Nasopharyngeale Entwicklung bei Patienten mit Lippen-Kiefer-Gaumenspalten

Ziel dieser röntgenkephalometrischen Studie war die Analyse von Einflussfaktoren auf naso- und velopharyngeale Konfiguration bei Patienten mit durchgehender einseitiger LKG-Spalte (uCLP) und gesunden Probanden. Insgesamt wurden 189 FRS-Bilder (66 uCLP-Patienten (LKG-Gruppe), 123 gesunde Probanden (Kontrolle) ausgewertet. Die Kontrolle zeigte altersabhängig komplexe Zusammenhänge zwischen nasopharyngealen Parametern und Schädelbasiskonfiguration, Gesichtsschädelaufbau sowie Oberkiefer-Position. LKG-Patienten zeigten eine maxilläre Retroposition, eine geringere Oberkieferlänge, einen mehr posterioren und kranialen Einbau des hinteren Oberkiefer-Komplexes, eine geringere anteriore Nasopharynxhöhe, einen mehr vertikalen nasopharyngealen Aufbau (Verringerung sagittaler weichgewebiger und knöcherner Nasopharynxdimensionen) und eine kürzere Velumlänge mit ungünstigerer „Need Ratio“. Gesichtsschädelaufbau und Wachstumstyp waren in der LKG-Gruppe mehr vertikal. The objective of this cephalometric study was to analyse influence factors on naso- and velopharyngeal configuration in patients with complete unilateral cleft lip and palate (uCLP) and healthy subjects. In total 189 cephalometric radiographs (66 uCLP-patients (CLP), 123 healthy persons (control) ) were analysed. The control showed age-dependend complex correlations between nasopharyngeal parameters and configuration of the skull base, facial morphology and position of the maxilla. CLP showed a retroposition of the maxilla, reduced length of the upper jaw, a more posteriorly and cranially impaction of the posterior maxillary complex, lower anterior nasopharyngeal height, a more vertical configuration of the nasopharynx ( reduced sagittal dimensions ( bone, soft tissues ) and a shortened velar length with a more unfavourable “need ratio”. Facial morphology and type of growth intended to be more vertical in CLP

Eine klinische prospektive Studie zur objektiven Hypernasalitätsdiagnostik mit dem Nasal-View-System bei Patienten mit Lippen-Kiefer-Gaumenspalten

An 95 Patienten mit Lippen-Kiefer-Gaumenspalte erfolgte eine objektive Hypernasalitätsdiagnostik mit dem NasalView(r)-System durch eine Screening-Messung ( nasaler + nichtnasaler Satz ) und eine ausführlichere Detail-Messung. Es wurde eine gute Reliabilität ( Test-Retest-Fehler < 2 % ) und mit einer Sensitivität von 83,3 % - 86,5 %, einer Spezifität von 87,0 % - 93,1 % und einer Testeffizienz von 84,2 % - 90,5 % eine gute Validität des NasalView(r) ermittelt. Im untersuchten Kollektiv wurden keine statistisch signifikanten geschlechtsspezifischen, altersbedingten oder spalttypbedingten Unterschiede festgestellt. Zwischen Patienten mit und ohne Velopharyngoplastik konnten keine signifikanten Unterschiede ermittelt werden. Patienten, die nach dem aktuellen Münsteraner Therapiekonzept nach Prof. Joos behandelt wurden, wiesen statistisch signifikant niedrigere und damit günstigere Rhinophoniegrade und Nasalanzwerte als die Vergleichsgruppe der nicht nach diesem Konzept therapierten Patienten auf

Objective Assessment of Hypernasality in Patients with Cleft Lip and Palate with the NasalView System: A Clinical Validation Study

Introduction. The objective of this investigation was to evaluate the reliability and validity of the NasalView system as a screening tool for hypernasality within the scope of a routine diagnostic procedure in cleft lip and palate patients. Material and Methods. In a collective of 95 patients with cleft and lip palate ranging from 4 to 25 years of age, hypernasality was exploited perceptually, patients were classified in four degrees, and nasalance was measured objectively with the NasalView system. Speech stimuli existed in one nasal and one nonnasal sentence; nasalance ratio and distance were calculated. Results. The test-retest error was within a range of 2%. Sensitivity ranged from 83.3% to 91.1% for the nonnasal sentence, from 70% to 78.4% for nasalance ratio and from 68.1% to 81.1% for nasalance distance. Specifity ranged from 87% to 93.1% for the nonnasal sentence, from 69.6% to 97.5% for nasalance ratio, and from 70.7% to 73.9% for nasalance distance. Conclusions. With a quick and gentle screening procedure, it is easily possible to identify hypernasal patients by an objective diagnostic tool of hypernasality, the NasalView system, with good reliability and validity

Nasopharyngeal Development in Patients with Cleft Lip and Palate: A Retrospective Case-Control Study

Introduction. The aim of this paper was to evaluate cephalometrically the nasopharyngeal development of patients with complete unilateral cleft lip and palate. Influencing factors were evaluated and cleft to noncleft subjects were compared to each other. Material and Methods. The lateral cephalograms of 66 patients with complete cleft lip and palate were measured and compared retrospectively to the cephalograms of 123 healthy probands. Measurements were derived from a standardized analysis of 56 landmarks. Results. We observed significant differences between cleft and control group: the cleft patients showed amaxillary retroposition and a reduced maxillary length; the inclination of the maxilla was significantly more posterior and cranial; the anterior nasopharyngeal height was reduced; the nasopharyngeal growth followed a vertical tendency with reduced sagittal dimensions concerning hard and soft tissue. The velum length was reduced. In the cleft group, an accumulation of mandibular retrognathia and an anterior position of the hyoid were observed. Skeletal configuration and type of growth were predominantly vertical. Conclusions. Our data provides a fundamental radiological analysis of the nasopharyngeal development in cleft patients. It confirms the lateral cephalogram as a basic diagnostic device in the analysis of nasopharyngeal and skeletal growth in cleft patients

The impact of hyperbaric oxygen therapy on serological values of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF)

<p>Abstract</p> <p>Background</p> <p>Hyperbaric oxygen (HBO) therapy is an effective adjunct treatment for ischemic disorders such as chronic infection or chronic wounds. It combines hyperoxic effects with the stimulating potential of post-therapeutic reactive hypoxia. As its crucial effects, stimulation of fibroblast growth, induction of collagen synthesis and the initiation of angiogenesis are discussed. Angiogenesis is a multistage process resulting in the growth of blood vessels. It includes degradation of extracellular matrix, proliferation and migration of different cell populations and finally formation of new vessel structures. This complex chain of procedures is orchestrated by different cytokines and growth factors. Crucial mediators of angiogenesis are basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF); their <it>in-vivo </it>function is still not fully understood.</p> <p>Methods</p> <p>Forty-three patients suffering from sudden sensorineural hearing loss or tinnitus were treated with HBO. The therapy included 10 sessions of 90 minutes each, one session a day. Serological levels of bFGF and VEGF were assessed by enzyme-linked immunosorbent assays performed according to the manufacturer's instructions on day 1, 2, 5 and 10 of HBO therapy and were compared to mean values of the control group, related to the patient's age and sex, and their development observed over the ten days of HBO.</p> <p>Results</p> <p>There was no sex- or age dependency of bFGF observed in the present study, whereas under HBO our results showed a significant mitigation of the bFGF concentration. In the present data, there was no connection between the VEGF concentration and the patients' ages. Women showed significantly higher levels of VEGF. There was no significant change of VEGF concentration or the VEGF/bFGF ratio during HBO. All scored results varied within the range of standard values as described in the current literature.</p> <p>Conclusions</p> <p>A significant effect of HBO on serum concentrations of bFGF and VEGF was not verified in the present study. Additional application of exogenous growth factors in conjunction with HBO was not obviously linked by a coherent cause-and-effect chain as far as wound healing is concerned.</p

German S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" – long version of the update 2023

Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutanepus squamous cell carcinoma in situ (Bowen’s disease) and actinic cheilitis. This guideline was developed at the highest evidence level (S3) and is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC

Release kinetics of VEGF₁₆₅from a collagen matrix and structural matrix changes in a circulation model

Abstract Background Current approaches in bone regeneration combine osteoconductive scaffolds with bioactive cytokines like BMP or VEGF. The idea of our in-vitro trial was to apply VEGF165 in gradient concentrations to an equine collagen carrier and to study pharmacological and morphological characteristics of the complex in a circulation model. Methods Release kinetics of VEGF165 complexed in different quantities in a collagen matrix were determined in a circulation model by quantifying protein concentration with ELISA over a period of 5 days. The structural changes of the collagen matrix were assessed with light microscopy, native scanning electron microscopy (SEM) as well as with immuno-gold-labelling technique in scanning and transmission electron microscopy (TEM). Results We established a biological half-life for VEGF165 of 90 minutes. In a half-logarithmic presentation the VEGF165 release showed a linear declining gradient; the release kinetics were not depending on VEGF165 concentrations. After 12 hours VEGF release reached a plateau, after 48 hours VEGF165 was no longer detectable in the complexes charged with lower doses, but still measurable in the 80 μg sample. At the beginning of the study a smear layer was visible on the surface of the complex. After the wash out of the protein in the first days the natural structure of the collagen appeared and did not change over the test period. Conclusions By defining the pharmacological and morphological profile of a cytokine collagen complex in a circulation model our data paves the way for further in-vivo studies where additional biological side effects will have to be considered. VEGF165 linked to collagen fibrils shows its improved stability in direct electron microscopic imaging as well as in prolonged release from the matrix. Our in-vitro trial substantiates the position of cytokine collagen complexes as innovative and effective treatment tools in regenerative medicine and and may initiate further clinical research.</p

Actinic Keratosis and Cutaneous Squamous Cell Carcinoma

Background: Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratoses (AK), are common. Physicians of multiple specialties are confronted with their treatment. Methods: This review is based on publications retrieved by a selective search in PubMed, as well as on the German guidelines on AK and cSCC, skin cancer prevention, and surgery with histologic guidance. Results: Local treatments for AK include lesional cryotherapy, curettage, and laser ablation as well as field-directed treatments with topical agents, e.g., diclofenac plus hyaluronic acid, imiquimod, 5-fluorouracil, ingenol mebutate, and photodynamic therapy. These treatments can be administered in various sequences or combinations, depending on individual factors and the stage of the disease. The gold standard of treatment for cSCC is histologically confirmed complete resection; radiotherapy is an alternative. Locally uncontrollable or metastatic disease is treated with systemic drugs. The use of various chemotherapeutic agents, EGFR-directed therapies, and the PD-I inhibitor cemiplimab, either singly or in combination, has been described in uncontrolled trials and case series. Cemiplimab has a reported response rate of 47% and was recently approved for the treatment of advanced cSCC. Conclusion: There are many options for the treatment of AK and cSCC that must be considered in the interdisciplinary care of these entities

Basosquamous Carcinoma of the Head and Neck: Clinical and Histologic Characteristics and Their Impact on Disease Progression

OBJECTIVES: Basosquamous carcinoma (BSC) is a rare tumor entity, and the most common onset is in the head and neck region (BSC-HN). The data on diagnosis, treatment, and especially risk assessment concerning disease course and outcome are deficient or inconsistent. This study aimed to evaluate risk factors for local relapse (LR) and lymph node metastasis (LNM) and their impact on progression-free survival (PFS). MATERIALS AND METHODS: In a retrospective monocentric study, patients with BSC-HN treated between 1999 and 2011 were analyzed regarding clinical and histologic characteristics. Prognostic parameters for LR, LNM, and PFS were evaluated. In total, 89 patients (55 male, 34 female, mean age of 71.8 years) with a mean follow-up time of 47.7 months (range 12-112) were included. RESULTS: LR occurred in four patients (4.5%), LNM occurred in five patients (5.6%). Patients with LNM had a significantly shorter PFS time (16.1 months) compared with patients without LNM (154.2 months; P < .001). Tumor depth and size (T classification), incomplete resection, localization at the ear, deep maximal vertical infiltration, muscle and vessel invasion all showed significant (P < .05) associations with LR, LNM, and shorter PFS time. BSC showed more histologic features of basal cell carcinoma (BCC), especially with regard to BerEP4 expression. CONCLUSION: While histology shows some typical characteristics of BCC, the biologic behavior and aggressiveness of BSC are similar to those of cutaneous squamous cell carcinoma. This is the first study to show that LR and, especially, LNM indicate a higher risk of an unfavorable outcome