Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy.</p><p><b>METHODS</b>A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy.</p><p><b>RESULTS</b>All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%.</p><p><b>CONCLUSIONS</b>The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.</p>

Fourth branchial abnormity and management experiences / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the fourth branchial abnormity and its managements.</p><p><b>METHOD</b>Twelve cases of the fourth branchial abnormity treated between January 2005 and April 2012 were reviewed.</p><p><b>RESULTS</b>Dissection of the recurrent laryngeal nerve was done in all cases. Partial thyroidectomy was performed in 10 cases, and 2 cases of them received selective neck dissection including level II, III, IV and VI. The abnormity lesions were found to pass posterior to the thyroid glands in the 10 cases and to pass through the inferior constrictor muscle into the pyriform sinus in 7 cases of them. The internal opening in the pyriform sinus demonstrated by preoperative examination couldn't be identified in the operation in one case. The abnormity tract terminated at the lateral surface of the esophagus in one case, passed into the cervical esophagus in one case, and terminated at the lateral surface of the thyroid gland in one case, and formed a cyst lateral to the thyroid gland in one case. No abnormity tract was found to loop around the hypoglossal nerve and to descend into the mediastinum. The left recurrent laryngeal nerve was cut off in one patient, although end to end anastomosis was performed immediately, the patient was still complicated with left vocal cord paralysis postoperatively. The median follow-up time of the cases was 24 months (8-88 months). One case was lost of follow up. No recurrence was found in 10 cases. Recurrence was found in one case, and no recurrence in 10 cases.</p><p><b>CONCLUSIONS</b>The presentation of congenital the fourth branchial fistula is variated significantly. Most abnormity lesions had close relations to the thyroid gland and the recurrent laryngeal nerve, thus the recurrent laryngeal nerve need to protect and partial thyroidectomy might be considered. In the recurrent cases when the abnormity couldn't be identified clearly, selective neck dissection including level II, III, IV and VI should be done long term follow up should be carried out in the cases that the internal opening couldn't be found.</p>

Tortuosity and kinking of cervical segment of internal carotid artery: an analysis of 7 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To outline the clinical manifestations and compare the different radiological methods of detecting malformation of cervical segment of internal carotid artery.</p><p><b>METHODS</b>A retrospective analysis of 7 cases with malformation of cervical segment of internal carotid artery between May, 2004 and April, 2011. CT angiography (CTA) and magnetic resonance angiography (MRA) were used to detect the morphology of cervical segment of internal carotid artery.</p><p><b>RESULTS</b>This disease entity provided no obvious symptoms in five cases, and such complains as pharyngeal foreign body sensation in one and odynophagia in another. Physical examination showed a bulge with pulsation on pharyngeal wall in four cases, and apparent normal pharynges in other three patients, all of which were covered with intact pharyngeal mucosa. Twelve carotid arteries were observed in seven cases, five of which were showed tortuosity and seven kinking. All of the five patients with recorded radiological materials had identified malformations of internal carotid artery, two of which were tortuosity bilaterally and two kinking bilaterally and one tortuosity and kinking respectively. CTA and MRA revealed tortuosity of cervical segment of internal carotid arteries.</p><p><b>CONCLUSIONS</b>No typical clinical symptoms were shown in the malformation of cervical segment of internal carotid artery. Pharyngeal bulge with pulsation could be encountered. CTA and MRA showed excellent ability to depict the malformation of cervical segment of internal carotid artery and its relationship with surrounding structures, which could protect carotid artery from unintended damage.</p>

A comparative study of complications in transoral CO2 and Nd:YAG laser surgery for glottic carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the complications in transoral CO2 and Nd:YAG laser surgery for the treatment of laryngeal carcinoma.</p><p><b>METHODS</b>Retrospective analysis of 83 cases of glottic laryngeal carcinoma treated with laser surgery from January 1, 1999 to December 31, 2008 was carried out. Thirty-two cases were treated with the CO2 laser, including Tis (2 cases), T1N0M0 (21 cases), T2N0M0 (8 cases), and T3N0M0 (1 case). Fifty-one cases were treated with the Nd:YAG laser, including Tis (3 cases), T1N0M0 (36 cases), T1N2M0 (3 cases), and T2N0M0 (9 cases).</p><p><b>RESULTS</b>Four complications (12.5%) occurred in the CO2 laser group. There was 1 local infection (3.1%), 1 numbness of the tongue (3.1%), 1 odontoseisis (3.1%), and 1 subcutaneous emphysema (3.1%). Twenty-seven complications (52.9%) occurred in 19 patients in the Nd:YAG laser group. There were postoperative bleeding 2 (3.9%), dyspnea 5 (9.8%), local infection 7 (13.7%), aspiration pneumonia 4 (7.8%), numbness of the tongue 2(3.9%), pharyngeal cutaneous fistula 1 (2.0%), vocal cord fixation 4 (7.8%), and laryngostenosis 2 (3.9%).</p><p><b>CONCLUSION</b>More complications were observed in the patients with Nd:YAG laser surgery when compared to the patients with CO2 laser surgery.</p>

Study on hemorrhage following coblation assisted uvulopalatopharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the postoperative hemorrhage between standard uvulopalatopharyngoplasty (UPPP) and coblation assisted UPPP, and to evaluate the related risk factors and preventive measures.</p><p><b>METHODS</b>Five hundreds and ninety seven patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent UPPP and coblation assisted UPPP between January 1, 1999, and September 30, 2009 were reviewed retrospectively. Two hundred and sixty three patients with coblation assisted UPPP and 334 patients with standard UPPP were treated respectively. Single factor statistic analysis, multiple factors Logistic regress statistic analysis and Wilcoxon test method for related risk factors were applied.</p><p><b>RESULTS</b>A total of 42 patients (7.0%) experienced postoperative bleeding. Among them, 24 patients with coblation assisted UPPP (9.1%) and 18 patients with UPPP (5.4%) had postoperative hemorrhage. Significant difference was not found in the degree of hemorrhage (z = 0.784, P > 0.05), hemorrhage site(χ(2) = 1.387, P > 0.05) and postoperative hemorrhage rates (χ(2) = 3.14, P > 0.05) between the two surgical techniques. Significant difference was found in the interval of hemorrhage after surgery between the two surgical techniques (χ(2) = 9.25, P < 0.01). History of hypertension, smoking, hepatic dysfunction was found to be correlated with the postoperative hemorrhage (Odd-ratio were respectively 7.326, 3.674, 2.707).</p><p><b>CONCLUSION</b>Coblation technique did not significantly increase UPPP postoperative hemorrhage.</p>

Selective neck dissection on the treatment of neck metastases in 63 patients with squamous cell carcinoma of hypopharynx / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the prevalence and distribution of cervical node metastases in squamous cell carcinoma of hypopharynx and evaluate the efficacy of selective neck dissection (SND) on the treatment of the neck metastases.</p><p><b>METHODS</b>A retrospective review was performed for 63 patients with squamous cell carcinoma of hypopharynx from January 1990 to December 2004. Lymph nodes were clinically negative in 17 patients and positive in 46 patients. There were 15 unilateral SND, 22 bilateral SND and 16 modified radical neck dissections (MRND). Ipsilateral MRND or radical neck dissections (RND) and contralateral SNDs were performed in 10 cases. Forty-eight patients were followed up and the follow-up interval ranged from 24 to 143 months and the median was 41 months.</p><p><b>RESULTS</b>Lymph nodes were pathologically negative (pN0) in 22 and positive (pN +) in 41 patients. A total of 106 positive nodes were found in 95 neck dissections. The distribution of the positive nodes were as follows: Level II 47.2% (50/106), Level III33.0% (35/106), Level IV11.3% (12/106), Level V2.8% (3/106), Level VI 5.7% (6/106). Contralateral nodal metastases and recurrence were observed in both cN0 and cN + cases. There were 18 neck recurrent cases. High incidence of neck recurrence after SND was found in level II and III. The 3-year estimated survival rate analysis were 58.1% for the pN0 and 44.9% for pN1 and 41.1% for pN2 patients. Cox regression analysis suggested N stage was the most important prognostic factor. The risk ratio was 1.7 in pN1 and 2.2 in pN2.</p><p><b>CONCLUSIONS</b>Lymphatic metastases was the most significant prognostic factor of hypopharyngeal squamous cell carcinoma. Bilateral selective neck dissection, when carefully indicated, offers functional advantages without oncologic compromise.</p>

Clinical efficacy of rapid Rhino Stammberger sinus dressing following endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the clinical benefits of rapid Rhino Stammberger sinus dressing (RR), a new nasal packing material for functional endoscopic sinus surgery (ESS), with traditional packing materials sorbalgon plus Vaseline gauze (SV) prospectively.</p><p><b>METHODS</b>Twenty-four patients with chronic sinusitis of the similar grade were enrolled in the study. After ESS, the nasal cavities of each patient were packed with RR in the right side as observing group and SV in the left side as control group. SV in the left nasal cavity was removed in the first day after operation and RR remained in the right nasal cavity until the first endoscopic follow-up 1 week postoperatively. The same perioperative treatments such as irrigation and local steroid were given in both sides of nasal cavities. The grade of rhinalgia, nasal obstruction, discharge, bleeding and epiphora in each side of nasal cavities were assessed on a visual analogue scale (VAS) by the patients at the operation day (packing period), the first day and the second day after operation respectively. Postoperative endoscopic assessment of nasal cavities including crust, discharge, pseudomembrane, edema of mucosa, bubble and ostium obstruction were carried out by a rhinologist on VAS at 1, 2, 3, 4, 6, 8 weeks postoperatively. The follow-up continued until the complete mucosal healing.</p><p><b>RESULTS</b>Three patients were dropped from statistical analysis. One of them with severe hypertension bleeding when he awoke from anesthesia, the RR was run out from the nasal cavity. The other two were lost in the follow-up. Twenty-one patients completed the follow -up ranging between 2-20 months. The scores of rhinalgia, epiphora at the operation day and the rhinalgia at the first day after operation in RR side were lower than SV side (P<0.05). The scores of the amount of crust at the first week after operation in RR side were lower than SV side (P<0.05). Statistically, no significant deference was found between RR and SV in the length of mucosal healing period.</p><p><b>CONCLUSIONS</b>Patients felt more comfortable with the package of RR than traditional material. No pain and secondary bleeding happened. The efficacy of RR on mucosal healing was similar with SV. RR showed some advantages and could be used as packing material following ESS.</p>