Nasal septal foreign body as a complication of dental root canal therapy: A case report.

BACKGROUND: Currently, there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy. Herein, we present an unusual case of a foreign body found in the nasal septum, which occurred after dental root canal therapy and two unsuccessful surgeries. CASE SUMMARY: A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk. Before consulting our department, the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely. A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum, which resulted in the healing of oral inflammation and nasal septum discomfort. An endoscopic foreign body extraction surgery (3rd removal surgery) was then successfully performed, using a needle as the reference. No nasal reconstruction was required after the operation. Postoperative healing was uneventful. CONCLUSION: Medical healthcare professionals should consider past medical history when dealing with foreign body cases. During septal foreign body extraction surgery, a needle could be used as a helpful reference.

[Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy].

OBJECTIVE: To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy. METHODS: A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy. RESULTS: All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%. CONCLUSIONS: The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.

[Fourth branchial abnormity and management experiences].

OBJECTIVE: To investigate the fourth branchial abnormity and its managements. METHOD: Twelve cases of the fourth branchial abnormity treated between January 2005 and April 2012 were reviewed. RESULTS: Dissection of the recurrent laryngeal nerve was done in all cases. Partial thyroidectomy was performed in 10 cases, and 2 cases of them received selective neck dissection including level II, III, IV and VI. The abnormity lesions were found to pass posterior to the thyroid glands in the 10 cases and to pass through the inferior constrictor muscle into the pyriform sinus in 7 cases of them. The internal opening in the pyriform sinus demonstrated by preoperative examination couldn't be identified in the operation in one case. The abnormity tract terminated at the lateral surface of the esophagus in one case, passed into the cervical esophagus in one case, and terminated at the lateral surface of the thyroid gland in one case, and formed a cyst lateral to the thyroid gland in one case. No abnormity tract was found to loop around the hypoglossal nerve and to descend into the mediastinum. The left recurrent laryngeal nerve was cut off in one patient, although end to end anastomosis was performed immediately, the patient was still complicated with left vocal cord paralysis postoperatively. The median follow-up time of the cases was 24 months (8-88 months). One case was lost of follow up. No recurrence was found in 10 cases. Recurrence was found in one case, and no recurrence in 10 cases. CONCLUSIONS: The presentation of congenital the fourth branchial fistula is variated significantly. Most abnormity lesions had close relations to the thyroid gland and the recurrent laryngeal nerve, thus the recurrent laryngeal nerve need to protect and partial thyroidectomy might be considered. In the recurrent cases when the abnormity couldn't be identified clearly, selective neck dissection including level II, III, IV and VI should be done long term follow up should be carried out in the cases that the internal opening couldn't be found.

[Tortuosity and kinking of cervical segment of internal carotid artery: an analysis of 7 cases].

OBJECTIVE: To outline the clinical manifestations and compare the different radiological methods of detecting malformation of cervical segment of internal carotid artery. METHODS: A retrospective analysis of 7 cases with malformation of cervical segment of internal carotid artery between May, 2004 and April, 2011. CT angiography (CTA) and magnetic resonance angiography (MRA) were used to detect the morphology of cervical segment of internal carotid artery. RESULTS: This disease entity provided no obvious symptoms in five cases, and such complains as pharyngeal foreign body sensation in one and odynophagia in another. Physical examination showed a bulge with pulsation on pharyngeal wall in four cases, and apparent normal pharynges in other three patients, all of which were covered with intact pharyngeal mucosa. Twelve carotid arteries were observed in seven cases, five of which were showed tortuosity and seven kinking. All of the five patients with recorded radiological materials had identified malformations of internal carotid artery, two of which were tortuosity bilaterally and two kinking bilaterally and one tortuosity and kinking respectively. CTA and MRA revealed tortuosity of cervical segment of internal carotid arteries. CONCLUSIONS: No typical clinical symptoms were shown in the malformation of cervical segment of internal carotid artery. Pharyngeal bulge with pulsation could be encountered. CTA and MRA showed excellent ability to depict the malformation of cervical segment of internal carotid artery and its relationship with surrounding structures, which could protect carotid artery from unintended damage.

[A comparative study of complications in transoral CO2 and Nd:YAG laser surgery for glottic carcinoma].

OBJECTIVE: To compare the complications in transoral CO2 and Nd:YAG laser surgery for the treatment of laryngeal carcinoma. METHODS: Retrospective analysis of 83 cases of glottic laryngeal carcinoma treated with laser surgery from January 1, 1999 to December 31, 2008 was carried out. Thirty-two cases were treated with the CO2 laser, including Tis (2 cases), T1N0M0 (21 cases), T2N0M0 (8 cases), and T3N0M0 (1 case). Fifty-one cases were treated with the Nd:YAG laser, including Tis (3 cases), T1N0M0 (36 cases), T1N2M0 (3 cases), and T2N0M0 (9 cases). RESULTS: Four complications (12.5%) occurred in the CO2 laser group. There was 1 local infection (3.1%), 1 numbness of the tongue (3.1%), 1 odontoseisis (3.1%), and 1 subcutaneous emphysema (3.1%). Twenty-seven complications (52.9%) occurred in 19 patients in the Nd:YAG laser group. There were postoperative bleeding 2 (3.9%), dyspnea 5 (9.8%), local infection 7 (13.7%), aspiration pneumonia 4 (7.8%), numbness of the tongue 2(3.9%), pharyngeal cutaneous fistula 1 (2.0%), vocal cord fixation 4 (7.8%), and laryngostenosis 2 (3.9%). CONCLUSION: More complications were observed in the patients with Nd:YAG laser surgery when compared to the patients with CO2 laser surgery.

[Study on hemorrhage following coblation assisted uvulopalatopharyngoplasty].

OBJECTIVE: To compare the postoperative hemorrhage between standard uvulopalatopharyngoplasty (UPPP) and coblation assisted UPPP, and to evaluate the related risk factors and preventive measures. METHODS: Five hundreds and ninety seven patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent UPPP and coblation assisted UPPP between January 1, 1999, and September 30, 2009 were reviewed retrospectively. Two hundred and sixty three patients with coblation assisted UPPP and 334 patients with standard UPPP were treated respectively. Single factor statistic analysis, multiple factors Logistic regress statistic analysis and Wilcoxon test method for related risk factors were applied. RESULTS: A total of 42 patients (7.0%) experienced postoperative bleeding. Among them, 24 patients with coblation assisted UPPP (9.1%) and 18 patients with UPPP (5.4%) had postoperative hemorrhage. Significant difference was not found in the degree of hemorrhage (z = 0.784, P > 0.05), hemorrhage site(χ(2) = 1.387, P > 0.05) and postoperative hemorrhage rates (χ(2) = 3.14, P > 0.05) between the two surgical techniques. Significant difference was found in the interval of hemorrhage after surgery between the two surgical techniques (χ(2) = 9.25, P < 0.01). History of hypertension, smoking, hepatic dysfunction was found to be correlated with the postoperative hemorrhage (Odd-ratio were respectively 7.326, 3.674, 2.707). CONCLUSION: Coblation technique did not significantly increase UPPP postoperative hemorrhage.

[Surgical treatment of lymphatic malformation located in head and neck in children].

OBJECTIVE: To evaluate the surgical approaches and therapeutic effect of lymphatic malformations located in head and neck in children. METHODS: Eleven cases of lymphatic malformations in the region of head and neck in children encountered between Jan. 1998 and Dec.2008 in Peking University First Hospital were retrospectively analyzed. Initial diagnosis was made based on the physical examination and then confirmed by MR and Enhanced CT imaging. Surgical therapy was used for patients with lymphatic malformation which exceeds 4 cm. The operative technique was as follows: mass resection and superficial parotidectomy (4 cases), mass resection and total parotidectomy (2 cases), mass resection with neck dissection (2 cases), mass resection with neck dissection and sternotomy (1 case), marginal mandibular branch of facial nerve dissection and mass resection (2 cases). Dissection outside the false capsule was applied during the operation and facial nerve was dissected from bole to terminal arborization. RESULTS: The mass was completely removed in all 11 cases without organ dysfunction and obvious disfigurement. The cure rate was 100%. Three cases suffered from a branch of facial nerve paralysis because of tension and 1 case had a Horner's syndrome after operation. One case needed a blood transfusion (150 ml) during the operation. All cases have been followed up with excellent results from 6 to 121 months, 32 months of the median, no mass recurrence. CONCLUSIONS: Dissection outside the false capsule of mass and dissection of facial nerve were applied in the surgical treatment of huge lymphatic malformations. These methods are effective in the preservation of function and avoidance of abnormality.

[Selective neck dissection on the treatment of neck metastases in 63 patients with squamous cell carcinoma of hypopharynx].

OBJECTIVE: To analyze the prevalence and distribution of cervical node metastases in squamous cell carcinoma of hypopharynx and evaluate the efficacy of selective neck dissection (SND) on the treatment of the neck metastases. METHODS: A retrospective review was performed for 63 patients with squamous cell carcinoma of hypopharynx from January 1990 to December 2004. Lymph nodes were clinically negative in 17 patients and positive in 46 patients. There were 15 unilateral SND, 22 bilateral SND and 16 modified radical neck dissections (MRND). Ipsilateral MRND or radical neck dissections (RND) and contralateral SNDs were performed in 10 cases. Forty-eight patients were followed up and the follow-up interval ranged from 24 to 143 months and the median was 41 months. RESULTS: Lymph nodes were pathologically negative (pN0) in 22 and positive (pN +) in 41 patients. A total of 106 positive nodes were found in 95 neck dissections. The distribution of the positive nodes were as follows: Level II 47.2% (50/106), Level III33.0% (35/106), Level IV11.3% (12/106), Level V2.8% (3/106), Level VI 5.7% (6/106). Contralateral nodal metastases and recurrence were observed in both cN0 and cN + cases. There were 18 neck recurrent cases. High incidence of neck recurrence after SND was found in level II and III. The 3-year estimated survival rate analysis were 58.1% for the pN0 and 44.9% for pN1 and 41.1% for pN2 patients. Cox regression analysis suggested N stage was the most important prognostic factor. The risk ratio was 1.7 in pN1 and 2.2 in pN2. CONCLUSIONS: Lymphatic metastases was the most significant prognostic factor of hypopharyngeal squamous cell carcinoma. Bilateral selective neck dissection, when carefully indicated, offers functional advantages without oncologic compromise.

[Clinical efficacy of rapid Rhino Stammberger sinus dressing following endoscopic sinus surgery].

OBJECTIVE: To compare the clinical benefits of rapid Rhino Stammberger sinus dressing (RR), a new nasal packing material for functional endoscopic sinus surgery (ESS), with traditional packing materials sorbalgon plus Vaseline gauze (SV) prospectively. METHODS: Twenty-four patients with chronic sinusitis of the similar grade were enrolled in the study. After ESS, the nasal cavities of each patient were packed with RR in the right side as observing group and SV in the left side as control group. SV in the left nasal cavity was removed in the first day after operation and RR remained in the right nasal cavity until the first endoscopic follow-up 1 week postoperatively. The same perioperative treatments such as irrigation and local steroid were given in both sides of nasal cavities. The grade of rhinalgia, nasal obstruction, discharge, bleeding and epiphora in each side of nasal cavities were assessed on a visual analogue scale (VAS) by the patients at the operation day (packing period), the first day and the second day after operation respectively. Postoperative endoscopic assessment of nasal cavities including crust, discharge, pseudomembrane, edema of mucosa, bubble and ostium obstruction were carried out by a rhinologist on VAS at 1, 2, 3, 4, 6, 8 weeks postoperatively. The follow-up continued until the complete mucosal healing. RESULTS: Three patients were dropped from statistical analysis. One of them with severe hypertension bleeding when he awoke from anesthesia, the RR was run out from the nasal cavity. The other two were lost in the follow-up. Twenty-one patients completed the follow -up ranging between 2-20 months. The scores of rhinalgia, epiphora at the operation day and the rhinalgia at the first day after operation in RR side were lower than SV side (P<0.05). The scores of the amount of crust at the first week after operation in RR side were lower than SV side (P<0.05). Statistically, no significant deference was found between RR and SV in the length of mucosal healing period. CONCLUSIONS: Patients felt more comfortable with the package of RR than traditional material. No pain and secondary bleeding happened. The efficacy of RR on mucosal healing was similar with SV. RR showed some advantages and could be used as packing material following ESS.

Adeno-associated virus-mediated Bcl-xL prevents aminoglycoside-induced hearing loss in mice.

BACKGROUND: Recent studies showed that aminoglycosides destroyed the cochlear cells and induced ototoxicity by producing reactive oxygen species, including free radicals in the mitochondria, damaging the membrane of mitochondria and resulting in apoptotic cell death. Bcl-x(L) is a well characterized anti-apoptotic member of the Bcl-2 family. The aim of this study was to determine the potential cochlear protective effect of Bcl-x(L) as a therapeutic agent in the murine model of aminoglycoside ototoxicity. METHODS: Serotype 2 of adeno-associated virus (AAV2) as a vector encoding the mouse Bcl-x(L) gene was injected into mice cochleae prior to injection of kanamycin. Bcl-x(L) expression in vitro and in vivo was examined with Western blotting and immunohistochemistry separately. Cochlear dissection and auditory steady state responses were checked to evaluate the cochlear structure and function. RESULTS: The animals in the AAV2-Bcl-x(L)/kanamycin group displayed better auditory steady state responses hearing thresholds and cochlear structure than those in the artificial perilymph/kanamycin or AAV2-enhanced humanized green fluorescent protein/kanamycin control group at all tested frequencies. The auditory steady state responses hearing thresholds and cochlear structure in the inoculated side were better than that in the contralateral side. CONCLUSIONS: AAV2-Bcl-x(L) afforded significant preservation of the cochlear hair cells against ototoxic insults and protected the cochlear function. AAV2-mediated Bcl-x(L) might be an approach with respect to potential therapeutic application in the cochlear degeneration.

[A case of facial palsy as a initial sign of Wegener's granulomatosis].

Wegener's granulomatosis (WG) is a multi-system disease characterized by granuloma formation and necrotizing vasculitis. It typically involves the upper and lower respiratory tract and kidney. Otologic involvement may occasionally be the initial symptom of WG. A case report of WG was described, which first presented as facial nerve palsy. The combination of facial nerve palsy, sensorineural hearing loss and otitis media was unusual. We should raise suspicion. Early diagnosis is vital if unnecessary surgical exploration is to be avoided. The diagnosis of a WG is made clinically based on clinical findings, histologic confirmation and titres of cytoplasmic pattern antineutrophil cytoplasmic autoantibodies (c-ANCA)/ Anti-proteinase 3 (Anti-PR3). Immunosuppressive therapy with steroids, cyclophosphamide (CTX) is required for relief. A delay in diagnosis may lead to devastating sequelae, such as facial nerve palsy and hearing loss. WG is a challenging disease for otorhinolaryngologist.

[Otologic manifestations of Wegener's granulomatosis].

OBJECTIVE: To evaluate the clinical features, pathologic diagnosis and laboratory test of otologic manifestation in Wegener's granulomatosis (WG). METHODS: Fourteen eases of WG with ear involvement were reviewed. The clinical course, method of treatment and outcomes in all cases were evaluated. Diagnosis of WG was made when the patients had clinical findings, clear histologic findings and a positive titer of antineutrophil cytoplasmic autoantibodies (ANCA). RESULTS In all 14 cases, the most frequent finding was chronic otitis media Sensorineural hearing loss was present in 1 case and facial nerve paralysis was present in 2 cases separately. There were 5 patients whose otologic manifestations were the primary involvement of WG. Fourteen cases had positive histologic diagnosis of WC while 13 cases were confirmed positive for ANCA. All patients were treated with glucocorticoids, immunosuppressive drugs, and finally got marked improvement. CONCLUSIONS: WG should he included in the differential diagnosis in cases of atypical inflammatory states of the ear, facial nerve paralysis and sensorineural hearing loss. Early diagnosis was made basing on the histologic findings and a positive titer of ANCA. Appropriate treatment were important to improve the otologic manifestations of WG.

[Percutaneous dilational tracheostomy].

OBJECTIVE: To describe and introduce a new technique for percutaneous dilational tracheostomy without the aid of a bronchoscope. METHODS: Ten patients who underwent rotating dilation tracheostomy with percutwist set were prospectively studied. The time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications for the procedure were evaluated. All procedures were performed without the aid of a bronchoscope. RESULTS: During the operations, blood pressure, ECG parameters were stable. One patient had short period of intraoperative oxygen desaturation. The mean operating time was 6.2 minutes with a range of 3 to 10 minutes. Eight procedures were performed without any difficulty, 2 procedures were performed with some difficulties which could be managed by the surgeon. Six patients had been examined under fibrobronchoscopy within one week postoperatively, no posterior tracheal wall injuries were found. One patient had peristomal bleeding after the operation, one patient had mild infection of the tracheostoma. There were no life threatening complications attributable to this technique. CONCLUSIONS: Controlled rotating dilation is a simple, rapid and safe bedside procedure. In the absence of bronchoscopic guidance, the procedure can be safely performed with precautions.

[Expression of adrenomedullin in the tissue with laryngeal carcinoma].

OBJECTIVE: To observe the expression of adrenomedullin (AM) in the patients with laryngeal carcinoma. METHODS: Two-step immunohistochemistry method was used to examine the expression of AM in the patients with laryngeal carcinoma. Radioimmunoassay was applied to determine the concentration of AM in the laryngeal carcinoma tissues, adjacent laryngeal mucosa of carcinoma tissues and in the plasma of patients and controls. RESULTS: Positive stainings for AM were found in all 21 specimen examined,distributed mainly in the cytoplasm of the laryngeal carcinoma cells. Positive stainings were more stronger in the circumference than in the center of tumor tissue for the highly and moderately differentiated tumors. While the stainings were distributed homogeneously for poorly and moderately differentiated tumors. The concentration of AM in the laryngeal carcinoma tissues (n = 44) and the adjacent mucosa (n = 44) were (49.67 +/- 28.33) pg/ml and (14.71 +/- 7.17) pg/ml (x +/- s) respectively and laryngeal tumor showed much higher concentration of AM than the adjacent mucosa (u = 135.00, P < 0.01). The concentration of AM in patients with laryngeal carcinoma of T2, T3 and T4 stage were (31.52 +/- 15.22), (56.63 +/- 18.51) and (96.12 +/- 18.22) pg/ml (x + s) respectively,and there were statistically significant difference among them. In the N stage, patients with higher stages were found to express significantly higher AM concentration, but there was not statistically significant difference between NO stage and N1 stage. In the M stage,patients with M1 stage were found to express significantly higher AM concentration (u = 31.00, P < 0.01). But there was not statistically significant difference between AM plasma concentration of laryngeal carcinoma patients and that of healthy controls. CONCLUSIONS: The results suggested that high expression of AM in tissues of laryngeal carcinoma was related with the TNM stage of laryngeal carcinoma, AM may play an important role in the development of the laryngeal neoplasma.

[Heterogeneous mutations of Wolfram syndrome I gene responsible for low frequency nonsyndromic hearing loss].

OBJECTIVE: To explore the mutations of Wolfram syndrome I gene (WFS1) in families affected by non-syndromic low frequency sensorineural hearing loss (NS-LFSNHL). METHODS: Twenty eight individuals from 6 pedigrees with hereditary non-syndromic low frequency sensorineural hearing loss as a dominant trait and cases of control were collected in the present study. The coding sequence of WFS1 gene was amplified by polymerase chain reaction (PCR), and direct DNA sequencing was performed to screen the entire coding region of the WFS1 gene for mutations in the WFS1. RESULTS: Three heterozygous missense mutations (2016 G-->T, 2379 G-->4A, 2766 G-->A) in the WFS1 gene were found in two families. Mutations in WFS1 were identified in all patients tested of the two pedigrees. None of the mutations was found in at least 280 control chromosomes and normal individuals of the families. These missense mutations affecting conserved amino acids in two pedigrees. CONCLUSIONS: Mutations in WFS1 are one of causes of non-syndromic low frequency sensorineural hearing loss, and the majority of mutations are missense mutations. Genetic counseling and genetic testing may be useful in the management of patients with this type of hearing loss.