Congenital median dermoid fistula of nasal dorsum: one case report / 临床耳鼻咽喉头颈外科杂志

Congenital median dermoid is an uncommon disease. Surgery is the main curative treatment. To review a clinical case and to summarise the characteristics and treatment experience of this disease, referring to the related literature, it is expected that we can provide more clinical thought and therapeutic method for congenital median dermoid fistula of nasal dorsum.

Surgical treatment for cervicothoracic esophageal carcinoma with tracheal involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical treatment and outcome of cervicothoracic esophageal carcinoma with tracheal.</p><p><b>METHODS</b>Ten cases of cervicothoracic esophageal carcinoma with tracheal invasion underwent surgical treatment between 2004 and 2011 was reviewed. Operative methods, complications, pathology, and prognosis were analyzed.</p><p><b>RESULTS</b>The patients were divided into 2 groups, 5 patients with cervical tracheal invasion group and 5 patients with cervicothoracic tracheal invasion. Thoracotomy and anterior mediastinal tracheostomy (AMT) were required for 5 patients with cervicothoracic tracheal invasion. The median follow-up was 23 months (ranging from 6 to 76 months). Of 5 patients with cervical tracheal invasion, 3 patients survived with free of disease for more than 5 years postoperatively, 1 patient died of local recurrence at 14 months postoperatively, and 1 patient died of cardiac infarction at 26 months postoperatively. Among 5 patients with cervicothoracic tracheal invasion, 2 patients died during hospitalization, and 1 patient died of local recurrence at 16 months postoperatively, and 2 patients died of distant metastasis at 6 and 20 months after surgery respectively.</p><p><b>CONCLUSIONS</b>Tracheal invasion is not a contraindication to radical operation for the cervicothoracic esophageal carcinoma. Surgical treatment has a good outcome in cervicothoracic esophageal carcinoma with only cervical tracheal invasion. If thoracic trachea is involved, especially when the length of the distal trachea is less than 5 cm, operation should be performed with caution.</p>

Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment outcome advanced hypopharyngeal carcinoma by surgery with laryngeal function preservation.</p><p><b>METHODS</b>Twenty cases with squamous cell carcinoma of the hypopharynx who were treated by the function preserved surgery between January 2000 and March 2012 were reviewed. Of the patients 19 were males and 1 female, and their median age was 62.0 years. Eight cases were only applied with total or subtotal hypopharyngectomy, and others received total or subtotal hypopharyngectomy with partial-laryngectomy. Postoperative functional training was performed. Radiotherapy was used in all cases from 2 to 4 weeks after surgery.</p><p><b>RESULTS</b>Speech intelligibility remained in all 20 patients and 80.0% of the patients were extracted the trachea tube in the average 60 days.</p><p><b>CONCLUSIONS</b>Laryngeal functions of larynx can be preserved in advanced hypopharyngeal carcinoma by total or subtotal hypopharyngectomy alone or plus partial laryngectomy with functional reconstruction, and the patients can maintain their rational speech and swallowing functions.</p>

Surgical management of cervical esophageal carcinoma in 16 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function.@*METHOD@#Sixteen patients with cervical esophageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypopharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the reconstraction with gastric-pharyngeal anastomosis. One patient received the cervical esophagectomy and partial hypopharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preservation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total larynx. All the patients were carried out the bilateral neck dissections.@*RESULT@#The surgical resection rate was 100% and no operative death occurred. The postoperative complications included pulmonary infection in two cases, anastomotic fistula in two cases, anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the laryngeal function is 12.5%. The 3-year survival rate is 30.7%, and the 5-year survival rate is 23.1%.@*CONCLUSION@#The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be reconstructed by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.

Management and classification of first branchial cleft anomalies / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We aimed to identify the different courses of first branchial cleft anomalies and to discuss the management and classification of these anomalies.@*METHOD@#Twenty-four patients with first branchial cleft anomalies were reviewed. The courses of first branchial cleft anomalies and their corresponding managements were analyzed. Each case was classified according to Olsen's criteria and Works criteria.@*RESULT@#According to Olsen's criteria, 3 types of first branchial cleft anomalies are identified: cysts (n = 4), sinuses (n = 13), and fistulas (n = 7). The internal opening was in the external auditory meatus in 16 cases. Two fistulas were parallel to the external auditory canal and the Eustachian tube, with the internal openings on the Eustachian tube. Fourteen cases had close relations to the parotid gland and dissection of the facial nerve had to be done in the operation. Temporary weakness of the mandibular branch of facial nerve occurred in 2 cases. Salivary fistula of the parotid gland occurred in one patient, which was managed by pressure dressing for two weeks. Canal stenosis occurred in one patient, who underwent canalplasty after three months. The presence of squamous epithelium was reported in all cases, adnexal skin structures in 6 cases, and cartilage in 14 cases. The specimens of the fistula which extended to the nasopharynx were reported as tracts lined with squamous epithelium (the external part) and ciliated columnar epithelium (the internal part). According to Work's criteria, 9 cases were classified as Type I lesions, 13 cases were classified as Type II lesions, and two special cases could not be classified. The average follow-up was 83 months (ranging from 12 to 152 months). No recurrence was found.@*CONCLUSION@#First branchial cleft anomalies have high variability in the courses. If a patient is suspected to have first branchial anomalies, the external auditory canal must be examined for the internal opening. CT should be done to understand the extension of the lesion. For cases without internal openings in the external auditory canal, CT fistulography should be done to demonstrate the courses, followed by corresponding treatment. Two special cases might be classified as a new type of lesions.

Selective neck dissection and the management of the hypopharyngeal cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the most appropriate form of selective neck dissection(SND) in the hypopharyngeal cancer with cervical lymph node metastasis.@*METHOD@#We have retrospectively analyzed the distribution and prevalence of cervical metastasis in 26 patients with hypopharyngeal squamous cell carcinoma from January 1998 to December 2008. All the patients underwent SND as part of the primary treatment. There were 34 elective SNDs and 17 therapeutic SNDs from 11 node-negative hypopharyngeal cancers and others node-positive.@*RESULT@#Occult metastasis was found in 6 patients (55%) with cervical metastasis confined to level II and III. Clinical node-positive necks were all pathologically identified with 6.7%, 66.7%, 86.7%, 46.7%, and 20.0% of the prevalence of metastasis to level I, II, III, IV and V respectively. The regional recurrences were found in 4 patients during the follow-up, which were all from cN+ patients. No patient experienced level I recurrence.@*CONCLUSION@#The results of this study suggest that SND (I-III) may be feasible for the treatment of cN0 hypopharyngeal cancer, which needs a larger sample to verify. Meanwhile, from our data, it has a satisfactory result to perform SND (II-V) with adjuvant radiotherapy for the cN+ patients.