Preventing and treating anterior commissure adhesion with mucosal flap: a study in canines and clinical cases / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases. Methods: A prospective experiment was performed from November 2019 to June 2021. Twenty five canines were randomly divided into 5 groups(A, B, C, D, E). Group A, B, C, D received anterior commissure injury by CO2 laser, then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex, silicone keels and without treatment, group E didn't injure the vocal cord after intubation. The keel was removed after 2 weeks, the larynx was harvested after 4 weeks. The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope, standard vocal cord length and standard glottic area. A retrospective analysis was performed on sixteen patients with anterior commissure lesion, who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021 (10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex). All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery. SPSS 20.0 software was used for statistical analysis. Results: No surgery accident or complication happened in canines and patients. The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A, C, D (Hstandard vocal cord length=31.688, Hstandard glottic area=16.444, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C, D(Hstandard vocal cord length=20.936, Hstandard glottic area=11.786, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A, B, E were not significantly different to that before surgery(tA left standard vocal cord length=2.636, tA right standard vocal cord length=2.582, tB left standard vocal cord length=2.707, tB right standard vocal cord length=2.673, tE left standard vocal cord length=0.370, tE right standard vocal cord length=0.821, tA standard glottic area=2.731, tB standard glottic area=2.753, tE standard glottic area=-0.529, P>0.05). The standard vocal cord length and standard glottic area after 4 weeks in group C, D were significantly lower than those before surgery(tC left standard vocal cord length=16.137, tC right standard vocal cord length=13.984, tD left standard vocal cord length=11.903, tD right standard vocal cord length=14.587, tC standard glottic area=10.280, tD standard glottic area=22.974, P<0.05). During 6-18 months of follow-up in clinical patients, no one developed a glottic web. Three months after surgery, Jitter, Shimmer, noise to harmonic ratio(NHR), the maximum phonation time(MPT)in all patients were significantly different from preoperative(tintralaryngeal mucosal flap jitter=24.885, tintralaryngeal mucosal flap shimmer=22.643, tintralaryngeal mucosal flap NHR=6.202, tintralaryngeal mucosal flap MPT=-9.661, tfree mucosal flap jitter=25.459, tfree mucosal flap shimmer=18.683, tfree mucosal flap NHR=5.705, tfree mucosal flap MPT=-20.840, P<0.05). Conclusion: Mucosal flap combined with silicone keel is an effective technique for preventing and treating anterior commissure adhesion. The effect of pedicled intralaryngea lmucosal flap is better.

Endoscopy and clinicopathological characteristics of upper gastrointestinal tract metastasis / 中国内镜杂志

Objective To explore the endoscopic and clinicopathological characteristics of upper gastrointestinal tract metastasis,it can improve the diagnosibility of endoscopists and pathologists. Methods Three cases of upper gastrointestinal tract metastasis and seven cases in the related literature were studied, and its endoscopy and clinicopathological findings were analyzed with a review of the literature, whose gastrointestinal symptoms were the first manifestation. Results Case 1 endoscopic detection of esophageal ulcer lesions, pathological diagnosis of metastatic cancer, considering the source of the lung, confirmed by imaging examination; Case 2 showed that the gastric body was prominent, and the pathological diagnosis was squamous cell carcinoma. It was suggested that the clinical examination should be carried out without metastasis, and then confirmed by imaging examination and bronchoscopy biopsy; Case 3 endoscopic examination revealed multiple polypoid lesions in the stomach and duodenum, and was pathologically diagnosed as metastatic renal cell carcinoma. 3 patients were correctly diagnosed, thus avoiding unnecessary radical surgical treatment. 7 cases of patients in the literature were aged, they were also in a variety of gastrointestinal symptoms and the first diagnosis, no previous history of cancer, endoscopic lesions in the stomach or duodenum, supplemented by immunohistochemical staining in pathological diagnosis were diagnosed as metastases, the primary tumor site without organ specific. Conclusion The metastasis of upper gastrointestinal tract is rare, especially when the gastrointestinal symptoms were the first manifestation,it is usually missed and misdiagnosed. The diagnosis relies on the endoscopic and pathological examination, supplemented by the imaging examination, so the patients could get effective treatment in time.

The diagnostic value of laryngeal electromyography in vocal fold paralysis and arytenoid dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation.@*METHODS@#The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed.@*RESULTS@#The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (<0.01) and turns (<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns.@*CONCLUSIONS@#LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.

Experimental study on different power CO2 laser for vocal cord injury / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the injury and repair of the subepithelial cordectomy by CO2 laser in different power.</p><p><b>METHODS</b>Thirty dogs were randomly divided into 5 groups according to different laser power such as A(1 W), B(3 W), C(5 W), D(8 W), E(cold instruments), 6 dogs in each group. Subepithelial cordectomy was performed on the dogs and the tissue damage and wound recovery were observed in different time after operation.</p><p><b>RESULTS</b>The mucosa reaction in group C, D was heavier than those in group A, B, E, and the wounds healed slowly with visible pathological scars. The densities of fibroblast and blood capillary were determined with optical microscope. It was found that those in group C, D were higher than those in group A, B, E. The difference was statistically significant (average P < 0.05). Observation by electron microscope showed that the injuries were lighter in group A, B, E and there was no significant difference in vocal cord repair process, while the injuries were more serious in group C, D with few elastic fibers in lamina propria and collagen fibers increased significantly after vocal cord repairing.</p><p><b>CONCLUSIONS</b>The tissue repair after subepithelial cordectomy by CO2 laser with low power (1 - 3 W) was similar to that by cold instrument surgery.</p>

Relationship of local recurrence with expression of protein P53 and PCNA in laryngeal carcinoma and its surgical margins / 第二军医大学学报

Objective: To explore the relationship of the local recurrence with the expression of protein P53 and PCNA in the primary lesions and the surgical margins of laryngeal carcinoma. Methods: The primary lesions and the surgical margins of laryngeal carcinoma of 36 patients were made into serial sections. Immunochemical method (H-E staining) was used to detect the expression of P53 and PCNA protein. Results: The positive rates of protein P53 and PCNA were 55.6% (20/36) and 88.9% (32/36) in the primary lesions,and 25%(9/36) and 30.6% (11/36) in the surgical margins, respectively. The recurrent rates of the primary lesions positive for P53 and PCNA were 35% (7/20) and 25% (8/ 32), respectively, which were higher than those negative for them (12.5% [2/16] and 25% [1/4]). The recurrent rates of surgical margins positive for p53 and PCNA were 44.4% (4/9) and 72.7% (8/11), respectively, which were higher than those negative for them (18.5% [5/27] and 4% [1/25]). The expression of P53 and PCNA proteins in the primary lesions and surgical margins was abnormal; the recurrent rate of the laryngeal carcinoma was 100% (4/4) after surgery. Conclusion: P53 and PCNA protein can be used as biomarkers for local recurrence of laryngeal carcinoma after operation. Detection of P53 and PCNA in both the primary lesions and the surgical margins may be of greater significance in forecasting local recurrence.