Reconstruction of orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection.@*Methods@#Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method.@*Results@#Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33).@*Conclusion@#Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient′s life.

Analysis of the clinical and pathological characteristics of sinonasal neoplasms / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical and pathological characteristics of sinonasal neoplasms.@*METHOD@#A cohort of 333 patients with sinonasal neoplasm, which were confirmed by surgical pathology, were enrolled in this study. The clinicopathological characteristics, in terms of age, sex, location, and disease constituent ratio were retrospectively reviewed.@*RESULT@#(1) In this series of patients, there were 200 males and 133 females, aged from 2 to 84 years, with a median of 54 years. The benign to malignant ratio was 1.1:1. As for their origination, 144 tumors arose from the nasal cavity, while, 191 tumors derived from sinus, including 90 from maxillary sinus, 31 from frontal sinus, 46 from ethmoid sinus, and 24 from sphenoidal sinus. (2) Disease constituent ratio decreased in order of epithelial tissue, soft tissue, lymphohematopoietic tissue, bone and cartilaginous tissue, ectopic intracranial tumors. The five most frequent malignant tumors were squamous carcinoma, lymphoma, adenoid cystic carcinoma, malignant melanoma and esthesioneuroblastoma, while, benign tumors ranked in the top five were papilloma, fibroma, osteoma, angioma and ectopic intracranial tumors,respectively. (3) Of 200 cases arising from epithelium, 118 were benign, 82 were malignant, and the benign to malignant ratio was 1.4:1. Of 68 cases from soft tissue, 37 were benign and 31 were malignant tumors (ratio, 1.2:1). Among the 22 cases from bone and cartilaginous tissue, 17 were benign and 5 were malignant (ratio, 3.4:1). With respect to the 29 cases from lymphohematopoietic tissue, the majority of tumors were malignant (28 cases), with only one benign case. In addition, ectopic intracranial tumors were also observed. Besides the above all, 12 cases of other types were found in this work.@*CONCLUSION@#Neoplasms from different parts of nasal cavity and paranasal sinus have specific clinical characteristics. The pathological types of these tumors may be highly diverged. The diagnosis and differential diagnosis depend mainly on pathological examination. Comprehensive treatment, which employs surgery in combination with other modalities, is the main strategy for these tumors.

Controlled hypotension with remifentanil and propofol in children during endoscopic sinus surgery / 中国医师进修杂志

Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.