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Abstract
BACKGROUND Infections of the orbit and of the periorbital region are not uncommon. Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a potential risk of lethal complications. Orbital infections are most prevalent in children and adolescents. The acute orbit has many causes, but the most frequent is an occurrence secondary to acute rhinosinusitis. PATIENTS AND METHODS Based on clinical cases, different causes and the present state of diagnosis are presented. The discussion deals with therapeutic strategies depending on the stage according to the current classification of orbital inflammation. CONCLUSIONS Orbital and periorbital inflammations represent a demanding challenge for interdisciplinary cooperation between ophthalmologists, ENT specialists and radiologists. In some cases maxillofacial surgeons and neurosurgeons have to be included as well. Accurate diagnosis and treatment may lead to the resolution of the infection and avoid ocular sequel or endocranial complications as well as a fatal outcome.
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Röpke E, Herde J, Bloching M. [Erdheim-Chester disease as differential diagnosis in bilateral exophthalmos]. Klin Monbl Augenheilkd 2004; 221:960-3. [PMID: 15562361 DOI: 10.1055/s-2004-813771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This report describes the case of a patient who had symmetrical exophthalmos, periorbital xanthelasmas and reduced vision. Next to Wegener's granulomatosis the differential diagnosis of Erdheim-Chester disease is discussed. It concerns a rare systemic histiocytosis of unknown etiology. Above all, the skeleton system with symmetrical long bone osteosclerosis is affected. Manifestations in the area of the orbit have seldom been reported with bilateral retrobulbar infiltrations, exophthalmos, diplopia, compression of the optic nerve and periorbital xanthelasmas.
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Sandner A, Bloching M. Erfahrungen mit einem subperiostalen Plattensystem aus Titan („Ti-Epiplating-System”) zur epithetischen Rehabilitation von Mittelgesichts- und Orbitadefekten. Klin Monbl Augenheilkd 2004; 221:978-84. [PMID: 15562364 DOI: 10.1055/s-2004-813769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses. METHODS AND MATERIAL The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System". DISCUSSION The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible. CONCLUSION The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.
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Bloching M, Duncker GI. Diseases of the Orbit - an Interdisciplinary Challenge. Klin Monbl Augenheilkd 2004; 221:893. [PMID: 15562350 DOI: 10.1055/s-2004-813787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Kösling S, Brandt S, Bloching M, Böhme S. [Indications of HR-CT in the early postoperative phase of stapedotomy]. ROFO-FORTSCHR RONTG 2004; 176:1122-6. [PMID: 15346288 DOI: 10.1055/s-2004-813193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This is an analysis of high-resolution computed tomography (HR-CT) performed in patients with and without symptoms after stapes surgery during the early postoperative phase. MATERIALS AND METHODS We examined 37 patients who underwent stapes surgery between January 1995 and December 2000. HR-CT of the temporal bone was performed in axial and coronal planes with 1-mm-slice thickness and table feed. A reoperation was performed in 7 patients. CT findings were compared with clinical follow up and surgical findings. RESULTS All patients showed postoperative opacification of the tympanic cavity and external auditory canal as well as partial opacification of the mastoid on CT scans. A dislocation of the prosthesis was found in 11 cases and air bubbles were seen in the vestibule of 5 patients. In one case, small bone fragments were detected in the vestibule. In 6 of 7 cases, CT results were confirmed by retympanotomy. CONCLUSIONS Due to overlapping of normal and pathological findings in the early postoperative period, indications for HR-CT are limited in this period.
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Röpke E, Berghaus A, Bloching M. [The ring-pin anastomosis technique. Long-term clinical experiences with the mechanical ring-pin system for microvascular anastomoses in reconstructive head and neck surgery ]. HNO 2004; 52:121-4. [PMID: 14968313 DOI: 10.1007/s00106-003-0895-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microvascular anastomosis remains one of the most critical aspects of free tissue transfer. Since microsurgical suture techniques are complicated and time-consuming, other techniques of anastomosis have been created. One of these is the ring-pin system. METHODS Between January 1996 and October 2001, 48 patients underwent reconstruction with a free radial forearm flap. In 20 patients the venous anastomosis was carried out using a ring-pin system with end-to-end technique. The clinical results were compared to the other 28 patients in whom the anastomosis was sutured with 9-0 prolene. RESULTS In the group using ring-pin anastomosis ( n=20), two flaps showed venous congestion within 24 h postoperatively. After revision the flaps were well perfused. In the other group with sutured vessels ( n=28), a transplant became ischemic in one patient due to venous thrombosis and had to be partly removed. The time of anastomosis was considerably shortened by the use of the ring-pin system. CONCLUSIONS The venous end-to-end-anastomosis using the ring-pin system can be carried out relatively easily and rapidly after a comparatively short period of training. Long-term results have shown good tissue tolerance of the material and sufficient blood circulation of the grafts.
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Abstract
BACKGROUND Patients with supraglottic laryngectomy often complain about persisting dysphagia because the resection includes the most important protective mechanisms of the airway. The additional resection of parts of the tongue base or the lateral hypopharyngeal wall leads to increasing aspiration problems. PATIENTS AND RESULTS Reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage in extended oro-hypopharyngeal and laryngeal carcinomas was carried out in seven patients from 1997 to 2002. In one patient, the reconstruction was performed in a second stage procedure after extended endoscopic laser resection. In four patients, the temporary tracheostomy was closed, and in five total oral feeding was possible. CONCLUSIONS Preliminary results show that a functional reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage to reconstruct the epiglottis helps to avoid chronic aspiration and to preserve the larynx.
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Bloching M, Götze G, Passmann M, Neumann K. [Sclerotherapy with OK-432 for cystic tumors in the neck region]. HNO 2004; 53:238-42. [PMID: 15221083 DOI: 10.1007/s00106-004-1102-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The intralesional injection of OK-432 has been proposed as an effective treatment of lymphangiomas and ranulas. The aim of this study was to review our experience with sclerotherapy of benign cervical cysts as an alternative method to surgical extirpation. PATIENTS AND METHODS We performed a case note review of six patients who received OK-432 injections in a concentration of 0.01 mg/ml between March 2002 and December 2003. RESULTS Disappearance of the lesions was achieved after one to three injections in all patients. We found a complete remission in two of six patients and a marked reduction in four of six patients. There were no significant complications observed. CONCLUSION OK-432 is an effective alternative in the treatment of benign cervical cysts, but it is very important to exclude malignancy-associated diseases before instillation of OK-432. Long-term results will be awaited.
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Bloching M, Bootz F, Burkert S. [HNO-relevant changes in the current TNM-classification of malignant tumours]. HNO 2004; 52:497-502. [PMID: 15133615 DOI: 10.1007/s00106-004-1103-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aust W, Sandner A, Löwe S, Bloching M. Häufigkeit des Auftretens von Komplikationen nach translaryngealer Punktionstracheotomie. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Röpke E, Bloching M. Dreidimensionale craniofaziale Rekonstruktionen mittels Tian-Mesh. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Sandner A, Bloching M, Kern C. Erfahrungen mit dem subfrontalen Zugang zur Rekonstruktion ausgedehnter Frakturen der Frontobasis. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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38
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Löwe S, Bloching M. Der MITEK® 1,3mm Mikro Anker in der rekonstruktiven Kopf- und Halschirurgie. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Hofmann VM, Liedtke H, Bloching M. Möglichkeiten und Grenzen der HBO-Therapie bei lebensbedrohlichen craniofazialen Infektionen. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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40
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Bloching M, Götze G, Passmann M. Sklerosierung von Halszysten mit OK-432–eine Alternative zur operativen Exstirpation? Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Rasinski C, Anft D, Bloching M. Ton- und Sprachwahrnehmung mit dem knochenverankerten Hörgerät BAHA unter Berücksichtigung der präoperativen Testung. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Amm S, Schön I, Bloching M. Der Einsatz von Bone Morphogenetic Protein-4 in Kombination mit NovaBone-C/M zur Knochenrekonstruktion. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Götze G, Bloching M. Folgezustände nach Anwendung der „Midfacial degloving“-Technik. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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44
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Böhme S, Kösling S, Bloching M. HR-CT des Felsenbeins in der frühen postoperativen Phase nach Stapeschirurgie. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Mühlbauer K, Amm S, Bloching M. Der endonasale Zugang bei Mukozelen der Nasennebenhöhlen – Eine retrospektive Analyse der letzten 10 Jahre. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Brandt S, Schulz T, Bloching M, Kösling S. Cephalocelen der Schädelbasis – Fallvorstellungen. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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47
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Wetzig F, Reinshagen A, Bloching M, Dunst J, Rieger A, Hoffmann F. Retroorbitale Raumforderungen als Differentialdiagnose zur Retrobulbärneuritis? AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Kösling S, Jüttemann S, Amaya B, Rasinski C, Bloching M, König E. Stellenwert der MRT bei Verdacht auf Innenohrmissbildung. ROFO-FORTSCHR RONTG 2003; 175:1639-46. [PMID: 14661134 DOI: 10.1055/s-2003-45335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE This is a prospective analysis of the value of MRI in suspected inner ear malformations. MATERIALS AND METHODS In 50 patients (43 children and young adults, 7 adults) with suspected inner ear malformation MRI (1.5 T) was performed. In addition, 42 of these patients underwent CT. For the analysis of the inner ear structures, the constructive interference in steady state (CISS) sequence with 0.7 mm slice thickness was used. Functional tests revealed a sensorineural hearing loss or deafness in 82 temporal bones (TB) and a combined hearing loss in 4 TB. The hearing loss was unilateral in 14 patients. MRI and CT findings were compared. RESULTS Imaging findings were normal in 58 TB. The pathological findings included inner ear malformations (35 TB), inflammatory changes (4 TB), partial obliteration of labyrinth (2 TB) and congenital aural atresia (1 TB). An isolated absence of the cochlear nerve (1 TB) could only be found by MRI. In the remaining cases, an inner ear malformation was diagnosed by MRI and CT with the same confidence but MRI was superior in displaying the fine details. CONCLUSIONS MRI will become the method of choice in the diagnosis of inner ear malformations.
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Welzel C, Bloching M, Born S, Berghaus A. [Pyoderma gangrenosum and orbital pseudotumor]. HNO 2003; 51:486-91. [PMID: 12858856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Pyoderma gangrenosum belongs to the chronic, neutrophilic and necrotic dermatoses. These very painful, inflammable and purulent skin-ulcers often arise after injury or surgical intervention. About half of the patients suffer from systemic disease, for example hematological, gastrointestinal or rheumatic diseases. Our report includes a 77-year-old female with a multilocular emergence of pyoderma gangrenosum following surgery for an orbital pseudotumor. An additional lesion was detected on her anterior neck. Because the possibility of wound-infection was suspected, the lesion was treated locally and with a systemic antibiotic therapy. After this treatment the condition of the wound deteriorated. Upon dermatological examination, pyoderma gangrenosum was identified and a immunosuppressive therapy with corticosteroids and cyclosporin was initiated. As a result of this treatment the lesion healed slowly--with the formation of typical, atrophic and reticular scars. A connection between the pyoderma gangrenosum and the orbital pseudotumor can, on the basis of similar clinical and structural characteristics, not be excluded. A related disease was not diagnosed in this patient. Recurrence can be predicted in patients who have had skin injuries, therefore strict observation is required.
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