Objective: Various transcranial and transfacial approaches have been described and each claims to provide the best exposure to the anterior skull base. Similarly, each approach claims the best outcomes following the resection of anterior skull base malignancies. We have always advocated a combined neurorhinological approach for the management of paranasal sinus malignancies that infiltrate the skull base, such as esthesioneuroblastomas. Materials and methods: At the outset, the technique was developed on cadaver specimens, imitating the limitations that might be imposed in the real-life situation when undertaking endoscopic sinus surgery. Additional exposure of the anterior cerebral fossa was achieved using a classical bifrontal approach. Starting with endoscopic or microscopic unroofing of the ethmoids, all relevant landmarks were identified. The frontal, sphenoid, and maxillary sinuses were then opened using endoscopic techniques. Results: The dissections proved that a broad exposure of the anterior skull base could be combined with clear endoscopic visualization of the nasal cavity and of all the paranasal sinuses from above. This facilitated complete eradication of lesions from the sinuses cavities, their walls, and the intracranial tumor. Discussion: The combined neurorhinosurgical transcranial approach to the anterior skull base and nasal and paranasal sinuses, avoiding trans-facial approaches, enables a multidiciplinary team to resect malignant tumors of the anterior skull base directly without unnecessary destruction of facial structures. It appears to provide better access than other more destructive methods like midfacial degloving or subfrontal approaches. Our single-stage approach also facilitates safe and effective reconstruction of the skull base. The technique can be employed for tumors of all sizes and is also used for orbital resections and decompression of the optic nerve and chiasma.

Since its introduction endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis (CRS) has been focused on the management of the ethmoids, differentiating between partial and total ethmoidectomy. The classification of the underlying process of ethmoiditis and the selection of the adequate surgical procedure are still open questions. The aim of this investigation was to evaluate a minimally invasive ESS procedure. We present a retrospective analysis of 112 cases of bilateral circumscribed ethmoiditis after partial ethmoidectomy performed by a single surgeon investigated by questionnaires and endoscopic follow-up. A comparison of symptoms and the subjective judgment of the patients before and after surgery showed that postoperative subjective scores of nasal obstruction and rhinorrhea improved in up to 90%, with no distinct differences between primary intervention (n=98) and revision (n=14). Ninety percent of all patients considered surgery successful. Signs of active rhinosinusitis were found in less then 20% of patients after partial ethmoidectomy. This demonstrates that partial ethmoidectomy is an effective treatment for CRS affecting only part of the ethmoid.

Objective: The subjective success of endoscopic sinus surgery (ESS)for chronic rhinosinusitis has been reported mainly after short-term follow-up studies, but may change with increasing time after surgery. We assessed in a retrospective study the medium-term clinical outcome of ESS as complete ethmoidectomy or pansinus surgery in 208 patients with chronic rhinosinusitis.Patients and methods: The senior author performed the surgeries according to his techniques. We used a questionnaire focusing on nasal obstruction, rhinorrhea, nasal dryness/crusts, sneezing, headache, smell, numbness in cheeks and lips, ear pressure, epiphora, and sore throat. Additionally the subjective influence of sinus surgery on asthma, bronchitis and allergic diseases was evaluated. The mean follow-up was 3.1 years.Results: Overall success was reported by 92% of all patients. Forty-one percent of all patients with complete ethmoidectomy and 32% of all patients with pansinus surgery described complete resolution of complaints. No differences in clinical success rates were noted when comparing primary surgery or revision. A favorable effect was also reported for asthma, bronchitis and allergic diseases.Conclusion: Improvements for nasal symptoms and coexisting complaints are demonstrated with a mean observation period of more than 3 years. The value of ESS is underlined for the treatment of patients with chronic rhinosinusitis.

Professor Dr.med Claus Wilhelm Jansen died in the morning hours on May 23, 2001, 5 days before his 80th birthday (Fig. 1). With respect to his good health during recent years, his death came unexpectedly and shocked his family, the German otorhinolaryngologic community, and many friends in the Politzer Society.FIG. 1.: Claus Wilhelm Jansen, 1921–2001.In Germany, Dr. Jansen held an extraordinary position. What is common in the United States is exceptional in Germany: medical innovations and scientific developments in the field of otorhinolaryngology originating from practicing doctors or private surgical groups. Here, university departments or larger hospital divisions are the traditional bases of clinical research. Dr. Jansen's ear, nose, and throat clinic, which he established in 1952 in the city of Gummersbach, was unique. Born in Cologne on May 28, 1921, he grew up literally in the shadows of the famous domed towers, becoming a decorated athlete in ice hockey and tennis. His medical studies were interrupted by military service in Russia during World War II. Practical work in different hospitals followed, with a specialization in otorhinolaryngology, which he completed in 1952 in Cologne. Parallel to his settlement in private practice, he studied microsurgery of the ear, observing Professor Horst L. Wullstein, who at that time worked in a nearby community hospital at Siegen. Tympanoplasty for chronic otitis media and stapedioplasty for otosclerotic deafness became his fields of interest, in which he soon realized his own new concepts. After a few years, he became a renowned specialist and could base his experience on vast material. His stupendous professional activities were essentially supported by a happy familial privacy, including his wonderful jolly wife Hilde and three charming daughters, who filled his home with joy and music and later presented seven grandchildren to Claus. Between 1969 and 1976, Dr. Jansen organized eight practical courses in otologic microsurgery at his service in Gummersbach, featuring dissection lectures and live color television demonstrations from his operating theater. He was assisted by an outstanding international faculty, consisting among others of David Austin (United States), Geza Jako (United States), Jean Marquet (Belgium), Jacob Sadé (Israel), Gordon D. L. Smyth (Northern Ireland), and Stewart M. Strong (United States). These experts learned Jansen's special combined approach to the middle ear, his “posterior tympanotomy,” and they contributed their own techniques. On the basis of this competent and very friendly cooperation, a working group of interested otosurgeons was established that became the nucleus of the Politzer Society, registered in the United States and introduced to the public at the First International Symposium for Middle Ear Surgery in Davos, Switzerland, in 1976. Claus Jansen was the president of the Politzer Society for a couple of years and organized several Politzer Society meetings, such as in Chicago (1980); Budapest, in affiliation with the World Congress of Otorhinolaryngology (1981); Montreux, Switzerland (1983); and Vienna (1985). Dr. Jansen published many articles in reputable journals, presented excellent films and videotapes at international congresses, and orally contributed to many symposia. He became corresponding or honorary member of the Argentine, Australian, Austrian, Irish, and Swiss otorhinolaryngologic societies, of the Fondation Portmann in Bordeaux, and the Istituto García-Ibañez in Barcelona, and was also a visiting guest professor at Boston University. Between 1983 and 1993, he was lecturer at the University of Mainz, Germany, and was appointed as medical professor by the Minister of Culture and Education in the state of North Rhine-Westphalia. He received the Heermann Prize from the German Society of Otorhinolaryngology–Head and Neck Surgery, a film prize from the American Medical Association, and the Semmelweis Medal from the Hungarian Otorhinolaryngology Society. The particular scientific merits of Dr. Jansen can be summarized by four statements. He was the initiator of the intact canal wall tympanoplasty, published in 1958, which avoided the classic open technique with its persistent radical cavity. His combined endaural-retroauricular approach thus opened opportunities for the reventilation of the retrotympanic spaces and allowed reconstruction of the ossicular chain in its physiologic dimensions, whereas up to this innovation the Types III through V tympanoplasties of Wullstein had reduced the tympanic cavity to a shallow cleft. Another valuable contribution was the introduction of cartilage autografts as the material of choice for the reconstruction both of the posterior canal wall, especially the lateral attic wall, and of parts of the ossicular chain. In 1961, he presented a related report to the World Congress of Oto-Rhino-Laryngology. He also published experiences with homologous and heterologous grafts and even xenografts. From his profound knowledge of chronic otitis media, Jansen always stressed the causative role of tubal dysfunction. In consequence, he added a personal technique of extended bone resection at the tubal orifice to his posterior tympanotomy. He also included endoscopy of the middle ear via the eustachian tube in his diagnostic arsenal. During recent years, Dr. Jansen was fascinated by mini-endoscopy of the inner ear. He devised special fiberoptic devices for the exploration of the vestibule with the hope of identifying morphologic changes of the inner ear structures and of their vascular supply in cases of progressive sensorineural deafness. It is a tragic fate that he died in Gummersbach the very morning when his newest videotape film on endoscopy of the vestibule was presented to the annual conference of the German ENT Society in Hamburg. The Politzer Society and many friends mourn the death of this outstanding personality, who gave a higher profile to middle ear surgery, and who was a vigorous, good-humored speaker at many occasions. Many of us will miss this good companion. Vale bene in excelsis!

Endoscopic surgery of the paranasal sinuses has become popular during recent years, but the endonasal approach into the frontal sinus was only rarely recommended. Using a surgical endoscope with 70° optical deflection, the fenestration of the frontal sinus from below has proved a valuable and safe procedure in more than 500 procedures. The control of complications like osteitis and mucopyoceles, and of foreign bodies and benign tumors has become practical with endoscopic exposure.

On the basis of our experience with a CO2 laser, gained at the ENT Department of the Erlangen University Hospital, an attempt is made to represent the advantages and disadvantages of laser treatment as compared with conventional methods, and to list the indications for its use. Over a period of one year, the CO2 laser was employed through the endoscope in the pharynx, larynx and trachea in a total of 108 patients.