Transnasal endoscopic removal of orbital apex cavernous hemangioma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the strategy and indications of endoscopic transnasal resection of orbital apex cavernous hemangiomas (OACH).</p><p><b>METHODS</b>Eleven patients aged from 30 to 62 years-old diagnosed as OACH bypostoperative histopathology were reviewed retrospectively. Four males and 7 females were included. Both ophthalmological examination and rhinologic evaluation were adopted preoperatively. The surgeries were carried out under general anesthesia endoscopically by the same senior surgeon. After ethmoidectomy, the orbital lamina papyracea was opened, and the orbital fat and muscles were pushed back into the orbit by using the brain cotton, and then the orbital tumor was removed. The patients were kept follow-up both in ophthalmologic and rhinologic departments.</p><p><b>RESULTS</b>As suggested by preoperative imagings, 4 lesions located in the extraconal space (nasal side), 6 between the optic nerve and the internal rectus muscle of the intraconal space, and 1 outside the optic nerve in the intraconal space. Total resection was achieved in 9 cases, and orbital decompressions were done in 2 cases. Meanwhile, orbital wall reconstruction was done in 7 cases. The follow up ranged from 6 to 47 months. Seven patients achieved visual acuity improvement and no deteriorations were found in other 4 patients. Defects of vision field in 3 patients disappeared after 2 weeks. No operative or postoperative complications occurred.</p><p><b>CONCLUSIONS</b>The OACH located in the nasal side of extraconal space and between the optic nerve and the internal rectus muscle of the intraconal space can be accessed endoscopically by intranasal approach. Using the brain cotton to push the orbital fat and muscles back into the orbit and an experienced endoscopic surgeon are important to access a successful intranasal endoscopic removal of orbital apex tumor.</p>

Histopathological change of cricoarytenoid joint after laryngeal recurrent nerve paralysis in dogs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the histopathological changes in cricoarytenoid joints in 32 animal models. The characteristic histopathological changes of arytenoid cartilages after recurrent nerve paralysis were evaluated.</p><p><b>METHODS</b>Sixteen dogs (32 vocal folds, 8 as normal control) were divided into different animal models of recurrent nerve paralysis as transection, half-section, ligation, or crush. The histopathological finds of arytenoid cartilages were analysed.</p><p><b>RESULTS</b>Arytenoid cartilages showed fibrin (12/24), disruption of the fibrous membrane (9/24), fibrillation (7/24) and degenerative changes in their joint surface structure (3/24) at various levels of intensity. The fibrin and disruption of the fibrous membrane were found 1 month after injury, and all changes appeared in 6 months. The fibrillation and arytenoid cartilages degenerative changes revealed in transaction group and ligation group, and became stronger in time of 6 months. The correlation among the fibrillation ratio and the normal control was positive (t were 6.23 and 3.65, P < 0.01). The correlation among the number of cellular of arytenoid cartilages and the normal control was positive (t = 2.78, P < 0.05). The fibrillation (7) and arytenoid cartilages degenerative changes (3) revealed in vocal fold fixation to influence the recovery of laryngeal function.</p><p><b>CONCLUSIONS</b>The histopathological change of cricoarytenoid joint after recurrent nerve paralysis was related to the severity of neural injury. Influence the recovery of laryngeal function more often from 6 months.</p>

Evaluation of the safety of aluminium adjuvant in the preparation of allergic rhinitis animal model / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect and safety of the formulation and dosage of aluminium adjuvant, Al(OH)(3), in the preparation of allergic rhinitis animal model.</p><p><b>METHODS</b>Sixty health BALB/c mice were divided randomly into 6 groups. Al(OH)(3) powder (5 mg) was used in one group, Al(OH)(3) colloid gel of different concentration (0.5 - 5 mg) was used in four groups, and normal saline was used in the control group. Ovalbumin injection and nasal topical challenge were used in the 5 testing groups to induce allergic rhinitis in mice. Normal saline was used in the control group.</p><p><b>RESULTS</b>Typical allergic rhinitis symptoms including frequent nasal scratching, and edema of peri-nasal mucosa were found in mice of the 5 mg Al(OH)(3) powder group. Eosinophils accumulation, goblet cells hyperplasia and hypersecretion were found in the mucosa of lateral nasal wall and inferior nasal turbinate. Neither obvious allergic rhinitis symptom, nor eosinophils accumulation in nasal mucosa was observed in the Al(OH)(3) colloid gel groups. Hemorrhagic ascites and lots of white nodules (foreign body granuloma) formation were found in the liver, spleen, and kidney of all mice of the 5 mg Al(OH)(3) colloid gel group. Five out of 10 mice of the 2 mg Al(OH)(3) colloid gel group exhibited above signs but of lower grade. Despite dispersed fine white sediment in the liver and mesentery, no obvious ascites was found in mice of the 1 mg and 0.5 mg Al(OH)(3) colloid gel groups.</p><p><b>CONCLUSIONS</b>Al(OH)(3) powder, 5 mg, is effective and safe in the preparation of allergic rhinitis animal model. Al(OH)(3) colloid gel of different concentration (0.5 - 5 mg) may cause side effects such as foreign body granuloma.</p>

Histopathological observation of bone remodeling in rabbit sinusitis model / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the histopathological finding of bone remodeling in rabbit sinusitis model at different time and the tendency, and to discuss the effect of bone in the pathogenesis of sinusitis.</p><p><b>METHODS</b>First, the rabbit sinusitis model was made, then the experimental animals were divided into 3 groups according to the time of infection. There were 8 rabbits in each experimental group, and 4 rabbits in the control group. The sinus specimen were collected, embedded and stained. The bone in the inoculating side and noninoculating side was scored, and the bone in inoculating side was evaluated quantitatively and semiquantitatively. The parameters included the thickness of mucosa, mucoperiosteum, the density of osteoblast, the amount of osteoclast.</p><p><b>RESULTS</b>The average bone score in the inoculating side was 2.250, 2.875, 2.875; in the noninoculating side was 1.625, 2.250, 2.500. Between group A and the control group, the difference of all three parameters had statistical significance. Between group B and group A, the difference of the thickness of mucosa and the density of osteoblast had statistical significance. Between group C and group B, none of the three parameters had statistical significance.</p><p><b>CONCLUSIONS</b>Bacterial sinusitis can lead to bone remodeling, obvious bone destroy can occur at the early phase, then the bone proliferation follows. These results demonstrate that bone remodeling is one of the basic histopathological characters of CRS and might be the reason to lead CRS to a constant and chronic process of inflammation.</p>

Pathologic diagnosis of specific infections in upper aerodigestive tract / 中华病理学杂志

<p><b>OBJECTIVE</b>To find a fast and simple method for detection of specific pathogens in upper aerodigestive tract.</p><p><b>METHODS</b>Sixty-one cases of specific infections in upper aerodigestive tract encountered during a 10-year period in Beijing Tongren Hospital were retrospectively studied. Six histochemical stains, including PAS, Giemsa, Gram, methylene blue, modified Warthin-Starry and acid-fast stains were applied. The morphology of different pathogens was studied and the staining patterns were compared.</p><p><b>RESULTS</b>There were 23 cases of pharyngeal treponemal infection, 10 cases of short treponemal infection, 4 cases of mycobacterial infection, 4 cases of infection by rhinoscleroma bacilli, 1 case of sinonasal fungal infection, 1 case of combined infection of bacteria and Oidium albicans, 2 cases of tonsillar Actinomycetes and 16 cases of non-specific bacterial infections. Both pharyngeal treponemal infection and infection by rhinoscleroma bacilli could be detected by modified Warthin-Starry stain. As for sinonasal fungal infection, PAS, Giemsa and modified Warthin-Starry stains were useful in differentiating different types of fungi. Mycobacteria were best demonstrated by conventional acid-fast stain.</p><p><b>CONCLUSIONS</b>Special histochemical stains performed on histologic sections are useful for diagnosing specific infections in upper aerodigestive tract.</p>

Histolopathologic features of CT scan typing of chronic rhinosinusitis and relation with prognosis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the histopathologic changes of the ethmoid bone in CT scan typing of chronic rhinosinusitis (CRS), and investigate relations with outcomes of endoscopic surgery.</p><p><b>METHODS</b>One hundred and twelve random CRS patients undergoing endoscopic sinus surgery at Tongren hospital were prospectively evaluated. According to the preoperative CT scan, these patients were divided into three groups of CT scan typing. The bony changes and bone remodeling of ethmoid bone were graded and relations with outcomes of endoscopic surgery were investigated.</p><p><b>RESULTS</b>The CT scan typing results of ethmoid sinus of CRS were as followed: 22.3% (type III), 39.3% (type II), and 38.4% (type I). Comparison of bone remodeling and postoperative endoscopic scores between the three groups revealed a significant difference (P = 0.01, P = 0.02). A trend toward more advanced bone remodeling grade in association with a higher postoperative endoscopic scores was identified, with a statistically significant correlation.</p><p><b>CONCLUSION</b>The Chinese CT scan typing of CRS has its pathological basis and can a useful method to predict the surgical outcomes of CRS. The new bone formation or bony tissue remodeling of sinus often represents pathogenesis of CRS and implicates the prognosis of sinus surgery.</p>

Evidence of bacterial biofilms in chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the presence of bacterial biofilms in mucosal specimens in patients operated for chronic rhinosinusitis.</p><p><b>METHODS</b>A total of 12 subjects undergoing endoscopic sinus surgery were included. The control group was 6 patients with obstructive sleep apnea-hypopnea syndrome. Six patients with chronic rhinosinusitis were enrolled in the study group. Mucosa of uncinate process, ethmoid bulla or maxillary sinus was obtained during endoscopic sinus surgery. All the samples were prepared using standard methods for scanning electron microscopy. Patients' information such as age, gender, symptoms, sinus CT, endoscopic examination, skin prick test were recorded in detail.</p><p><b>RESULTS</b>Standard-preparation scanning electron microscopy displayed denuded epithelium and disarrayed cilia in chronic rhinosinusitis patient's mucosa. In the study group, bacterial biofilms of different morphology were seen in five samples; One sample showed filamentous structure like fungi. Using strict scanning electron microscopy morphologic criteria, 83.3% samples in the study group were found to have micrographic evidence of biofilms. No bacterial biofilms were detected in the control group.</p><p><b>CONCLUSIONS</b>In the patients undergoing surgery for chronic rhinosinusitis, different degree of mucosal injury could be found. Bacteria biofilms of different life stages were demonstrated to be present. No bacterial biofilms were detected in the control group.</p>

Pathologic diagnosis of early syphilis in nasal cavity and oropharynx / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the pathologic changes in nasal and oropharyngeal mucosa caused by treponema pallidum (TP) infection.</p><p><b>METHODS</b>Twenty-five cases of nasal and oropharyngeal syphilis were retrieved from the archival files of Department of Pathology of Beijing Tong Ren Hospital collected during the period from June 1996 to September 2005. The hematoxylin and eosin-stained slides were reviewed. Histochemical study using modified Warthin-Starry stain and immunohistochemical study using polyclonal antibody for TP were carried out. The diagnosis of early syphilis was confirmed by rapid plasma regain (RPR) and TP hemagglutination (TPHA) tests.</p><p><b>RESULTS</b>Among the 25 cases studied, 20 showed neutrophil infiltration, microabscess formation and plasma cell infiltration in the lamina propria. Endothelial swelling of small blood vessels and syphilitic vasculitis was also seen. Tonsillar ulcers associated with abundant plasma cells, lymphocytes and histiocytes were noted in 14 cases. One of which demonstrated florid reactive lymphoid proliferation, with transforming lymphoid cells of various stages identified. Pseudoneoplastic squamous cell proliferation was seen in one case. Spirochetes were detected by modified Warthin-Starry stain in mucosal microabscesses and squamous epithelium in 20 cases, around small blood vessels in 5 cases, and on the surface of tonsillar ulcers in 14 cases. Abundant TP were also found in smears of exudates in 6 cases. TP antigen was detected in 4 cases by immunohistochemical staining. All the 25 cases studied were RPR (1:8 to 128) and TPHA-positive.</p><p><b>CONCLUSIONS</b>Early syphilis involving nasal cavity and oropharynx has distinctive pathologic features. Detailed histologic examination, together with modified Warthin-Starry stain for demonstration of spirochetes, is important to obtain a correct diagnosis.</p>

Pathogenic and clinicopathologic study of invative mycosis in nose and paranasal sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the mechanism of fungi invasion into the mucosal tissue, and to analyse the clinical-pathological relationship.</p><p><b>METHODS</b>The clinical data of 16 patients with invasive mycosis in the nose and paranasal sinus proved by pathologic examination between Apr, 1984 and Aug, 2002 were reviewed retrospectively. There were 7 males and 9 females with an average age of 48.6 years. The pathologic morphology of fungi found in these patients was investigated. Fourteen of 16 tissue samples from the paranasal sinuses obtained by endoscopic operation were cultivated for the fungi. One sample of invasive mycosis was observed under electron-microscope.</p><p><b>RESULTS</b>Fourteen cases were found to have following underlying conditions, including diabetes (n = 4), malignant tumor (n = 5). The infected sites were as follows: 7 cases presenting in unilateral maxillary sinus, 6 cases involving over two nasal sinuses, 8 cases invading the orbit. Of all 16 patients, 15 were positive (93.7%) for the culture. The positive rate of aspergillus was 62.5% and mucoraceae was 25.0%. The overall mortality rate was 50.0% after investigation from 6 months to 5 years. From 16 surgical specimens, hypha were proved in all cases for histopathologic methods. All of the 16 granulomatous and crumbley materials from the paranasal sinuses were found that inflammatory responses were predominantly neutrophilic leucocytes invasion (100%), suppurative granuloma formed in 15 cases (93.7%). Invasive diseases were characterized by prominent infarcts (27.8%), angio-invasion (100%), and surprisingly, prominent optic nervous invasion (16.7%) in biopsies.</p><p><b>CONCLUSIONS</b>The incidence of invasive mycosis is correlated with patients who suffered from diabetes, malignant tumor and other basic diseases causing depression of immunological function. The pathologic study shows that the fungi which invade the tissue are mostly aspergillus or mucoraceae, and the fungal vasculitis is the direct reason for tissue damage.</p>

Experimental study of the biocompatible and osteoinductive behavior of the hydroxyapatite/ultra-high molecular weight polyethtlene composite / 中华整形外科杂志

<p><b>OBJECTIVE</b>To compare the biocompatibility and osteoinductive behavior of HA (hydroxyapatite) and HA/UHMWPE (ultra-high molecular weight polyethtlene) composite in orbital implantation.</p><p><b>METHODS</b>Osteoectomy of the upper orbital rim was perform on 24 adult New Zealand rabbits. The animals were randomly divided into 4 groups with 6 of each. The HA, HA/UHMWPE composite or UHMWPE (10 mm x 10 mm x 3 mm in size) was implanted to the upper orbital defect of the animal in respective group. Animals were sacrificed at 1, 4, 8, 12 weeks. Histopathologic sections of the implants were evaluated and compared with light and transmission electron microscopy study.</p><p><b>RESULTS</b>During the experimental period of 12 weeks, there was no implant extrusion or displacement. In the groups of HA and HA/UHMWPE composite, vascular ingrowth and fibroblasts were observed shortly and osteocytes were seen at 8 weeks. Calcium deposition of the implants showed a laminar fashion at 12 weeks. In the group of UHMWPE, fibrous membranes were seen around the implant at 1 week. Transmission electron microscopy study showed that in the HA and HA/UHMWPE groups, fibroblasts and vascular ingrowth could be seen, but osteocytes were not observed.</p><p><b>CONCLUSION</b>HA/UHMWPE composite demonstrated biocompatibility and osteoinductive property. It would be a good substitute for bone, particularly for orbital bone.</p>

Study on pathological features and diagnosis, differential diagnosis of olfactory neuroblastoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To observe the common characteristics of pathological morphology and immunohistochemical staining of olfactory neuroblastoma (ONB), and to raise the diagnostic ability for ONB.</p><p><b>METHODS</b>34 cases of ONB, 11 cases of rhabdomyosarcoma (RMS) and 76 cases of malignant lymphoma (ML) were collected, the clinical information were investigated, and the biopsy samples were stained and observed as follows: (1) Routine HE staining and viewed under the light microscope. (2) Expression of neuron-specific enolase (NSE), chromogranin-A (CgA), leukocyte common antigen (LCA), desmin, and sarcometic actin (S-actin) were determined in both ONB and RMS cases. In addition, S-100 protein, cytokeratin (AE1/AE3) were detected in the ONB and myoglobulin detected in the RMS. ML samples were stained for LCA, CD45RO, CD56, and CD20. The NSE, CgA, desmin and S-actin were stained in 10 cases of NK/T cell ML and 9 cases of B cell ML additionally. (3) 4 cases of ONB, RMS and ML were observed under transmission electron microscope respectively.</p><p><b>RESULTS</b>The ages and clinical manifestations of ONB, RMS and ML were similar. The morphological characteristics of ONB included epithelial nests; net of angioma-like fibrous connective tissues; small round cells and small short spindle cells and nucleus; glandular and squamous liked epithelium; Homer-Wright and Flexner rosette; bunch of neurofibrilla, etc. NSE and CgA were expressed in small cells. S-100 protein was positive in the area of bunch of neurofibrilla. AE1/AE3 was positive in epithelial cells, LCA, while desmin and S-actin were all negative. Ultrastructurelly, there were neurosecretory granules and neurofibrilla in the cytoplasm of a few tumor cells. Although there were some similarities among ONB, RMS and ML under the light microscope, their characteristics of pathologic morphology, immunohistochemical staining and transmission electron microscope were different.</p><p><b>CONCLUSIONS</b>The features of the morphological changes are the most important basis to make diagnosis for ONB. The results of immunohistochemical staining can verify it further and play an important role in its differential diagnosis. Transmission electron microscope is very important but not essential for its diagnosis.</p>