O. Kleinsasser

Clinical and morphological aspects of laryngeal cysts

To our knowledge only a few defined studies have been carried out on laryngeal cysts. These cysts represent a mixed group of benign laryngeal lesions that can cause diagnostic and therapeutic difficulties. The aim of this study was to characterize their histological structure and localizations in the larynx as well as to discuss theories about their genesis. Between 1973 and 1996, 342 laryngeal cysts were treated at Phillips University of Marburg, while from 1990 to 1996, 74 were treated at Justus Liebig University of Giessen. In all, 416 laryngeal cysts were treated by endolaryngeal microsurgery. All clinical charts were reviewed retrospectively and surgical specimens examined histomorphologically. Findings showed that 58.2% of the laryngeal cysts were located in the glottic area and 18.3% in the ventricular folds. The remainder were located on the aryepiglottic fold (2.2%) and interarythenoid region (0.7%). Two congenital cysts were also treated. Approximately 56% of the laryngeal cysts were lined by squamous cell epithelium, 37% by respiratory epithelium and 7% by oncocytic epithelium. In general, the laryngeal cysts were found to be a collection of inhomogenous lesions from different histogenetic origins with diverse symptoms related to their site and size. On the basis of our investigations, a new classification was established concerning the genesis and development of laryngeal cysts by subdividing cysts into congenital cysts, retention cysts, and inclusion cysts.

Terminal tubulus adenocarcinoma of the nasal seromucous glands. A specific entity

SummaryA distinctive species of adenocarcinoma arising in the region of the middle turbinate and ethmoid is described. While these tumors generally behave rather benignly, some lesions are capable of invading the cranial cavity as well as metastasizing. Histologically the cells and the structure of these tubular-papillary cystadenocarcinomas show such a striking similarity to the terminal tubules of the seromucous glands that the term “terminal tubulus adenocarcinoma” is proposed. As similar glands can be found in all portions of the upper and lower aerodigestive tracts, it is also possible that these tumors may occur throughout this entire area.

External trauma to the larynx : classification, diagnosis, therapy

Abstract In contrast to internal trauma to the larynx caused by endolaryngeal procedures, trauma to the larynx caused by external forces is relatively rare. Nevertheless, the great variety of these external traumata warrants a thorough diagnosis and understanding of each case as well as a standardized and accepted method for classifying these injuries. These preconditions will facilitate successful therapy. At our three institutions cases of external trauma to the larynx, including the mechanisms of trauma, were reviewed and analyzed. Cases were classified according to the mechanisms and the sequelae of trauma. The three major categories were (a) external trauma due to the impact of blunt objects, (b) trauma after tearing of the neck and the larynx longitudinally, and (c) external trauma caused by sharp objects and gunshots. In the great majority of cases external trauma to the larynx was caused by blunt pressure and was most often due to strangulation in the course of (attempted) suicide or homicide. In a smaller number of cases sharp instruments caused external traumata. In patients surviving the immediate trauma a meticulous laryngological assessment is necessary. In addition to indirect laryngoscopy, we consider microlaryngoscopy as being indicated for investigating the soft tissues of the endolarynx. The status of the laryngeal skeleton can be determined more precisely via high-resolution computed tomography and ultrasound. Early diagnosis and appropriate therapy have a significant impact on the patient’s condition later, especially as regards scar formation, ease of breathing, and voice quality.

Immunohistological reaction patterns of cervical lymph nodes in patients with laryngeal carcinomas.

SummaryAn attempt was made to assess the immunological importance of regional lymph node histology in relation to the survival of 107 patients with carcinoma of the larynx, operated on from 1973 to 1982 at the ENT-Clinic in Marburg. A total of 2765 sections of lymph nodes removed during neck dissections were examined microscopically to evaluate the morphological patterns of response. Microscopically, four distinct patterns were defined. Patients whose lymph nodes demonstrated immunological responses according to patterns I and II in the form of either expanded inner cortices or increased numbers of germinal centers had a greater 5-year survival rate than those patients whose lymph nodes showed an unstimulated pattern. Eight patients whose lymph nodes showed a depleted pattern, IV, did not survive more than 3 years. Morphological assessment of immunological activity in lymph nodes draining malignant tumors seems to be of value in predicting survival. The evaluation of the reaction pattern and difficulties in methodology, however, set definite limitations to our study.

Mittelohrcarcinome nach Tympanoplastik

SummaryFirst report on two observations of squamous cell carcinomas observed 8 and 9 years after tympanoplasties. The tumors appeared under clinical pictures of a recurrent cholesteatoma and a temporallobe abscess. The pathogenesis of these carcinomas arising in operation cavities is discussed.

Ameloblastome des Oberkiefers

SummaryAmeloblastomas usually arise in the mandible, very rarely (15–20%) in the maxilla.The tumour is characterized by its slowly infiltrating and destructive growth, a lack of typical roentgenological structures in the upper jaw and the occurrence of multiple recidives after incomplete resections. The histologic structure of the ameloblastoma and some of its variants are described.Because of its histologic and clinical similarity the ameloblastoma must be differentiated from the adenoidcystic carcinoma and the craniopharyngeoma.An evaluation of case reports in literature shows — as well as our own experience — that ameloblastomas of the upper jaw must be operated radically from the beginning like carcinomas. Irradiation can only achieve temporary remission of the tumour.

Klassifikation und ?grading? von Gesichtsschdelfrakturen

Die Zerst6rung des Lappens der Tympanoplastik ist leicht zu verstehen, weil wir wissen, dab auch bei intakten Trommelfellen h/iufig eine Perforation durch Ohrmykosen vorkommt. Wir k6nnen aber nicht die Art der Innenohrsch/idigung durch Pilze erklfiren. Die Vorstellung einer Ototoxizitfit der Clotrimazoll6sung ist durch das Bestehen des Falles der Innenohrschwerh6rigkeit ohne Behandlung mit Clotrimazol zu verwerfen. Wir sind aber der Meinung, dab die Pilze, und zwar der Aspergillus niger, vielleicht durch Verbreitung der von ihm abgesonderten Toxine in den Innenohrrfiumen oder durch allergische Reaktion diese tiefe Innenohrsch/~digung verursachen kann. Die Tatsache, da/3 bei zahlreichen Aspergillosen des Mittelohres, in Ffillen von Ohrmykosen bei offenen Pauken, keine Innenohrschfidigung vorkam, f~hrt uns zur Hypothese, dab die Operation ein enthemmender Faktor beim Anfall des Innenohres zu Aspergillus bildet.

Mucoepidermoidtumor, eingeschlossen in einen Parotislymphknoten

SummaryFirst report on a mucoepidermoid tumor arosen within a parotid lymphnode, as a result of a malformation.ZusammenfassungErster Bericht über einen als Resultat einer Fehlbildung primär innerhalb eines Parotislymphknotens entstandenen Mucoepidermoidtumor.

Sofortige Rekonstruktion der frakturierten Stirnhöhlenvorderwand — Vorgehen und Verlaufskontrolle

Summary701 cases of traumatic lesions of the facial soft tissues and facial bones were treated within 5 years at the Marburg University ENT Clinic. In 68 cases fractures of the anterior wall of the frontal sinus — often in combination with posterior wall-, rhinobasis- and other fractures were found.In all these cases, as early as possible after the trauma, in an often long time consumin procedure, the anterior wall of the frontal sinus was reconstructed immediately. Reconstruction was performed by wiring the osseus fragments using even particles down to a size of one squarecentimeter. In no case, even in cerebrospinal liquorrhoea and open brain damage, any complications — as inflammation or rejection of bone particles — have occurred. The excellent cosmetic results of this immediate reconstruction are lasting now up to 5 years.Bone scintigrams with TC 99 show that these bone particles from the desmocranium undergo a certain degree of transformation and are integrated again into the cranial bones without much resorption.

Multiple maligne Tumoren bei Patienten mit Larynx-Karzinomen

SummaryOf 496 patients with laryngeal cancer, 45 developed cancer in another organ. In seven patients, triple primary tumours were detected. Multiple malignant tumours in the region of the upper respiratory and alimentary tracts were frequent, especially noticeable was the combination larynx and lung tumours. The differential diagnosis between primary multiple cancers and metastasis, which is often difficult, shall be discussed. The prognosis of the double cancer is bad, since the second tumours are diagnosed late in the patients, who are usually very old. Of patients, who were free of the first cancers during the five years limit, each fifth later developed a new cancer. This indicates carrying out the postsurgery examination beyond the five years limit.