489例听障儿童HCMV-DNA载量及抗体水平分析

目的分析听障儿童人巨细胞病毒(human cytomegdoviras,HCMV)核酸(DNA)检出情况、IgG抗体检出率及浓度的变化。方法选取2010年9月~2020年12月于我中心就诊的听障儿童489例为观察组,选取129例健康体检儿童为对照组。采用荧光定量PCR方法检测尿液HCMV DNA含量;采用ELISA方法检测血液HCMV IgG抗体。结果听障儿童尿液HCMVDNA阳性检出率38.24%(187/489)。187例阳性标本病毒平均浓度为3.65×10⁵(1.34×10³~2.79×10⁷)拷贝/ml,均高于对照组(P=0.000<0.05),听障儿童血液HCMV IgG抗体阳性检测率为78.32%(383/489),明显高于对照组(P=0.000<0.05),中高浓度例数明显高于低浓度组(P=0.005<0.05)。结论HCMV感染与儿童听力障碍明显相关,动态监测CMV-DNA/IgG,及时发现HCMV感染,控制感染和实施优先预防,对有效减少听力障碍的发生有重要意义。     

Lasik治疗屈光不正术中并发症的临床分析

目的分析Lasik手术中并发症发生的原因和预防处理措施.方法应用SchwindSupratome微型角膜切开刀和LasersightLSX型准分子激光对232例448眼行Lasik手术.结果并发症有游离角膜瓣2眼(0.45%),角膜瓣形成不全4眼(0.9%),结膜下出血195眼(43.53%),角膜血管翳出血9眼(2%),角膜瓣位置偏离4眼(0.9%),薄角膜瓣2眼(0.45%),角膜层间异物残留18眼(4.01%).结论Lasik治疗屈光不正安全有效,手术技巧提高和熟练掌握机器的性能有助于减少并发症和增加手术的安全性.     

表层角膜屈光手术后疼痛及角膜刺激症状的观察

目的 探讨表层角膜屈光手术不同手术方式术后疼痛以及角膜刺激症状的差异.方法 选取行表层角膜屈光手术的近视患者600例(1 200眼),根据不同手术方式分为准分子激光屈光性角膜切削术(PRK)组、乙醇法准分子激光上皮瓣下角膜磨镶术(LASEK)组和微型上皮刀法准分子激光上皮瓣下角膜磨镶术(Epi-LASIK)组,比较三组之间的疼痛指数以及角膜刺激症状.结果 术后第1天,PRK组与LASEK组疼痛指数及角膜刺激症状差异无统计学意义,Epi-LASIK组与其余两组差异有统计学意义.术后第2天、第3天,PRK组与其余两组相比差异有统计学意义,LASEK组与Epi-LASIK组相比差异无统计学意义.术后第5天三组之间疼痛指数以及角膜刺激症状差异均无统计学意义.结论 表层角膜屈光手术后疼痛是导致患者术后不适的主要因素.手术方式不同,患者术后的疼痛指数以及角膜刺激症状存在差异.     

EB病毒在儿童腺样体肥大和扁桃体炎组织内的定量研究及意义

目的:探讨EB病毒在儿童慢性扁桃体炎、腺样体肥大中的流行病学特点及其在儿童腺样体肥大、慢性扁桃体炎疾病发病机制中的作用.方法:采用实时荧光定量PCR技术对52例慢性扁桃体炎、腺样体肥大患儿手术摘除的腺样体、扁桃体组织及血浆标本进行EB病毒定量检测.结果:患有慢性扁桃体炎和(或)腺样体肥大的儿童扁桃体、腺样体组织中EB病毒感染率为51.9%;其中男性患儿EB病毒感染率为50.0%,女性患儿为55.6%,两者差异无统计学意义(P＞0.05).扁桃体组织EB病毒感染率为40.4%,腺样体组织为48.9%,差异无统计学意义(P＞0.05).学龄组(7～14岁)患儿扁桃体和腺样体组织EB病毒感染率为65.5%,明显高于学龄前组(2～6岁)患儿的感染率(34.8%).比较轻、中、重度肥大的腺样体组织中EB病毒-DNA拷贝数发现:重度肥大组EB病毒-DNA拷贝数明显高于其他两组(P＜0.05).52例患儿血浆标本检测发现:EB病毒-DNA拷贝数均在正常范围内(＜1×10~3 copies/ml).结论:腺样体肥大组织与慢性扁桃体炎组织对EB病毒有相同的易感性,男、女性患儿的扁桃体和腺样体组织对EB病毒易感性基本相同,且随着患儿年龄的增长、病程的延长,EB病毒的感染率也会相应增高.腺样体的增生、肥大与EB病毒的感染有一定相关性.     

儿童扁桃体腺样体低温等离子手术迟发性出血的初步研究

目的 比较低温等离子手术与常规手术方式在儿童扁桃体、腺样体手术后迟发性出血(手术24 h后)率及出血时间点的情况,初步探讨导致低温等离子手术迟发性出血的可能原因.方法 回顾性分析的方法研究采用传统手术和低温等离子手术行扁桃体切除和(或)腺样体刮除术1～14岁患儿术后迟发性出血率及出血时间点的差异.传统组为2005年4月至2006年7月行传统冷法手术(即传统手术刀切除,对周围组织没有热损伤的方法)的患儿,等离子组为2008年4月至2009年9月行低温等离子扁桃体切除和(或)腺样体消融术的患儿.结果 传统组患儿484例,术后迟发性出血2例,迟发性出血率为0.4%,出血时间点1例为术后2 d,另1例为术后3 d.等离子组患儿502例,术后迟发性出血11例,迟发性出血率为2.2%,出血时间点2～12 d,中位数为6.0 d.其中等离子刀初学者主刀手术的迟发性出血率为2.6%(10/385),技术操作熟练者手术的迟发性出血率为0.9%(1/117).等离子组迟发性出血率高于传统组(χ2=5.987,P=0.014),两组出血时间点差异无统计学意义(Mann-Whitney检验U=2.500,P=0.103).13例出血患儿中创面局部或上呼吸道感染者6例,术后进食不当的3例.结论 低温等离子技术应用于儿童扁桃体腺样体手术后迟发性出血的原因可能与手术技能经验不足、止血稳定性欠佳等有关,术后感染和进食不当也会造成迟发性出血,应引起临床重视.     

角膜再移植原因与植片失活的危险因素分析

目的 分析再次角膜移植的原因及影响角膜植片存活的危险因素。 方法 收集2010年1月至2018年12月于青岛眼科医院行角膜移植患者2060例资料,回顾性分析再次角膜移植的原因、首次角膜移植的原发病、既往及再次角膜移植的手术方式及术后并发症等资料。 结果 其中228例为再次角膜移植术(11.07%)。204例患者(207眼)接受再次角膜移植,其中189眼接受1次再次角膜移植,15眼接受2次再次角膜移植,3眼接受3次再次角膜移植,男性137例,女性67例,接受再次移植时的年龄为11~81岁,平均(49.93±14.32)岁。再次角膜移植的主要原因为角膜植片溃疡(60例,26.32%)、角膜植片内皮功能失代偿(58例,25.44%)、原发病复发(41例,17.98%)及角膜移植片混浊(32例,14.04%)。再次角膜移植的原发病主要为化脓性角膜炎(69眼,33.33%)、单纯疱疹病毒性角膜炎(32眼,15.46%)、角膜烧伤(22眼,10.63%)与角膜营养不良和变性(21眼,10.14%)。202例再次角膜移植的术式为穿透性角膜移植术(88.60%),26例再次角膜移植的术式为板层角膜移植术(11.40%),内皮移植术0例。再次角膜移植术式与既往角膜移植术式之间存在相关性(连续性校正χ2=43.365,P<0.01),既往手术方式影响再次角膜移植的手术方式。Cox多因素回归分析感染性原发病(P=0.005)、角膜植片直径>8.75 mm(P=0.040)、继发青光眼(P=0.027)以及角膜植片免疫排斥(P=0.047)是穿透性角膜移植失败的危险因素;感染性原发病(P=0.011)、角膜植片直径>8.75 mm(P=0.016)是前板层角膜移植失败的危险因素。 结论 再次角膜移植的主要原因为角膜植片溃疡,其次为角膜植片内皮功能失代偿,再次为原发病复发。再次角膜移植的原发病以化脓性角膜炎最多见,其次为单纯疱疹病毒性角膜炎,再次为角膜烧伤。既往手术方式影响再次角膜移植的手术方式。感染性原发病、角膜植片直径>8.75 mm、继发青光眼及发生免疫排斥是影响穿透性角膜移植术后植片存活的危险因素。感染性原发病和角膜植片直径>8.75 mm是影响前板层角膜移植术后植片存活的危险因素。     

角膜地形图仪对近视眼角膜屈光力检测的分析

目的全面准确地了解近视眼角膜屈光状态.方法采用计算机辅助角膜地形图仪检测近视眼角膜最大子午线屈光力(Smik1)及与其呈垂直子午线屈光力(Smik2).结果Smik1与Smik2在不同屈光度间无明显关联.Smik1＞Smik2,二者差值(△k)及偏心率(e值)随屈光度增高而变大.即近视眼角膜屈光力在不同屈光度间差异无显著性(P＜0.05),角膜散光多为循规性的,且随屈光度增高散光程度变大.结论角膜地形图仪能快速、全面、准确提供角膜的屈光状态指标,在角膜屈光手术中的应用价值将越来越受到重视.     

CO2激光手术治疗声门型喉癌疗效分析

目的总结CO2激光手术治疗声门型喉癌的临床治疗效果.方法对1992年8月～1998年4月激光手术治疗的217例声门型喉癌进行临床分析.217例中原位癌(Tis) 22 例,T1a病变108 例,T1b病变38例,T2病变46例,T3病变3例.术后随诊3～9年.结果 217例支撑喉镜下CO2激光手术后21例局部复发,局部复发率为9.7%(21/217).T1a复发率5.6%(6/108), T1b复发率21.1%(8/38),T2复发率13.0%(6/46),T3复发率(1/3),组间差异有显著性 (χ2值=6.102,P<0.01).病变侵犯前联合复发率21.6%(13/60),病变未侵犯前联合复发率5.1%(8/157),两组间差异有显著性 (χ2值=13.64,P<0.01).217例激光手术治疗的患者,201例存活,失访4 例(按死亡计算),死亡12例.3年生存率97.2%(211/217),5年生存率89.4%(118/132).结论激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,并发症的发生率低.     

咽旁间隙肿瘤不同手术入路选择策略及疗效分析CSCD

目的分析咽旁间隙肿瘤不同手术入路的选择策略及其疗效,为其诊疗提供参考。方法回顾性分析2014年1月~2021年6月于重庆医科大学附属第一医院耳鼻咽喉科接受手术治疗的53例咽旁间隙肿瘤患者的临床资料和随访结果,依据CT/MRI评估肿瘤大小与位置,包括与茎突、颈内动脉、颅底、硬腭及腮腺的关系。结果53例患者中,1例双侧发病。采用内镜辅助下的经口入路15例、经颈入路9例、经口经颈联合入路2例、经鼻入路3例,传统经颈入路25例。茎突前与茎突后的肿瘤症状(χ^(2)=27.50,P<0.001)和病理类型(χ^(2)=27.28,P<0.001)差异有统计学意义,不同手术入路的肿瘤与茎突(χ^(2)=18.78,P<0.001)、颈内动脉(χ^(2)=11.57,P=0.009)、腮腺(χ^(2)=10.64,P=0.015)的关系差异有统计学意义,而手术时间(H=7.46,P=0.113)、术中出血量(H=7.51,P=0.111)、完整切除率(χ^(2)=5.02,P=0.261)及术后并发症发生率(χ^(2)=5.49,P=0.207)无明显差异。7组配对分析中观察到内镜辅助下经口入路术中出血量(Z=-0.845,P=0.398)和术后住院天数(Z=-0.315,P=0.752)较传统经颈入路更少,但统计学差异并不显著。结论内镜辅助下切除咽旁间隙肿瘤的适应证已经得到了扩展,应针对肿瘤的性质、体积及位置延伸选择合理的手术方式,在保证手术疗效的同时尽可能降低手术创伤。     

耳硬化症初次及再次锤骨-镫骨底板开窗术治疗效果的分析比较

目的分析比较耳硬化症初次及再次修正锤骨-镫骨底板开窗术的手术疗效。方法回顾性分析瑞士卢瑟恩州立医院2002年4月至2017年12月连续收治耳硬化症患者,根据是初次行锤骨-镫骨底板开窗术(primary malleostapedotomy,P-MS)或是再次手术行修正的锤骨-镫骨底板开窗术(rivision malleostapedotomy,R-MS),将患者分为初次手术组(P-MS组)和修正手术组(R-MS组),对二者术中所见、术后听力结果进行比较。采用SPSS 23.0软件进行统计学分析。结果共70例患者(73耳)纳入研究。P-MS组35例38耳,男17例、女18例,平均年龄(43.6±10.5)岁;R-MS组35例35耳,男16例、女19例,平均年龄(47.3±10.9)岁;两组之间年龄、性别、手术侧别差异均无统计学意义(P值均>0.05)。除镫骨固定外,P-MS组术中所见主要为砧骨固定(50.0%,19/38),而R-MS组则为假体移位(60.0%,21/35)。500~3000 Hz和500~4000 Hz纯音听阈,R-MS组术后气骨导差(ABG)分别缩小(15.2±13.8)dB和(17.3±14.4)dB,P-MS组术后ABG分别缩小(18.1±8.2)dB和(18.3±8.5)dB,两组间比较,差异均无统计学意义(P值均>0.05)。R-MS组术后ABG明显大于P-MS组[500~3000 Hz:(16.1±11.8)dB比(8.5±5.7)dB;500~4000 Hz:(17.5±11.9)dB比(9.7±6.0)dB;P值均<0.05];R-MS组手术成功率(术后ABG<10 dB)显著低于P-MS组(500~3000 Hz:31.4%比65.8%,χ^2=8.606,P<0.05;500~4000 Hz:22.9%比57.9%,χ^2=9.240,P<0.05),而手术失败率(术后ABG>30 dB)显著高于P-MS组(500~3000 Hz和500~4000 HZ均为11.4%比0,χ^2值均=3.280,P值均<0.05)。两组各有3耳术后出现感音神经性聋(平均骨导听阈升高>10 dB),差异无统计学意义(500~3000 Hz和500~4000 Hz均为8.6%比7.9%,χ^2值均=0.011,P值均>0.05)。R-MS组初次修正手术(R-MS1)后ABG小于20 dB的比例为80.0%(20/25),而二次修正手术(R-MS2)后该比例为37.5%(3/8),二者差异有统计学意义(χ^2=5.18,P<0.05)。结论与初次锤骨-镫骨底板开窗术相比,再次修正手术引起感音神经性聋的风险并没有增加,而且仍能明显提高听力,但效果较初次手术差,失败风险高。二次修正手术效果欠佳,手术需谨慎,可以考虑助听器或其他听觉植入装置。     

The seroprevalence of hepatitis B,hepatitis C,and human immunodeficiency virus in patients undergoing septoplasty

Introduction

Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood–borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide.

Intraoperative adverse events in minor oral surgery. Risk analysis]

AIM OF THE STUDY: The aim of this prospective study was to evaluate oral surgical procedures performed as day surgery under local anesthesia. We examined patients' general condition, and besides checking for intraoperative complications we analyzed postoperative bleeding in patients with hemostatic disorders. PATIENTS: The patient population consisted of 1540 patients (797 female, 743 male), who underwent a total of 2055 minor oral surgical procedures over a 5-year period (1998-2002). Before the treatment started a data file was made for each patient, which contained information on his or her past medical history, concomitant medication, why the operation was indicated, premedication, anesthetic and surgical techniques applied, and postoperative treatment. RESULTS: Systemic pathologies influencing surgical decisions were found in 316 patients (20.5%), affecting 676 interventions (32.9%). In 109 patients (5.3% of the 2055) altered hemostasis was found. The surgical procedures recorded were: (operative) tooth extraction (n=394), interventions for surgical conservation of teeth (n=272), treatment for cysts (n=140), surgical revisions (n=46) and preprosthetic surgery (n=19). Passing complications, mostly systemic in nature, occurred during 27 sessions of local anesthesia (1.3%). There were 87 adverse events intraoperatively (4,2%), most of which were confined to the surgical field; specifically 15% of these complications took the form of hemorrhage. We observed no significant correlation between the occurrence of intraoperative complications and patients' gender, predisposing systemic pathologies including bleeding disorders, or age. Postoperative hemorrhage was observed significantly more frequently in patients with impaired hemostasis and required admission to hospital for inpatient treatment in 2 cases. CONCLUSION: According to our investigation, oral surgery can be performed in patients with compromised general condition with as few intraoperative complications as in patients with no general medical problems. However, in individual cases specific risk factors can be present and oral surgery may be temporarily contraindicated, at least as day surgery.     

Complications in surgical treatment of malocclusions. Report of 50 years experience]

BACKGROUND: During the past few decades, orthognathic surgery has become routine in oral and maxillofacial surgery. As these surgical interventions are elective, the goal is a low complication rate. The aim of this study was to analyze the intraoperative and postoperative complications after orthognathic surgery without considering orthodontic relapse. PATIENTS AND METHODS: The medical files of 507 patients were reviewed who had been treated in the department of oral maxillofacial surgery at the Martin-Luther-Universit?t in Halle-Wittenberg during a period of 51 years. The indication for orthognathic surgery was mandibular hyperplasia in 314 cases (61.9%), mandibular hypoplasia in 69 cases (13.6%), mandibular hyperplasia with a frontal open bite in 53 cases (10.5%), maxillary hyperplasia with a cleft in 30 cases (5.9%), maxillary hyperplasia in 22 cases (4.3%), severe laterognathia in 10 cases (2.1%), and isolated frontal open bite in 9 cases (1.5%). The surgical procedures were as follows: bilateral sagittal split osteotomy (n = 336, 66%), Le Fort I osteotomy (n = 29, 5.9%), bimaxillary osteotomy (n = 35, 6.3%), and segment osteotomy (n = 107, 21.1%). Rigid fixation was used in 147 patients. RESULTS: In 55% of the patients a postoperative neurosensory deficit of the inferior alveolar nerve was observed, which was only found in 28% after 1 year. Inflammatory wound healing was found in 5.3% of the patients. CONCLUSION: Due to antibiotic perioperative prophylaxis and modern rigid osteosynthesis devices, orthognathic surgery has become a routine method in maxillofacial surgery with predictable surgical results.     

Allograft tracheoplasty technique for management of refractory tracheal stenosis

OBJECTIVES: Extensive tracheal airway defects represent a clinical dilemma. Although resection and reanastomosis and staged tracheoplasty may prove beneficial in some cases, recurrent or extensive circumferential stenosis remains a reconstructive challenge. We report the use of the allograft tracheoplasty technique for the reconstruction of recurrent, extensive defects of the trachea and cricoid. METHODS: Nine consecutive patients with recurrent tracheal stenosis were treated with the two-stage allograft tracheoplasty technique. A retrospective review was performed to evaluate for prior surgery, length of stenosis, surgical technique, and outcome. All 9 patients underwent multiple surgical procedures for acquired tracheal stenosis (average, 3.4 procedures) before undergoing the allograft tracheoplasty technique. Before surgery, all patients were tracheotomy-dependent. RESULTS: The patients were assessed 8 to 39 months after allograft tracheoplasty. The primary airway disorders included postintubation stenosis (n = 6), surgical resection for malignancy (n = 1), and idiopathic stenosis (n = 2). Three defects involved 30% to 60% of the cricoid cartilage, and 4 defects were complete circumferential tracheal defects. Five patients underwent an island deltopectoral flap for closure of the tracheoplasty site. One patient had a superficial wound infection at the cartilage recipient site, and 1 patient had a hematoma at the deltopectoral flap donor site. All 9 patients were successfully decannulated without shortness of breath, stridor, or recurrent stenosis at the time of follow-up. CONCLUSIONS: Allograft tracheoplasty is a new technique for the reconstruction of recurrent tracheal stenosis. It appears to be reliable for extensive airway defects that are refractory to conventional tracheoplasty techniques.     

The Prevalence of Hepatitis C Virus Infection in Oral Lichen Planus in an Ethnic Chinese Cohort of 232 Patients

Aim Oral lichen planush (OLP) is a chronic inflammatory disease, and has been reported to have a correlation with hepatitis C virus (HCV) infection in some regional investigations. In this study, we investigated the prevalence of HCV in patients with oral lichen planus in an ethnic Chinese cohort.Methodology The antibody of HCV infection was detected by using enzyme-linked immunosorbent assay. Moreover, the clinical characteristics of whole the cohort have also been studied, such as the gender, age, clinical type, habits and social factors.Results Of all 232 patients, the antibody of HCV infection was detected positive in 4 patients (1.72%) using enzyme-linked immunosorbent assay. It was lower than that in control group of 2.5%, but not significant (P=0.309). The positive rate of HCV antibody in the erosive type ones (4.2%) was higher than that in the reticular type ones (1.0%), but this difference was proved to be not significant (P=0.389). The clinical characteristics of whole cohort, such as the gender, age, clinical type, habits and social factors, showed the outcome obtained in the present study were similar to thao of our previous study. Conclusion HCV may play no etiological role in oral lichen planus in ethnic Chinese OLP patients.     

10年单中心听神经瘤患者手术治疗回顾性研究

目的回顾性分析本中心手术治疗的听神经瘤患者,对临床特点、术前影像学、手术切除率、术后神经功能状态及术后并发症进行统计分析,并借此探讨听神经瘤患者的规范外科治疗策略。方法:回顾性分析自2007年6月至2017年6月于本中心接受外科治疗的单侧听神经瘤患者,统计分析患者一般资料,肿瘤大小、手术时间,术中出血量、肿瘤切除率、神经功能评估、术前(后)听力学检查及术后并发症等数据,并对上述各项数据进行多元逻辑回归分析。探讨肿瘤大小与手术时间、术中出血量及术后并发症之间的关系。结果:根据纳入排除标准,共有557名患者进入本研究,手术均采用枕下乙状窦后入路,患者平均年龄45.8±10.8岁;其中男性230例(37.7%);肿瘤直径≥3cm者468例(84.0%);平均手术时间5.2±1.8小时;术中出血量337±145ml;肿瘤达全切者513例(92.1%),次全切者44例(7.9%);518例患者达到术中面神经解剖保留(93.0%);术后House-Brackmann分级评估面神经功能Ⅰ-Ⅲ级者471例(84.6%);术前听力可用者41例,术后听力可用者12例(29.3%)。术后发生脑脊液漏者16例(2.9%),发生术侧面部麻木者12例(2.2%),出现复视者18例(3.2%),出现后组颅神经麻痹症状者15例(2.7%),术后颅内出血者5例(0.9%)。校正多元逻辑回归分析结果显示,肿瘤大小与手术时间、术中出血量、术后面瘫及复视发生率之间呈正相关关系(P<0.05),当肿瘤最大直径>5cm时,术中出血量显著增加(P<0.05)。结论:单侧听神经瘤患者手术治疗的难点是术中神经功能的保护。减少手术操作的机械损伤、运用术中神经电生理监测技术对提高治疗效果十分关键。肿瘤大小与手术时间、术中出血量及术后神经功能障碍发生率呈正相关关系。     

Prevalence of biofilm-forming bacteria in chronic rhinosinusitis

BACKGROUND: Recently, biofilms have been implicated in the pathogenesis of recalcitrant chronic rhinosinusitis (CRS). We sought to determine the prevalence of biofilm-forming cultures obtained from patients with CRS and clinical factors that may contribute to biofilm formation. METHODS: Endoscopically guided sinonasal cultures were obtained in duplicate from CRS patients with evidence of mucopurulence. Bacterial swabs were sent for microbiological characterization and were simultaneously evaluated for biofilm-forming capacity by a modified Calgary Biofilm Detection Assay. Biofilm formation was based on concomitant values of biofilm-forming Pseudomonas aeruginosa O1 (PAO1) (positive control) and non-biofilm-forming mutants sad-31 (type IV pili) and sad-36 (flagella K; negative control). Samples, with growth greater than the sad-31 mutant, were designated as biofilm formers. RESULTS: Sinonasal cultures were obtained from 157 consecutive patients (83 female patients) over a 4-month period. Forty-five samples (28.6%) showed biofilm formation. Among patients with a prior history of functional endoscopic sinus surgery (FESS), 30.7% (n = 42) showed biofilm growth. For patients naive to surgical intervention (n = 20), only 15% showed biofilm formation. A positive, statistically significant correlation existed between biofilm formation and number of prior FESS procedures. Polymicrobial cultures, Pseudomonas aeruginosa, and/or Staphylococcus aureus comprised 71% of samples. Chi-squared analysis showed an association with prior infections, but not with any pharmacologic therapy or comorbidies. CONCLUSION: We show a high percentage of CRS patients (28.6%) whose sinonasal mucopurulence has biofilm-forming capacity. Postsurgical patients had a high prevalence of biofilm-forming bacteria, a possible reflection of the severe nature of their disease. Additional studies are warranted.     

Prophylactic antibiotics for head and neck surgery with flap reconstruction.

The leading cause of postoperative morbidity in patients undergoing major head and neck surgical procedures is postoperative infection. This prospective randomized multi-institutional clinical trial was designed to compare the effectiveness of clindamycin phosphate and high-dose cefazolin sodium therapy in preventing postoperative wound sepsis in patients undergoing contaminated head and neck surgical procedures in which flap reconstruction was required. Either clindamycin phosphate (900 mg) or cefazolin sodium (2 g) therapy was instituted intravenously prior to surgery and continued every 8 hours, for a total of 24 hours. The patients received postoperative follow-up, and the wounds were graded according to the worst condition observed. One hundred cases were evaluated. Fifty-one patients received clindamycin and 49 patients received high doses of cefazolin; wound infection developed in 10 patients (19.6%) and 11 patients (21.6%), respectively. This difference was not statistically significant. The average duration of surgery was approximately 8 hours for both the infected and the noninfected groups of patients. High-dose cefazolin and clindamycin have similar efficacy when administered prophylactically under these circumstances. Reconstruction with free vascularized tissue may aid in reducing postoperative wound infection.     

Endoscopic management of cerebrospinal fluid rhinorrhea

PURPOSE: Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF rhinorrhea with long-term follow-up. METHODS: Retrospective data analysis of patients that were diagnosed with anterior skull base CSF rhinorrhea and underwent endoscopic repair at a tertiary institution. Data were analyzed to determine the etiology and location of CSF leaks. Diagnostic techniques, surgical techniques, and surgical outcomes were reviewed. RESULTS: Ninety-two patients were diagnosed with CSF rhinorrhea and underwent endoscopic repair over a 12-year period. Forty-eight were males, and 44 were females. The average age was 49 (range 6-81) years. Average follow-up was 25 months, with a range of 12 to 82 months. The etiology of CSF leak was prior endoscopic sinus surgery in 23 patients (25%), idiopathic in 19 (21%), neurosurgery in 17 (18%), trauma in 18 (20%), and the presence of meningocele/encephalocele in 11 patients (12%). The most common location of the defect was the sphenoid sinus (n = 36, 39%), followed by ethmoid roof (n-27, 29%), and cribriform plate (n = 24, 26%). Endoscopic repair was initially successful in 78 (85%) patients. Seven additional patients underwent successful revision endoscopic repair for an overall success rate of 92% (n = 85). Five (6%) large skull base defects were eventually repaired by neurosurgery using open intracranial techniques. No major complications were encountered. CONCLUSION: The intranasal endoscopic approach is an effective and safe technique in the surgical management of anterior skull base CSF rhinorrhea. Long-term success rate in our patient population was 92%.     

Adenoid cystic carcinoma of the base of the tongue

A retrospective review of 14 patients with adenoid cystic carcinoma of the tongue treated between 1955 and 1997 was performed. Treatment consisted of surgery (n = 2), radiotherapy (n = 2), chemotherapy (n = 1), or combination therapy (n = 9). The 2-, 5-, and 10-year absolute survival rates were 92%, 79%, and 63%, respectively. Seventy-five percent of the patients who died of cancer succumbed to distant metastases. However, long-term survival was common despite a high incidence of local and distant recurrence. The presence of positive surgical margins, the incidence of regional metastases, the incidence of perineural invasion, the initial stage of disease, and the eventual development of locoregional recurrence and distant metastases did not significantly alter the survival rate. Surgical extirpation combined with postoperative radiotherapy is advocated for the treatment of adenoid cystic carcinoma of the tongue. Given the indolent nature of this disease process, surgery should be directed toward conservation of speech and swallowing function.