Markus Jungehuelsing

Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas.

Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV‐DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases.

Impact of functional endoscopic sinus surgery on symptoms and quality of life in chronic rhinosinusitis.

Objectives Chronic rhinosinusitis restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery modifies patients symptom profiles and quality of life.

Surgical treatment for hypopharynx carcinoma : feasibility, mortality, and results

This study seeks to evaluate treatment modalities, mortality after surgery, survival, and local control rates for a consecutive cohort of patients with cancer of the hypopharynx treated according to a prospective protocol that favors surgery as an initial approach to the disease. The charts of 228 consecutive patients with previously untreated hypopharyngeal squamous cell carcinoma were reviewed. Outcome measures (overall survival, disease specific survival, and local control) were calculated using the Kaplan-Meier estimator. Of 228 consecutive patients, 136 (59.6%) were found suitable for initial surgical treatment. Of the remaining 92 patients, 18 (7.9%) had nonresectable lymph node metastases, 16 (7.0%) had unresectable primary tumors, 13 (5.7%) refused surgery, and 13 (5.7%) presented distant metastases during initial diagnostic evaluation. Of those who had surgery, 46 had larynx-sparing procedures, 54 had total laryngectomy, and 36 had total laryngo-pharyngectomy. None of the patients who had surgery died postoperatively. Actuarial 5-year overall survival was 27.2% for all 228 patients, 39.5% for the 136 patients with surgical treatment, and 61.1% for the 46 patients who were treated with larynx-sparing procedures.

Primary parotid malignoma surgery in patients with normal preoperative facial nerve function: outcome and long-term postoperative facial nerve function.

Objectives/Hypothesis: Most patients with primary parotid cancer present with normal facial nerve function. The common surgical strategy for these patients is to perform a parotidectomy with facial nerve preservation. Nevertheless, the functional outcome for the facial nerve and oncological outcome is unclear.

Is There a Need for Positron Emission Tomography Imaging to Stage the N0 Neck in T1-T2 Squamous Cell Carcinoma of the Oral Cavity or Oropharynx?

Objectives: We assess whether negative findings on computed tomography (CT), magnetic resonance imaging (MRI), and/or 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) may contribute to the decision-making process of elective neck dissection (eND) in patients with squamous cell carcinoma of the oral cavity or the oropharynx (oSCC) staged cT1-T2 cN0 cM0. Methods: We interpreted CT, MRI, and 18FDG-PET images separately, after combining the data of CT with those of 18FDG-PET and the data of MRI with those of 18FDG-PET. Each set of results was then compared with the histopathologic results of ipsilateral or bilateral eND in a prospective, blinded study. Results: The histopathologic examination of 594 lymph nodes revealed 4 metastases less than 4 mm in diameter and 3 micrometastases (less than 2 mm) in 6 of 17 patients. On CT, MRI, and 18FDG-PET, respectively, 5, 5, and 0 cases were true-malignant (true positives) and 4, 10, and 1 cases were false-malignant (false positives). The accuracy was not enhanced by fusing CT with 18FDG-PET or MRI with 18FDG-PET. Conclusions: The detectability threshold of occult metastases appears to be below the spatial and contrast resolution of CT, MRI, and 18FDG-PET. The decision for eND in patients with cT1-T2 cN0 cM0 oSCC cannot be based upon cross-sectional imaging at the resolutions currently available.

Human herpesvirus type 8 in salivary gland tumors

BACKGROUND The new human herpesvirus type 8 (HHV-8) has been detected in all types of Kaposis sarcomas, as well as in body-cavity lymphomas and Castlemans disease, furthermore molecular biologic studies have identified a number of potential viral oncogenes. There is evidence for sexual transmission of HHV-8 in HIV-seropositive patients, but the route of infection among the HIV-seronegative population is uncertain. Findings of HHV-8 DNA in saliva in some cases are suggestive of nonsexual transmission associated with latent infection of the salivary gland (as it is known for EBV, CMV, HHV-6 and HHV-7). OBJECTIVE As little is known about the etiological factors of salivary gland tumors and to give more insights into HHV-8 cell tropism normal salivary gland tissue (n=12) and different salivary glands neoplasm (n=58) were tested for HHV-8 sequences and antigens in HIV-seronegative patients. STUDY DESIGN Biopsies of both normal salivary gland and tumors were investigated for HHV-8 sequences. A nested-PCR method was used for amplification of HHV-8 DNA fragments and the nature of the amplification products was confirmed by Southern blot hybridization. In addition, we used an in situ hybridization technique and immunohistochemical staining for detection of HHV-8 infected cells. The sera of the respective patients were tested for anti-HHV-8 antibodies using commercial IFA and an ELISA-assay. RESULTS HHV-8 DNA sequences could be detected in one bilateral MALT-lymphoma of the parotid gland of a HHV-8 seropositive female patient suffering from Sjögrens syndrome (SS). The remaining parotid samples did neither show HHV-8 sequences nor HHV-8 antigens. Using above assays only one additional patient was seropositive for HHV-8. CONCLUSION Our data suggest that HHV-8 does not usually infect the salivary gland in HIV-seronegative patients and does not seem to play a pathogenic role in vascular and epithelial salivary gland neoplasm. Pathogenic role of HHV-8 in Sjögrens syndrome associated MALT-lymphoma remains unclear and should be subject of further studies.

Modifications of the midline mandibulotomy for access to the parapharyngeal space

When considering a mandibular osteotomy for access to resect a parapharyngeal neoplasm, the following goals should be considered: preservation of the facial nerve, complete removal of the neoplasm without tumor rupture, maintenance of the preoperative teeth occlusion, acceptable temporomandibular joint function, functional preservation of the inferior alveolar nerve sensation, and satisfying aesthetic results. We propose a modified median osteotomy technique, which combines the advantages of sufficient exposition of the tumor with very good functional and aesthetic results. A case series of nine patients suffering from extended pleomorphic adenomas of the inner lobe of the parotid gland is presented. Laryngoscope, 2010

Cytokines in allergic and nonallergic rhinosinusitis

that LAUP for the treatment of snoring is time limited, requiring further treatment in some patients. Methods: LAUP was performed in the outpatient setting using the CO 2 laser and local anesthesia in all patients. A 5year follow-up sleep questionnaire was completed by two thirds of patients with a recurrence of snoring. Results: Results of our study are based on a 5-year experience from June 1993 to June 1998. A total of 409 patients were treated with LAUP for snoring and obstructive sleep apnea. A recurrence of snoring occurred in 15 (3.7%) patients. Conclusion: LAUP is a relatively new procedure for the treatment of snoring and obstructive sleep apnea with no longterm follow-up reported in the literature. Conclusions from this 5-year experience with 409 patients are that 3.7% of patients treated with LAUP had recurrence of snoring and that there are no patient characteristics that predict the recurrence of snoring.

Digital subtraction versus magnetic resonance sialography: Comparison

healthy mother, was noted to have a hearing loss right after birth. He underwent 3 BSERs on different occasions, TOAEs on 2 different occasions, and extensive imaging of the internal auditory canals and inner ears. The child has no other congenital abnormalities. On examination, normal otoscopy was found on both sides, and no other ENT or head and neck abnormalities were found. There was no response to sound stimuli, but balance was normal. Results: All BSERs showed no response bilaterally. TOAEs at age 2 years were present but, when repeated on several other occasions, were consistently absent. A C T scan revealed an absent IAC on the right and a severely malformed IAC on the left, where only the fallopian canals for the facial nerves were present. The inner and middle ear structures were present and apparently normal. Conclusions: It is very unusual to see a congenitally absent IAC with a normally formed inner ear. We will discuss the embiology and restricted treatment options in such cases. The boy is still under investigation.

Surgery for hypopharynx carcinoma: Feasibility and outcome

dition and worsening of disease were the most common events leading to an AD discussion. All patients were open to the subject of AD. Those patients with an AD stated that discussion regarding AD should begin at diagnosis of disease and should be a regular part of follow-up. Seven of the 15 patients without ADs were not prepared to have an AD in place. All patients with ADs found the H&N-specific AD informative and useful. Conclusion: AD is an effective means by which patients maintain control over their care and treatment. The presence of an AD does not ensure that patients understand all aspects of their choices. Time and explanation of management issues were found to correct most misconceptions. AD discussions should be an integral part of follow-up for patients and should begin early in the course of treatment. The H&N-specific AD addresses issues unique to H&N patients (carotid rupture, airway obstruction). This AD was well received by patients and was able to clearly document their wishes regarding management of carotid rupture, airway distress, tracheostomy, and nutrition issues. AD issues must be continually addressed and revisited to keep patients well informed so that they may maintain effective control over their care.