Preservation of laryngeal function in surgical treatment of pyriform sinus carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and the related surgical techniques of laryngeal function preservation in surgical treatment of pyriform sinus cancer.</p><p><b>METHODS</b>Two hundred and thirty cases (stage I, 6; stage II, 10; stage III, 91; stage IV, 123) with pyriform sinus cancer were treated surgically from 1978 to 1996 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University. The methods of removing tumor and repairing surgical defects were depended on the extension of lesions. The laryngeal and pharyngeal functions were rebuilt by normal tissue preserved with lesions entirely removed. One hundred and fifty-eight cases were surgically treated with laryngeal functions preserved and 72 cases total laryngectomy. The most of the cases received postoperative radiotherapy.</p><p><b>RESULTS</b>The overall 3 and 5 year survival rates were 67.4% (155/230) and 48.3% (111/230) respectively. For stage I, the survival rate was 5/6; stage 11, 70.0% (7/10); stage III, 57.1% (52/91) and stage IV, 38.2% (47/123); the 3 and 5 year survival rates in functionally preserved group were 67.7% (107/158) and 50.0% (79/158), while in none functional group were 66.7% (48/72) and 43.1% (31/72), respectively. 75.3% (119/158) patients have laryngeal functions (voice,respiration and deglutition) completely restored and 24.7% (39/ 158) partially restored(voice and deglutition).</p><p><b>CONCLUSIONS</b>The preservative surgery is feasible for the selected pyriform sinus cancer cases. Choosing and following optimum surgical methods is a prerequisite for improving the quality of life of the cases.</p>

Surgical approaches to the skull base neoplasms / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the best surgical approach to the skull base neoplasms.</p><p><b>METHODS</b>Retrospective analysis the 79 skull base neoplasms cases treated with surgical resection in Qilu hospital of Shandong university from 1992 to 2002. Eleven surgical approaches including midfacial degloving, frontal coronal discission, nasal eversion, maxillary swing, partial maxillary resection, total resection of orbit, mandibular swing, combination of front, temple, preauricular, post aureum, neck, and transoral approaches were used to resect the tumor which involved fossae pterygopalatine, paranasal sinuses, nasopharynx, antero, meso and posterobasilar region, lobi frontalis and lobi temporalis of cerebrum.</p><p><b>RESULTS</b>Seventy-nine skull base neoplasms were totally removed and no one died from the operation. Although 5 cases complicated with cerebrospinal fluid leak and all recovered within 1 week, no serious cranium-cerebrum complication occurred. In 29 patients with benign tumor including 11 cases of meningioma, 3 cases of chondroma, 1 case of hemangio-meningioma, 1 case of cavernous hemangioma, 2 cases of osteodysplasia fibromas, 9 cases of neurofibroma, 1 case of glomus jugular tumor, 1 case of neurilemmoma, 19 have survived over 5 years and the longest one has survived over 8 years. For 50 patients with malignant tumor including 3 cases of well-differentiated squamous cell carcinoma, 17 cases of moderately differentiated squamous cell carcinoma, 11 cases of poorly differentiated squamous cell carcinoma, 1 case of undifferentiated carcinoma, 2 cases of chondrosarcoma, 5 cases of canceration of papilloma, 2 cases of adenocarcinoma, 1 case of esthesioneuroblastoma, 2 cases of malignant fibrohistiocytoma, 1 case of fibrosarcoma, 2 cases of malignant mixed tumour, 3 cases of sarcoma survival rates of 3 and 5 years were 59.2% (29/49), 38.5% (10/26) respectively.</p><p><b>CONCLUSION</b>In order to resect the tumor completely and reduce the complication and malformation as far as possible, different surgical approaches must be designed according to the pathological changes characters and involved area,and the surgeon should select the shortest approach, avoid to damage the important neurovascular structure, and resect the tumor through the natural anatomy space by the shelter incision.</p>

Surgical treatment of postcricoid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the surgical techniques in surgical treatment of postcricoid carcinoma.</p><p><b>METHODS</b>Twenty-one cases with postcricoid carcinoma were treated surgically. The TNM stage were as follows: T3NOM0 5 cases, T3N1M0 1 case, T3N2M0 2 cases, T4NOM0 7 cases, T4N1M0 4 cases, T4N2M0 1 case, T4N3M0 1 case. The laryngeal and pharyngeal functions were rebuilt by the remaining tissue when the lesions entirely removed. Ten cases were surgically treated with laryngeal functions preserved and 11 cases with total laryngectomy. Eight cases were received unilateral neck dissection, and 3 cases were received bilateral neck dissection. All the cases received postoperative radiotherapy.</p><p><b>RESULTS</b>The follow-up interval varied from 60 to 276 months with average interval 96 months. Four cases died of cervical metastasis,3 died of local recurrence, 1 died of cardiopulmonary failure, 2 died of unknown reasons. The overall 3 and 5 year survival rates were 61.9% (13/21) and 52.4% (11/21), respectively. Among 10 cases having laryngeal functions partially restored (voice and deglutition), the postoperative complications included 5 cases of pharyngeal fistula, 3 hypopharyngeal stenosis and 1 severe aspiration.</p><p><b>CONCLUSIONS</b>The preservative surgery is feasible for the selected cases with postcricoid carcinoma. The laryngeal function can be partially restored with lesions entirely removed. The patients can gain satisfied survival rate and quality of life.</p>

Clinical study of combined approach of tympanoplasty and mastoidectomy with close technique / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To improve the surgery results and living quality of patients following the operation of the combined approach of tympanoplasty and mastoidectomy with close technique.</p><p><b>METHODS</b>The clinical data and following-up results of 49 patients treated with combined approach of tympanoplasty and mastoidectomy with close technique and 82 patients treated with open mastoidectomy with tympanoplasty were retrospective analyzed.</p><p><b>RESULTS</b>In the group treated with combined approach tympanoplasty, all patients got dry ear in 20 days and 31 patients' hearing level enhanced over 15 dB after the operation; but in the group treated with open mastoidectomy with tympanoplasty, only 13 patients got dry ear in 20 days and no patients' hearing level enhance over 15 dB after the operation. Although the recurrence rates between two groups were not significant difference, the patients of former group not only took a shorter recovery time and got a better hearing recovery, but also kept a normal external auditory meatus, at the same time, they need not to clear scab at fixed period all life long.</p><p><b>CONCLUSIONS</b>When performed on carefully selected patients, combined approach tympanoplasty was a feasible surgical method to improve the surgery results and living quality of patients following the operation, however, the advanced equipment and perfect operation skill are necessary.</p>

Surgical approaches for sinonasal tumors with intracranial extension / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical approaches for sinonasal tumors with intracranial extension.</p><p><b>METHODS</b>Seventeen patients with intracranial invasion tumors were treated surgically by maxillectomy combined with frontal or infratemporal approaches in 11 cases, including squamous cell carcinoma 8 cases, papillocarcinoma 2 cases and meningioma 1 case. Nasofrontal bone translocation in 1 case which was a meningioma case, craniofacial approaches in 5 cases, including squamous cell carcinoma 4 cases and esthesioneuroblastoma 1 csae.</p><p><b>RESULTS</b>One of two meningioma cases with cavernous sinus invasion was incompletely resected, another case was resected en bloc. In malignant group, ten cases were treated by nasomaxillectomy combined with frontal or infratemporal approaches. One patient died 1 year after operation, 7 cases survived for over 3 years, and 5 for over 5 years. Five cases were treated by craniofacial approach, among them, one patient died 6 months after operation, 4 cases survived for over 3 years, and 2 for over 5 years. All patients healed smoothly.</p><p><b>CONCLUSIONS</b>Maxillary nasopyramid translocation combined with frontocranial or infratemporal approach is available for en bloc removal of sinonasal tumors with intracranial extension. The nasofrontal bone translocation is available for removal of tumors with limited intracranial extension and well developed frontal sinus. Cranioanterolateral facial approach is suitable for nasocranial tumors with facial bone involvement.</p>