Analysis of clinical risk factors of the deep space neck absces / 中国耳鼻咽喉头颈外科

OBJECTIVE To identify the clinical risk factors related to the increasing likelihood of surgical drainage and the medical therapy failure in deep space neck abscess. METHODS The clinical data of 111 consecutive patients from January 2009 to June 2016 with deep space neck abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. RESULTS All patients had successful resolution of their infections by medical therapy and(or) surgical drainage. At the level of α=0.05, dyspnea was the risk factor of increasing likelihood of surgical drainage (β=3.001, OR=20.099); the maximum dimension of abscess>2.0 cm was not only the risk factor of increasing likelihood of surgical drainage(β=2.396, OR=10.979), but also that of medical therapy failure(β =4.618, OR=101.313). Age, sex, white blood cell count at presentation, fever, diabetes, neck swelling, and multiple space abscess of neck did not increase the risk of surgical treatment (P>0.05, respectively). CONCLUSION Active preoperative preparation and surgical intervention should be used with those who have dyspnea and the maximum dimension of abscess >2.0 cm as soon as possible. However, those who without dyspnea and abscess size less than or equal to 2.0 cm may be recovered without incision and drainage of operation by only sufficient and effective intravenous antibiotics treatment under close guarded surveillance.

The reliable treatment choice of nasopharyngeal angiofibroma and causes of operative bleeding / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To introduce the efficacy of three surgical options for juvenile nasopharyngeal angiofibroma (JNA) resection, and causes of operative bleeding.@*METHOD@#Retrospective analysis of 36 JNAs,three surgical options were used to resect the tumor. There were 15 cases of Class I tumors , using endoscopic nasal cavity approach. Eighteen cases of class II tumors, via extended Caldwell-Luk incision, using the transantral-infratemporal fosse-nasal cavity combined approach for tumor resection. Three cases of class III tumors, the combined intracranial and extra-cranial approach was used to resect the tumor. Meanwhile, report six typical cases for reference.@*RESULT@#Fifteen (15/36) cases of class I tumors, 14 cases were completely resected for the first time without recurrence, 1 recurrence case was re-resected using the same approach. Eighteen (18/36) cases of class II tumors, 13 cases were completely resected for the first time without recurrence, 5 recurrence cases were re-resected totally. Three (3/36) cases of class III were not completely removed, and underwent about 40 Gy radiotherapy with good effects.@*CONCLUSION@#Using these three surgical options can effectively remove different types of JNA. When necessary, the intracranial residue can use radiotherapy. Under direct vision to separate the tumor, and effective hemostasis play crucial roles for complete removal of the tumor.

Management of pterygoid venous plexus hemorrhage during resection of a large juvenile nasopharyngeal angiofibroma: a review of 27 cases.

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

Study and analysis on the hemorrhage of pterygoid venous plexus in large nasopharyngeal angiofibroma resection / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To our knowledge, study of the intraoperative profuse bleeding of pterygoid venous plexus (PVP) in large nasopharyngeal angiofibroma resection has not yet been reported. Attention should be paid to this topic in clinical practice.@*METHOD@#From 1981 to 2009, 44 cases of JNAs were treated in our hospital. Twenty-six of 44 cases were large nasopharyngeal angiofibromas according to the Fisch classification system(Fisch type III 16, type IV 10). The amount of intraoperative blood loss in these 26 cases varied from 200 ml to 5200 ml. Factors influencing intraoperative bleeding of 26 large nasopharyngeal angiofibroma resections were analyzed retrospectively. The intra-operative observations and imaging data of three typical cases were hereby studied.@*RESULT@#After embolization of the tumor-supplying branches of the external carotid artery(ECA), both the intraoperative observations and imaging data demonstrated that the pterygoid venous plexus (PVP) played a crucial role in intraoperative hemorrhage.@*CONCLUSION@#PVP in the infratemporal fossa communicates with craniofacial veins. There is no valve between these veins. Once PVP is seriously damaged, venous blood of all craniofacial veins will flow out profusely. In the first operation, the intact PVP in the fatty pad generally can be identified and separated from the tumor by delicate surgical managements. If an unsuccessful operation due to serious hemorrhage had been done previously, then scar tissue might tightly adhere with PVP, tumor and the pterygoid muscles, and separation of the tumor from PVP without bleeding is more difficult. Appropriate surgical approach and correct hemostatic procedure of every bleeding point should be done carefully under direct vision. Using finger or instrument for quick blind dissection should be prohibited.

Perioperative managements of huge lobulated nasopharyngeal angiofibromas with intracranial extensions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize our experience of successful and failed management in 8 huge lobulated nasopharyngeal angiofibromas with intracranial extensions, and introduce some key points of perioperative treatments.@*METHOD@#Eight male case with an average age of 18 years, were all lobes extending into middle and/or anterior cranial fossa, in which 5 cases revealed blood supply from the internal carotid arteries and 3 cases were reoperated because of recurrence. Preoperatively, the tumor were evaluated by CT, CTA, MRI and/or MRA, and super selective embolization of the feeding arteries were crucial procedures. The combined craniofacial approaches were used to excise these tumors.@*RESULT@#Five cases were removed completely, and 3 cases were removed partly in which 2 were due to serious bleeding caused by lack of DSA technique at that time and 1 were due to neglecting the tumor lobe in the sphenoid sinus of the other side.@*CONCLUSION@#Reasonable perioperative management are very important for control of intra-operative blood loss, complete remodeling of the tumor and avoiding complication.

Significance of a glenoid fossa approach for management of extensive lesions in the lateral skull base.

OBJECTIVE: This article is designed to relate our experiences with a glenoid fossa approach for exposing the outer border of extensive lesions in the lateral skull base. MATERIALS AND METHODS: In this series, there were five large paragangliomas with the longest diameter of 6.5 cm in length, one large jugular schwannoma with extratemporal components, and one severe case of petromastoiditis with otogenic pachymeningitis, edema of the temporal lobe, and mental disorder. All lesions of these cases were treated via a glenoid fossa approach combined with other reasonable approaches. RESULTS: The glenoid fossa approach resulted in crucial advantages: 1) it effectively exposes the outer border of extensive lesions in the lateral skull base; 2) it provides safe distal control of the facial nerve and internal carotid artery in the skull base; 3) it obviates the need for anterior transposition or rerouting of the facial nerve; and 4) it obviates sacrifice of the intact middle ear or section the mandibular condyle. There is no postoperative mandibular dysfunction because the mandibular articular capsule and articular tubercle are kept intact. CONCLUSION: On the basis of our experiences, the glenoid fossa approach is a safe, quick, and useful design for adequate exposure of the outer border of extensive lesions in lateral skull base surgery.

Identification of AP1 cis-element and transcriptional effect on cytokeratin 13 gene expression / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the type of CTGAATCA from -nt.199 to -nt.192 of the cytokeratin 13(CK13) gene 5' flanking region and determine its transcriptional effect on CK13 gene expression.</p><p><b>METHODS</b>The CAT systems were used to assess the effects of different motifs of CK13 gene 5' flanking region on transcription. The clones of pCAT-enhancer with the total length, -nt.207 to +nt.63 and the same length of -nt.207 to +nt.63, but the T, G of -nt.198, -nt.197 being changed to A, T of the CK13 gene 5' flanking region, were constructed and transferred to HeLa cells with the help of lipofectin. Then work was done to detect the instant CAT expression of different clones and evaluate the effects of CTGAATCA of the 5' flanking region on CK13 gene expression. The type of the cis-element of CTGAATCA was identified with electrophoretic mobility shift assay (EMSA) and competition-EMSA.</p><p><b>RESULTS</b>CTGAATCA in the CK13 gene 5' flanking region is an AP1 cis-element by EMSA and competition-EMSA, it promotes CK13 gene expression.</p><p><b>CONCLUSION</b>CTGAATCA from -nt.199 to nt.192 of the CK13 gene 5' flanking region is an AP1 reaction element, not a cAMP reaction element. It promotes transcriptional activity of CK13 gene 5' flanking region.</p>