Eur Arch Otorhinolaryngol (2007) (Suppl 1) 264:S5–S151 DOI 10.1007/s00405-007-0344-7 HNS - Head and Neck Surgery, Larynx and Others INSTRUCTIONAL COURSES indication for EPT in patients with squamous cell cancer of the upper aerodigestive tract. HIC 1 Thyroid surgery and dealing with complications HIC 3 Jan Betka Digital volume tomography in oto-rhino-laryngology Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Faculty Hospital Carsten Dalchow Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic Park-Klinik Weissensee, Scho¨ nstr. 80, 13089 Berlin, Germany The course provides overview of technique of thyroid surgery The digital volume tomography (DVT) is an extension of pano- including both standard and up-to-date modern methods includ- ramic tomography. With this diagnostic technique, characterized ing not-cold instruments (harmonic knife), miniinvasive methods, by high resolution, minimal section thickness of 0.125 mm, and endoscopic thyroid surgery. The extent of surgery (total thyroid- three-dimensional (3D) display, small pathological processes can ectomy, hemithyroidectomy) is discussed. Various procedures for be well visualized. identification of the recurrent nerve (including nerve monitoring) The digital volume tomograph Accu-I-tomo (Morita, Kyoto, and parathyroid glands are shown. The question how to drain (if Japan) was routinely used to examine patients with a history of a any) the wound is gone over. Finally special focus is aimed at disease in the field of oto-rhino-lanyngology. A 3D dataset of a dealing with complications—recurrent nerve palsy (unilateral, cylinder was obtained in one 360° rotation with 80 kV and 8 mA bilateral), parathyroid gland injury. adjustments. The images of the temporal bone region are analysed with special 3D-software. The data were displayed after recon- struction on a PC monitor in three planes oriented vertically to each other with minimal intersection distance and a minimal HIC 2 section thickness of 0.125 mm. The section angle, section thick- Electroporation therapy in head and neck cancer ness, and intersectional distance were modified to selectively de- pict individual structures. The first generation DVT with M. Burian, M. Formanek, B. Zeitlinger dimensions of a 3 · 4 cm cylinder and a grey scale of 256 was later AKH Vienna, Vienna, Austria replaced by the second generation DVT visualizing 6 · 6 cm with Electroporation therapy (EPT) is a new and promising method to a grey scale of 4,096. treat solid tumors. The presence of an electrical field increases the Clinical investigations showed smallest bony modifications of permeability of cell membranes. This mechanism allows for trans- the temporal bone and frontal skull base with the DVT. Small membraneous transport of a variety of compounds into the cell lesions like an erosion of the ossicles, semicircular canals, cochlea, interior. Using bleomycin as a cytotoxic agent, this method can be internal auditory canal or apex of the temporal bone as well as used in the treatment of squamous cell cancer of the head and neck. pathologies of the frontal skull base can be routinely visualized. The tumor is infiltrated with bleomycin and subsequently The 3D presentation allows good spatial orientation and a precise treated by means of a six needle applicator which delivers the planning of surgical approaches. electrical fields to the tumor and tumor surrounding tissue. Since Digital Volume Tomography expands the application of diag- EPT act very tumor specific, it is possible to spare healthy tissue in nostic possibilities in the lateral and frontal skull base. Therefore we the surrounding of the tumor to a high extent. believe improved pre-op diagnosis can be achieved along with more The device as well as the technique of Electroporation Therapy accurate planning of the surgical procedure. In comparison with will be shown in detail during the course. EPT seems to serve as an conventional CT and digital volume tomography, DVT delivers a interesting, tissue sparing treatment alternative in head and neck smaller radiation dose and a higher resolution coupled with lower cancer. Future trials have to figure out the most appropriate purchase price of the equipment. 123 S6 Eur Arch Otorhinolaryngol (2007) (Suppl 1) 264:S5–S151 HIC 4 tarily.FEES plays an important key role in the diagnostic work-up Challenges of professional voice because it allows a direct morphological and functional analysis of theupperaerodigestivetract.Thetargetofthiscourseistopresentthe Felix de Jong1, Willy Wellens2, Manuel Pais Clemente3, current status of FEES and it´ s position within the diagnostic arma- Bozena Woznica4, John Rubin5, Ekaterina Osipenko6, mentarium. Based upon history, the standardized, but individually Antonio Schindler7, Willem Kersing8 tailored endoscopic procedure will be demonstrated, as well as ben- 1Leuven, Belgium; Nijmegen, The Netherlands efits and limitations. Case reports illustrate the theoretical back- 2 Leuven, Belgium ground. Furthermore, new developments and trends are discussed. 3Oporto, Portugal Conclusions: FEES is an important tool for the ENT specialist/ 4Poznan, Poland phoniatrician in the management of the dysphagic patient. 5London, UK 6Moskow, Russia 7 HIC 6 Milano, Italy Mucosal melanomas 8Enschede, The Netherlands B. Folz The voice has been acknowledged to be the primary tool for com- Germany munication, that in turn has been described as the most existential act of man. The voice is used to express emotions and meanings. Background: Malignant mucosal melanoma of the upper aerodi- Consequently, voice problems often have a significant psychologi- gestive mucous membranes is a rare tumor. In comparison with cal, social, physical, occupational and communicational impact on cutaneous and ocular melanoma the prognosis is poor. Most studies an individual. Professional voice use can be characterized as a top have been case series and reports about larger series are rare. The sport, representing a great mental and physical effort. Professional aim of the course is to provide the participants with the key voice disorders are often complex with a multifactor genesis and the knowledge about mucosal melanoma with regard to natural history, professional voice has been found to be influenced by and exposed diagnosis, therapy and prognosis. to various and different risk factors. These risks factors broadly may Methods: The data presented are based on 51 cases from three dif- be classified for the sake of description into four domains: vocal ferent centers and an extensive literature survey. load, physical factors, psycho-emotional factors and environmental Results: The nose and paranasal sinuses are the most commonly factors. To develop occupational safety and health in voice pro- affected site in the head and neck with regard to mucosal melanoma. fessions it is essential to demonstrate the relationship between voice The basic symptoms are diffuse and not specific for the disease, they problems and the various risk factors, in order to create a risk profile rather reflect the typical signs of nasal malignancies, like unilateral of the professional voice user. The impact of a voice problem de- nasal obstruction, epistaxis, nasal discharge, headaches and in ad- pends also on how an individual perceives the problem. Therefore, it vanced cases—diplopia. If possible therapy should be surgical, but is extremely relevant to assess the degree of handicap and the risk even with clear margins the recurrence rate is 80%. The explanation factors that are perceived to exert a negative influence on the voice in might lie in satellite tumors, micrometastasis and tumor cell subjects with voice complaints and those with a voice handicap. migration within the mucosa at early stages of the disease. Rare sites Remarkably, often insufficient attention is paid to voice training in for tumor manifestation are the pharynx, larynx and the middle ear. various educations for professions with high vocal demands. Repeated therapy achieves prolongued survival and combined Obviously there is a need for adequate voice training and the pre- therapies show a tendency towards better results. The overall diction of voice problems in the concerning educations. prognosis however is bad, the 5-year-survival is below 40%. Conclusion: Mucosal melanoma is a rare tumor with a poor prog- nosis. The course tries to provide key knowledge about the disease, HIC 5 which could to establish diagnostic and therapeutic standards for Current diagnostics of swallowing disorders: the ENT this rare tumor. Pooling data from different centers might then help specialist´s and phoniatrician´s role to gain more knowledge about the disease. Doris-Maria Denk-Linnert, Gudrun Mancusi ENT Department, Division of Phoniatrics and Speech Pathology, HIC 7 Medical University of Vienna, Wa¨ hringer Gu¨ rtel 18-20, 1090 Clinical application of different laryngoplasty Vienna, Austria techniques Objective: Over the last years, diagnostics and therapy of oro-pha- G. Friedrich ryngeal swallowing disorders have become a major task for the ENT Ear, Nose and Throat Hospital, Department of Phoniatrics, Speech specialist/phoniatrician within a multidisciplinary team. Statistics and Swallowing, Auenbruggerplatz 26/28, 8036 Graz, Austria demonstrate the individual, social and economic relevance of an adequate dysphagia management. Up to 14% of patients in acute Every surgery performed direct on the vocal folds in evitable care hospitals and up to 60% in nursing hospitals suffer from