A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO2 laser cauterization, and the open-surgery group underwent the following surgery: first, we performed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

Progress on treatment of transverse patella fractures with tension band fixation / 中国骨伤

Transverse fracture is the most common in patella fracture and tension band fixation is one of the most effective methods. Surgical wire tension band technique is simple, the use of materials is also simple, but it is not strong and difficult to promote. Kirschner tension band technique can get satisfactory reduction with reliable fixation, but it is easy to complicate with steel wire breakage and Kirschner loosening. Screw tension band technique inherits the traditional advantages of simple manipulation and reliable fixation, also overcomes the disadvantages of early activity limitations caused soft tissue irritation of tension band around knee, the slippage and breakage of internal fixation, and the technique can be popularized generally.

A comparison between endoscopic-assisted submandibular gland resection via retroauricular hairline incision and conventional submandibular gland resection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility, the risks and the advantages of endoscope-assisted submandibular gland resection using a retroauricular hairline incision (RAHI) by comparing it with the conventional submandibular gland resection.</p><p><b>METHODS</b>Twenty eight patients with benign lesions of the submandibular gland were included in the prospective clinically controlled study. Thirteen patients had endoscope-assisted resection using the RAHI approach and 15 cases had conventional transcervical approach resection. The size, location and adjacency of all lesions were evaluated by CT or MRI before surgery. The pathologic diagnoses of all cases were identified as benign diseases using fine needle aspiration biopsy. The two groups were compared for incision length, operation time, bleeding, incision cosmetic result, and complications.</p><p><b>RESULTS</b>All 28 operations were successfully performed. Incision length in the endoscopic group was significantly longer than that in the transcervical group (Z = -4.516, P < 0.01), and the surgical time was longer in the endoscopic group (Z = -3.263, P < 0.01). After three months the mean subjective satisfaction score for the incision scar in the endoscopic group was significantly higher than that in the transcervical group (Z = -4.472, P < 0.01). In the endoscopic group, 2 cases (15.4%) with temporary numbness of the earlobe and 1 case (7.7%) with a temporary marginal mandibular nerve paralysis were found postoperatively. However, they recovered within 1 month. All 28 patients were disease free with a follow-up of 10 to 24 months (median of 18 months).</p><p><b>CONCLUSIONS</b>Endoscope-assisted submandibular gland resection via RAHI is feasible and safe for the treatment of benign submandibular gland lesions. In comparison with the transcervical approach, this method can provide better cosmetic results without significant complications.</p>

Preliminary experience with endoscope-assisted transoral excision of the submandibular gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland.</p><p><b>METHODS</b>A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8 were chronic sialoadenitis (2 cases with sialolith), 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fine needle aspiration cytology (FNAC) or fine needle aspiration biopsy (FNAB).</p><p><b>RESULTS</b>Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1 - 3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months (median follow-up period: 36 months).</p><p><b>CONCLUSIONS</b>Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland. The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.</p>

Diagnosis and treatment of congenital fourth branchial anomaly / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the anatomic features, clinical presentations, diagnosis, differentiations and treatments of congenital fourth branchial anomaly(CFBA).</p><p><b>METHODS</b>The clinical data of 8 patients with CFBA were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 8 patients aging from 27 to 300 months (median age: 114 months), 4 male and 4 female; 3 untreated previously and 5 recurrent. All lesions, including 1 cyst, 3 sinus (with internal opening) and 4 fistula, located in the left necks. Three patients presented acute suppurative thyroiditis, 4 deep neck abscesses, and 1 neck lump. Preoperative examinations included barium esophagogram, direct laryngoscopy, ultrasonography, CT, MRI, and so on. The principles of managements were adequate drainage, infection control during acute period and radical surgery during quiescent period. Classic surgical approach consisted of complete excision of branchial lesions, dissection of recurrent laryngeal nerve and partial thyroidectomy. Selective neck dissection was applied in recurrent cases to extirpate branchial lesions, scarrings and inflammatory granuloma. Postoperatively, 1 case was with local incision infection which healed by wound care; 1 case was with temporary vocal cord paralysis which completely recovered 1 month after operation. No recurrence was found in all of 8 cases with follow-up of 13 to 42 months (median: 21 months).</p><p><b>CONCLUSIONS</b>CFBA relates closely anatomically with recurrent laryngeal nerve and thyroid grand. The barium esophagogram and direct laryngoscopy are the most useful diagnostic tools. CT and MRI are all beneficial to the diagnosis of CFBA. The treatment key to CFBA is the complete excision of lesion during a quiescent period after inflammatory control, together with the dissection of recurrent laryngeal nerve, partial thyroidectomy and partial resection of lamina of thyroid cartilage (if necessary), which all can decrease the risk of complications and recurrence. For recurrent cases, selective neck dissection is a safe and effective surgical procedure.</p>