Preliminary experience of surgical treatment for torus tubarius hypertrophy in children / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the incidence of symptomatic torus tubarius hypertrophy (TTH) in recurred OSA in children, and to explore the preliminary experience of partial resection of TTH assisted with radiofrequency ablation. Methods: From January 2004 to February 2020, 4 922 children, who diagnosed as OSA and received adenotonsillectomy at the Department of Otolaryngology, The 4th Medical Center of the PLA General Hospital, were retrospectively reviewed. There were 3 266 males and 1 656 females, the age ranged from 1 to 14 years old(median age of 5.0 years). Twenty-two cases were identified with recurrence of OSA syndrome, and the clinical data, including sex, age of primary operation, age of recurrence and presentation, and opertation methods were analyzed. Follow-up was carried out by outpatient visit or telephone. Graphpad prism 5.0 software was used for statistical analysis. Results: Twenty-two cases were identified as recurred OSA and received revised surgery in 4 922 cases. Among these 22 cases, 11 cases were diagnosed as TTH resulting in an incidence of 2.23‰(11/4 922), 1 case was cicatricial adhesion on tubal torus (0.20‰, 1/4 922), 10 cases were residual adenoid combined with tubal tonsil hypertrophy (2.03‰, 10/4 922). Median age of primary operation was 3.0 years (range:2.4 to 6.0 years) in 11 TTH cases. Recurrent interval varied from 2 months to 5.5 years (2.4±1.9 years) after first operation. Age of revised partial resection of TTH was 7.0±2.7 years (range: 4.0 to 12.0 years). Average time interval between primary operation and revised operation was 3.5±2.1 years (range: 0.5 to 6.0 years). Individualized treatments were carried out based on partial resection of TTH assisted with radiofrequency ablation. All of 11 cases received satisfied therapeutic results without nasopharyngeal stenosis occured. Twenty-two cases were followed up for 1.6 to 13 years (median follow-up time was 6.2 years). Conclusions: TTH contributed to recurred OSA in child. TTH might be misdiagnosed as tubal tonsil hypertrophy. Partial resection of TTH assisted with radiofrequency ablation was a safty and effective treatment.

Effect of four line tension relaxing for nasal deviation rectification under endoscope / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effect of four line tension relaxing septorhinoplasty for nasal deviation complicated with the deformity of nasal septal cartilage under endoscope.</p><p><b>METHODS</b>Seventeen patients with nasal septum deviation from December 2009 to April 2011 were included in this study. The patients were divided into different groups depending on different deformity of quadrangular cartilage. Different surgical methods were used according to different deviation of nasal septum. First, a C-shape or L-shape incision was made on one side of the nasal septum under endoscope, then the nasal septal cartilage was separated from the angle formed by two greater alar cartilages, perpendicular plate of the ethmoid bone, the junction of vomer and maxilla at the nasal crest, and the upper lateral cartilage, this procedure was applied to correct deviation of nasal septum and nasal pyramid by decompression, which was named four lines tension relaxing correction.</p><p><b>RESULTS</b>Seventeen patients with nasal septal deviation obtained satisfied curative effect. Nasal deviation and deviation of nasal septum were all corrected, patients got better appearance and good nasal ventilation, no complication was observed.</p><p><b>CONCLUSION</b>Nasal deviation complicated with the deformity of nasal septal cartilage could be completely corrected by only one septorhinoplasty operation--four lines tension relaxing correction.</p>

Correlation study between obstructive level diagnosed by Apnea Graph and cephalometric posterior airway space in obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the correlation between Apnea Graph (AG) analysis of airway obstruction and cephalometric assessment of the posterior airway space in the diagnosis of obstructive level in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), so as to improve the preoperative diagnostic accuracy and the therapeutic outcome.</p><p><b>METHODS</b>Thirty patients (28 males and two females) who were diagnosed with severe OSAHS (mean AHI 58.6) by overnight polysomnography in recent 3 months were enrolled. The ages of the patients ranged from 35 to 59 years old with the median age of 41.5 years old. The mean body mass index (BMI, x(-) ± s) was (28.8 ± 4.1) kg/m(2). Mean apnea-hypopnea index (AHI) was (58.6 ± 16.4)/h. The lowest oxygen saturation was averaged to 0.69 ± 0.09. All patients underwent AG study as well as cephalometric analysis preoperatively. A correlation analysis was performed between the percentage of lower level obstructions measured by AG and the posterior airway space (PAS) evaluated by cephalometric analysis.</p><p><b>RESULTS</b>All of the 30 patients had the obvious narrow PAS of 4.4 - 10.8 mm, with the average of (7.6 ± 2.1) mm. Their constituent ratios of lower level obstruction ranged from 2 to 87 percent with the median ratio of 15.5% [9.0%; 35.8%]. Among all the patients, only 2 cases had more than 50 percent obstruction of the airway at lower level, 8 cases had 30 to 40 percent obstruction, and 6 cases had the narrow PAS less than 6 mm. The constituent ratio of lower level obstructions had a negative rectilinear correlation with the data of PAS (r = -0.6511, P < 0.01), which meant the patient with a higher percentage of lower obstruction had the tendency to have a corresponding narrower PAS. Two cases whose constituent ratios of lower level obstructions were not compatible with the rectilinear tendency due to tonsillar hypertrophy were reported.</p><p><b>CONCLUSIONS</b>AG analysis of airway obstruction and cephalometric assessment of the PAS could provide comparable and consistent results for the diagnosis of obstructive level in OSAHS. However, the tonsillar hypertrophy should be considered when using AG to identify the airway obstruction.</p>