Emergency rescue and vascular reconstruction of carotid artery rupture: A report of 6 cases / 第二军医大学学报

Objective To summarize our experience in rescuing fatal bleeding induced by carotid artery rupture(CAR) and in ascular reconstruction. Methods Six patients (11 times) with CAR-induced fatal bleeding were treated in our department uring Dec. 2002 to Dec. 2008. The patients included 4 males and 2 females, with an age range of 12-67 years old and a median of 48 years old. The primary illness included vocal cord paralysis (2 cases) after operation of thyroid carcinoma, recurrent thyroid carcinoma (1 case), recurrent hypopharyngeal carcinoma (1 case), head and neck trauma (1 case) and carotid body tumord case). Four patients received radiotherapy (60-80 Gy) before second operation. One patient (2 times) had in-nominate artery blowout, 4 (8 times) had common carotid blowout, and one had internal carotid artery blowout. CAR occurred during or after surgical operations in 4 patients (8 times) and was caused by external injury in 1 case (1 time). Results Restore of CA after complete exposure of rupture was performed for 5 times, anastomosis by artificial blood vessel for 1 time, direct anastomosis for 1 time, reconstruction by great saphenous vein for 2 times, and ligation of total carotid artery for 2 times. Of all patients, 3 cases undergoing vascular reconstruction succeeded by one try, 2 by 2 tries, and 2 cases underwent ligation of artery because of suture falling off for radiotherapy of infection. Muscle flaps including pectoralis major myocutaneous flap (3 cases) and sternocleidomastoid faps (2 cases) were used to protect vascular anastomosis. All cases were successfully rescued, without perioperative death. One patient developed hemiplegial after ligation of carotid artery. All cases had complete follow-up data. One patient died due to bleeding one week after discharge, 1 died due to ecurrent tumor within one year after operation. By now one patient survived for 3 years and 3 for 5 years. Conclusion Once CAP occurs, prompt press by hands and quick anti-shock procedure are the prerequisites of successful rescue. econstruction or repair of carotid artery can prevent complications of the nervous system, and individualized vascular reconstruction trategy should be employed. Ligation of carotid is effective to rescue patients of CAR, but it should only be chosen when reconstruction is impossible.

Surgical management and reconstruction of petrous internal carotid artery involved in malignant tumors of lateral skull base / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of reconstruction of internal carotid artery after ablation of malignant tumors in lateral skull base.</p><p><b>METHODS</b>Four male patients with malignant tumors in lateral skull base involved internal carotid artery underwent surgical treatment during Jan 2006 to Jan 2009 were retrospectively analyzed. MRI, CT and DSA were performed in all patients and showed that petrous internal carotid arteries (PICAs) were invaded, with luminal narrow. After radical dissection of tumors and the invaded PICAs, saphenous veins were used to reconstruct the PICAs. All cases were applied with postoperative concomitant radiochemotherapy. Three cases underwent total resection of temporal bone and one case underwent sub-total resection of temporal bone. Retrusion of facial nerve was performed in one case and reconstruction of facial nerve in three cases; Resection of sigmoid sinus and jugular foramen was performed in three cases. Resection and repair of meninges were performed in three cases. Free abdominal rectus and latissimus dorsi muscle myocutaneous flaps were used to repair the defect of lateral skull base and the flaps were well survived.</p><p><b>RESULTS</b>No significant neurovascular complications occurred in the patients. Postoperative DSA showed that the reconstructed PICAs were in well conditions. Follow up showed two patients survived tumor-free for five years, one patient had recurrence three years after operation and survived with tumor, and one patient died of recurrence one year after operation.</p><p><b>CONCLUSIONS</b>Reconstruction of PICA by saphenous vein offered the possibility of radical resection of malignant tumors in lateral skull base involved PICAs.</p>

Combination of genioglossus advancement by non-trephine technic with uvulopalatopharyngoplasty for treatment of obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and reliability of genioglossus advancement and hyoid suspension with non-trephine technic (GAHM) and uvulopalatopharyngoplasty (UPPP) for surgical obstructive sleep apnea-hypopnea syndrome treatment.</p><p><b>METHODS</b>Twenty-six patients (4 female and 22 male) were classified as moderate and severe cases in terms of apnea hypopnea index (AHI) and Friedman classification in the present study. All cases patients underwent genioglossus advancement and hyoid suspension with non-trephine technic Uvulopalatopharyngoplasty UPPP. Pre- and postoperative polysomnography and Epworth sleepiness scale were performed to assess the therapeutic outcomes.</p><p><b>RESULTS</b>The whole operation time ranged from 120-180 minutes. The average amount of bleeding in genioglossus advancement was about 50-100 ml. There were no severe complications during and after the operation. All the cases were followed up to one year. After surgery, AHI was decreased in both group cases, (42.9 +/- 6.6 vs 16.2 +/- 5.7) in the severe group, and 21.3 +/- 4.4 vs 11.3 +/- 5.2 (x(-) +/- s) in the moderate group. With success defined as AHI decreased by more than 50 per cent after surgery, the total success rate in moderate and severe group was 83.3% and 91.7%, respectively (P < 0.01). Furthermore, the success rate of the moderate group was higher than those of the severe group (P < 0.01).</p><p><b>CONCLUSION</b>GAHM combined with UPPP may be beneficial for the moderate and severe OSAHS patients with oropharyngeal and hypopharyngeal obstruction.</p>

Investigation and analysis on Wenchuan area earthquake trauma to ear, nose and throat / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The epidemic data of Wenchuan area earthquake trauma of ear, nose and throat were investigated.</p><p><b>METHODS</b>Affected families and sufferers of part of disaster area in Sichuan province in 2008 were investigated with emphasis on severity, cause and treatment of otorhinolaryngologic trauma.</p><p><b>RESULTS</b>Two hundred and twenty-seven cases of otorhinolaryngologic trauma in survival crowd 3 days after earthquake were included in this study. Most of them were minor trauma or complex lesion. There were 185 cases of soft tissue wound in head and face, 13 cases of fracture of the nose, 18 cases of hemorrhage of the nose, 7 cases of fracture of the skull base, 4 cases of lacerated wound of the auricle. Diagnosis and management were carried out by medical aid post and field ambulance on different condition. The methods of treatment included debridement and suture of soft tissue wound and positioning of fracture. If there was serious injury and accompanied complex lesion, the patients should be sent to hospital after emergent treatment. Forty-six cases were treated in medical aid post, except 3 cases of complex lesion by transportation, 43 cases recovered in 5 to 10 days after treatment. One hundred and eighty-one cases were treated in field ambulance, except 3 cases with fracture of skull base by transportation. Among 31 hospitalized patients, 26 recovered and were discharged before 26th of may, 5 were still in ward because of complex lesion. Among 147 cases treated out of wards with soft tissue wound, 146 cases recovered and bone fracture in rehabilitation. 1 case of lacerated wound of auricle was infected with delayed healing. There were no complication in all cases.</p><p><b>CONCLUSIONS</b>For earthquake trauma of the ear, nose and throat, emergent management are debridement, suture and positioning of fracture. For seriously injured patient, transportation to hospital in time can decrease complications and death rate.</p>

Display of different injuries of recurrent laryngeal nerve in laryngeal electromyography / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the display of different types injuries of recurrent laryngeal nerve (RLN) in laryngeal electromyography (LEMG).</p><p><b>METHODS</b>LEMGs of one hundred and forty-seven patients (147 sides) with traumatic unilateral vocal cord paralysis (UVCP) were studied. After LEMGs, the RLNs exploration operations were performed. The condition of RLNs injury and laryngeal muscles was observed and recorded during the operation.</p><p><b>RESULTS</b>The severe injuries of RLNs were found during operation. The types of injuries were listed as ligation (58 cases), adhesion (28 cases) and cut (61 cases). The waveform morphology of LEMG was recorded less in the patients with the RLNs cut than that in the patients with the RLN ligation or adhesion, respectively. 75.4% RLNs cut showed spontaneous waveform while 96.4% RLNs adhesion and 94.8% RLNs ligation. When the RLN was cut off, single pattern was showed oftener. When the RLN was adhered or ligated, mixed pattern was showed oftener. 92.9% RLN adhesion showed misdirect-regeneration-potentials while 70.7% RLN ligation and 24.6% RLN cut. There were significant difference between two types, but the compound muscular active potential (CMAP) amplitude wasn't significantly different. Evoked amplitude could be recorded in 91.4% patients with ligation and its amplitude was (23.6 +/- 8.1)%, in 85.7% patients with adhesion and its amplitude (16.3 +/- 5.2)%, in 29.5% patients with cut and its amplitude (2.6 +/- 4.2)%.</p><p><b>CONCLUSIONS</b>The display of different injuries of RLN in LEMG presents significant difference. If RLN was cut off, the CMAP might be recorded in most cases. The clinical injury of RLN often is followed by sub-clinic reinnervation.</p>