Clinical anatomic study on the segment and adjacent of tract of congenital pyriform sinus fistula / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the anatomic tract of congenital pyriform sinus fistula (CPSF).@*Methods@#A total of 90 patients with CPSF undergoing open surgery between August, 2007 and March, 2017 at the Department of Guangdong General Hospital were retrospectively analyzed.@*Results@#The tracts of all the fistulas actually walked far different from those of theoretical ones. A whole fistula may be divided into 4 segments according to adjacent anatomy of CPSF. The posterior inner segment to the thyroid cartilage was initial part of the fistula. It originated from the apex of pyriform sinus, then piercing out of the inferior constrictor of pharynx inferiorly near the inferior cornu of the thyroid cartilage (ICTC), and descended between the lateral branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The ICTC segment was the second part of the fistula, firstly piercing out of the inferior constrictor of pharynx and/or cricothyroid muscle, and then entering into the upper pole of thyroid. The relationship between fistula and ICTC could be divided into three types: type A (medial inferior to ICTC) accounting for 42.2% (38/90); type B (penetrate ICTC) for 3.3% (3/90); and type C (lateral inferior to ICTC) for 54.5% (49/90). The internal segment in thyroid gland was the third part of fistula, walking into the thyroid gland and terminating at its upper pole (92.2%, 83/90) or deep cervical fascia near the upper pole of thyroid (7.8%, 7/90). The lateral inferior segment to thyroid gland was the last part of the fisula, most of which are iatrogenic pseudo fistula, and started from the lateral margin of thyroid gland.@*Conclusions@#CPSF has a complicated pathway. Recognition of the tract and adjacent anatomy of CPSF will facilitate the dissection and resection of CPSF in open surgery.

Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies.@*Methods@#Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases.@*Results@#Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web.@*Conclusions@#CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Expression and its significance of CD44 in SP cells of nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Discussion of expression and its significance of CD44 in SP cells of nasopnaryngeal carcinoma.@*METHOD@#Flow cytometry was used to sort cultured CNE-2 cells of nasopharyngeal carcinoma for obtaining CD44-SP and CD44+SP cells. Biological differences of CNE-2, CNE-2 SP, CNE-2 NSP, CNE-2 CD44+SP and CNE-2 CD44-SP cells were statistically analyzed by experiments such as cell migration experiments, plate clone formation assay, cell cycle analysis and sensitivity tests to chemotherapeutics.@*RESULT@#Two point 3 perent of SP cells were extracted from CNE-2 cells of nasopharyngeal carcinoma, among which 36.5% was CD44+SP cells. Abilities of proliferation, cell migration and plate clone of CD44+SP cells were significantly higher than other cells (P < 0.01), and its tolerance to chemotherapeutics was significantly higher too (P < 0.01).@*CONCLUSION@#The proportion of SP cells in nasopharyngeal carcinoma cells was small, but SP cells had strong activeness in the aspect of cell proliferation with a "seed" characteristic of tumor cells. As CD44+SP cells played an important role in proliferation and chemotherapy resistance of nasopharyngeal carcinoma, it indicated that CD44 can be one of the surface markers of SP cells of nasopharyngeal carcinoma.

The long-term clinical efficacy of endoscopic surgery of primary sinonasal malignant neoplasms / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the long-term clinical efficacy of endoscopic surgery of primary sinonasal malignant neoplasms and find out the potential postoperative prognostic factors.@*METHOD@#Forty-three clinical cases of primary sinonasal malignant neoplasms treated under endoscopy were analyzed retrospectively.@*RESULT@#Fifteen patients died. The 1-year, 2-year, 3-year and 5-year survival rates were 83. 7% (36/43), 74. 4% (32/43), 69. 8% (30/43) and 65. 1% (28/43), respectively. Kaplan-Meier single-variable analysis showed that gender, T grade, TNM stage and pathological types of olfactory neuroblastoma were statistically significant prognostic factors (P< 0. 05). COX Pro-Portional hazard models showed that TNM stage was an independent prognostic factors.@*CONCLUSION@#Endoscopic surgery for primary sinonasal malignant neoplasms is a safe and effective minimally invasive surgical treatment, and it is an important supplement to the traditional surgery. Gender, T grade, TNM stage and pathological types of olfactory neuroblastoma might be significant prognostic factors.

The clinical application of modified rhytidectomy incision in superficial parotid tumor surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the modified rhytidectomy incision in superficial parotidectomy.@*METHOD@#Thirty-five patients with superficial parotid tumor were included in this study. A modified rhytidectomy incision often used in facial plastic surgery was used for superficial parotidectomy and subtotal superficial parotidectomy with preservation of facial nerve and great auricular nerve. The follow-up study included the exposed region, the cosmetic effect of this approach and the rate of complication.@*RESULT@#All patients healed without salivary fistula, and were satisfied with this modified approach. Temporary paralysis of the marginal mandibular branch of facial nerve were found in five patients, and six patients felt insensible around earlobe after operation. They all recovered in 1 to 3 months after surgery, no recurrence was happened during follow-up in 36 to 60 months (median follow-up period was 48 months).@*CONCLUSION@#The modified rhytidectomy incision provided good exposure, had less complication and better cosmetic outcome.

The treatment of diabetes mellitus complicated acute necrotizing sinusitis / 重庆医学

Objective To investigate the treatment of diabetes mellitus complicated acute necrotizing sinusitis .Methods By way of reviewing the clinical procedures of 2 patients with diabetes mellitus complicated acute necrotizing sinusitis .Results In perioper-ative period ,by means of glycemic control ,anti-infection ,and emergency surgery to remove the necrotic tissue in nasal sinuses and open the sinuses ,one of the patients discharged from hospital after 8 days .He has been followed up for more than 4 years without recurrence ,and is still in follow-up .Due to complicating renal failure and ascites ,the another patient gave up treatment and dis-charged on the third postoperative day ,and died on the same day .Conclusion Glycemic control ,homeostasis ,surgical removal of necrotic tissue and anti-infection treatment in perioperative period as soon as possible ,is the key to a successful treatment .

The short duration functional electrical stimuli do not cause mRNA expression change of K(ATP) channel and acute inflammation cytokine in recurrent laryngeal nerve / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate whether the inflammation response and K(ATP) channel damage happened because of acute injury after functional electrical stimuli (FES) act on the recurrent laryngeal nerve (RLN).@*METHOD@#Thirty rabbits were divided into 3 groups by 10 rabbits for each group. The unilateral RNL were stimulated by FES with cuff electrode in first group. There was electrode on the RNL without FES in second group. The third group was normal control. The electrical generator and isolation unit provide electrical stimulation to the RLN at 50 Hz, with 4 mA current, for 2ms pulse duration. The total train duration was 5 seconds (2 seconds on; 3 seconds off). The RLN were collected in 1 hour after 3 hours electrical stimuli. We measured mRNA expression of injury acute response inflammation cytokine IL-10, TGF-beta1, TNF-alpha and K(ATP) Subunit protein Kir6.1, Kir6.2, SUR2AB, using real-time reverse transcribed-polymerase chain reaction. PCR products were verified by electrophoresis in agarose gels. We investigated the vocal synchronic adductive movement with RLN FES by endoscopy. We investigated the nerve local RNL morphological burn. Data were analyzed with the One-way ANOVA analysis of SPSS version 13.0 for Windows.@*RESULT@#There were no significance difference among three groups in mRNA expression of inflammation cytokines IL-10, TGF-beta1, TNF-alpha and K(ATP) channel protein Kir6.1, Kir6., SUR2AB. We did not find the nerve morphological burn in all rabbits RLN. The vocal synchronic adductive movement were normal during stimuli time.@*CONCLUSION@#The short duration functional electrical stimuli do not cause mRNA expression change of K(ATP) channel and acute inflammation cytokine in recurrent laryngeal nerve.

Selective neck dissection for treating recurrent branchial anomalies / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the role of selective neck dissection in the treatment of recurrent branchial anomalies.@*METHOD@#The clinical data of 18 patients with recurrent branchial anomalies were retrospectively analyzed. In accordance with the embryologic and anatomic features of branchial anomalies, different types of selective neck dissection were applied. With dissection and protection of important vessels, nerves and other structures, enbloc resection principles were applied to extirpate branchial lesions, scarrings and inflammatory granuloma during the operation.@*RESULT@#Of all 18 patients, 16 cases were healed with primary healing, 2 cases with local incision infection were healed after dressing changes. A temporary facial nerve paralysis occurred in 1 case with recurrent first branchial cleft fistula postoperatively, and completely recovered 2 months after operation. A postoperative temporary vocal cord paralysis occurred in 1 case with recurrent fourth branchial cleft fistula, and totally recuperated 1 month after operation. No recurrences were found in all 18 cases with a follow-up period of 12-78 months (average 35 months).@*CONCLUSION@#Selective neck dissection is a safe and effective surgical procedure for the radical treatment of recurrent branchial anomalies.