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Wilhelm T.,Head Neck and Facial Plastic Surgery | Stelzer T.,Head Neck and Facial Plastic Surgery | Hagen R.,University of Würzburg
Ear, Nose and Throat Journal | Year: 2016

Involvement of the middle ear after viral infections of the upper airways may lead to serous otitis media with effusion in the absence of bacterial infection. This can be accompanied by a concomitant shading of the mastoid air cells, which could manifest as a reduced opacity on computed tomography (CT) in the absence of a history of chronic mastoiditis or acute inflammatory signs. This can lead to a subsequent impairment of inner ear function. CT scans reveal an extended pneumatization of the temporal bones in affected patients. Inner ear hearing impairment can probably be attributed to a concomitant labyrinthine reaction-the so-called toxic inner ear lesion. If no remission occurs within 5 days after initial conservative treatment (paracentesis or hemorrheologic infusions), surgical treatment with a mastoidectomy can accelerate hearing restoration. We conducted a retrospective, nonrandomized study of short- and long-term hearing outcomes in patients with a toxic inner ear lesion who had been treated with conservative measures alone (CONS group) or with surgery (SURG group) in a tertiary care referral center. Our study group was made up of 52 consecutively presenting patients (57 ears) who had been seen over a 10-year period; there were 20 patients (21 ears) in the CONS group and 32 patients (36 ears) in the SURG group. Initially, 15 CONS patients (75%) and 18 SURG patients (56%) complained of dizziness or a balance disorder. The initial averaged sensorineural hearing loss (over 0.5, 1.0, 2.0, and 3.0 kHz) was 32.4 ± 15.6 dB in the CONS group and 35.4 ± 12.0 dB in the SURG group. At follow-up (mean: 31.7 mo), the SURG group experienced a significantly greater improvement in hearing (p = 0.025). We conclude that patients with viral otitis media and concomitant noninflammatory mastoiditis with impairment of inner ear function (sensorineural hearing loss) experience a better hearing outcome when a mastoidectomy is performed during primary treatment. © 2016 Vendome Group, LLC All rights reserved.


Wilhelm T.,Head Neck and Facial Plastic Surgery | Kruger J.,Head Neck and Facial Plastic Surgery
Ultrasound in Medicine and Biology | Year: 2011

During the development of a transoral endoscopic, minimally invasive approach for thyroidectomy, the question arose as to how the distances of the submandibular gland (SG)-hyoid bone (HB)-thyroid gland (TG) change in differing head positions and how the TG itself changes shape. In a prospective, two-armed ultrasound study we studied 20 healthy volunteers each, all with no history of neck surgery or thyroid disease. Distances were measured in normal, reclined and "reclined with open mouth" positions. We found no remarkable differences and the distances were comparable with conventional open or minimally invasive thyroidectomy approaches. The TG lengthened significantly during reclination. This may result in a difficult preparation in the region of the suspensory ligament and may therefore increase the rate of postoperative vocal cord palsy caused by stretching of the recurrent laryngeal nerve. A supine flat position may minimize the risk of this postoperative complication of thyroidectomy. © 2011 World Federation for Ultrasound in Medicine & Biology.


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.


Teymoortash A.,University of Marburg | Rassow S.,University of Marburg | Bohne F.,University of Marburg | Wilhelm T.,Head Neck and Facial Plastic Surgery | Hoch S.,University of Marburg
International Journal of Oral and Maxillofacial Surgery | Year: 2016

The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control. © 2015 International Association of Oral and Maxillofacial Surgeons.


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.


Wilhelm T.,Head Neck and Facial Plastic Surgery | Metzig A.,Visceral
World Journal of Surgery | Year: 2011

Background: We have developed a new approach for endoscopic minimally invasive thyroidectomy (eMIT) in anatomical studies. Safety and feasibility were demonstrated in an animal study and then the eMIT technique was applied for the first time successfully in humans on the 18 March 2009. Methods: In a prospective study, we performed this eMIT technique on eight patients suffering from nodular change of the thyroid gland. All patients were evaluated regarding recurrent laryngeal nerve function, intra- and postoperative complications, and postoperative outcome, particularly with respect to swallowing disorders. Results: A total thyroidectomy and a partial resection were performed in four cases each. In three cases, a conversion to open surgery was necessary due to specimen size. No local infection at the incision site or within the cervical spaces occurred within the direct postoperative course. No intraoperative bleeding necessitating conversion to open surgery was observed. In one case, a permanent palsy of the right recurrent laryngeal nerve was noted. Voice function and breathing were not affected. Paresthesia of the mental nerve did not occur in all patients and in those in which it did occur, it resolved within 3 weeks. Mean follow-up time was 10.9 months. Conclusions: The experimental development of the eMIT technique has led to its first clinical application in humans. In this prospective proof-of-concept study in humans, the thyroid gland was reached via the transoral endoscopic approach in an anatomically defined layer without any relevant damage to vessels. Limitations to this technique are determined by specimen volume (up to 30 ml) and nodule size (up to 20 mm). © 2010 Société Internationale de Chirurgie.


Wilhelm T.,Head Neck and Facial Plastic Surgery | Klemm W.,ELK Berlin Chest Hospital | Leschber G.,ELK Berlin Chest Hospital | Harlaar J.J.,Rotterdam University | And 3 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: In recent years, several surgical disciplines adopted endoscopic techniques. Presently, natural orifice approaches are under exploration to reduce surgical access trauma. We have developed a trans-oral endoscopic approach for endoscopic mediastinal surgery and have tested this new technique in preclinical studies for feasibility and safety. Methods: We conducted an experimental anatomical study in fresh-frozen cadavers. By a midline, sublingual incision, we placed an optical scissor through a 6.0-mm trocar in the pretracheal region and created a working space; two additional trocars were placed by bi-vestibular incisions in the oral cavity. We visualized and followed the trachea down to the main bronchi. Paratracheal and subcarinal lymph nodes were resected bilaterally; the specimen could be removed through the midline channel. In an additional animal study in pigs, we tested the feasibility and safety for this surgical approach. Anatomical dissection allowed an estimate of collateral damage. Results: In all cases, we could reach the target region endoscopically, and no conversion was necessary. Landmarks (the brachiocervical trunk, the azygos vein, and the pulmonary artery) were visualized easily and kept intact. A working space in the mediastinum could be established by the insufflation of air at 6-8mmHg. It was possible to harvest the specimen through the midline channel. Anatomical dissection of the cervical access route as well as of the mediastinal region showed no collateral damage. In the animal study, we encountered seroma of the surgical field due to the conditions of the animal model. The other outcomes with respect to pain and food intake were normal until the third postoperative day. No local infections occurred. Intraoperative gas exchange was normal and was not influenced by CO 2 insufflation with respect to blood gas analysis. Conclusion: These preclinical studies showed that the mediastinum could be reached by a trans-oral endoscopic approach, based on natural orifice surgery. Complete compartment resection of the paratracheal and subcarinal lymph node stations was possible in a well-defined and clearly visible working space. This approach may enhance the extent of mediastinal resections in oncologic surgery. © 2010 European Association for Cardio-Thoracic Surgery.


PubMed | University of Marburg and Head Neck and Facial Plastic Surgery
Type: Journal Article | Journal: International journal of oral and maxillofacial surgery | Year: 2016

The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control.


Involvement of the middle ear after viral infections of the upper airways may lead to serous otitis media with effusion in the absence of bacterial infection. This can be accompanied by a concomitant shading of the mastoid air cells, which could manifest as a reduced opacity on computed tomography (CT) in the absence of a history of chronic mastoiditis or acute inflammatory signs. This can lead to a subsequent impairment of inner ear function. CT scans reveal an extended pneumatization of the temporal bones in affected patients. Inner ear hearing impairment can probably be attributed to a concomitant labyrinthine reaction-the so-called toxic inner ear lesion. If no remission occurs within 5 days after initial conservative treatment (paracentesis or hemorrheologic infusions), surgical treatment with a mastoidectomy can accelerate hearing restoration. We conducted a retrospective, nonrandomized study of short- and long-term hearing outcomes in patients with a toxic inner ear lesion who had been treated with conservative measures alone (CONS group) or with surgery (SURG group) in a tertiary care referral center. Our study group was made up of 52 consecutively presenting patients (57 ears) who had been seen over a 10-year period; there were 20 patients (21 ears) in the CONS group and 32 patients (36 ears) in the SURG group. Initially, 15 CONS patients (75%) and 18 SURG patients (56%) complained of dizziness or a balance disorder. The initial averaged sensorineural hearing loss (over 0.5, 1.0, 2.0, and 3.0 kHz) was 32.4 15.6 dB in the CONS group and 35.4 12.0 dB in the SURG group. At follow-up (mean: 31.7 mo), the SURG group experienced a significantly greater improvement in hearing (p = 0.025). We conclude that patients with viral otitis media and concomitant noninflammatory mastoiditis with impairment of inner ear function (sensorineural hearing loss) experience a better hearing outcome when a mastoidectomy is performed during primary treatment.

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