Multiple reoperation of recurrent maxillofacial huge dermatofibrosarcoma protuberans / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To Summary the experience of surgical treatment for many times in 1 case of maxillofacial huge dermatofibrosarcoma protuberans.@*METHOD@#The patient was diagnosed with dermatofibrosarcoma protuberans according to the pathological examination. From 2004 to 2011, the patient underwent extensive surgical resection, Mohs micrographic surgery(MMS) and free flap grafting method as surgical treatment for many times, and was closely followed-up after operation.@*RESULT@#The tumor was completely removed in each operation, with wound skin graft survived. But relapse occured repeatedly, recurrence interval was from 7 months up to five years and eight months,recurrence interval gradually extended, all of the recurrence occurred at Mohs microsurgery cut edge.@*CONCLUSION@#Eexpanded resection is the preferred treatment for the early stage maxillofacial huge dermatofibrosarcoma protuberans. For advanced stage tumor, expanded resection should be combined with Mohs microsurgery. Free flap grafting was suggested in primary repair insteading of myocutaneous flap. At the same time, postoperative assistant radiotherapy, strengthen follow-up and early intervention were suggested.

Nasal endoscope negative pressure cleaning and sinupret drops to treat radiation nasosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the effect of nasal endoscope negative pressure cleaning and sinupret drops to treat radiation nasosinusitis (RNS).@*METHOD@#One hundred and fifty-three patients with nasopharyngeal carcinoma were randomly divided into treatment group A, B, C . Group A using nasal endoscope negative pressure cleaning and sinupret drops, group B using nasal endoscope negative pressure cleaning and normal saline spray washing, group C using saline nasal irrigation through nasal catheter. All patients with sinusitis condition were evaluated at the end of radiotherapy, three months and six months after radiotherapy.@*RESULT@#Comparison between groups, three periods of RNS incidence, moderate to severe RNS incidence are A < B < C. Six months after radiotherapy, group A compared with group C, there are significant difference (P < 0.01), group A and group C compared with group B respectively, the difference was statistically significant (P < 0.05).@*CONCLUSION@#Nasal endoscope negative pressure cleaning and sinupret drops can significantly reduce the long-term incidence of RNS, especially obviously reduce the incidence of moderate to severe RNS,which is a practical and effective method to treat RNS.

Clinical analysis of 23 patients with ossifying fibroma of paranasal sinuses / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical features and treatment options of ossifying fibroma of paranasal sinuses.@*METHOD@#A retrospective evaluation of twenty-three patients with ossifying fibroma of paranasal sinuses was presented. The choice of surgical operations on ossifying fibroma of paranasal sinuses was mainly decided by the location and area of ossifying fibroma. Radical operations were performed in twenty-one patients, ten of them through a lateral rhinotomy approach, eight through nasal endoscopic approach, four through Caldwell-Luc approach, one through coronal approach.@*RESULT@#Two patients were performed partial resection by nasal endoscopic surgery. Diagnoses of all cases were confirmed by pathology. All patients outcomes were successful, no serious complication from the surgical technique occurred. Twenty cases were followed-up for six months to nineteen years. Two patients recurred.@*CONCLUSION@#Earlier diagnosis, CT scan, proper surgery, and radical resection are the keys to the treatment of ossifying fibroma of paranasal sinuses.

Comparison between three-way and standard laryngeal mask airways for children with pulmonary disorders undergoing diagnostic endoscopies

To compare the safety and efficacy between a three-way laryngeal mask airway[TLMA] and a standard laryngeal mask airway [SLMA] in children with pulmonary disorders. We retrospectively analyzed 60 pediatric patients with pulmonary disorders who had surgical procedures with general anesthesia [oxygen flow rate: 1L/min] and volume control ventilation. Among the patients, 42 were inserted with TLMA [group T] and 18 were administered with SLMA [group S]. Several parameters were obtained before, during and after the endoscopic procedure. Ease of insertion and the conditions during insertion were comparable in both groups. There were no significant differences between the two groups regarding changes in hemodynamic and blood gas parameters. However, patients in group S spent significantly longer time in surgery [group T: 35 +/- 24 min compared with group S: 53 +/- 31 min, P < 0.05] and ventilated [group T: 52 +/- 26 min compared with group S: 68 +/- 28 min, P < 0.05] than those in group T. TLMA can be considered more effective for ventilation in children with pulmonary disorders who are undergoing general anesthesia.

Detection and correlation of lipopolysaccharide, vitamin D receptor and matrix metalloproteinase-9 in the middle ear cholesteatoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression and concentration of lipopolysaccharide (LPS) and matrix metalloproteinase-9 (MMP-9) in middle ear cholesteatoma and discuss their relations.@*METHOD@#Twenty-nine cases of middle ear cholesteatoma tissue, 18 cases of external auditory canal tissue were detected by limulus amebocyte lysate assay (LAL-assay), and expression of MMP-9 protein in formalin-fixed, paraffin-embedded tissues was detected by immunohistochemical method.@*RESULT@#The concentrations of LPS in cholesteatoma were higher than that in external auditory canal tissues. In group of cholesteatoma: M = 0.739 0, IQR = 0.6203, and in group of external auditory canal tissues: M = -0.2538, IQR = 1.1692 (P 0.05). LPS, MMP-9 weren't significantly correlated by Spearman test.@*CONCLUSION@#LPS was responsible for middle ear cholesteatoma and its related bone erosion. MMP-9 was related to the development of middle ear cholesteatoma. There's no correlation between LPS and MMP-9.

The combined application of dissociate skin flap and vacuum sealing drainage on the defect of the large neck neoplasms after surgical procedures / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the effect of the combined application of dissociate skin flap and vacuum sealing drainage (VSD) for the repairing for defect after surgical management of huge neck neoplasms.@*METHOD@#Nineteen patients with huge neck malignant tumor involving the skin of the neck were given radical operation, making use of VSD covering the wound surface. After giving 6.65-7.98 mm Hg continuous negative pressure drainage for 72 h, the patients turned to be treated by intermittent negative pressure therapy with 2 min free interval after each treatment period for 5 min. After dismantling the VSD at 7th to 10th day postoperatively, the good wounds covered by granulation tissue were treated by the skin graft operation with dissociate skin flap from thighs; as for the wounds of which the granulation tissue didn't grow well and important cervical tissues was not fully covered by the granulation tissue, VSD was applied again for 1 week, followed by the skin graft operation.@*RESULT@#Nineteen patients have received a total of 23 times of VSD wound treatment, one-stage operation time was significantly shortened. The granulation tissue grew faster on the wound after VSD treatment, and the important cervical tissues such as great vessels could be well covered. The infection and tumor recurrence were observed directly after dismantling the VSD. The skin graft transplantation would be performed after 1-3 weeks.@*CONCLUSION@#The treatment by vacuum sealing drainage combined with skin graft for surgical wounds of huge neck tumor postoperatively has the advantages of simple operation, little injury and promotion of the wound healing, which is an effective way for treatment of neck skin defect by surgical operation for the huge tumor.

Ventilatory efficiency of three-way laryngeal mask airway in tracheal foreign body removal / 中华麻醉学杂志

Three-way laryngeal mask airway (tLMA) was used in 31 patients aged 4-68 yr, weighing 10- 79 kg undergoing tracheal foreign body removal under general anesthesia. Anesthesia was induced with propofol 3 mg/kg, vecuronium 0.12 mg/kg and remifentanil 0.4 μg/kg. tLMA was inserted. The patients were mechanically ventilated. Anesthesia was maintained with iv infusion of propofol 2 mg . Kg-1 ? H-1, vecuronium 0.08 mg·kg-1·h-1 and remifentanil 0.15 μg·kg-1 ·min-1 . Radial artery was cannulated for BP monitoring and blood sampling. The operation time was 6-34 min and mechanical ventilation time 19-45 min. There was no significant change in SP, DP, HR, VT, Ppeak and Ppeak CO, during operation as compared with the baseline values before anesthesia. SpO2 was significantly increased at T2-6. PCO2, PO2 and O2sat were obviously improved after tLMA was used. All the patients emerged bom anesthesia within 30 min after operation. No aspiration, obvious gastrointestinal inflation, and pharyngeal and laryngeal edema and injury occurred. Mild agitation occurred in a short time during the recovery period in one patient. No complication occurred.