鼻丘及其邻近结构CT观察及其在内窥镜鼻窦手术中的 …

目的 为了深入开展鼻内窥镜下额窦手术和鼻腔泪囊造口术等，观察鼻丘形态及其邻近结构的关系。方法 采用鼻窦连续冠状和矢状和矢状位扫描，观察１００例患者（包括鼻中隔偏曲３０例，慢性鼻炎４０例，慢性鼻窦炎３０例），其中成人８０例，儿童２０例。结果①绝大多数病例（９９％）有鼻丘气房，儿童（９￣１６岁）鼻丘发育与成人相比无差异性；②鼻丘形态变化很大，但与中鼻甲前端、筛泡和鼻泪管的关系是恒定的；③鼻丘向上气化程     

慢性泪囊炎合并鼻腔鼻窦疾病的临床诊疗分析

目的 探讨慢性泪囊炎同时合并有鼻腔鼻窦疾病的患者,同期手术治疗的效果和可行性.方法 回顾2009年3月～2020年12月32例慢性泪囊炎合并有鼻腔鼻窦疾病的患者,我们同期行鼻腔鼻窦手术和鼻腔泪囊吻合术,术后定期进行鼻内镜观察及泪道冲洗.结果 32例慢性泪囊炎合并有鼻腔鼻窦疾病患者,鼻中隔偏曲14例,鼻中隔偏曲合并慢性鼻...     

鼻内镜下鼻腔泪囊造孔术3例经验与教训

2009年我科派出1名医师到首都医科大学附属北京同仁医院耳鼻咽喉头颈外科进修学习。有机会跟随周兵等老师学习鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎。鼻内镜下泪囊鼻腔造孔术避免了经皮手术损伤内眦血管和韧带的弊病,无面部瘢痕,手术并发症少,同时可矫正影响泪囊造孔引流,导致手术失败的鼻腔、鼻窦疾病或解剖异常等因素,如鼻窦炎、鼻息肉、泡状中鼻甲及鼻中隔偏曲等,临床效果良好,较鼻外泪囊鼻腔吻合术有明显的优点。我们将该技术引进我院,于2009年8月～2010年3月尝试在鼻内镜下行鼻腔泪囊造孔术3例,现与希望开展此技术的同仁分享经验和教训。     

鼻内镜下泪囊鼻腔造口术

慢性泪囊炎的治疗方法传统为泪囊鼻腔吻合术，颜面部遗留瘢痕。手术操作烦杂，时间长。我院自１９９６年２月起开展鼻内镜下泪囊鼻腔造口术，效果满意，报告如下。1 临床资料与方法1．１ 临床资料于门诊选择慢性泪囊炎成年人患者１５只眼，女９只，男6只；所有病例均为患眼溢泪、溢脓；病史３年～１２年不等；经药物系统治疗、冲洗及探通无效，无严重重要器官功能障碍及出血性疾病患者。1．２ 手术方法常规体位，消毒，２％地卡因鼻腔粘膜表面麻醉，１％利多卡因作鼻丘粘膜下浸润麻醉。如有鼻中隔弯曲、中鼻甲前端大等作相应处理。鼻外使用…     

鼻内窥镜下泪囊鼻腔电钻造孔术

近年来，鼻内窥镜下鼻内泪囊鼻腔造孔术治疗慢性泪囊炎已有文献报道［１～３］。我们应用鼻内窥镜下泪囊鼻腔电钻造孔术治疗慢性泪囊炎，取得了良好的疗效。该手术方法与单纯鼻内窥镜下鼻腔泪囊造孔术相比，具有出血少、组织损伤少、骨孔大小易于控制、骨孔创缘光滑、造瘘孔不易有肉芽生长、造口上皮化时间短等优点。1 临床资料全部病例为１９９７年１０月至２０００年１１月我院收治的慢性泪囊炎患者。４０例（４６眼）中，女３２例（３7眼），男８例（９眼）；女３２例中，伴有鼻中隔偏曲者４例，钩突肥大３例，中鼻甲肥大２例。男８例中…     

鼻腔疾患并发慢性泪囊炎的鼻内窥镜手术治疗

近年 ,我们对 2 0例 ( 2 6侧 )鼻腔疾患并发慢性泪囊炎患者 ,在鼻内窥镜下行鼻腔疾患手术并鼻腔泪囊造口术 ,效果良好。报告如下。1　资料与方法2 0例中 ,男 8例 ,女 1 2例 ;年龄 2 5～ 75岁。其中 6例并发鼻息肉 ;6例并发鼻中隔高位偏曲者中 ,有 1例同时并发肥厚性鼻炎 ;5例并发肥厚性鼻炎 ;另 3例并发中鼻甲肥大或钩突肥大。手术均在电视监视下进行 ,先在鼻内窥镜下根据需要行鼻息肉摘除术、鼻中隔矫正术、中下鼻甲部分切除术、钩突切除术 ,再行鼻内窥镜下鼻腔泪囊造口术。在中鼻道前端的鼻外侧壁上作以钩突前界为后缘长 1 cm的正方形切口…     

经眼光导纤维引导鼻内镜下鼻腔泪囊造口术治疗慢性及复发性泪囊炎的临床研究

目的:探讨鼻内镜下鼻腔泪囊造口术中鼻内泪囊定位的新方法.方法:68例慢性泪囊炎患者(包括31例复发性泪囊炎)经鼻内镜行鼻腔泪囊造口术,术中将眼内光导纤维投射到鼻腔外侧壁的光斑作为泪囊在鼻腔外侧壁的投影.结果:使用眼内光导纤维引导,泪囊定位准确,进行鼻内镜下鼻腔泪囊造口术时手术时间明显缩短,手术简化.2例2次手术者再阻塞,其余患者随访2年无复发,无并发症发生,成功率为97.06%(66/68).结论:将眼内光导纤维用于鼻内镜下鼻腔泪囊造口术中对泪囊定位的方法简单可行,值得推广应用.     

经鼻内窥镜鼻腔泪囊造口术

泪囊阻塞问题一直延用泪囊鼻腔吻合术解决。随内窥镜鼻窦外科和鼻眼相关外科的发展，使人们对鼻内进路的鼻腔泪囊造口术发生兴趣。下面就手术适应证、术前检查、手术方法及手术后处理等问题进行综述。     

18例鼻中隔偏曲伴外鼻畸形临床诊疗体会

目的 探讨鼻中隔偏曲合并外鼻畸形的解剖学形成特点,总结分析同期行鼻中隔偏曲矫正和外鼻畸形整复手术方法。方法 回顾性分析2016年3月—2019年3月收治的18例鼻中隔偏曲矫正同期外鼻畸形整复患者的临床资料,其中大翼软骨发育异常11例,鼻中隔软骨尾侧端畸形5例,上颌骨鼻棘畸形2例,所有患者均先行鼻中隔偏曲矫正术;并针对不同类型的畸形结构特征单独或同时使用了缝合矫形、切除矫形和支撑矫形方法。所有患者术后随访1年以上,比较手术前后患者的鼻腔通气功能和外鼻形态视觉模拟量表(VAS)评分。结果 术后1年鼻腔通气功能和外鼻形态VAS量表评分明显低于术前,术后1年双侧鼻腔总阻力明显低于术前,差异均具有统计学意义(P均<0.05)。18例患者鼻内镜检查、鼻腔鼻窦CT显示术后鼻中隔偏曲与外鼻畸形形态改善明显。结论 总结了鼻中隔偏曲并外鼻畸形的解剖学构成分类和常用手术方法体会,为临床工作中兼顾鼻腔功能与美学的治疗策略提供参考。     

经鼻内镜取出泪囊结石1例

患者,女,34岁.主诉鼻阻塞头痛2年,右眼溢泪35 d.门诊曾诊断为:①鼻中隔偏曲;②右侧慢性泪囊炎.于2006年12月12日来我院就诊.鼻内镜检查:鼻前庭皮肤正常,鼻腔黏膜慢性充血,双下鼻甲黏膜无肿胀,表面光滑.鼻中隔向右"C"型偏曲.右眼视力正常,内眦部皮肤无红肿,结膜无充血.泪道冲洗后有脓性物返出.鼻窦冠状位CT检查:鼻中隔向右偏曲,全组副鼻窦窦腔黏膜无肥厚,窦壁骨质结构无异常,鼻甲无肥大.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Congenital nasal masses: diagnosis and management

One hundred and nine congenital nasal masses which presented to two children's hospitals over a 20 year period are reviewed. The diagnosis of the nasal mass is discussed with respect to age, mode of presentation, and site of the lesion, and a management protocol is advocated.     

Reverse Optokinetic After-nystagmus Generated by Gaze Fixation During Optokinetic Stimulation

Gaze fixation during optokinetic stimulation generates an after-nystagmus with a slow component towards the reverse direction of the optokinetic stimulation. The duration and maximum slow component velocity (SCV) of this "reverse OKAN" were observed by changing the duration, velocity and direction of the optokinetic stimulation in nine normal volunteers. The duration of reverse OKAN increased with increasing stimulation time but was unaffected by changes in the stimulation velocity. The maximum SCV of reverse OKAN decreased with an increase in the stimulation velocity but was not significantly affected by changes in the optokinetic stimulation time. There was no directional difference among the horizontal, upwards and downwards reverse OKANs. The reverse OKAN was thought to be generated by a mechanism different from the velocity storage mechanism which produced optokinetic nystagmus and the first phase of OKAN. Retinal slip during the optokinetic stimulation was considered to be an input to the mechanism which generated the reverse OKAN. We hypothesize that the mechanism causing the reverse OKAN may be a generator of the second phase of OKAN, which was also intimately connected with self-motion sensation during the optokinetic stimulation.     

Tissue-engineered human nasal septal cartilage using the alginate-recovered-chondrocyte method

OBJECTIVES: Tissue engineering of nasal septal cartilage has numerous potential applications in craniofacial reconstruction. Chondrocytes suspended in alginate gel have been shown to produce a substantial cell-associated matrix. The objective of this study was to determine whether cartilage tissue could be generated using the alginate-recovered-chondrocyte (ARC) method, in which chondrocytes are cultured in alginate as an intermediate step in tissue fabrication. METHODS: Nasal septal chondrocytes from five patient donors were isolated by enzymatic digestion, then expanded in monolayer culture. At confluency, a portion of those cells were seeded at high density onto a semipermeable membrane and cultured for 14, 21, or 28 days (monolayer group). The remaining cells were suspended in alginate and cultured until a cell-associated matrix was observed (10-17 days). Cells and their associated matrix were released from alginate (ARC group), seeded onto a semipermeable membrane, and cultured as already described. DNA (Hoechst 33258 Assay), glycosaminoglycan (GAG; dimethylmethylene blue assay), and collagen (hydroxyproline assay) were analyzed biochemically. Immunohistochemistry was performed to assess expression of collagens type I and type II. Histochemistry was performed to localize cells accumulating sulfated GAG (Alcian blue stain). RESULTS: The ARC constructs, in contrast to the monolayer constructs, had substantial structural stability and the histologic and gross appearance of cartilaginous tissue. ARC constructs demonstrated significantly greater GAG and collagen accumulation than monolayer constructs (P <.05). Histologic analysis revealed substantial GAG and collagen type II production and only moderate collagen type I production. The composition of the matrix was thus similar to that of native human septal cartilage. CONCLUSIONS: Tissue-engineered human nasal septal cartilage using the ARC method has the histologic and gross appearance of native cartilage and has biochemical composition more like that of native cartilage than monolayer constructs. This is the first report of human nasal septal neocartilage formation without the use of biodegradable scaffolds.     

Jaw osteosarcomas

Introduction

Osteosarcoma (OS) is the most frequent bone malignant tumor. It is usually found on long bones, 5 to 10% are located on jaws, accounting for 0.5 to 1% of all facial tumors. There is little published data which concerns only few patients. Our aim was to study retrospectively cases of facial bone OS in adults, and to compare our results with published data to suggest an optimal management scheme.

Patients and method

Thirty-three patients were managed for an OS, from January 1997 to January 2007. Fourteen patients with a maxillary and mandibular OS, treated in first-intention in our unit, were included. The following data were analyzed: age; personal history; circumstance of discovery; clinical, functional, and physical signs; loco-regional extension and metastasis radiological investigation. The histological slides were systematically reviewed. The protocol, therapeutic outcome, and follow-up were studied.

Results

The mean age at diagnosis was 43. Swelling was the most frequent functional sign. The mean delay before management was 3.4 months. The most frequent radiological presentation was a lytic and hyperdense image. The diagnosis was suggested after CT scan in 57.1% of cases. The biopsy was correlated to the anatomopathological analysis in 78.6% of cases. The most common treatment was surgical exeresis completed by chemotherapy. The 5-year survival rate was 50%.

Discussion

Jaw OS are specific because of their localization and specific bone ultrastructure. Their management remains controversial: should they be managed like limb OS or treated more specifically? Neoadjuvant chemotherapy, even if it delays exeresis for 3 months, seems to stop the growth or reduce the tumor. An early anatomopathological analysis of the surgical piece determines adjuvant therapy. The negative prognostic factors are: maxillary localization because of limited exeresis margins, tumoral size, and osteoblastic sub-type.     

Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey

IntroductionHead & neck surgery encompasses a variety of surgical approaches for benign and malignant conditions. Due to the complexity in treating patients with head and neck pathology, it is necessary to adhere to basic surgical principles to decrease complications. Among them, surgical site infection can be prevented using a surgery quality protocol including the correct use of antibiotics and optimization of nutritional status.Materials and methodsA survey was sent through the YO-IFOS and SEORL-CCC international mailing list.ResultsA total of 435 surgeons completed the survey. Of the respondents, 97.7% confirm that they scrub their hands before surgery, 40.9% respondents recommend nutritional support according to sign and symptoms, 60.9% use of antibiotic prophylaxis in clean surgery and just 9.2% use clindamycin in combination.ConclusionThis survey has broadened the scope regarding H&N surgical safety around the globe. Identifying innovative ways in which surgical care may be improved is mandatory.