Analysis of prognostic factors of primary mucosal melanoma in nasal and oral cavity / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Primary mucosal melanoma of nasal and oral cavity is a rare tumor with a poor prognosis. This study aims to summarize the clinical features and survival status and then to evaluate the prognostic factors.@*METHOD@#Clinical data of 66 patients with mucosal melanoma in nasal and oral cavity treated from Jan. 1980 to Jan. 2005, were retrospectively reviewed. All patients received the surgery. The following parameters: gender, age, primary location, tumor size, presence of ulcer, presence of pigment aggravation, lymph node metastasis, treatment mode and initially treatment outcome were investigated to evaluate their potential impact on survival. Kaplan-Meier method and Log-rank test were used for survival analysis. Cox proportional hazards regression was used for multivariate analysis.@*RESULT@#The primary locations were nasal cavity (34 cases), oral cavity (23 cases) and paranasal sinuses (9 cases). All patients received surgery. Thirty-seven patients received post-operative adjuvant treatments. Of which, 12 received adjuvant chemotherapy. 8 received adjuvant immunotherapy, 5 received adjuvant chemotherapy and immunotherapy, 8 received adjuvant radiotherapy and 4 received adjuvant radiotherapy and chemotherapy. Local recurrence, lymph node metastasis or distant metastasis appeared in 15 patients at 6 months after the primary treatment. The distant metastasis rate was 15.2% (10/66). The average survival time was 77.9 months, the median survival time was 33.7 months. The 3-year and 5-year overall survival rates were 41.4% and 31.1% respectively. Multivariate analysis showed that tumor size, lymph node metastasis and initially treatment outcome were significant prognostic factors for overall survival.@*CONCLUSION@#The prognosis of mucosal melanoma in nasal and oral cavity is poor. Tumor size, lymph node metastasis, initially treatment outcome are independent prognostic factors for overall survival. The effect of post-operative adjuvant treatments is not clear, and further studies are needed.

Clinical analysis on 28 cases of head-neck malignant fibrous histiocytoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical feature and treatment of head-neck malignant fibrous histiocytoma (MFH).@*METHOD@#A retrospective analysis on the clinical data of 28 cases of MFH were carried out, of which 9 were in the maxilla, 3 in the nasal cavity, 5 in the larynx, 3 in the parotid, 3 in the temporal bone, 1 in the hypothyroid, and 4 in the head and neck region. All of the cases underwent immune histochemistry: 4 cases of surgery alone, 23 cases of surgery followed by radiotherapy, and 1 case of radiotherapy alone.@*RESULT@#Except 5 cases lost follow-up after 1 year, all the other cases were followed-up over 3 years, the survival rate for 1 or 3 years was respectively 96.4% (27/28) and 57.1% (16/28); 23 cases were followed up for 5 years, the survival rate was 26.1% (6/23). The recurrent rate in 3 years was 60.7% (17/28), with 1 to 7 times recurrence at a mean interval of 5.6 months. Twelve recurrent cases were adopted expanded resection of non-defined operation except 1 case with radiotherapy.@*CONCLUSION@#The diagnosis of MFH depends on the technology of immune histochemistry. Early diagnosis, expanded resection, and integrated therapy could reduce the recurrence and increase the survival rate; the recurrence could adopt expanded resection of non-defined operation to prolong the life.

Clinical analysis on 28 cases of head-neck malignant fibrous histiocytoma / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical feature and treatment of head-neck malignant fibrous histiocytoma (MFH).Method:A retrospective analysis on the clinical data of 28 cases of MFH were carried out, of which 9 were in the maxilla, 3 in the nasal cavity, 5 in the larynx, 3 in the parotid, 3 in the temporal bone, 1 in the hypothyroid, and 4 in the head and neck region. All of the cases underwent immune histochemistry: 4 cases of surgery alone, 23 cases of surgery followed by radiotherapy, and 1 case of radiotherapy alone.Result:Except 5 cases lost follow-up after 1 year, all the other cases were followed-up over 3 years, the survival rate for 1 or 3 years was respectively 96.4%(27/28) and 57.1%(16/28); 23 cases were followed up for 5 years, the survival rate was 26.1%(6/23). The recurrent rate in 3 years was 60.7%(17/28) ,with 1 to 7 times recurrence at a mean interval of 5.6 months. Twelve recurrent cases were adopted expanded resection of non-defined operation except 1 case with radiotherapy.Conclusion:The diagnosis of MFH depends on the technology of immune histochemistry. Early diagnosis, expanded resection, and integrated therapy could reduce the recurrence and increase the survival rate; the recurrence could adopt expanded resection of non-defined operation to prolong the life.

Diagnosis and treatment of serious adult airway obstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the diagnosis and treatment of serious adult airway obstruction.@*METHOD@#Eighty six adult cases admitted to our hospital for serious airway obstruction from 1995 to 2006, were analyzed retrospectively.@*RESULT@#Among the 86 cases, 34 cases (39.5%) had inflammatory diseases, 32 cases (37.2%) had neoplastic diseases and 9 cases (10.5%) had traumatic diseases. In addition, 3 cases of laryngeal spasm, 6 cases of laryngeal stricture, 2 cases of bilateral laryngeal paralysis and 1 case of asphyxia with aspiration were also include in this study. The patients who had laryngeal or tracheal obstruction were 60 cases (69.8%) and 13 cases (15.1%). In addition, 46 cases (53.5%) and 4 cases (4.7%) had tracheotomy or endotracheal intubation. Twenty six cases were only adopted medical treatment to relieve dyspnea. The final diagnosis of the 86 cases was made and the serious airway obstruction was was relieved within 2 hours. While 14 cases (16.3%) had serious complications and 6 cases (6.9%) had operative complications occurred. One cases (0.2%) died.@*CONCLUSION@#The causes of serious adult airway obstruction could be complicated, the site and character of obstruction would change constantly. Quick diagnosis, timely removal of the obstruction should be critical factors to improve curative effect.

Resection of invasive head and neck neoplasms involving skull base / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the operative methods of invasive head and neck neoplasms involving skull base.@*METHOD@#Thirty-two cases with invasive head and neck neoplasms involving anterior and lateral skull base, from 1997 to 2005, were treated with surgical resection. Nine surgical approaches including endoscopic transnasal approach for five cases, combined craniofacial approach for three cases, maxillary resection approach for 15 cases, transpalatal approach for one case, transmandibular approach for one case, lateral neck-mandibular incision approach for two cases, combined retroauricular and neck approach for one case, frontotemporal approach for two cases, and facial translocation approach for two cases were used to resect the tumors.@*RESULT@#Four cases with nasal sinus mucocele were only applied drainage and one case with chordoma was subtotally resected. The tumors of the rest 27 cases were totally removed. Although one case complicated with cerebrospinal fluid leak and recovered within one week, no one died from the operation and no serious cranium-cerebrum complication occurred. Eight cases with benign tumor were followed up for six months to eight years without recurrence and no one died. For 24 cases with malignant tumor, survival rates of three and five years were 63.2% (12/19), 41.7% (5/12) respectively.@*CONCLUSION@#Surgical approach must be designed according to the pathological change's characters, site and invasive range. Favorable curative effect could be achieved by resecting tumors totally as possible, protecting important constitutions, and adopting proper reparative techniques.