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ZusammenfassungDie Aktualisierung der Leitlinie war ein wichtiger Schritt, um mit zunehmender Verbreitung der Sialendoskopie und anderer minimalinvasiver Verfahren Behandlungsstandards zur Therapie der Sialolithiasis und der Speichelgangstenosen zu definieren. Im Rahmen der Aktualisierung wurden die diagnostischen und therapeutischen Algorithmen dem aktuellen Wissensstand angepasst. Sie werden in diesem Artikel in verkürzter Form mit Betonung der praxisrelevanten konservativen Therapieoptionen wiedergegeben.

The update of this guideline was an important step to define standards for the use of sialendoscopy and other emerging minimally invasive techniques for the therapy of sialolithiasis and other obstructive salivary gland diseases. The current actualization was necessary to adapt the diagnostic and therapeutic algorithms to the current scientific knowledge. In this article they are presented in a shortened version with a focus on conservative therapeutic measures which are especially relevant for daily practice.Die Aktualisierung der Leitlinie war ein wichtiger Schritt, um mit zunehmender Verbreitung der Sialendoskopie und anderer minimalinvasiver Verfahren Behandlungsstandards zur Therapie der Sialolithiasis und der Speichelgangstenosen zu definieren. Im Rahmen der Aktualisierung wurden die diagnostischen und therapeutischen Algorithmen dem aktuellen Wissensstand angepasst. Sie werden in diesem Artikel in verkürzter Form mit Betonung der praxisrelevanten konservativen Therapieoptionen wiedergegeben.

BACKGROUND Patients presenting with a cystic lateral neck lesion may present diagnostic challenges against a backdrop of varied non-malignant and malignant etiologies. PATIENTS A total of 133 consecutive cases who underwent cystic neck tumor removal were evaluated for etiology and diagnostic procedure in order to develop an algorithm for therapeutic efficiency. RESULTS In 92 of 133 cases, a non-malignant tumor was diagnosed. In 41 cases, malignant lymphadenopathy was found. In cases with malignancy, males (p=0.001) and the elderly (p=0.001) were affected more frequently. Primary tumors were discovered by pan-endoscopy before neck surgery or in a second pan-endoscopy (with tonsillectomy and mapping biopsies) in cases with histologically confirmed squamous cell carcinoma. During intraoperative frozen-section evaluation (40 cases), a total of 30 patients underwent neck dissection during the first neck operation. CONCLUSION In patients older than 40 years who present with cystic neck lesions, we recommend pan-endoscopy and intraoperative frozen section in cases where malignancy is suspected in order to avoid secondary neck dissections and delays in therapy.

The retrograde approach (RP) to nerve identification is a method seldom used in parotid surgery. A systematic review comparing this method to the standard anterograde approach (AP) with respect to facial nerve palsy (FNP) does not currently exist. In a meta-analysis according to the PRISMA statement, eight publications, including one randomized controlled trial, were selected. The primary aim was to compare the temporary and permanent FNP resulting from the two dissection methods. Facial nerve function was graded according to the House–Brackmann Scale. The secondary goal was a comparison of the cut–suture times (CST), the volume of healthy tissue (VHT) dissected, the rates of postoperative hematoma (PH), and postoperative infection (PI). Temporary FNP was noted in 18.2% in the RP group as well as in 34.4% in the AP group. Permanent FNP occurred in 0.9% RPs and 2.4% APs. According to the mixed-effect logistic regression model, there was no significant difference between the two groups in the pooled odds ratio (OR) for either temporary [OR 2.64, 95% confidence interval (CI) 0.97–7.21] or permanent FNP (OR 4.31, 95% CI 0.44–42.28). The CST was significantly shorter in the RP group (p = 0.005), with a significantly smaller VHT dissected (p

Objective Patients presenting with a cervical mass are common for head and neck specialists and present a diagnostic challenge against the backdrop of a wide variety of etiologies. The objective of the present study was to evaluate the significance of a mass in the supraclavicular fossa for etiology, diagnostic procedure, and therapy. Study design Individual retrospective cohort study. Methods We reviewed the data of 211 consecutive cases (116 male, 95 female) with excisional biopsy or tumor removal of a supraclavicular mass. Results In 202 of 211 cases, a biopsy was taken from a lymph node. In 182 biopsies, a malignant lymphadenopathy was found (117 metastases, 65 malignant lymphoma). The histologic findings of metastatic diseases were adenocarcinoma (48), followed by squamous cell carcinoma (22). The majority of primary carcinomas were located below the clavicle (94), in the lung (32), in the breast (29), and in the head and neck region (18). In the left supraclavicular fossa, only metastases of the genitourinary tract were significantly more frequent (16 of 17). In nonmalignant tumors (29), tuberculosis (11) was most prevalent. In 79% of biopsies, the neck mass was the first manifestation of the disease. Conclusion The location of a cervical mass in the supraclavicular fossa provides a strong indication of malignancy. A biopsy is mandatory in the majority of patients presenting with a supraclavicular mass. In cases of metastatic disease, the location of a cervical mass helps identify the primary site. Histologic findings are essential for further diagnostic steps, therapy, and prognosis. Level of evidence 4. Laryngoscope, 128:646-650, 2018.

Objective Recent studies have suggested that patients with obstructive sleep apnea (OSA) might be affected by olfactory impairment. However, more evidence is needed on the effect that OSA has on the chemical senses (olfaction and gustatory) of these patients, and whether continuous positive airway pressure (CPAP) treatment might help to reverse possible impairment. Methods A prospective study was conducted with 44 OSA patients (17 female and 27 male, mean age 54 ± 9.9 years) who were diagnosed via polysomnography and eligible for CPAP treatment. Orthonasal olfactory and gustatory function was measured with the extended Sniffin' Sticks test battery and "taste strips," respectively, before and after CPAP treatment. Results Baseline olfaction was decreased in OSA patients and after CPAP therapy olfactory scores (odor threshold-discrimination-identification score [TDI]: baseline 29.4 ± 4.11 after CPAP 32.3 ± 4.82; p = 0.001; odor threshold [THR]: baseline 5.28 ± 1.69 after CPAP 6.78 ± 2.61; p = 0.000; odor identification [ID]: baseline 12.9 ± 1.95 after CPAP 13.6 ± 1.33; p = 0.013) improved significantly. In contrast, neither baseline taste function in OSA patients nor gustatory function after treatment seemed to be affected. Conclusion Orthonasal olfactory function in patients with OSA improves under CPAP therapy; however, gustatory function is not impaired in OSA patients.

In the original publication of the article, first name and last names of all authors were swapped.

Objective Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours. Methods We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%). Results Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma. Conclusion The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10–20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.

Objective: A group of patients with recurrent parotitis had clinical symptoms suggesting an obstruction of the glandular duct system, though without any signs of sialoliths or other ductal pathologies. Methods: Clinical and radiological data of five patients with recurrent obstructive parotitis and long-standing definite bruxism were reviewed retrospectively. Ultrasonography, MRI, and sialendoscopy were performed for evaluation of ductal pathologies as the cause of glandular obstruction. Electromyography was used to evaluate the activity of masticatory muscles in all patients. The parotitis was treated with injection of botulinum toxin into the buccinator muscle. Results: Dilatation of the Stensen's duct proximal to the area of the buccinator muscle was shown in radiological examination with no evidence of ductal strictures. Electromyography revealed an abnormal activity of the ipsilateral buccinator muscle. All patients were free of disease after treatment of the buccinator muscle. Discussion: Bruxism should be considered as a possible cause of recurrent parotitis.

Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility.After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed.The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (20 mm in diameter) and current surgical instruments still did not match the requirement of this technique.This study demonstrated that the transoral approach of eMIT is anatomically safer and more feasible than that of TOPP.

Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (p > 0.001). AOI (grade 2) displayed the same properties in the middle section (p

Viral infections of the upper respiratory airways can lead to a delayed viral otitis media (VOM) caused by a diffusion of viruses/virus particles through the round window membrane and resulting in sensorineural hearing loss. The treatment of choice is immediate paracentesis, evacuation of all fluids from the middle ear cavity, and haemorrheological infusions. However, in some cases, persistent symptoms may be an indication for a surgical approach using mastoidectomy. In high-resolution computed tomography, an extended small-sized pneumatisation of the mastoid cells with complete shading was found in these non-responsive cases. Therefore, a direct means of inner ear affliction through weak parts of the labyrinthine bone may be hypothesised. Patients suffering from a toxic inner ear lesion (TIEL) following a common cold, treated over a 10-year period in a Tertiary Care Centre (N = 52, 57 ears), were identified and the morphological characteristics of the temporal bones of affected patients were examined by means of high-resolution computed tomography (hrCT). The findings were compared with a matched control group of 64 normal ears (CONT). Measurements included the grade of pneumatisation, distances within the temporal bones and Hounsfield units (HU) at defined anatomical structures. In the TIEL group, we found a small-sized pneumatisation in 79.4 % and a medium-sized pneumatisation in 10.9 %, thus differing from the CONT group and the literature data. Thickness of the bone wall of the lateral semicircular canal (LSC) and distances within the aditus ad antrum were significantly reduced in the TIEL group. HU's were markedly lower in the TIEL group at the precochlea, the LSC, and dorsolateral to the promentia of the LSC. There was a correlation between the HU's at the prominentia of the LSC and the hearing loss (p = 0.002). Persisting interosseous globuli, as described in 1897 by Paul Manasse, form an osseochondral network within the otic capsule and may be responsible for a direct means of toxic inner ear infection. The CT-morphometric results support this thesis. In the group of these patients (TIEL) a CT-scan and in non-responders to conservative treatment a surgical approach by mastoidectomy is recommended.

Die Hyperplasie der Tonsilla pharyngea ist dann als Erkrankung anzusehen, wenn sie im Sinne eines Adenoid-Syndroms durch mechanische Verlegung und/oder chronisch-entzundliche Veranderungen des Nasenrachens Krankheitssymptome hervorruft. Der folgende Beitrag beschreibt die Diagnostik, Differenzialdiagnosen und den aktuellen Stand der Therapie.

Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad).Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery[0]or thereafter[1]). The findings at resection site and pain were measured.Results. 869 patients were included (183TEmic; 686TEtrad). PTH requiring RTT was not seen in theTEmicgroup on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In theTEmicgroup, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates forTEtradwere as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p>0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p=0.007).Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in theTEmicgroup. Benefit forTEmicwas observed in high-volume and long experienced surgeons.

Transverse beam coupling impedance is a source of beam instabilities that limits the machine performance in circular accelerators. Several beam based techniques have been used to measure the transverse impedance of an accelerator, usually based on the optics distortion produced by the impedance source itself. Beam position monitor turn-by-turn analysis for impedance characterization has been usually employed in large circumference machines, while synchrotron light sources have mainly used slow orbit based techniques. Instead, the work presented in this paper uses for the first time turn-by-turn data at ALBA to advance the measurement technique into the range of the typically small impedance values of modern light sources. We have measured local impedance contributions through the observation of phase advance versus bunch charge using the betatron oscillations excited with a fast dipole kicker. The ALBA beam position monitor system and the precision of the turn-by-turn analysis allowed to characterize the main sources of transverse impedance, in good agreement with the model values, including the impedance of an in-vacuum undulator.

The representations of the skewed normal distribution given in Propositions 1–4 in Genton (Ed., 2004) are considered here from a unified geometric point of view and are, based upon this, generalized in two respects. On the one hand, the four concrete representations motivate us for a unified and much more general algebraic–geometric representation of the skewed normal distribution (Theorems 1 and 2 as well as Remarks 2 and 3); on the other hand, the mentioned representations are generalized to the elliptically contoured case (Propositions and Corollaries 1c–4c).