小儿软骨性声门下蹼的诊断和治疗

目的　探讨小儿声门下蹼的诊断、评估及手术治疗。方法　总结2014年8月~2018年3月收治的4例小儿软骨性声门下蹼患儿资料，其中诊断为先天性喉蹼Ⅳ型1例，Ⅲ型3例，行全麻下喉裂开+软骨性蹼黏膜下切除+临时支撑管治疗。结果　3例患儿术前气管切开，切开时间分别为13、13、6月龄，1例患儿术中气管切开。2例留置临时支撑管于术后7、11天自行拔除，2例术后14天由医师拔除。4例均在支撑管拔除当天即行气管堵管成功，经3~5个月持续堵管后顺利拔除套管。结论　对小儿先天性软骨性喉蹼Ⅲ或Ⅳ型，采用喉裂开+软骨性蹼黏膜下切除+临时支撑管的方法效果良好，短期拔管率高，无并发症。     

新生儿重度上呼吸道梗阻的病因分析

目的了解新生儿重度上呼吸道梗阻的原因。方法回顾性分析47例发生重度吸气性呼吸困难的新生儿的临床表现、直接喉镜、CT、上消化道造影等检查结果及治疗经过。结果47例中先天性疾病占87．2％（41／47）：先天性喉喘鸣15例，占31．9％，其中6例伴有胃食管反流；上呼吸道先天性囊肿14例（舌根囊肿10例，会厌囊肿3例，喉囊肿1例），占29．8％，其中有13例曾被误诊为先天性喉喘鸣；先天性总气管狭窄3例；先天性喉蹼2例；声带麻痹2例；皮耶-罗宾综合征3例；猫叫综合征2例。急性膜性喉气管支气管炎6例。47例中3例放弃治疗，44例经吸氧、药物治疗后呼吸困难缓解，其中曾行气管插管、吸痰37例次，行直接喉镜、支撑喉镜手术19例次。结论新生儿重度上呼吸道梗阻病因以先天性疾病为主，对这类患儿应及时进行相关检查，尽早明确病因，迅速解除梗阻，以降低新生儿死亡率和预防不良后遗症的发生。     

儿童复发性呼吸道乳头状瘤病的联合治疗

目的：探讨儿童复发性呼吸道乳头状瘤病（JO-RRP）的治疗方法。方法：回顾性分析36例JO-RRP患儿的临床资料，针对病情分别采用支撑喉镜下激光切除术（27例）和喉裂开造口激光切除术（9例），对复发≥2次／年或（和）病变范围累及≥2个解剖亚区的28例患儿术后1周给予干扰素治疗。结果：全部患儿术后均无明显误咽，28例（77．8％）已拔除气管套管。并发症包括：声音嘶哑8例，喉狭窄6例，肺部感染3例。结论：支撑喉镜下激光切除术和喉裂开造口激光切除术是治疗JO-RRP的有效术式，术后联合干扰素治疗可抑制复发。     

先天性会厌囊肿临床表现及误诊分析

目的:探讨先天性会厌囊肿临床表现及误诊原因.方法:回顾性分析19例先天性会厌囊肿患儿临床表现及诊治经过.结果:19例患儿临床表现包括喉喘鸣、呼吸急促、吸气性呼吸困难、吸奶中断或呛咳、哭声低弱含混等.其中15例首诊被误诊:诊为新生儿肺炎者9例(47.4%),支气管肺炎5例(26.3%),咽喉炎1例(5.3%).所有患儿行小儿超细纤维喉镜检查后诊断为先天性会厌囊肿,并经病理证实.结论:本病临床易误诊,对于出现喉喘鸣伴有上呼吸道阻塞症状的患儿,应尽早作上呼吸道检查.小儿超细纤维喉镜检查可明确病因,及时治疗.     

喉显微外科技术在严重新生儿上气道梗阻中的应用

目的 探讨严重新生儿上气道梗阻病因、临床特征及喉显微外科手术疗效,以提高新生儿阻塞性呼吸困难的诊治水平。 方法 采用观察性研究,分析16例咽喉相关的严重上气道梗阻新生儿临床资料。 结果 共纳入患儿16例(男9例、女7例),出生后7~28 d出现临床症状,包括吸气性呼吸困难、喉喘鸣、三凹征等。其中先天性喉软化症6例、下咽及舌根囊肿3例、喉部血管瘤2例、喉入口畸胎瘤1例、先天性喉蹼1例、双声带麻痹1例、继发性声门下狭窄1例、插管后喉粘连1例。16例患儿均给予相应显微外科治疗,手术顺利。顺利拔管患儿15例,仅1例喉软化症患儿拔管后仍有明显呼吸困难,行气管切开。 结论 严重新生儿上气道梗阻多与咽喉病变相关,需早期行局部及全身检查明确病因及诊断,对有手术指征者积极采取微创手术治疗,可挽救患儿生命,取得满意疗效。     

新生儿及婴幼儿先天性喉囊肿的临床特点及诊治探讨

目的：对62例新生儿及婴幼儿先天性喉囊肿的诊治进行分析,探讨不同术式的特点。方法：回顾性分析62例新生儿及婴幼儿先天性喉囊肿患儿的资料。经完善颈部触诊、喉镜检查以及CT或MRI等相关术前检查后,所有患儿均在全身麻醉下行喉囊肿切除术。根据分类选择手术术式,1例混合型患儿行颈外进路囊肿摘除术;61例喉内型患儿中,12例行传统咬除囊壁术,12例行动力切削系统切除术,37例行低温等离子射频消融术。结果：62例喉囊肿患儿手术顺利,随访0.5~7.0年无复发。结论：对儿童先天性喉囊肿进行分类分析后选择合适的手术方式,可避免不必要的开放式手术进路,阻止囊肿复发和重复的内镜治疗或气管切开术。低温等离子射频消融术治疗儿童喉囊肿具有手术时间短、术中出血少、术后反应轻、复发率低等优点,值得临床推广。     

电视镜下喉膜植入术治疗喉蹼疗效观察

喉蹼是喉腔两侧膜状的联结所造成的喉部狭窄,可以是先天性畸形,也可以是后天因素引起(如外伤、术后粘连等).单纯切除喉蹼后,往往容易再次粘连,而采用喉裂开后支撑管植入术,则损失范围较大且容易造成永久性的声音嘶哑.2007-12-2009-03我科在支撑喉镜加电视内镜下喉蹼切开并硅胶膜植入治疗各类喉蹼病例18例,现报告如下.     

先天性杓间喉蹼

先天性喉蹼多发生于喉前连合处,位于杓状软骨间者仅占喉蹼中之1～2%,并认为症状多不显著,不需特殊处理。作者对1976～1990年间16例杓间喉蹼患儿的资料进行分析,其结果与以往报道不尽相同。16例中有12例出生时即有呼吸困难,另4例也于1周内先后出现呼吸道阻塞症状。喉镜检查除见杓间有膜状组织外,伴有喉部其它发育异常者14例,其中杓状软骨明显增大9例,声门下狭窄8例。16例中有10例还伴非呼吸系统的发育异常(如先天性心脏病等),其中5例有多发性畸形。因     

婴幼儿喉蹼的诊断与治疗

目的总结各种类型婴幼儿喉蹼的临床表现、手术方法及疗效。方法分析12例婴幼儿喉蹼的临床资料，其中先天性喉蹼5例（4例声门型，1例声门下型）；继发性喉蹼7例（1例结核性喉蹼，6例创伤性喉蹼）。诊断主要依靠病史和临床表现，确诊通过纤维喉镜的检查和病理检查。治疗主要依靠支撑喉镜下进行喉显微手术，激光或微波是必要的辅助技术，特异感染者需先治愈原发疾病后，再考虑手术。结果先天性喉蹼随诊3个月～1年半，4例声门型喉蹼术后无粘连，无复发，发音清晰，手术效果好；另1例声门下型，暂不需手术。结核性喉蹼1例随诊半年，声带无粘连，发音清晰，未见肺结核复发。6例创伤性喉蹼均为喉乳头状瘤患儿，术后随诊3～6个月，1例未见复发，5例均复发需再次手术。结论先天性喉蹼确诊依靠纤维喉镜，手术效果好，无复发，不需放置喉模。结核性喉蹼需病理诊断，早期原发病的诊疗十分重要。继发于喉乳头状瘤的创伤性喉蹼，手术效果不甚理想，提高手术技巧，掌握最佳手术时机可能会减少复发机会。     

先天性环状软骨畸形致新生儿窒息死亡一例

先天性环状软骨狭窄是一种非常少见的畸形 ,通常是在尸检时才能做出诊断。 1 987年Ｂｅｒｋｏｖｉｔｓ等[1] 进行文献回顾 ,发现以往共报道 1 4例先天性环状软骨狭窄畸形 ,其中只有 5例治疗取得成功。本文报道 1例尸检确诊的先天性环状软骨畸形。患儿男 ,生后 1 0分钟 ,因窒息、呼吸窘迫而死亡。患儿生后立即出现窒息 ,急行气管内插管抢救。直达喉镜显露喉部后见双侧声带运动良好 ,声门裂大小正常 ,声带下方气管内实性团块阻塞 ,气管插管不能进入失去抢救机会 ,患儿窒息死亡。死亡后尸检显示环状软骨弓明显隆起、增宽、畸形 (图 1 ) ,会厌、…     

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.