A new classification of maxillary defect and simultaneous accurate reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To select the preferred flaps for the reconstruction of different maxillary defects and to propose a new classification of maxillary defects. Methods: A total of 219 patients (136 males and 83 females) underwent the simultaneous reconstruction of maxillary defects in the Beijing Tongren Hospital, Capital Medical University, between January 2005 and December 2018 were reviewed. Age ranged from 16 to 78 years. Based on the proposed new classification of the maxillary defects, 22 patients with class Ⅰ defects (inferior maxillectomy), 44 patients with class Ⅱ defects (supperior maxillectomy), 132 patients with class Ⅲ defects (total maxillectomy) and 21 patients with class Ⅳ defects (extensive maxillectomy) were enrolled. Survival rate, functional and aesthetic outcomes of flaps were evaluated. Survival analysis was performed in 169 patients with malignant tumor, Kaplan-Meier method was used to calculate the survival rate, and Log-rank method was used to compare the difference of survival rate in each group. Results: A total of 234 repairs for maxillary defects were performed in 219 patients. Fibula flaps were used in 4/13 of class Ⅰ defects; temporal muscle flaps (11/24, 45.8%) and anterolateral thigh flaps (6/24, 25.0%) used in class Ⅱ defects; temporal muscle flaps (71/128, 55.5%), anterolateral thigh flaps (6/24, 25.0%) and fibula flaps (12/128, 9.4%) used in class Ⅲ defects; and anterolateral thigh flaps (8/20, 40.0%) and rectus abdominis flaps (8/20, 40.0%) used in class Ⅳ defects. The success rate of local pedicled flaps was 95.6% (109/114) and that of free flaps was 95.8% (115/120). Thrombosis(10/234,4.3%) was a main reason for repair failure. Among the followed-up 88 patients, swallowing and speech functions recovered, 82 (93.2%) of them were satisfied with appearance, and 75 (85.2%) were satisfied with visual field. The 3-year and 5-year overall survival rates were 66.5% and 63.6%, and the 3-year and 5-year disease-free survival rates were 57.1% and 46.2%, respectively, in the 169 patients with malignant tumors. Conclusion: A new classification of maxillary defects is proposed, on which suitable flaps are selected to offer patients good functional and aesthetic outcomes and high quality of life.

Clinical comparative study of free posterior tibial artery perforator flap and radial forearm free flap for head and neck reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the clinical application results of the FPTF (free posterior tibial artery perforator flap) and RFFF (radial forearm free flap) for reconstruction of head and neck defects. Methods: A retrospective analysis of 27 cases treated with FPTF (19 males and 8 females, aged 14-69 years) and 24 cases with RFFF (11 males and 13 females, aged 22-69 years) for head and neck defect reconstruction at Beijing Tongren Hospital of Capital Medical University from January 2015 to December 2020 was conducted. Flap size, vascular pedicle length, matching degree of recipient area blood vessels, preparation time, total operation time, hospital stay, recipient area complications, donor area complications and scale-based patient satisfaction were compared between two groups of patients with FTPF and RFFF. SPSS 26.0 statistical software was used for statistical analysis. Results: There was no statistically significant difference between the two groups of patients in tumor T staging (P=0.38), primary sites (P=0.05) and mean flap areas ((53.67±29.84) cm2 vs. (41.13±11.08) cm2, t=-1.472, P=0.14). However the mean vascular pedicle length of FPTF was more than that of RFFF ((11.15±2.48)cm vs. (8.50±1.69)cm, t=-4.071, P<0.01). The donor sites of 4 patients in FPTF group could be sutured directly, while all the 24 patients in RFFF group received skin grafts from the donor sites. There was no statistically significant difference in the recipient area arteries between two groups of flaps (P=0.10), with more commonly using of the facial artery (RFFF: FPTF=21∶27), but there was significant difference in the recipient area veins (P<0.01), with more commonly using of the external jugular vein in RFFF (14/24) than FPTF (4/32) and the posterior facial vein in FPTF (27/32) than RFFF (9/24). There were 10 recipient complications and 3 donor complications in RFFF group; no recipient complication and 3 donor complications occurred in FPTF group. With patient's subjective evaluation of the donor site at 12 months after surgery, FPTF was better than RFFF (χ²=22.241, P<0.01). Conclusions: FPTF is an alternative to RFFF in head and neck reconstruction and has unique advantages in aesthetics and clinical application.

Retrospective study of thyroid invasion and central lymph node metastasis in 124 patients with hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the characteristics of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma, and the impact on survival rate and quality of life. Methods: A retrospective analysis of 124 cases (122 males and 2 females with age range from 36 to 78 years old) with laryngopharyngeal squamous cell carcinoma who were initially treated in the Department of Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to December 2017 was performed. The clinical data included tumor location, pathological T stage, pathological N stage, invasion of thyroid gland, central lymph node metastasis, surgical procedures and so on. Patients were grouped according to if presence of thyroid invasion and central lymph node metastasis. With follow-up, the survival was analyzed by Kaplan-Meier method, and tumor recurrence and metastasis were evaluated. Results: Of the patients, 12 patients had thyroid involvement and 5 patients had central lymph node metastasis. The incidence of thyroid involvement was 8.16% (8/98) in pyriform sinus, 1/18 in posterior pharyngeal wall and 3/8 in posterior cricoid wall, with statistically significant difference (χ2=15.076,P=0.008). The incidence of central lymph node metastasis was 1.02% (1/98) in pyriform sinus, 3/18 in posterior pharyngeal wall and 1/8 in posterior cricoid wall, also with statistically significant difference (χ2=11.205, P=0.008). There was no statistical correlation between thyroid invasion or central lymph node metastasis and gender, smoking or alcohol exposure history and tumor pathological differentiation (all P>0.05). The 3-year overall survival rate was 80.65% and the 3-year recurrence free rate was 85.48%. Totally 24 patients died in 3 years, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. Local recurrence occurred in 18 patients, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. There was no significant difference in survival between patients with and without thyroid invasion and central lymph node metastasis (all P>0.05). There were significantly difference in 3-year overall survival and relapse-free survival among the groups with different T stages, N stages, pathological stages and tumor pathological differentiation levels (all P<0.05). There were significantly differences in the levels of serum calcium and FT3 between the groups with or without thyroid invasion and central lymph node metastasis (all P<0.05). Conclusion: The incidences of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma are rare, and the risk of occurrence is related to the primary site of tumor. Comprehensive evaluation, correct decision-making and accurate treatment could be helpful to cure radically the tumor, to prevent recurrence and to improve the quality of life of patients.

Silencing novel long non-coding RNA FKBP9P1 represses malignant progression and inhibits PI3K/AKT signaling of head and neck squamous cell carcinoma in vitro / 中华医学杂志(英文版)

BACKGROUND@#Long non-coding RNAs (lncRNAs) play key roles in human cancers. In our previous study, we demonstrated that lncRNA FKBP prolyl isomerase 9 pseudogene 1 (FKBP9P1) was highly expressed in head and neck squamous cell cancer (HNSCC) tissues. However, its functional significance remains poorly understood. In the present study, we identify the role and potential molecular biologic mechanisms of FKBP9P1 in HNSCC.@*METHODS@#Quantitative real-time polymerase chain reaction was used to detect the expression of FKBP9P1 in HNSCC tissues, matched adjacent normal tissues, human HNSCC cells (FaDu, Cal-27, SCC4, and SCC9), and human immortalized keratinocytes cell HaCaT (normal control). Cal-27 and SCC9 cells were transfected with sh-FKBP9P1-1, sh-FKBP9P1-2, and normal control (sh-NC) lentivirus. Cell counting kit-8 assay, colony formation assay, wound healing assay, and trans-well assay were used to explore the biologic function of FKBP9P1 in HNSCC cells. Furthermore, western blotting was used to determine the mechanism of FKBP9P1 in HNSCC progression. Chi-squared test was performed to assess the clinical significance among FKBP9P1 high-expression and low-expression groups. Survival analyses were performed using the Kaplan-Meier method and assessed using the log-rank test. The comparison between two groups was analyzed by Student t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.@*RESULTS@#FKBP9P1 expression was significantly up-regulated in HNSCC tissues (tumor vs. normal, 1.914 vs. 0.957, t = 7.746, P < 0.001) and cell lines (P < 0.01 in all HNSCC cell lines). Besides, the median FKBP9P1 expression of HNSCC tissues (1.677) was considered as the threshold. High FKBP9P1 level was correlated with advanced T stage (P = 0.022), advanced N stage (P = 0.036), advanced clinical stage (P = 0.018), and poor prognosis of HNSCC patients (overall survival, P = 0.002 and disease-free survival, P < 0.001). Knockdown of FKBP9P1 led to marked repression in proliferation, migration, and invasion of HNSCC cells in vitro (P all < 0.01). Mechanistically, silencing FKBP9P1 was observed to restrain the PI3K/AKT signaling pathway.@*CONCLUSIONS@#Silencing lncRNA FKBP9P1 represses HNSCC progression and inhibits PI3K/AKT (phosphatidylinositol 3 kinase/AKT Serine/Threonine Kinase) signaling in vitro. Therefore, FKBP9P1 could be a potential new target for the diagnosis and treatment of HNSCC patients.

Analysis for potential targeting genes of TPF regimen induction chemotherapy in hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

To analyze the differentially expressed genes related to the chemosensitivity with the TPF regimen for hypopharyngeal squamous cell carcinoma and to measure potential functional targeting genes expressions. Twenty-nine patients with primary hypopharyngeal cancer who underwent induction chemotherapy with TPF from January 2013 to December 2017 in Beijing Tongren Hospital were enrolled for microarray analysis, including 28 males and 1 female, aged from 43 to 73 years old. Among them, 16 patients were sensitive to chemotherapy while 13 patients were non-sensitive. Illumina Human HT-12 Bead Chip was applied to analyze the gene expressions and online bioinformatics analysis was used to analyze the differentially expressed genes. Reverse transcription and quantitative real-time PCR (RT-qPCR) was used to measure the mRNA expression of potential functional genes of TPF induction chemotherapy in 43 samples, 29 from original patients and 14 from additional patients. Graphpad prism 7.0 software was used for statistical analysis. A total of 1 381 significantly differentially expressed genes were screened out. By GO analysis, up-regulated genes included sequestering in extracellular matrix, chemokine receptor binding and potassium channel regulator activity; down-regulated genes included regulation of angiogenesis, calcium ion binding and natural killer cell activation involved in immune response. With KEGG database analysis, down-regulated pathways included ECM-receptor interaction and peroxisome and up-regulated pathways included Glutathione metabolism and PPAR signaling pathway. The expressions of CD44 and IL-6R were significantly different and appeared biologically significant. CD44 was significantly upregulated in insensitive tissues (0.54±0.06) compared with sensitive tissues (0.33±0.04)(0.01). IL-6R was significantly downregulated in insensitive tissues (0.44±0.03) compared with sensitive tissues. (0.68±0.03) (0.01). CD44 and IL-6R may be potentially functional genes of TPF induction chemotherapy in hypopharyngeal squamous cell carcinoma.

Evaluation of swallowing function after cricohyoidoepiglottopexy / 局解手术学杂志

Objective To investigate the evaluation ways and effects of swallowing function after cricohyoidoepiglottopexy(CHEP). Methods Selected 92 patients of glottic carcinoma who were admitted into hospital from February 2014 to January 2017,and all the patients were given cricohyoidoepiglottopexy(CHEP)therapy and function reconstruction.Modified barium swallow(MBS),modified penetration as-piration scale(MPAS),and fiberoptic endoscopic evaluation of swallowing(FEES)were applied after the surgery.And the prognosis of patients was followed up.Results There was one patient who was not able to extubate,and the extubation time of tracheaostomy tube and stomach tube were respectively(12.04 ±5.42)week and(8.00 ±2.19)d among the remaining 91 cases.Three months after operation,the laryngeal function were good in 84 cases,moderate in 6 cases and poor in 2 cases,the incidence of complications was 6.5%.The fundamental frequency and fundamental frequency perturbation three months after operation were significantly lower than thos before operation(P<0.05). With the extension of postoperative time,the MPAS score of patients with MBS and FEES evaluation were obviously decreased(P<0.05). The MBS assessment score were respectively(3.87 ±0.98)points,(1.64 ±0.65)points,(1.09 ±0.33)points at 15 days,30 days and 60 days after operation.The FEES evaluation score were respectively(3.27 ±1.33)points,(1.73 ±1.11)points,(1.18 ±0.89)points at 15 days,30 days and 60 days after operation.With the MBS assessment as the gold standard,the sensitivity of FEES assessment to normal,false aspiration and aspiration were 100%,76.7%and 86.7%,respectively,and the specificity were 86.7%,97.1% and 98.3%,respectively. Conclusion The cricohyoidoepiglottopexy and laryngeal defect repair in the treatment of glottic carcinoma can effectively preserve the laryn -geal function,reduce the incidence of postoperative complications,improve pronunciation function,and the FEES and MBS evaluation of laryn-geal function have good accuracy,and they have good clinical significance to understand the degree of postoperative aspiration.

MicroRNAs regulate epithelial-mesenchymal transition of supraglottic laryngeal cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study microRNAs (miRNAs) expression profiles associated with epithelial-mesenchymal transition (EMT) in lymph node metastasis of supraglottic laryngeal squamous cell carcinomas(SGLSCC).</p><p><b>METHODS</b>Primary tumor tissue samples of 12 SGLSCC patients were collected, including 6 patients clinically diagnosed with lymph nodes metastasis (N(+)) and 6 patients with lymph nodes metastasis-free (N0), for miRNA microarray gene-expression profiling to identify the differences between N(+) and N0 groups. Differentially expressed miRNAs was verified using quantitative real-time PCR in 20 patients with N(+) and 20 patients with N0. Target genes for the miRNAs associated with EMT in SGLSCC metastasis were analyzed.</p><p><b>RESULTS</b>Ten miRNAs differentially expressed between N(+) group and N0 group were determined. Comparing with N0 group, nine miRNAs were over-expressed and one miRNA was expressed at lower level in N(+) group. The genes for miR-192, miR-143, miR-409 and miR-634 were predicted as target genes that could promote EMT of laryngeal cancer cells by targeted inhibiting Krüppel-like factor 17(KLF17), E-cadherin and phosphatidylinositol 3 kinase (PI3K).</p><p><b>CONCLUSIONS</b>The miRNAs over-expressed in group N(+) can be used to predict cervical lymph node metastasis in SGLSCC. The miRNAs as new markers could improve the diagnosis and treatment of SGLSCC.</p>

Antagonism between gene therapy and epigenetic therapy on human laryngeal carcinoma tumor-bearing mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gene therapy and epigenetic therapy have gained more attention in cancer treatment. However, the effect of a combined treatment of gene therapy and epigenetic therapy on head and neck squamous cell carcinoma have not been studied yet. To study the mechanism and clinical application, human laryngeal carcinoma cell (Hep-2) tumor-bearing mice were used.</p><p><b>METHODS</b>A xenograft tumor model was established by the subcutaneous inoculation of Hep-2 cells in the right armpit of BALB/c nu/nu mice. The mice with well-formed tumor were randomly divided into six groups. Multisite injections of rAd-p53 and/or 5-aza-dC were used to treat tumor. Tumor growth was monitored by measuring tumor volume and growth rate. p53 and E-cadherin protein levels in tumor tissues were detected by immunohistochemical staining. The mRNA levels were monitored with FQ-PCR.</p><p><b>RESULTS</b>Gene therapy was much more effective than single epigenetic therapy and combined therapy. The gene therapy group has the lowest tumor growth rate and the highest expression levels of p53 and E-cadherin.</p><p><b>CONCLUSIONS</b>The combined treatment of gene and epigenetic therapy is not suggested for treating head and neck carcinoma, because gene therapy shows an antagonistic effect to epigenetic therapy. However, the mechanisms of action are still unclear.</p>

Influence on cell proliferation by small interfering RNA of Cyclin Y expression in laryngeal cancer cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The effects of lentivirus-mediated suppression of Cyclin Y (CCNY) expression on the proliferation of laryngeal cancer cells were investigated in vitro.</p><p><b>METHODS</b>The lentivirus vectors containing a small hairpin RNA (shRNA) to target CCNY were constructed.Hep-2 cells were divided into the following two experimental groups:the negative control group (control lentivirus infected cells) and CCNY knockdown group (CCNY shRNA-expressing lentivirus infected cells). After Hep-2 cells were infected, Real-time PCR was used to measure CCNY expression. The influence of CCNY on the proliferation of laryngeal cancer cells were assessed using MTT and colony formation experiments.Each experiment was performed in triplicate and repeated three times.</p><p><b>RESULTS</b>Lentiviruses expressing shRNA against CCNY were constructed and Hep-2 cells were infected with above mentioned lentivirus at MOI (Multiplicity of infection) of 120.Real-time PCR analysis showed that the mRNA expression of CCNY in Hep-2 cells in the knockdown group was significantly decreased (P < 0.05); the mRNA level of CCNY was 75.3% lower in the si-CCNY group than in the si-CTRL group. After 5 days of lentiviral infection, the cell viability was significantly lower in cells infected with the CCNY-shRNA lentivirus compared to cells infected with the control lentivirus following a 6-day incubation. The colony number was decreased by 60% in Hep-2 cells infected with the CCNY-shRNA-lentivirus infected cells following a 10-day incubation.</p><p><b>CONCLUSIONS</b>The results suggested that lentivirus-mediated downregulation of CCNY expression decreased the proliferation and growth potency of laryngeal cancer cells.Lentiviruses delivering shRNA against CCNY may be a promising tool for laryngeal cancer therapy.</p>

Clinical analysis on nonfunctioning parathyroid cysts: a report of six cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical and pathological characteristics, diagnoses and treatments of nonfunctioning parathyroid cysts.</p><p><b>METHODS</b>Six cases of nonfunctioning parathyroid cysts treated in Tongren Hospital during 2002 - 2009 were retrospectively analyzed. Nonfunctioning parathyroid cysts in the six patients were inadvertently found as neck masses by physical examination. The levels of serum calcium, phosphorus and parathyroid hormone were normal. Five cases of 6 patients with imaging suggested the existence of cystic mass in the back of inferior thyroid in 5 cases of the 6 patients.</p><p><b>RESULTS</b>Tumors in the 6 patients were removed surgically and diagnosed as parathyroid cysts with post-operative pathological examination. PTH (parathyroid hormone), CgA (chromogranin A), Syn (synaptophysin) expressions in the tumors were positive. No recurrence was found with follow-up of 2 - 9 years after operation.</p><p><b>CONCLUSIONS</b>Surgical resection is most effective for the treatments of nonfunctioning parathyroid cysts and pathologic examination is required for the determined diagnosis of this disease. Fine needle aspiration can be helpful for the diagnosis before operation.</p>

Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traditional techniques used for harvesting the pectoralis major myocutaneous (PMMC) flap have accompanying disadvantages, such as the necessity for an upper chest skin incision, the bulkiness of myocutaneous tissue at the pedicle of the flap, and the risk of total or partial necrosis of flap tissue. The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.</p><p><b>METHODS</b>Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects, including 21 cases in the treatment group and 20 cases in the control group. In the treatment group, ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles, as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap. A line, from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery, was drawn to determine the axis of the PMMC flap. In the control group, PMMC island flaps were designed according to conventional methods without using ultrasonography.</p><p><b>RESULTS</b>According to the ultrasonic marks, the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was (5.1 ± 1.2) cm. The time from designing to transferring the island flap was significantly shorter in the treatment group ((51.0 ± 10.5) minutes) compared with the control group ((78.0 ± 13.9) minutes, P < 0.01). The rate of partial necrosis was 4.7% (1/21) in the treatment group and 35.0% (7/20) in the control group. There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.</p><p><b>CONCLUSION</b>Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.</p>

Inhibition of human laryngeal carcinoma growth by gene therapy and epigenetic therapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the effects of gene therapy and epigenetic therapy on the tumor growth of laryngeal carcinoma and the underlying mechanisms.</p><p><b>METHODS</b>The animal model of human laryngeal carcinoma was established by the subcutaneous inoculation of Hep-2 cells at the right armpit of BALB/c nu/nu mice. The tumor-bearing mice were randomized into 4 groups, p53 therapy group(rAd-p53), epigenetic therapy group(5-aza-dC), combination therapy group (rAd-p53+5-aza-dC) and control group. The gene and protein expressions of molecular markers p53 and E-cadherin were detected by FQ-PCR and immunohistochemistry.</p><p><b>RESULTS</b>By the day 20 of the treatments, the mean tumor volumes were(106.09 ± 24.40)mm(3) in p53 therapy group, (166.55 ± 40.11) mm(3) in epigenetic therapy group, (126.11 ± 22.49) mm(3) in combination therapy group,and (252.83 ± 54.09) mm(3) in control group. Both gene therapy (F = 37.30, P < 0.05) and epigenetic therapy (F = 4.79, P < 0.05) inhibited the growth of xenografted tumors, with an interaction effect (F = 22.01, P < 0.05) between the two groups. The integral optical density value of p53 protein expression of p53 therapy group (628.07 ± 95.16) was significantly higher than that of combination therapy group (494.76 ± 100.22), (t = 8.72, P < 0.05). The integral optical density values of E-cadherin protein expression were 558.89 ± 97.58 in p53 therapy group, 380.41 ± 90.60 in epigenetic therapy group, 494.76 ± 102.88 in combination therapy group,and 162.60 ± 40.38 in control group respectively, indicating the enhancements of E-cadherin protein expression by gene therapy (F = 45.24, P < 0.05) or epigenetic therapy(F = 5.73, P < 0.05)and the existence of interaction effect (F = 21.82, P < 0.05) between gene therapy and epigenetic therapy. The expression levels of p53 gene were 4.43 ± 0.12 in p53 therapy group, 1.06 ± 0.11 in epigenetic therapy group, 3.51 ± 0.10 in combination therapy group,and 1.09 ± 0.11 in control group, respectively, showing an interaction effect between gene therapy and epigenetic therapy (F = 298.11, P < 0.05). The expression levels of E-cadherin gene were 4.50 ± 0.34 in p53 therapy group, 2.02 ± 0.16 in epigenetic therapy group, 2.99 ± 0.12 in combination therapy group, and 1.00 ± 0.11 in control group, respectively. The expression of E-cadherin gene was enhanced by gene therapy (F = 329.12, P < 0.05)or epigenetic therapy(F = 88.57, P < 0.05), with an interaction effect between the two therapies (F = 122.17, P < 0.05).</p><p><b>CONCLUSIONS</b>Xenografted tumors of human laryngeal carcinoma cells are inhibited by gene therapy, the epigenetic therapy and the combination therapy. The gene therapy was significantly better than the epigenetic therapy or the combination therapy. There might be antagonistic effect between p53 and 5-aza-dC.</p>

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.</p><p><b>METHODS</b>A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34 ± 3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.</p><p><b>RESULTS</b>All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.</p><p><b>CONCLUSION</b>The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.</p>

Complications of CO₂ laser surgery in the treatment of laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma, to analyze related factors and to propose preventive measures.</p><p><b>METHODS</b>Retrospective analysis of 912 cases of laryngeal carcinoma (35 cases of supraglottic cancer and 877 cases of glottic cancer) treated only with laser surgery in Tongren Hospital was carried out. Among the glottic cancer, carcinoma in situ (Tis), T1, T2 and T3 were 53, 659, 158 and 7 cases. The follow-up period ranged from 2 to 18 years, with a median follow-up time of 9.3 years.</p><p><b>RESULTS</b>Of 912 cases, 824 cases were still alive, 29 cases failed to be followed-up (taken into dead number), and 59 cases were dead. The recurrent rate was 9.4% (86/912). Three year survival rate was 95.6% (775/811) and five year survival rate was 87.9% (518/589). The incidence of surgery complications was 9.1% (83/912). Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17.1%(6/35) and 8.8% (77/877), respectively, with no difference between the two groups (χ(2) = 2.85, P > 0.05). Incidence of complications of Tis, T1, T2 and T3 cases of glottic cancer were 5.7%(3/53), 7.8% (51/659), 13.3% (21/158) and 28.6% (2/7) respectively, with significant difference (χ(2) = 8.97, P < 0.05). Incidence of complications of glottic carcinoma with and without anterior commissure incision were 12.8%(31/242) and 7.2%(46/635) respectively, with significant difference between the two groups (χ(2) = 6.78, P < 0.05). Incidence of complications in the patients underwent type II, III, IV, V cordectomy were 3.8% (4/105), 7.0% (20/287), 9.7% (22/226) and 12.0% (31/259) respectively, with significant difference (χ(2) = 7.96, P < 0.05).</p><p><b>CONCLUSIONS</b>There are some potential risks and complications intra- and post-operatively, according to the sites and extent of the primary tumors and the range and depth of removed tissues. It needs to take active preventive measures to reduce the incidence of complications.</p>

Total thyroidectomy: indications and complications / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the indications and complications of the total thyroidectomy in the management of thyroid cancer.</p><p><b>METHODS</b>Fifty-one patients with thyroid cancer operated with total thyroidectomy in a period from April 2007 to June 2010, were retrospective analyzed. There were 48 cases of papillary adenocarcinoma, 1 follicular adenocarcinoma, and 2 medullary carcinoma as well, 2 cases with hyperthyroidism, 3 cases with remote metastasis. There were 17 males and 34 females who in their age ranged from 5 years old to 82 years old with a middle age of 50 years old. Among the 45 cases who were initial surgical management patients, there were 17 T1, 13 T2, 7 T3, 8 T4; and there were 31 N0, 11 N1a, 3 N1b, 2 M1. The recurrent laryngeal nerve and the parathyroid gland, and supper laryngeal nerve were exposed routinely. Lymph nodes in Level VI were dissected in all patients, and Level II-IV dissected in 25 patients. ¹³¹I were administrated in 8 patients.</p><p><b>RESULTS</b>Patients were followed up from 1 month to 36 months. There were no patients died and lost of follow up. The two years survival rate was 100.0% (15/15). Pathological examination showed that the multiple focal disease rate was 42.2% (19/45), the cervical lymph nodes metastases rate was 51.0% (26/51). There was no permanent paralysis of recurrent laryngeal nerve and outer branch of supper laryngeal nerve. The permanent hypoparathyroidism rate was 3.9% (2/51). One case with contralateral lymph node metastasis was reoperated and survived without disease. Two cases with remote metastasis were alive with steadied disease.</p><p><b>CONCLUSIONS</b>Under the skilled hand, total thyroidectomy is a safe procedure in the management of thyroid cancer. Totally exposing the parathyroid gland and laryngeal nerve is the key point to prevent the major complications.</p>

Reconstruction of mid-face defects following the removal of malignant neoplasms: A review of 80 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms.</p><p><b>METHODS</b>Eighty cases(54 males, and 26 females, age ranging from 23 - 79, with a median age of 53.5 years), of midface malignant tumors from 1997 - 2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects, reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients, 6 cases were with type I (external nasal) defect, 56 with type II (maxillary) defect, 14 with type III (naso-facio-maxillary) defect and 4 with type IV (maxillary defect combined with naso-facio-orbital cutaneous deficiency).</p><p><b>RESULTS</b>The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases (91.2%). Kaplan-Meier analysis showed total 3-year and 5-year survival rates were 63.8% and 40.6%, respectively.</p><p><b>CONCLUSIONS</b>One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.</p>

Transoral carbon dioxide laser surgery for treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of transoral CO2 laser in treatment of hypopharyngeal carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 24 cases of hypopharyngeal carcinoma from 1994 to 2005 in the Department of Head and Neck. All cases were treated with endoscopic laser surgery and adjuvant selective neck dissection or radiotherapy. The follow-up period was more than 3 years. Twenty-four patients (21 male, 3 female) were classified as follows: 14 cases were T1N0M0, 4 were T1N1M0, 1 was T1N2bM0, 3 were T2N0M0 and 2 were T2N2bM0.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis showed the overall 5-year survival rate was 74.9%, and the 5-year survival rate of T1 lesions and T2 lesions was 78.8% and 60.1%, respectively. The overall 5-year local control rate was 82.1% and 5-year larynx preservation rate was 87.0%. Six of 7 patients with local-regional recurrences underwent salvage surgery and radiotherapy. Finally 4 of them died of recurrence again and 2 were survival. The other one of 7 patients had distant metastasis, and died after radiochemotherapy. One patient died of non-neoplastic diseases. Two patients experienced minor complications with conventional ambulatory treatment without sequelae. All survival patients had laryngeal preservation except the one who received salvage surgery of the hypopharynx and larynx.</p><p><b>CONCLUSIONS</b>Endoscopic CO2 laser surgery with adjuvant selective or modified radical neck dissection and radiotherapy is an alternative for the treatment of selected hypopharyngeal carcinoma, associated with satisfying curative effects and a high larynx preservation rate.</p>

Application of modified pectoralis major myocutaneous island flap in head and neck surgeries / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To preserve the function of the donor site and good cervical shape, a modified pectoralis major myocutaneous island flap was designed.</p><p><b>METHODS</b>The modified pectoralis major myocutaneous flaps were used to repair primarily the defect in head and neck surgery. In all 17 cases, six cases were patients with recurrence of larynx or hypopharynx cancer, four cases with hypopharynx cancer, three cases with base of tongue cancer, two cases with recurrence of maxillary cancer, one case with tonsillar cancer and one case with pharyngeal fistula after hypopharyngeal cancer surgery. Before operation, ultrasound was used to mark the projection of the pectoral branches of thoracoacromial artery, and the pectoralis major myocutaneous were designed according to the axle between lowest entering muscle point of the artery and the fourth intercostals perforator spot of mammary artery; the incision was designed to turn laterally in an oriental direction at the top of the flap and upward along the anterior axillary line; the internal pectoral nerve was reserved, as well as the partial lateral pectoral nerve. The flaps were transferred to recipient site either above or below the clavicle on the premise of the integrity of clavicular part.</p><p><b>RESULTS</b>The distance of the lowest entering muscle point of pectoral branche measuring during operation, which was all in sternocostal part, to the midpoint of inferior clavicula margin was (4.9 +/- 1.2) cm (average +/- s), and in 76.5% (13/17) of the patients, the location was coincidence by ultrasound. The length between entering muscle point and the fourth intercostals perforator spot of mammary artery was (1.8 +/- 0.5) cm. All the myocutaneous flaps were alive except one case. The flap was given up as a result of the vessel pedicle injure. The distal end of the flap was dehisced from the residual tongue in one case with base of tongue cancer and healed with changing dressing. Two pharyngeal fistulas in another two cases were healed with conserved treatment. The rate of the flap survival was 94.1% (16/17). Functions as adduction and adtorsion of major pectoral muscle were integrated within 4 weeks to 3 months. Also, the good looking of the neck and upper chest was maintained.</p><p><b>CONCLUSIONS</b>The location of pectoral branches of thoracoacromial artery and the site of the lowest entering muscle point marked by ultrasound detection could help the design of the flap. The modified pectoral' s major myocutaneous flap designing presented better functional protection and reach longer distance and left a better looking for neck and upper chest.</p>

Association between genetic polymorphisms in methylenetetrahydrofolate reductase and risk of laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine whether genetic variations in methylenetetrahydrofolate reductase (MTHFR) are associated with the risk of laryngeal squamous cell carcinoma (LSCC) in a Chinese population.</p><p><b>METHODS</b>Two hundred and seven cases with LSCC and 400 matched health controls were genotyped for the MTHFR 677C > T and 1298A > C polymorphisms by PCR-restriction fragment length polymorphism (PCR-RFLP) methods. The relation between these genotypes and risk of LSCC and gene-environment interaction were analyzed. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated by using unconditional Logistic regression model.</p><p><b>RESULTS</b>The individuals with 677CT and 677TT genotype had a 1.66-fold (95% CI 1.08-2.52) and 3.35-fold (95% CI 2.07-5.54) increased risk of developing LSCC compared with those who had 677CC genotype. The individuals with MTHFR 1298A > C genotype was not significantly different between the two groups. Furthermore, cigarette smoking was also found to interact with MTHFR 677C > T polymorphism in increasing the risk to LCSS further demonstrating the role of gene-environment interaction in development of LSCC.</p><p><b>CONCLUSIONS</b>These findings suggested that the MTHFR 677C > T polymorphism may contribute to the risk of developing LSCC among Chinese population.</p>

Treatment of supraglottic carcinoma with carbon dioxide laser / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of CO2 laser in treatment of supraglottic carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 32 case of supraglottic carcinoma from February 1995 to June 2005, TNM classified as follows: T1N0M0: 20 cases, T1N1M0: 2 cases, T2N0M0: 8 cases and T2N1M0: 2 cases. The patients were treated with endoscopic laser surgery and selective neck dissection (12 cases) or functional neck dissection (4 cases). The follow-up period was more than 3 years.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis shows the overall 5-year survival rate was 90.6%, and the 5-year survival rate of T1 lesions and T2 lesions was 95.6% and 78.2%, respectively. The overall 5-year local control rate was 96. 8%. The 5-year local-regional control rate was 90.3%. With T1 90.9% and T2 89.0% respectively. Two patients had local recurrences, one underwent salvage supraglottic horizontal laryngectomy, another one underwent total laryngectomy. Two cases with regional recurrences underwent radical neck dissection. One of them with concurrent local recurrence was survival after salvage operation. Another one with only regional lesion died of recurrence and pulmonary metastasis after treatment. Four patients experienced minor complications without sequelae. All survival patients had laryngeal preservation except the one who received total laryngectomy.</p><p><b>CONCLUSIONS</b>The results of this study show that endoscopic CO2 laser surgery is highly effective in the treatment of selected supraglottic carcinoma. It shows reliable curative effects and a high larynx preservation rate.</p>