end-expiratory mucosal temperature values (r = -0.88) negatively correlated with the rhinomanometrical data. Conclusion This study supports the fact that there is a negative correlation between nasal mucosal temperature and nasal resistance. Changes in nasal patency seem to influence nasal mucosal temperature. Within this context, nasal thermoreceptors might play an important role concerning the perception of nasal patency.

Potential Advantages of a Single-Port, Operator-Controlled Flexible Endoscope System for Transoral Surgery of the Larynx

Introduction: Transoral surgery of the larynx is commonly performed with a rigid laryngoscope, a microscope, and a laser. We investigated the potential utility of a flexible, single-port, robot-assisted and physician-controlled endoscopic system to enable easy, transoral surgical access to the larynx. Methods: Transoral laryngeal surgery was performed in human cadavers (n = 4) using the Flex System and compatible flexible instruments. Anatomical landmarks were identified, and mock surgical procedures were performed. Results: Standard laryngeal surgical procedures were completed successfully in a human cadaver model. The built-in HD digital camera enabled high-quality visualization of the larynx. Epiglottectomy, as well as posterior cordectomy, were performed by laser and radio-frequency resection. The flexible design of the compatible tools enabled a nontraumatic approach. Conclusion: The Flex System has the potential to improve surgical access to the larynx, especially in patients with challenging anatomy. The associated flexible instruments enabled completion of surgical procedures in the larynx in a human cadaveric model. Further clinical studies, as well as the development of supplemental technology and tools, are recommended for future clinical applications.

Detection of paranasal ectopic adrenocorticotropic hormone-secreting pituitary adenoma by Ga-68-DOTANOC positron-emission tomography–computed tomography

Ectopic adrenocorticotropic hormone (ACTH)‐secreting tumors account for approximately 10% of Cushings syndrome (CS). We present an extremely rare case of a patient with CS caused by an ectopic ACTH‐secreting pituitary adenoma (EAPA) of the ethmoid sinus. The tumor was identified by positron‐emission tomography–computed tomography (PET/CT) using the somatostatin receptor analogue Ga‐68‐DOTANOC. Transnasal endoscopic resection was performed and the patient showed significant clinical improvement with normalization of the endocrine pituitary axis. Immunostaining showed a somatostatin receptor 2 and 5‐positive ACTH‐producing adenoma. In patients with ectopic ACTH secretion, Ga‐68‐DOTANOC‐PET/CT may play an important role in the localization of EAPA. Transnasal endoscopic resection is the therapy of choice.

Recent advances in robot-assisted head and neck surgery.

This article reviews current clinical applications and experimental developments for robotic surgery in the head and neck with special focus on financial challenges, current clinical trials, and the controversial aspect of haptic and tactile feedback.

Demonstration of nasopharyngeal surgery with a single port operator‐controlled flexible endoscope system

Nasopharyngeal surgery is commonly performed with a rigid endoscope using a transnasal or transoral approach. Here, we demonstrate a flexible single port computer‐assisted endoscopic system enabling easy transoral access to the nasopharynx.

The auricle's cavum conchae composite graft in nasal reconstruction.

Background Autologous transplants consisting of skin and cartilage, so-called composite grafts (CGs), are useful in nasal reconstruction of multilayered defects. A CG from the auricles cavum conchae serves both functional and esthetic demands. This article outlines the indications and the requirements of the CG, making special considerations to improve wound healing, and discusses our results in consideration with recent publications. Methods A retrospective case–control study assessing the functional and esthetic long-term results in the donor and recipient site is presented. Results Between 2005 and 2011, 91 patients received differently sized CGs of the auricle for nasal reconstruction. In 85/91 cases the donor site defect was closed using a retroauricular pedicled island flap. Six of 91 defects were closed primarily. Indications were multilayered defects of the nasal vestibule, the nasal floor, the inner nasal valve, and the lateral sidewall. The main indication for surgery was skin malignancies. One of 91 major and 14/91 minor complications were observed. Seventy-seven of 91 patients received a custom-made prosthesis to prevent stenotic scarring. The 2.5-year follow-up showed excellent results of stability and shape at the donor and recipient site. Conclusion The auricular inner lining CG is a versatile and reliable autologous transplant, which is ideal for multilayered nasal reconstruction because of easy harvesting, little donor site morbidity, and its convex shape. Septal splints and custom-made prosthesis secure healing and prevent stenotic scarring.