Zur Therapie schlafbezogener Atmungsstörungen (SBAS) wird das Prinzip einer Vorverlagerung der Zunge verfolgt, um ihr Zurücksinken mit Einengung der Atemwege während des Schlafs zu verhindern. Die vorliegende Studie erprobt eine passive Fixierung der Zunge über ein Implantat an einer speziell dazu entwickelten Unterkieferschiene.

Corrected by: Intracochleäres Schwannom: Eine Differenzialdiagnose bei menièriformen BeschwerdenLaryngorhinootologie 2011; 90(01): E3-E3DOI: 10.1055/s-0030-1249708

Forward displacement of the tongue is a verified principle in the therapy of sleep disorders which prevents the tongue from sinking backwards thus avoiding obstruction of the upper respiratory tract during sleep. In this feasibility study a novel oral appliance which connects to a pin implanted within the tongue was investigated.A new tongue positioning system using previously implanted tongue piercings as a pivot was developed. By pulling the tongue forward the oral device prevents airway obstruction. In our study we fitted 10 subjects who already had the tongue pierced with the developed oral device. The subjects underwent two nights of polysomnography with and without using the tongue positioning system. Wearing comfort and side effects were evaluated using a questionnaire. Moderate alcohol consumption was used to provoke snoring or apnea in the subjects. Tongue positioning with and without the device was visualized with oropharyngeal MRI.Subjects did not report any discomfort or side effects wearing the device. Subjects showed only moderate snoring or apnea after alcohol consumption and snoring after alcohol consumption was reduced with the device. The average apnea/hypopnea index (AHI) was 0.8/h without the device. Using the device led to an increase of apnea in the subjects. MRI visualization showed that the device did not keep the upper airway space opened by fixing the tongue.The effectiveness of the tongue positioning system should be improved by a modification which should be investigated in patients with preexisting sleep disorders.

Ziele: Stellenwertbestimmung der MRT bei klinischer Verdachtsdiagnose der NNO. Wegen der klinisch problematischen differenzialdiagnostischen Eingrenzung der NNO zu Krankheitsbeginn und dem zwingenden Therapiebedarf Notwendigkeit der Validierung der Befunde hinsichtlich diagnostischen Zugewinns/Therapierelevanz. Methode: 80 Patienten mit der klinischen Verdachtsdiagnose einer NNO wurden durch die MRT (Siemens Impact 1,0 T) mittels eines speziellen standardisierten Protokolls (hochauflösende Fett-Wasser supprimierte Sequenzen coronal, T1 transversal nativ und nach Kontrastmittel mit Fettsättigung) untersucht. Die erhobenen Befunde wurden mit klinischen und paraklinischen Daten korreliert. Ergebnis: 40 Patienten zeigten eindeutige Befunde einer NNO (Plaques, deutliche Sehnerven- und Sehnervenscheidenverbreiterung). Bei 25 Patienten zeigten sich bildmorphologisch keine eindeutigen Korrelate für eine NNO. Bei 15 Patienten konnten andere Entitäten (Tumoren einschließlich Filiae, NHL, Entzündungen), die die klinische Symptomatik erklärten, nachgewiesen werden. In 81% hatte die MRT einen diagnostischen Zugewinn zur Folge. Schlussfolgerung: Weil eine entzündlich-ischämische Pathogenese für den akuten Visusverlust, der zur Verdachtsdiagnose der NNO führt, nicht grundsätzlich anzunehmen ist, kommt der MRT im Rahmen des diagnostischen Konzepts bei der NNO eine Schlüsselstellung zu. Neben der Detektion bzw. dem Ausschluss von entzündlichen Läsionen ist die MRT in der Lage, weitere differenzialdiagnostische Einordnungen zu ermöglichen. Der gewonnene Zuwachs an Informationen ist klinisch relevant bzw. führte direkt zu differenzierten Therapieentscheidungen.

OBJECTIVE:The aim of the present work was to establish a method for orbital volume calculation based on MR scanning data for the sake of better radiation hygiene.MATERIALS AND METHODS:The orbital volumes of 35 ophthalmologically healthy children were calculated on the basis of MRI scans. After data transfer to a separate workstation, volumetric analysis was carried out by two independent radiologists using semi-automated software. The accuracy of the calculated values was compared with orbital volumes measured by anatomic preparations and given in studies by various authors.RESULTS:Volume calculation was possible in all patients using MRI data. There is an acceptable agreement with the presented anatomic facts and the measured values of Bentheley. In the Wilcoxon test there was not a big difference between the courses of the values (p = 0.507).CONCLUSION:Even though we can obtain a better image of the bizarre structure of the bony orbits with CT, MR-based volumetry of the orbit is a reliable method and is not burdened by radiation exposure. It can thus be an important condition for the planning and the controlling of modern therapeutic concepts in treating anophthalmos and microphthalmos.

OBJECTIVE:We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively.STUDY DESIGN:A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated.RESULTS:The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively.CONCLUSIONS:Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.

The incidence of intraosseous hemangiomas is very low. Most of them occur in adult females. The mandible,the zygoma,the maxilla, and the frontal and nasal bones are the areas of most frequent localization in the facial region. The intraosseous hemangioma is a benign, slowly growing,bony hard tumor causing facial deformity. It is diagnosed histologically. We report a case of an 18-year-old male with an intraosseous cavernous hemangioma located in the perpendicular lamina of the ethmoid bone. Intraosseous hemangioma often has characteristic signs on a CT scan, with either coarsened trabeculae lying adjacent to the vascular channels or multifocal lytic areas creating a honeycomb pattern. Because of the age of the patient we considered a midline granuloma and a chondrosarcoma. The therapy of choice is surgical excision; radiation is done in exceptional cases only.

Explosive amusement and deterrent articles such as New Year's Eve cannons and rockets, toy pistols, and blank guns are not at all harmless items. Their potential dangerousness is often extremely underestimated. Two damaging mechanisms are important: during explosions, high pressures and temperatures develop and a considerable sound pressure level can be measured. If the explosion happens near the human body (intentionally or inadvertently), not only superficial lesions can occur, but also (mainly due to contact shots) serious, deep-seated tissue damage, especially in the head and neck region with its endangered sense organs such as eye and ear, the vessels and nerves supplying the brain, the speech- and voice-forming apparatus, and in particular the face, can be the consequence. Their mutilation can lead to serious and extensive interpersonalchanges. Accidents are published in the relevant otological and forensic medical papers, but nevertheless it seems important to us to point out the dangerousness of these readily available items.

Zusammenfassung Explosiv-knallende Belustigungs- oder Abschreckartikel, wie Silversterböller oder Raketen, Spielzeug-, Schreckschuss-, Reiz- und Signalwaffen, sind keinesfalls harmlos – sie werden in ihrer potentiellen Gefährlichkeit meist extrem unterschätzt. Dabei stehen 2 Schädigungsmechanismen im Vordergrund: bei der Explosion entstehender Druck und entstehende Hitze sowie erhebliche Schalldruckpegel. Geschieht das Explosionsereignis versehentlich oder beabsichtigt zu dicht am menschlichen Körper, so können daraus nicht nur oberflächliche Hautläsionen, sondern – bei unmittelbarem Kontakt – erhebliche, tiefreichende Gewebezerstörungen resultieren. Dies gilt im besonderen Maße für das Kopf-Hals-Gebiet mit seinen gefährdeten Sinnesorganen, wie Auge und Ohr, seinen das Gehirn versorgenden zu- und abführenden Gefäßen und Nerven, dem Stimm- und sprachbildenden Apparat sowie nicht zuletzt dem Gesicht, dessen Verstümmelung weitreichende zwischenmenschliche Veränderungen zur Folge haben kann. Zwar sind aus dem otologischen und rechtsmedizinischen Schrifttum entsprechende (Un)fälle bekannt, dennoch erscheint es uns enorm wichtig, anhand kasuistischer Schilderungen auf die Gefährlichkeit der frei im Handel erhältlichen Artikel hinzuweisen.