The clinical experience of transnasal endoscopic approach for skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the method of surgical treatment via trans-nasal endoscopic approach in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma.</p><p><b>METHODS</b>Fifteen patients with osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma who underwent operation via trans-nasal endoscopic approach from 2008 to 2013 were retrospectively reviewed. The typical clinical manifestations included headache (NRS 6-9: 11 cases), foul odor (10 cases), epistaxis (4 cases), hearing loss (5 cases, 7 ears), tinnitus (4 cases, 5 ears). All patients underwent operation via trans-nasal endoscopic approach. During the operation, the diseased region was fully exposed, the necrotic tissue was resected, the necrotic bone was removed by high-speed electric drill, and the drainage was made unobstructed. The perioperative treatment and follow-up were carried out.</p><p><b>RESULTS</b>After operation, all patients were diagnosed pathologically as osteoradionecrosis and mucosal chroinic inflammation, 1 case combined with fungal sphenoid sinusitis. Headache (9 cases) and foul odor (9 cases) resolved after operation. The follow-up was lasted 18-82 months, 13 cases were survival, 1 case lost to follow-up, 1 case died of cerebral hemorrhage.</p><p><b>CONCLUSION</b>Surgical treatment via trans-nasal endoscopic approach is safe and effective in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma, and is helping to improve the survival rate and survival quality.</p>

Analyses of therapeutic and prognostic factors for rN3 neck recurrence of nasopharyngeal carcinoma after primary radiotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment and prognosis for rN3 neck recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy.</p><p><b>METHODS</b>A total of 37 cases with rN3 neck recurrence after radiotherapy in NPC between October 2003 and August 2013 were retrospectively analyzed. Of them 19 cases presented with lymph node (LN) metastasis in supraclavicular fossa, 18 cases had metastasis LN > 6 cm, 10 cases received chemoradiotherapy, and 27 cases underwent neck dissection including modified radical neck dissection (MRND) for 9 cases, radical neck dissection (RND) for 18 cases. Six of 18 cases with RND underwent reconstructive surgery with pectoralis major flap, 12 cases received postoperative radiotherapy and 20 cases had postoperative adjuvant chemotherapy.</p><p><b>RESULTS</b>Eight patients had documented recurrence or residue, 17 patients developed distant metastases, one patient showed recurrence and distant metastasis. The 5-year overall survival rate and disease-free survival rate were 27.5% and 21.6% respectively, and the median survival time was 41 months. The survival rate in surgery group was significantly higher than that in chemoradiotherapy group, and the prognosis of patients with LN > 6 cm was better than that of patients with metastasis LN to supraclavicular fossa.</p><p><b>CONCLUSIONS</b>Patients with rN3 NPC are prone to metastasis, and patients with supraclavicular fossa lymph node metastasis had poor prognosis. Surgery combined with chemoradiotherapy is an effective treatment for the patients without distant metastasis.</p>

Application of narrow band imaging endoscopy in early diagnosis of nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the use of NBI (narrow band imaging) in early the diagnosis of nasopharyngeal carcinoma.</p><p><b>METHODS</b>A total of 55 cases with nasopharyngeal lesions (including 9 cases of nasopharyngeal carcinoma after treatment) were examined and diagnosed by white and NBI endoscopy between October 2011 and March 2012, and their diagnosis efficacies were evaluated based on pathological diagnosis as a gold standard. Chi-square test was used to analyze data.</p><p><b>RESULTS</b>Of 55 cases, 12 cases were pathologically diagnosed as chronic mucosa inflammation and 43 as nasopharyngeal carcinoma including 6 recurrent cases, of 43 cases, 40(93.0%) were diagnosed by NBI endoscopy and 18 (41.9%) by white endoscopy. Of 12 cases with early nasopharyngeal carcinoma (5 for stage I and 7 for stage II) , 5(100.0%) for stage I, and 6(85.7%) for stage II were diagnosed by NBI endoscopy but only 1(14.3%) for stage II by white endoscopy, with a statistically significant difference (χ(2) = 10.000, P = 0.008;χ(2) = 7.143, P = 0.029).</p><p><b>CONCLUSION</b>NBI endoscopy can be used in early diagnosis of nasopharyngeal carcinoma and check after treatment.</p>

Dynamic observation of EB virus DNA load before and after the treatment in patients with nasopharyngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Dynamic observation of Epstein-Barr virus (EBV) DNA load before and after the treatment in patients with Nasopharyngeal carcinoma (NPC), predicting the incidence of distant metastasis and offering more personalised choice of therapies.@*METHOD@#Fifty-four cases of patients with NPC were taken by fluorescence quantitative PCR assay of EBV DNA load before and after the treatment, all patients were followed up according to plan and carried out the progression-free survival (PFS) and overall survival (OS).@*RESULT@#EBV DNA load in plasma of patients with NPC can partly reflect the clinical characteristics of patients; EBV DNA load in some patients with distant metastasis was higher than those patients with continuous remission when they were not started treatment (P < 0.05); For those patients whose EBV DNA copies were lower than 20,000 copies/mI before the treatment, the progression-free survival and overall survival rates were higher than those high expression patients, and the difference were statistically significant (PF < 0.01 and P < 0.05).@*CONCLUSION@#The EBV DNA load in the plasma of NPC patients can partly predict the occurrence of distant metastases before treatment.

The value of narrow band imaging laryngoscope for laryngopharyngeal reflux disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the value of narrow-band imaging (NBI) laryngoscope for the diagnosis and therapy of the laryngopharyngeal reflux disease (LPRD).@*METHOD@#Analyzed the NBI laryngoscope characteristic findings of the throats of 46 LPRD patients which confirmed the diagnosis according to the reflux symptom index (RSI) and reflux finding score (RFS) both positive and the proton pump inhibitor therapy effective.@*RESULT@#The NBI laryngoscope findings as follows: erythema and edema between the arytenoid cartilages (71.7%), the epiglottis congestion (67.4%), pharyngeal isolation/integration erythema (65.2%), pharyngeal pebbles--like changes (65.2%), hypertrophy of the posterior commissure (52.2%), vocal cord erythema and edema (47.8%), vocal nodules or vocal polyps with erythema, or edema (39.1%), arytenoid cartilages edema and erythema (21.7%), ventricular edema, erythema and laryngeal ventricle disappeared (17.4%), granuloma (6.5%), ulcers (4.3%), false vocal cord ditch (4.3%).@*CONCLUSION@#LPRD has characteristic findings. NBI laryngoscope is easy to operate and has a high value on the diagnosis and the treatment of the LPRD.

Effect of p53 gene therapy on the local immunity and the efficacy of patients with nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the tumor regression and local immune function in nasopharyngeal carcinoma patients treated with p53 gene therapy.@*METHOD@#The two-step immunohistochemical was done to detect the expression of tumor-infiltrating lymphocytes (TIL) T-cell receptor-CD3, CD4, CD8 and B cell receptor-CD20 in the primary tumor tissue of nasopharyngeal carcinoma. Nasal endoscopy with MRI or CT was used for evaluation of tumor size.@*RESULT@#The expression of CD3, CD4, CD8 was significantly increased after p53 gene treatment (P 0.05). In conventional treatment group, CD3, CD4, CD8 and CD20 (P > 0.05) did not show any significant difference. In gene therapy group at 3 months after treatment, 20 patients had achieved CR, 10 PR, 1 SD, 1 PD. In conventional treatment group, 11 patients had achieved CR, 12 PR,5 SD,3 PD. The response rate between treatment group and control group (CR+PR) was different (P < 0.05). CD3 and CD4 expression was correlated with tumor regression rate (P < 0.05, P < 0.01), and CD8 expression was correlated with the CR rate (P < 0.05).@*CONCLUSION@#T cells are the most proliferative cell of TII. in NPC patients after p53 gene therapy The local cellular immune status is positively correlated with tumor regression rate.

A prospective study of surgery combined with concurrent radiochemotherapy in the treatment of patients with early stage nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma.@*METHOD@#Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia.@*RESULT@#(1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant.@*CONCLUSION@#The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.

The diagnosis and treatment of relapsing polychondritis (a case report) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To enhance the understanding of the diagnosis and treatments of relapsing polychondritis (RP).@*METHOD@#We present a 37-years-old woman with RP, and review the literatures.@*RESULT@#Initial presenting symptoms of the patient was auricle perichondritis. The patient was diagnosed as sudden deafness firstly. After 2 months, she consulted otolaryngologists at second time with a variety of involvement of the ear, nose, larynx or heart. She was diagnosed as relapsing polychondritis finally.@*CONCLUSION@#RP was rare autoimmune system disease, early clinical manifestation were atypical, misdiagnosis and diagnostic errors usually occurred. Corticosteroids, immunosuppressive agents, dapsone and surgical operation could be used in these patients to control symptoms.

Clinical analysis of 17 patients with relapsing polychondritis / 中国医师进修杂志

Objective To enhance the level of the diagnosis and treatment of relapsing polychondritis(RP).Methods Clinical data of 17 patients of RP were studied retrospectively. Results Of the patients,ear was involved in 16 cases, nose in 10 cases, laryngotracheobronchial region in 9 cases, eyes in 8 cases, joints in 4 cases, cardiovascular system in 1 case.Of 17 cases-1 died from respiratory complications. Fifteen patients had recurrence over twice,1 patient had sixth recurrence. Conclusions RP is rare autoimmune system disease, early clinical manifestation are nontypical, misdiagnosis and missed diagnosis. Corticosteroids, immunosuppressive agents, dapsone and surgical operation are used in these patients to control symptoms.

Facial nerve root combing scraping for hemifacial spasm / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effective intracranial surgical method for hemifacial spasm which can be operated more safely and easily.@*METHOD@#Twenty-five cases of hemifacial spasm underwent intracranial facial nerve root combing scraping by improved retrosigmoid approach. The compressing vessels were found in 10 cases and could be removed easily. Both microvascular decompression and facial nerve root combing scraping were performed to reduce recurrence. The other cases with perforating artery or without any compressing vessels underwent the facial nerve root combing scraping and cutting off partially for about 1/6 to approximately 1/5 neural fibers.@*RESULT@#Hemifacial spasms were obliterated in 22 cases (88%) after operation, obviously relieved in 2 cases (8%), invalid in 1 case (4%). Varied facial nerve paralysis was observed in 25 patients, but no hearing disturbance and other serious complication occurred. Follow-up for 2 to approximately 8 years showed there were recurrences in 2 cases (8%) and the facial nerve paralysis of 25 cases recovered in 1 to approximately 6 months after operation.@*CONCLUSION@#The facial nerve root combing scraping is an effective and safe microsurgical procedure which has wide-ranged indication and less complication. It is very important to select suitable treatment for the patient individually during the operation to improve the efficacy and lower the risk.