74例鳃裂囊肿及瘘管临床分析

目的 总结74例鳃裂囊肿及瘘管的临床特点,探讨其诊疗方法。 方法 收集2010年1月至2019年9月收治的74例鳃裂囊肿和鳃裂瘘患者的临床资料并结合文献进行回顾性分析。 结果 本组患者中有50例为第二鳃裂病变,13例为第一鳃裂病变,10例为第三鳃裂病变,1例为第四鳃裂病变,于我院初次手术时术前误诊率为10.81%。所有患者均采取手术治疗,随访3个月~10年。除3例失访患者外,67例患者一次性治愈,3例患者术后复发,1例患者术后出现永久性面神经麻痹。 结论 先天性鳃裂囊肿及瘘管临床表现多样,鉴别诊断较为复杂,应合理选用多种检查手段,术前准确评估,制定个体化的手术方案彻底切除病灶是首选治疗方法。     

Laryngoplasty with a radialis pedicle flap from the forearm: a surgical procedure for voice rehabilitation after total laryngectomy

Tracheoesophageal puncture and insertion of a prosthetic voice device is currently the most widely surgical procedure for vocal rehabilitation after total laryngectomy. The disadvantages of voice prostheses are high initial phonation pressure, formation of granulation tissue around the voice shunt, blockage, displacement of the prosthesis, leakage of the prosthesis or the voice shunt, spontaneous occlusion when the prosthesis is accidentally removed and difficulties in replacing and cleaning the prosthesis. In an effort to avoid these problems, a substitute laryngeal tube (laryngoplasty) was fashioned from a revascularized forearm flap and connected to the trachea and pharynx in seven patients with extensive laryngohypopharyngeal carcinoma. All seven developed a voice comparable with patients fitted with a voice prosthesis. An advantage of this graft is the low phonation pressure required for voice production. Problems with aspiration have not occurred even after radiotherapy. While still in the hospital, five patients learned to speak without using their hands through the use of a tracheostomal valve. Judging by these results, this surgical procedure is a practical alternative to a voice prosthesis.     

Voice rehabilitation following total laryngectomy: microvascular laryngeal replacement-plasty (laryngoplasty) instead of voice prosthesis

Since the introduction of the so-called voice prostheses tracheoesophageal puncture is currently the most widely used surgical procedure for vocal rehabilitation after total laryngectomy. The voice prosthesis renders possible a reliably reproducible voice, which is superior (period of uninterrupted sound production, basal frequency, voice intensity) to the other techniques (esophageal speech, external vibrators, other surgical reconstructive measures), but has the following disadvantages: high initial phonation pressure, formation of granulation tissue around the voice shunt, blockage or leakage of the prosthesis or the voice shunt, displacement of the prosthesis, spontaneous occlusion when the prosthesis is accidentally removed, overtaxing the patients who have difficulties in replacing and cleaning the prosthesis. As an alternative new surgical technique a substitute larynx tube (laryngoplasty) was formed by a microvascular anastomotic forearm flap and connected to the trachea and pharynx in ten patients with extensive (T3-T4) laryngohypopharyngeal carcinoma. All ten patients developed a voice comparable with those of patients who have a voice prosthesis (frequency, voice intensity, period of uninterrupted sound production). An advantage of this graft over the voice prosthesis is that the phonation pressure required is low. While they were still in hospital eight patients learned to speak without using their hands by means of a tracheostomal valve. So far (six months postoperative) this surgical procedure has proved to be a practicable surgical alternative to a voice prosthesis.     

Major complications following tracheoesophageal puncture for voice rehabilitation

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.     

Subcutaneous cervicofacial and mediastinal emphysema complicating tooth extraction: case report

Subcutaneous emphysema is a rare and well-known complication of dental procedures. Many cases go unrecognized and resolve spontaneously, while others may require specific surgical management to prevent complications. We present a case of cervicofacial and mediastinal emphysema which occurred during a routine dental procedure and a review of the literature on differential diagnosis and management.     

Maxillary sequels in labial-alveolar-velopalatine clefts. Orthodontic management

Routine othodontic management is unavoidable in all patients with cleft lip and palate after primary surgery. This management combines dental arch alignment with maxillary expansion of the lesser fragment before alveolar bone grafting. To treat dental arch asymmetry, the space of the missing lateral incisor is preserved until the age of dental implant. Otherwise, dento-orthopedic treatment attempts to normalize transversal dental dimension once alveolar bone grafting is done in order to prepare the surgical advancement of the maxilla.     

Surgical and prosthesis-related complications using the Groningen button voice prosthesis

Prosthesis-assisted tracheoesophageal speech has advanced speech rehabilitation appreciably. However, the surgical technique and the use of a prosthesis may give rise to complications. In a retrospective study on 132 consecutive patients rehabilitated with a Groningen button voice prosthesis, the complications were assessed, the average follow-up being 21 months. Surgical complications were not observed. Prosthesis-related complications, which were encountered in 28%, were all of a minor nature and mainly consisted of granulation formation and hypertrophic scarring; these appeared to be easily treatable. The complications found were few and insignificant in comparison with reports in the literature. This may be attributed to the uncomplicated surgical procedure for the insertion of the Groningen button. Moreover, the prosthesis is self-retaining and requires hardly any care from the patient. Permanent removal of the prosthesis usually requires surgical closure, which is a simple procedure performed under local anaesthesia.     

Rationale for a fixed implant-supported transitional prosthesis in full-arch implant restorations

The use of a fixed transitional prosthesis in implantology remains quite seldom, although the concept of temporization and progressive loading of prosthetic restorations has become a main issue in modern dentistry. Fixed tansitional prostheses play an important role in the validation of full-arch implant-supported restorations, and in the success of implant treatments in general. This paper reviews the basic treatment principles, and discusses the different technical options available to the clinician. In simple cases, a hard resin bridge may be sufficient. However, for complex cases, we should better use fixed implant-supported temporary prosthesis, made in resin on a metallic infrastructure. Moreover, this one could be use as the framework of the permanent prosthesis. This technical solution offers the best guaranty for implant and oral rehabilitation validation before the permanent prosthesis installation.     

Incidence of tracheo-oesophageal fistulas after primary voice rehabilitation with the Provox or the Eska-Herrmann voice prosthesis

Salivary leakage can be a major symptom of valve failure or incorrect positioning of indwelling voice rehabilitation valves in a tracheo-oesophageal fistula. Usually, removal of the valve for a short time leads to shrinking of the fistula or a simple valve replacement procedure resolves the problem. If the fistula, however, does not close spontaneously, symptoms persist and the fistula may have to be closed surgically. In a retrospective study, data of 103 patients who underwent laryngectomy and primary voice rehabilitation between 1989 and 1998 with either the Provox or the Eska-Herrmann prosthesis were compared with regard to surgical fistula closure requirement. A total of 55 patients underwent laryngectomy and primary voice rehabilitation with the Eska-Herrmann and 48 with the Provox prosthesis. Initial tumour treatment also included post-operative radiotherapy for all patients in the study. In total, surgical fistula closure had to be performed in three patients, all of whom had been treated with the Provox prosthesis. The time span between initial voice rehabilitation and surgical closure of the fistula was 5 months, 21 months and 24 months in all three patients respectively. None of the fistulas developed in relation to recurring tumour disease. The Provox prosthesis seem to have a higher risk of developing fistulas necessitating surgical intervention, even years after initial tumour therapy, than the Eska-Herrman prosthesis. These complications may be due to the larger tracheo-oesophageal fistula necessary to fit the larger diameter of the Provox prosthesis. Received: 19 December 2000 / Accepted: 10 April 2001     

Voice rehabilitation after laryngectomy with voice prostheses. Results of a prospective follow-up study]

Although the results of surgical rehabilitation by means of voice prostheses are on the average better than rehabilitation via oesophageal speech, the tracheoesophageal puncture (TEP)-technique has so far not been widely used in Germany. The majority of hospitals still prefer the "traditional" method of voice rehabilitation using oesophageal speech. The present prospective study was undertaken to compare the results of postlaryngectomy vocal rehabilitation, if patients were offered the surgical voice rehabilitation via voice prosthesis as an alternative to oesophageal speech. Taking into account all the patients who underwent laryngectomy from 1989 until 1990 in Tübingen, primary surgical voice rehabilitation was performed in 44 out of 54 patients (81.5%). Interestingly enough, 34 patients who underwent laryngectomy were able to perform communication via the telephone on the day of their discharge. Moreover, one-third of the laryngectomised patients showed a significant increase in speech intelligibility within the first six months after laryngectomy. 36 patients with laryngectomy were able to attain proficiency 6 months after surgery. In 12 patients the prosthesis had to be removed, since either phonation was impossible or patients successfully learned and preferred oesophageal speech. In conclusion, independent of the method of voice rehabilitation (prosthesis, electrolarynx, oesophageal speech), our results support the hypothesis that a voice rehabilitation regimen will yield a higher rehabilitation rate of patients if rehabilitation via surgical voice is offered as an alternative to learning the oesophageal voice. Therefore, it seems to be advisable that patients are allowed to have the choice between surgical rehabilitation and oesophageal speech restoration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vocal rehabilitation with tracheoesophageal prosthesis. Study of peri-prosthetic leakages

OBJECTIVES: Peri-prosthetic leakages are a frequent complication of tracheoesophageal prosthesis used in the vocal rehabilitation of laryngectomized patients. The authors examine the effect of pre or post operative radiotherapy upon the incidence of this complication. MATERIALS AND METHOD: In a retrospective study of 67 patients rehabilited with a phonatory prosthesis between 1993 and 2002, pre or post-operative radiotherapy was carried out in 61 patients. RESULTS: A peri-prosthetic leakage occured in 38.8% of the cases. The pre or post-operative radiotherapy was not a statistically significant cause of leakage, as the age of the patient and the surgical procedure. CONCLUSION: Although not supported by the statistical study because of a lack of cases, the radiotherapy remains for the authors a factor determining in the mechanism of the peri-prosthetic leakages and bad forecast for their treatment. Realized before the surgery, it contra-indicates the phonatory prosthesis at the time of the tumor resection. In case of post-operative radiotherapy, the risks must be clearly explained to the patient.     

Early repair for infants with cleft lip and nose

OBJECTIVE: To study the results 10 years after early surgical cleft lip and nose repair. PATIENTS AND METHODS: We present the outcome of 123 early cleft lip repairs whose condition was managed in a multidisciplinary team according to a strict protocol. We give the observation results of operations of a single surgeon's neonatal surgery over a 10-year period in term of aesthetic assessments and dental arch relationships. One hundred and twenty-three patients were operated on during the first 4 weeks of life; a subgroup of 40 child had been operated on at a week or less of age. RESULTS: The results show good aesthetic assessments and dental relationships, with facial growth appropriate for the age. CONCLUSIONS: We are currently encouraging early cleft lip and nose repair in the full-term baby as the good method of management of newborns with cleft.     

Aerodynamic and sound intensity measurements in tracheoesophageal voice

BACKGROUND: In laryngectomized patients, tracheoesophageal voice generally provides a better voice quality than esophageal voice. Understanding the aerodynamics of voice production in patients with a voice prosthesis is important for optimizing prosthetic designs and successful voice rehabilitation. OBJECTIVES: To measure the aerodynamics and sound intensity in tracheoesophageal voice production. STUDY DESIGN AND METHODS: We built a special setup, which consisted of a Pentium 200 MHz computer with an AD-DA interface card and Labview 4.01 software. In an oral/nasal mask we constructed several mass flow sensors and a microphone. This measured both the oral airflow and the level of sound. For the measurement of endotracheal pressure, which is the driving force behind the airflow, we used a transducer which was connected to the tracheostoma. The endoesophageal pressure was measured at the level of the prosthesis in the esophagus by a Mikrotip transducer. Using this we could determine how much the voice prosthesis contributes to the overall pressure drop of the phonatory tract. Furthermore, the average airflow rate as a function of the sound pressure levels could be determined. RESULTS: In our population, 6 out of 7 patients showed a positive relationship between trans-source airflow and generated sound intensity. We compared our prosthesis pressure drop values with in vitro data and found that there are some differences, possibly due to difference in age of the prosthesis and physiological circumstances in vivo. The overall contribution of the voice prosthesis to the airway resistance depends on the level of phonation and the type of device. In our patient group it is apparent that the pharyngoesophageal (PE) segment has the greatest share of the total pressure drop, especially at higher airflow rates. We measured a 27% pressure drop in airflow over the voice prosthesis. Different tracheostoma occlusion methods did not have any effect on the aerodynamics and sound intensity. One patient that had had a jejunal graft for reconstruction showed, not unexpectedly, extremely different aerodynamic values. We were unable to define optimal airflow rates or optimal resistance values for sound production in the PE segment. CONCLUSION: The aerodynamic characteristics of voice production in laryngectomized patients with voice prostheses are determined by both prosthetic factors and PE segment tissue factors. In our patient group the PE segment is responsible for the greatest pressure drop. We found no significant difference in pressure drop and sound intensity for different tracheostoma occlusion methods.     

Treatment strategies in exudative otitis media in children with aquired cleft lip and palate

The paper presents incidence of hearing problems in 100 children with aquired cleft lip and palate (ACLP) aged 1 to 16 years. An age aspect of the problem is analysed. The patients were at different stages of rehabilitation for ACLP. Conservative and surgical policies in management of children with exudative otitis media and ACLP are analysed. Surgical results depending on the disease stage are provided.     

Ösophagusperforation mit Mediastinalabszess

INTRODUCTION: Surgical voice rehabilitation after total laryngectomy is still only a partially solved problem. Because of easy handling and rare complications, the Provox voice prosthesis has become common in voice rehabilitation. CASE REPORT: The 69 year old patient underwent laryngectomy, selective bilateral neck dissection and the implantation of a Provox voice prosthesis because of a glottic squamous cell carcinoma (pT(4), pN(0), M(0)). Postoperative healing ensued without any complications. During adjuvant radiochemotherapy, the patient developed distinctive cervical edema which led to a tilting of the Provox prosthesis. Due to a perforation of the posterior esophageal wall, the patient developed a pronounced mediastinal abscess which was relieved through a transcervical mediastinotomy. Antibiotic therapy led to a partial remission of the symptoms. CONCLUSION: Severe complications may not only occur during the early phase of surgical voice rehabilitation, but also at a much later stage, after completion of the healing process. A voice prosthesis which is too long or generates pressure from a radiogenic edema, cannula and finger pressure used to close the tracheostoma is transmitted through the prosthesis and may lead to a perforation of the posterior esophageal wall. In particular, when the tissue is injured during the course of radiotherapy, this type of complication should be taken into consideration.     

Surgical voice restoration in alaryngeal patients

Blom Singer’s technique of surgical voice restoration in laryngectomized patient is a highly successful method of speech rehabilitation. This technique has been further simplified and adopted in 20 of our cases with 90% success in acquiring speech. Though primary tracheo-oesophageal puncture (TEP) is a good attempt of rehabilitation, we feel that post-operative healing and fibrosis will displace the puncture site causing difficulty to insert the prosthesis by the patient. The high success rate with secondary TEP makes us believe that it is a better technique to be adopted. Further, plan for secondary TEP will give enough time to the patients to develop oesophageal speech, if they are capable of.     

Allogreffe de face et implantologie basale (implant-disques à appuis corticaux)

Introduction

We report a case of total oral rehabilitation with basal implants (cortically anchored disk-design implants) on a patient who received a facial allograft 1 year earlier.

Observation

A 31-year-old patient was suffering from a plexiforme neurofibroma spread into the soft tissues of the oral cavity with huge deformations of the jaws. The operation consisted in pulling out numerous supernumerary impacted teeth, removing unnecessary soft tissues, settling six basal implants in the maxilla and seven in the mandible. The following day, two resin bridges were adjusted and cemented onto the implant abutments. The permanent bridges were settled 2 months and half later. The outcome was still unremarkable 2 years after the implant procedure.

Discussion

This case report raises important issues, notably the relevance of an oral rehabilitation with implant-supported prostheses on an immunosuppressed patient. In this specific case, this was impossible to achieve using removable prostheses. A facial reconstruction with its plastic, functional, and social goals seemed inconsistent without an oral rehabilitation. Even if they have not been published, cases of grafted patients with dental implants are unexceptional. Lastly, this rehabilitation has been planned for a particularly monitored patient. The second important question regards the choice of the basal implantology. This option has been motivated by the possibility to complete the case in one sole operation with provisional prostheses cemented the day after that act like orthopaedic external fixators providing an exceptional primary stability. The cortical anchorage, which was the only reliable on this patient, allowed to avoid bone grafting. Finally, the particular thinness of the implant emergence limits to the minimum the communications between bone and oral cavity. We would like to stress that the only objective of this observation was to document a specific case and possibly to open the way to a scientific study in accordance with the regulations of clinical research.     

Osseointegrated Oral Implants in Head and Neck Cancer Patients

After cancer treatment in the head and neck area, mastication and speech are often affected. Some of the problems encountered can be solved by adequate dental rehabilitation. However, dental rehabilitation is often compromised for various reasons. The change in anatomy due to surgery often results in lack of denture-bearing mucosa. The effects of radiotherapy on the salivary glands and the mucosa result in dry oral tissue and diminished retention of removable dentures. Osseointegrated oral implants can help to solve these problems. Although implant treatment for patients with cancer of the head and neck is covered by the Dutch national health insurance, and there is therefore no financial obstacle, implants have not, so far, been widely used with these patients. In order to establish the possible reasons for this, an analysis was performed. Retrospective data on 95 consecutive patients were collected from records. The indication for the use of oral osseointegrated implants was reviewed. Analysis of the data showed that 45% did not need specific prosthetic rehabilitation. An indication for the use of osseointegrated implants was found in 25% of the patients. For various reasons, only 3% actually received implants. In striving to completely rehabilitate a cancer patient, the possible use of osseointegrated oral implants should be evaluated before the initial oncological treatment begins. The insertion of implants during the initial surgical procedure should be considered more often, with a view to reducing the number of surgical procedures.     

The role of a psychologist in a rehabilitation of the patients with laryngeal cancer after total laryngectomy with implantation of the voice prostheses

The new possibilities of voice rehabilitation in patients with laryngeal cancer who undergo total laryngectomy have been opened with the surgical insertion of voice prostheses after performing of the tracheoesophageal shunt. This method enables to achieve a voice of better quality which leads to improved patients' general well-being. The cornerstone of the rehabilitation after an implantation of voice prosthesis is an appropriate psychosocial attitude of a patient towards combating of a cancer and his motivation for a verbal communication. In this review we have characterized both a role of the psychologist in the diagnostic and therapeutic team and psychological attitudes of the patients with cancer. These problems were illustrated by the clinical cases.     

Provox voice prosthesis — The Indian experience

Following Total Laryngectomy, Tracheo-oesophageal speech prosthesis offers the most reliable form of voice rehabilitation. Of the various prostheses currently available. The Provox voice prosthesis developed by the Netherlands Cancer Institute has been the most popular due to its superior design and in-dwelling nature. At the Apollo Cancer Hospital, Hyderabad, 17 patients underwent speech rehabilitation with the Provox voice prosthesis between February 1999 and July 2000. Speech rehabilitation was successful in all patients with the majority (82%) developing Good—Excellent speech. Two patients required replacement and one patient discontinued use of the prosthesis. There were no complications in any of the other patients.