Diagnosis and surgical treatment of sinonasal phosphaturic mesenchymal tumor / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the diagnosis and surgical treatment of sinonasal phosphaturic mesenchymal tumor (PMT). Methods: The medical records of nine patients who had been diagnosed as sinonasal PMT in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai JiaoTong University Affiliated Sixth People's Hospital between January 2015 and May 2020 were collected, including 4 males and 5 females, ranging from 36 to 59 years. The patient's previous history, clinical manifestations, imaging findings, laboratory results, surgical procedure, pathological results and postoperative follow-up data were analyzed by descriptive statistical analysis. Results: All patients presented hypophosphatemia and tumor-induced osteomalacia (TIO) with a disease course of 1 to 19 years. The imaging examination and intraoperative findings identified two cases with peripheral tissue infiltration, two cases with contralateral nasal cavity invasion, and one case with intracranial invasion. Five patients underwent unilateral endoscopic resection while two patients underwent bilateral endoscopic resection, and the remaining two patients underwent unilateral transorbital ethmoid artery ligation plus endoscopic tumor resection and endoscopic combined with transfrontal tumor resection (n=1 each). Expect for one case developed recurrence and intracranial involvement, the other patients achieved clinical remission and no recurrence was observed during the six-month follow-up. Conclusions: The diagnosis of sinonasal PMT needs combination of clinical manifestation, imaging, and pathological findings. Complete surgical excision and long-term postoperative follow-up are imperative.

Analysis of allergens characteristic in 4637 patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the distribution of allergens in patients with allergic rhinitis during the past 5 years in Shanghai area, and provide clinical reference for management strategies with regional character.</p><p><b>METHODS</b>Patients with symptoms of allergic rhinitis were given skin prick test (SPT) from June 2005 to May 2010. Among the patients, the distribution of all allergens was analyzed. The positive rate was compared with age, gender, season, and so on.</p><p><b>RESULTS</b>Among 4637 individuals, the total positive rate of SPT was 62.84%. Dust mites were identified as the mostly responsible allergens. There was significant difference of variation with seasons (χ2=93.581, P<0.01), the highest rate was found in autumn and the lowest was found in spring. There was significant difference of the positive rate in different months (χ2=112.001, P<0.01), the most in October. There was a negative correlation between the positive rate and age (r=-0.792, P<0.01). The response intensity to dust mite allergy was decreased with age increased (P<0.01).</p><p><b>CONCLUSIONS</b>Dust mites were identified as the most common allergens among patients with allergic rhinitis during the past 5 years in Shanghai area. The younger group had the tendency of higher positive rate and response intensity than the elder. The positive rates of dust mites varied with different seasons.</p>

An endoscopic approach to reconstruction of skull base defects using a vascular pedicled nasoseptal mucoperiosteal flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach.</p><p><b>METHODS</b>The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C), one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy, one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively.</p><p><b>RESULTS</b>Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat. All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period.</p><p><b>CONCLUSION</b>The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.</p>