Combined endonasal and orbital approach for annulus of Zinn area decompression in dysthyroid optic neuropathy

BackgroundDysthyroid optic neuropathy (DON) is a serious complication of thyroid-associated ophthalmopathy (TAO) that can cause permanent vision loss from orbital apex syndrome. Urgent management of high-dose corticosteroid pulse therapy is recommended, and salvage orbital apex decompression surgery may require in refractory patients ineffective with corticosteroid pulse therapy.PurposeTo evaluate the short-term efficacy and safety of combined endoscopic endonasal and orbital approach decompression in the annulus of the Zinn (AZ) area in refractory dysthyroid optic neuropathy (DON).MethodsIn this retrospective study, patients who underwent combined endoscopic endonasal and orbital approach decompression around the AZ area for the treatment of refractory DON from May 2021 to March 2022 were enrolled. A total of 15 orbital apex were decompressed across 9 patients. The demographic, imaging, and surgical data, as well as preoperative and postoperative best corrected visual acuity (BCVA), proptosis degree and Modified-Chinese-TAO-QOL scores, were collected and assessed. The t-test was used to identify differences between preoperative and postoperative parameters: visual acuity, proptosis and QOL scores.ResultsThe mean best corrected visual acuity (BCVA) improved from 0.79 ± 0.77 LogMAR preoperatively to 0.21 ± 0.27 LogMAR (P < 0.001) postoperatively. Additionally, proptosis decreased from 22.25 ± 2.01 mm to 18.42 ± 1.85 mm (P < 0.01), with an average decrease of 3.7 mm. The preoperative scores of the visual, psychological, and comprehensive components of QoL were 14.60 ± 9.08, 37.49 ± 6.26 and 26.75 ± 3.70, respectively, which significantly improved postoperatively to 54.18 ± 7.23, 68.78 ± 12.53 and 61.88 ± 9.37, respectively. The postoperative follow-up time ranged from 2 to 11 months, and the median follow-up time was 7 months. There was 1 case of transient postoperative sinusitis and 1 new case of transient diplopia, which was relieved after 3 months.ConclusionCombined endoscopic endonasal and orbital approach adequate decompression for AZ area significantly improves visual acuity and QOL in patients with DON.     

Visual changes after transnasal endoscopic versus transcaruncular medial orbital wall decompression for dysthyroid optic neuropathy

ObjectiveTo compare postoperative changes in visual acuity between the transnasal endoscopic approach and the transcaruncular approach when comparison of preoperative values used for medial orbital wall decompression in patients with dysthyroid optic neuropathy.MethodsWe included 14 patients (23 sides) and divided them into a transnasal group (11 sides, 8 patients) and a transcaruncular group (12 sides, 6 patients). Visual acuity was examined preoperatively, on postoperative days 1, 3, and 7, and at a final follow-up visit. The differences in postoperative improvement of the logarithm of the minimum angle of resolution (logMAR) visual acuity and critical flicker frequency (CFF) between the two surgical groups at each time point were analyzed using the Mann–Whitney U test.ResultsPostoperative improvement in logMAR visual acuity on postoperative days 1 and 3 and that in CFF on postoperative day 1 were greater in the endonasal group than in the transcaruncular group (P < 0.050). Vision was improved or maintained in all patients in the transnasal group at the final follow-up. One patient in the transcaruncular group had loss of vision on one side and decreased vision on the other side after surgery.ConclusionMedial orbital decompression appears to provide better postoperative vision when performed by the transnasal approach than by the transcaruncular approach in patients with dysthyroid optic neuropathy.     

Trans-ethmoidal optic nerve decompression

Blunt head injury frequently results in visual impairment, the optimal treatment of which is still debated. Over a 5-year-period (1987–1991) 111 patients with indirect optic nerve injury resulting from closed head trauma have been treated. In each case loss of vision was the only neurological deficit. In group A, 66 patients were initially treated with large doses of prednisolone (80 mg/day) for 3 weeks. Twenty-seven patients improved on steroids alone. In the remaining 39 patients in whom either unsatisfactory or no improvement occurred a transethmoidal optic nerve decompression was performed. Twenty-two patients in the latter group improved, thus yielding an overall improvement rate of 74.2% in group A. Group B (control), in which 45 patients were treated with prednisolone only (80 mg/day for 3 weeks), had an overall improvement rate of 51% (23 patients). The study reveals that while nearly half of such patients can improve on steroids alone, optic nerve decompression significantly improves recovery rates in patients where conservative treatment is unsatisfactory (P < 0.05). Total loss of vision not responding to steroids, absence of waveform on visual evoked response, and presence of an optic canal fracture indicate a poor prognosis.     

Traumatische Optikusneuropathie

Background

Traumatic optic nerve neuropathy (TON) is defined as injury to the optic nerve with subsequent vision loss due to head or craniocerebral trauma. The treatment of this disease is the subject of controversial discussions. The purpose of the present study was to investigate pre- and immediate postoperative visual acuity in patients with unilateral TON and to compare the results with the time interval between trauma and surgical intervention.

Patients and Methods

A total of 20 patients with unilateral TON and considerable vision loss were examined. All were treated with high dose corticoids and underwent microsurgical optic nerve decompression. Visual acuity was determined pre- and postoperatively. In long-term follow-up visual acuity was determined 3?months postoperatively.

Results

Postoperatively, nine patients (45%) achieved an improvement in visual acuity of more than 0.4, and another three patients (15%) an improvement of ??0.2. At 3?months postoperatively another four patients achieved a further improvement of their visual acuity of >0.2. A decrease in visual acuity was not observed in any case, nor were major surgical complications.

Conclusions

Factors which predict good prognosis for vision recovery include a short time interval between trauma and intervention, edema, and/or hematoma of the optic nerve sheath. Factors which predict a worse prognosis are a fracture line directly through the nerve canal, a time period between trauma and intervention of more than 24?h, and initial complete amaurosis.     

外伤性视神经损伤的临床处理

目的 :观察经鼻外筛蝶窦径路行视神经减压术辅助药物治疗对外伤性视神经损伤的疗效。方法 :14例外伤性视神经损伤患者经鼻外筛蝶窦径路行视神经减压术的同时辅以大剂量激素及神经营养药物治疗。结果 :总有效率为 5 7.14% ,术中、术后无任何严重并发症 ;其中 2例伤后 8、11d手术 ,术后 6个月仍无光感。结论 :鼻外筛蝶窦径路行视神经减压术损伤较小 ,术野暴露充分 ,简易安全 ;同时辅以药物治疗 ,更有利于神经功能恢复。综合性治疗对外伤性失明患者是一种较好的措施。     

影像导航下视神经减压术治疗外伤性视神经病

目的探讨影像导航下视神经减压术治疗外伤性视神经病（TON）的临床特点和预后影响因素。方法回顾性分析自2015年1月—2018年12月山西医科大学第二医院收治的20例TON患者的临床资料。通过单因素分析和非条件Logisitic回归分析评估不同因素对TON治疗效果的影响。结果术后随访3个月至1年,总有效率为60.0％（12/20）,其中术前有光感及以上者有效率为100.0％（6/6）,无光感者有效率为42.9％（6/14）。受伤1周内手术者,有效率75.0％（9/12）。术前CT显示视神经管骨折者,有效率为22.2％（2/9）。单因素与多因素结果均显示：术前视力、CT显示视神经管骨折是患者手术预后的影响因素。结论鼻内镜下视神经减压术是治疗TON的有效手段。术前有光感及以上是视力改善的保护性因素,术前CT显示视神经管骨折是视力无改善的危险性因素。对于伴有复杂颅面部外伤的患者,影像导航的应用可以达到精准定位,有效减压的目的,从而提高手术疗效,值得推广。     

Colesteatoma: influencia de la técnica quirúrgica y el estadio EAONO/JOS en los resultados audiológicos

Introduction and objectiveThe treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient's hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study are to determine the influence of the surgical technique use and this classification on patient's hearing outcomes.MethodsA retrospective study that include patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 is carried out. Based on pre-surgical computed tomography (CT) images, disease is staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry are analysed according to the surgical technique used and according to the stage of the disease.Results143 patients with no statistically significant differences in hearing thresholds before surgery are included. One year after surgery, all the patients’ airbone pure tone average (PTA) and mean differential auditory threshold have improved significantly (P = .01 and P = .001). Those patients who undergo tympanoplasty with two-stage canal wall up mastoidectomy presente better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved airbone PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001 and P = .013). The mean differential auditory threshold is also better (P = .008) in the patients who undergo tympanoplasty with canal wall down mastoidectomy one year after the procedure.ConclusionsReconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement is significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.     

Comparisons among vestibular examinations and symptoms of vertigo in sudden sensorineural hearing loss patients

ObjectivesVertigo in sudden sensorineural hearing loss (SSNHL) is hypothesized as an extension of the disease caused by the anatomical proximity of the cochlea and vestibule. The present study aimed to demonstrate the association of vestibular function test (VFT) results with SSNHL disease severity and prognosis.Materials and methodsThis study assessed clinical records of 263 SSNHL patients admitted to our hospital, between January 2010 and October 2017. Steroid treatment comprised high-dose intravenous dexamethasone (16 mg/d) or oral methylprednisolone (64 mg/d) for 4 days and tapered oral methylprednisolone for 8 days after discharge. Caloric tests were performed in all patients, and cervical vestibular-evoked myogenic potential (c-VEMP) and ocular VEMP (o-VEMP) tests were performed in 209 and 144 patients, respectively.ResultsNinety six patients had vertigo, and caloric abnormalities were observed in 119 patients. Initial PTA in patients with vertigo were worse than in those without vertigo (63.0 dB vs 72.7 dB, P = .002). Initial PTA in patients with abnormal o-VEMP was worse than in those with normal o-VEMP (61.4 dB vs 73.0 dB, P = .004). PTA improvement after steroid treatment in patients with vertigo was lower than in those without vertigo (25.0 dB vs 20.9 dB, P = .028). PTA improvement after treatment in patients with abnormal caloric results was lower than in those with normal caloric results (26.0 dB vs 18.4 dB, P = .013).ConclusionThe functions of vestibular organs, particularly the utricle and lateral semicircular canal, are associated with disease severity and hearing outcome in SSNHL patients.     

Influence of surgical technique on residual cholesteatoma location and prevalence

ObjectiveCompared to canal wall up (CWU) tympanoplasty, canal wall reconstruction (CWR) allows better visualization of cholesteatoma extension. The canal wall up approach provides good functional outcomes, but with higher rates of residual cholesteatoma. The aim of this study was to compare residual cholesteatoma prevalence and location between the two approaches.MethodSubjects were adult patients with residual cholesteatoma following CWU or CWR surgery between January 1, 2010 and December 31, 2015. During this period, 94 patients underwent CWU and 71 CWR; 22 presented with residual cholesteatoma: 16 after CWU (R-CWU group) and 6 after CWR (R-CWR group).ResultsThere was no significant inter-group difference in residual cholesteatoma prevalence: 17% after CWU, 8.4% after CWR. Locations comprised: 13 (81%) in the attic, 9 (56%) in the tympanic cavity and 4 (25%) in the mastoid in the R-CWU group, and 6 (100%) in the attic in the R-CWR group. There were significantly fewer tympanic cavity locations after CWR compared to CWU (P = 0.046).ConclusionResidual cholesteatoma prevalence did not significantly differ between the CWU and CWR approaches. The most frequent location was the attic; significantly more locations were in the tympanic cavity with the CWU approach. These findings are important for surgeons and neuro-radiologists during follow-up.     

Resultados tras la rehabilitación vestibular y terapia Wii® en pacientes con hipofunción vestibular unilateral crónica

Introduction and objectivesVestibular rehabilitation therapy is an exercise-based programme designed to promote central nervous system compensation for inner ear deficit. The objective of the present study was to analyse the differences in the perception of handicap, the risk of falls, and gaze stability in patients diagnosed with chronic unilateral vestibular hypofunction before and after vestibular rehabilitation treatment with complementary Wii^® therapy.Materials and methodsA review was performed on the clinical histories of patients in the vestibular rehabilitation area of a university hospital between April 2009 and May 2011. The variables studied were the Dizziness Handicap Inventory, the Dynamic Gait Index and dynamic visual acuity. All subjects received complementary Wii^® therapy.ResultsThere were 69 cases (41 woman and 28 men), with a median age of 64 years. The initial median Dizziness Handicap Inventory score was 40 points (range 0-84, percentile 25-75 = 20-59) and the final, 24 points (range 0-76, percentile 25-75 = 10.40), P < .0001. The initial median for the Dynamic Gait Index score was 21 points (range 8-24, percentile 25-75 = 17.5-2.3) and the final, 23 (range 12-24, percentile 25-75 = 21-23), P < .0001. The initial median for dynamic visual acuity was 2 (range 0-6, percentile 25-75 = 1-4) and the final, 1 (range 0-3, percentile 25-75 = 0-2), P < .0001.ConclusionA reduction was observed in the Dizziness Handicap Inventory Values. Values for the Dynamic Gait Index increased and dynamic visual acuity improved. All these variations were statistically significant.     

Peri-tumoral infiltrate associates with postoperative prognosis of patients with OSCC: Stronger association in HPV negative patients

PurposeThe current data on the relationship between local inflammatory infiltration and prognosis in oral squamous cell carcinoma (OSCC) are limited and controversial, especially in different HPV status. In this study, we analyzed the relationship between peri-tumoral inflammatory infiltrate (PTI) and HPV status and prognosis of patients with OSCC after surgery.MethodsA retrospective cohort of 99 primary OSCC patients who underwent surgery was constructed. P16 immunohistochemistry was used to determine HPV status. PTI was determined by hematoxylin-eosin staining and quantified into four levels: none (Score 0), weak (Score 1), moderate (Score 2) and strong (Score 3). The associations of PTI with clinico-pathological characteristics, HPV status and survival were examined.ResultsMost OSCC patients had weak to moderate PTI. PTI was significantly associated with lymph node metastasis (P = 0.041), and patients with moderate PTI had significantly better OS (P = 0.009) than those with no PTI. In HPV negative OSCC, patients with moderate PTI also had significantly better OS (P = 0.019) than those with no PTI. However, PTI was not significantly associated with survival in HPV positive OSCC.ConclusionsIn HPV negative OSCC, moderate PTI may suggest a better postoperative prognosis than no PTI.     

Clinical characteristics and prognosis of patients with hypopharyngeal cancers with multiple primary cancers: A propensity score matched analysis

PurposeThis study aimed to identify the clinical characteristics of hypopharyngeal squamous cell carcinoma (HPSCC) patients with multiple primary cancers (MPCs) and to compare differences between patients with metachronous and synchronous MPCs.Material and methodsThis study included 219 patients with HPSCC treated at our center between 2008 and 2020; the clinical characteristics and prognosis of 66 patients with MPCs were analyzed. Propensity score matching (PSM) was used to balance the factors between patients with synchronous and metachronous MPCs.ResultsSixty-six patients with HPSCC (66/219, 30.1%) experienced MPCs, of which 29 were synchronous and 37 were metachronous. The esophagus (n = 39, 59.1%), lung (n = 10, 15.2%), and oropharynx (n = 4, 6.1%) were the three most common sites of MPCs in both the synchronous and metachronous groups. More patients with synchronous MPCs were stage T1–2 (82.8% vs. 59.5%, P = 0.041) compared to those with metachronous MPCs. Among the 24 pairs of patients after PSM, patients with metachronous MPCs had higher 3-year progression-free survival (PFS) (52.5% vs. 16.3%, P < 0.001) and overall survival (OS) (58.5% vs. 22.1%, P = 0.001) than those with synchronous cancers. Multivariate Cox analysis showed that patients with synchronous MPCs had shorter PFS (HR 4.45, 95% CI 1.819–10.885, P = 0.001) and OS (HR 3.918, 95% CI 1.591–9.645, P = 0.003).ConclusionMPCs are common among patients with HPSCC, and patients with metachronous MPCs had better survival than those with synchronous MPCs. Clinicians should be aware of the possibility of MPCs in patients with HPSCC and optimize treatment to improve outcomes.     

外伤性视神经损伤经鼻内镜视神经减压手术时期选择及疗效观察

目的 观察鼻内镜下视神经减压术治疗外伤性视神经损伤的疗效和最佳手术时间.方法 对1998年4月至2007年3月90例头部和(或)颌面外伤后发生93眼外伤性视神经损伤的患者进行回顾性分析.所有患者接受鼻内镜视神经减压术前对药物治疗均无反应或效果不佳.受伤至手术时间1～97 d,中位手术时间5.5 d.术前无视力71眼,有视力22眼(1眼光感,5眼眼前手动,13眼眼前指数,1眼视力0.04,2眼视力0.1).随访时间6 d～2年,中位随访时间8 d.结果 视神经减压术后35例(36眼,38.7%)视力有改善,53例(55眼,59.1%)无变化,2例(2眼,2.2%)视力下降.术前有视力的患者中,视力改善者达68.2%(15/22眼),外伤后立即或逐渐失明的患者中视力改善分别只有22.9%(8/35眼,仅2眼视力恢复到大于0.02)和36.1%(13/36眼,5眼视力恢复到大于0.02),术前有视力和无视力两组视力术后恢复差异非常显著(X2=11.864,P<0.01).无视力的患者中,伤后3 d内手术视力改善为41.2%(7/17眼),3 d后手术视力改善下降到25.9%(14/54眼),但两者之间差异无统计学意义(X2=1.46,P>0.05).不同受伤部位比较,视神经管内外侧壁同时骨折手术效果最好(55.6%,10/18眼),其次为内侧壁骨折(45.7%,21/46眼),最差为没有骨折(20%,4/20眼)和单纯外侧壁骨折患者(11.1%,1/9眼).结论 为了挽救患者视力,应尽早行鼻内镜视神经减压手术,即使伤后立即丧失视力也不要放弃手术治疗.但手术后所获得的满意的视力恢复仍然需要进一步研究.     

Comparison of sonotubometry,impedance, tubo-tympano-aerography,and tubomanometry to test eustachian tube function

PurposeThere is currently no gold standard for the diagnosis of eustachian tube (ET) dysfunction. To provide an objective basis for the clinical diagnosis of ET dysfunction, we explored the characteristics of sonotubometry, impedance, tubo-tympano-aerography (TTAG), and tubomanometry (TMM) in volunteers with healthy ETs.Materials and methodsSonotubometry, impedance, TTAG, and TMM tests were performed in 110 healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed.ResultsThe ET opening rate was compared between sonotubometry with dry swallowing, impedance with the Valsalva maneuver, TTAG with the Valsalva maneuver, and TMM with a nasopharyngeal pressure of 50 mbar in 100 (90.9%), 102 (92.7%), 99 (90.0%), and 104 (94.5%) ears, respectively; there was no significant difference among the four methods (P = 0.575). In sonotubometry, both dry swallowing and the Valsalva maneuver were superior to wet swallowing in terms of detecting ET opening (P = 0.000). In TMM, both the opening rate and the external auditory canal pressure were positively correlated with the nasopharyngeal pressure. Specifically, the opening rate and external auditory canal pressure increased with an increase in the nasopharyngeal pressure (r = 0.271, P = 0.000; r = 0.315, P = 0.000, respectively).ConclusionsSonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical practice, the appropriate ET function test should be chosen on the basis of the patient's specific condition.     

鼻内镜下视神经减压术治疗外伤性视神经病72例

目的 探讨视神经减压术治疗外伤性视神经病的疗效。方法 对大剂量糖皮质激素冲击治疗无效的外伤性视神经病患者72例（73眼），采用鼻内镜下视神经减压术治疗。外伤至手术时间1～57d，其中≤3d15例，4—7d37例，8—10d9例，11—15d5例，16～30d5例，〉30d1例。术前视力：光感以上18眼；无光感55眼。结果 术后随访3个月-5年。73眼中46眼视力有不同程度的提高，总有效率63．01％。原无光感的55眼中，31眼视力有提高，有效率56．36％。有光感以上视力的18眼中，15眼视力有提高，有效率83．33％。术后全部患者术腔上皮化，术中无并发症发生。结论 经鼻内镜筛蝶窦入路视神经减压术进路简捷，损伤较小、疗效确切，且不遗留面部瘢痕，容易为患者所接受。对伤后时间较长、大剂量激素治疗无效、视力损伤严重的患者，手术仍有挽救视力的可能。     

手术联合药物治疗外伤性视神经病的疗效分析

目的 评价手术联合药物治疗外伤性视神经病(traumatic optic neuropathy,TON)的疗效,分析影响临床疗效的因素.方法 对69例(70眼)确诊为TON并行鼻内镜下视神经管减压术联合药物治疗患者的临床资料作回顾分析.将入院时视力分为无光感、光感、眼前手动、眼前指数和能见标准视力表(0.02以上)5个级别,分别计为Ⅰ～Ⅴ级.入院视力Ⅰ级(无光感)者40眼,18眼因CT证实严重视神经管骨折,急诊行鼻内镜下视神经管减压术;22眼入院后先行糖皮质激素冲击治疗后再行手术治疗.入院视力I级以上者30眼,CT显示视神经管骨折的16眼行急诊手术;14眼行糖皮质激素冲击治疗3 d后行手术治疗.随访3～12个月,观察视力恢复情况.结果 入院视力有光感者疗效显著优于入院视力无光感者(90.0%比27.5%),两组疗效相比差异有统计学意义(χ2=26.98,P<0.001).入院视力Ⅰ级患眼,糖皮质激素冲击治疗后视力提高者手术疗效(80.0%)优于无改变者(5.9%),两组疗效相比差异有统计学意义(χ2=12.09,P<0.001).结论 对于无光感的患者,经药物冲击治疗后视力仍无改善者,手术疗效较差;治疗前视力是影响疗效的主要因素.影像学检查有无视神经管骨折,不应作为是否手术的决定因素.     

Risk factors associated with microbial colonisation and infection of tracheostomy tubes

BackgroundA long-term tracheostomy tube has the potential to cause significant morbidity and mortality in both hospitalised patients and those in the community. This study aims to assess the rates of microbial colonisation and infection of tracheostomy tubes.Materials and methodsConsecutive patients were enrolled from both inpatient and outpatient settings during their routine tracheostomy changes. During changes, culture swabs were taken from the cuff/outer-cannula and inner-cannula. Analysis were performed to compare culture results with risk factors.Results65 patients were enrolled in the study. Inpatients (65.9% vs 38.1%, χ² 4.48, p = 0.03), increasing acuity of care (from outpatient; ward; HDU; and ICU in increasing acuity) (τ_b = 0.289, p = 0.012), cuffed tracheostomy tubes, (66.7% vs 39.1%; χ² 4.59, p = 0.032); diabetics (64.6% vs 35.3%; χ² 4.39, p = 0.036); and males were associated with increased colonisation (72.4% vs 44.4%; χ² 5.12, p = 0.024).ConclusionFactors associated with an increase in colonisation and infection of tracheostomy tubes were location, and in males, diabetics and in cuffed tubes.     

经鼻内镜视神经减压术治疗外伤性视神经病

目的 探讨经鼻内镜视神经减压术治疗外伤性视神经病(TON)的临床疗效及相关预后因素.方法 回顾性分析深圳市龙岗区耳鼻咽喉医院2015-2018年21例TON患者经过大剂量激素冲击治疗无效后经鼻内镜行视神经减压术,术后以提高患者视力级别作为判断临床疗效的标准.结果 术后常规予抗生素及激素、改善循环、营养神经等药物治疗,所...     

Anatomic measures of upper airway structures in obstructive sleep apnea

ObjectiveDetermine if anatomic dimensions of airway structures are associated with airway obstruction in obstructive sleep apnea (OSA) patients.MethodsTwenty-eight subjects with (n = 14) and without (n = 14) OSA as determined by clinical symptoms and sleep studies; volunteer sample. Skeletal and soft tissue dimensions were measured from radiocephalometry and magnetic resonance imaging. The soft palate thickness, mandibular plane-hyoid (MP-H) distance, posterior airway space (PAS) diameters and area, and tongue volume were calculated.ResultsCompared to controls, the OSA group demonstrated a significantly longer MP-H distance (P = 0.009) and shorter nasal PAS diameter (P = 0.02). The PAS area was smaller (P = 0.002) and tongue volume larger in the OSA group (P = 0.004). The MP-H distance, PAS measurements, and tongue volume are of clinical relevance in OSA patients.ConclusionsA long MP-H distance, and small PAS diameters and area are significant anatomic measures in OSA; however the most substantial parameter found was a large tongue volume.     

眶-筛-蝶联合径路视神经减压术的临床应用

目的 :探讨提高视神经管内段损伤疗效的方法。方法 :采用眶 筛 蝶联合径路对 5 2例视神经管内段损伤进行减压术治疗 ,全程松解视神经。结果 :术后视力得到不同程度恢复者 2 2例 ,视力改善率为 42 .3%。其中继发性视力损伤 2 3例 ,视力提高者占 73.9% ;原发性视力损伤 2 9例 ,视力提高者占 17.2 %。随访 6个月 ,视力恢复至 0 .0 5～ 0 .6。结论 :眶 筛 蝶联合径路视神经减压术进路短 ,视野宽 ,便于操作 ;且解剖标志清楚 ,易定位 ,更安全 ,更适合筛、蝶窦发育不良 ,骨质增生者。