Ralph M. W. Rödel

Impact of Anterior Commissure Involvement on Local Control of Early Glottic Carcinoma Treated by Laser Microresection

Objectives: To analyze the impact of anterior commissure involvement on local control, survival, and laryngeal preservation in patients with early glottic cancer (pT1a–pT2a) treated with unimodality laser microsurgical resection.

ENDOSCOPIC LASER SURGERY OF EARLY GLOTTIC CANCER : INVOLVEMENT OF THE ANTERIOR COMMISSURE

Early glottic cancer can be cured with transoral laser resection, but in cases with anterior commissure involvement, there is still controversy concerning the best treatment modality.

Human Cortical Motor Representation of the Larynx as Assessed by Transcranial Magnetic Stimulation (TMS)

Objectives: To analyze characteristic features and details on motor‐evoked potentials (MEPs) of the cricothyroid and vocalis muscles from single‐pulse cortical transcranial magnetic stimulation (TMS) in normal subjects to characterize cortical motor representation of laryngeal muscles.

Retrospective analysis of 35 patients with acinic cell carcinoma of the parotid gland

PURPOSE This retrospective study evaluated data pertaining to the history, symptoms, treatment, and prognosis of a series of patients treated for acinic cell carcinoma (ACC). PATIENTS AND METHODS Data were based on the records of 35 patients. Follow-up was done by analyzing their records and contacting the referring doctors. RESULTS In 71% of the ACC patients, painful swelling of the lateral region of the face was the main symptom. Facial paralysis occurred in 11% of cases before treatment. Tumor recurrence after therapy was noted in 42% of cases. Highly differentiated ACC was the most frequent histologic subtype (74%). The grade of differentiation of the tumor was decisive for the prognosis. Highly differentiated ACC had a better prognosis (2 years overall survival, 100%; 5 years overall survival, 83%; 10 years overall survival, 50%) than lowly differentiated tumors (2 years overall survival, 70%; 5 years overall survival, 50%; 10 years overall survival, 30%). CONCLUSION ACC is a rare tumor located mainly in the parotid gland that is characterized by some special attributes. Surgery is the therapy of choice. Prognosis depends mainly on the histologic subtype.

Tongue Representation in the Lateral Cortical Motor Region of the Human Brain as Assessed by Transcranial Magnetic Stimulation

Motor evoked potentials (MEPs) of the lingual muscles elicited by focal cortical transcranial magnetic stimulation (TMS) with a figure 8-shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface. Bilateral reproducible responses could be observed at coil positions mostly varying from approximately 6 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses were obtained at a mean stimulus position of about 11 cm lateral and 3 cm anterior to the vertex with similar onset latencies, but with significantly higher amplitudes on the contralateral side (3.5 ± 1.9 mV, 9.5 ± 1.1 ms contralateral; 2.6 ± 1.5 mV, 9.7 ± 1.0 ms ipsilateral). Comparing our data on the orbicularis oculi muscle with the results obtained on lower lip muscles, we found a considerable overlap of those coil positions from which reproducible MEPs could be elicited in both groups of target muscles, but the lingual area was placed more laterally. Thus, a statistically significant separation of the cortical representation areas of lingual and lower lip mimetic muscles is possible by focal cortical TMS, reflecting somatotopic organization of the face-associated motor cortex.

Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer.

Background and Purpose:Transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy.Patients and Methods:From 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H&N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test.Results:After a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL.Conclusion:TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL.Hintergrund und Ziel:Lasermikrochirurgie und adjuvante Strahlentherapie sind in der Klinik der Autoren etablierte Behandlungsmethoden lokal fortgeschrittener Larynxkarzinome mit guten onkologischen Ergebnissen und einer hohe Rate an Organerhalt. Bei organerhaltender Therapie sind funktionelle Einschränkungen oft unvermeidbar. Neben den onkologischen Ergebnissen sollten in dieser Studie das objektive Ausmaß solcher Einschränkungen und deren subjektive Wertung durch die Patienten untersucht werden.Patienten und Methodik:Von 1994 bis 2006 wurden 39 Patienten (zehn UICC-Stadium III, 29 UICC-Stadium IVA/B) mit lokal fortgeschrittenen Larynxkarzinomen mittels Lasermikrochirurgie und adjuvanter Strahlentherapie behandelt. Bei zehn Patienten erfolgte im Rahmen der Nachsorge in den Jahren 2006/2007 eine Erhebung von Lebensqualitätsdaten. Die Schluckfunktion wurde flexibel endoskopisch überprüft, die Atmung durch eine Bodyplethysmographie. Die Objektivierung der Stimmqualität erfolgte durch das Göttinger Heiserkeitsdiagramm.Ergebnisse:Nach einer medianen Beobachtungsdauer von 80,8 Monaten betrugen die 5-Jahres-Überlebensrate 46,8% und die lokoregionale Kontrollrate 76,5%. Eine Salvage-Laryngektomie bei Lokalrezidiv erhielten vier Patienten, so dass im Verlauf eine 89,7%ige Rate an Larynxerhalt erreicht werden konnte. Bei der objektiven Untersuchung der Funktionseinschränkungen zeigte sich bei fünf Patienten eine gelegentliche Aspiration bei kräftigem Hustenreflex. Die übrigen fünf Patienten wiesen keine Schluckstörung auf. Eine Normalstimme lag bei keinem Patienten vor. Es bestand jedoch keine signifikante Korrelation der objektivierten Funktionsstörungen mit den Lebensqualitätsfunktionsskalen: Subjektiv schätzen die Patienten ihre Lebensqualität als gut ein.Schlussfolgerung:Lasermikrochirurgie und adjuvante Strahlentherapie sind eine Therapieoption für lokal fortgeschrittene Larynxkarzinome, die neben guten onkologischen Ergebnissen eine hohe Rate an Organerhalt ermöglicht. Die Patienten schätzen ihre Lebensqualität im weiteren Verlauf subjektiv als gut ein. Die tatsächlichen funktionellen Einschränkungen werden durch die Lebensqualitätsdaten allerdings nicht sicher abgebildet. Daher ist zur objektiven Beurteilung posttherapeutischer Funktionsergebnisse die klinische Erhebung funktioneller Befunde erforderlich.

Transcranial Cortical Magnetic Stimulation of Lower-Lip Mimetic Muscles: Effect of Coil Position on Motor Evoked Potentials

The effect of the coil position along the interaural line on motor evoked potentials of lower-lip muscles to cortical transcranial magnetic stimulation was investigated in 17 healthy subjects. Using a figure-8-shaped coil, we observed ipsi- and contralateral middle-latency motor evoked potentials in all subjects, when the coil was centered within an area between 4 and 13 cm lateral to the vertex. Maximal responses (mean amplitude 1.4 ± 0.8 mV contralateral, 0.7 ± 0.5 mV ipsilateral) with shortest mean onset latencies (11.3 ± 1.6 ms contralateral, 12.1 ± 2.8 ms ipsilateral) were obtained at a stimulus position of 10 cm lateral to the vertex. Cortical maps of mean amplitude and mean response duration showed inverse U-shaped configuration. Furthermore, we observed an additional polyphasic and mostly bilateral response in 16 of the 17 subjects.

Motor Potentials of Lower-Lip Mimetic Muscles and Distal Arm Muscles to Cortical Transcranial Magnetic Stimulation: The Possibility of One-Dimensional Separation of Two Cortical Representation Areas

The cortical representation of the abductor pollicis brevis muscle (APB) was investigated by transcranial magnetic stimulation (TMS) along the interaural line on the head surface in 17 healthy subjects. Comparing amplitudes of motor evoked potentials (MEPs) with those obtained by cortical TMS of lower-lip muscles, we found a considerable overlap between the areas from which reproducible MEPs of APB and lower-lip muscles could be elicited. However, there was a statistically significant separation of the two areas, the APB area being placed more medially. With regard to short examination procedures it can be concluded that a separation between distal arm and facial muscles is possible not only by two-dimensional cortical mapping procedures, but also by one-dimensional cortical TMS.

Cortical Transcranial Magnetic Stimulation of the Frontalis Muscle: Characteristic Features and Details on Motor-Evoked Potentials of the Forehead

The effect of coil position on the head surface along the interaural line on motor-evoked potentials (MEPs) of the frontalis muscle due to cortical transcranial magnetic stimulation was investigated in 16 healthy subjects. Bilateral reproducible responses could be observed in all subjects investigated at coil positions varying from 2 to 12 cm lateral to the vertex. MEP amplitudes of the frontalis muscle offered no significant side differences neither in amplitude nor in onset latency. Despite a considerable overlap, a statistically significant separation (p < 0.0001) of the two areas from which reproducible MEPs of upper and lower mimetic muscles could be elicited was evident for the calculated mediolateral center with the frontalis muscle area being placed more medially. Our findings are in accordance with anatomical studies indicating a predominance of corticonuclear descending fibers to lower but not to upper facial motoneurons.