Outcomes and quality of life evaluation following endoscopic endonasal approach for sinonasal malignancies / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyse the outcomes and the prognostic factors of patients with sinonasal malignancies following endoscopic endonasal approach, and to compare the pre- and post-operative quality of life.@*Methods@#A retrospective single-center review of 79 patients who underwent endoscopic endonasal approach for sinonasal malignancies in Beijing Tongren Hospital from October 2004 to March 2017 was performed, including 51 males and 28 females, with a median age of 48 years. Data of demography, imaging (including nasal CT and MRI before operation), histopathology and treatment strategy were collected. Recurrence and distant metastasis were diagnosed according to endoscopic examination, MRI and general check-up after surgery. Pre- and post-operative quality of life scores were obtained by sinonasal outcome test-22, visual analog scale and anterior skull base surgery questionnaire. SPSS 22 software was used for statistical analysis.@*Results@#The study consisted of 13 pathological types with sinonasal T1-T4 stage tumors, including cervical lymph nodes and/or distant metastasis. All patients underwent endoscopic endonasal approach surgery. After 43 months of median follow-up time, the overall, disease-free, and recurrence-free survival rates at 1, 3, 5 and 10 years was 97.4%, 92.5%, 92.5% and 83.7%; 83.2%, 68.3%, 56.8% and 33.6%; 84.5%, 66.6%, 58.0% and 34.4%, respectively. Postoperative recurrence was an independent risk factor affecting the overall survival rate (HR=8.852, P=0.044), and preoperative recurrence (secondary surgery) was an independent risk factor affecting the disease-free and recurrence-free survival rate (HR value was 2.237 and 2.095 respectively, P value was 0.029 and 0.047 respectively). After surgery, the olfaction and nasal scab got worse, while the nasal obstruction and breathing were improved.@*Conclusions@#Endoscopic endonasal approach for sinonasal malignancies can achieve satisfactory outcomes, and has obvious advantages in improving the quality of life. Postoperative recurrence and preoperative recurrence are the prognostic factors.

Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation / 中华耳鼻咽喉头颈外科杂志

Objective@#To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with Draf Ⅲ so as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics.@*Methods@#Ten patients underwent nasalization with Draf Ⅲ in Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively. Postoperative follow-up of all patients was more than 1 year. All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar. VAS scores including nasal obstruction, stimulation in frontal sinus, and headache were collected at the same period. The control model was a normal person. Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models. Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0.@*Results@#The airflow pressure in frontal sinus ostium was (7.21±1.39)×104 Pa (Mean±SD), which was lower than that in normal subjects (8.99×104 Pa) under deep inspiratory simulation. But, the velocities in frontal sinus ostium and frontal sinus were (40.10±2.46) m/s and (28.19±1.73) m/s respectively, which were higher than those in normal one (2.70 m/s, 0.73 m/s). The airflow patterns of the two models were basically similar. There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively. No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms.@*Conclusions@#The airflow pattern and distribution after nasalisation with Draf Ⅲ are like those of normal person. There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.

Analyses of clinical and radiological characteristics of IgG4-related rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

Objectives@#To discuss the clinical and radiological features of IgG4-related rhinosinusitis.@*Methods@#In this retrospective research, the clinical data of 16 patients diagnosed with IgG4 related rhinosinusitis, who were enrolled in Beijing Tongren Hospital from November 2013 to September 2017, were collected. The clinical features, laboratory findings, radiological findings, histological features, treatment and prognosis were all summarized.@*Results@#There were 12 males and 4 females among 16 patients, and male-to-female ratio was 3︰1. The age was between 30 to 70 years old, with median age of 52 years old. The chief nasal complaints were nasal obstruction and hyposmia, complicated with proptosis and eyelid swelling in 11 patients (11/16). Serum IgG4 levels were elevated in all patients and the value was over 1.44 g/L, and one patient serum IgG4 level was up to 49.70 g/L. Computed tomography (CT) showed the mainly affected sinuses were bilateral ethmoid sinus and olfactory cleft. The classic feature of CT scans was thickening of the involved bilateral ethmoid sinus mucous membrane with ethmoid bone absorption, which was mainly at midline. Histological features were severe inflammation of the mucosal tissue with mass of neutrophils and plasma cell infiltration. All patients were treated by methylprednisolone combined with cyclophosphamide or methotrexate. Remission of symptoms was detected in all patients.@*Conclusion@#The clinical features of IgG4-related rhinosinusitis are often accompanied by orbital tissue involvement, elevated IgG4 serum concentration, associated sinus imaging changes, and sensitive glucocorticoid and immunosuppressive therapy.

Modified CT olfactory cleft scores are predictive factors of olfactory functionafter surgery in chronic rhinosinusitis with nasal polyps / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyze the value of modified sinus CT score in olfactory function evaluation before and after functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps(CRSwNP). METHODS Fifty-four patients who underwent functional endoscopic sinus surgery for CRS with nasal polyps were enrolled in this prospective study by inclusion criteria and exclusion criteria. T&T methods and olfactory function VAS were used to analyze the subjective olfactory function and were performed preoperatively and at 6 months after surgery. In modified sinus CT score, middle turbinate and superior turbinate associated olfactory cleft areas were used to evaluate the anterior olfactory cleft score(AOCS) and posterior olfactory cleft score(POCS). Sinus CT scans Lund-Mackay scores were also collected before surgery. The correlation between the status of the olfactory cleft on CT, Lund-Mackay score and the preoperative and postoperative olfactory results were investigated.RESULTS Among 54 patients, there were 36 male and 18 female, with average age of 47.9 years old(from 24 to 67 years). There were 30 patients followed 6 months after surgery. The findings of olfactory cleft opacification and the CT Lund-Mackay scores had a positive correlation with preoperative olfactory results(P<0.001). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT Lund-Mackay score. The AOCS was more significantly correlated with the postoperative olfactory results than the other parameters.CONCLUSION Preoperative CT findings, especially the anterior portion of the olfactory cleft had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

Effects of nasal cavity ventilation expansion techniques on airlfow patterns of the upper airway / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo compare the aerodynamic differences before and after nasal cavity ventilation expansion techniques in patients with OSAHS. METHODSA total of 30 adult patients with OSAHS were included in this study. Pre-operative upper airway CT of each subject was acquired. Each subject underwent surgery. Postoperative upper airway CT was obtained at least 3 months later. By means of CFD simulation method, numerical simulation was performed to calculate the airflow dynamic indexes of the upper airway. The pre-and post-operative aerodynamic characteristics were compared. RESULTSAfter operation, post-operative negative pressure nephogram of the nasal cavity indicated more smooth variation of pressure gradient, post-operative velocity nephogram of nasal cavity indicated slower airflow velocity. Proper values of flow field indicated the volume of nasal cavity increased significantly (t=4.025,P<0.01), the total nasal airway resistance decreased significantly (t=-2.065,P<0.01). The total negative pressure of the upper airway decreased significantly (t=-2.659,P<0.01) after operation. However, the proper values of flow field increased in 5 patients. CONCLUSIONNasal cavity ventilation expansion effectively increase the volumes of nasal cavity, improve the nasal ventilation, and reduce the air flow velocity of both nasal cavity and pharynx in OSAHS patients, those reduce the pharyngeal negative pressure and the pharyngeal collapse. However, for patients with its narrowest segment at the velopharyngeal level, operation cannot do anything or even aggravate the pharyngeal collapse. Operation should be performed individually.

A study on the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma.@*METHOD@#A retrospective study was carried out among 15 patients diagnosed as fontal sinus inverted papilloma, which had underwent endoscopic Draf II b surgery. The clinical success rate and surgical success rate were calculated by survival analysis.@*RESULT@#In all patients, there were 1 (6.67%) recurrence,1 (6.67%) stenosis, 4 (26.67)% complete closure, and 1 (6.67%) mucocele cyst. The 3-year clinical success rate was 93.3%, and the 3-year surgical success rate was 65.0%.@*CONCLUSION@#Draf II b surgery is feasible when the frontal sinus inverted papilloma is involved in the area of the pupil center line, and the frontal neo-ostium stenosis or complete closure is a common complication after surgery. Thus a close follow-up is recommended during the first year after the surgery. Further study is necessary to find a better way to reduce the complication rate.

Prospective study on the impact of nasal function after Draf III frontal sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of nasal function after Draf III frontal sinus surgery (Draf III) or the modified endoscopic Lothrop procedure (EMLP).</p><p><b>METHODS</b>It was a prospective study with self-control. The pre-operative clinical data of 30 patients (from 2010 to 2013, Beijing Tongren Hospital) who underwent Draf III surgery, with the testing results of T&T olfactory testing, acoustic rhinometry and rhinomanometry before and 1 year after operation in these patients were collected in this study. All patients complete visual analogue scale (VAS), a telephone follow-up questionnaire of olfactory function used by Wormald and Lund-Kenndy endoscopy score simultaneously with testings above. Most of 30 patients were chronic rhinosinusitis (CRS) with recurrent nasal polyps or systemic risk factors like asthma and aspirin-intolerance, called refractory rhinosinusitis. SPSS 19.0 software was used to analyze the data.</p><p><b>RESULTS</b>89.3% (25/28) of these patients improved in nasal obstruction 1 year after operation, and the cure rats was 57.1% (16/28, VAS = 0). The level of improvement in nasal obstruction was significantly correlated with pre-operative nasal obstruction severity (r = 0.909, P < 0.01). 76.7% (23/30) improved in olfactory function 1 year after operation in all 30 patients, and 88.2% improved in patients with nasal polyps (CRSwNP). It was also found that olfactory function 1 year after operation was significantly related to Lund-Kennedy endoscopy scores (r = 0.671, P < 0.01), but was not correlated with VAS scores of nasal obstruction (P = 0.349).</p><p><b>CONCLUSION</b>The Draf III frontal sinus surgery has a significantly positive effect on olfactory and ventilation function post-operatively, especially on refractory rhinosinusitis.</p>

Clinical analysis of the correlation factors of chronic sinusitis osteitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyse the severity of chronic sinusitis osteitis and the correlation factors by global osteitis scoring scale(GOSS).</p><p><b>METHODS</b>Three hundreds and thirty-four patients with chronic rhinosinusitis with or without nasal polyps(CRSwNP/CRSsNP) were enrolled prospectively in a large tertiary referral center. Preoperative sinus CT was analysed by PHILIPS MxLiteView software.Using grading and classification of GOSS, the association between GOSS and gender, age, smoking, CRS course, asthma, skin prick test(SPT), aspirin sensitive asthma (ASA), nasal polyp, Lund-Mackay, Lund-Kennedy, the number of previous sinus surgeries was examined.Finally a marker factors of severity of CRS osteitis was concluded.</p><p><b>RESULTS</b>There was no association between CRS osteitis and gender(P = 0.542), age(P = 0.092), smoking(P = 0.695), SPT(P = 0.182). Multiple liner regression analysis showed that there was no association between CRS osteitis and nasal polyps, ASA and asthma (all P > 0.05). The severity of CRS osteitis was correlated with the number of previous sinus surgeries, Lund-Mackay scores, Lund-Kennedy scores, CRS course (r1 = 0.528, r2 = 0.170, r3 = 0.193, r4 = 0.146, respectively, all P < 0.01).</p><p><b>CONCLUSIONS</b>Osteitis is an important reason of refractory chronic rhinosinusitis. The number of previous sinus surgeries can be used as an important marker for the severity of the osteitis.</p>

Expression and significance of osteopontin and muscle segment homeobox gene Msx2 in sinonasal inverted papilloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression level and significance of osteopontin (OPN) and muscle segment homeobox2 (Msx2) in sinonasal inverted papilloma (SNIP), and the relationship with the process of SNIP malignant transfomation.@*METHOD@#Immunohistochemical method was used to detect the expression of osteopontin and Msx2 in 32 cases of sinonasal inverted papilloma (SNIP), 30 cases of inflammatory nasal polyp paraffin tissue (INP) and 30 cases of sinonasal inverted papilloma with carcinoma. According to the pathology results SNIP were divided into mild dysplasia, moderate dysplasia, severe dysplasia. All the datas were analyzed by SPSS13.0.@*RESULT@#The positive expression of OPN and Msx2 in the SNIP with carcinoma were all 100% (30/30), were significantly higher than the SNIP and INP, and the pairwise comparisons were all statistically significant (P < 0.05). The expression of OPN and Msx2 in the SNIP were divided according to pathological. There was significant difference between mild dysplasia and severe dysplasia group (P < 0.05), while there were not significant difference between light degree of dysplasia and moderate dysplasia group, moderate dysplasia and severe dysplasia group. And the expression of OPN and Msx2 was positively correlated in SNIP (P < 0.01).@*CONCLUSION@#OPN and Msx2 may play an important role in the pathway of progression of SNIP, which may be identified as the new therapeutic targets.

Resection of the ossifying fibroma of paranasal sinuses and anterior skull base with nasal endoscope under the guidance of image navigation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the role of image navigation in resection of the ossifying fibroma of paranasal sinuses and anterior skull base with nasal endoscope.@*METHOD@#Fourteen cases with ossifying fibroma involving paranasal sinuses and anterior skull base were underwent intranasal endoscopic surgery under the guidance of image navigation. Sequential nasal sinuses CT scans were obtained before and after operation. CT scans demonstrated that the nasal septum, orbital wall and anterior skull base were involved in every case. The anterior boundary of the frontal recess cells was involved in 10 cases. The lesions were adjacent to the orbital apex and optic canal in 5 cases. The sella turcica and clivus were invaded in 3 cases and the pterygopalatine fossa was invaded in 2 cases.@*RESULT@#The tumors were thoroughly removed in all cases. The average operative time was 280 minutes and the average registration time of navigation was 9 minutes. Postoperation CT scans demonstrated that the tumors were totally resected.@*CONCLUSION@#The image-guided endoscopic surgery of the ossifying fibroma of paranasal sinuses and anterior skull base provided accurate tumor resection, increased surgical effectiveness, decreased overall surgical complications.

Analysis of prognostic factors in endoscopic surgery for juvenile nasopharyngeal angiofibroma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Analyzing the prognostic factors in endoscopic surgery of juvenile nasopharyngeal angiofibromas (JNA).@*METHOD@#Forty-seven records of JNA, treated with the endoscopic, from 2002 to 2008 were reviewed retrospectively. Previous surgery in other hospitals, sites involved, whether selective embolization was performed before surgery, feeding vessels, operative techniques and follow-up results were recorded. Evaluated factors include previous surgery for resection of JNA, vascular supply from carotid artery, surgery after selective embolization, involvement of cavernous bone in the root of pterygoid process, greater wing of sphenoid bone, interpterygoid fossa, infratemporal fossa and orbit. Chi-square test was used.@*RESULT@#Operations were done under general anesthesia. The follow-up time was 12 to 87 month (median 35 month). During follow up, six patients presented recurrent lesions. Chi-square test showed that deep invasion of the cavernous bone in the root of pterygoid process was related to recurrence (P<0.05). There was no statistically significant difference between other factors and recurrence. Imaging examination showed that recurrent tumor was around the root of pterygoid process.@*CONCLUSION@#Deep invasion of the cavernous bone in the root of pterygoid process which was related to recurrence deserve close attention before and after endoscopic surgery.

An observation of the bone remodeling in rabbits sinusitis model with CT scan / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the bone remodeling in rabbits sinusitis model by CT scan and observing the CT manifestations and time sequence related tendency.METHODS Forty white rabbits(New Zealand) were divided into 5 groups and each group had 8 rabbits.After the sinusitis models were made by incomplete ostia-obstructed and inoculated staphylococcus,we choose one group to be detected by CT scan separately at each time point(2,4,6,8 and 12 weeks after operation).The items we are going to evaluate conclude bone destroy,bone proliferation and sclerosis,soft tissue change,homonymy nasal cavity,opposite side and subcutaneous soft tissue change.The main items were bone destroy,bone proliferation and sclerosis.RESULTS The changes in soft tissue,homonymy nasal cavity,opposite side and subcutaneous soft tissue appear in each group.The main bone manifestation of the change in 2weeks and 4weeks group is bone destroy,no evident bone proliferation and sclerosis.Bone destroy,bone proliferation and sclerosis coexist in the 6 weeks,8 weeks and 12 weeks group.The number of bone destroy and bone proliferation in 6weeks,8 weeks and 12 weeks group is 7,7,6 and 3,5,7 separately.There weren't significant difference about other items among the groups.CONCLUSION The CT manifestations of bone remodeling feature in rabbits sinusitis model include bone destroy,bone proliferation and sclerosis.In the early phase,the main manifestation is bone destroy.While in the late phase(no less than 6 weeks),bone destroy and bone proliferation coexist and the bone proliferation become more obvious over time.

Modified intranasal endoscopic dacryocystorhino-stomy / 中国耳鼻咽喉头颈外科

OBJECTIVE To present the modified intranasal endoscopic dacryocystorhinostomy (MIEDCR) and the clinical results. To discuss the modified operative technique and its purpose. METHODS A total of 31 cases (35 eyes) with chronic dacryocystitis who underwent MIEDCR were included in this study. There were 27 female and 4 male. The age was ranged from 9 to 70 years (mean 31 years). The preoperative dacryocystography was taken in all cases. The follow up time was 6 to 20 months. RESULTS Among the 31 cases with chronic dacyocystitis, 4 patients suffered bilateral chronic dacyocystitis. Dacryocystitis related to nasal endoscopic surgery was found in 2 cases (2 eyes). Four cases (5 eyes) had prior laser lacrimal duct surgery. Two patients had external dacrypcystorhinotomy experience. 34 MIEDCR procedures (97.1 %) were successful. Twenty eight patients (32 eyes) were free of their symptoms and kept stoma patency. The shift of mucosal flap was found in one case when Merocel was removed. The rhinostomy of another 2 cases were closed due to mucosal scar and one of them received revision surgery. There were no operative complications. CONCLUSION The preserved nasal mucosal flap which was replaced over the denuded bone would avoid scar formation and hyperostosis and is benefit to gain a satisfied and good clinical effects of dacryocystorhinostomy.