Nebulized glucocorticoid combined with olfactory training in the treatment of postviral olfactory dysfunction / 中国耳鼻咽喉头颈外科

OBJECTIVETo investigate the efficacy and safety of nebulizing glucocorticoid combined with olfactory training in the treatment of postviral olfactory dysfunction.METHODSPatients with postviral olfactory dysfunction were recruited in this study. All patients underwent T&T olfactory testing, sinonasal computer tomgraphy scanning, as well as magnetic resonance scanning of the olfactory pathway. Nebulizing glucocorticoid (pulmicort repulse) was inhaled once daily at the starting dose of 2 mg tapered to 1 mg after two weeks combined with olfactory training for 4 weeks. T&T olfactory testing were repeated after 4-week treatment.RESULTS Twenty four patients received teatment, with a mean age of 54 years old(range 37 to 81 years old), a mean olfactory dysfunction course of 2.20 months(range, 0.25-9 months). Of whom, 21 were anosmia, 3 were hyposmia. After teatment, complete recovery were achieved in 4 patients(16.7%), obvious improvement in 9 (37.5%), improvement in 5 (20.8%), no improvement in 6 (25.0%). No side effect and untoward effect were found.CONCLUSIONThe primmary outcomes suggest the efficacy and safety of nebulizing glucocorticoid combined with olfactory training in the treatment of postviral olfactory dysfunction.

Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To identify the landmarks of transpterygoid approach and to report its application in a series of cases.</p><p><b>METHODS</b>Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed.</p><p><b>RESULTS</b>In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.</p><p><b>CONCLUSION</b>An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.</p>

Transnasal endoscopic anatomy of the clivus and approaches consideration / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#In-depth understanding of endoscopic anatomy of the skull base is the cornerstone of the development of endoscopic endonasal skull base surgery. The purpose of this study is to explore the anatomical landmarks of the clivus for endoscopic endonasal skull base surgery.@*METHOD@#Eight silicon-injected adult cadaveric heads (16 sides) were dissected performing endoscopic endonasal approach. The clivus and adjacent structures were exposed; and their anatomy shown in detail. High-quality pictures were produced.@*RESULT@#The clivus was subdivided into the upper, the middle and the lower clivus. Extracranial soft tissue landmarks and bony landmarks were presented. Intradural landmarks of the upper clivus were the interpeduncular cistern, posterior cerebral artery, posterior communicating artery, superior cerebellar artery, cranial nerve III and cerebral peduncle; intradural landmarks of the middle clivus were the prepontine cistern, basilar artery, cranial nerve VI and pons; intradural landmarks of lower clivus were premedullary cistern, vertebral artery, cranial nerve XI and medulla oblongata. Surgical routes to the clivus were the upper clivus approach, middle clivus approach, lower clivus approach and panclival approach.@*CONCLUSION@#An understanding of the complex anatomy of the clivus is paramount for surgically dealing with the disease involved clivus and adjacent region.

Cochlear Implantation in Children with Secretory Otitis Media / 听力学及言语疾病杂志

Objective To study the feasibility and rehabilitation outcomes of one -stage cochlear implantation (CI) in profound deaf children with secretory otitis media (SOM ) .Methods A total of 11 profound deaf children with soal receired one -soage unilateral cochlear implantation with a follow -up period from 13~60 months .In-flamed mucosa in the mastoid as well as exudates were removed radical1y at the time of implantation for adequate drainage of the middle ear .After the sugery ,the patients were followed up and the hearing and rehabilitating out-comes were eveluated .Results All 11 patients were successfully operated with 8 cases in the right ear and 3 cases in the left ear .Among them ,7 cases were nucleus 24 CA ,1 case losa clarion AB 90 K ,2 cases were medel combi 40+and 1 case was pulsar .All patients were successfully operated .No infectious complications occurred .No recurrence of secretory otitis media was observed .After initial stimulation and post regular fitting ,the status of the implant-able devices were all stable .All the implantees had satisfied hearing and entered normal kindergartens or schools . Conclusion Profound deaf pediatric patients with SOM are not an absolute contraindication for CI .With sufticient pre-operation preparontion ,proper trentment and nursing .Cochlear implantation should be condnote as early as possible better rehabilitation performance .

Immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the application of immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve.</p><p><b>METHODS</b>Ten patients with thyroid cancer invading unilateral recurrent laryngeal nerve underwent radical surgery and immediate recurrent laryngeal nerve reconstruction. The reconstructive surgical approach included recurrent laryngeal nerve decompression surgery, end-to-end anastomosis of the recurrent laryngeal nerve, anastomosis of ansa cervicalis nerve to the recurrent laryngeal nerve, and nerve-muscle pedicle (NMP) technique. Among the ten patients, one underwent nerve decompression, one underwent end-to-end anastomosis of the recurrent laryngeal nerve, seven had anastomosis of ansa cervicalis to recurrent laryngeal nerve, and one case had anastomosis of ansa cervicalis to recurrent laryngeal nerve combined with nerve-muscle pedicle (NMP) technique. The effect of surgery was evaluated by videolaryngoscopy, maximum phonation time (MPT), phonation efficiency index (PEI) and voice assessment. T-test was used in the statistical analysis.</p><p><b>RESULTS</b>All of the 10 patients had no complications including tumor recurrence and hypoparathyroidism after the surgery. Their hoarseness symptoms were improved, and the patients returned to normal or near-normal voice. Postoperative videolaryngoscopy showed that paralyzed vocal cord returned to normal muscle tone and volume, and the vocal cord vibration and mucosal wave were symmetric and the patients got good glottal closure. The pre- and post-operative maximum phone times of the patients were (4.52 ± 0.89) s and (11.91 ± 1.87) s, respectively (P < 0.01). The pre- and post-operative phonation efficiency indices were (1.37 ± 0.43) s/L and (4.02 ± 1.33) s/L, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>In patients with thyroid cancer invading unilateral recurrent laryngeal nerve, immediate recurrent laryngeal nerve reconstruction following radical surgery of thyroid cancer can effectively achieve recovery in phonation function and improve the quality of life of the patients.</p>

A study of modified lateral pharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome: primary outcomes analysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To describe a modified lateral pharyngoplasty with partial transsection of levator veli palatine muscle in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and report the primary outcomes.@*METHOD@#Retrospective review was performed in sixty patients with OSAHS. All the patients underwent modified surgical procedures, including partial transsection of levator veli palatine muscle and high soft palatoplasty.@*RESULT@#The patients with a reduction of the AHI at least 50% were 6 (6/60, 10%). The patients with a reduction of the AHI at least 50% and a postoperative AHI < 20 were 44 (44/60, 73.3%). The patients with a postoperative AHI < 5 were 10 (10/60, 16.7%). Postoperative complications were postoperative bleeding in two cases (3.3%) and short-term velopharyngeal insufficiency in 10 cases (16.7%).@*CONCLUSION@#Lateral pharyngoplasty with partial transsection of levator veli palatine muscle provides a safe and effective procedure for selected OSAHS patients with oropharyngeal collapse as the main site.

Etiology and treatment of delayed epistaxis after endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the etiology and management of delayed epistaxis after endoscopic surgery.@*METHOD@#To retrospectively analyze the clinical data of 11 cases for epistaxis after nasal endoscopic surgery. To compare their precipitating factors, their surgical approach, time and site of bleeding and management in order to find the intrinsic rules.@*RESULT@#The precipitating factors, bleeding sites and treatments varied among patients.@*CONCLUSION@#Delayed epistaxis after endoscopic surgery can not be neglected. There may be some precipitating factors. The surgical approach may be related to the bleeding site. It is better to treat the epistaxis using the endoscope to explore the bleeding site and to give corresponding intervention.

Application of mitomycin in laryngeal surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the application of mitomycin in laryngeal surgery.@*METHOD@#Retrospective analysis of the clinical data of 48 patients who had vocal cord lesion involving anterior commissure. The treatment of 30 patients treated with microsurgery and external application of mitomycin, while that of the others were only done with microsurgery.@*RESULT@#Among the 30 patients who were treated with microsurgery and mitomycin, only 2 patients of which showed slight adhesion of anterior commissure after surgery. While in the group of microsurgery, there were 6 patients who had adhesion of anterior commissure adhesion after surgery.@*CONCLUSION@#Mitomycin could prevent vocal adhesion after laryngeal surgery.

Early local flap reconstruction in nasal defect due to severe infection after rhinoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the feasibility, option of surgical method and surgery opportunity of local flap reconstruction in nasal defects due to severe infection after rhinoplasty.@*METHOD@#The clinical datum of eleven patients, who had 15 cases of local flap reconstruction due to severe infection after rhinoplasty, were analyzed retrospectively. The lesions included defects of nasal dorsum, nasal tip and anterior-nare-vestibular fistula. Areas of defects ranged from 1.5 cm x 1.2 cm to 2.0 cm x 2.5 cm and fistula diameters fell between 0.6 cm and 0.9 cm. Based on the principal of nasal aesthetic sub-unit, nasal defects were restored with local flaps, such as nasal dorsum flaps, rhomboid flaps and nasal columella-tip flaps. The early changes and the maintenances of nasal contour after reconstruction were observed.@*RESULT@#All 15 reconstructions were carried out 2 weeks after control of infection, and stage-I recovery was achieved in all the cases. In the follow-up periods from 4 to 27 months, all the flaps survived. only 2 cases had distortion of nasal tips, however, they were recovered with subcutaneous injection restoration; the other cases received satisfactory nasal contour where the flaps matched well with the neighbor skin in color, texture and extent of actinic dermatitis.@*CONCLUSION@#Based on the principal of nasal aesthetic sub-unit, the individualized early local flap reconstruction would have good effect on nasal function and aesthetics, which will restore self-confidence of the patients as soon as possible.

Stage-I functional reconstruction of traumatic deviated nose deformity with chronic rhino-sinusitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the feasibility, surgical method, surgical effect and postoperative complications of stage-I functional reconstruction of traumatic deviated nose deformityaccompanied with chronic rhino-sinusitis.METHODS 37 patients with traumatic deviated nose deformity accompanied with chronic rhino-sinusitis were selected in this study.Methods of stage-I reconstruction included endoscopic nasal septoplasty, functional endoscopic sinsus surgery(FESS), turbinectomy, rhinoplasty and so on.The patients were followed up for one month after operation.The shape of the nose was observed and the nasal bias was measured also.At 3 months after operation, the therapeutic effect about the chronic nasosinusitis was estimated by endoscopic check and patients' subjective symptom.The data obtained preoperatively and postoperatively were treated with statistical methods.RESULTS 37 patients with traumatic deviated nose deformity were selected in this study.The postoperative bias was 2.04 ?0.97 mm and preoperative bias was(6.64?2.21) mm.A t-test revealed the significant difference between pre-and postoperative bias(t=6.374, P