Topographic bone thickness maps to evaluate the intuitive placement of titanium miniplates for nasal prostheses

The aim of this study was to evaluate the intuitive placement of titanium miniplates. The hypothesis was that virtual planning can improve miniplate placement. Twenty patients were included in the study. These patients were fitted with 21 titanium miniplates (16 y-plates, three t-plates, and two u-plates) to retain nasal prostheses between 2005 and 2017. Colour-coded topographic bone thickness maps (TBTMs) were created in fused pre- and postoperative computed tomography. Implants were virtually transposed at the position of highest bone thickness. The bone thickness index (BTI) was calculated as the sum of points assigned at each screw (1 point per millimetre up to 4 mm, and 5 points for greater values) divided by the number of screws. One plate broke after 2.8 years, thus plate survival after 5 years was 91% using the Kaplan-Meier method. The BTI for all 21 plates increased from 3.4 to 4.1 points using virtual transposition (P<0.001). No significant changes were observed in t- and u-plates, but the median BTI increased from 3.1 to 4.1 points (P<0.0005) in 16 y-plates. The change was substantial (≥0.5 points) in 9/16 y-plates. Therefore, the hypothesis that virtual planning improves implant placement was accepted.

Early nasal reconstruction after skin-preserving excision of squamous cell carcinoma of the nasal vestibule

Surgery for early-stage squamous cell carcinoma of the nasal vestibule (SCCNV) may lead to facial disfigurement. We wanted to investigate if skin-preserving excision of SCCNV with reconstruction is oncologically, aesthetically, and functionally justifiable in cases with proximity to the skin. From 2010 to 2016, 16 patients underwent skin-preserving excision of T1-2 N0 SCCNV by a lateral rhinotomy approach at a tertiary referral center. The inner nose was reconstructed using a mucoperichondrial septal flap for the inner lining and a septal pivot flap and/or auricular cartilage grafting for the framework. Nasal appearance was measured on pre- and postoperative photographs. Median follow-up was 5.4 years. Three (19%) patients received adjuvant radiotherapy. Two (12.5%) recurrences occurred locally, but not at the site of preserved skin. The Kaplan-Meier estimate of local control rate after 5 years was 83%. All patients could be salvaged, giving an ultimate control rate of 100%. Nasal tip projection decreased by 6.7% (p < 0.001), and it was retained normal or near normal in 87.5% of patients. Nasal axis changed by 1.7° (p = 0.5). Nasal deviation occurred in 6.25% (1/16) of patients, and minor alar retraction in 6.25% of patients (1/16). Nasal breathing was normal or close to normal in 75% (12/16) of patients. Skin-preserving excision of SCCNV is oncologically justifiable in selected cases even in proximity to nasal skin. Early inner nasal reconstruction preserves nasal form and function to a high degree. This technique is a suitable alternative to rhinectomy and to avoid the sequelae of radiotherapy in selected cases.

Primary surgical treatment of nasal vestibule cancer - therapeutic outcome and reconstructive strategies

OBJECTIVE

The treatment strategy of squamous cell carcinoma of the nasal vestibule (SCCNV) is controversial. The objective of this study is to investigate the role of surgery, which is the preferred treatment option at our institution.

DESIGN

This was a monocentric prospective study of patients that were diagnosed with SCCNV between 2005 and 2013.

MATERIAL AND METHODS

Twenty-six patients were included. Tumors were staged using the UICC (7th edition) TNM classification of nasal cavity cancer and the classification proposed by Wang. The primary treatment was surgery in all patients. Survival data were statistically analyzed using the Kaplan-Meier method. The median follow-up time was 6 years.

RESULTS

Using the UICC classification, 9/26 tumors were staged as pT1 (35%), 7/26 as pT2 (27%), and 10/26 as pT4a (39%). Using the classification by Wang, 9/26 tumors were staged as pT1 (35%), 15/26 as pT2 (58%), and 2/26 as pT3 (8%). Reconstruction was performed using an implant-retained prosthesis in 50% of patients and by plastic surgery in the remaining 50%. Only 2/26 patients (8%) needed adjuvant radiation therapy. The five-year recurrence-free survival (RFS) was 86.7%, disease-specific survival was 96.2% and overall survival was 91.8% after five years.

CONCLUSION

Surgery in SCCNV gives an excellent prognosis and minimized the need for radiotherapy.

Quality of life after nasal cancer resection - surgical versus prosthetic rehabilitation

BACKGROUND

Nose reconstruction following resection of nasal carcinomas is controversial. The objective of this study is to investigate the effect of surgical reconstruction versus prosthetic rehabilitation on patient quality of life (QOL).

DESIGN

This was a monocentric prospective study of patients diagnosed with nasal carcinoma from 2003 to 2013. QOL was evaluated using two organ-specific questionnaires (Rhinoplasty Outcome Evaluation [ROE] and the Functional Rhinoplasty Outcome Inventory-17 [FROI-17]) and a generic questionnaire, the Short-Form 36 Health Survey (SF-36).

MATERIAL AND METHODS

Sixty-four patients were included. Patients completed the ROE, FROI-17, and SF-36 questionnaires after nasal reconstruction. Questionnaires were completed by 62.8% of the 51 alive patients.

RESULTS

Recurrence-free survival (RFS) was 89.9%, disease-specific survival was 94.5%, and overall survival was 75.5% after five years according to the Kaplan-Meier method. Considering initial tumor stage, early stage patients had a significantly higher self-confidence score in FROI-17 subgroup analysis. In contrast, advanced stage patients showed a significantly higher score for social functioning in SF-36. Prosthetically fitted patients scored highly on the ROE questionnaire showing a high degree of aesthetic satisfaction. Surgically reconstructed patients showed a high degree of self-confidence on the FROI-17 questionnaire. However, the organ-specific ROE and FROI-17 scores were not significantly different between patients who received surgical reconstruction and prosthetic rehabilitation after oncological resection. When comparing the rehabilitation method as a function of tumor stage, there was significantly better score for physical functioning in early stage surgically reconstructed patients in the SF-36, but no significant differences in organ-specific QOL.

CONCLUSION

Surgical reconstruction and prosthetic rehabilitation after nasal cancer resection have the same effect on organ- and non-organ-specific QOL.

[Grafts with microvascular anastomosis. Their use in the head and neck region following radiotherapy and vessel depletion]

Surgical tumor removal is often the treatment of choice in patients with head and neck squamous cell carcinoma. Depending on the extent of tumor resection, large defects are often produced in the individual head and neck regions, necessitating reconstructive surgery to avoid further functional impairment. In principle, this decision depends on the size and location of the defect, the aesthetic importance of the region and the functional significance of the area to be replaced. Reconstructive free flap procedures in patients who have undergone radiotherapy or exhibit vessel depletion in the neck due to multiple previous surgical interventions are particularly challenging. In order to ensure the best possible outcomes of surgical oncology therapies under difficult circumstances, this paper discusses the important factors and variables that can increase the success rate of microvascular grafts in irradiated or multiply resected patients.

[Differential diagnosis of headaches in otorhinolaryngology]

Facial pain and headaches are heterogeneous, therefore, a differential diagnosis, interdisciplinary survey and mapping of the pain symptoms are essential for determination of treatment concepts. This requires an otorhinolaryngology (ENT) adapted zoning of the various pains in the head and neck in line with the classification of the International Headache Society (IHS). In this review, idiopathic, symptomatic and neuralgic facial pain and headaches will be differentiated and classified according to their location from the ENT medical point of view. This provides otolaryngologists with a simplified, targeted diagnosis and subsequent indication for therapy.