Therapeutic effects of small fenestra stapedotomy with semiconductor diode laser: a comparison with microdrill / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effects of small fenestra stapedotomy with semiconductor diode laser and microdrill in patients with otosclerosis.</p><p><b>METHODS</b>Twenty-six patients (29 ears) undergoing stapedotomy with semiconductor diode laser and 19 patients (21 ears) with microdrill were compared for the hearing results and complication rates.</p><p><b>RESULTS</b>No statistically significant differences were found in postoperative speech frequency and high frequency pure tone average in closing the air-bone gap between the two groups. The ears treated by stapedotomy with semiconductor diode laser showed significantly better preoperative minus the postoperative air-bone gap and milder dizziness.</p><p><b>CONCLUSION</b>In spite of the good hearing outcomes in both groups, small fenestra stapedotomy with semiconductor diodelaser can achieve better results and reduce the incidence of complications.</p>

Perioperative management of severe obstructive sleep apnea hypopnea syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the perioperative management of severe obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Fifty-three patients with severe OSAHS received uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction. All the patients were treated with automated continuous positive airway pressure (CPAP) for 3-7 days before operation and automated antibiotic therapy administered in the oropharynx, with 24 h ECG monitoring postoperatively. Polysomnography were carried out before and 6 months after surgery.</p><p><b>RESULTS</b>The preoperative apnea hypopnea index (AHI) and lowest SaO(2) (LSaO(2)) were 58.4-/+5.1/h and 0.650-/+0.059, respectively, which were 15.5-/+3.2/h and 0.864-/+0.064 at 6 months after surgery, respectively, showing significant changes after surgery (P<0.01). Dyspnea occurred in 2 cases after operation, intraoperative bleeding in 1 case, primary bleeding in 2 cases and hypertension crisis in 1 case.</p><p><b>CONCLUSION</b>Severe OSAHS patients are subject to great surgical risk. Application of auto-CPAP before operation can significantly improve the patients' tolerance of surgery and anesthesia, and reduce the surgical risks and preoperative complications.</p>

Clinical application of uvulopalatopharyngoplasty with uvula preservation and tongue base radiofrequency reduction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effect of uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction for obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Forty six patients with OSAHS were enrolled. One group (n = 22) of patients only received uvulopalatopharyngoplasty with uvula preservation, while the other group (n = 24) had both uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction. Polysomnography and distance between anterior pillars (DBAP), distance between posterior pillars (DBPP), length of roft palate, distance between tongue base and posterior pharyngeal wall (DBTP) were measured before and 6 months after surgery.</p><p><b>RESULTS</b>The pre-operation apnea hypopnea index (AHI), x +/- s, lowest SaO2 (LSaO2) of first group were (56. 5 +/- 6. 0)/h, and 0.626 +/- 0.060 respectively, and 6 months after surgery, AHI was (23.7 +/- 2.7)/h, LSaO2 was 0.797 +/- 0.053. The pre-operation AHI, LSaO2 of second group were (58.4 +/- 5.1)/h, and 0.650 +/- 0.057 respectively, and 6 months after surgery, AHI was (15.5 +/- 3.2)/h, LSaO2 was 0.864 +/- 0.064. After surgery AHI and LSaO2 have changed in both groups (P<0.001). Six months after operation, DBAP and DBPP became withy, length of soft palate became short (P<0. 001). In one group the validity ratio is 72.7% (16/22), the other group the validity ratio is 87.5% (21/24) (P< 0.05), and pharyngeal posterior airway width (PPAW) became withy (P <0.001).</p><p><b>CONCLUSIONS</b>For OSAHS patients, the obstructive regions should be evaluated. The combined surgery of uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction could have a better result.</p>

An experimental study of mucociliary clearance of trachea reconstructed with free jejunum / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate tracheal mucociliary transport change after reconstructed with free jejunum.</p><p><b>METHODS</b>Twelve canine models of extensive circumferential tracheal defects reconstructed with revascularized jejuno combined with Ni-Ti alloy mesh tube were established. Every canine model was marked in cervical skin projecting the lower resected margin of trachea lumen and was injected 50% barium sulfate mucilage as a tracer into the trachea lumen under bronchoscopy. Record the time from tracer injected into trachea lumen to its arriving glottis (mucociliary transit time, MTT) and the length from tracer injected into trachea lumen to glottis (mucociliary transport length, MTL). Mucociliary transit rate (MTR), as MTL/ MTT, was calculated. The same procedure was performed at preoperative and postoperative 7th day, 1 month, 3 months and 6 months.</p><p><b>RESULTS</b>There were statistical significance between preoperative MTR and 1 month postoperative MTR (P < 0.05). There were no differences between preoperative MTR and postoperative MTR at the 7th day, 1 month, 3 months and 6 months. There were also no differences between postoperative MTR at the 7th day and 1 month, 3 months and 6 months.</p><p><b>CONCLUSION</b>In new tracheal tract reconstructed with free jejunum, MTR becomes normal at 3 months postoperatively.</p>

Salvage surgical approach for patients with post-radiation local recurrent nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate salvage surgical approaches and efficacy for post-radiation local recurrent nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Thirteen patients with post-radiation local recurrent NPC underwent salvage surgical treatment by routes as transpalatal approach, nasal medial swing approach, maxillary swing approach and infratemporal fossa approach. All cases were followed up for 2 to 5 years. Analysis was done on the indications and efficacy of these 4 different approaching routes.</p><p><b>RESULTS</b>No immediate operative complications occurred for all these 13 cases. Four patients with T1 and T2a operated via transpalatal approach and nasal medial swing approach survived more than 3 years. Five patients with T2b and T3 operated via maxillary swing approach. Among them, two patients died at second and 24th month after operation, one survived with tumor and died at 13rd month after operation, two were alive free of tumor for 2 and 4 years after operation. Four patients with T4 operated via infratemporal fossa approach. Among them, three died in 1 year, one was alive free of tumor for 2 years.</p><p><b>CONCLUSIONS</b>Surgical approaches were decided by a comprehensive consideration of recurrent tumor site and invasive range to achieve the best operative site exposure with minimal traumatic damage.</p>