A New Transnasal Approach to Endoscopic Marsupialization of the Nasolabial Cyst

Objective: Nasolabial cyst is a mucus-secreting, nonodontogenic cyst in the nasofacial area. It is usually situated behind the ala nasi, extending backward beneath the nasal floor into the inferior meatus and forward into the labio-gingival sulcus behind the upper lip. Patients with nasolabial cysts generally undergo surgical removal of the cyst via a transoral sublabial approach. This article reports a simple, less invasive surgical procedure for the treatment of nasolabial cysts. Study Design: A transnasal endoscopic marsupialization method was designed to treat patients with nasolabial cysts. From 1996 through 1998, 16 consecutive patients underwent this new surgical procedure. Methods: With patients under local anesthesia, the roof of the cyst, which was firmly attached to the mucous membrane of the anterior nasal floor, was removed transnasally with a sickle knife and scissors. Under the guidance of a nasoendoscope, the opening of the cyst was widened with bite forceps. Meanwhile, the cut edges of the nasal mucosa and the epithelium lining of the cyst were adequately matched. The nose was then loosely packed. Results: All but 1 of the 15 patients were successfully treated with this technique, and the whole surgical procedure was usually completed within 15 to 20 minutes. Postoperative endoscopic and radiological findings revealed that the cyst was replaced by an air-containing sinus with a persistent opening at the anterior or anterolateral nasal floor. There has been no evidence of mucus accumulation in the newly created sinus or recurrence of the cyst during a mean follow-up of 16 months. Conclusions: Transnasal endoscopic marsupialization is a simple and effective surgical procedure for treatment of nasolabial cysts.     

Clinical characteristics and surgical treatment outcomes of vallecular cysts in adults

Conclusion: It is suggested that transoral complete excision is the ideal treatment for adult vallecular cyst to avoid life-threatening acute airway obstruction and disease recurrence. Objective: The objective of this study was to review the clinical characteristics and surgical treatment outcomes of vallecular cysts in adults. Methods: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2009 to December 2014. Results: Nine patients (≥ 19-years-of-age) with a vallecular cyst were identified. Most of the patients had minimal or no symptoms at diagnosis. The presence of a vallecular cyst was confirmed in all of the patients by fiberoptic laryngoscopy. All of the cases with a vallecular cyst were treated by the transoral surgical procedure. Recurrence of the vallecular cyst was identified in two (22.2%) patients. One patient had been disease-free after the third operation through the transoral approach. Another patient who underwent marsupialization has been observed without surgery. There were no major complications resulting from surgical intervention.     

鼻前庭囊肿发生机制的探讨

目的：探讨鼻前庭囊肿的发生机制及临床表现。方法：回顾地分析42例鼻前庭囊肿的临床表现、病理学检查和手术治疗效果。结果：42例鼻前庭囊肿被覆上皮类型中,24例为假复层柱状上皮,5例为复层鳞状上皮,5例为单层立方上皮,8例为其中2种上皮的混合;23例发现有杯状细胞。所有病例均经唇龈沟进路手术切除,随访6个月～10年未见复发。结论：鼻泪管系统的发育异常在鼻前庭囊肿的发生机制中可能起主要作用。手术治疗鼻前庭囊肿时,彻底切除较内镜下开窗引流更为合理。     

Cystic lesions of the jaws in children.

Sixty nine pediatric patients with cystic lesions of the jaws were successfully diagnosed and treated. Thirty one (45%) were dentigerous cysts (D.C.), 15 (22%) were eruption cysts (E.C.), 12 (17.3%) were traumatic bone cysts (T.B.C.), nine (13.3%) were radicular cysts (R.C.), one (1.5%) was primordial cyst (P.C.) and one (1.5%) globulomaxillary cyst (G.M.C.). The mean age for E.C., R.C., D.C., T.B.C. was 4.7, 9.2, 11.5, and 13.3 years, respectively. The mean age of E.C. is significantly (P<0.05) younger than D.C. and T.B.C. but not from R.C. No significant age differences were found between R.C., D.C. and T.B.C. The differences in mean cyst diameter were not significant. Male to female ratio was 1. The treatment modalities were: marsupialization, enucleation or enucleation with bone grafting. The findings demonstrate that the distribution and characteristics of jaw cysts in children is unique and is different from the distribution in adults. The relatively high rate of developmental cyst and the fact that they occur in an area with rapid developmental changes, suggest the need for more conservative surgical management in this selected patient population.     

原发于蝶窦外侧隐窝囊肿的诊断与鼻内镜手术治疗

目的　探讨原发于蝶窦外侧隐窝囊肿的临床特征及鼻内镜治疗的疗效。方法　回顾性分析我院2007～2015年间收治的9例原发于蝶窦外侧隐窝囊肿患者的临床资料及术后随访结果。其中7例患者以面颊部麻木感为主诉,2例患者进行性视力下降为主诉;头面部均无明显阳性体征。均于全麻内镜下经蝶窦入路行囊肿开窗引流术。结果　所有患者术中及术后均无并发症发生,术后症状均消失。随访6～24个月,所有患者的囊肿引流口均与蝶窦相通形成永久性引流口,无闭塞或复发。结论　①原发于蝶窦外侧隐窝囊肿的有其独有的症状及影像学特征,区别于一般的蝶窦囊肿;②鼻内镜下经蝶窦入路行囊肿开窗切除术是治疗原发于蝶窦外侧隐窝囊肿的微创、安全、有效术式。     

Endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incisions

The objective of this study was to evaluate the technique of endoscope-assisted concurrent resection of thyroglossal duct cysts and benign thyroid nodules via a small submental incision. Endoscope-assisted thyroglossal duct cyst excision and subtotal thyroidectomy were performed via a small submental incision in six patients with thyroglossal duct cysts and benign nodular thyroid lesions. The thyroglossal duct cysts and thyroid lesions were completely excised. The incisions were 3–4 cm in length, and the mean operation time was 84 ± 11 min. The mean volume of blood loss was 19 ± 5 mL. Postoperative pathological examination findings confirmed the diagnosis of thyroglossal duct cyst in all patients. The thyroid lesions were nodular goiter in three patients and thyroid adenoma in three patients. No postoperative complications such as hematoma, pharyngeal fistula, hypocalcemia, recurrent laryngeal nerve paralysis, or dysphagia were observed. No changes in the planned surgical procedure were required, and no recurrent lesions were detected during follow-up. In conclusion, patients with thyroglossal duct cysts and benign thyroid lesions can be treated by endoscopic excision via a small submental incision, thereby avoiding large neck incisions and resulting in better postoperative cosmetic outcomes.     

鼻内镜下上颌骨囊肿开放术

目的:探讨鼻内镜下上颌骨囊肿开放术的有效性和可行性。方法:对13例侵犯上颌窦或鼻腔底的上颌骨囊肿在鼻内镜下行上颌骨囊肿开放术,即行鼻内镜下囊肿下鼻道或鼻腔底开放术,囊肿囊壁被全部或部分切除。结果:随访6～36个月,13例患者未出现面部隆起、鼻塞及鼻腔溢液等症状,囊肿无复发。结论:鼻内镜下上颌骨囊肿开放术适用于侵犯上颌窦或鼻腔底的上颌骨囊肿,较传统手术创伤小,简单高效,受侵牙齿可尽量保存。     

鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿

目的：研究鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿和术后处理方法及长期疗效。方法：对24例侵入眼眶的鼻窦黏液囊肿患者,均采用鼻内镜下造口术;术后按内镜鼻窦手术后的常规处理,重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化。结果：随访1～5年。24例患者术后均无囊肿复发,无眶内并发症,眼球复位。结论：鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿,无复发和并发症,是一种值得推荐的手术方式;术后处理的重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化;长期复查是必要的。     

等离子射频消融术与常规剪切术治疗会厌囊肿疗效比较

目的 探讨低温等离子射频切除术治疗成人会厌囊肿的效果以及与常规剪切术相比的优势.方法 60例成年患者,随机分为等离子射频切除组与常规剪切组,低温等离子射频切除组应用ArthroCare(美国)系统及Evac70刀头,常规剪切组应用腹腔镜剪刀进行常规剪切及止血,双盲观察记录两种方法的手术时间、术后疼痛VAS评分、会厌充血肿胀程度、伪膜脱落情况及术后并发症.结果 等离子射频切除组手术时间快于常规剪切组,术后第1～6天等离子射频切除组疼痛低于常规剪切组,伪膜开始脱落时间不存在差异,术后第8天等离子射频切除组伪膜脱落更多,术后第1～3天等离子射频切除组充血会厌肿胀更轻,两组患者均未发生术后呼吸困难及出血.术后随访12个月,所有患者均无复发.结论 低温等离子射频切除会厌囊肿效果较好,与常规剪切术相比,手术时间短,患者术后前6天疼痛更轻,恢复更快.     

Long-term outcomes of cruciate marsupialization of intra-nasal cysts in patients with congenital dacryocele

ObjectivesTo evaluate the long-term outcomes of cruciate marsupialization of intranasal cysts associated with congenital dacryocele.MethodsThis is a retrospective review of 15 patients of dacryoceles with intranasal cysts who underwent cruciate marsupialization of the medial wall of the cyst. Post-operative follow up for a minimum of 9 months was an inclusion criterion for analysis. Data analyzed include demographics, clinical presentations, previous interventions, associated systemic abnormalities, clinical course following marsupialization and recurrences. Primary outcome measures were resolution of the dacryocele and symptomatic relief from epiphora.ResultsThe mean age at presentation was 1.6 months with a female preponderance (60%). History of prematurity (pre-term) was noted in 20% (3/15). Swelling in the lacrimal sac area (dacryocele) was the universal presentation. Five patients (33.3%) had a prior conservative treatment. Four patients (26.6%) had respiratory distress with feeding. Acute dacryocystitis was noted in 26.6% (4/15). At a mean follow up of 19.1 months, successful outcomes were achieved in 86.6%.ConclusionCruciate marsupialization of intranasal cysts achieves good results in patients with congenital dacryocele, which are maintained over a long period of time. Early diagnosis and management may prevent acute dacryocystitis in these patients.     

Management of subglottic cysts with Mitomycin-C-A case series and literature review

Objectives

To describe the management and outcomes of seven infants with subglottic cysts. To assess the role of Mitomycin-C in the management of subglottic cysts. To discuss the relationship of subglottic cysts with gastro-esophageal reflux. To extensively review the literature on subglottic cysts.

Design

Retrospective case series and literature review.

Methods

Case series of seven children with subglottic cysts at a tertiary care hospital. Charts were reviewed to determine birth history, gender, intubation history, comorbidities, age at presentation, presenting symptoms, interventions and follow-up.

Results

Between 2001 and 2009, seven patients aged 4-13 months were diagnosed with and treated for subglottic cysts. All children had a history of intubation and had evidence of gastro-esophageal reflux. All children were treated with endoscopic marsupialization (CO₂-laser, cupped forceps) or bronchoscopic rupture; with or without concomitant topical Mitomycin-C therapy. Infants were followed clinically and with interval endoscopy with a minimum follow-up of 6 weeks. No patients receiving topical post-marsupialization Mitomycin-C (0/4) had cyst recurrence. Those patients who did not receive Mitomycin-C therapy recurred more frequently (66% - 2/3). Cysts ruptured with the bronchoscope tip recurred (66% - 2/3) more often than cysts undergoing endoscopic marsupialization (0/6). The one bronchoscopic rupture case that did not recur was the one in which Mitomycin-C was used concomitantly. Patient follow-up was at 2, 4 and 6 weeks post-procedure.

Conclusion

Endoscopic marsupialization is the treatment of choice for subglottic cysts. Gastro-esophageal reflux has a strong association with subglottic cysts. The post-marsupialization application of Mitomycin-C may have a role in reducing the recurrence rate and scarring after surgical treatment of subglottic cysts.     

The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis

Clin. Otolaryngol. 2010, 35 , 18–24. Objective: To evaluate the effects of a coexisting epiglottic cyst on the clinical course and airway management of acute epiglottitis in adults. A review of the airway risk factors were studied in adults with acute epiglottitis in South Korea from 1997 to 2009. Design: Retrospective chart review. Setting: Academic tertiary care referral medical center. Participants: The study included 117 adult patients that were diagnosed with acute epiglottitis laryngoscopically over a period of 12 years. Two distinct groups were identified: one with acute epiglottitis associated with an infected epiglottic cyst (n = 29, 25%) and the other with acute epiglotittis without a cyst (n = 88, 75%). Main outcome measures: Patient background data, clinical manifestations, laboratory data, airway management, outcomes, and recurrence were recorded. Results: Eight (28%) out of 29 patients with an infected epiglottic cyst required airway intervention compared to the four (5%) out of 88 patients without a cyst. The difference between the two groups was statistically significant (P = 0.001). Five out of six patients with recurrent acute epiglottitis had a coexisting epiglottic cyst. The recurrence of acute epiglottitis in patients with a cyst was significantly more frequent (P = 0.003). Twelve patients (10%) required airway intervention. There was no mortality found in this study. Logistic regression analysis showed that an older age, dyspnoea, a high pulse rate, and the presence of an epiglottic cyst were associated with an increased risk for airway obstruction. Conclusions: The results of this study showed that a pre-existing epiglottic cyst might be associated with a suppurative infection of the supraglottis. Infected epiglottic cysts increased the risk for airway obstruction and recurrence of acute epiglottitis.     

Safe, complete resection of epiglottic cysts with phono-ultra-microsurgical technique

Generally, epiglottic cysts have been treated by the puncture technique or surgical resection. However, these techniques can result in accidental injury to the cyst wall. As a result, the contents of the cyst may spread throughout the larynx, trachea and pharyngeal cavity. The ideal treatment would involve complete resection without cyst perforation. We use a completely different approach for the resection of epiglottic cysts, with successful results, which we term the advanced phono-ultra-microsurgical technique. One difference between this method and previous techniques of surgical epiglottic cyst resection is that the cyst is sealed off before resection in order to prevent rupture and spread of its contents. To enable this, we have developed a special device to facilitate suturing of the vocal fold epithelium, utilising a knot-pusher. This suturing technique allows complete removal of epiglottic cysts. Our technique allows optimal prevention of cyst rupture and spread of contents.     

颈外径路Sistrunk手术治疗成人复发性舌甲状舌管囊肿的临床分析

目的 探讨成人复发性舌甲状舌管囊肿（LTGDC）的临床特点、误诊原因及手术治疗。方法 回顾性分析2018年1月—2021年3月收治的6例反复复发的成年LTGDC患者,术前行甲状腺B超提示甲状腺位置并排除异位甲状腺,颈部CT检查明确肿物大小、部位及与舌骨的关系,喉咽部MRI明确肿物性质。手术均采用颈外径路Sistrunk手术。结果 6例患者曾误诊为会厌囊肿4例,舌根囊肿2例,均已行囊肿切除术,复发时间3周至1年。所有患者行颈外径路Sistrunk手术完整切除甲状舌管囊肿及瘘管,术后病理确诊为甲状舌管囊肿。术后随访1年以上无复发。结论 复发性舌根部或会厌间隙的囊性肿物应考虑LTGDC的可能性。所有患者术前均应行喉镜检查和颈部影像学检查以了解囊肿的形态、位置及其和舌骨的关系来选择手术方式。对于成人复发性LTGDC,Sistrunk手术可彻底切除囊肿减少复发。     

Pharyngeal localizations of branchial cysts

Two cases with unusual pharyngeal localizations of branchial cysts medial to the great neck vessels and pharyngeal constrictor muscle are presented. The authors reviewed the theories of origin of the branchial cysts and the surgical treatment options. In their first case the transoral approach was chosen. Because of previous unsuccessful attempts at surgical treatment, the pharyngeal cyst was extremely adherent to adjacent tissue with much scar tissue, and it was very difficult to remove. As a result of this disappointing operation, an external neck exploration was indicated in the second patient. Histological examinations confirmed that the excised cysts were branchial in both cases. Received: 25 September 1997 / Accepted: 19 February 1998     

内镜辅助经口入路颌下腺切除的初步经验

目的 探讨内镜辅助经口入路颌下腺切除术的指征和利弊.方法 同顾性分析12例内镜辅助经口入路颌下腺切除术患者的临床资料.术前诊断慢性颌下腺炎8例(2例含涎石),多形性腺瘤3例,颌下腺囊肿1例.所有病例术前经影像学评估,其中8例经细针穿刺细胞学或细针穿刺组织学活检确诊.结果 术后2例出现暂时性的舌体麻木和舌体运动障碍,1～3个月后完全缓解;无其他并发症.术后1个月未损害面容满意度采用视觉模拟量表评分均为10分,所有患者都满意.多形性腺瘤患者随访时间12～48个月(中位数36个月),未见复发.结论 内镜辅助经口入路良性颌下腺病损切除术安全、可行,优点是无颈部瘢痕和面神经下颌缘支损伤的风险.

Abstract：

Objective To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland. Methods A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8were chronic sialoadenitis (2 cases with sialolith), 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fineneedleaspiration cytology (FNAC) or fineneedle aspiration biopsy (FNAB). Results Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1-3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months(median follow-up period:36 months). Conclusions Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland . The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.     

Tornwaldt's cyst: incidence and a case report

Tornwaldt's cyst is an uncommon type of nasopharyngeal cyst that may cause clinically significant symptoms. We reviewed reports of 31,855 computed tomography (CT) scans and 21,158 magnetic resonance imaging (MRI) scans to ascertain how many Tornwaldt's cysts were discovered incidentally. These images had been obtained between Jan. 1, 1994, and Dec. 31, 1999, at the University of Virginia Health Sciences Center. We found that 32 Tornwaldt's cysts had been incidentally detected in 20 women and 12 men. Four of these cysts had been found on CT (0.013%; mean size: 0.66 cm3) and 28 on MRI (0.13%; mean size: 0.58 cm3). The overall rate was 0.06% (32/53,013). The most common indications for imaging in these patients were headache, seizures, dizziness/vertigo, and pharyngeal symptoms. We also report the case of a patient with a symptomatic Tornwaldt's cyst whose symptoms resolved after treatment with endoscopic marsupialization. Tornwaldt's cyst should be remembered as an uncommon but potentially treatable cause of many symptoms seen in a typical otolaryngology practice.     

Solitary bone cysts of jaws: surgical treatment and follow-up of six cases

BACKGROUND: The aim of our study was to assess the long term follow-up in six patients who all presented with solitary cysts and underwent minor surgery. At follow-up treatment (range 16 months to 18 years) efficacy was evaluated and screened for any possible future complications. MATERIAL AND METHODS: Since 1985 all patients who presented in the Department of oral and Maxillo-Facial Surgery with a simple bone cyst were retrospectively included in the study. A total of only 6 patients underwent surgery. One patient with a condylar cyst was seen with a delay of 16 months. The others were examined over 5 years. RESULTS: Surgery allowed us to confirm the diagnosis and achieve the treatment of the cyst. One patient who had a cyst in the ramus and was re-operated for a follicular cyst adjacent to the wisdom tooth. No complication or recurrence was observed.     

Evaluation of pediatric subglottic cysts

Introduction

Subglottic cysts (SGCs) are increasingly recognized as a cause of upper airway obstruction in previously intubated infants. Endoscopic marsupialization with cold steel instruments or CO₂ laser has been reported to be the standardised treatment method for SGCs. SGC case series of 9 patients who were treated with endoscopic marsupialization with cold steel instruments or CO₂ laser and mechanical decompression with balloon dilatation are presented.

Patients and methods

Retrospective study of 9 cases of subglottic cysts treated between 2003 and 2010 was done. Diagnoses were made by performing flexible nasopharyngolaryngoscopy and surgical treatment was done through endoscopic marsupialization with cold steel instruments or CO₂ laser.

Results

The age range of SGC patients were between 3 months and 36 months (average 12, 11 months). Two of the patients were female (2/9), 7 of them were male (7/9). SGC diagnoses were made by flexible nasopharyngolaryngoscopy. History of intubation was noted in 3 of the patients (3/9). Duration of intubation was 28 days, 6 days, and 8 days respectively. Cysts were multiple in all cases, and located posteriorly and laterally at the subglottic area and upper trachea. The patients presented with were stridor, fail to thrive, and recurrent croup attacks. Treatment methods preferred for these patients were endoscopic marsupialization with cold steel instruments or CO₂ laser and mechanical decompression with balloon dilatation. The follow-up period after treatment ranged between 8 months and 3 years. Recurrence of the SGCs did not happen and re-evaluation under general anesthesia was reserved for the symptomatic patients.

Conclusion

Diagnostic laryngoscopy and bronchoscopy are important in diagnosing SGC. History of premature birth and intubation are not ‘sine qua non’ of SGC as SGC may be congenital as well. Symptoms of SGCs may mimic the characteristic features of chronic obstructive lung disease, so evaluation of the airway should be considered in such infants if they have stridor or hoarseness not responding to routine treatment. Laryngoscopy and bronchoscopy are routinely indicated for airway evaluation in at-risk infants.