The reliable treatment choice of nasopharyngeal angiofibroma and causes of operative bleeding / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To introduce the efficacy of three surgical options for juvenile nasopharyngeal angiofibroma (JNA) resection, and causes of operative bleeding.@*METHOD@#Retrospective analysis of 36 JNAs,three surgical options were used to resect the tumor. There were 15 cases of Class I tumors , using endoscopic nasal cavity approach. Eighteen cases of class II tumors, via extended Caldwell-Luk incision, using the transantral-infratemporal fosse-nasal cavity combined approach for tumor resection. Three cases of class III tumors, the combined intracranial and extra-cranial approach was used to resect the tumor. Meanwhile, report six typical cases for reference.@*RESULT@#Fifteen (15/36) cases of class I tumors, 14 cases were completely resected for the first time without recurrence, 1 recurrence case was re-resected using the same approach. Eighteen (18/36) cases of class II tumors, 13 cases were completely resected for the first time without recurrence, 5 recurrence cases were re-resected totally. Three (3/36) cases of class III were not completely removed, and underwent about 40 Gy radiotherapy with good effects.@*CONCLUSION@#Using these three surgical options can effectively remove different types of JNA. When necessary, the intracranial residue can use radiotherapy. Under direct vision to separate the tumor, and effective hemostasis play crucial roles for complete removal of the tumor.

Significance of heparanase, bFGF and VEGF in angiogenesis for nasopharyngeal angiofibroma outspreading / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the expression of HPA, bFGF and VEGF in nasopharyngeal angiofibroma, and then explore its significance of inducing angiogenesis in the tumor's expansibility growth.@*METHOD@#The expression of heparanase, bFGF, VEGF and CD105 were examined in 30 (I - II period 9 cases, III - IV period 21 cases) samples from nasopharyngeal angiofibroma and 20 inferior turbinate tissues by immunohistochemical staining technique. The microvascular density (MVD) were measured by the immunohistostaining of CD105. The MVD was analyzed with the clinical stage.@*RESULT@#The positive rates of the HPA, bFGF and VEGF expression in JNA tissues were significantly higher than that in inferior turbinate group (P < 0.05). The positive rates of HPA, bFGF and VEGF expression in III - IV period were obviously higher than that in I - II period (P < 0.05). The expression of bFGF and VEGF in JNA tissues was respectively positive correlated with the HPA (r = by 0.499, 0.582, P < 0.05); In JNA tissues, the mean MVD in both HPA and bFGF positive group was higher than each one single positive group or both negative express group (P < 0.05). And the mean MVD in both HPA and VEGF positive group was higher than each one single positive group or both negative express group (P < 0.05).@*CONCLUSION@#HPA can induce angiogenesis to promote tumor growth by releasing bFGF and VEGF. Targeting the HPA can be a new direction in JNA adjuvant treatment.

Study and analysis on the hemorrhage of pterygoid venous plexus in large nasopharyngeal angiofibroma resection / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To our knowledge, study of the intraoperative profuse bleeding of pterygoid venous plexus (PVP) in large nasopharyngeal angiofibroma resection has not yet been reported. Attention should be paid to this topic in clinical practice.@*METHOD@#From 1981 to 2009, 44 cases of JNAs were treated in our hospital. Twenty-six of 44 cases were large nasopharyngeal angiofibromas according to the Fisch classification system(Fisch type III 16, type IV 10). The amount of intraoperative blood loss in these 26 cases varied from 200 ml to 5200 ml. Factors influencing intraoperative bleeding of 26 large nasopharyngeal angiofibroma resections were analyzed retrospectively. The intra-operative observations and imaging data of three typical cases were hereby studied.@*RESULT@#After embolization of the tumor-supplying branches of the external carotid artery(ECA), both the intraoperative observations and imaging data demonstrated that the pterygoid venous plexus (PVP) played a crucial role in intraoperative hemorrhage.@*CONCLUSION@#PVP in the infratemporal fossa communicates with craniofacial veins. There is no valve between these veins. Once PVP is seriously damaged, venous blood of all craniofacial veins will flow out profusely. In the first operation, the intact PVP in the fatty pad generally can be identified and separated from the tumor by delicate surgical managements. If an unsuccessful operation due to serious hemorrhage had been done previously, then scar tissue might tightly adhere with PVP, tumor and the pterygoid muscles, and separation of the tumor from PVP without bleeding is more difficult. Appropriate surgical approach and correct hemostatic procedure of every bleeding point should be done carefully under direct vision. Using finger or instrument for quick blind dissection should be prohibited.

Perioperative managements of huge lobulated nasopharyngeal angiofibromas with intracranial extensions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize our experience of successful and failed management in 8 huge lobulated nasopharyngeal angiofibromas with intracranial extensions, and introduce some key points of perioperative treatments.@*METHOD@#Eight male case with an average age of 18 years, were all lobes extending into middle and/or anterior cranial fossa, in which 5 cases revealed blood supply from the internal carotid arteries and 3 cases were reoperated because of recurrence. Preoperatively, the tumor were evaluated by CT, CTA, MRI and/or MRA, and super selective embolization of the feeding arteries were crucial procedures. The combined craniofacial approaches were used to excise these tumors.@*RESULT@#Five cases were removed completely, and 3 cases were removed partly in which 2 were due to serious bleeding caused by lack of DSA technique at that time and 1 were due to neglecting the tumor lobe in the sphenoid sinus of the other side.@*CONCLUSION@#Reasonable perioperative management are very important for control of intra-operative blood loss, complete remodeling of the tumor and avoiding complication.

Early diagnosis and treatment of the tympanic isthmus obstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the treatment and diagnosis of early tympanic isthmus obstruction and dysfunction of eustachian tube.@*METHOD@#Three hundred patients (338ears) suffering from early tympanic isthmus obstruction were examinated and observed from 1991 to 2004, and were injected triamcinolone into tympanic cavity at the position of hypokinesis or blockaded the external acoustic meatus according to different state of the illness.@*RESULT@#Two hundred and sixty of three hundred case were cured, thirty cases were improved, ten cases were inefficacy.@*CONCLUSION@#Tympanic isthmus obstruction is a pathognostic type of secretory otitis media. There is significant difference between tympanic isthmus obstruction and secretory otitis media caused by dysfunction of eustachian tube. Prolonged tympanic isthmus obstruction is a reason of primary cholesteatoma of epitympanum's pathogeny. It is important to diagnose and treat of the tympanic isthmus obstruction early.

Herpesviridae and laryngeal neoplasia / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the relationship between herpesviridae and malignant or benign laryngeal diseases.Method:128 paraffin-embedded laryngeal squamous cell carcinoma and laryngeal epithelium hyperplastic lesions were detected by polymerase chain reaction (PCR) and PCR-ISH for herpesviridae. Result:HSV-1 was detected in 10 cases by PCR,among them 3 were laryngeal squamous cell carcinoma (LSCC),1 was carcinoma in situ(CIS),4 were laryngeal polyps and 2 were laryngeal keratosis. Except 1 LSCC and 1 CIS, 8 of 10 cases were positive while detected by PCR-ISH. In benign diseases, signals were shown from basal layer to superficial cell; in malignant lesions, the signals were scattered in the diseases.Conclusion:Most of laryngeal diseases were not related to herpesviridae, but HSV-1 may acts as initiator in the development of a few cases.