99Tc m-DTPA SPECT/CT imaging in the diagnosis of cerebrospinal fluid leakage / 中华核医学与分子影像杂志

Objective:To investigate the diagnostic efficacy and clinical application value of 99Tc m-diethylene triamine pentaacetic acid (DTPA) SPECT/CT imaging in cerebrospinal fluid leakage (CSFL). Methods:A total of 23 patients (11 males, 12 females; age (44.2±15.1) years) who underwent endoscopic repair surgery for suspected CSFL in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital between April 2018 and January 2020 were retrospectively reviewed. All patients performed 99Tc m-DTPA SPECT/CT imaging, paranasal sinus high resolution CT (HRCT) and MRI before surgery. The diagnostic efficacies of 3 imaging techniques were calculated according to the result of surgery regarded as the golden standard. χ2 test was used to compare the qualitative and localized diagnostic efficacies of 3 imaging techniques for CSFL. Results:Of 23 patients, 21 were finally confirmed with CSFL and 24 leak locations were identified according to the results of surgery; the other 2 patients had no obvious CSFL and no leak location was found during the operation. The sensitivity and accuracy of 99Tc m-DTPA SPECT/CT, MRI and HRCT for the diagnosis of CSFL were 100%(21/21) and 95.7%(22/23), 85.7%(18/21) and 82.6%(19/23), 76.2%(16/21) and 69.6%(16/23), respectively. The accuracy of 99Tc m-DTPA SPECT/CT, MRI and HRCT for the diagnosis of leak location was 79.2%(19/24), 50.0%(12/24) and 45.8%(11/24), respectively. There was no statistically significant difference of diagnostic efficacies for CSFL among 3 imaging techniques ( χ2 values: 0.451-3.453, all P>0.05). For leak location, the diagnostic efficacy of 99Tc m-DTPA SPECT/CT was significantly better than that of MRI and HRCT ( χ2 values: 4.463, 5.689, both P<0.05). Conclusion:99Tc m-DTPA SPECT/CT imaging shows an excellent diagnosis efficacy not only for CSFL but also for leak location, which is helpful for guiding surgery.

Endoscopic endonasal dacryocystorhinostomy assisted by image guidance system to chronic dacryocystistis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To estimate the value of nasal endoscopic dacryocystorhinostomy combined image guidance system in treating chronic dacryocystistis.@*METHOD@#Thirteen cases (14 eyes) performed surgeries with nasal endoscopic dacryocystorhinostomy combined image guidance system from January 2010 to August 2013 were retrospectively analyzed. Their clinical data were analyzed and the effect of the surgery was evaluated.@*RESULT@#All patients were followed-up for more than half a year. Of all patients,12 eyes were cured, 2 eyes were improved and 0 eyes were noneffective. The total treatment effectiveness was 100%. There was no complication for all cases.@*CONCLUSION@#Nasal endoscopic dacryocystorhinostomy combined image guidance system is an effective and reliable treatment method for chronic dacryocystistis, especially for intraoperative location of lacrimal sac and control of operating process.

Skin prick test using two different allergen prick reagents, a comparative study in Shanghai / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the results of skin prick test with allergens of Allergopharma company or ALK company in Shanghai area.@*METHOD@#The study included 9 233 patients diagnosed as allergic rhinitis. The patients were divided in to two groups (Allergopharma group and Alutard-SQ group) SPT was given from June, 2005 to Feb, 2013. The results of the positive rate using two reagents were analyzed and compared.@*RESULT@#There were no significant differences between the two groups in age and gender (P > 0.05). The total positive rate in Allergopharma group was 62.90%, and 59.68% in Alutard-SQ group. The positive rate in Allergopharma group was significantly higher than that in Alutard-SQ group (P < 0.01). Dermatophagoides farinae (Der f) and Dermatophagoides pteronyssinus (Der p) were identified as the mostly responsible allergens. The positive rate of Der f in Allergopharma group and Alutard-SQ group was 55.23% and 45.57% respectively. The same rate were 54.83% and 47.89% of Der p. There were significant differences of the positive rate of two allergens in both groups (P < 0.01).@*CONCLUSION@#The total positive rate was different using different allergens for SPT among the patients diagnosed as allergic rhinitis of the same area. Dust mites were identified as main allergens. The positive rate was different when using different reagents, which needed more attention to make the decision of specific immune therapy.

Reconstruction of external nose defect with local flaps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The role of different local flaps in small external nasal skin defect reconstruction was discussed.@*METHOD@#Forty-two cases of the small size nasal defects (diameter < 2 cm) were repaired with local external nose flap (includes the dorsal nasal flap, nasolabial flap and bilobed flap). The clinical and follow-up data were analyzed of patients with small external nasal skin defects, who accepted different local flaps reconstruction. Dorsal nasal flap, nasolabial flaps (includes island flap, slid flap and axial flap) and bilobed flap were tailored to reconstruct different external nasal defect. Twenty-seven patients were male and fifteen patients were female, the patients' age ranged from 28 to 74 years, the median age was 61 years. Thirty-eight cases resulted from resection of skin malignant tumor and four cases were benign lesions. The diameter of defects was 1-2 cm. The defects were reconstructed by single-stage dorsal nasal flap in 7 cases. There were 30 cases of caudolateral nasal defects were reconstructed by nasolabial flap, single-stage island nasolabial flap in 7 cases, axial flap in 18 cases and slid flap in 5 cases. Superior lateral defects were reconstructed by single-stage bilobed flap in 5 cases.@*RESULT@#All defects were repaired successfully. All tissue flaps survived and had not necrosis. There was no tumor recurrence during 3 months to 2 years follow-up.@*CONCLUSION@#The dorsal nasal flap, nasolabial flap and bilobed flap can be used safely and effectively to repair the small external nasal defect and have satisfactory curative effect.

Endoscopic reconstruction skull base using pedicled nasoseptal flap and its anatomy measurement / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success.@*METHOD@#The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap.@*RESULT@#The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2.@*CONCLUSION@#One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.

Endonasal endoscopic salvage surgical treatment for local recurrent nasopharyngeal cancer / 临床耳鼻咽喉头颈外科杂志

Nasopharyngeal cancer is a low differentiated squamous cell carcinoma, and the radiation therapy is the primary choice. It's 5 year survival rate may reach 64.4%, while 10.0% cases may suffer from the local recurrence. The salvage radiation or surgery is still the main choice for recurrent cases now. However the recurrent tumor become radiation insensitive and meanwhile, morbidity and mortality become higher. The experience of open salvage surgery on the recurrent radiation insensitive tumor had been proved safely, and the related morbidity and mortality are acceptable. Recently, the endoscopic salvage surgery has been developed, some preliminary experience has been obtained and the result looks promising. In this article, the pathobiological characteristics of the postradiation local recurrent nasopharyngeal cancer, the anatomy of nasopharyngus and related skull base area, especially the petroclival region and current situation of endonasal endoscopic salvage surgery were reviewed here. Basic principle of oncological surgery that endoscopic surgery should followed and possible endoscopic surgical approaches were proposed.

Reconstruction of large external nose defect with forehead flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the role of forehead flap in large external nasal defect reconstruction.@*METHOD@#We retrospectively reviewed the clinical and follow-up data of 11 patients with large or full-thickness external nasal defects, which were reconstructed with single-or two-stage interpolated or island forehead flaps from January 2007 to June 2011. All patients were male,defects of 9 cases were resulted from resection of skin malignant tumor and traumatic defect in 2 cases. The average diameter of defects was 3.3 cm (2.5-5.0 cm). Four cases had alar full thickness defect. The supratrochlear and angular artery of the elders (>70 yrs) and patients with suspicious peripheral blood vessel lesions were scanned before the surgery by Doppler ultrasonic. The defects were reconstructed by two-stage interpolated flap in 7 cases; five cases were reconstructed by single-stage island flap technique. A nasolabial flap based on piriform aperture was turned into the nasal cavity to reconstruct the lining.@*RESULT@#All defects were repaired successfully. All tissue flap survived and the scar was not conspicuous. One patient had nostril stenosis with mild nasal congestion complain at the 6th postoperative month.@*CONCLUSION@#The forehead flap, interpolated or island, can be used safely and effectively to repair the large external nasal defect in experienced hands.

The role of MR and endoscopy in postoperative management of skull base reconstruction by vascular pedicle septal flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the significance of MR and endoscopy in the postoperative management of skull base reconstruction with a vascular pedicle nasoseptal mucoperiosteal flap.@*METHOD@#The immediate, and delayed postoperative MR imaging scans and endoscopic data of 8 patients who underwent endonasal endoscopic reconstruction of skull base dural defects with a vascular pedicle nasoseptal mucoperiosteal flap were retrospectively studied. Among the 8 patients, 7 cases have integrated immediate, delayed postoperative MR and synchronous endoscopic data which were harvest at the first week and at a 3- to 7-month interval respectively. One case was followed up by CT and endoscopy. The intracranial parenchymal changes, local situation of skull base defect site, the septal flap, healing of flap donor site and the transition of naso sinus mucosa were fully evaluated to explore the healing process and to improve the success rate of the reconstruction.@*RESULT@#We can obtain the key postoperative information of intracranial and the skull base reconstruction site with MR and endoscopy. The MR can exclude the intracranial complications such as postoperative intracranial hematoma, cerebral edema, or pneumocephalus, and clearly show the location and extent of skull base defects, the position of the flap, the overlapping manner between the dural defect margin and the flap and the postoperative cerebrospinal fistula. In immediate and postoperative follow-up with MR, the septal flap had homogeneous enhanced image with a roughly "C" figure under the skull base, indicating stable blood supplement. The synchronous endoscopic examination also proved the survival of the septal flaps in 7 cases , the cerebrospinal fluid leakage in 1 case. One case flap necrosis. The septal flaps presented edema and congested in the immediate postoperative endoscopy, and returned to normal in the delayed examination. The non-vascular materials such as gelatin sponge and fat tissue had the different characteristics signal. Nasal mucosal edema and sinus ventilation continually recovered during the follow up and the exposed septal cartilage on the donor site resurfaced by mucosa in 2 months.@*CONCLUSION@#MR and endoscopy could provide the critical postoperative information about the vascular pedicle septal flap reconstruction. MR combined with endoscopy not only could rule out the complications, but also could gain the information such as the position, blood supply and healing of the flap, at the same time detected the cerebrospinal fluid leakage to provide accurate information for the secondary stage reconstruction. The information got from MR and endoscopy were important for the surgeon and the radiologist to recognize the flap and to evaluate for variations that may suggest potential flap failure.

Surgical management of sinonasal and adjacent skull base benign fibro-osseous lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the use of transnasal endoscopy and open surgical approaches for management of sinonasal and adjacent skull base benign fibro-osseous lesions, the surgical methods, precautions, clinical efficacies were also described.@*METHOD@#Fifteen patients were reviewed, including osteoma in 6 cases, Ossifying fibroma in 2 cases and fibrous dysplasia in 7 cases. Analyzed the pathological features and CT images, and to select surgical approach according to the location and extent of lesions. Eleven patients were operated through transnasal endoscopic procedure, including 7 cases with ipsilateral nasal approach and 4 cases with extended binasal approach; 4 cases with open surgical approach, including trans-eyebrow approach in 1 case and bicoronal approach in 3 cases.@*RESULT@#All patients were followed up for 2 months to 4 years, gross resection of lesions in 10 cases but partial resection in 5 cases with fibrous dysplasia. The clinical symptoms and facial deformity in all cases were eliminated or significantly relieved postoperatively. Cerebrospinal fluid leakage occurred in 1 case, was successfully repaired during the endoscopic operation. Preoperative diplopia in 3 cases, 2 cases disappeared after six months, one case was improved significantly. There were no postoperative orbital or intracranial complications.@*CONCLUSION@#Surgery is an effective means to resect lesions which had obviously clinical symptoms. The location and extent of lesions were the decisive factor to choose an open or endoscopic approach. Endoscopic sinus surgery can manage the midline skull base lesions which extend from the posterior wall of the frontal sinus to the clivus, well the open surgical approach is suitable for lesions locating the area beyond the medial orbital wall. No matter choosing which approach, osteoma, ossifying fibroma can be completely removed. For the fibrous dysplasia, as an extensive but self-limiting lesion, the surgery is performed only for relieving symptoms and facial deformity. So the partial resection is preferred and reasonable other than radical total resection. Even the severe fibrous dysplasia lesions caused the optic canal stenosis but present normal vision, it is unnecessary to perform prophylactic decompression of the optic nerve.

Endoscopic diathermy of the sphenopalatine artery as the primary management for refractory epistaxis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the methodology and efficacy of endoscopic sphenopalatine artery diathermy in management of refractory epistaxis.@*METHOD@#Twenty patients with severe intractable posterior epistaxis, who had underwent various procedures like nasal packing, electro- or chemical cautery or others and still exacerbated, were subjected to this study. Under general anesthesia, according to the endoscopic anatomy of the sphenopalatine foramen, the sphenopalatine artery was identified under the posterior tip of the middle turbinate. After the pedicle of the artery was delineated, a bipolar cauterized the artery and transected it.@*RESULT@#Twenty patients have been followed up for 5 to 20 months with an average of 10 months. No patients suffered recurrent epistaxis during the period. Only 1 patients in this series reported minor nasal adhesion.@*CONCLUSION@#Diathermy of sphenopalatine artery, as a purely endonasal procedure, is an effective and microinvasive means of achieving long-term control of refractory epistaxis. It has few complications associated with other forms of arterial ligation.

Applied anatomy of HPS-UPPP to treat OSAS / 吉林大学学报(医学版)

Objective:The paper provided the basis of morphology to treat severe obstructive sleep apneasyndrome (OSAS) by applying hard palate short uvulopalato-pharyngoplasty (HPS-UPPP) in clinic.Methods:The curve length of hard palate and soft palate,the distance between the greater palatine foramenwere measured with vernier caliper and the position relation of the nerve and vessels passing throughgreater palatine foramen was observed in 100 oranium and 50 cadaver. Results:The curve length of hardpalate was 49.3± 0. 28 mm;the curve length of soft palate was 26.1±0. 30 mm;the distance between thegreater palatine foramen was 27.3±0. 24 mm. Conclusion:The results have the guiding significance in re-moval of length of hard palate and soft palate ,and the way of operation.