Clinical features and management analysis of 11 cases of laryngocele / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize clinical features and our experience of the diagnosis and treatment of laryngocele. Methods: Clinical data of 11 laryngocele patients in department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Shanxi Medical University from January 2012 to December 2021 were retrospectively reviewed, including 9 men and 2 women, aged from 12 to 75 years, with median age of 56 years. Electronic laryngoscope was performed in 10 of all patients, laryngeal CT in 10 and cervical color ultrasound in 5 before operation.All the operations were performed under general anesthesia, and the external cervical approach was used for external and combined laryngocele. The internal laryngocele was resected by low temperature plasma through transoral endoscopy. Patients were followed up regularly after operation to evaluate the effect. Clinical feature, types of lesions, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eleven laryngocele patients were divided into mixed type (n=6), internal type (n=4) and external type (n=1).Nine patients presented with hoarseness or dysphonia, 7 with cervical mass and 1 with airway obstruction. Surgical resections were done through external cervical approach (n=7)or transoral endoscopic approach (n=4). All the operations were successful and no complication occurred. All cases were followed up from 17 to 110 months. No recurrence was encountered. Conclusions: Laryngocele is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and electronic laryngoscope is essential to evaluate the location, and extent of the lesion, and to make the surgical plan.Complete surgical excision is required. Surgical resection is the only effective method for the treatment of laryngocele.

Application of image guided technique in rhino-orbital related endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

To review retrospectively six cases of rhino-orbital related endoscopic surgeries aided by Fusion electromagnetic system,to explore the indications and clinical value of image guided technique in endonasal endoscopic surgery.Retrospective research methods were used.In this study,six cases of nasal endoscopic sinus surgery using Fusion electromagnetic system were analyzed,including 1 nasal penetrating foreign body,2 optic nerve decompressions,1 orbital apex hemangioma,1 sieve frontal sinus cyst,1 intraorbital mass biopsy.The preparation time of navigation system,the accuracy of intraoperative positioning and surgical coherence,intraoperative and postoperative complications of surgery were recorded.The average preparation time was(8.13 ± 1.858)min.In the navigation,the sinus ostium,orbital cardboard,skull base,optic nerve,internal carotid artery and other important structures can be accurately located in all patients,while registrations had been accurate within 1 mm.Six patients were successfully operated by image guided technique.There was no intracranial or intraorbital complications due to intraoperation error.Image guided technique allows for a truely microinvasive and accurate rhino-orbital related endoscopic surgeries.It requires less preoperative preparation time,has high surgical navigation accuracy,improves the surgical coherence and safety,and reduces the surgical complicationgs.However,as an auxiliary tool,it can not replace the surgeon's anatomical knowledge,surgical training and clinical experience.

Preliminary investigation into the allergic rhinitis complicated with acute bacterial sinusitis in mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop a mouse model of bacterial rhinosinusitis superposed on allergic rhinitis (AR), and to explore whether ongoing allergic rhinitis enhance the acute sinus infection and inflammation associated with Streptococcus pneumoniae (SP).</p><p><b>METHODS</b>Fourty mice of C57BL6/J were randomly divided on average into 4 groups: A [ovalbumin (OVA) + SP], B [OVA + normal saline (NS)], C [phosphate buffered solution (PBS) + SP] and D (PBS + NS). (1) Group A and B were sensitized by intraperitoneal injection with 200 microl (10%) OVA on days 1 through 9, and exposed to OVA (6%) intranasally on days 10 through 17, to induce allergic inflammation. OVA was replaced with PBS in group C and D in the same way. (2) Subsequently, group A and C were inoculated with SP intranasally on day 13, and NS was used in group B and D. On the 6th day after inoculation, mice were killed. Blood was collected from the orbital venous sinus after anesthesia. The heads were embedded with paraffin and serial sections were followed and stained with hematoxylin-eosin and toluidine blue (0.5%) for histological analysis and inflammation cells count. The number of polymorphonuclear neutrophils (PMN) and eosinophils (EOS) per square millimeter of sinus mucosa were calculated by using a computer-aided special software under microscope.</p><p><b>RESULTS</b>AR models were successfully established in 9 mice from group A and 8 from group B. Histologic examination of the sinus from group A and B revealed significant mucosal edema and dilated venules. The symptoms were mild in group C, and no symptom was observed in group D. PMN (x +/- s) in group A (139.3 +/- 26.5)/mm2 was significantly higher than that in group B (70.7 +/- 16.7)/mm2, C (63.0 +/- 14.7)/mm2 and D (40.2 +/- 14.1)/mm2 respectively (P < 0.01); EOS and serous IL-5 level in group A (134.6 +/- 25.5)/mm2, (48.2 +/- 13.9) pg/ml and B (116.2 +/- 25.2)/mm2, (40.8 +/- 7.8) pg/ml, were higher than that in group C (16.7 +/- 2.7)/mm2, (23.9 +/- 8.7) pg/ml (P < 0.05) and D (13.4 +/- 4.9)/mm2, (24.6 +/- 6.5) pg/ml (P < 0.05).</p><p><b>CONCLUSIONS</b>The data demonstrate that an ongoing local allergic response augments bacterial infection in mice, and allergic sensitization alone without SP does not induce the sinus infection.</p>

Differential gene expression profile in seasonal allergic rhinitis with and without asthma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To screen the differential expression gene profile in nasal mucosa of seasonal allergic rhinitis (SAR) and SAR with asthma, oligonucleotide microarray (Affymetrix HG-U133-plus2) was employed to analyze the changes of gene expressions with GeneSpring software.</p><p><b>METHODS</b>Inferior turbinate mucosa was obtained from five SAR patients and four SAR with asthma patients. Total RNA was extracted from the nasal mucosal biopsies and pooled into one SAR control pool and one SAR with asthma patient pool, and biotin-labeled cRNA probes were hybridized with Affymetrix HG-U133-plus2 array. The hybridization results were confirmed by RT-PCR analysis. The analysis of differential expression profiles were performed by GeneSpring software 7.3.</p><p><b>RESULTS</b>Out of 47,000 analysed transcripts, 1,900 genes were differentially expressed at least 2-fold in which 849 genes were up-regulated and 1,051 genes were down-regulated in nasal mucosa of SAR with asthma patients compared with that in SAR patients. These genes were involved in cell metabolism, gene transcription, cell proliferation, signal transduction, immune response, enzyme activity, transmembrane receptor activity, cytoskeletal protein binding, and many other aspects. Pathway analysis displayed 161 groups, of which including more than 20 genes were as follow: cytokine-cytokine receptor interaction, focal adhesion, cell adhesion molecules (CAMs), regulation of actin cytoskeleton, cell communication, gap junction, MAPK signaling pathway, calcium signaling pathway, leukocyte transendothelial migration, and purine metabolism.</p><p><b>CONCLUSIONS</b>The data suggested that multigentic expression and regulation changes were involved in the development of SAR and SAR complicated with asthma, whose molecular mechanisms might be elucidated by identification of these differential genes.</p>