下颌外旋切除咽及颅底肿瘤

目的 探讨咽及颅底肿瘤切除的最佳手术入路。方法 １３例咽及颅底肿瘤中，鼻咽部２例，口咽部４例，咽旁间隙５例，咽旁颞下区２例。均采用下颌骨切开外旋入路进行了根治性切除。同期行咽后淋巴结清扫术５例，改良根治性颈清扫术２例，咽部缺损以胸大肌皮瓣整复５例。恶性肿瘤术后均接受了辅助性放射治疗。结果 １３例患者中恶性肿瘤１０例，良性肿瘤３例。１２例切口愈合良好，１例术后胸大肌皮瓣感染坏死，延缓愈合。１例吞咽困     

上颌外旋及下颌外旋切除前中颅底、咽、咽旁间隙肿瘤的手术研究

目的探讨彻底切除前中颅底、咽、咽旁间隙肿瘤的理想手术入路.方法采用不同部位的上颌外旋入路切除16例前、中颅底肿瘤,此16例肿瘤均累及多区,范围广泛;采用下颌外旋入路治疗26例鼻咽、口咽、咽旁及颅底肿瘤.结果16例上颌外旋术后随访2～5年,生存4年以上3例,3年以上6例,2年以上6例,术后1.5月死亡1例.26例下颌外旋术后随访18个月～6年,4例良性肿瘤情况良好,无复发,22例恶性肿瘤中,2例0.5年内死亡,2例1年余复发,1例术后2年死于肺部转移,4例存活5年以上,6例存活4年以上,3例存活3年以上,3例存活2年以上,1例存活1年以上.大部分病例仍在继续随访中.结论上颌外旋及下颌外旋入路是彻底切除前中颅底、咽、咽旁间隙肿瘤理想、可靠的手术入路.     

颅面拆装入路广泛性颅底肿瘤手术

目的：探讨颅面装装入路在颅底广泛性肿瘤切除术中的应用。方法：１０例范围广泛的颅底区肿瘤分别采用了额鼻拆装，颅同联合入路；上颌窦壁拆装，上颌窦鼻腔入路；颞颧下颌骨拆装，颞面联合入路等３种手术方式切除。结果：２例良性肿瘤术后随访１－３年无复发。８例恶性肿瘤术后，５例已存活３年以上，其中３例已 活５年以上；另３例均在术后３年内死亡或失访，结论：采用颅同拆装入路施行颅底肿瘤切除术，术野暴露较充分，有利于病     

下颌骨外旋咽、颅底肿瘤切除术4例报告

目的总结下颌骨外旋咽、颅底肿瘤切除术的体会.方法 4例咽及颅底肿瘤均采用下颌骨外旋入路进行手术切除.同期颈淋巴结清扫术2例,咽侧壁缺损以咽后壁局部黏膜转移修复2例.结果 3例恶性肿瘤完全切除;1例脊索瘤未完全切除,术后发生脑脊液鼻漏,填塞后痊愈.2例口咽癌中,1例术后1年死于局部复发,另1例术后2年10个月死于肺部转移.1例咽旁恶性混合瘤已术后3年2个月,仍在随访中.1例脊索瘤2年5个月死于颅内广泛转移.结论此手术入路能充分显露咽、中颅底、咽旁间隙、斜坡和颈椎,并能从颈部向上至颅底,将肿瘤完全切除,手术安全,后遗症轻微.     

口咽癌的外科治疗

目的：探讨口咽癌扩大切除一期再建的手术方法，观察并发症及术后语言，吞咽功能恢复情况。方法：３０例口咽癌中软腭癌２例，扁桃体癌３例，咽侧壁癌１６例，舌根癌９例；Ⅲ，Ⅳ期患者６３．３％（１９／３０），颈淋巴结转移５３．３％（１６／３０），２２例用下颌骨切开外旋或切除切支入路进行了肿块根治性切除，同期行颌下清扫术１例，肩胛舌骨肌上清扫术３例，根治性颈清扫术２６例。咽部缺损用带蒂胸大肌皮瓣整复１７例，胸倘     

前颅底区恶性肿瘤的治疗——附17例报告

目的：探讨前颅底区恶性肿瘤的秣入路、修复方法和综合治疗。方法：１９９２￣１９９８年６年间我们共收治的１７例前颅底区恶性肿瘤患者,９例采用了颅面眶联合进路的方法一次性完整切除肿瘤,并在术中采用了带蒂的颞肌肌瓣、颞肌筋膜瓣、帽状腱膜瓣、额肌肌瓣或肌皮瓣等＋骨板或＋游离植皮等方法,对前颅底区的组织缺损进行了一期修复,１３例手术前后辅以放射治疗和／或化学治疗。结果：存活５年以上５例,３年以上２例,２年以上     

上颌骨外旋入路切除颅底及咽旁间隙肿瘤

目的：探讨颅底及咽旁间隙肿瘤切除的最佳手术入路。方法：2例咽旁间隙肿瘤、1例颅底肿瘤患者均采用上颌骨外旋入路，取Weber-Ferguson-Longmire切口，形成以咬肌为蒂的上颌骨肌皮瓣并外旋，充分暴露鼻咽部及咽旁间隙，直视下完整切除肿瘤。以颊部脂肪堵塞残留空腔，行上颌骨骨瓣复位。结果：3例术后切口愈合良好，颌面部无明显畸形及颌面功能障碍，其中1例术后行放疗。3例术后随访10个月～2年，肿瘤均无复发。结论：上颌骨外旋是切除颅底及咽旁间隙肿瘤的较佳手术入路，能充分暴露颅底及咽旁间隙、鼻咽部，在直视下完整分离切除肿瘤，手术安全，损伤小，术后功能恢复良好。     

筛窦及前颅底外科

对侵犯前颅底、颅内的鼻腔、鼻窦肿瘤２３例，施行了根治性手术，其中良性肿瘤５例，恶性肿瘤１８例，使用带蒂帽状腱膜、颅骨膜，重建被切除的颅底骨质和硬脑膜。手术均采用颅面联合切除术，术后无严重并发症，无１例发生脑脊液鼻漏或出现脑脑膜膨出。恶性肿瘤患者３年生存率为４４４％。     

斜坡肿瘤的外科治疗

目的为提高斜坡肿瘤患者的生存率和生存质量，总结选择合适的手术进路和尽可能彻底清除病变及减少并发症的经验。方法根据患者的症状、体征和影像学分析结果，分别采用经口－硬腭进路、面中－蝶窦进路和前颅底硬膜外－眶进路手术治疗了累及斜坡的肿瘤２７例，其中６例脊索瘤，２例颅咽管瘤和１９例斜坡恶性肿瘤。术后接受了辅助性放射治疗，２例鼻咽癌和２例筛窦癌患者于手术及放射治疗前接受了控制性升降血压的变压化学疗法治疗。结果２７例斜坡肿瘤患者中，１例筛窦癌患者因局部出血导致脑干受压于术后第３天死亡，余２６例均无严重并发症，切口愈合良好。８例良性肿瘤中，１例术后２年以上存活，５例术后３年以上存活，２例术后８年以上存活。存活的１８例恶性肿瘤中，２例术后６年以上存活，１１例术后２年以上存活，１例术后３年零４个月死亡，２例术后１年半死亡，２例术后４个月死亡。恶性肿瘤２年以上生存率为７３．７％（１４／１９）。结论斜坡肿瘤的外科治疗，必要时配合放射治疗和化学治疗可明显提高患者生存率和生存质量。     

14例颅底肿瘤的手术治疗

目的：探讨颅底肿瘤的手术方法。方法：本文报道１４例颅底肿瘤的手术治疗效果，介绍了３种颅底肿瘤的手术方法，即：耳前“∩”形切口颞蝶进路、改良的颞下窝进路、上颌骨拆装术，并对各自的适应症及优越性进行了讨论。结果：１４例颅底肿瘤，良性６例，恶性８例。６例良性肿瘤术后随诊１￣７年，无复发；８例恶性肿瘤中，１例因年龄大，术后７个月死于心脏病，１例术后３年死于复发，１例术后４年带瘤生存，其余４例皆随诊２年以上     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

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.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.