Endoscopic transnasal approach for nasopharyngeal angiofibroma without arterial embolism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of endoscopic resection without arterial embolism for nasopharyngeal angiofibroma and the strategy of decreasing the bleeding during the operation.</p><p><b>METHODS</b>The clinical data of twenty-five cases of nasopharyngeal angiofibroma were retrospective analyzed, including 3 cases of Radowski stageIIa, 5 cases of stageIIb, 4 cases of stageIIc and with 13 cases of stage IIIa. All cases did not receive the arterial embolism, and controlled hypotension were adopted under endoscopic transnasal approach during the tumor resection. Two cases were added the labiogingival incision. During the operation, under the opening vision, cutting out the outside of the infratemporal fossa, and the pterygoid process to adequate exposure the pterygopalatine fossa and infratemporal fossa.Early recognition of anatomical landmarks and establish the safety plane, along the periphery of the tumor to proceed with micro-separation, early blocking tumor nutrient vessels, en bloc resection of the tumor and some other ways to reduce bleeding and tumor resection.</p><p><b>RESULTS</b>Amount of bleeding during operation was 600-1500 ml, none of them had internal carotid artery injury and intracranial injury or some other complication.Follow-up 2-3 years was available in all patients, except 1 case with residual of tumor surrounding the optic nerve, the other 24 cases had no residual tumor and relapses.</p><p><b>CONCLUSIONS</b>The preoperative occlusion and artery ligation may not be needed.Surgical technique is the key to reduce blood loss, and it is feasible to have endoscopic resection of nasopharyngeal angiofibroma with proper operating technique.</p>

The clinical analysis and treatment of facial paralysis caused by temporal bone tumors / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical features, pathologic characteristics and treatments of the facial paralysis caused by temporal bone tumors.@*METHOD@#Retrospective analyzed the 23 clinical data of peripheral facial paralysis caused by temporal bone tumors, including 11 cases of facial nerve tumor: facial nerve neurilemmoma in 8 cases, facial nerve neurofibroma in 3 cases; 12 cases of temporal bone malignant tumor: temporal bone squamous cell carcinoma in 9 cases, chondrosarcoma in 1 case, rhabdomyosarcoma in 2 cases. All the patients accepted the CT scan examination and MRI examination. Twenty-three cases were surgically treated: facial nerve tumor resection were performed in 11 cases, among those, through mastoid approach in 7 cases, combined mastoid with middle cranial fossa approach in 3 cases, combined mastoid with parotid approach in 2 cases. Eight cases underwent facial nerve graft following the surgical removal of tumors. Twelve cases were temporal bone malignant tumor resection: among those, extended mastoidotympanectomy in 5 cases, subtotal temporal bone resection in 6 cases, total temporal bone resection in 1 case, all were treated by radiotherapies after surgeries.@*RESULT@#Whether the tumors go along the facial nerve in imaging is the major identification method to identify the facial nerve tumors or no-facial nerve tumors. During the 3-8 years follow-up, 10 patients who were totally removed the facial nerve tumor were no recurrence, 1 patient had tumors present. The recurrence rate of temporal bone malignancy was 41. 7% (5/12), 5 cases of Stell stage T2 and 5 cases of stage T3. The 5-year survival rate was 66.7% (8/12).@*CONCLUSION@#Most of facial nerve tumors that cause the facial palsy are benign, and no-facial nerve tumors are most common among the malignant tumors. CT and MRI films are valuable for the diagnosis. Operation is the major treatment, the manner of the operation bases on the type and the extent of the tumors. Facial nerve grafting can improve the facial neurological function after the tumor excision. Malignancy should be treated by combination of operation and radiotherapy, etc.