啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

鼻内窥镜在反复鼻咽部活检中的作用

目的研究在鼻内窥镜下实施鼻咽部活检术诊断鼻咽癌的意义。方法52例行鼻内窥镜下鼻咽 部活检术。结果所有患者均1次行鼻内窥镜下鼻咽部活检术,24例诊为鼻咽癌,28例病检为鼻咽部黏膜慢 性炎症。阴性者随访1年以上,无1例后诊为鼻咽癌。结论在鼻内窥镜下实施鼻咽部活检术能检查鼻咽部 各个部位,可在一处反复活检取得深层组织且能控制标本的大小,用此法可以确认鼻咽癌。     

鼻内镜检查在鼻咽癌诊断中的应用价值

目的评价鼻内镜检查对鼻咽癌的诊断价值. 方法对耳鼻咽喉科就诊的2 300例患者施行经鼻腔鼻内镜下鼻咽部检查,连接影像工作系统记录图像文字资料,可疑病变在鼻内镜直视下取活检. 结果 28例患者经鼻内镜检查及活检病理诊断为鼻咽癌,其中25例1次活检明确诊断,3例2次活检明确诊断.鼻内镜检查前行间接鼻咽镜检查的病例中,23例发现病变,5例阴性.CT扫描病例中25例显示异常,3例阴性. 结论鼻内镜检查光亮度强,分辨率高,能早期发现鼻咽部黏膜细微病变.鼻内镜直视下取活检准确率高.该检查对鼻咽癌诊断、鼻咽癌放疗后监控和病例随访具有重要价值.     

Indikation zu operativen Eingriffen im Bereich des Nasenrachenraumes und der mittleren Schädelbasis

Summary The size of pathological finding and the histopathologic substrate in the nasopharynx and the mid-portion of the skull-base is decisive for all operative procedures in this region. Pathological changes due to trauma are exeptions.Furthermore, the operative indication is dependent on age and health condition of the patient. The risks as well as the necessity of the operation must be carefully considered.Besides routine diagnosis which includes endoscopy and biopsy, tomograms, angiograms and other supporting examinations are necessary.For the treatment of malignancies of the nasopharynx and the middle of the base of skull the high voltage irradiation of the primary tumor and regional lymphnodes is the therapy of first choice. It can also be used in combination with cytostatic drugs or in the form of synchronization. The indication for operative procedure is given only in few cases.Today, operative approach is only indicated for benign pathological changes — some few other cases excepted. The removal of small benign tumors (cysts, fibromas, choanal polypes), the inferior conchotomy or hyperplastic tubal elevations can be performed directly looking through a nasopharyngeal endoscope. The same is true for the removal of cicatricial stenosis or mucosal scars. With deformations (choanal atesia) the transpalatinal way of approach is preferred to others. This method is also convenient for large tumors of the nasopharynx, the choanas and the middle of the base of the skull. With plastic reconstruction a good functional result can be obtained. This is shown with own examples.     

Classification of nasopharyngeal microvessels detected by narrow band imaging endoscopy and its role in the diagnosis of nasopharyngeal carcinoma

Conclusions: The new NBI classification of nasopharyngeal mucosal microvessels was helpful in differential diagnosis for benign and malignant lesions of the nasopharyngeal region. NBI endoscopy facilitates the detection of superficial nasopharyngeal lesions and might enable early diagnoses of NPC.

Objectives: To propose a new microvessel diagnostic classification using narrow band imaging (NBI) endoscopy and to investigate the role of an NBI classification in the diagnosis of nasopharyngeal carcinoma (NPC).

Methods: Between January 2009 and December 2010, a total of 290 patients with a suspected nasopharyngeal tumor were enrolled in this study. The NBI endoscopic system was used to examine the nasopharynx. Each lesion was observed by NBI endoscopy and judged according to the detailed morphologic findings of epithelial microvessels. The superficial microvessel patterns were classified into five types (types I–V). The diagnostic effectiveness of NBI for benign and malignant nasopharyngeal lesions was evaluated.

Results: Approximately 93.5% (29/31) of lymphoid hyperplasia appeared as the type II microvessel pattern under NBI endoscopy, whereas 96.2% (51/53) of nasopharyngeal radiation-induced inflammation exhibited the type III or IV microvessel pattern. The characteristics of NPC under NBI endoscopy mainly appeared as a type V microvessel pattern (79.5%, 167/210), and the sensitivity, specificity, predictive value (PPV), and negative predictive value (NPV) of type V in the diagnosis of NPC were 79.5%, 91.3%, 96.0%, and 62.9%, respectively. NBI endoscopy could significantly improve the detection of superficial lesions (χ^2?=^?12.789, p?=?.000).     

Correlation of PET-CT,MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer

IntroductionSurgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the post- radiotherapy period is improved.ObjectiveThe role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings.MethodsA total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients’ age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed.ResultsRecurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036).ConclusionsMagnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.     

鼻内镜下鼻窦骨纤维异常增殖症累及颅底或眼眶的手术治疗

目的 探讨鼻内镜下鼻窦骨纤维异常增殖症累及颅底或眼眶的手术治疗与经验总结。方法 回顾性分析2017年7月—2020年12月南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科收治的13例采用鼻内镜手术治疗累及颅底或眼眶的鼻窦骨纤维异常增殖症患者的临床资料,结合手术治疗及术后疗效进行综合评价。结果 13例患者术后均无严重并发症,受累颅底或眼眶病变组织彻底切除,无眼球功能障碍及脑脊液鼻漏。随访6～48个月,所有患者均无复发。结论 对于累及颅底或眼眶的鼻窦骨纤维异常增殖症的患者,鼻内镜结合导航及等离子技术可彻底切除病变组织以达到功能重建的效果。     

Endoscopic management of skull base osteoradionecrosis

OBJECTIVE: Osteoradionecrosis is one of the most serious complications in radiotherapy of nasopharyngeal carcinoma. We describe a new endoscopic approach to resolve resultant skull base osteoradionecrosis. The objective of this study is to evaluate the efficacy of endoscopic management of skull base osteoradionecrosis. STUDY DESIGN: A prospective study of the outcome of endoscopic management for patients with skull base osteoradionecrosis. METHODS: Between 1994 and 1998 six patients who had irradiation previously for nasopharyngeal carcinoma had skull base osteoradionecrosis. A sinoscopic approach was applied for diagnosis and sequestrectomy. This diagnosis was based on the criterion of exposed necrotic bone after removing all crust in the nasopharynx and further confirmed on pathological examination after sequestrectomy. Effective cure was defined as intact mucosal coverage without any ulcer or exposed necrotic bone observed in the nasopharynx and the absence of antecedent accompanying symptoms after management. RESULTS: Six patients (10%) were symptom free. Five (83.3%) patients had effective cure. There was no surgical morbidity or mortality. CONCLUSION: Endoscopic sequestrectomy is a justified approach to skull base osteoradionecrosis.     

Anwendung eines aktiven Haltearms in der endoskopischen Kopf-Hals-Chirurgie

Background

It has been shown that a third hand is useful for holding the endoscope during endoscopic surgery so that both hands of the surgeon are free for instrumentation.

Material and methods

Experimental tests were performed with the mechatronic robotic camera holding system Soloassist on anatomical specimens in the area of the nose, nasopharynx and larynx.

Results

An ergonomic set-up and the practical application are easily possible. The third hand enables a still and clear picture without undesired camera movement and all instruments can be controlled by the surgeon. There would appear to be some room for improvement as the working area is limited due to an additional instrument. The camera holding system shows a very high velocity for head and neck surgery.

Conclusion

Until the active holder can be used regularly in clinical practice in the field of head and neck surgery, more technical modifications have to be implemented.     

A transnasal foreign body penetrating the spinal cord from the nasopharynx

Objective and importanceThis is the first article regarding a transnasal Foreign bodies (FB) penetrating the spinal cord. We tried to remove it safely with a bilateral approach by performing a nasal endoscopy and partial laminectomy.Clinical presentationDuring logging work, a tree hit the occipital region of a 47-year-old man, producing unconsciousness with left paresis. Although he did not remember his injuries due to traumatic amnesia, a computed tomography (CT) scan showed a metal rod lodged from the left side wall of the nasopharynx to the spinal column at the cranial–cervical transition.InterventionA C1 laminectomy, partial occipital bone resection, and endoscopic intranasal extirpation were done jointly by an otolaryngologist and neurosurgeon under general anesthesia to safely remove the FB. All procedures were performed in the right lateral decubitus position so we could approach both the nasopharynx and occipital sides. The otolaryngologist withdrew the FB from the nasal cavity using an endoscope while the neurosurgeon monitored the occipital bone side. The FB was safely removed.ConclusionThe site of penetration at the nasopharynx contracted gradually to a scar with no cerebrospinal fluid (CSF) leak. The patient was finally discharged 39 days after surgery with no motor/sensory paralysis.     

鼻内镜下鼻后神经丛解剖研究

目的 探讨鼻内镜下鼻后神经丛(PNNP)的构成及分布特点,为后续行鼻内镜下高选择性PNNP切断术提供解剖学参考。方法 利用5具(10侧)冰鲜尸头灌注标本,经内镜下中鼻道入路,解剖蝶腭孔周围区域内结构;利用5具人体标本解剖前接受的鼻窦CT扫描结果,经影像学工具测量相应结构间距离。利用内镜系统采集解剖图像,影像测量软件获取影像学数据,并由资深放射科医师盲法测量。在解剖过程中,寻找蝶腭孔周围区域重要解剖标志及各结构间的毗邻关系。去除腭骨蝶突及蝶骨鞘突骨质,开放骨性腭鞘管,暴露PNNP咽支,在腭鞘管前口外侧探查定位翼管神经。结果 PNNP出蝶腭孔后均存在3个主要分支与蝶腭动脉分支血管伴行,前下方有与蝶腭鼻后外侧支伴行的鼻腔外侧壁支,后上方有与上鼻甲动脉伴行的上鼻甲支,后内侧有与鼻后中隔动脉伴行的鼻中隔支,蝶腭神经节在翼腭窝内即发出咽支,未穿出蝶腭孔,通过腭鞘管进入鼻咽部,且翼管前口均位于腭鞘管前口的外侧。腭鞘管前口外侧壁至翼管前口内侧壁间距,内镜下测量值(5.90±1.12)mm,影像学测量值(6.30±1.06)mm。结论 通过解剖定位腭鞘管,开放骨性腭鞘管,暴露其中的PNNP咽支,探讨腭鞘管前口与翼管前口之间的位置关系及术中规避翼管神经及蝶腭神经节的安全操作范围,为变应性鼻炎精准手术治疗提供解剖依据。     

鼻中隔黏膜瓣重建鼻咽部放疗后坏死有效率的Meta分析

目的 系统评价鼻咽癌患者应用鼻中隔黏膜瓣重建鼻咽部放疗后坏死(PRNN)清创术后鼻咽部缺损的有效性。方法 应用计算机检索Pubmed、Cochrane Library、Embase、Web of Science等英文数据库,以及中国知网(CNKI)、万方(WANFANG)、维普(VIP)等中文数据库,检索时间为自数据库建立至2021年2月1日,检索鼻中隔黏膜瓣修复PRNN术后鼻咽部缺损的临床研究。由两位研究者独立筛选文献、提取资料后,应用RStuido软件进行效应量分析。结局指标为鼻中隔黏膜瓣重建鼻咽部缺损的有效率。此外,搜索并分析仅以鼻咽坏死组织清创治疗PRNN的研究作为参考。结果 初次检索获得文献1005篇,根据纳入及排除标准,最终纳入5篇单臂回顾性研究,共145例患者,鼻中隔黏膜瓣重建鼻咽部缺损成功率为84%(95%CI=[0.72,0.96],I²=74%)。同时,检索到9篇仅以鼻咽坏死组织清创治疗PRNN的研究,其上皮化率为47%(95%CI=[0.31,0.62],I²=94%)。结论 鼻中隔黏膜瓣作为有效的修补材料,可用于PRNN清创手术中鼻咽部缺损的重建,需要更多的前瞻性队列研究或随机对照试验以进一步研究。     

鼻咽癌局部复发或残留病灶的Nd：YAG激光手术挽救治疗

目的 探讨Nd:YAG激光手术挽救治疗鼻咽癌放射治疗后鼻咽局部复发或残留的可行性和临床疗效。方法在鼻内镜下经鼻腔Nd:YAG激光,对35例鼻咽癌经根治性放射治疗后鼻咽局部复发或残留病灶进行治疗。手术在局麻下进行,在鼻内镜直视下,激光功率调整在50W左右,YAG激光光纤经同侧或对侧鼻腔导入鼻咽部,气化切除肿瘤病灶。部分患者术后接受了再放射治疗,放射剂量20-60Gy不等。结果 手术均顺利完成。术后3年、5年生存率分别为51.4%、30.3%。结论 鼻内镜下Nd:YAG激光挽救手术是治疗鼻咽癌放射治疗后鼻咽局部复发或残留的有效手段,丰富了鼻咽癌放射治疗失败后的外科治疗手段。术后是否再需放射治疗,视具体情况决定。     

Assessment of adenoid size in children by fibreoptic examination

In order to investigate the relationship between the size of the adenoid and upper respiratory symptoms in children, fibreoptic examination of the nasal cavity and nasopharynx was performed in 817 children. The size of the adenoid was classified into three categories according to the distance between the vomer and the adenoid tissue. There was a significant relation between the size of the adenoid and the complaints of nasal obstruction (P < 0.001) and of snoring (P < 0.001), but not with the presence of purulent sinusitis. In the whole population, the size of the adenoid correlated well with the results of tympanometry (P < 0.001), but this does not hold in all age groups. This study has confirmed adenoid hypertrophy as a common aetiological factor in children with the complaints of nasal obstruction and snoring. The enlargement of the adenoid only partially explains the occurrence of otitis media with effusion. The introduction of the flexible fibrescope in the examination of the nasal cavity and nasopharynx in children is of great clinical value, especially in the selection of children for adenoidectomy. It is a minor invasive examination well tolerated by most children, giving more information than a lateral skull radiograph and avoiding unnecessary radiation.     

脱氧葡萄糖-正电子发射断层显像在鼻咽癌放疗后鼻咽颅底病变的诊断效果研究

目的探讨脱氧葡萄糖-正电子发射断层显像（F-18-fluoro-2-deoxyglucose positron emission tomography，FDG-PET）在鼻咽癌放疗后鼻咽颅底病变中的诊断价值。方法通过9例行FDG-PET、CT和（或）MRI检查，以及内镜下鼻咽颅底病灶探查活检术的鼻咽癌放疗后患者，比较FDG-PET、CT和（或）MRI与病理活检结果。结果9例鼻咽癌放疗后患者中CT和（或）MRI提示枕骨斜坡复发7例，可疑复发2例；FDG-PET鼻咽颅底有浓聚灶9例；病理确诊复发3例，慢性炎症和（或）骨组织部分坏死6例。PDG—PET诊断准确率是33．3％（3／9），假阳性率为66．7％（6／9）。结论FDG-PET对鼻咽癌放疗后鼻咽颅底病变诊断有一定假阳性率，确诊需根据内镜下的病理诊断。     

EBV-positive mucocutaneous ulcer presenting as a nasopharyngeal tumor in an immune suppressed patient

BackgroundWe describe an unusual presentation of EBV-associated mucocutaneous ulcer presenting as a large tumor of the nasopharynx in an immune suppressed child. This condition is newly characterized and has not been well-studied in the otolaryngology literature.Case reportOur patient is a 12-year-old female undergoing chemotherapy for T-cell acute lymphoblastic leukemia who presented with progressively severe headaches, nasal obstruction, facial pain/pressure, photophobia, fever and otalgia associated with neutropenia and refractory to empiric antibiotic therapy. Bedside nasal endoscopy and imaging revealed signs of acute sinusitis and a large nasopharyngeal mass suspicious for neoplasm. The mass was eccentric to the right and distending the right fossa of Rosenmuller. She underwent endoscopic sinus surgery and biopsy of her nasopharyngeal mass. Pathologic analysis of the nasopharyngeal mass revealed EBV-positive mucocutaneous ulcer.ConclusionThis is an unusual presentation of a rare entity. EBV-positive mucocutaneous ulcer warrants awareness among otolaryngologists and is not well-described in our literature.     

放大喉镜在鼻咽部检查中的应用

目的 评价放大喉镜在鼻咽部检查中的应用价值.方法 对耳鼻咽喉科就诊的6774例患者施行放大喉镜下鼻咽部检查,连接影像工作系统记录图像文字资料,可疑病变在放大喉镜或鼻内镜直视下取活检.结果 患者对放火喉镜的耐受率98.9%(6700/6774)明显优于间接鼻咽镜30.9%(2095/6774),差异有统计学意义(X~2=6872.75,P＜0.005).放大喉镜可清晰呈现鼻咽部多种病变,能及早发现可疑病变.615例曾分别用纤维鼻咽镜(192例)及鼻内镜(423例)检查显示鼻咽部隆起,放大喉镜检查发现其中418例双侧对称,表面光滑,未见异常,经病理检查证实为正常组织;其他197例于放大喉镜下也显示为鼻咽部隆起,经病理检查证实为各种良恶性病变.结论 放大喉镜检查光亮度强,分辨率高,能早期发现鼻咽部病变,诊断准确率和活检阳性率较高,对鼻咽部疾病诊断具有重要价值.     

Adenoid measurement accuracy: A comparison of lateral skull film,flexible endoscopy,and intraoperative rigid endoscopy (gold standard)

ObjectiveTo compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size.MethodsA cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy.ResultsThe average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p?0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p?0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34)ConclusionFlexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.     

In vivo diagnosis of nasopharyngeal carcinoma using contact rhinoscopy

OBJECTIVES: To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC). STUDY DESIGN: Prospective study to examine the nasopharynx of 30 patients with nasopharyngeal carcinoma and 18 subjects with normal nasopharynx in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany, 7215 AA, 00 and 7215 BA, 300; 23 cm long; 4 mm in diameter). METHODS: The superficial cells of the normal nasopharynx and the nasopharyngeal tumors were stained with 1% methylene blue and examined with contact rhinoscopes at high magnifications (x 60 and x 150). The areas under examination were then biopsied. The contact endoscopic images were compared with the corresponding hematoxylin and eosin-stained histologic sections of the biopsied tissues. RESULTS: Sixty-six procedures were performed in 48 patients. The images of normal pseudostratified ciliated epithelium and squamous epithelium were readily recognized by contact endoscopy in all subjects with normal nasopharynx (10 men and 8 women; mean age, 51.9 y). Twenty-six of 30 patients with NPC (86.6%; 18 men and 8 women; mean age, 50.6 y) were successfully examined by contact endoscopy under local anesthesia. In these 26 patients, two patterns of malignant cells were identified with contact endoscopy. The patterns of contact endoscopic images corresponded well with the histologic findings. CONCLUSION: Contact endoscopy is an accurate and reliable office-based procedure, which allows for in-vivo diagnosis of nasopharyngeal carcinoma.