Clinical observation on relation between nasal mucosa contact point and headache / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To verify the correlation between nasal contact point and headache and to discuss the significance of nasal endoscopic surgery through observation of clinical outcomes in patients with nasal mucosa contact point treated by endoscopic surgery.</p><p><b>METHODS</b>Forty-five patients diagnosed as nasal mucosa contact headache were treated by nasal endoscopic surgery. The results were analyzed retrospectively, including headache degree, headache frequency, lasting time and total time between before and 6, 18, and 24 months after operation. The data were processed by rank-sum test by SPSS 18.0 software.</p><p><b>RESULTS</b>6, 18 and 24 months after operation, the headache degree (VAS scores were 1.50 [0; 4.00], 2.00 [0; 5.00], 3.25 [0; 5.75], respectively) was relieved (VAS score was 6.00 [5.25; 8.25] before operation) dramatically (Z value were -4.913, -4.070 and -3.095, respectively, all P < 0.01). The total time of headache 6, 18, 24 months after operation (It were 0.07 [0; 3.50], 0.26 [0; 7.77], 1.04[0; 17.15] h, respectively) was shortened (It was 25.20 [4.00; 186.00] h before operation) significantly (Z value were -4.368, -3.652, -2.500, respectively, all P < 0.05).</p><p><b>CONCLUSIONS</b>One of the key causes of patients suffered from intractable headaches is mucosal contact in the nasal cavity. The pain in these patients could be relieved through surgical correction of intranasal anatomic abnormalities. Nasal mucosa contact might not be the only etiology of intractable headache since the mechanism of headache is complicated and variable. The effect of endoscopic surgery needs to be estimated by long-term follow-up.</p>

Surgical treatment of recurrent parathyroid carcinoma with invasion of the upper aerodigestive tract / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation.</p><p><b>METHODS</b>Six cases reviewed, in which the age ranged from 32 to 79 years old. The initial diagnoses and surgical procedures, the sites and surgical treatment of the recurrent disease, and the chemical markers, such as parathyroid hormone (PTH) and serum calcium, were retrospectively studied. The preoperative PTH levels ranged from 860 to 2830 ng/L. In 4 patients the recurrence diseases were founded in the tracheoesophageal groove, of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement. Selective neck dissection for level II, III, IV and VI was taken in all cases in addition to the removal of the local recurrent diseases. Recurrent laryngeal nerves were so badly embedded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation. Prophylactic tracheostomy was carried out in 5 cases.</p><p><b>RESULTS</b>PTH level dropped more than 70% of that prior the operation at 10 min after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively, and hypocalcemia disappeared in 2 days postoperatively. All cases experienced significant improvement in symptoms and signs in the first three days postoperatively. PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months, while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases, respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in 3 cases separately. Of 5 patients with tracheostomy, the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation.</p><p><b>CONCLUSIONS</b>Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes. Both the precise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.</p>