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Τετάρτη 20 Οκτωβρίου 2021

Free rectus abdominis myocutaneous flap for the reconstruction of major and complex defects in the craniofacial regions after ablation of advanced sinonasal carcinomas

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):907-913. doi: 10.3760/cma.j.cn115330-20210601-00320.

ABSTRACT

Objective: To explore the method and plausibility of using free rectus abdominis flap (FRAF) to reconstruct the major and complex defects in the craniofacial regions after ablation of advanced sinonasal carcinoma. Methods: From 2007 to 2018 at No. 980 Hospital of Joint Logistic Supportive Force of People's Liberation Army of China, 13 patients with advanced carcinoma of nasal cavity and paranasal sinuses, including 11 males and 2 females, aged from 33 to 67 years, were treated with FRAF to repair the invasion of skull base, face and orbit. Based on adequate and meticulous preoperative evaluations on patients and tumors, complete resection of tumor bulks was performed. According to the sites, characters and extents of the defects, FRAF was introduced in different ways into reconstruction of major an d complex defects in the craniofacial regions after resection of advanced sinonasal carcinomas, restoring the structure and contour of the craniofacial region. Results: Complete resection of tumors was achieved in all cases. For repairing the major and complex defects resulted from tumor ablation, FRAF graft was conducted in 13 patients with advanced sinonasal carcinomas. The recipient vessels were facial artery and vein in 9 cases, superficial temporal artery and vein in 4 cases. Vascular bridging with the external jugular vein was carried out in 2 cases who underwent submandibular neck dissections, in which facial artery and vein were used as recipient vessels. Free fibular flap was used along with FRAF in a case undergone bilateral maxillectomy. Pedicled galea capitis and periosteal flap were applied simultaneously in 3 cases with dura defects at the skullbase resulted from tumor resection. All flaps used in 13 cases survived uneventfully without major complications, with successful repair of defects, reconstruction of structures and restoration of contour of craniofacial regions. Conclusion: With adequate evaluation of resectability of tumors as well as nature and extent of defects after tumor removal, FRAF transplantation is an ideal method and strategy of choice for reconstructing the major and complex defects in craniofacial regions resulted from tumor ablation of advanced sinonasal carcinomas.

PMID:34666436 | DOI:10.3760/cma.j.cn115330-20210601-00320

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Retrospective study of thyroid invasion and central lymph node metastasis in 124 patients with hypopharyngeal carcinoma

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):956-961. doi: 10.3760/cma.j.cn115330-20210222-00077.

ABSTRACT

Objective: To investigate the characteristics of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma, and the impact on survival rate and quality of life. Methods: A retrospective analysis of 124 cases (122 males and 2 females with age range from 36 to 78 years old) with laryngopharyngeal squamous cell carcinoma who were initially treated in the Department of Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to December 2017 was performed. The clinical data included tumor location, pathological T stage, pathological N stage, invasion of thyroid gland, central lymph node metastasis, surgical procedures and so on. Patients were grouped according to if presence of thyroid invasion and central lymph node metastasis. Wit h follow-up, the survival was analyzed by Kaplan-Meier method, and tumor recurrence and metastasis were evaluated. Results: Of the patients, 12 patients had thyroid involvement and 5 patients had central lymph node metastasis. The incidence of thyroid involvement was 8.16% (8/98) in pyriform sinus, 1/18 in posterior pharyngeal wall and 3/8 in posterior cricoid wall, with statistically significant difference (χ2=15.076,P=0.008). The incidence of central lymph node metastasis was 1.02% (1/98) in pyriform sinus, 3/18 in posterior pharyngeal wall and 1/8 in posterior cricoid wall, also with statistically significant difference (χ2=11.205, P=0.008). There was no statistical correlation between thyroid invasion or central lymph node metastasis and gender, smoking or alcohol exposure history and tumor pathological differentiation (all P>0.05). The 3-year overall survival rate was 80.65% and the 3-year recurrence free rate was 85.48%. T otally 24 patients died in 3 years, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. Local recurrence occurred in 18 patients, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. There was no significant difference in survival between patients with and without thyroid invasion and central lymph node metastasis (all P>0.05). There were significantly difference in 3-year overall survival and relapse-free survival among the groups with different T stages, N stages, pathological stages and tumor pathological differentiation levels (all P<0.05). There were significantly differences in the levels of serum calcium and FT3 between the groups with or without thyroid invasion and central lymph node metastasis (all P<0.05). Conclusion: The incidences of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma are rare, and the risk of occurrence is related to the primary site of tumor. Comprehensive evaluation, correct decision-making and accurate treatment could be helpful to cure radically the tumor, to prevent recurrence and to improve the quality of life of patients.

PMID:34666444 | DOI:10.3760/cma.j.cn115330-20210222-00077

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Short-term efficacy of anti-IgE monoclonal antibody in patients with recurrent chronic rhinosinusitis with nasal polyps combined with asthma

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Oct 7;56(10):1035-1041. doi: 10.3760/cma.j.cn115330-20210608-00338.

ABSTRACT

Objective: To investigate the short-term efficacy of anti-IgE monoclonal antibody (Omalizumab) in the treatment of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) complicated with asthma. Methods: Patients with recurrent CRSwNP and comorbid asthma in Beijing TongRen Hospital from May to December of 2020 were continuously recruited and received a 4-month therapy of stable background treatment plus Omalizumab. Results of visual analog scales (VAS) of nasal symptoms, sino-nasal outcome test-22 (SNOT 22) and nasal polyp scores were collected at baseline and post-treatment (1, 2, 3 and 4 months after treatment). Blood routine tests, total nasal resistances (TNR), minimum cross-sectional areas (MCA), total nasal cavity volumes (NCV), forced expiratory volumes in one second (FEV1)/forced vi tal capacity (FVC) and adverse events were collected at baseline and 4 months after treatment. All results were evaluated for short-term efficacy of Omalizumab. GraphPad Prism 8.2.1 was used for statistic analysis. Results: Ten patients were collected, including 3 males and 7 females, aged (41.13±12.64) years old (x¯±s). Compared to results at baseline, the VAS scores of nasal obstruction, rhinorrhea, hyposmia and headache after 4 months treatment were significantly decreased (1.80±1.48 vs 6.70±2.83, 2.40±1.27 vs 6.40±3.44, 2.70±2.91 vs 8.20±2.25, 0.60±1.08 vs 3.60±2.72, t value was 5.045, 4.243, 5.312, 3.402, respectively, all P<0.01). The scores of SNOT-22 (25.6±20 vs 61.3±33.32, t=4.127, P=0.002 6), nasal polyp scores (2.20±0.92 vs 4.60±0.84, t=9.000, P<0.01) and the count and percentage of eosinophils in peripheral blood were significantly decreased ((94.10±97.78)×10 9/L vs (360.00±210.80)×109/L, (32.90±27.06)% vs (64.40±20.73)%, t value was 3.678, 2.957, respectively, all P<0.05). NCV (0-5 cm and 0-7 cm) of patients were improved from baseline ((12.62±2.84) cm3 vs (10.40±2.09) cm3, (27.50±14.15) cm3 vs (16.81±6.40) cm3, t value was 2.371, 2.445, respectively, all P<0.05). Conclusions: The 4-month treatment of Omalizumab can significantly improve the nasal symptoms and quality of life of patients with recurrent CRSwNP complicated with asthma, shrink nasal polyps size and reduce the number of peripheral blood eosinophils. Omalizumab can be used as an alternative therapy for refractory CRSwNP patients in the future.

PMID:34666463 | DOI:10.3760/cma.j.cn115330-20210608-00338

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Predictive diagnostic value of serum 25-hydroxyvitamin D3 in eosinophilic chronic rhinosinusitis with nasal polyps

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Oct 7;56(10):1051-1058. doi: 10.3760/cma.j.cn115330-20210427-00232.

ABSTRACT

Objective: To compare the value of 25-hydroxyvitamin D3 (25-(OH)D3) with other clinical parameters in the prediction and diagnosis of eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP). Methods: Eligible chronic rhinosinusitis with nasal polyps (CRSwNP) patients and healthy subjects in the Affiliated Hospital of Guizhou Medical University from January to April of 2021 were included for this study. The age, gender, past history and other basic characteristics of all subjects were recorded. The CRSwNP patients were classified into ECRSwNP and non-eosinophilic chronic rhinosinusitis with nasal polyps (nECRSwNP) endotypes by the percentage of tissue eosinophils. Serum 25-(OH)D3 levels measurements were performed in all subjects. Paranasal sinus CT scans, blood eosinophil counts, and det ermination of total immunoglobulin E (total IgE), Th1/Th2 plasma cytokines and nasal nitric oxide (nNO) levels were performed before surgery. Logistic regression analysis was used to evaluate the related factors of ECRSwNP. Receiver operating characteristic (ROC) curves was used to evaluate the predictive potential of the clinical parameters. Results: One hundred and twenty-seven CRSwNP patients and 40 healthy subjects were recruited, including 74 males and 93 females of the patients, with the age of (38.73±13.05) years. In patients with ECRSwNP, serum 25-(OH)D3 levels were significantly lower than those in nECRSwNP patients ((26.14±4.58) ng/ml vs (35.71±7.86) ng/ml, t=-8.564, P<0.01). The prevalence of asthma, prevalence of allergic rhinitis, peripheral blood eosinophil counts, total IgE levels, nNO levels and CT scores ratio for ethmoid sinus and maxillary sinus (E/M ratio) of ECRSwNP patients were significantly higher than those in nECRSwNP patie nts (all P<0.05). However, there was no significant difference in Th1/Th2 cytokines levels between the histological types of CRSwNP (all P>0.05). Among the predictive indicators, 25-(OH)D3 had the highest predictive value, with ROC area under curve (AUC) value of 0.882. The best cut-off point of 28.5 ng/ml for 25-(OH)D3 demonstrated a sensitivity of 0.871 and a specificity of 0.762 for ECRSwNP. Conclusion: Measurement of serum 25-(OH)D3 level may be used as an effective method to distinguish between ECRSwNP and nECRSwNP.

PMID:34666465 | DOI:10.3760/cma.j.cn115330-20210427-00232

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Carney complex characterized by jugular foramen myxoma: a case report

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Carney complex is a hereditary condition associated with spotty skin pigmentation; myxomas, which are benign (noncancerous) connective tissue tumors; and a number of other tumors of the endocrine (hormone-producing) glands. Tumors can be benign or cancerous. A benign tumor means the tumor can grow but will not spread.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):990-992. doi: 10.3760/cma.j.cn115330-20200924-00769.

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PMID:34666452 | DOI:10.3760/cma.j.cn115330-20200924-00769

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Primary giant laryngitis myofibroblastoma in a child: a case report

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):995-997. doi: 10.3760/cma.j.cn115330-20201030-00842.

NO ABSTRACT

PMID:34666454 | DOI:10.3760/cma.j.cn115330-20201030-00842

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Combined autologous fascia transplantation with autologous fascia and fat injection into the vocal fold for sulcus vocalis

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Oct 7;56(10):1080-1086. doi: 10.3760/cma.j.cn115330-20201204-00908.

ABSTRACT

Objective: To assess voice outcomes after surgical technique for typeⅡ and type Ⅲ sulcus vocalis. Methods: The data of 39 cases of bilateral type Ⅱ-Ⅲ sulcus vocalis were collected and analyzed retrospectively. There were 29 patients with bilateral type Ⅲ sulcus vocalis, and 10 patients with type Ⅲ on one side and typeⅡon the contralateral vocal cord. All of vocal cords were applied autologous anterior rectus sheath fascia transplant, and 68 sides of vocal cords with type Ⅲ sulcus vocalis were also applied autologous fascia and fat injection. Two male patients, whose results from transplant and injection were not satisfied, were carried out cricothyroid myotomy one year after surgery. Subjective and objective voice evaluations were performed before and after operation. Results: One patient was found mild adhesion on the middle part of vocal cords, and all the other 38 patients recovered well and there were no complications. During 5-6 weeks after surgery, breathy voice was the feather. Then vocal quality and glottal closure were gradually improved and became steady in 12 months. It showed that all the subjective and objective parameters, except for fundamental frequency, were significantly improved (P<0.05), and obvious improvement was achieved in glottal closures and mucosal waves in 35 patients. Three patients obtained no significant vocal quality improvement after transplant and injection surgery, and two male patients of them achieved improvement in mucosal waves and MPT after bilateral cricothyroid muscle amputations. One patient, who was revealed with mild adhesion, achieved a satisfied result after adhesion separation and suture. All the patients who originally had feelings of fatigue and voice discontinuity during phonation gained si gnificant improvement postoperatively. Steady function with no complications was observed during the 36 months (up to 5 years in 20 patients) follow-up period. Conclusions: Autologous fascia transplantation combined fascia and fat injcetion can lead to excellent long-term results, and it is a good treatment option for pathologic sulcus vocalis. Cricothyroid muscle amputations can reduce the tension, and may improve vibration property of the vocal fold in patients with pathological sulcus vocalis.

PMID:34666469 | DOI:10.3760/cma.j.cn115330-20201204-00908

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Effect analysis on endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):951-955. doi: 10.3760/cmj.j.cn115330-20210303-00099.

ABSTRACT

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and ca psule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.

PMID:3466644 3 | DOI:10.3760/cmj.j.cn115330-20210303-00099

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Tonsillectomy as a treatment for SAPHO syndrome: a case report

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Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare chronic inflammatory disorder of bone, joint, and skin characterized by synovitis, osteitis, hyperostosis, and enthesitis, typically with pain, swelling, and tenderness in affected areas.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Oct 7;56(10):1102-1104. doi: 10.3760/cma.j.cn115330-20201217-00929.

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PMID:34666473 | DOI:10.3760/cma.j.cn115330-20201217-00929

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Intraductal carcinoma of parotid gland: a case report

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Oct 7;56(10):1106-1108. doi: 10.3760/cma.j.cn115330-20210215-00065.

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PMID:34666475 | DOI:10.3760/cma.j.cn115330-20210215-00065

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Use of coblation in resection of nasopharyngeal angiofibroma of nasopharynx under nasal endoscope: report of 3 cases

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Sep 7;56(9):981-983. doi: 10.3760/cma.j.cn115330-20201120-00882.

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PMID:34666449 | DOI:10.3760/cma.j.cn115330-20201120-00882

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