Pathogenesis of dysplasias of the face and the ear and dystopias of the temporal region

Dysplasias of the face and ear are supposed to be caused by a premature involution of 3 different embryonal arteries of the branchial arches: (1) Dysfunction of the mandibular artery causes the otocephalia syndrome; (2) that of the stapedial artery causes dysplasias of the face; (3) dysfunction of the hyoid artery entails dysplasias of the ear; and (4) combination of (2) and (3) (dysfunction of truncus hyostapedialis) results in simultaneous dysplasias of the face and the ear. The earlier the deficiency of blood supply occurs the more serious the resulting dysplasias are. The dystopias in the temporal region (auricles, facial nerve, ossicles, petrous bone) are the consequence of an overbending of the proximal hyoid arch caused by a retardation in the development (shortening) of the mandibular arch. Therefore, dystopias of the ear always occur together with dysplasias of the face. Phenotype and appearance on radiographs are discussed.     

回返穿通动脉与面听神经关系的解剖学研究

目的：介绍回返穿通动脉(RPA)与面-听神经的关系，为桥小脑角(CPA)的前庭-耳蜗神经(VN)血管减压术提供有实用价值的解剖学资料。方法：测量20具经甲醛固定的成人尸颅，观察CPA内与面、听神经有关的RPA的解剖结构，重点是与VN间的位置关系。结果：RPA出现率为100％，发出1个分支的有30侧(75．0％)，2个分支的有10侧(25．0％)；位于面神经(FN)、VN之间有32侧(80．0％)，其中87．5％位于FN中外2／3。VN的血管接触率为95％，有2支或2支以上血管与VN接触的有20侧(50．0％)。结论：了解、熟悉RPA与面-听神经的关系，对提高VN显微血管减压术的成功率以及临床影像学的诊断价值具有指导意义。     

承上启下薪火传承

满载丰硕成果的2007年在世人注目中落下帷幕，新的一年在满怀希望的期盼中开始了新的征程。回眸过去学科发展建设的一年，我们成功地举办了第十届中华耳鼻咽喉头颈外科学术会议、全国鼻部感染与变态反应及耳鼻咽喉颅底外科专题学术会议、全国中耳疾病的外科治疗专题学术会议，首届全球华人耳鼻咽喉头颈外科学术会议等一系列高质量的学术活动；     

Dimensions of the cricoid cartilage and the trachea

OBJECTIVE: Important dimensions of the cricoid cartilage and trachea have been studied. Knowledge of size, variations in size, and configuration of these structures is important when tracheal intubation, stenting, endoscopy, and transplantation are to be performed. METHODS: In 34 male and 27 female adult human specimens, 1,861 measurements of the cricoid cartilage and trachea were performed. RESULTS: The smallest dimension was found in the frontal plane. The mean inner diameter of the cricoid in this plane with mucous membrane in situ was in women 11.6 mm (range, 8.9-17.0 mm) and in men 15.0 mm (range, 11.0-21.5 mm). The configuration varied more than expected. For example, the angle between the longitudinal axes of the cricoarytenoid joint facets ranged from 42 degrees to 74 degrees in women and from 37 degrees to 75 degrees in men. The mean distance between these joint facets was 10.3 mm (range, 7.4-13.0 mm) in women and 12.6 mm (range, 8.0-18.2 mm) in men. The cross-section of the trachea varied much in configuration, the smallest frontal diameter being as little as 9.9 mm in women and 12 mm in men. CONCLUSIONS: In some women the inner diameter of the cricoid ring does not permit passage of a standard-size (7 mm, internal diameter [ID]) tracheal tube or a standard-size rigid endoscope through the larynx without mucosal damage. The small distance between the cricoarytenoid joints in many women and some men is the basis for of the clinical observation that women, especially, receive pressure necroses at the medial sides of the arytenoid cartilages attributable to tracheal intubation with standard tubes. The large difference in almost all sizes and shapes of the cricoid cartilage and trachea makes it impossible to standardize the rigid stents used in these organs. When transplantation to the larynx is planned, this variation of the anatomy must be considered.     

Herpes and the head and neck: the difficulties in diagnosis

A case of primary herpes of the head and neck is presented. The exact source of infection and the precise diagnosis proved difficult to establish, but evidence tended to support a diagnosis of varicella zoster infection as opposed to a herpes simplex infection, though a dual infection was not ruled out. Herpes simplex has specific clinical features which usually make its distinction from varicella zoster clear cut. In this case we relied heavily on laboratory investigations to improve the accuracy of our diagnosis since the clinical characteristics were blurred. Unlike varicella zoster there has been little written about herpes simplex infections specifically affecting the ear, face and neck.     

细胞凋亡与激光对内耳损伤关系的研究

目的 研究激光对内耳的损伤过程中细胞凋亡最终是否参与,并探讨激光对内耳损伤的机制。方法 选用健康雄性听力正常的豚鼠24只,随机分成对照组及实验A、B、C组,每组6只。对照组只打开听泡暴露圆窗龛,实验组分别以平均功率为1W、3W及5W的超脉冲CO2激光在豚鼠左耳耳蜗底周造孔。术前1d和处死前分别检测豚鼠听性脑干反应(auditory brainstem response,ABR)。术后1d断头处死豚鼠,扫描电镜形态学观察,DNA末端转移酶介导的缺口末端标记法(TUNEL)检测细胞凋亡。结果 实验B组和实验C组术后ABR III波阈值较术前提高(P<0.05)。实验C组外毛细胞纤毛散乱,并有散在缺失,实验B组外毛细胞纤毛稍散乱,无缺失,而对照组和实验A组基本正常。实验C组耳蜗螺旋神经节细胞、耳蜗神经细胞及外毛细胞等处见明显凋亡阳性细胞,实验B组上述部位仅见散在少量凋亡阳性细胞,而对照组和实验A组未见明显改变。结论 高峰功率激光对内耳的结构和功能有损伤,细胞凋亡在其中起了重要作用。     

Microscopic anatomy and muscle architecture of the commissure of the lips in the newborn infant and the adult]

The muscular structure of the commissura of the buccal orifice in humans confers on it a special significance. It consists of two layers each apparently having a well-defined function. Deep layer. Quite distinct at the embryonic stage, it develops rapidly in the new-born. It consists of the internal orbicular muscle, or Poirier's sphincter oris, and the two buccinator muscles. This layer, of functional importance for digestion, is formed by a central sphincter surrounded by two cavitary muscles. In the new-born, it forms a real suction apparatus. From this point of view, the internal orbicular and the two buccinator muscles are the equivalent respectively of the circular and longitudinal fibres of the muscular digestive tunic. This layer is more cavitary and sphincteral than platysmal. Superficial layer. Platysmal, muscular it is dependent on the cephalic superficial fascia, it is mimetic. This layer is made up of platysmal muscles converging on the commissura. The labial muscular network of the platysmal muscles forms the external orbicular. This layer, which is rudimentary in the new-born, develops during growth alongside relationships (mimic-phonation). It appears complete in adults. Facial superposition and commissural fusion of the deep and superficial layers confer a dual function of the buccal orifice: --digestive by means of the deep sphinctero-cavitary layer, --mimetic by means of the superficial platysmal layer. Wilst growth is taking place, the digestive layer in fact assumes mimetic function and the platysmal layer may intervene at will in the functioning of the digestive sphincter. The commissura labiorum is the anatomical site at which the cutaneous and digestive coats converge. Briefly, the buccal orifice is a digestive sphincter complete with mimetic function. Has not the face become a cortical organ in the course of evolution?     

颞下窝咽侧区肿瘤的诊断与手术治疗

目的 寻求颞下窝咽侧区肿瘤的早期诊断及有效的手术途径。方法1978～2002年我院手术治疗颞下窝咽侧区肿瘤75例。手术采用4种进路：①颌下进路。②截断下颌骨颌下联合进路。③耳前颌下进路。④经上颌窦前外进路。绝大多数采用第1种手术入路。恶性肿瘤术后行放疗或化疗；继发性肿瘤在切除原发性肿瘤的同时予以切除。结果手术效果良好，无并发症。良性肿瘤38例术后6个月～18年(其中26例超过5年以上)，1例复发。恶性肿瘤37例中，12例死亡，5例失访，余20例观察3～5年无复发及转移。结论①颞下窝咽侧区肿瘤CT扫描及针吸细胞病理检查是有效的诊断手段。②颌下进路是该区肿瘤较好的手术途径。③术中彻底止血、尽可能消灭死腔及负压引流对预防切口感染和预防呼吸道阻塞都相当重要。     

Comparative study on the morphology and the composition of the otoliths in the teleosts

Conclusion. Saccular otoliths of teleosts were mostly larger than utricular otoliths, which might relate to the three-dimensional movement. The large and heavy otolith may be better suited in saccules of the bottom and reef fishes. The quantities of iron in lagenar otoliths were found to be lower than those of birds. The function of the fish lagena remains to be elucidated by further studies. Objective. To evaluate the morphological characteristics and the chemical composition of the otoliths in fishes as related to behaviour and habitat. Materials and methods. We studied the morphology of the otoliths of 18 genera of fishes (81 samples) divided into 3 groups: saltwater fish (13 genera), freshwater fish except for the carp family (3 genera) and carp family fish (2 genera). The otoliths and the living environments were compared. The chemical composition was analysed using a synchrotron X-ray fluorescence analyser. Results. Bottom fishes generally have larger saccular otoliths, and migrating fishes have smaller saccular otoliths. In comparing the bottom/reef fishes and the migrating fishes in salt water, the former tended to have larger saccular otoliths. In saltwater bottom fishes the tendency was found that the thinner the head, the larger was the saccular otolith. We found significant quantities of iron, zinc and manganese in the lagenar otoliths.     

鼻腔外侧壁筛窦切除术治疗Ⅰ、Ⅱ期鼻腔筛窦癌

目的探讨早期鼻腔筛窦癌的治疗方法及其效果。方法回顾性分析我院1995年1月至2001年10月应用鼻腔外侧壁筛窦切除术治疗7例Ⅰ期、18例Ⅱ期鼻腔筛窦癌的效果。结果术后随访3～5年,失访2例,局部复发6例,3年生存率70.8%（17/24）,5年生存率50.0%（8/16）,无严重并发症发生。结论鼻腔外侧壁筛窦切除术治疗Ⅰ、Ⅱ期鼻腔筛窦癌疗效确切,并发症少。     

Content analysis and intratest performance profiles on the Columbia and the TONI

This research note presents the results of a content analysis of the Columbia Mental Maturity Scale and the Test of Nonverbal Intelligence (TONI). We also compared the intratest performance of a selected sample of language-impaired (LI) and MA-matched normal language children on these two tests. These analyses are an extension of Johnston's (1982) report on the Leiter. The content analysis revealed differences in the nature of perceptual and conceptual items on the Columbia and the TONI. Consistent with Johnston's findings, the intratest comparisons revealed no significant group differences. LI and normal-language children performed significantly better on the perceptual-type items than the conceptual-type items. The predominance of perceptual items was particularly evident in the TONI.     

Cytomegalovirus and the otolaryngologist

Human cytomegalovirus (CMV) is ubiquitous and has been documented as the etiologic factor in several diseases ranging from respiratory tract infection to congenital deafness. Special clinical manifestations of CMV of interest to the otolaryngologist are presented as related to the temporal bone and audiovestibular system, the facial nerve, the aerodigestive tract, the thyroid, the hematopoietic-lymphoreticular system, and salivary gland. In addition, current concepts of CMV oncogenic potential are discussed as they relate to head and neck neoplasms. The results of a study performed on surgical pathology specimens obtained from 26 patients, in an attempt to isolate CMV in tissue culture from salivary gland and/or neoplasms of the head and neck, detected no evidence of viral presence. The significance of these findings and the role of future research is discussed.     

Hemangioma cavernous of the nasal cavity and the maxillary sinus--case report and review of the literature

Hemangiomas of the nasal cavity and especially paranasal sinuses are very rare. Authors reported a case of hemangioma cavernous of the nasal cavity and maxillary sinus in a 34-year-old women. Diagnostic procedures, therapeutic intervention were presented and literature reviewed.     

Specific morphological and functional features of the mucous membrane in the upper respiratory tract and the middle ear and the methods for their study

The currently available data on the peculiarities of the morphological structure of the mucous membrane in the middle ear cavities are presented in conjunction with information on the functional features of the upper respiratory tract and the middle ear. A comprehensive review of the modern methods for the study od the mucociliary activity of the mucous membrane of the upper respiratory tract is provided.     

A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology

Background: There was great interest in the 19th and early 20th century in classifying human races as Caucasian, Asian African etc. according to nasal shape and size, and the nasal index was the most commonly used measurement to differentiate races. Objective of review: To determine if there is any clinical relevance of the shape and size of the nose in relation to physiology, pathology and surgery. Type of review: Systematic review. Search strategy: A structured search of PubMed was performed from 1966 to 2008 for each section of the review focusing on the ethnic variations in nasal index, the effect of climate of nasal shape, ethic variations of nasal physiology and racial predilection for sinonasal pathology. Results: Nasal proportions do vary between ethnic groups but the size and shape of the nose does not define Caucasian, Asian and African races respectively. Anthropologists agree that the nasal variations are due to man’s adaptation to the environment. However, this theory remains to be proven. Published data on nasal physiology have not shown significant differences between the ethnic groups despite obvious differences in nasal proportions. There is no evidence of ethnic specific predilection to disease due to anatomical variation, physiological vulnerability or genetic susceptibility. Rhinology research is often confounded by classifying populations according to race, as racial characteristics are not based on any scientific principles and the nasal index may be a more reliable discriminator. The only area in which the size and shape of the nose is of relevance is in aesthetic and reconstruction surgery. Conclusions: Nasal proportions are important aesthetically but appear to have little relevance to the rhinologist.     

巴曲酶治疗全频下降型突发性耳聋的疗效观察及与凝血功能的相关性分析

目的 探讨巴曲酶治疗全频下降型突发性耳聋的疗效与巴曲酶敏感性及凝血功能指标的相关性。方法 回顾性分析2019年1月—2021年2月全频下降型突发性耳聋患者48例,根据患者纤维蛋白原(FIB)的变化分为敏感组及非敏感组,检测患者凝血功能包括活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、FIB的变化及治疗前后纯音听阈变化。结果 ①48例患者总有效率为75.0%,其中平坦型总有效率为72.4%,全聋型总有效率为78.9%,敏感组有效率为85.7%,非敏感组有效率为60.0%,敏感组有效率高于非敏感组,差异具有统计学意义(P<0.05);②敏感组患者治疗后与治疗前相比FIB、APTT下降,TT、PT升高,差异具有统计学意义(P<0.05),非敏感组患者治疗后较治疗前FIB降低,TT升高,差异具有统计学意义(P<0.05)。治疗后,敏感组FIB低于非敏感组,TT、PT高于非敏感组,差异具有统计学意义(P<0.05)。结论 巴曲酶敏感性与临床治疗效果具有相关性,主要与FIB、PT、TT密切相关,与APTT相关性不大,但机体可能通过APTT内源性凝血功能,降低出血风险。巴曲酶可增强抗凝血功能,促进内耳微循环,使抗凝、纤溶和凝血在一定范围内保持平衡,安全性良好。     

The billy goat and the goatee of the ear

The term tragus is used to describe the small, flat, triangular cartilaginous prominence situated anteriorly to the entrance of the external auditory canal. The purpose of this historical note is to study the etymology of the term tragus, meaning billy goat, and to analyse the process that led to its current anatomical definition and the various interpretations of this term in the medical literature.     

Correction of the Glosso-Larynx and Resultant Positional Changes of the Hyoid Bone and Cranium

In ankyloglossia with deviation of the epiglottis and larynx (ADEL) the tongue is located forward and as a result the epiglottis is elevated and leans towards the mouth. The larynx is also raised and curves ventrally. Various symptoms have been observed as a result of this condition. Correction of the glosso-larynx (CGL) is the operation performed to treat ADEL. The CGL procedure and the results obtained with it are reported in this paper. In addition, we studied the following six parameters using head and neck X-rays before and after CGL (the changes in these parameters as a result of CGL are shown in parentheses): ( i ) the shortest vertical length between the hyoid bone and mandible (+10.3 mm); ( ii ) the vertical length between the hyoid bone and the tangent line of C2-4 (+4.6 mm); ( iii ) the shortest length between the hyoid bone and the chin (+2.9 mm); ( iv ) the angle between the hyoid bone and the tangent line of C2-4 (+3.3°); ( v ) the length of H-M, where H is the intersection of a tangent line of C2-4 and a vertical line from the hyoid bone and M is the intersection of a tangent line of C2-4 and the mandible (+7.4 mm); and ( vi ) the width of the narrowest part of the hypopharynx (+3.0 mm). The changes in all the measured parameters after CGL were significantly different ( p <0.05).