Endoscope-assisted repair of zygomatic arch fracture via a short hidden preauricular incision / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the relevant applied technique and clinical value of endoscope-assisted repair of zygomatic arch fracture via a short hidden preauricular incision.</p><p><b>METHODS</b>There were 7 cases of unilateral zygomatic arch fracture and 10 cases of unilateral zygomatic fracture. Reduction and fixation of zygomatic arch in all cases were performed via a short preauricular incision assisted by endoscope.</p><p><b>RESULTS</b>Symmetric malar was achieved in all cases after operation. There was no difficulty in opening mouth, no chewing problems or severe complications.</p><p><b>CONCLUSIONS</b>Endoscope-assisted repair of zygomatic arch fracture via a short hidden preauricular incision can be an alternative operation for zygomatic arch fracture.</p>

Significance of preserving the posterior branch of the great auricular nerve in parotid surgery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility, technique and significance of preserving the posterior branch of the great auricular nerve in parotid surgery.</p><p><b>METHODS</b>48 cases with parotid tumor who underwent regular parotid surgery with cosmetic incision were included. The sensory testing was carried out in upper auricle, lobule, infra-auricular, pre-auricular and post-auricular region preoperatively and at 10 days, 1 month, 6 months and 12 months after operation.</p><p><b>RESULTS</b>The posterior branch of the great auricular nerve was preserved in 35 out of 48 patients. There was no sensory loss in the upper auricle and post-auricular region. Early after operation, sensory disturbance was found in lobule, infra-auricular region, but significantly in pre-auricular region. The sensory disturbance was recovered slowly to nearly normal level at six months after operation. 13 cases with sacrifice of the nerve had a significantly higher sensory disturbance and a longer recovery time.</p><p><b>CONCLUSIONS</b>Preservation of the posterior branch of the great auricular nerve during parotid surgery is technically feasible and can reduce the postoperative sensory disturbance and possible permanent sensory loss. It further helps to improve the quality of life early after operation.</p>

Observe the dissection of the tunnels of augmentation rhinoplasty under endoscope / 中华整形外科杂志

<p><b>OBJECTIVE</b>To observe and analyse the dissection of the tunnels in traditional blind operation of augmentation rhinoplasty.</p><p><b>METHODS</b>11 Cases of augmentation rhinoplasty were collected and be observed by an endoscope as soon as the tunnels were formed during the operations.</p><p><b>RESULTS</b>(1) Some of the tunnels did not go through one layer. (2) The bilateral cartilage separated in the mid-line. (3) There were two blood vessels in the surface of alar cartilage. There were perforating blood vessels in the edge of pyriform aperture. (4) In some cases whose incision were in unilateral alar margin, the tunnel were asymmetric.</p><p><b>CONCLUSION</b>In some cases of traditional blind operation of augmentation rhinoplasty, tunnels were not suitable, they were asymmetric; and there were desmo and septa in the tunnels. Those might be the causes of complications post-op of augmentation rhinoplasty.</p>

Endoscope-assisted parotidectomy for benign tumors via a short hidden auricular incision / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate a technique of endoscope-assisted parotidectomy for benign tumor via a short hidden auricular incision.</p><p><b>METHODS</b>Twenty-six volunteer patients were selected for the new approach, 16 with mixed tumor, 9 Warthin's tumor and 1 lymphoepithelial cyst. The tumor size was 1.6 approximately 3 cm (average 2.2 cm) and the incision ranged 3.5 approximately 5.5 cm(average 4.5cm) divided into two parts: 1) basic segment--started from anterio-superior crease of tragus, went downward along tragal margin and pre-earlobial fold,and stopped at earlobe root; 2) extended segment--went from earlobe root, curved down posterio-inferiorly. The length of the latter was generally not beyond 1 cm. The procedure began with raising the myo-cutaneous flap and dissecting the whole posterior portion of the gland. Thus, two working spaces needed for endoscopic manipulation could be artificially created with suitable retracting instruments. Endoscopic view was then established, and the surgeons operated continuously in the later steps. Modified techniques, such as the antegrade facial nerve dissection, retrograde great auricular nerve dissection and direct coagulate-cut method with ultrasonically activated scalpel, were employed to archive the goals of endoscopical nerve preservation and tissue resection.</p><p><b>RESULTS</b>All tumors were entirely removed. No postoperative paralysis occurred, excepting 1 case who suffered from an temporary paralysis for two months. The appearance was good due to overlapping the short scar onto the irregular line of auricular contour and hiding its lowest part in the earlobe shadow.</p><p><b>CONCLUSIONS</b>Parotidectomy for benign tumors could be safely done via a much-shortened incision, assisted by an endoscope. The postoperative stress of patients can be obviously reduced with the minimally invasive manipulation and the good appearance.</p>

The value of endoscopic technique in maxillofacial and neck regions / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the value of endoscopic technique in maxillofacial and neck regions.</p><p><b>METHODS</b>This retrospective review included 102 clinical patients with superficial masses in maxillofacial and neck regions. The indications, incisions, endoscopic space preparation and the key points of operative process were analysed.</p><p><b>RESULT</b>All of the results were satisfying.</p><p><b>CONCLUSION</b>The endoscopic technique in treating superficial masses in maxillofacial and neck regions had the advantage of wide indications, multiple incision choices, easy control of operative layers and less complications. And the recent and remote effects were excellent.</p>

Minimally invasive technique of parotidectomy for benign parotid tumors / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate a minimally invasive technique of parotidectomy in treatment of benign parotid tumors.</p><p><b>METHODS</b>This retrospective review included 49 patients with benign parotid gland tumors. The modified technique included incision, flap elevation, facial nerve dissection, the great auricular nerve preservation and postoperative disposal.</p><p><b>RESULTS</b>All tumors were resected completely. The operation lasted 1.5 approximately 2.5 h; the average length of incisions was from 5.5 cm to 7.5 cm, and the average postoperative hospital stay was 4 days. There were no permanent facial nerve injury, no obvious scars and no depressed deformity observed postoperatively. During the 6 months approximately 5 years following-up, no tumor recurrence was found.</p><p><b>CONCLUSION</b>The minimally invasive technique of parotidectomy reduces the disadvantages of the traditional procedure, and improves the quality of operation.T.</p>

Using ultrasonically activated scalpels as major instrument for vessel dividing and bleeding control in minimally invasive video-assisted thyroidectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To establish new techniques on the control of vessel dividing and bleeding in minimally invasive video-assisted thyroid surgeries.</p><p><b>METHODS</b>One hundred and seventy volunteer patients with nodular goiter, adenoma and Graves' disease consecutively received the endoscopic thyroid operation according to Miccoli's mode from April 2002 to June 2003. The approach was designed to use ultrasonically activated scalpels [Harmonic Scalpel (R), Johnson & Johnson, USA] as a major, suction-dissector or others as supplementary instruments during the whole process. During the operations, two methods, "sequenced dissect-coagulate-cut" and "pre-coagulation + interlaced cut-suck-coagulate-dissect", were employed and separately evaluated for their safety or efficacy.</p><p><b>RESULTS</b>All of the procedures, except that 2 (their lesions were proven to be "cancer" by frozen section and need different treatment), were successfully completed. None of them were interrupted and converted to open surgery due to uncontrolled bleeding or severe postoperative hematoma. Branches of major thyroid vessels can be directly divided by ultrasonic scalpel without ligation or using hemoclips, supposing the technique of "sequenced dissect-coagulate-cut" method was strictly used. Bleeding during intra-gland dissection can be effectively controlled by the combined techniques of precoagulation of the vessels and the capsule vessel network near and around the incision, and then, by coordinating manipulation with a special multiple functional ultrasonic scalpel and a suction-dissector, supposing the technique of "interlaced cut-suck-coagulate-dissect" was properly employed.</p><p><b>CONCLUSIONS</b>Using ultrasonic scalpels as major, suction-dissector or others as supplementary instruments, manipulating cooperatively during the whole process, can be an ideal fashion in the site of a narrow gasless working space via a small single incision in anterio-inferior neck. And this may dramatically simplify the manipulation, and hence greatly reduce the operative difficulty. The reforms resolved two key technique problems in Miccoli's endoscopic operation: vessel-dividing and bleeding-control, therefore, laying a sound basis for the clinical application of this special approach.</p>