Trans oral approach to the nasopharynx and clivus using the Le Fort I osteotomy with midpalatal split

The Le Fort I level osteotomy is a procedure well known to oral and maxillofacial surgeons, who routinely use it to correct midfacial skeletal deformities and alter the dental occlusion. This osteotomy can also be used as a maxillotomy for access to more superiorly and posteriorly situated structures. The downfracture technique provides the surgeon with a safe approach that allows visualization of the maxillary sinuses, nasal cavity, nasopharynx, base of the skull and upper cervical spine. This approach can also be combined with a midline lip split, mandibulotomy and glossotomy to give access to retropharyngeal structures. By modifying the combined Le Fort I and transmandibular approach utilizing a midline split of the hard and soft palate, the access to the clivus can be improved considerably. The clinical applications of these combined procedures in the treatment of basilar invagination and tumors of the nasopharynx are discussed.     

Volumetric modulated arctherapy for locally advanced nasopharyngeal carcinoma: Clinical efficacy and late toxicity

PurposeWe report our experience of 86 consecutive patients with locally advanced nasopharyngeal carcinoma who were treated with volumetric modulated arc therapy.Materials and methodsWe retrospectively reviewed the medical records of 86 patients with histologically proven primary nasopharyngeal carcinoma treated with volumetric modulated arctherapy technique radiotherapy. Primary endpoints were local, regional, distant control, and overall survival, second endpoint was late toxicity.ResultsThe median age was 47.5 years (range: 13–79 years) with sex ratio 1.09. At diagnosis, rhinologic symptoms represented the most common clinical presentation, reported by 61 patients (70.9%). Almost 88.4% of patients presented non-keratinizing undifferentiated carcinoma histology (n = 76). Most of the patients presented a locally advanced disease defined by stage III and IVa (95.3%). Therefore, 31 patients were treated by concurrent chemoradiation (36%), 52 patients received induction chemotherapy followed by concurrent chemoradiotherapy (57%), three patients received induction chemotherapy followed by exclusive radiotherapy (3.5%). and three patients treated with exclusive irradiation (3.5%). With a median follow up of 15.7 months (range: 4–33.3 months), nine patients died (10.4%), three presented local or locoregional relapse (3.4%), while nine patients presented distant recurrences (10.4%). The two years overall and disease-free survival rates were 88.7% and 83.1% respectively, locoregional control was 100% at 12 months and 96.2% at 24 months, and the two years distant failure-free survival was 86.7%. Time to relapse was the only prognostic factor in univariate analysis for overall survival in our study. The therapeutic tolerance was good with 61.7% of grade 3 and 2.3% grade 4 hyposialia respectively, 46.5% of otological disorders and no radionecrosis was noted.ConclusionVolumetric modulated arctherapy technique with concurrent chemoradiotherapy is an effective treatment for nasopharyngeal carcinoma with excellent overall and locoregional control without severe toxicity. Distant metastasis is the major site of failure, so induction chemotherapy added to chemoradiotherapy must be discussed in multidisciplinary consultation meeting because it significantly improved recurrence-free survival and overall survival, as compared with chemoradiotherapy alone.     

Adenoid cystic carcinoma of the nasopharynx: 27-year experience

Objective/Hypothesis: Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with special biological features. Clear consensus is not available regarding the clinical characters, management approaches, and prognostic factors. We presented one institution's experience with this tumor and the outcomes of treatment. Study Design: Retrospective clinical analysis. Methods: The medical records of 26 patients with NACC at one institution between 1976 and 2003 were reviewed. Patient records were analyzed for clinical characteristics, management approaches, and outcomes. Survival analysis was performed by Kaplan‐Meier method, comparison between groups was performed using log‐rank test. Results: The lymphatic metastases rate and distant metastases rate were 3.8% and 26.9%, respectively. Epstein‐Barr virus did not have a close relationship to the incidence of NACC. The 5‐year disease free survival rate and overall survival rate (OS) for all patients were 30.3% and 54.8%, respectively. In the stage I, II and III patients, the 5‐year OS were 87.5% and 49.4%, respectively in patients treated mainly by combined surgical treatment with radiotherapy and those treated mainly by radiotherapy. Cranial nerves invasion, advanced stage and nonsurgical treatment indicated a significant worse OS, whereas combined surgical treatment was an independent factor affecting disease free survival rate and OS. Conclusions: NACC is a malignancy with low rate of lymphatic metastases. NACC should be treated by combined surgical operation and radiotherapy. Cranial nerves invasion, stage and treatment approach might be important factors affecting the prognosis of the patients with NACC.     

基于数据挖掘的中医药治疗鼻咽癌放疗后口干用药规律分析

目的:使用中医传承辅助系统(TCMISS)对中医内服方药治疗鼻咽癌放疗后口干用药、证型规律等进行分析.方法:检索并筛选1990年1月至2020年5月中国知网(CNKI)、维普资讯中文期刊服务平台及万方数据知识服务平台中关于中医药治疗鼻咽癌放疗后口干临床研究中的中药处方,利用TCMISS构建数据库后,运用关联规则及复杂系...     

鼻咽癌细胞增殖与凋亡的对比研究

目的:为探讨鼻咽癌细胞凋亡与鼻咽癌临床分期、病理分级、组织学类型以及细胞增殖周期的关系。方法:采用流式细胞术检测30例鼻咽癌、6例鼻咽慢性炎症病变新鲜组织的凋亡细胞百分比及细胞周期各时相细胞成分。结果:鼻咽炎症组织、腺癌、低分化鳞癌及复发癌细胞凋亡百分比分别为8.31%、5.60%、22.33%、23.80%;T2、T3、T4以及Ⅱ、Ⅲ、Ⅳ期鼻咽低分化鳞癌凋亡百分比分别为17.32%、19.43%、27.73%;14.75%、18.90%、24.86%。S期细胞百分比分别为14.04%、17.59%、19.57%;15.30%、22.30%、32.28%。鼻咽癌细胞凋亡百分比与S期细胞百分比呈正相(r=0.793),有显著性差异(P<0.05)。结论:鼻咽癌细胞增殖与细胞凋亡呈正相关,具有较高增殖活性的鼻咽癌同时伴随较高的细胞凋亡。     

徐力教授治疗恶性肿瘤经验举隅

目的：总结归纳徐力教授治疗恶性肿瘤的临床经验。方法：遵循治未病的思想,采用扶正祛邪的中药组方治疗,强调辨病与辨证相结合,调节情志,重视饮食。结果与结论：该法治疗恶性肿瘤疗效显著,无副作用。     

Advanced carcinoma of the nasopharynx. 2. Pattern of failure in 256 patients

Of 256 patients with advanced carcinoma of the nasopharynx, 82% presented with Stage IV disease. The 5-year survival was 15% with 83% failing within 2 years. Prognosis was related to stage (p less than 0.03), neck status (p less than 0.03), initial performance status (p less than 0.001) and radiation dose (p less than 0.003). With no pathological neck glands (N0), less than 5% failed radiotherapy. Overall, 36% had distant metastases, correlating with the N Stage (p less than 0.001) but not with the T Stage. The most frequent site of metastasis was lung, then bone and liver. Radical neck dissection failed to increase tumor control, contributing to three fatal complications. New radiotherapeutic regimens have so far failed to substantially improve the results.     

Age‐specific size of the normal adenoid pad on magnetic resonance imaging

Conclusions regarding the significance and appearance of the adenoids incidentally noted on magnetic resonance (MR) scans of the brain largely rely on observations of previously published plain film data. In order to determine the age specific appearance of normal adenoid tissue as measured on sagittal T1‐weighted midline MR images, we evaluated 189 patients without a history or clinical evidence of adenoid disease, who were sequentially referred for an MR scan of the brain. The thickness of the adenoid pad was measured to the nearest 1 mm along a line through the pharyngeal tubercle constructed perpendicular to the anterior clival surface. Patients were grouped according to age. Normal subjects demonstrated an age specific variation in the size of the pad with the maximal size being attained in early childhood and then steadily decreasing in later childhood and adulthood (P = 0.0001). The adenoids were largest in the 7–10 years age group (mean, 14.59 mm) and steadily declined to 4.83 mm by 60 years of age. Previous surgery had no effect on adenoid measurement (P = 0.582). Magnetic resonance scans provide an excellent method for assessing the adenoid pad.     

正常人不同体位下口咽、鼻咽部变化的对比研究

目的：初步探讨仰卧位是口咽、自咽腔组织阻塞部位及阻塞程度的改变。为阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的治疗提供有关依据。方法：青年男性１５人,每人分别拍常规头影测量侧位片及仰卧位头颅侧位片,比较二者口咽、鼻咽腔组织变化情况。结果：仰卧位时软腭位置、舌骨位置明显向咽后壁方向移位,最小矢状咽径显著减小。结论：拍摄仰卧位Ｘ线头颅侧位片对于ＯＳＡＳ的诊断、术前评估及术中效定可提供更为可靠的依据。