Superior horn of thyroid cartilage dysplasia in 1 case / 临床耳鼻咽喉头颈外科杂志

The external stimuli and other reasons may result in hyperplasia and abnormal angle of the upper corner of the thyroid cartilage. The upper corner of the thyroid cartilage has anatomical variations. To oppression stimulate carotid artery, cervical sympathetic dry section and so on, could causing pharyngeal foreign body sensation and sore throat. By surgical removal of the thyroid cartilage hyperplasia upper corner, postoperative symptoms would be resolved.

Pathologic changes of the genioglossus in patients with obstructive sleep apnea hypopnea syndrome dominated by lingual region obstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the pathological changes of genioglossus with transmission electron microscope (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) dominated by lingual region obstruction, and to explore the role of tongue organizations in the pathogenesis and its clinical significance.@*METHOD@#Thirty-eight cases of genioglossus were collected from the patients received UPPP and partial glossectomy (3060 severe group 15 cases), 6 adult patients without oropharyneal and hypopharyneal obstructive disease received tongue tumor resection or trauma debridement surgery were collected as control group. The features of morphological changes in genioglossus were observed by TEM.@*RESULT@#Under the TEM, in the control group,the muscle fibers of the genioglossus organization arranges regular, mitochondrial shape between muscle was regular; The below 3 kinds of variations existed simultaneously in all genioglossus specimens of all the OSAHS patients. In the mild group, myofibrillar atrophied, arranged sloppily, the gap was increased, localized filaments were edema, connective tissue between muscle bundles was proliferated, mitochondria were swelling, some were spherical, crests were still clear; In the moderate group, myofibrillar obviously atrophied with different diametric sizes and disorderliness, the Z lines were shortened or distorted, part of the myofibrillar ruptured, dissolved or disappeared, the connective tissues between muscle bundles were obviously proliferated, mitochondria were swellen, vacuolar degeneration, crests were vague, shorten and irregulatio; In the severe group, a large number of myofibrillar were fractured, dissolved, disorganized, integrated condensate lumpy, spotty or flake arranged, Z-lines were distorted or disappeared. Mitochondria were sizes, showed vacuolar degeneration, crests were disappeared, some changes were flocculent, mitochondria accumulation phenomenon was visible in some samples. Moreover, with the AHI increased, the occurence ratio of mild changes was decreased while severe changes occurence ratio increased.@*CONCLUSION@#The changes of genioglossus and mitochondrial in OSAHS patients is a continuous, progressive process, moverover, with the aggravation of OSAHS, genioglossus histopathological changes had gradually worsening tendency.

The clinical investigation of the potential complications of H-UPPP surgery in removing the partial pharyngeal muscle / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#In order to improve the postoperative effect of modified UPPP, removing the partial pharyngeal muscle in surgery, we investigate the postoperative effect, the characteristics of pharyngeal cavity and the potential complications in OSAHS patients.@*METHOD@#To choose 82 OSAHS patients with obstructive oropharyngeal plane diagnosed by Apneagraphy (AG), Fibre nasopharyngoscope combined with Müller examination and nasopharyngeal 3D-CT, which had completed clinical data inpatients in the anesthesia underwent of the partial pharyngeal muscles in the postoperative, divided into a control group of 26 cases, operating the H-UPPP surgery which did not remove partial pharyngeal muscle; The experimental group of 56 cases did a H-UPPP surgical which removed partial pharyngeal muscle of possible concurrent symptoms such as nasal regurgitation, Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease. Patients were evaluated the sleepiness by ESS(Epworth sleepiness scale) in 6 months after the surgery, compared with the preoperative ESS scores, do a t test for statistical analysis. AG can be used to evaluate effects of the UPPP after 6 months. By measuring uvula length (L1), extent from free edge of soft palate to postpharyngeal (L2) and stenosis of nasopharynx width (L3) mean, we investigate the characteristics of pharyngeal cavity using the multiple linear regression to do the hypothesis test and evaluate the association between measuring mean and effect. Using SPSS19.0 software do the preoperative contrast analysis.@*RESULT@#After 6 months in surgery, 56 cases in the experimental group, effect in 50 cases (89.29%), effective in 6 cases (10.71%); ESS score: Preoperative 11.74 +/- 2.48, after the first 6 months 3.84 +/- 2.05. Twenty-six cases in control group,effect in 19 cases (73.08%), effective in 7 cases (26.92%); ESS score: Preoperative 11.91 +/- 2.40, after the first 6 months 6.92 +/- 2.47, t-test P value of less than 0.05 between the experimental group and the control group; There are no ear fullness, hearing loss, increase their own sound which reflect eustachian tube dysfunction and other complications in two groups; The function of pharyngeal cavity could be recovered normal lever after 6 months; After 6 months of the operation, in the experimental group and the control group L1 mean was respectively (5.91 +/- 3.38) mm and (6.20 +/- 3.76) mm (P>0.05); L2 mean was respectively (15.70 +/- 3.29)mm and (15.35 +/- 1.44) mm (P> 0.05); L3 mean was respectively (20.54 +/- 3.33) mm and (16.43 +/- 2.21) mm (P<0.05). Nasal fauces pitch mean was significantly widened. By the multiple linear regression analysis, the postoperative effect has the linear correlation between L2 and 1,3 residual mean with the negative correlation. Due to the standardized coefficient, L3 residual mean has the most influence on the postoperative effect.@*CONCLUSION@#Modified UPPP surgery removing the partial pharyngeal muscle is in favor of upgrading the postoperative effect with significantly increasing the width of postoperative nasal pharyngeal isthmus area, then there are not occur the eustachian tube dysfunction, the soft palate function, swallowing and articulation function disabled.

Research on failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome and reoperation method / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome (OSAHS), and explore the methods of reoperation.@*METHOD@#By selecting 27 patients, who accepted surgical treatment for OSAHS and recurred, we analyzed failure reasons and obstructive location by apneagraph, nasopharyngeal 3D-CT, electronic nasopharynlaryngoscope. Among them, 14 patients accepted reoperation, such as uvulopalatopharyngoplasty (UPPP), nasoendoscopic surgery, adenoidectomy, partial glossectomy, tracheotomy were applied matching to differential obstructive location. AHI, lowest SaO2, Epworth sleepiness scale (ESS), complication were recorded after 6 months.@*RESULT@#After 6 months, their AHI decreased from 48.19 +/- 13.11 to 11.32 +/- 4. 42, ESS scores decreased from 12.93 +/- 4.60 to 4.93 +/- 1.44, P<0.05. Two of the 14 patients were cured, while the other 12 were efficient. No complications were observed.@*CONCLUSION@#Obstructive location judgement and proper surgical operation are the keys of the treatment. Preoperative AG sleep monitoring, nasopharyngeal 3D CT, electronic nasopharynlaryngoscope examination for determining blocking plane, the decision of surgery which is significant.

Significance of AG in OSAHS operation treatment guidance and evaluation of postoperative efficacy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Apneagraph can be used to discuss which the best operation scheme is for OSAHS. Effects of uvulopalatopharyngoplasty can be assessed by Apneagraph in obstructive sleep apnea hypopnea syndrome (OSAHS) patients.@*METHOD@#Fifty-six patients with OSAHS received the modified UPPP operation were randomly selected in our hospital. The AG and PSG were applied for diagnosis and evaluation of operation effects. The sleepiness state was assessed by ESS (Epworth sleepiness scale) 6 months after the surgery, compared with the preoperative ESS scores using attest for statistical analysis. We used the SPSS19.0 software to carry our data analysis.@*RESULT@#After 6 months, the evaluation of postoperative efficacy came out to be completely controlled in 42 cases (75%), significantly effective in 14 cases (25%), and uncured in 0 cases. Correlation between the transpalatal obstruction proportion and the AHI reduction percentage was significantly positive (r = 0.667). There were 38 patients with oropharynx obstruction percentage more than 73.35% presented completely controlled in 34 cases (89.47%), significantly effective in 4 cases (10.33%), and uncured in 0 cases.@*CONCLUSION@#AG has the dual functions of analyzing sleep-related respiratory disturbance events and determining upper airway obstruction sites. AG application in the postoperative evaluation of modified uppp has significantly objective guide significance. The modified UPPP for treatment of OSAHS can improve the operation effect. Patients with oropharynx obstruction percentage more than 73.5% don't need to receive the operation for treatment of retroglottal region.

Histopathologic and morphological changes of palatopharyngeal soft tissue in patients with mild, moderate, and severe obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the histopathologic and morphological changes of palatopharyngeal soft tissues in patients with different degrees of obstructive sleep apnea hypopnea syndrome (OSAHS) patients.@*METHOD@#Thirty-eight male OSAHS patients were divided into 3 groups according to AHI, namely mild group (n = 10), moderate group (n = 13),and severe group (n = 15). The soft palate tissues with partial palatopharyngeal arch and palatoglossal arch tissues were obtained from surgery and processed with conventional paraffin embedding. The sections were stained by HE and observed under a light microscope. The histological quantitative changes of the specimens were measured by analyzing the constituent ratios of glandular tissue, fat tissue and interstitial elements. Statistical analysis was performed.@*RESULT@#1) Optical microscope showed that (100 times), as the aggravation of the OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis, accompanied by liquefied degeneration of basal cell; The mucous membrane and submucosal connective tissue contain a certain number of lymphocytes infiltration. The mucosa and submucosal layer of loose connective tissue contain inflammatory cells and a lot of fat vacuoles can be observed; The soft palate mucous acini have inconsistent and irregular shape, among which there are a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini with dark stained cytoplasm; The palatoglossal muscle and palatopharyngeus muscle fibers can't be identified with disordered arrangement of structure, showing pleomorphic changes including swelling, atrophy and degeneration. Some of elastic fibers were disrupted and a lot of fat cells infiltration was observed. (2) The constituent ratios of the three kinds of tissues in soft palate from different degrees of OSAHS patients show that quantitative changes of glandular tissue and interstitial elements among the mild, moderate and severe OSAHS group patients exhibit statistically significant differences (P 0.05).@*CONCLUSION@#With the rising of severity of OSAHS, the soft palate squamous epithelial cells are swollen and irregular, exhibiting hyperkeratosis. Between acinar cell we could see a certain amount of fat cells infiltration. Some mucous acini are replaced by serous acini. Muscle fibers of palatopharyngeal tissue have pleomorphic changes of swelling, atrophy and degeneration.

Clinic and pathological analysis the larynx leukoplakia in 74 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate.@*METHOD@#Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service.@*RESULT@#None of eighteen cases of pure leukoplakia was recurrence. Fifty-six cases were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recurred, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration.@*CONCLUSION@#Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epithelial dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

Expression of gene BRMS1 and CD44v6 protein in supraglottic laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) and CD44v6 protein in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 protein and CD44v6 protein were examined by using immunohistochemical method in 70 cases of paraffin-embedded supraglottic cancer tissues and their surrounding laryngeal normal mucosa tissues (LNT).@*RESULT@#The expression of BRMS1 protein in LNT of supraglottic cancer was positive, and the positive rate was 85.7% (60/70); in tumor tissue was negative or lower expression, and the positive rate was 35.7% (25/70). The expression of CD44v6 protein in tumor tissue of supraglottic cancer was positive, the positive rate was 82.9% (58/70), in LNT was negative. There was a significant difference in BRMS1 and CD44v6 protein expression between the supraglottic cancer tissue and LNT (P0.05). The expression of BRMS1 protein was related to the expression of CD44v6 protein (r = -0.9042, P0.05), there is a significant survival difference at 3-year between the group with positive CD44v6 protein expression and the group with negative CD44v6 protein expression in tumor tissues (P<0.05).@*CONCLUSION@#The expression of BRMS1 protein in supraglottic cancer is significantly decreased and the expression of CD44v6 protein in supraglottic cancer is significantly increased. The expression of BRMS1 protein and CD44v6 protein has a close relationship with pathologic differentiation and clinical stage and cervical lymph node metastasis of supraglottic cancer. Combined detection of the expression of them in supraglottic cancer may provide a significant parameter to judge the cervical lymph node metastasis of supraglottic cancer.

Clinic and pathological analysis the larynx leukoplakia in 74 cases / 临床耳鼻咽喉头颈外科杂志

Objective: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. Method: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. Result: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six ca-ses were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recured, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. Conclusion:Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epitheli-al dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

Expression and clinical significance of breast cancer metastasis suppressor 1 mRNA in supraglottic laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) mRNA in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 mRNA was examined by using RT-PCR method which take beta-actin mRNA as reference template in 66 cases of supraglottic cancer tissues and their adjacent normal mucosa tissues (ANT).@*RESULT@#The expression of BRMS1 mRNA in the tissues of supraglottic cancer is lower significantly than that in the tissues of ANT ( P<0.05). There is correlation between BRMS1 mRNA expression and the clinical stage, differentiation and cervical lymph node metastasis in the laryngeal supraglottic cancers (P<0.05). There is no correlation between BRMS1 mRNA expression and sex and age.@*CONCLUSION@#Expression of BRMS1 mRNA in supraglottic cancer is lower than that in adjacent normal mucosa. The decrease of BRMS1 mRNA expression may be related to clinical stage and low differentiation and lymph node metastasis of supraglottic laryngeal cancer.

The Study of Relationship Between Bcl-2 & p53 Gene Protein Expression and Radiation Sensitivity in Laryngeal Carcinoma / 医学研究杂志

Objective The purpose of this study was to determine the relationship between Bcl-2 and p53 gene protein expression and radiation sensitivity according to the biologic character of laryngeal carcinoma.Methods Using monoclonal antibody for Bcl-2 and p53 gene protein,70 cases of laryngeal carcinoma were stained by immunohistochemical DACO CSA System method.Bcl-2 and p53 gene protein expression were divided into 3 levels:intense,moderate and negative expression.The relationship between expression intensity and radiation sensitivity was tested with Cramer method.Results There was relationship between each gene protein expression and radiation sensitivity.The relationship between cooperative expression and radiation sensitivity was higher than that of individual expression.Conclusion There was significant relationship between Bcl-2 and p53 gene protein coocperative expression and radiation sensitivity.The Bcl-2 and p53 gene protein cooperative expression can be consult criteria in predicting prognosis of radiation therapy of laryngeal carcinoma and instructing clinic therpy.

The Modified Uvulopalatopharyngoplasty(UPPP)to Prevent the Complications and Destroy of UPPP / 医学研究杂志

Objective To improre typieal proeedure of UPPP,increase clinical effects and deerease complioations caused by the operation.Methods Twenty eight patients with obstructive sleep apnea syndrome who had been confirmed by PSG in our hospital from 2003 to 2005 were involved in this study.1)improving stripping method:the fat and tonsil were removed by electric knife.2)improving molding method:the muscle of uvula was maitained,but the fat was removed;mucous and the tissue under it were double-layer sutured.3) the data before and 6 months after UPPP were analyzed by questionnaire and polysomnography(PSG)detection.Result No fissuration occurred.The distance between soft palate and posterior wall was 3?0.6 before operation and it was 6?0.8 6 months after operation.The effect is 100% based on the questionnaire investigation and PSG detection.Conclusions 1)Hemostasis of electric knife was reliable;2)Double-layer suture of mucous and the tissue under it can avoid hemorrhage and insure molding of pharyngeal cavity;3)The results of the uvula preservation can improve the effect of the UPPP by increasing the nasopharyngeal and oropharyngeal cavity,and avoiding velopalatal insufficiency.