Thursday, May 20, 2021

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):417-423. doi: 10.3760/cma.j.cn115330-20200613-00500.

ABSTRACT

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complet e excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

PMID:34010992 | DOI:10.3760/cma.j.cn115330-20200613-00500

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A Caldwell-luc approach assisted endoscopic resection of juvenile nasopharyngeal angiofibroma

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):544-545. doi: 10.3760/cma.j.cn115330-20210115-00022.

NO ABSTRACT

PMID:34011016 | DOI:10.3760/cma.j.cn115330-20210115-00022

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Masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):465-470. doi: 10.3760/cma.j.cn115330-20210225-00087.

ABSTRACT

Objective: To investigate the outcomes of masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults and to explore surgical indications. Methods: A retrospective chart review of 37 patients (11 males, 26 females, with (40.3±12.7) years old)who underwent masseter nerve-innervated free gracilis muscle transfer for smile reanimation between 2016 and 2017 was performed. Patient-reported quality of life (facial clinimetric evaluation, FaCE), physician-reported facial function (eFACE facial grading scale), and oral commissure excursion were compared preoperatively and postoperatively. SPSS 11.0 software was used to analyze the data. Results: Thirty-seven patients were followed up in one year after surgery. Significant postoperative improvements were demonstrated for commissure excursion with smile (preoperatively: (-1.2±3.1) mm, postoperatively: (6.1±3.5) mm, t=-31.1, P<0.01), ipsilateral FaCE (preoperatively: (29.4±14.1), postoperatively: (57.6±23.4), t=-38.1, P<0.01), eFACE score (Composite score t=-35.8, Static score t=-29.1, Dynamic score t=-41.3,Midface score t=-43.9, all P<0.01), respectively. Conclusion: Masseter nerve-innervated free gracilis muscle transfer is an good option for dynamic smile reanimation in adult patients who have undergone treatment for long-standing facial paralysis.

PMID:34011000 | DOI:10.3760/cma.j.cn115330-20210225-00087

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Study on the clinical characteristics of isolated congenital anosmia

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):442-446. doi: 10.3760/cma.j.cn115330-20210219-00070.

ABSTRACT

Objective: To retrospectively analysely the electrophysiological and imaging features of isolated congenital anosmia (ICA) and to assess the clinical phenotypic characteristics and classification of ICA. Methods: Clinical data of 30 ICA patients in Beijing Anzhen Hospital from 2012 to 2019 was retrospectively reviewed, including 13 males and 17 females, aged (35±19) years. The control group consisted of 30 healthy people from medical examination center, including 13 males and 17 females, aged (39±14) years. The clinical characteristics of ICA were analyzed using Sniffin' Sticks test, olfactory event-related potentials (oERPs), trigeminal event-related potentials (tERP) and olfactory pathway MRI. SPSS 17.0 software was used to compare the difference of olfactory function between the two groups. Th e correlation between olfactory bulb, olfactory sulcus structure and age was observed, and the clinical phenotype characteristics of ICA patients were analyzed. Results: The subjective olfactory function was completely lost in ICA patients. oERP was absent in all of the ICA patients, but showed normal N1 and P2 waves in controls. tERP could be evoked in 63.3% (19/30) of ICA patients, and signals in these patients showed higher amplitude in the N1 ((-10.33±6.93) μV vs (-5.11±2.71) μV, t=-10.113, P<0.01) and P2 ((+17.25±8.51) μV vs (+7.31±3.46) μV, t=5.443, P<0.01) waves than that of the controls. Olfactory bulbs were aplastic in 80.0% (24/30) of patients and hypoplastic in 20.0% (6/30) of patients. Fifty-six point seven percent (17/30) of patients had bilateral olfactory sulcus deletion while 43.3% (13/30) had dysplasia, and all of the patients exhibited a depth of olfactory sul cus less than 8 mm. Both the structure of olfactory bulbs and olfactory sulcus were not associated with age for ICA patients (r value was -0.174 and 0.325, respectively, all P>0.05). Conclusions: ICA patients show neurophysiologic deficits and some anatomic differences compared with healthy controls. The absence of oERP combining with a depth of olfactory sulcus less than 8 mm is the important indicator for clinical diagnosis of ICA. The structure of olfactory bulb may be a critical factor for clinical classification of ICA.

PMID:34010996 | DOI:10.3760/cm a.j.cn115330-20210219-00070

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Successful treatment of hemophagocytic syndrome caused by auricle infection: one case report

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噬血细胞综合征是由原发或继发性免疫异常导致的过度炎性反应综合征,病情发展快,易误诊及漏诊,致死率较高,主要表现为发热、全血细胞减少、肝功能损害、凝血功能障碍及组织细胞吞噬形态完整的红细胞、白细胞和血小板。本文报道一例成人女性患者中耳炎术后耳廓感染诱发噬血细胞综合征并救治成功的病例,为耳科医生提供临床借鉴和参考。.

Hemophagocytic syndrome is an excessive inflammatory response syndrome caused by primary or secondary immune abnormalities. The disease develops rapidly, is easy to be misdiagnosed and missed, and has a high fatality rate. It mainly manifests as fever, pancytopenia, liver damage, Blood coagulation dysfunction and tissue cells phagocytize red blood cells, white blood cells and platelets with intact morphology. This article reports a case of auricle infection in an adult female patient with otitis media that induced hemophagocytic syndrome and was successfully treated, providing clinical reference and reference for otologists. .

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May 7;56(5):493-495. doi: 10.3760/cma.j.cn115330-20200602-00466.

NO ABSTRACT

PMID:34011004 | DOI:10.3760/cma.j.cn115330-20200602-00466

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Open Approaches to Stensen Duct Scar

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Duct scar in the form of stenoses or stricture is the second leading cause of obstructive sialadenitis after stone. Over the past decade, there has been a growing experience demonstrating the effectiveness of endoscopic techniques in the minimally invasive management of salivary duct stenosis. Less information, however, is available with regard to open approaches for recurrent or complex ductal stenoses. This article reports on a case of gland preservation using an open ductal technique that originally was applied in cases of traumatic Stensen's duct injury.
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The Evaluation and Management of Carcinoma of the Minor Salivary Glands

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There are several hundred minor salivary glands throughout the upper aerodigestive tract, aiding in lubrication and protection of the system. Compared with all tumors of the head and neck and those of the six major glands, neoplasms of the minor glands are rare. However, more than half are found to be malignant, prompting a low threshold for further work-up. This review discusses the evaluation of patients who present with masses of the minor salivary glands, including strategies for tissue diagnosis and staging. Management options for and long-term survival outcomes of the most common malignancies affecting these glands are also discussed.
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Indications for Facial Nerve Monitoring During Parotidectomy

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Facial nerve injury is the most feared complication during parotid surgery. Intraoperative electromyographic nerve monitoring can be used to identify the facial nerve, map its course, identify surgical maneuvers detrimental to the nerve, and provide prognostic information. Data regarding outcomes with facial nerve monitoring are heterogeneous. In contrast, the incidence of permanent weakness has not been shown to be significantly affected by use of nerve monitoring. For revision surgery, studies show that monitored patients had (1) weakness that was less severe with quicker recovery and (2) shorter operative times compared with unmonitored patients.
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Transoral Excision of Parapharyngeal Space Tumors

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Transoral excision of parapharyngeal space (PPS) tumors has increased in popularity along with the increased use of robotic and endoscopic surgical technology. Here, the authors highlight the indications, techniques, outcomes, and complications of transoral approaches to PPS tumors, with a special emphasis on salivary tumors of the PPS and the transoral robotic surgery approach.
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Incorporating Sialendoscopy into the Otolaryngology Clinic

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Simple sialendoscopy procedures may be performed in the outpatient clinic with few complications. This process spares patients the risks, increased cost, and time burdens of sialendoscopy under general anesthesia. Sialendoscopy procedures may be incorporated into the outpatient practice after gaining experience with these procedures in the operating room. Diagnostic sialendoscopy, dilation of stenosis, and endoscopic sialolithotomies of small, freely mobile stones are appropriate for in-office sialendoscopy in many instances.
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Management of Mucoceles, Sialoceles, and Ranulas

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Mucoceles are common salivary gland disorders. Mucoceles are benign, mucus-filled extravasation pseudocysts that commonly arise on the lower lip of children and young adults. Although surgical excision is commonly performed to remove these lesions, other treatments include marsupialization, micromarsupialization laser ablation, cryotherapy, intralesional steroid injection, and sclerosing agents. Traumatic sialoceles commonly arise from injury to the parotid duct. Treatment of sialoceles from acute parotid duct injury and for delayed presentations after injury are discussed. Ranulas are a subtype of mucocele from the sublingual gland classified as superficial or plunging. Treatment of ranulas must address the sublingual gland.
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Management Options for Sialadenosis

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Sialadenosis (sialosis) is a chronic, noninflammatory, nonneoplastic, bilateral, often painless enlargement of the salivary glands, most frequently affecting the parotid glands. Approximately 50% of cases are associated with an underlying disease process. The pathogenesis of sialadenosis is unknown but likely results from an autonomic neuropathy. The key to management is diagnosis and management of any poorly controlled underlying medical process.
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