Angioleiomyoma in the head and neck region / 中国耳鼻咽喉头颈外科

[A BSTR ACT] OB J ECTI V E To i mprove the recognization of clinical, imaging and pathological characteristics of angioleiomyoma (ALM) in the head and neck region. METHODS We retrospectively reviewed the data of 20 patients with ALM in the head and neck region between 2000 and 2012. RESULTS Seven male and 13 female patients were included in this study. The average age was 52.5 (from 28 to 74 years). The symptom in most cases (n=14) was the painless mass, 4 tumors originating in the nasal cavity presented with nasal obstruction or (and) epistaxis, and the other 3 cases were accidentally found by physical examination. The results of B-ultrasonography in 10 ALM cases of subcutaneous or deep space were homogeneously hypoechoic echo texture, straight and linear vessels in the tumor with convergence to one point with a circumscribed margin. MRI in 5 cases demonstrated typically a well-defined mass, which showed hypointensity or isointensity to muscle on T1WI, and heterogeneous hyperintensity on T2WI. All lesions showed obviously delayed enhancement on contrast MRI. HE stain showed that the tumors were formed by bundles of spindle-shape smooth muscle cells circumscribing numerous slit-like blood vessels in most cases. Immunoperoxidase staining revealed that the tumor cells were strongly positive for calponin, desmin and smooth muscle actin (SMA) in the cytoplasm of the smooth muscle cells. The positive expression of progestogen receptor and estrogen receptor was seen in 7 cases and 4 cases respectively among 10 cases. All patients underwent surgery, and recovered well postoperatively without recurrence or malignancy. CONCLUSION The clinical manifestations of ALM are nonspecific. ALM has distinctive imaging features in B-ultrasonic and MRI examination. Histological examination and immunoperoxidase staining can make a definite diagnosis of the disease. Progestogen receptor and estrogen receptor can be expressed in ALM. The postoperative prognosis is good.

Giant tonsillolith in a child / 临床耳鼻咽喉头颈外科杂志

We describe a case of a 7-year-old child with Down syndrome who presented with loud snoring and cessation of breath during sleep and was found to have a large calculus (20 mm X 12 mm X 12 mm) in her left tonsil by CT scan for which tonsillectomy with adenoidectomy were done. This is one of the youngest reported cases in the literature.

The clinical value of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck by methylene blue method and radiolabeled tracer method / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical value of sentinel lymph node (SLN) detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck (cN0) by methylene blue method, radiolabeled tracer method and combination of these two methods.@*METHOD@#Thirty-three patients with cN0 laryngeal carcinoma and six patients with cN0 hypopharyngeal carcinoma underwent SLN detection using both of methylene blue and radiolabeled tracer method. All these patients were accepted received the injection of radioactive isotope 99 Tc(m)-sulfur colloid (SC) and methylene blue into the carcinoma before surgery, then all these patients underwent intraopertive lymphatic mapping with a handheld gamma-detecting probe and blue-dyed SLN. After the mapping of SLN, selected neck dissections and tumor resections were peformed. The results of SLN detection by radiolabeled tracer, dye and combination of both methods were compared.@*RESULT@#The detection rate of SLN by radiolabeled tracer, methylene blue and combined method were 89.7%, 79.5%, 92.3% respectively. The number of detected SLN was significantly different between radiolabeled tracer method and combined method, and also between methylene blue method and combined method. The detection rate of methylene blue and radiolabeled tracer method were significantly different from combined method (P < 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The accuracy and negative rate of SLN detection of the combined method were 97.2% and 11.1%.@*CONCLUSION@#The combined method using radiolabeled tracer and methylene blue can improve the detection rate and accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately represent the cervical lymph node status in cN0 laryngeal and hypopharyngeal carcinoma.

Analysis of basal cell adenoma of the parotid gland: nine cases report / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To improve recognization of clinical, imaging and pathological characteristics of basal cell adenoma (BCA) of parotid gland.@*METHOD@#We collected and analyzed the data of the clinical manifestation, imaging features, histological and immunohistochemical characteristics of BCA of parotid gland (n = 9).@*RESULTS@#Among 9 patients, 2 male, 7 female, and the average age was 55.2 (from 34 to 66 years). The clinical manifestation showed the painless mass in the parotid region. Seven cases underwent CT and other 2 cases underwent MRI. Imaging showed all tumors were located in the superficial lobe, roughly spherical and non-lobulated in shape, with well-defined boundary. The maximal diameter was less than 30 mm. Seven cases showed slightly high density shadow of soft tissue on plain CT. Compared with the parotid signal intensity, two cases showed hypointensity on T1WI and high signal on T2WI. All lesions showed obvious enhancement on delayed contrast CT or MRI. Cystic changes occurred in two cases. Gross observation: the tumors were solid in section, grey, medium in nature and clear with the surrounding tissues. Cystic changes occurred in the superficial region of superficial lobe of two cases. The capsule of tumor was well circumscribed in 8 cases and focally involved in another case. Microscopy: The parenchyma of BCA was mainly composed of basaloid cells, with myoepithelial cells palisading at the periphery of the epithelial nests. Basal membrane separated the parenchyma from the stromal, the latter lacking the myxochondroid matrix. Immunohistochemistry: basaloid cells were positive for CKpan, CD117 and CKL, while myoepithelial cells were positive for P63, SMA, and calponin. The Ki-67 lablel ing index of tumour cell was 0-4%. All patients performed superficial lobe parotidectomy and tumor dissection, and they recovered well postoperatively without tumor recurrence or malignancy.@*CONCLUSION@#The BCA of parotid gland has distinctive imaging and pathological features with favourable postoperative prognosis.

Wide chondrosarcoma of the larynx in female: a case report / 临床耳鼻咽喉头颈外科杂志

A case of a 67-years-old female with well-differentiated chondrosarcoma of the left lamina of the thyroid cartilage, cricoid cartilage and arytenoid cartilage is reported, in which a total arytenoidectomy and partial resection of the left thyroid cartilage and cricoid cartilage were performed. The postoperative course has been successful except for the existence of a tracheal stoma and slight hoarseness. There has been no evidence of recurrence or metastasis in 6 years of follow-up.

Study on treatment of 26 cases with nasal basal cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the relationship between surgical margin and recurrence of nasal basal cell carcinoma.@*METHOD@#Twenty-six cases of nasal basal cell carcinoma were analyzed. Mohs microsurgical operation was used in 15 cases and conventional operation was used in 11 cases.@*RESULT@#Twenty-six cases of the tumors were resected and the wound defect was repaired concurrently. Two cases with tumor recurrence were subjected secondary resection and then no recurrence occurred.@*CONCLUSION@#Intraoperation frozen section can help guide the surgical margin. Skin tissue was saved and the repair was facilitated, it also help save the skin tissue , facilitate the repair, reduce the recurrence rate but increased the operation cost and time.

Modified intranasal endoscopic dacryocystorhinostomy in chronic dacryocystitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the technique and curative effect of modified intranasal endoscopic dacryocystorhinostomy (EDCR) for chronic dacryocystitis.@*METHOD@#Twenty-two patients (Twenty-three eyes)with chronic dacryocystitis, undergoing modified intranasal EDCR were retrospectively analyzed in this study.@*RESULT@#The follow-up period ranged from six months to ten months. Twenty eyes were cured successfully and two eyes had relieved symptoms. While one case failed. No serious complications were found. The total effective rate was 22/23 (95.7%).@*CONCLUSION@#The modified intranasal EDCR is an effective method to treat chronic dacryocystitis.

The expression and its potentially clinical significance of EphA2 in nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the expression of EphA2, and investigate its correlation with the development, progression, invasion, metastasis, angiogenesis and prognosis in nasopharyngeal carcinoma(NPC).@*METHOD@#Immunohistochemical staining was used to determine the expression level of EphA2 protein in 61 cases NPC and 20 cases chronic nasopharyngitis samples. The clinically pathological data and results of follow-up were collected. Microvessel density (MVD) was also measured by immunohistochemical staining method with CD34 in NPC.@*RESULT@#The positive rate of EphA2 protein staining in NPC was 60.66% (37/61), while that in nasopharyngitis samples was 10.0% (2/20). The positive rates of EphA2 protein in NPC were 27.27% (3/11) in stage I, 56.25% (9/16) in stage II, 68.19% (15/22) in stage III, and 83.33% (10/12) in stage IV. The positive expressions of EphA2 in T1 + T2 and T3 + T4 with neck lymph node and distant metastasis were 58.33% (7/12) and 88.89% (16/18) respectively, while those in T1 +T2 and T3 + T4 without metastasis were 31.25% (5/16) and 50.00% (6/12) respectively. The cumulative survival of patients in the EphA2 positive group at 5 years was only 0.324 (12/37), while 0.500 (12/24) in the EphA2 negative group. The positive expression of EphA2 protein was correlated with the clinical stage, the neck lymph node metastasis and distant metastasis, and prognosis of NPC, respectively (P < 0.05). MVD in EphA2 protein positive group (45.32 +/- 4.91) was significantly higher than that in EphA2 protein negative group (28.69 +/- 3.99, P < 0.01).@*CONCLUSION@#EphA2 may play an important role in the development and progression of NPC. It is closely associated with the invasion, metastasis, angiogenesis and prognosis of NPC.

The expression and potentially clinical significance of heparanase in nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of heparanase in nasopharyngeal carcinoma and the relationship between the expression of it and clinically pathological features of nasopharyngeal carcinoma.@*METHOD@#The expression of heparanase protein in 70 cases of nasopharyngeal carcinomas and 10 cases of normal nasopharyngeal tissues was detected by immunohistochemical staining. The date of expression combined clinical features, which included clinical stage, cervical lymph node metastasis rate, the rate of metastasis and recurrence, combination of, the 5-year survival rate, and other analysis, was analyzed.@*RESULT@#The positive rate of heparanase protein in cancerous tissues was 52.9% (37/70), while it was 0% in normal nasopharyngeal tissues. The positive rates of heparanase protein in patients were 30.0% (6/20) in stage I, 45.80% (11/24) in stage II, 70.6% (12/17) in stage III, 88.9% (8/9) in stage IV respectively. Heparanase positive tumors were associated with a higher incidence of lymph node metastasis (67.4%, 31/46) than heparanase negative ones (25.0%, 6/24). The rate of distant metastasis and regional recurrence in the heparanase positive group was 48.6% (18/37), but only 15.2% (5/ 33) in the heparanase negative group. The cumulative survival of patients in the heparanase negative group at 5 years was 78.8% (26/33), but only 24.3% (9/37) in the heparanase positive group. The clinical stage of disease, lymph node metastasis, the rate of distant metastasis and regional recurrence of nasopharyngeal carcinoma were correlated with positive expression of heparanase protein.@*CONCLUSION@#The expression of HPA was associated with invasion and metastasis and prognosis of nasopharyngeal cancer, and it may be a new target for the anti-treatment of nasopharyngeal cancer. (P < 0.01), and heparanase expression level inversely correlated with the patient survival (P < 0.01).@*CONCLUSION@#Heparanase may play important roles in the invasive infiltration, metastasis, and prognosis in nasopharyngeal carcinoma, clearly indicating that heparanase is a possible target for anticancer drug development.

Repair of facial nerve defects by using acellular nerve allografts implanted with Schwann cells in rats / 中华创伤杂志

Objective To observe the effects of in vitro isolated Schwann cells co-cultured with chemically acellular nerve allografts on improving repair of large facial nerve defects. Methods A total of 30 Wistar rats were equally randomized into three groups, ie, experimental group, allograft group and autograft group. Nerve defect of 12 mm in length was made in the left inferior buccal branch of facial nerve and repaired with acellular nerve allograft implanted with Schwann cells, acellular nerve allograft and fresh tibial nerve autograft respectively. At the 5th month postoperatively, the function and morpholo-gy of the regenerated nerves were observed by electrophysiological method, methylene blue staining and transmission electron microscope. Results In experimental group, the recovery rate (operation side/normal side) of amplitude of nerve-muscle action potential was (35.8±2.5)%, the lantency recovery rate (normal side/operation side) (65.8±2.9)%, the number of the regenerated axon 1 570±188 and the myelin thickness (0.383±0.031) μm. The results in the experimental group were significantly supe-rior to those in the acellular nerve allograft group (P < 0.05), with similar results to fresh nerve autograft group (P > 0.05). Conclusion Transplantation of Schwarm cells in acellular nerve allograft can im-prove repair of large facial nerve defects.

Repair of rat facial nerve defects with rabbit acellular nerve by chemical extraction / 中国耳鼻咽喉头颈外科

0.05). In the xenogeneic fresh nerve graft group, the xenogeneic nerve segment was rejected and absorbed by the recipient. CONCLUSION Xenogeneic acellular nerve could sustain facial nerve regeneration, and may be a substitute to autograft for repairing facial nerve defects.

Repair of facial nerve defects with acellular nerve allograft in rats / 中华创伤杂志

0.05). Conclusion Acellular nerve allograft may be a substitute to autograft repairing facial nerve defects.

Microsurgical anatomy of the region of Dorello's canal / 安徽医科大学学报

Objective　To provide microanatomic basis for direct microsurgical operation on the region of Dorello's canal. Methods　The structures of the region of Dorellos canal were observed and measured on 30 sides of adult cadaverical heads under microscope. Results　①Dorello's canal was an osteofibrous canal composed of Gruber ligament, petrous apex and the lateral border of the upper part of clivus. The roof of Dorello's canal was mainly composed of Gruber ligament. The maximal distance from roof to bottom of Dorello's canal was 2.14 mm±0.70 mm. ②Abducens nerves passed through the lateral 1/3(56.7%) or intermedial 1/3(43.3%) of Dorello's canal to the cavernous sinus. The nutrient arteries of abducens nerves were originated from the dorsal meningeal arteries, and 83.3% of them traversed Dorello's canal by one stem, medially to abducens nerves. ③The point of abducens nerves entering cavernous sinus was 3.97 mm±1.83 mm posterior to the ascending portion of intracavernous carotid artery, 3.11 mm±0.95 mm medial to the Meckel's cave. Conclusion　In the region of Dorello's canal, the positions of abducens nerves and their nutrient arteries are steady, and they should be protected during operation.

Endoscopic Frontal Sinus Surgery through the Agger Nasi Cell / 中国微创外科杂志

Objective To discuss the effectiveness of endoscopic frontal sinus surgery through the agger nasi cell. Methods Twenty-seven patients with chronic frontal sinusitis were treated with endoscopic frontal sinus surgery. The frontal sinus was opened by resecting the agger nasi cell. Results The frontal sinus were opened successfully in all the patients. No complications occurred except periorbital bruising in 3 eyes. Nasendoscopy showed that the frontal sinus drainage pathway was normal after the operation. During a 6-month follow-up, the symptoms of the frontal sinus disappeared in 18 of the patients, improved in 7, and were not changed in 2. Conclusions Endoscopic frontal sinus surgery through the agger nasi cell is effective for chronic frontal sinusitis.The method is worth being widely used.