Development of Nasal Continuum Minimally Invasive Surgical Robot System / 中国医疗器械杂志

In order to improve the operation difficulties in the narrow space of the nasal maxillary sinus, the nasal continuum minimally invasive surgical robot system is designed. The ball-and-socket joints and NiTiNol tubes are used as the main body of the continuum structure to improve the degree of freedom. The hardware systems and software systems are designed. The security control policies are planned. Finally, the robot confirmed prototype experiments are conducted and the feasibility of continuum robot confirmed through master-slave control experiment and animal experiment.

Study on the method of microelectrodes implantation of artificial facial nerve prosthesis in closed mouth of orbicularis oris muscle in monkeys with facial nerve paralysis / 中华口腔医学杂志

Objective@#To explore the optimal method of microelectrode implantation that can produce efficient mouth closure with microelectrode for orbicularis oris muscle (OOM) in rhesus monkeys with unilateral peripheral facial paralysis (UPFP) in order to provide basis for the research and development of artificial facial nerve prosthesis (AFNP).@*Methods@#Right lateral peripheral facial paralysis model on four healthy rhesus monkeys (two males and two femles, aged 5-6 years, weighed 2.0-3.0 kg) were prepared. AFNP electric stimulation was used to induce closed-mouth reaction of the affected OOM with a one-way rectangular pulse, 50 Hz frequency and 0.2 ms pulse width in vitro. Around the affected lateral OOM, four stimulus electrodes implantation positions were selected at the upper lip (position A), the lower lip (position B), the connection with the corner of the mouth to the ipsilateral tragus (position C), and the horizontal line of the mouth angle (position D). According to the different implantation positions of three stimulation electrodes on the stimulation side of AFNP and the results of our previous study, six groups of microelectrode implantation methods were designed. In Group A, two microelectrodes were implanted at position A and one microelectrode was implanted at position B; in Group B, one microelectrode was implanted at position A, B and C respectively; in Group C, one microelectrode was implanted at position A and two microelectrodes were implanted at position B; in Group D, one microelectrode was implanted at position A, B and D respectively; in Group E, one microelectrode was implanted at position A, C and D respectively; in Group F, one microelectrode was implanted at position B, C and D respectively. The minimum stimulating current (threshold current) required for effective mouth closure were recorded. The threshold and peak current values were compared using one-way ANOVA and LSD-t multiple comparisons.@*Results@#The microelectrodes of the AFNP stimulating side in Group E and F failed to induce a smooth mouth closure. The microelectrodes in A, B, C and D group induced smooth mouth closure. The threshold current value of OOM contraction on affected side in the Group A, B, C, and D were (1.35±0.05), (1.02±0.04), (1.40±0.04) and (1.10±0.02) mA, respectively (F=295.302, P<0.001), with the lowest value in Group B and there was significant difference between the current value in Group B and those in the other groups (all P<0.05). The peak current value of OOM contraction on affected side in the four groups were (3.95±0.02), (2.95±0.03), (3.99±0.05) and (3.51±0.01) mA, respectively (F=1 014.985, P<0.001). Group B showed the best lip-closure morphology observed with naked eyes.@*Conclusions@#When three output microelectrode of the AFNP stimulated side are separately imbedded into the upper lip, the lower lip and the connection with the corner of the mouth to the ipsilateral tragus, AFNP can sufficiently induce closed-mouth reaction. These positions are suitable as priority options microelectrodes implantation positions for the microelectrodes of the AFNP stimulated side.

Positions of the implanted stimulating electrodes for artificial facial nerve for inducing contraction of the orbicularis oris muscle in rabbit with peripheral facial paralysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the optimal positions of the implanted stimulating eletrodes for artificial facial nerve (AFN) for inducing contraction of the orbicularis oris muscle (OOM) in rabbit with peripheral facial paralysis.@*Methods@#According to the four microelectrodes of the AFN stimulating side, four modes of the implanted positions were divided. In line with different modes, the electrodes were implanted into the affected OOM of the rabbits with unilateral peripheral facial paralysis. AFN output electric stimulation to induce contraction of the affected OOM with uniform stimulating frequency and pulse length in vitro. Then compared the stimulus threshold amplitude and the peak amplitude separately among different modes by SAS 9.3 version statistical software.@*Results@#The differences of the stimulus threshold amplitude and the peak amplitude had no statistically significant separately between the first mode and the second mode (P>0.05), but there were statistically significant differences between the third mode and the fourth mode (P<0.05). Both kinds of the amplitudes were approximated between the first mode and the second mode respectively, and higher than those in the third mode or the fourth mode. Furthermore, both kinds of the amplitudes in the fourth mode were higher than those in the third mode.@*Conclusions@#The microelectrodes of the AFN stimulating lateral are implanted into the upper lip with a public microelectrode and an output microelectrode, into the lower lip with an output microelectrode, and into the way, which is located to the angle 40° to 45° about the line joining between the midpoint of the ipsilateral auricle root and the corner of the mouth with an output microelectrode. This is the third positional mode which requires lowest effective stimulus current intensity. Thus the mode is suitable as the optimal placement programme.

Cause and treatment of unilateral vocal cord paralysis / 临床耳鼻咽喉头颈外科杂志

Unilateral vocal cord paralysis(UVCP) is defined as affected side vocal cord emerges immobility or motion weakening and abnormal tension due to unilateral intrinsic laryngeal muscles suffering from disorder about motor nerve. The patients usually present with hoarse voice, disability of high pitch, cough, aspiration, or a combination of these symptoms. There are increasing therapeutics researches and case analyses regarding UVCP in recent years. Thus this review summarized the progression about its causes and treatment methods.

Comparative study of eyelid closure induced by electric exciting different sites on odoiculads oculi muscle / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Directly excited the denervated orbicularis oculi muscle (OOM) by electric current on rabbits, to induce efficient eyelid closure, and seek the optimal sites for such excitation that can produce efficient eyelid closure with the minimal excitating current in the least channel.</p><p><b>METHODS</b>Bilateral peripheral facial paralysis model on 20 healthy NewZealand rabbits (40 sides) were prepared. Exciting current was designed for two-way rectangular pulse, 35 Hz frequency and 0.2ms pulse width. The current intensity could be adjusted between 0 and 2.5 mA. Middle of upper-orbit (A), outer orbital rim (B), and middle of lower-orbit (C) sites were located around the OOM. Each site underwent parallel muscle fiber excitation by 2.5 and 5 mm distance dual-electrode respectively, additional dual-electrodes were also placed in A- B and A- C positions. All resulted in a total of 8 different exciting methods, and were labeled A2.5, A5.0, B2.5, B5.0, C2.5, C5.0, AB and AC. Then the current was adjusted to achieve efficient eyelid closure. The minimal current intensity needed was regarded as threshold value.</p><p><b>RESULTS</b>All efficient eyelid closure occurrence rates of 8 methods were compared with combined χ(2) test and showed significant difference. A crossed χ(2) test showed the rates of C2.5, C5.0, and AC was significant lower than the highest methods. Except 3 methods above, the mean threshold values of remain 5 methods were compared with ANOVA test and showed significant difference. Further Fisher's LSD test showed B2.5 had the lowest mean value, was significant lower than A2.5 and AB, P < 0.001, and had no significant difference with A5.0 and B5.0, P > 0.05. A5.0's mean value was significant lower than A2.5's, P < 0.05.</p><p><b>METHODS</b>B2.5, B5.0 and A5.0 were more likely to achieve a perfect closure.</p><p><b>CONCLUSIONS</b>Middle of supraorbital margin (A) and outer orbital rim (B) are the ideal sites for electric excitation. Exciting the two sites can sufficiently induce the contraction of denervated OOM, leading to high efficient eyelid closure occurrence rates, more perfect closure meanwhile with lower threshold current value, which are priority options.</p>

Surgical treatment for severe stenosis of esophageal access / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the surgical management for the severe stenosis of peripheral esophageal access.@*METHOD@#Twenty-three patients who underwent severe stenosis of peripheral esophageal access from 2000 to 2009, were retrospectively reviewed. The surgical plan was selected by considering the stage of stenosis, dilatation, reconstruction of hypopharynx, oesophagus or larynx.@*RESULT@#Twenty-two patients resumed a normal oral diet and 21 cases succeeded in decannulation, no stenosis recurred after a 1-9 years follow-up.@*CONCLUSION@#The severe stenosis of peripheral esophageal access can get good results when the appropriate surgical plan were choice.

Clinical therapeutic effects of staging tympanoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinic characteristic and curative effect of staging tympanoplasty for chronic suppurative otitis media and cholesteatoma otitis media.@*METHOD@#Curative effects of 132 patients cured by staging tympanoplasty and 325 patients cured by no staging tympanoplasty were retrospectively analyzed. Curative effects include ABG value (the reduced value of air-bone conduct gaps after operation), recrudescence of cholesteatoma, tympanic membrane reperforation and wet ear after operation.@*RESULT@#In staging tympanoplasty group, ABG is 28.4 dB, rate of tympanic membrane reperforation is 1.5%, recrudescence of cholesteatoma is 0% and rate of wet ear after operation is 0%. In no staging tympanoplasty group, ABG is 21.3 dB, rate of tympanic membrane reperforation is 2.2%, recrudescence of cholesteatoma is 4.0% and rate of wet ear after operation is 1.2%.@*CONCLUSION@#The ABG, the rate of recrudescence of cholesteatoma in staging tympanoplasty group is much better than that in no staging tympanoplasty group. Tympanic membrane reperforation and wet ear after operation rate have no significant difference in statistic between two groups. We can conclude that staging operations will maintain and improve hearing level more effectively compare to no staging operation.

Management of the parotid gland tumor and its long-term outcome / 中国耳鼻咽喉头颈外科

OBJECTIVE To discuss the surgical methods and their long term efficacy of management of the parotid tumor.METHODS The clinical data of 86 cases with parotid tumor underwent operation between 1997 and 2004 in our hospital were retrospectively analyzed.There were 53 male and 33 female with their age from 23 to 84 years(mean 57 years old). All the patients underwent superficial parotidectomy or extensive superficial parotidectomyenl or total parotidectomy.Selective or functional neck dissection was carried out in some cases.The function of facial nerve was evaluated after operation in all patients. Postoperative radiotherapy was performed in all malignant cases with a dose of 50 to 70 Gy.The patients were followed-up for 36 to 120 months.RESULTS There were 73 benign cases and 13 malignant cases. Five of 8 malignant tumors were found in deep lobe gland.Only one benign tumor locally recurred.The local- regional control rate of the benign tumor was 98.3%. The 3-year survival rate and local-regional control rate in malignant neoplasm were 69.2 % and 84.6 % respectively.The cervical lymph nodes metastasis rate was 23.1% in postoperative pathologic study.The facial nerve preservation rates were 97.3 % and 69.2 % in benign and malignant cases respectively.CONCLUSION The superficial parotidectomy is the basic surgical method.Extensive superficial parotidectomy or total parotidectomy can be used if necessary.The facial nerve and its branches should be preserved during operation. The malignant tumor is more frequently found in deep lobe of the parotid gland.