Fluorescence diagnosis aims to improve the management of oral cancer via early detection of the malignant lesions and better delimitation of the tumor margins. This paper presents a comparative study of normal inspection, combined fluorescence diagnosis (CFD) and its 2 main components, autofluorescence and 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PPIX) fluorescence. Biopsy-controlled fluorescence imaging and spectral analysis were performed on a total of 85 patients with suspected or histologically proven oral carcinoma both before and after topical administration of 5-ALA (200 mg 5-ALA dissolved in 50 ml of H 2 0). Fluorescence excitation was accomplished using filtered light of a xenon short arc lamp ( ‫؍‬ 375-440 nm). As for CFD, a "streetlight" contrast (red to green) was readily found between malignant and healthy tissue on the acquired images. In terms of tumor localization and delimitation properties, CFD was clearly favorable over either normal inspection or its 2 components in fluorescence imaging. The performance of CFD was found to be impeded by tumor keratinization but to be independent of either tumor staging, grading or localization. In spectral analysis, cancerous tissue showed significantly higher PPIX fluorescence intensities and lower autofluorescence intensities than normal mucosa. There is a great potential for CFD in early detection of oral neoplasms and exact delimitation of the tumors' superficial margins and an advantage over white light inspection and each of its 2 main components. The method is noninvasive, safe and easily reproducible. © 2002 Wiley-Liss, Inc. Key words: combined fluorescence diagnosis; autofluorescence photodetection; protoporphyrin IX; 5-aminolevulinic acid; oral cancer; spectroscopyMalignant neoplasms of the upper aerodigestive tract are of major importance in modern health care. Head and neck cancer is the fifth most common cancer worldwide. 1 In most industrialized countries, both morbidity and mortality rates of squamous cell carcinoma of the oral cavity or oropharynx show an upward tendency. A possible way to increase cure rates of oral cancer lies in early detection followed by radical surgery. 2 However, early lesions are often hard to detect and are sometimes overlooked, even by experienced clinicians. These early invasive carcinomas or carcinomas in situ might simply appear as flat, inconspicuous irregularities of the mucosal surface and may lack typical morphologic characteristics of malignant tumors. At the same time, especially when tongue-like, submucosal spreading of malignancy or diffuse infiltration into surrounding tissue layers is present, superficial demarcation of the tumor borders via simple inspection and/or other common diagnostic procedures often remains unsatisfactory. This may result in prolonged operation times or, in the worst case, might prevent a successful resection in terms of tumorfree borders, along with increased rates of local recurrence and a reduction in 5-year survivals. 3 To facilitate diagnosis of early or secon...

Diode laser treatment of hyperplastic inferior nasal turbinates is a useful procedure, which can be performed as an outpatient surgery under local anesthesia, resulting in a controlled coagulation and ablation of the soft tissue. The short operation time and the good results provide an excellent patient acceptance.

Laser treatment of hyperplastic inferior nasal turbinates can be considered as a useful, cost-effective, and time-saving procedure for the reduction of hyperplastic inferior nasal turbinates. Short operation time, good results, and minor side effects compared to other surgical methods provide an excellent clinical response of the patients.

Objectives: Ea rly cance r d e tection is the best way to improve the prognosis of patie nts with oral cancer. Ther efore this study presents qua ntita tive fluorescence m ea sure ments and r esults in the visualization of cancerous oral mucosa with 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PPOO. Methods: Time progression and type of porphyrin accumulation were analyzed in n eoplastic and surrounding h ealthy ti ssu e of 58 p a tients with a suspected cancer of the oral ca vity by measuring emission spectra of 5-ALA-induced PPIX fluore ce nce. Fluorescen ce im· a ges in the r ed and green spectral range from the tumor tissu e wer e r ecorded with a charge-coupled d evice camera. R esults: After topical application of 0.4% 5-ALA and incubation for 1 to 2.5 hours, all patients r evealed high er inten sities of r ed fluoresce nce in n eoplastic tissu e compared with the surrounding normal tissu e. Maximum contrast w as r eached after 1.5 hours of incuba tion. In 13.8% (n = 8) of the patie nts, additional findings like dysplasia, carcinoma in situ, primary tumor, secondary carcinomas, and tumor branch es w er e found by means of fluorescence marking in contrast to white light examination. An evaluation of the biopsy specimen s r esulted in a sp ecificity of 60% and a sens itivity of 99o/o. Conclusions: As a fluorescent m ark er, PPIX could r epresent a possible n ew dia gnostic tool to det ect early malignant and s condary lesions in the oral cavity. In addition, 5-ALA-induced PPIX fluorescen ce is promising a s a u sefuJ intraoperative tool for d etermining ad equate Pres nted in port at the Fourth International Symposium on Predictive Oncology and Therapy, Nie , Fronce, 0 tobcr 24 -27, 1998.From the D partmcnt ofOtorhinolaryngology-Head and Neck Surg ry (A.L., c.B ., o.o.l, the Laser R s~a rch. Labo reto~ (H.s. , ~~.M., R.B.), and th e In stitute of Pathology (S.A.)

Recent developments should have aided to reduce postoperative complications of endoscopic sinonasal surgery: Computerised tomography (CT) and magnetic resonance imaging (MRI) allow a more precise preoperative view of the anatomic situation and possible variations. The Lund-MacKay-Index provides a tool to assess the extent of the disease, and by introducing microscopic-endonasal and computer-assisted sinunasal surgery (CAS) as well as providing the corresponding training technical progress has been made. We analysed the data of 2,596 patients with acute or chronic rhinosinusitis who underwent surgery between 2000 and 2005 using the procedure of Stammberger. We saw 3.1 % minor complications (minor bleedings, perforation of the lamina papyracea), 0.9 % major complications (severe bleedings, cerebrospinal fluid (CSF) leaks, lesion of the ductus lacrimalis), and one (0.04 %) serious complication (meningitis). When we compared these figures with those of reports from the late 90 s by correlating opacification, type of operation, the surgeon's experience and employing CAS with the outcome we did not find a distinct improvement in the rate of postoperative complications. Serious complications and those resulting in permanent harm such as carotid artery injury, cerebral deficit or death have, however, become very rare. A grading into I (minor), II (major) and III (serious) complications is proposed, to point out this critical grade-III proportion, which should not exceed 0.1 %.