不同内镜手术入路对翼腭窝及颞下窝的显露程度比较及其临床应用价值探讨

目的应用不同的内镜手术入路解剖翼腭窝及颞下窝,比较内镜下各手术入路的显露范围,为恰当选择内镜手术入路处理翼腭窝及颞下窝病变提供解剖学方面的依据。方法 4具8侧成人尸头标本,0°内镜引导下分别采取上颌窦后壁入路、扩大上颌窦后壁入路、鼻腔外侧壁入路、揭翻经上颌窦入路进行解剖学研究,观测各手术入路的有效显露范围。结果上颌窦后壁入路能显露翼腭窝上部和颞下窝内侧区深部;扩大上颌窦后壁入路在以上手术入路的基础上进一步显露翼腭窝下部;鼻腔外侧壁入路再进一步显露整个上颌窦和上颌窦底壁平面以上的颞下窝内外侧区;揭翻经上颌窦入路则能更进一步显露整个颞下窝。结论不同的内镜手术入路对翼腭窝及颞下窝的显露程度各不相同,以此为基础选择相应的手术入路处理不同范围的翼腭窝及颞下窝病变将有利于充分显露和有效切除病变,并尽可能避免不必要的手术损伤和并发症。     

鼻内镜手术颌内动脉翼腭段的应用解剖

目的：研究颌内动脉翼腭段的走行及分支规律,为经鼻内镜手术过程中合理处理颌内动脉提供解剖学依据。方法：10具去脑颅底骨正中裂开,显微镜下解剖蝶腭动脉,经鼻内镜上颌窦入路开放翼腭窝,暴露颌内动脉翼腭段所有分支,将上颌窦后、内壁交界的凹陷定义为A点,通过眶下孔的水平线与上颌窦前壁、后外侧壁交线相交于B点,上颌窦前壁、后外侧壁和底壁的交点为D点,BD连线的中点为C点,颌内动脉翼腭段发出的第一分支点为C′点,观察其分支及走行规律。结果：蝶窦口下缘到鼻后中隔上动脉的距离为（5．88±2．21）mm;C′点位于AC上13侧,占65%（13／20）;位于AB上5侧,占25％（5／20）;位于AD上1侧,占5％（1／20）;高于AB1侧,占5％（1／20）。结论：熟悉颌内动脉的分支及走行对于治疗顽固性鼻出血和翼腭窝手术有重要意义;本实验中利用A、B、C、D点为参照点确定颌内动脉走行的方法,有助于内镜经鼻（上颌窦）手术中颌内动脉的定位及结扎处理。     

翼腭窝的临床解剖

翼腭窝手术常用于结扎上颌动脉,翼管神经切断等。翼腭窝的暴露以开放上颌窦后壁内上部为最好,除去骨壁切开骨膜即见大量脂肪组织,细心分离出深部相当粗的上颌静脉,并可见其下搏动的上颌动脉及来自圆孔的上颌神经和内下方的蝶腭神经节。蝶腭神经的变异很大。在圆孔的内侧是翼管     

翼腭窝鼻内镜临床解剖学研究

目的研究翼腭窝鼻内镜下临床解剖,为内镜下翼腭窝手术提供解剖学依据。方法10例(20侧)中国成人干性颅骨,用0°、25°Wolfe鼻内镜,在监视器下,分别从翼上颌裂、鼻腔以及底部不同角度观察翼腭窝结构。结果翼腭窝是一狭窄裂隙,由蝶骨体、蝶骨翼突和腭骨垂直板、上颌窦后壁共同围成,大小为(21.4±0.8)mm×(5.2±0.3)mm×(3.2±0.3)mm,从上面观察似三棱锥体型,上宽下窄。鼻内镜从翼上颌裂置入翼腭窝,可以观察到翼腭窝顶部眶下裂与位于其外侧3mm的圆孔,向下可见翼腭窝底部腭大孔与腭小孔。将鼻内镜置入鼻腔观察,咬除上颌窦骨性开口后方腭骨垂直部骨质并咬除上颌窦后内侧骨壁,0°鼻内镜可以窥及整个翼腭窝以及后壁全貌,后壁呈上宽下窄的梯形,见其内下方之翼管开口以及外上角之圆孔,二者之间有一明显的纵形骨嵴分隔。结论经鼻内镜下去除上颌窦口后部骨质以及部分上颌窦后内侧壁,可以完整显露整个翼腭窝的结构,表明翼腭窝范围的疾病可以采用鼻内镜处理。     

上颌窦前壁入路翼腭窝手术的解剖学研究

目的:测量翼腭窝(PPF)的骨性标志和血管神经,为PPF的手术提供解剖学依据。方法:在20具(40侧)干颅骨上对PPF的重要结构(翼腭裂、蝶腭孔、翼管等)的形状、大小及毗邻结构进行测量。在10具(20侧)4%多聚甲醛固定的成人头颅标本上,进行模拟上颌窦手术入路的解剖,测量相关的参数。然后,对这些湿颅骨进行正中矢状切开,在手术显微镜下自正中向外侧打开上颌窦的内壁,PPF的内壁,观察PPF内三叉神经上颌动脉的走行,对上颌支的属支进行测量。结果:PPF呈一狭长的漏斗形间隙,经8个自然管道与鼻腔、口腔、咽、眶、颞下窝、颅中窝相交通,其主要内容物包括上颌动脉翼腭段及其分支,上颌神经及蝶腭神经节等。PPF内组织分为的神经层,血管层。结论:①对于PPF的病变可以采取上颌窦进路,在打开上颌窦的后外壁时,可以以上颌窦的内壁、顶壁和后壁三者的交点为解剖标志;用磨钻打开骨壁暴露PPF。②手术时可以以圆孔和翼管为安全标志,建立起手术的安全界限;有助于保护重要结构,防止手术误入颅内。     

鼻内镜下经鼻径路解剖翼腭窝区临床观察

目的 研究鼻内镜下经鼻径路观察翼腭窝区的临床解剖特点, 以期为手术提供参考。方法 5例(10侧)成人尸头标本经乳胶灌注后, 在0°鼻内镜下分别经蝶腭孔和上颌窦后壁两种手术径路显露翼腭窝, 再开放蝶窦, 充分暴露视神经、颈内动脉及蝶窦外侧壁相关结构, 观察各解剖结构的三维立体关系。结果 不同手术径路显露翼腭窝的范围不同, 祛除上颌窦内侧壁后能最大程度显露翼腭窝内所有解剖结构, 开放蝶窦后能观察翼腭窝与蝶窦区域相关结构的解剖关系。结论 只要熟悉鼻内镜下翼腭窝及邻近区域的解剖结构及关系, 选择合适的病例, 鼻内镜下经鼻行翼腭窝区手术是安全可行的。     

向腭部延伸的经中鼻道上颌窦开窗术

腭骨分垂直板和水平板两部分。水平板构成硬腭的后份,在中线形成腭中缝,垂直板上缘有眶突和蝶突,两突之间的切迹称蝶腭切迹,蝶腭切迹与蝶骨底部形成蝶腭孔,蝶腭动脉、鼻腭神经、鼻后上神经经蝶腭孔入鼻腔;垂直板前缘与上颌窦内壁后份相接,构成上颌窦内壁的后1/3;后缘与翼突内侧板相接,构成翼腭窝的前上缘。腭骨在鼻内上颌窦开窗术中为蝶腭动脉的重要定位标志。简要复习了该区的解剖并报道了向腭部延伸的经中鼻道上颌窦开窗术及其疗效。手术在局麻下进行,静脉注射止痛剂及镇静剂,经翼腭管注入2%利     

经上颌窦扩大径路切除翼腭窝肿瘤

鼻咽血管纤维瘤向前扩展可至鼻腔和筛房,向外侧经蝶腭孔进入翼腭窝,由此再向上过眶下裂,越眶尖或经眶上裂连颅中窝。本病手术进路有经腭、经筛窦、鼻侧切开及颌后间隙进路等。本文介绍当肿瘤侵犯翼腭窝时可单纯采用经上颌窦进路或结合其他进路,此径路可暴露肿瘤,结扎颌内动脉,并可轻易地经眶下裂剥出肿瘤。手术方法:在唇下从中线作一延长切口,向外连上颌结节,切开上颌骨骨膜,向上分离至眶下孔,上颌前壁用骨钳咬除,然后广泛切除窦腔后壁,直到能暴露翼腭窝肿瘤为止,可能时在切除肿瘤前结扎颌内动脉。若要进入鼻腔及鼻咽部,应除去窦腔内壁,肿瘤侵犯筛窦,应从上颌窦内打开筛房,并仔细剥离;若肿瘤进入更外侧     

经鼻内镜翼腭窝和颞下窝应用解剖学研究

目的探索经鼻内镜翼腭窝、颞下窝恒定的解剖标志,为手术处理该区域病变奠定基础。方法对11例尸头行鼻内镜侧颅底解剖学研究。经鼻内镜经中鼻道、蝶腭孔、上颌窦后壁入路,暴露翼腭窝及颞下窝的重要血管、神经及骨性解剖标志,并测量各解剖标志间的距离。结果经鼻内镜可恒定暴露蝶腭孔、翼管、圆孔、蝶腭神经节、眶下神经、卵圆孔、棘孔等重要侧颅底标志。鼻小柱基底到蝶腭孔、翼管、圆孔、卵圆孔、棘孔、破裂孔的距离分别为（69±3）、（73±3）、（75±3）、（90±5）、（96±4）、（88±3）mm。结论经鼻内镜可显露翼腭窝及颞下窝重要解剖结构,且各解剖结构可通过相互之间的距离及位置在鼻内镜二维平面上互相定位,以更直观、安全的处理该区域的病变。     

内镜下经鼻腔上颌窦入路翼腭窝手术的临床应用解剖学研究

目的：为鼻内镜翼腭窝手术提供翼腭窝解剖学资料。方法：10％甲醛固定的15具成人头颅湿标本,从正中锯开,切除下、中鼻甲,前、后组筛房,上颌窦口后面腭骨垂直部骨质及上颌窦后外壁,暴露翼腭窝内的结构,逐层进行解剖,记录所涉及到的组织结构,探查其毗邻关系。结果：经鼻腔上颌窦入路可充分显露翼腭窝,翼腭窝内主要结构是上颌动脉、上颌神经及其分支,所有动脉分支直径都〈3mm。结论：鼻内镜翼腭窝手术在理论上较安全可行。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

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.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.