Value of three-dimensional CT in the diagnosis of cricoarytenoid dislocation / 中华放射学杂志

Objective:To investigate the value of three-dimensional (3D) CT in diagnosing cricoarytenoid dislocation.Methods:From January 2021 to December 2021, 31 patients with unilateral cricoarytenoid dislocation who had been treated by reduction forceps at the Affiliated BenQ Hospital of Nanjing Medical University were collected retrospectively, and their voice recovered or improved significantly after therapy. The preoperative CT images were reconstructed by volume rendering (VR). The dislocated side (left and right), type of dislocation (total dislocation and subluxation), and dislocation direction (anterior, posterior, internal and external dislocation) of cricoarytenoid dislocation were observed. According to arytenoid articular surface of cricoid cartilage exposed completely or not (caused by arytenoid displacement), they were divided into complete dislocation and subluxation. According to the direction of arytenoid displacement and the part of arytenoid articular surface of cricoid cartilage exposed, they were divided into anterior, posterior, internal and external dislocation. According to the shape of the vocal cords on laryngoscope, anterior and posterior dislocation of each case was judged, and then compared with that of CT.Results:On VR images, there were 28 cases of cricoarytenoid subluxation (90.3%, 28/31) and 3 cases of complete dislocation (9.7%, 3/31). Left cricoarytenoid dislocation was 26 cases (83.9%, 26/31) and right cricoarytenoid dislocation was 5 cases (16.1%, 5/31). Posterior dislocation was 28 cases (90.3%, 28/31) and anterior dislocation was 3 cases (9.7%, 3/31). There were 23 cases of internal dislocation (74.2%, 23/31), 2 cases of external dislocation (6.4%, 2/31), and 6 cases without obvious internal and external dislocation (19.4%, 6/31). Three cases of complete dislocation were left posterior internal dislocation.There were 24 cases of left posterior dislocation (77.4%, 24/31), 4 cases of right posterior dislocation (12.9%, 4/31), 2 cases of left anterior dislocation (6.4%, 2/31) and 1 case of right anterior dislocation (3.2%, 1/31). On laryngoscope, there were 19 cases of posterior dislocation (61.3%, 19/31), 9 cases of anterior dislocation (29.0%, 9/31), 3 cases were difficult to assess (9.7%, 3/31) because of aryepiglottic fold covering. Sixteen cases (55.2%, 16/28) were consistent with 3D CT, and 12 cases (42.8%, 12/28) were inconsistent.Conclusion:The 3D CT is a reliable method to evaluate cricoarytenoid dislocation, which can show dislocated side, type and direction of cricoarytenoid dislocation clearly.

The significance of circulating tumor cells in head and neck squamous cell carcinoma: a preliminary study / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the significance of circulating tumor cells (CTC) in squamous cell carcinoma of the head and neck (HNSCC).@*Methods@#Twenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected (experimental group), including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage (5 cases) and Ⅲ- Ⅳ stage (19 cases). All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique (CellCellector system) was used to detect CTC. SPSS23.0 was used for statistical analysis.@*Results@#The total capture rate of CTC in patients with HNSCC before treatment was 70.8% (17/24), with 40% (2/5) for patients at I-Ⅱ stage, and 78.9% (15/19) for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% (8/16). There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis (P>0.05). CTC was related to tumor staging and tumor differentiation (P<0.05). The positive rate of EGFRVⅢ in CTC was 26.3% (5/19).@*Conclusions@#The CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.

The Effects of Phonosurgery for Vocal Fold Nodule Combined with Botulinum Toxin of Type A Injection in Adults / 听力学及言语疾病杂志

Objective To investigate the effects of phonosurgery combined with botulinumtoxinof type A in-jection in adults with vocal nodules .Methods A total of 76 adults with diagnosis of vocal nodules were studied in this experiment .They were divided into two group according to the different treatments :the surgery group (n=40) ,and the group with the combined botulinum toxin of type A injection (n=36) .Preoperative and postoperative examinations consisted of electronic laryngoscope ,stroboscopic laryngoscope ,voice assessments of subjective and objective evaluations using GRBAS classification and voice disorder index (VHI) .The evaluation parameters were the longest phonation time (MPT) ,jitter and shimmer and dysphonia severity index (DSI) .The results from the two groups were compared .Results There were 5 cases cured ,28 cases improved and 7 cases of now effects in the surgery group .The effective rate was 82 .5％ .There were 30 cases cured and 6 cases improved in the combined in-jection group with the effective rate of 100％ .There were 22 cases with good glottis closure and 18 cases with incom-plete closure in the surgery group postoperatively ;in the combined injection group ,30 cases glottis closed well and 6 cases still closed incompletely .The differences of postoperative VHI ,MPT ,jitter ,shimmer and DSI in addition to G were significant different between the two groups .Conclusion Phonosurgery combined with botulinum toxin of type A injection is an effective way for the treatment of vocal fold nodules in adults .

Enrichment and detection of circulating tumor cells and its application in head and neck squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Circulating tumor cells are tumor cells from the primary tumor or metastatic tumor to fall off into the circulatory system. They are closely related to the recurrence and metastasis of tumor. Detection of circulating tumor cells as a "liquid biopsy" , to get the tumor information through non-invasive sampling method. It has the advantages of short time of tumor diagnosis, repeatable operation, and has gradually replaced the traditional biopsy. In this paper, the enrichment and detection of circulating tumor cells and its application in head and neck squamous cell carcinoma were reviewed.

Preliminary report on meticulous operation of thyroid lobectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Thyroid lobectomy can be programmed to operate as "step by step". Each step must be performed meticulously with quality control, so as to minimize the complications of surgery.</p><p><b>METHODS</b>From May 2013 to Auguest 2014, the meticulous thyroid operation was conducted in 72 cases (144 lobectomies). Pre- and post-operative evaluations by strobe laryngoscopy, parathyroid hormone (PTH), and blood calcium examinations were conducted in all cases.</p><p><b>RESULTS</b>Four cases (5.6%) had transient recurrent laryngeal nerve paralysis after surgery, but no permanent recurrent laryngeal nerve paralysis. There was no transient or permanent superior laryngeal nerve paralysis. Transient hypoparathyroidism occurred in 10 cases, with no permanent hypoparathyroidism. No case presented with postoperative bleeding or infection.</p><p><b>CONCLUSIONS</b>"Meticulous operation of thyroid lobectomy" may minimize effectively the complication of surgery.</p>

Transoral CO2 laser surgery for early glottic carcinoma with anterior commissure involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.</p><p><b>METHODS</b>Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.</p><p><b>RESULTS</b>Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.</p><p><b>CONCLUSIONS</b>Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.</p>

Application of philosophy on comprehensive analysis of adenoid hypertrophy space occupying effect in meticulous adenoidectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To achieve targeted and meticulous surgery of adenoid hypertrophy, a comprehensive analysis of adenoid hypertrophy space occupying effect and morphological evaluation were conducted and the clinical results were retrospectively analyzed.@*METHOD@#One hundred and sixty-three children with adenoid hypertrophy were treated in our department from May 2013 to May 2014. All children received three examinations preoperatively, including: Nasopharyngo-fiberoscopy, Audiometry and Tympanometry. Based on the results, space occupying effect of adenoid hypertrophy was divided into three types: vertical hypertrophy type, horizontal hypertrophy type and vertical & horizontal hypertrophy type. We assumed the causal relationship with vertical hypertrophy type to snoring (nasal blockage) and horizontal hypertrophy type to secretory otitis media respectively. All children received transoral endoscopic adenoidectomy with radiofrequency ablation.@*RESULT@#The postoperative followup of these children for 6 to 12 months showed that the vertical hypertrophy type and horizontal hypertrophy type children all recovered from the syndromes of snoring (nasal blockage) and secretory otitis media respectively. The nasopharyngo-fiberoscopy showed that the nasopharyngeal space was smooth and the bilateral choanas opened well. No recurrence was found.@*CONCLUSION@#The philosophy of comprehensive analysis on adenoid hypertrophy space occupying effect could help the surgeons understand adenoid hypertrophy better and can guide the adenoidectomy more meticulously.

Long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy(TON) and to explore its possible influencing factors.@*METHOD@#To summarize the clinical data of 39 cases underwent transnasal decompression, which were followed-up for more than 1 year. The data, including optic canal CT scanning, flashed-elicited visual-evoked potential (FVEP), preoperational vision and visual field examination were reviewed. Nasal endoscopic optic nerve decompression was preformed. Whether or not optic nerve sheath incision decided to perform was according to preoperative CT and situations in operation. Postoperative follow-up including vision, visual field, funduscopy, nasal endoscopy were performed.@*RESULT@#Total efficacy rate was 30. 77% (12/39), inefficacy rate was 69. 23%(27/39). The efficacy rate was 85. 71% with better than nolight perception, and the efficacy rate was 18. 75% with nolight perception, the clinical effect in the group of preoperative better than nolight perception was better than that of nolight perception, the difference was statistically significant (P 0. 05). The efficacy rate was 26. 32% with optic nerve sheathincision, while the efficacy rate was 35. 00% without optic nerve sheath incision, and there was no statistically significant difference (P>0. 05); Postoperative vision tended to stabilize until about 6 months post-operation, without complications.@*CONCLUSION@#The long-term efficacy of nasal endoscopic opticnerve decompression for TON was certain; The efficacy with preoperative residual vision was better than that of nolight perception, the factor of long or short duration from the trauma point to the operation point and the factor of optic nerve sheath incision didn't influence long curative effect. To avoid the secondary damage to the optic nerve after trauma was the key to increase long curative effect in TON.

Treatment of recurrent laryngeal papilloma by submucosal resection and the effect on prognosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy of submucosal resection by CO2 laser in the treatment of recurrent laryngeal papilloma and the effect on prognosis.@*METHOD@#A total of 11 patients diagnosed as recurrent laryngeal papilloma were included in this review. Papilloma was marked before operation and checked under fibro-laryngoscope. Papilloma was resected completely including the submucosal tissure with CO2 laser or microequipment. In widespread papilloma, false membrane in raw surface were cleared 7-10 days after operation. Surgical specimens (including membrane) were detected by routine pathology, HPV typing and immunohistochemical pathologic examination. The patients were checked once a month in the first 3 months after operation, and then once for every 3 months. Once the hoarseness and other symptoms aggravated or the disease was recurrent, the patients were treated immediately.@*RESULT@#HPV viral DNA was found in 10/11 cases, with HPV11 (7/11 cases) and HPV6 (3/11 cases). Cases with regards to follow-up, from 6 months to 1 year, 3 cases were followed up 1 year after operation, without recurrence. Five patients including 2 children were followed up 6 to 12 months after operation, without recurrence. Two children underwent 2 or 3 operations, were followed-up more than 6 months withouting recurrence.@*CONCLUSION@#Papilloma submucosal resection could decrease postoperative recurrence and is worth to be further investigated.

Thyroid operation after the discussion on drainage technology / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the possibility of thyroidectomy/lobectomy without drainage after surgery.@*METHOD@#Eighty-eight consecutive cases with thyroid mass have been underwent operations including: lobectomy group(42 cases), thyroid lobectomy with contralateral partial thyroidectomy group (17 cases) and total thyroidectomy group (29 cases) from 2013. 06 to 2014. 06 in Nanjing Tongren Hospital. FIfteen patients with thyroid operation in other hospital were collected from 2014. 01 to 2014. 06, the recovery of postoperative incision were compared.@*RESULTS@#Eighty-four cases were smoothly discharged from hospital except 4 thyroidectomy cases suffered from a small amount of effusion in surgical cavity. Our postoperative wound recovery were more in line with the principle of cosmetology compared with other hospital operation group.@*CONCLUSION@#Drainage following thyroidectomy is not essential, if the thyroid surgery is meticulous in each step of the surgery, and can increase the effect of beauty.

Preservation of parathyroid during the thyroidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.</p><p><b>METHODS</b>Forty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed. Of them 26 cases with malignant and 17 cases with benign thyroid diseases.</p><p><b>RESULTS</b>Intraoperatively, all 4 parathyroid glands were identified in 27 cases, 3 parathyroids in 10 cases and 2 parathyroids in 6 cases. Intraoperative parathyroid transplantation was performed in 6 cases, including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation. With the follow-up of 1-3 months after surgery, 10 cases presented with transient hypocalcemia, 8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.</p><p><b>CONCLUSION</b>Accurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.</p>

Clinical study on vocal cords spontaneous rehabilitation after CO2 laser surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the spontaneous rehabilitation and phonation quality of vocal cords after different types of CO2 laser microsurgery.@*METHOD@#Surgical procedures based on Remacle system Type I, Type II, Type III, Type IV and Type V a respectively. Three hundred and fifteen cases with hoarseness based on strobe laryngoscopy results were prospectively assigned to different group according to vocal lesions apperence,vocal vibration and imaging of larynx CT/MRI. Each group holded 63 cases. The investigation included the vocal cords morphological features,the patients' subjective feelings and objective results of vocal cords.@*RESULT@#There are no severe complications for all patients in perioperative period. Vocal scar found in Type I ,1 case; Type II, 9 cases ;Type III, 47 cases; Type IV, 61 cases and Type Va 63 cases respectively after surgery. The difference of Vocal scar formation after surgery between surgical procedures are statistical significance (χ2 = 222.24, P 0.05). This happened in shimmer parameter and the maximum phonation time (MPT) as jitter. There are no statistical significance between Type IV and Type Va on MPT (P > 0.05).@*CONCLUSION@#Morphological and functional rehabilitation of vocal cord will be affected obviously when the body layer is injured. The depth and range of the CO2 laser microsurgery are the key factors affecting the vocal rehabilitation.

Feasibility of endoscope assisted resection of submandibular gland through a dermatoglyph incision / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the feasibility of endoscope assisted resection of submandibular gland through a dermatoglyph incision.@*METHOD@#We choose 5 patients diagnosed as benign diseases of submandibular gland from 2005 to 2010 in Beijing Tongren Hospital. Each patient was given a careful design of dermatoglyph incision preoperatively and an endoscope assisted surgery on the submandibular gland. The details of surgery procedure were described as follow. The inferior edge of the capsule of the submandibular gland was incised, and the traveling characteristics of facial artery, submandibuar gland branch of submental artery, branches of anterior facial vein were identified with endoscopic assistance. Branches of vascular and submandibular postganglionic fibers were treated with bipolar coagulation hemostasis. The submandibular duct was identified and isolated, teased downward from the floor of the mouth, and then ligated. The gland was lifted off the digastric tendon and removed. Suction drainage was used with a plastic tube and the incision was closed with mattress suture. The incision length, intraoperative bleeding, complication and operation duration were retrospectively, reviewed in the traditional group.@*RESULT@#Of the endoscopic group, the incision lengths varied from 2.0-2.5 cm with an average of 2.3 cm. The operation durations varied from 41-87 min, with an average of 64 min. The total intraoperative bleeding was about 5 to 10 ml. No facial paralysis nor infection occurred both intra-and post-operatively. No relapse was detected in the long-term follow-up (4 months to 5 years). Compared with the traditional group, the incision length and bleeding decreased dramatically while the operational duration increased.@*CONCLUSION@#Endoscope assisted resection of submandibular gland through dermatoglyph incision will minimize the damage to surrounding tissue and obtain good cosmetic results.

Function of MMP-2 and TIMP-2 in laryngeal carcinomas and the relationship among expression of MMP-2, TIMP-2 and microvessel density / 中国耳鼻咽喉头颈外科

OBJECTIVE To understand the function of MMP-2 and TIMP-2 and the relationship among expression of MMP-2, TIMP-2 and microvessel density in laryngeal carcinomas. METHODS The expression of MMP-2, TIMP-2 and CD34 in 37 laryngeal carcinomas patients were studied with immunohistochemical staining. The staining results were studied morphometrically with computer image analysis. RESULTS The mean values of MMP-2 expression and microvessel density (MVD) in squamous cell carcinoma group with lymph node metastasis were significantly higher than that without lymph node metastasis (P

Detection of disseminated tumor cells in the peripheral blood of patients with laryngeal or laryngopharyngeal carcinomas / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the diagnostic and prognostic value of molecular biological detection of DTC in peripheral blood. METHODS 32 cases of laryngeal or laryngopharyngeal carcinoma were investigated. DTC in peripheral blood was detected by nested reverse transcription polymerase chain reaction,using CK19mRNA as the marker. RESULTS In the RT-PCR study,15 of 32 cases (46.9 %) showed a positive result. Ten of the 25 cases (40 %) of laryngeal carcinoma were positive. Fix of the remaining 7 cases (71.4 %) of laryngopharyngeal carcinoma were positive. All controls were negative. Of the 20 cases without lymph node metastasis,6 were positive; of the 12 cases with lymph node metastasis,9 were positive. The positive rate of the group with lymph node metastasis was higher than that of the group without lymph node involvement(P

Study on mutations of the PDS gene in large vestibular aqueduct syndrome / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyze for mutations of the PDS gene in patients with sensorineural hearing loss associated with enlarged vestibular aqueduct and analyze the molecular pathogenesis of enlarged vestibular aqueducts. METHODS Eighteen sporadic cases of large vestibular aqueduct syndrome and twelve control individuals with normal hearing were included in this study. Exons 6 and 9 of the PDS gene in all subjects were amplified by polymerase chain reaction and analyzed by direct DNA sequencing. RESULTS Analysis revealed 2 single base changes in exon 6 of one patient with large vestibular aqueduct syndrome. One was a G→C transversion at nucleotide position 611, and the other was a T→G transversion at nucleotide position 612, resulting in a predicted Gly→Ala substitution at position 204. No mutation in exons 6 and 9 of the PDS gene was found in the PDS gene of the control individuals. CONCLUSION Mutations of the PDS gene are responsible for the large vestibular aqueduct syndrome. Analysis of the PDS leftover sequence in patients with large vestibular aqueduct syndrome is the next step in elucidating the complicated causes of this disease.

Preservation of laryngeal function in treatment of hypopharyngeal carcinoma / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study the surgical technique and results of laryngeal function preservation in treatment of hypopharyngeal carcinoma.</p><p><b>METHODS</b>A retrospective review of 305 patients with malignant neoplasms of the hypopharynx (279 males, 26 females, age ranging from 14 to 77 years) was performed from 1978 to 1996. In the 305 patients (stage I, n = 6; stage II, n = 12; stage III, n = 82; stage IV, n = 205), the sites of origin were pyriform sinus (n = 234), postcricoid (n = 21), posterior pharyngeal wall (n = 35) and superior hypopharynx (n = 15). Of the 305 patients, 206 (67.54%, stage I, n = 6; stage II, n = 12; stage III, n = 65; stage IV, n = 123) were surgically treated with laryngeal function preserved and 99 (32.46%, stage III, n = 17; stage IV, n = 82) had no laryngeal function preserved. All had 55-75 Gy radiotherapy according to their need.</p><p><b>RESULTS</b>A total of 206 patients (67.54%) were surgically treated with laryngeal function preserved, totally (voice, respiration and deglutition) in 139 (67.5%) and partially (voice and deglutition) in 67 (32.5%). 99 patients (32.46%) had no laryngeal function preserved. The overall 5-year survival rate of the 305 patients was 44.8%, which segregated to 83% (stage I), 71% (stage II), 58% (stage III), and 36% (stage IV). The 5-year survival of the laryngeal function preserved group was 48% (n = 66), the rate of complications 28% (n = 58) and the rate of residual tumor 5.8% (n = 12), compared with the no laryngeal function preserved group 37% (n = 20), 31.3% (n = 31), and 6% (n = 6) (P > 0.05).</p><p><b>CONCLUSION</b>Only a small proportion of patients (31/305, 10%) with hypopharyngeal carcinoma who require total laryngectomy and preservation of the laryngeal function is feasible for eradication of tumor and preservation of laryngeal function.</p>