Background Primary squamous cell carcinoma of the parotid gland is a rare but extremely aggressive malignant disease. Clinically, it usually presents as a painless mass. Cases of slowly progressive peripheral facial nerve palsy as the only sign of a malignant neoplasm of the parotid gland are rare and are often confused with Bell's palsy. However, progressive peripheral facial nerve palsies without signs of regeneration should be considered suspicious for malignancy until proven otherwise and require further diagnostic work-up.

Hintergrund Das primäre Plattenepithelkarzinom der Gl. Parotis ist eine seltene jedoch äußerst aggressive maligne Erkrankung. Klinisch präsentiert es sich meist durch eine schmerzlose Raumforderung. Fälle einer langsam progredienten peripheren Fazialisparese als einziges Symptom einer malignen Neoplasie der Glandula Parotis sind selten und werden initial häufig mit einer Bell´schen-Parese verwechselt. Progrediente periphere Fazialisparesen ohne Anzeichen einer Regeneration sind jedoch bis zum Beweis des Gegenteils als malignitätsverdächtig zu werten und bedürfen weiterer Diagnostik.

INTRODUCTION:Primary squamous cell carcinoma of the parotid gland typically presents as a palpable, often painless mass. Peripheral facial palsy as the only sign of malignant neoplasia is rare. In these cases, the diagnosis is regularly confirmed by radiological imaging followed by surgical exploration and biopsy. However, if there is no detection of malignant lesions and no evidence of a tumor, the reluctance to take a biopsy of an unremarkable nerve can lead to misdiagnoses. CASE REPORT:A 40-year-old female patient without medical history presented to our clinic with a complete right-sided peripheral facial palsy that had slowly progressed for 2.5 years. All other otorhinolaryngological examination findings were within normal limits. Magnetic resonance imaging examination of the head and neck and 18-fluorodeoxyglucose positron emission tomography showed unremarkable results. We proceeded with surgical exploration, which revealed no evidence of a tumor and an externally completely unremarkable facial nerve. A biopsy from the main trunk area of the nerve revealed an infiltration by a squamous cell carcinoma. Total parotidectomy with resection and reconstruction of the facial nerve and neck dissection was performed. Considering the absence of a primary tumor and other tumor formations the diagnosis of a completely regressive primary squamous cell carcinoma of the parotid gland was confirmed. CONCLUSION:In conclusion, in the case of slow-onset peripheral facial palsy that persists without signs of recovery, a gadolinium-enhanced MRI should be performed. If imaging is unremarkable and there is no primary tumor detection along the course of the facial nerve, a surgical exploration with biopsy of the facial nerve is necessary.

Fragestellung Blutungskomplikationen nach Tonsillektomie (TE), Adenotonsillektomie (ATE), Tonsillotomie (TT) und Adenotonsillotomie (ATT) dienen als Argument für die stationäre Behandlungsbedürftigkeit. In dieser bundesweiten Studie sollte die Häufigkeit von Blutungen nach stationärer TE, TT, ATE und ATT erfasst und Risikofaktoren hierfür nachgegangen werden.

Aim Bleeding complications following tonsillectomy (TE), adenotonsillectomy (ATE), tonsillotomy (TT) and adenotonsillotomy (ATT) are a principal reason for in-house tonsil surgery. This nationwide German study aimed to evaluate postoperative bleeding and its risk factors after in-house TE, TT, ATE and ATT.

The inpatient care of children after ENT surgery is organized heterogeneously across Germany. In this statement, the working group on Pediatric ENT comments a national survey on the status quo of child care after ENT interventions in German hospitals. The statement should serve as a basis for further interdisciplinary discussion.

Full thickness skin grafting is a common technique for reconstructing defects in the head and neck area. We propose the use of an addition-cured silicone as an individually moulded silicone dressing to keep the vulnerable skin graft in place, prevent shearing forces and create a moist environment. The silicone dressing is applied directly on the graft, using a double cartridge system. The silicone is moulded to the skin graft and hardens quickly, integrating thread knots into its material and creating good adherence to the graft. Charts of 24 patients who had undergone reconstruction with full thickness skin graft from the neck after surgery for skin tumors in the head from November 2017 to October 2020, were reviewed retrospectively to quantify the degree of post-operative graft loss and durability of the dressing. Medical silicone based on venylpolysiloxane is a safe and durable dressing which makes postoperative dressing changes expendable. Trial registration The study was approved by the institutional review board of the Brandenburg state medical association (S 4(bB)/2021).

Zusammenfassung Die stationäre Betreuung von Kindern nach Operationen im HNO-Bereich ist deutschlandweit heterogen organisiert. In dieser Stellungnahme kommentiert die Arbeitsgemeinschaft Pädiatrische HNO-Heilkunde eine nationale Umfrage zum Status quo der Kinderversorgung nach HNO-Eingriffen in deutschen Kliniken. Diese dient als Grundlage für die weitere interdisziplinäre Diskussion.

Purpose: The right choice of dressing after skin grafting, especially in the anatomically complex and aesthetically important head and neck area, is difficult. It is important to have a dressing which is durable and doesn't need a lot of dressing changes. This study introduces a novel, individually moulded silicon dressing; and investigates the number of dressing changes, durability of the dressing and the aesthetic outcome of patients receiving this new type of dressing, in comparison to a control group. Materials and methods: The present retrospective single center controlled case series study reports our experiences using two different types of dressing on patients undergoing full thickness skin grafts in the head during the period 01 May 2016 to 01 May 2020. Data were analysed according to the type of dressing with either a transparent moulded silicone dressing or an established silicone sheet dressing. Results: 52 patients were included in the study. We found no difference in the aesthetic outcome and complication rate (p > 0.05) between the two groups. The number of days until first dressing change after surgery, the number of dressing changes or follow up visits in the outpatient care until complete wound healing, and the overall number of dressing changes were all statistically significantly reduced (p < 0.05). Conclusion: Addition-cured silicone used as a moulded dressing in full thickness skin grafts has longer durability and leads to a significant reduction of dressing changes with equal aesthetic outcome compared to an establishes silicone sheet dressing.

Zusammenfassung Kopf-Hals-Tumoren sind weltweit auf Platz 6 der häufigsten Krebsarten. Neben den klassischen Noxen Alkohol und Tabak sind für Oropharynxkarzinome mittlerweile Infektionen mit humanen Papillomviren (HPV) als pathogenetisch auslösende Faktoren identifiziert worden. HPV-assoziierte Oropharynxkarzinome steigen in Europa, Japan und den USA immer weiter an. Die Onkoproteine E6 und E7 stellen dabei die pathogenetisch entscheidenden Faktoren dar. Die Prognose der Patienten mit HPV-assoziierten Oropharynxkarzinomen ist unter allen primär oder sekundär eingesetzten Therapiemodalitäten (Operation, adjuvante oder palliative Chemo- oder Radiotherapie, molekular zielgerichtete Therapie oder Immuncheckpointblockade) günstiger. Das 2017 aktualisierte Cancer Staging System des American Joint Committee on Cancer führt HPV-assoziierte Oropharynxkarzinome nun als gesonderte Entität auf. Trotz der günstigeren Prognose wird in aktuellen Leitlinien eine Deeskalation der Therapie bei Patienten mit HPV- oder p16-positivem Oropharynxkarzinom außerhalb kontrollierter klinischer Studien abgelehnt. Eine HPV-Impfung junger Männer sollte empfohlen werden.

BACKGROUND:Fiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED).METHODS:In a prospective multicenter observational study from 2006 to 2010, 180 adult patients in intensive care and those scheduled for ear, nose and throat surgery underwent PDT using TED. Data collection was performed using a structured protocol. The patients were observed according to PDT phase (phase 1: puncture, phase 2: dilatation and phase 3: cannula insertion). The descriptive data are given as the number (percent) of cases and the mean ± standard deviation (SD) where appropriate. The relationships between dichotomous and categorical parameters were analyzed using the chi-square test. P values ≤ 0.05 were considered significant.RESULTS:PDT was performed in 179 patients. The procedure time was 14.8 ± 6.2 (mean ± SD) minutes. Pneumothorax or procedure-related lethal complications did not occur. Other adverse events included tracheal ring fractures (17.1%), desaturations (6.8%), special incidents (6.2%), bleeding (5.5%), anesthesia complications (4.5%) and posterior tracheal wall injuries (1.1%).CONCLUSION:The use of TED in PDT is feasible, and the incidence of complications and adverse events was comparable with that of PDT using the flexible endoscope. Tracheal ring fractures in PDT cannot be avoided by the use of a rigid endoscope. With TED, the airway always remains open thus the use of jet ventilation via the TED during PDT is possible.

Kopf-Hals-Tumoren sind weltweit auf Platz 6 der häufigsten Krebsarten. Neben den klassischen Noxen Alkohol und Tabak sind für Oropharynxkarzinome mittlerweile Infektionen mit humanen Papillomviren (HPV) als pathogenetisch auslösende Faktoren identifiziert worden. HPV-assoziierte Oropharynxkarzinome steigen in Europa, Japan und den USA immer weiter an. Die Onkoproteine E6 und E7 stellen dabei die pathogenetisch entscheidenden Faktoren dar. Die Prognose der Patienten mit HPV-assoziierten Oropharynxkarzinomen ist unter allen primär oder sekundär eingesetzten Therapiemodalitäten (Operation, adjuvante oder palliative Chemo- oder Radiotherapie, molekular zielgerichtete Therapie oder Immuncheckpointblockade) günstiger. Das 2017 aktualisierte Cancer Staging System des American Joint Committee on Cancer führt HPV-assoziierte Oropharynxkarzinome nun als gesonderte Entität auf. Trotz der günstigeren Prognose wird in aktuellen Leitlinien eine Deeskalation der Therapie bei Patienten mit HPV- oder p16-positivem Oropharynxkarzinom außerhalb kontrollierter klinischer Studien abgelehnt. Eine HPV-Impfung junger Männer sollte empfohlen werden.

Der Nachweis von qualitativen und quantitativen VerÄnderungen im Bereich zellulÄrer Onkogene erlaubt Einblicke in die Mechanismen von Wachstum, Teilung und Differenzierung von gesunden und tumorÖsen Zellen. Derartige VerÄnderungen lassen sich auf der Ebene der DNS (Genamplifikation, -mutation und -rearrangement), der RNS und der Proteine (erhÖhte Genexpression) nachweisen. Eine klinische Relevanz fÜr Hals-Nasen-Ohren-Tumoren fand sich bisher bei einer Amplifikation und verstÄrkten Expression des c-mycGens (Korrelation mit fortgeschrittenen Tumorstadien und schlechter Prognose) sowie einer Amplifikation der Gene bcl-1, hst und int-2 (Korrelation mit Nikotinabusus und schlechter Prognose). Eine pathogenetische Bedeutung bei der Tumorentstehung scheint die verstÄrkte Expression des EGF-Rezeptors (EGF = epidermal growth factor) zu haben. Im Gegensatz zu normaler Schleimhaut ist die Expression dieses Rezeptors bei manifesten Karzinomen und bei chronischen EntzÜndungen der Schleimhaut infolge eines Alkohol- und Nikotinabusus deutlich erhÖht. Klinische Fortschritte durch den Nachweis dysregulierter Gene sind in den nÄchsten Jahren vor allem im Hinblick auf ein biologisches Tumorstaging zu erwarten. Erhofft werden dabei prospektive Aussagen zum Wachstumsverhalten eines Tumors, aber auch zu seiner Radio- und ChemosensibilitÄt.

In Austria, around ten new cases of laryngeal cancer can currently be expected per 100.000 persons each year whereas three out of 100.000men develope hypopharyngeal cancer. Among women, the incidence in both types of carcinoma is lower by a factor of around 5. All in all, the rate of new cases seems to have been constant or to have slightly decreased in the last few years.Approximately 70% of all laryngeal cancer are glottic cancer, that is to say originating from the vocal cords. About 30% are supraglottic tumours, true subglottic cancers are very rare. The majority of hypopharyngeal tumours originate from the piriform sinuses. Vocal cord tumours lead to a typical symptom that can be early detected: hoarseness. Thus, voice problems in adults that persist for several weeks should therefore always checked by laryngoscopy. This leads to there being a real possibility of early diagnosis of laryngeal cancer, which means that today, approximately 60% of all laryngeal tumours can be diagnosed in stage I or II according to UICC or as intraepithelial lesions (former carcinoma in situ). In glottic cancer about 75% are diagnosed in these early stages, whereas in supraglottic tumours the rate is only about 30% and in hypopharyngeal cancer it is less then 15%.Surgery, radiation therapy, chemo-or immunotherapy are the principal types of oncological treatments currently available. The following conditions generally need to be met for curative surgical treatment options:Local tumour, no systemic metastasisTumour has to be resectable in healthy marginsmortality/morbiditySurgery must not lead to unreasonable mutilationLack of other therapeutic alternatives having an equal or lesser impactIn the following pages, indications for the surgical treatment of laryngeal and hypopharyngeal cancer will be discussed and the results of surgical therapy will be summarised briefly.

Conclusions. The presented results add further support to the observation that laser microsurgery is the preferential surgical treatment for recurrent respiratory papillomatosis (RRP). A meticulous follow-up for early recognition of local recurrence and malignant transformation is recommended. Objectives. Endoscopic microsurgery continues to be the treatment of choice for RRP. The aim of this study was to evaluate the outcome of patients treated surgically. We focused on demographic data, recurrence rates, and treatment-related complications. Patients and methods. The charts of 194 patients treated at our institution between 1963 and 1993 were analyzed retrospectively. Results. In all, 64 patients (33%) underwent a total of 137 operations using the CO2 laser; 130 patients (67%) underwent a total of 565 microlaryngeal operations by surgery with cold instruments. Five percent of the patients treated with conventional microlaryngeal surgery and none of the patients treated with laser surgery required tracheostomy (p < 0.05). Postoperative glottic webs and scar formations were found in 6% of all patients after laser surgery and 20% after conventional surgery (p < 0.05). The different methods of treatment did not affect the rate of recurrence (p = 0.61) Malignant transformation or secondary airway carcinoma were observed in 4% of all patients.