Three-dimensional laryngeal model for planning of laryngeal framework surgery

CONCLUSION: The three-dimensional prototype model was useful for planning of laryngeal framework surgery. OBJECTIVE: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. MATERIALS AND METHODS: A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). RESULTS: We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.     

Three-dimensional imaging of the larynx for pre-operative planning of laryngeal framework surgery

Modern laryngeal framework surgery (LFS) requires an exact understanding of the laryngeal biomechanics and precise pre-operative planning, for which bi-planar imaging is not sufficient. The aim of the study was to test whether MIMICS®, a commercially available software package for three-dimensional (3D) rendering of high-resolution computerised tomography (HRCT), is suitable for 3D imaging of the larynx, analysis of laryngeal biomechanics and pre-operative planning. We examined four cadaver larynx and one patient larynx. In the five larynges, all relevant structures and landmarks could be 3D visualised. Superimposing of two HRCT scans shows that when the arytenoids move from ‘respiration’ to ‘phonation’, they perform a rotating, translating and tilting motion. Moreover, we could demonstrate that the vocal fold elongates by 7% with cricothyroid approximation. We conclude that MIMCS^® is well suited for 3D imaging of the larynx, analysis of laryngeal biomechanics and pre-operative planning of LFS procedures.     

Absence of high-risk human papilloma virus in p16 positive inverted sinonasal papilloma

ObjectivesSinonasal inverted papilloma (SIP) is a relatively rare disease, and its etiology is not understood. It is characterized by locally aggressive growth and a strong tendency to recur despite its benign histology.AimsThe aim of this study was to identify the presence of human papilloma virus (HPV) and its surrogate marker p16 in SIP tissue samples from a regional cohort.Material and methodsSubjects were identified from our regional center cohort of 88 SIP patients treated between 1984–2014. From these subjects, 54 were included in this study. Of these, 53 biopsies were analyzed with PCR, and 54 samples were immunohistochemically stained for p16. DNA was extracted from histopathologically verified SIP. Genotype screening for 13 high risk-, 5 oncogenic and 6 low risk HPV types was performed using the PapilloCheck® HPV-screening test.ResultsHPV analysis was successful for 38 of 53 samples. Of the 38 successfully analyzed samples, only 2 samples were positive for HPV 11. Notably, p16 was present in the epithelia in all samples, and in the papilloma lesions in 37 samples.ConclusionSince only 2 out of 38 SIPs were positive for HPV (type 11), and at the same time p16 was positive in epithelia in all samples and in 37 of 38 papilloma lesions of the samples, it is concluded that p16 cannot be used as a surrogate marker for high-risk HPV-infection in SIP. We are currently planning a prospective, multicenter study in order to increase the study power and in order to be able to better evaluate the clinical implications of HPV-and p16 in SIP.     

鼻内镜联合鼻外径路在鼻腔鼻窦内翻性乳头状瘤手术中的应用

目的：探讨鼻内镜联合鼻外径路手术能否降低鼻腔鼻窦内翻性乳头状瘤术后的复发率。方法：将我科2000年1月至2006年1月收治的鼻腔鼻窦内翻性乳头状瘤且随访资料完整的病例分成两个阶段（2000年1月至2003年1月,2003年1月至2006年1月）行回顾性分析：前一阶段多采用单纯鼻内镜下手术,后一阶段根据病变范围多采用鼻内镜联合鼻外径路手术,比较相同 Krouse分级病例两种手术方式术后复发率有无差异。结果：KrouseⅠ、Ⅱ级病例两种手术方式的复发率差异无统计学意义,KrouseⅢ级病例鼻内镜联合鼻外径路手术的复发率低于单纯鼻内镜下手术的复发率。结论：对于KrouseⅢ级的鼻腔鼻窦内翻性乳头状瘤,鼻外径路手术恰能对目前的鼻内镜手术起到很好的补充,鼻内镜联合鼻外径路手术能更彻底地切除肿瘤,减少残留、复发,同时尽可能地减少创伤     

Dexmedetomidine sedation for laryngeal framework surgery

OBJECTIVES: Sedation for laryngeal framework surgery has lacked easy modulation between appropriate pain control, airway protection, and the alertness appropriate for vocal testing. Our objective was to determine whether dexmedetomidine hydrochloride could safely and effectively be used as the sole intravenous anesthetic agent in conjunction with local anesthesia for laryngeal framework procedures. METHODS: We undertook a prospective review of 14 patients who underwent laryngeal framework surgery with dexmedetomidine anesthesia in 2004 and 2005. All dexmedetomidine doses, sedation levels, and vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation level, were recorded every 15 minutes by the anesthesiologist throughout the duration of the procedures. Operative conditions were noted by the surgeon, focusing special attention on airway protection, patient arousability, and patient comfort. RESULTS: Dexmedetomidine sedation produced hemodynamic and respiratory values that were maintained near preoperative values, and overall pharyngeal-laryngeal integrity provided superior operating conditions for the patient and the operating surgeon. CONCLUSIONS: We believe that dexmedetomidine provides excellent sedative and operative conditions for awake laryngeal framework procedures. Coupled with local anesthesia, dexmedetomidine produced virtually no undesirable hemodynamic or respiratory effects, while allowing for adequate sedation the majority of the time. The operative conditions were markedly improved over those of previous standard monitored anesthesia regimens.     

鼻内窥镜在鼻内翻性乳头状瘤手术中的价值

目的 :探讨鼻内窥镜在鼻内翻性乳头状瘤手术中的价值。方法 :鼻内翻性乳头状瘤患者 2 9例中 ,采用鼻内窥镜手术者 15例 (鼻内窥镜组 ) ,经鼻侧切开手术者 14例 (鼻侧切开组 ) ,并将两种手术结果进行比较。结果 :随访 1.8年。并发症 :鼻内窥镜组 (1例 )明显低于鼻侧切开组 (5例 ) ,P <0 .0 1;住院时间 :鼻内窥镜组 (13.1d)明显短于鼻侧切开组 (2 0 .4d) ,P <0 .0 1;术中出血量 (Ⅰ～Ⅱ级 ) :鼻内窥镜组 (175ml)亦明显少于鼻侧切开组 (5 2 5ml) ,P <0 .0 1。结论 :鼻内窥镜术是治疗Ⅰ～Ⅱ级鼻内翻性乳头状瘤一种较好的方法 ,其主要优点是避免了面部切口 ;对Ⅲ～Ⅳ级病例 ,使用鼻内窥镜术应持谨慎态度 ,鼻侧切开术仍不失为安全、可靠的治疗方法     

Detection of human papillomavirus type 57 in a case of inverted nasal papillomatosis in Japan

Human papillomavirus (HPV) type 57 DNA was detected in recurrent nasal inverted papillomatosis, in a 60-year-old Japanese male, using Southern blot hybridization. HPV types 6, 11, 16 and 18 were not detectable in the papilloma. Previous studies have shown that HPV types 6, 11, 16 and 18 were mainly found in nasal papillomatosis in other laboratories but the actual detection rate of virus was low. We speculate that this low detection rate may be due to the lack of a method for detecting HPV type 57.     

Safety of paediatric day-stay laryngeal surgery for recurrent respiratory papillomatosis

ObjectivesSafety assessment of day-stay laryngeal surgery in a cohort of children with recurrent respiratory papillomatosis (RRP). Recurrent respiratory papillomatosis is a chronic debilitating disease which usually requires multiple recurrent interventions under general anaesthesia. Day-stay surgery is an attractive option as it allows avoiding the inconvenience and costs of routine overnight admissions while recovering in the safe environment of the family home. This is the first study to assess the safety of day-stay laryngeal surgery in this cohort of patients.MethodsRetrospective cohort study of all consecutive RRP procedures performed between December 1998 and May 2015 in a single paediatric tertiary-level hospital.ResultsA total of 465 surgical procedures were performed in 20 patients. Average age on diagnosis was 4.5 years. 415 (89.25%) of the procedures were done as day cases without overnight admission. Average number of procedures per patient was 20 and 25 for Children positive to HPV6 and HPV11, respectively. Only one patient after one single procedure (presenting 0.21% of total procedures, 0.24% of day-stay procedures) represented after discharge.ConclusionsDay-stay surgery for children with RRP has a favourable safety profile in selected cases.     

Inverted schneiderian papilloma of the supraglottis: Case report

Inverted schneiderian papillomas are rare benign tumors, most often arising from the sinonasal mucosa. We describe a case of a 59‐year‐old female with an inverted papilloma of the supraglottis. This is the first reported case of a supraglottic‐presenting inverted papilloma. Although rare, this case demonstrates that these tumors should be considered during workup of supraglottic laryngeal masses. Laryngoscope, 127:2830–2832, 2017     

Presence of human papillomavirus type-6-related sequences in inverted nasal papillomas

Summary Twenty DNA samples obtained from seven cases of inverted papillomas, eight cases of nasal polyps and five cases of chronic sinusitis were investigated by Southern blot hybridization for the possible presence of sequences homologous to human papillomavirus (HPV) types 6, 11, 16 and 18. HPV type-6-related DNA was identified in one of the seven inverted papillomas. The restriction endonuclease cleavage patterns showed that this latter DNA is a new subtype of HPV type 6 DNA. In the other six papillomas and in all cases of nasal polyps and chronic sinusitis, no HPV sequence could be demonstrated, even under low stringent conditions (T _m–40°C). These results indicate that HPV infection might be one of the possible causative factors in the pathogenesis of inverted papillomas but is not essential for the induction of the tumor.     

鼻内镜下泪前隐窝入路治疗上颌窦内翻性乳头状瘤的疗效分析

目的 探讨鼻内镜下经泪前隐窝入路(即鼻腔外侧壁入路)手术治疗上颌窦内翻性乳头状瘤的疗效及并发症。 方法 回顾性分析2014年9月至2016年3月收治的21例内翻性乳头状瘤的临床资料。 结果 21例患者通过鼻内镜经泪前隐窝入路手术治疗上颌窦病变,术中均完全清除窦内病变,且术中、术后病理证实为内翻性乳头状瘤。术后愈合良好,无严重并发症。1例患者术后6个月局部复发,再次手术切除,现随访12个月无复发。 结论 经泪前隐窝入路进入上颌窦切除病变是一种微创、安全、有效的处理内翻性乳头状瘤的手术方式。     

Endoscopic surgery for inverted papilloma originating from the sphenoid sinus and related clinical characteristics

Conclusions. Bony changes on CT imaging of inverted papilloma (IP) are useful for predicting tumor origin and recurrence sites. Because the lateral wall and floor of the sphenoid sinus are the most common origin and recurrence sites, the anterior wall of the sphenoid sinus should be opened as wide as the lateral wall and inferiorly to the level of the floor, especially in deeply pneumatized sphenoid sinuses. Objectives. The incidence of isolated sphenoid IP is exceedingly low. So far, there have not been studies on the usual origin and recurrence sites of the sphenoid sinus. We sought to identify the sites of origin and recurrence and describe clinical characteristics, radiological features, and proper endoscopic management. Patients and methods. We retrospectively reviewed medical records of patients with IP of the sphenoid sinus. Data collection included clinical presentations, origin and recurrent sites, radiological features, and surgical methods. Results. Seven patients were identified. The most common symptoms were headache and nasal obstruction. Radiological findings showed that most tumors extended into the nasal cavity or ethmoid sinus combined frequently with erosion of the lateral wall or intersinus septum. We noted simultaneous attachment to multiple walls in five subjects, including both lateral wall and floor attachment in three subjects.     

鼻内翻性乳头状瘤的术式选择和疗效分析

目的 探讨鼻内翻性乳头状瘤(NIP)的手术治疗策略及相应疗效情况。 方法 回顾性分析2010年10月至2016年10月收治的181例NIP患者的临床资料。患者术前均行鼻内镜、CT或MRI检查,明确病变范围,根据Krouse分期系统进行临床评级,综合评估并制定手术方法,其中鼻内镜手术124例,鼻侧切开术27例,鼻内镜联合柯-陆式手术30例。术后随访1~6年。 结果 181例NIP患者术后总复发率为17.7%(32/181),其中鼻内镜手术复发率为15.3%(19/124),鼻侧切开术复发率为25.9%(7/27),鼻内镜联合柯-陆式手术复发率为20.0%(6/30),差异无统计学意义(P>0.05)。对不同分级患者术后复发率进行统计,其中Ⅰ级复发率为11.8%(2/17),Ⅱ级复发率为11.6%(8/69),Ⅲ级复发率为17.2%(11/64),Ⅳ级复发率为35.5%(11/31),级别越高复发率相对越高;各级之间术后复发率差异有统计学意义(P<0.05)。 结论 鼻内镜手术已成为NIP主要治疗方式,疗效与鼻外径路术式相仿。高分级NIP复发率较高,而合理选择术式彻底切除肿瘤及严格的术后随访则是其治疗成功的关键。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的:探讨鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术的疗效及应用价值.方法:回顾性分析1999年7月～2005年4月诊治的有完整随访资料的40例经鼻内镜手术治疗的鼻腔鼻窦内翻性乳头状瘤患者的临床资料.结果:所有病变均一次完全手术切除,5例患者接受术后放疗.无严重并发症发生.术后随访24～93个月,平均45.1个月,6例复发,其中3例恶变,3例死亡.复发时间18～58个月,平均37.3个月.结论;经鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤安全、有效、微创,彻底切除肿瘤、术后定期随访是治疗成功的关键.     

External vs endoscopic approach for inverted papilloma of the sino-nasal cavities: a retrospective study of 136 cases

Conclusion. Endoscopic removal, with or without external technique, can be performed in a majority of inverted papilloma cases. This method has subsequent recurrence rates that are comparable to those of more aggressive external techniques and it is more cost efficient with less morbidity. Objectives. To analyze the clinical outcomes of our 21-year experience (1986–2006) in treating inverted papillomas using different treatment modalities. Patients and methods. The patients were divided into a conventional surgery group (CSG) and an endoscopic surgery group (ESG) and were staged according to the system developed by Krouse. A retrospective assessment was performed. Results. The recurrence rates were 4.3% in ESG and 9.5% in CSG. There was no significant difference in the recurrence rates according to the treatment modality used and the Krouse stage in the two groups. Mean operation time was 72.93±18.51 min in the ESG and 112.02±56.52 min in the CSG. Mean period of hospital stay was 4.66±1.75 days in the ESG and 9.54±4.79 days in the CSG. The complication rate was 3.2% in the ESG and 33.3% in the CSG. There was a significant difference in the operation time, length of hospital stay, and complication rate in the two groups.     

Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases

OBJECTIVE: The objective of this study is to compare the surgical options for treatment of inverted papilloma to determine the appropriate indications for conservative and aggressive management. STUDY DESIGN AND SETTING: A retrospective review of 160 patients with a diagnosis of inverted papilloma treated by the two senior authors (w.l. and h.f.b.) between 1973 and 2001. RESULTS: The study group consisted of 124 male and 36 female patients with an average age of 56 years. The follow-up period ranged from 10 months to 16 years (mean, 5.2 years). Seventy-eight patients (49%) had undergone prior surgery. Lateral rhinotomy was performed in 112 patients (70%), with a recurrence rate of 18%. Conservative removal was performed in 41 patients (26%), including 30 (19%) endoscopic approaches, with a recurrence rate of 12%. The remaining patients underwent midfacial degloving, osteoplastic approach, or craniofacial resection. The rate of malignant transformation was 7%. CONCLUSION: We present the largest personal series of cases of inverted papilloma to date. Our data suggest that conservative approaches, especially endoscopic removal, can be performed on selected lesions with recurrence rates that are comparable to those of more aggressive techniques. Those inverted papillomas that recur after treatment may represent a subset of lesions with an inherent aggressiveness, for which optimal treatment has yet to be determined.     

Complications of laryngeal framework surgery (phonosurgery)

The rising popularity of surgery involving the laryngeal framework (surgical medialization of immobile vocal folds, vocal fold tightening, pitch variation, etc.) has resulted in increasing case experience. Little has appeared in the literature regarding complications or long-term results of this type of surgery. Several years' experience in a major referral center with various types of laryngeal framework surgery has led to a small number of complications. These have included late extrusion of the prosthesis and delayed hemorrhage. A review of these complications and recommendations for modification of technique to minimize them in the future are discussed.     

Inverted papilloma — an analysis of 30 cases

Clinical, radiological and surgical details of 30 patients of inverted papilloma treated between the years 1990-1995 were analysed. Inverted papilloma is a benign but locally aggressive tumour. Unilateral nasal obstruction with or without bleeding was the commonest presenting feature. More than half of the patients gave history of previous surgery. CT scan is a good modality to know the exact extent of the lesion and plan surgery. Radical surgery was done in all patients. We had recurrence in 1 patient (3.3%) and two patients had carcinomatous change (6.6%). The results are presented with brief review of literature.