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Wiegand S.,Justus Liebig University | Sesterhenn A.M.,Justus Liebig University | Zimmermann A.P.,Justus Liebig University | Strassmann G.,UKGM | And 2 more authors.
Anticancer Research | Year: 2013

Background: Surgical treatment remains the mainstay therapy for recurrence of head and neck cancer after previous radiotherapy. In inoperable cases, interstitial high-dose rate brachytherapy is a treatment option for local dose escalation. Patients and Methods: A retrospective analysis of all patients who were treated solely with brachytherapy for advanced non-resectable recurrences of squamous cell carcinomas of the head and neck and who previously received radiotherapy was performed. Results: A total of 12 patients with advanced recurrences were treated with interstitial brachytherapy with a fraction dose of 2-3 Gy and a total focal dose of 20-33 Gy. The shortest survival after brachytherapy was 4 weeks. The longest clinical course without evidence of local recurrence is 4 years and 11 months. Conclusion: In selected cases brachytherapy can be used as the last-line or palliative therapy for patients with advanced recurrence head and neck carcinomas. Possible complications and the reduction of quality of life due to tracheostomy should be considered.

Mandapathil M.,University of Marburg | Greene B.,University of Marburg | Wilhelm T.,Head Neck and Facial Plastic Surgery
European Archives of Oto-Rhino-Laryngology | Year: 2015

The transoral resection of pharyngeal and laryngeal tumors is challenging due to their location in a narrow anatomic space. In this study, the visualization and resection in the area of the pharynx and larynx using a novel computer-assisted flexible endoscopic robotic system are evaluated. The Medrobotics® Flex® System (Medrobotics Corp., Raynham, MA, USA) is an operator-controlled flexible endoscope robotic system that includes a flexible endoscope and computer-assisted controllers, with two accessory channels for the use of compatible, 3.5 mm flexible instruments. In six human cadavers, four basic procedures (tonsillectomy, base of tongue resection, hemi-epiglottectomy and resection of false vocal cords) were performed bilaterally by two surgeons. Success in appropriate visualization of the target structure and resection was documented. The driving and resection time was determined for each procedure. An appropriate exposure and resection within the pharynx and larynx was achieved in all cases. Both surgeons experienced a learning curve in driving the system and performing the procedures. The Medrobotics Flex® system is a promising tool for transoral resections within the pharynx and larynx. Good visualization, access, and resectability are hereby clear advantages of the system compared to commonly used systems. © 2014, Springer-Verlag Berlin Heidelberg.

Wilhelm T.,Head Neck and Facial Plastic Surgery | Metzig A.,Visceral
Surgical Endoscopy | Year: 2010

Background: The transoral endoscopic approach for thyroid surgery was based on a previous attempt to reach the thyroid gland by an axilloscope. In contrast to this single-port access, endoscopic minimally invasive thyroidectomy (eMIT) uses three access points (sublingual and bivestibular). This results in a sufficient triangulation of instruments, making surgical procedures in the anterior neck region possible. Methods: The idea and development of the eMIT technique are described in detail. Anatomic studies, the development of the surgical access in a cadaver study, and the animal study for safety and feasibility of this transoral endoscopic approach for surgery of the anterior neck are outlined. Also, the foundations and ethical aspects are addressed in the context of developing a surgical innovation, which resulted in the first clinical application of this technique in humans. Results: The preclinical studies regarding endoscopic minimally invasive thyroidectomy proofed feasibility in a human cadaver studies as well as safety in a short-time survival animal study. The first clinical application in a 53-year old patient was successful without any significant complications; expected benefits (no postoperative pain or dysphagia, no visible scar) could be demonstrated. Conclusions: The eMIT technique represents a promising new surgical approach for endoscopic surgery in the anterior neck region. The whole development was based on principles for surgical innovation published after the authors' preclinical studies. At this writing, after an initial clinical study with humans, the time has come to compare this new technique with other endoscopic and minimally invasive approaches in a prospective randomized multicenter trial. © 2010 Springer Science+Business Media, LLC.

Wiegand S.,Justus Liebig University | Ott A.,Justus Liebig University | Zimmermann A.P.,Justus Liebig University | Wilhelm T.,Head Neck and Facial Plastic Surgery | And 2 more authors.
Lymphatic Research and Biology | Year: 2013

Background: The head and neck region is the most common site for lymphatic malformations. The aim of the present study was to analyze the exact localizations of lymphatic malformations of the neck. Methods and Results: The patients' charts of 48 patients with lymphatic malformations of the neck were retrospectively analyzed regarding gender, age at diagnosis, age at initial presentation, morphologic type, size, and localization. The median age of the patients at presentation was 11.9 years. Macrocystic malformations were observed in 13 patients (27%), mainly in the lateral neck. Microcystic lesions occurred in 22 patients (46%), predominantly in the floor of mouth. Mixed lymphatic malformations occurred in 13 patients (27%) without a preferred localization. The morbidity of patients with microcystic and mixed lesions was higher than of patients with macrocystic lymphatic malformations. Conclusion: The cause for the different localization of microcystic and macrocystic lymphatic malformations is still not clarified. One reason may is the different structure of the surrounding connective tissue, which is compact in the floor of mouth and loose in the neck lateral neck so that macrocystic cysts can arise. Maybe both types of malformation have a different etiology. However, this will have to be clarified in further studies. © 2013, Mary Ann Liebert, Inc.

Teymoortash A.,University of Marburg | Bohne F.,University of Marburg | Kissing L.,University of Marburg | Daniel H.,University of Marburg | And 4 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2016

There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien–Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not significantly differ in both age groups. Disease-free and overall survival showed no significant differences for the two age groups by the Kaplan–Meier analysis (p = 0.66 and 0.08, respectively). Total laryngectomy in combination with neck dissection can be considered in elderly patients with satisfactory oncological and surgical outcome. © 2016, Springer-Verlag Berlin Heidelberg.

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