肉毒杆菌毒素A在耳鼻咽喉科的应用

文章对肉毒杆菌毒素Ａ的药理作用、毒副作用、禁忌证及在耳鼻喉科的应用进行综述,认为在治疗局灶性肌张力障碍方面,是安全而有效的,值得推广应用。     

肉毒杆菌毒素在耳鼻咽喉科的临床应用

肉毒杆菌毒素(Botulinum Toxin,BTX)早在1897年被发现,1977年开始在志愿者人体应用,1980年第一篇有关报道在文献发表,1989年获FDA认证,现已被安全广泛的应用于临床.在耳鼻咽喉科的治疗应用发展很快,至少用于12种疾病,其中包括各种发音障碍、张力障碍、痉挛、斜颈、面神经麻痹及面部皱纹等[1].     

肉毒杆菌毒素在耳鼻咽喉科的作用和应用的回顾

肉毒杆菌毒素是一种由肉毒杆菌产生的神经毒素 ,对神经肌肉接头处有高度特异性 ,可产生暂时的和可逆的去神经作用 ,副作用和并发症有限。肉毒杆菌毒素正在被安全广泛应用于临床 ,被 FDA(食品、药品管理局 )许可的疾病为 :痉挛 ,半面痉挛 ,斜视等。在耳鼻咽喉科 ,肉毒杆菌毒素用于治疗至少 12种疾病 ,研究表明注射肉毒杆菌毒素对于暂时缓解症状有很高的成功率。痉挛性发音困难可能是肉毒杆菌毒素在耳鼻咽喉科最广为人知的用处 ,该病包括内收型和外展型。从1984年开始 ,将肉毒杆菌毒素经皮肤或经口注射入甲杓肌用于治疗内收肌痉挛性发音困难…     

肉毒杆菌毒素的基础研究及其在耳鼻咽喉科临床应用

肉毒杆菌毒素可用于治疗多种耳鼻咽喉科疾病，安全有效，本文重点介绍其结构、药理、毒性、治疗技术及具体的临床应用。     

肉毒杆菌毒素A治疗味觉出汗的一些新进展

味觉出汗主要发生在腮腺手术后 ,部分是由于腮腺外伤或感染所致 ,约有 15 %的患者自觉症状严重 ,迫切要求治疗 ;肉毒杆菌毒素 A能抑制乙酰胆硷的释放 ,局部注射是治疗味觉出汗的一种简便、安全、有效的方法 ,且疗效持续时间长 ,同时患者对此具有良好耐受性。该作者首先发现并予以报道 ,随后得到同道的证实。近年来 ,随着对有关味觉出汗的诊断和治疗的进一步研究 ,作者发现一些特殊情况 ,并基于这些有关情况取得令人满意的疗效。本文着重介绍如下 :1使用肉毒杆菌毒素 A治疗前应掌握明确的既往史是成功治疗的保证。含有抑副交感神经作用的药…     

人造骨的组织学表现及在耳鼻咽喉—头颈外科的应用

人造骨作为骨缺损的修复材料在实验室和临床应用中都得到了广泛研究。本重点综述人造骨的组织学表现和在耳鼻咽喉-头颈外科重建手术中的应用进展，认为人造骨特别是骨水泥有着较好的生物相容性，能与机体有机结合并不引起机体的异物反应，人造骨在耳鼻咽喉科一头颈外科的重建手术中有着广阔的应用前景。     

A型肉毒毒素在面颈部肌痉挛的应用

近10年来,临床上A型肉毒毒素(BTXA)局部注射治疗面颈部肌痉挛的应用越来越广泛,但由于剂量和方法不同,其疗效和不良反应亦不同。我们对1998年8月～2004年2月接受BTXA注射治疗的2160例面、颈部肌痉挛患者进行回顾性分析,现报告如下。1资料与方法1.1临床资料2160例患者,男1107例,     

Update on botulinum toxin use in facial plastic and head and neck surgery

PURPOSE OF REVIEW: The purpose of this review is to discuss current trends in the medicinal use of botulinum toxin in head and neck and facial plastic surgery. The basic science of botulinum toxin is presented along with a comparison of the subtypes currently available on the market. Site-specific applications of botulinum toxin in the head and neck region are presented. RECENT FINDINGS: The use of botulinum toxin continues to expand, both in volume and in number of applications. The main application of botulinum toxin in facial plastic surgery is in the effacement of dynamic or hyperkinetic facial lines. The granting of US Food and Drug Administration approval for the use of Botulinum Toxin type A in the treatment of glabella lines marks a major milestone for the more widespread usage of this product in cosmetic settings. Additional cosmetic applications include crow's feet, marionette lines, and platysma banding. Noncosmetic applications in the head and neck include dystonias (including torticollis), facial and generalized muscle spasms, migraine headaches, hyperhidrosis, spasmodic dysphonia, sialorrhea, gustatory sweating, and involuntary movement disorders. SUMMARY: The use of botulinum toxin in the treatment of hyperkinetic conditions and disorders of excessive salivation is well established and enjoys an excellent safety profile. The cosmetic use of botulinum toxin continues to expand. The chronic use of botulinum toxin specifically for cosmetic purposes is worthy of additional study.     

经口入路机器人手术在耳鼻咽喉头颈外科中的应用

摘要：目的总结经口入路机器人手术（transoral robotic surgery,TORS）在耳鼻咽喉头颈外科应用的临床经验。方法2010年11月~2015年7月南京军区南京总医院耳鼻咽喉科应用“达芬奇”机器人手术系统对10例咽喉部病变患者行TORS, 回顾性分析患者临床资料,总结手术体会。结果10例患者均顺利完成手术。术野暴露平均用时34 min（20～60 min）,调整开口器次数2~5次,平均手术时间为67 min（30～130 min）。患者平均住院时间为8 d（6～14 d）,恢复经口进食平均需要5 d（2～10 d）,出院时均可经口进食。术中及术后均未出现并发症。恶性肿瘤患者的术后病理学检查示切缘均未见癌细胞残留。结论在掌握好适应证的前提下,应用“达芬奇”机器人手术系统可以独立完成多种类型耳鼻咽喉头颈外科手术,其手术创伤小,患者术后恢复快,有着巨大的临床应用价值。     

耳鼻咽喉头颈外科专业学位研究生课程案例库的构建及应用

案例教学是运用典型案例,提高学生分析、解决问题能力的一种教学方法。案例库的建设是案例教学有序开展的保障,其通过收集临床案例资料,结合耳鼻咽喉头颈外科硕士研究生教学大纲及教学目标进行整理、加工。栏目分设耳科、鼻科、咽喉及头颈肿瘤外科疾病,每个案例包括基本资料、主诉、病史、症状、体格检查、辅助检查、诊断、治疗、随访等,并选定相应检索词。案例设置难易分为入门案例和提高案例,从特征类型分为典型案例和不典型案例。案例库的内容在教学实践应用中不断修正,使其最适合于耳鼻咽喉头颈外科专业学位研究生临床教学。     

Management of Jehovah's Witnesses in otolaryngology, head and neck surgery

It is imperative that surgeons should have some knowledge and understanding of the beliefs of Jehovah's Witnesses to respect the patient's wishes and effectively minimize and manage blood loss. The objective of this review was to provide a management strategy for Jehovah's Witness patients undergoing otolaryngology, head and neck surgery, because there is paucity of information regarding this within our literature. A systematic review of medical literature was conducted. Articles were identified using MEDLINE (1966-2007). The search strategy used Medical Subject Heading terms Jehovah's Witnesses, Beliefs, Ethical and Legal issues, Blood transfusion alternatives, ENT, Head and Neck surgery in Jehovah' witnesses. There is a broad range of nonblood surgical management strategies available in other specialities, making major surgery possible within this population. This review suggests recommendations in elective surgery, trauma, and emergencies.     

Burnout in academic chairs of otolaryngology: head and neck surgery

BACKGROUND: Burnout can be characterized by a low degree of personal accomplishment and a high degree of emotional exhaustion and depersonalization using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). With increasing demands and constraints placed on academic department chairs, the risk of developing burnout may be increasing. The prevalence of burnout in chairs of academic departments of otolaryngology and the factors associated with it have not been previously described. OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the prevalence of burnout in otolaryngology chairs and to identify the factors that are associated with burnout development. Understanding these elements can lead to improved prevention, recognition, and treatment of professional burnout. STUDY DESIGN: A cross-sectional questionnaire-based study of 120 academic chairs of otolaryngology in the United States was performed. METHODS: A confidential questionnaire was mailed to U.S. otolaryngology chairs. The questionnaire consisted of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self efficacy survey, 5) a spousal support survey, and 6) the MBI-HSS. Statistical analyses were performed using Pearson correlation and analysis of variance, and burnout data were compared with previously reported data from other department chairs and physicians. RESULTS: Questionnaires were returned from 107 department chairs for a response rate of 89%. Chairs were on average 56 years of age, serving as chair for a mean of 11 years. Average work week was 68 hours and did not vary significantly with increasing duration as chair. Sixty-six percent of time was spent delivering patient care, 8% in research, and 26% performing administrative duties. MBI-HSS scores demonstrate 3% of chairs experiencing high burnout, 81% of chairs with moderate burnout, and 16% of chairs with low burnout. On average, chairs have low depersonalization scores, low-moderate emotional exhaustion scores, and low-moderate personal accomplishment scores. High emotional exhaustion or depersonalization was correlated with low self-efficacy, low spousal support, disputes with the dean, department budget deficits, working nights and weekends, Medicare audits, loss of key faculty, and being a malpractice defendant. High personal accomplishment was correlated with increased time spent performing administrative duties. When compared with other physician specialties, otolaryngology chairs demonstrate less sense of emotional exhaustion and depersonalization but also slightly less sense of personal accomplishment. Duration as chair, age, and hours worked per week were not associated with increased burnout. CONCLUSIONS: Most otolaryngology chairs experience moderate levels of burnout. The biggest risk factors for burnout include low self-efficacy, low spousal support, disputes with the medical school dean, department budget deficits, and nights/weekends worked. These findings may help department chairs identify and prevent burnout and may help in developing programs to minimize burnout in our field's academic leaders.     

Use of botulinum toxin in pediatric otolaryngology and laryngology

The use of botulinum toxin in adult otolaryngology has been commonly used in conditions such as spasmodic dysphonia, cricopharyngeal spasm, palatal myoclonus, sialorrhea, and for cosmetic reasons. The current use of botulinum toxin in pediatric otolaryngology and laryngology has primarily been off label and in children older than 2 years of age. This review discusses the different applications of botulinum toxin in pediatric patients and its effectiveness in treating different pediatric conditions.     

近发际缘内头皮冠状切口径路在耳鼻咽喉头颈外科手术中应用的临床意义

目的 探讨近发际缘内头皮冠状切口手术径路在耳鼻咽喉头颈外科手术中的临床意义。方法 采用经近发际缘内头皮冠状切口入路,行颧骨复合体骨折切开复位内固定术20例;额窦巨大囊肿4例;额窦骨瘤2例;额部良性肿块2例,分析、观察总结此切口的优缺点。结果 28例疗效满意,所有切口均Ι期愈合,无面部切口瘢痕遗留、术后面神经瘫痪、脑膜撕裂脑脊液漏出现。结论 近发际缘内头皮冠状切口手术入路,在颅脑及颌面外科经常使用。在耳鼻咽喉头颈外科手术中应用此切口,术野显露充分,对比颜面部中上份一些传统入路难以操作的手术更方便,更能提高手术质量。直视下的手术能避免在该区域手术操作中的面神经损伤脑膜损伤脑脊液鼻漏的并发症,同时也隐藏了颜面部的手术切口瘢痕达到术后面部美观之功效。该切口是面中上份手术切口径路的理想选择,值得在耳鼻咽喉头颈外科手术中应用推广。     

CT引导下经皮穿刺活检术在耳鼻咽喉-头颈外科的临床应用

目的 探讨CT引导下经皮穿刺活检术的临床应用价值。方法 CT引导下用Siemens Somatom HiQ-S型和 GE Light SpeedQX/I型螺旋CT扫描仪及 Angiomed自动活检枪行经皮穿刺活检术24例。结果 24例均1次穿刺到位,并均得到定性诊断,无并发症发生。结论 CT引导下经皮穿刺活检术成功率和诊断准确率高,并发症少,作为内镜补充检查值得临床推广应用。