Neoadjuvant chemotherapy in the treatment of locally advanced olfactory neuroblastoma in 25 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the efficacy of neoadjuvant chemotherapy (NACT) in the treatment of locally advanced olfactory neuroblastoma (ONB), and to explore the factors related to the efficacy of NACT. Methods: A total of 25 patients with ONB who underwent NACT in Beijing TongRen Hospital from April 2017 to July 2022 were retrospectively analyzed. There were 16 males and 9 females, with an average age of 44.9 years (ranged 26-72 years). There were 22 cases of Kadish stage C and 3 cases of stage D. After multiple disciplinary team(MDT) discussion, all patients were treated sequentially with NACT-surgery-radiotherapy. Among them, 17 cases were treated with taxol, cis-platinum and etoposide (TEP), 4 cases with taxol, nedaplatin and ifosfamide (TPI), 3 cases with TP, while 1 case with EP. SPSS 25.0 software was used for statistical analysis, and survival analyses were calculated based on the Kaplan-Meier method. Results: The overall response rate of NACT was 32% (8/25). Subsequently, 21 patients underwent extended endoscopic surgery and 4 patients underwent combined cranial-nasal approach. Three patients with stage D disease underwent cervical lymph node dissection. All patients received postoperative radiotherapy. The mean follow-up time was 44.2 months (ranged 6-67 months). The 5-year overall survival rate was 100.0%, and the 5-year disease-free survival rates was 94.4%. Before NACT, Ki-67 index was 60% (50%, 90%), while Ki-67 index was 20% (3%, 30%) after chemotherapy [M (Q1, Q3)]. The change of Ki-67 before and after NACT was statistically significant (Z=-24.24, P<0.05). The effects of age, gender, history of surgery, Hyams grade, Ki-67 index and chemotherapy regimen to NACT were analyzed. Ki-67 index≥25% and high Hyams grade were related to the efficacy of NACT (all P<0.05). Conclusions: NACT could reduce Ki-67 index in ONBs. High Ki-67 index and Hyams grade are clinical indicators sensitive to the efficacy of NACT. NACT-surgery-radiotherapy is effective for patients with locally advanced ONB.

Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.</p><p><b>METHODS</b>Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.</p><p><b>RESULTS</b>The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.</p><p><b>CONCLUSIONS</b>Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.</p>

Clinical implication of global osteitis score system and its role in evaluation of osteitis of chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of Global Osteitis Score System (GOSS). To determine the association between GOSS, Lund-Mackay scores and Lund-Kennedy scores and to investigate the incidence of osteitis in patients with chronic rhinosinusitis (CRS).</p><p><b>METHODS</b>Three hundreds and thirty-four patients with CRS were enrolled prospectively in a large tertiary referral center. The paranasal sinus bone Hounsfield unit (HU), thickness, scope were measured by PHILIPS MxLiteView software. Nasal endoscopy Lund-Kennedy score was analyzed in all patients. Sinus CT scans of all patients were analyzed for Lund-Mackay score and for osteitis using the GOSS. Association between GOSS and Lund-Mackay, Lund-Kennedy was examined.</p><p><b>RESULTS</b>The incidence of osteitis in patients with chronic rhinosinusitis was from 33.83% to 53.89%. Average GOSS score of osteitis was 7.51 ± 7.27. The highest incidences of osteitis were in the maxillary and anterior ethmoid sinuses. The left anterior ethmoid sinuses was 37.2%. The right anterior ethmoid sinuses was 32.8%. The left maxillary sinuses was 46.1%. The right maxillary sinuses was 42.2%. Global osteitis score were significantly correlated with Lund-Mackay and Lund-Kennedy scores (r value were 0.497 and 0.409 respectively, all P < 0.001).</p><p><b>CONCLUSIONS</b>GOSS can define and evaluate the extent and the severity of osteitis in patients with CRS by using CT, and can also reflect the extent and the severity of CRS.</p>

Removal of Schwannoma in the pterygopalatine and infratemporal fossa via endoscopic prelacrimal recess approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemporal fossa (PPF and ITF) through postero-lateral wall via prelacrimal recess approach (PLRA). The surgical technique and indications were presented and discussed.</p><p><b>METHODS</b>Six patients aged from 29-59 year-old with Schwannoma in the PPF and ITF, who received the tumor resection via PLRA under endoscope, were enrolled in this paper. Three were female and 3 were male. All of them received preoperative CT and MRI. The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia. Schwannoma was histopathologically confirmed after surgery. The postoperative periodical CT and MRI follow up was conducted.</p><p><b>RESULTS</b>The tumors were removed completely in these 6 patients. No recurrence was found during 19.3 months follow up on the average. Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards. Only 1 patient had mild altercation numbness at the end of follow up.</p><p><b>CONCLUSIONS</b>Schwannoma involved PPF and ITF can be removed endoscopically via PLRA. The lateral wall of nasal cavity might be kept intact. It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.</p>

CT and MRI diagnosis of lesions in unilateral maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the CT and MRI findings of lesions in unilateral maxillary sinus, and to compare the effect of CT and MRI in the differential diagnosis of lesions in unilateral maxillary sinus.</p><p><b>METHODS</b>Retrospective analysis of CT and contract-enhanced MRI imaging data from 34 patients with lesions in unilateral maxillary sinus which were diagnosed by endoscopic sinus surgery and postoperative pathology. The CT and contract-enhanced MRI's value in the differential diagnosis in lesions in unilateral maxillary sinus was analysed.</p><p><b>RESULTS</b>All 34 patients had unilateral maxillary sinus lesions. On CT: soft tissue density shadow in the unilateral maxillary sinus was found in all 34 cases. Five cases showed spot high density with thickening bone in the maxillary sinus wall. Eleven cases showed expansion of the opening of maxillary sinuses. Two cases showed broken lateral wall of nasal cavity . One case showed soft tissue density shadow in the maxillary sinus with curve edge with high density shadow which had a tooth shadow in it. Other 14 cases showed only soft density shadow in the maxillary sinuses. On MRI: all 34 cases revealed lower signals on T1WI compared to gray matter. Little loss signal were found in the inner of the maxillary sinus fungal balls on T1WI. Enhanced MR imaging showed no enhanced in nasal sinusitis, sinus cysts and polyp of posterior naris. In homogenous enhancing and "the cerebral convolution sign" were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases. Higher signals were seen in the nasal sinusitis, fungal balls and the polyp of posterior naris cases on T2WI. In homogenous signal with different levels were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases on T2WI.</p><p><b>CONCLUSIONS</b>CT and MRI examination are important in the diagnosis of the unilateral maxillary sinus lesions. Both CT and MRI had more differential diagnostic value in the unilateral maxillary sinus lesions than only CT used.</p>

Intranasal endoscopic prelacrimal recess approach to maxillary sinus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS). We report a new approach to MS without ablation of NLD and IT.</p><p><b>METHODS</b>This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma (IP), two had nasal polyps, two had Kubo's postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed.</p><p><b>RESULTS</b>All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications.</p><p><b>CONCLUSION</b>The diffuse or severe diseases of MS may be the potential indications for PLRA.</p>

Clinical application of Draf IIb frontal sinusotomy and it's modified procedures / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize the follow-up outcomes of Draf IIb frontal sinusotomy and it's modified procedures, and to discuss the surgical indications and prognostic factors.</p><p><b>METHODS</b>Thirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma (IP), 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography (CT) scans. Patients with tumor accepted magnetic resonance imaging (MRI). The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea received magnetic resonance cisternography (MRC). The Draf IIb frontal sinusotomy and it's modified Draf IIb-1-3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope.</p><p><b>RESULTS</b>Among 19 cases of Draf IIb, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf IIb-1, 2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf IIb-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf IIb-3 were mucocele. The follow-up ranged from 8 to 73 months. Twenty-two cases of the frontal nepostium were widely opened, 7 were stenosis and 3 were closed. Revision surgery was seen in 2 cases with IP. All of them had no complications.</p><p><b>CONCLUSIONS</b>The Draf IIb frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.</p>

Analysis of follow-up outcomes of endoscopic modified Lothrop procedure / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up the follow-up outcomes of endoscopic modified Lothrop procedure (EMLP) and retrospectively analyze the indications, methods and prognostic factors of EMLP.</p><p><b>METHODS</b>The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper. The mean age was 45.6 (ranging from 14 to 72 years). There were 52 males and 21 females. Only patients with follow-up time greater or equal to 6 months were included. Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients. All patients were followed under endoscope.</p><p><b>RESULTS</b>There were 21 inverted papilloma in the frontal sinus, 16 chronic sinusitis with asthma, 12 frontal sinusitis, 9 chronic sinusitis with or without polyps, 7 osteoma of the frontal sinus, 4 frontal mucocele, 3 allergic fungal sinusitis and 1 congenital encephalocele. Sixty-one cases had prior surgical history (1.8 times on the average). Their mean follow-up was 25.0 months, (ranging from 6 to 122 months). At the end of follow-up, 44 cases (60.3%) had well opened frontal drainage pathway. Twenty-five (34.2%) was re-stenosed and 4 (5.5%) closed. Seven cases (9.6%) underwent revision surgeries. There were no surgical complications.</p><p><b>CONCLUSIONS</b>EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis. Combined with medical treatment, EMLP will have a better results for chronic sinusitis with or without polyps and asthma. The degree of diseases, mucosal loss, anatomic variability and prior surgeries are important prognostic factors.</p>

Juvenile nasopharyngeal angiofibroma: endoscopic surgery and follow-up results / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results.</p><p><b>METHODS</b>The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded.</p><p><b>RESULTS</b>There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03).</p><p><b>CONCLUSIONS</b>The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.</p>

Histopathological observation of bone remodeling in rabbit sinusitis model / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the histopathological finding of bone remodeling in rabbit sinusitis model at different time and the tendency, and to discuss the effect of bone in the pathogenesis of sinusitis.</p><p><b>METHODS</b>First, the rabbit sinusitis model was made, then the experimental animals were divided into 3 groups according to the time of infection. There were 8 rabbits in each experimental group, and 4 rabbits in the control group. The sinus specimen were collected, embedded and stained. The bone in the inoculating side and noninoculating side was scored, and the bone in inoculating side was evaluated quantitatively and semiquantitatively. The parameters included the thickness of mucosa, mucoperiosteum, the density of osteoblast, the amount of osteoclast.</p><p><b>RESULTS</b>The average bone score in the inoculating side was 2.250, 2.875, 2.875; in the noninoculating side was 1.625, 2.250, 2.500. Between group A and the control group, the difference of all three parameters had statistical significance. Between group B and group A, the difference of the thickness of mucosa and the density of osteoblast had statistical significance. Between group C and group B, none of the three parameters had statistical significance.</p><p><b>CONCLUSIONS</b>Bacterial sinusitis can lead to bone remodeling, obvious bone destroy can occur at the early phase, then the bone proliferation follows. These results demonstrate that bone remodeling is one of the basic histopathological characters of CRS and might be the reason to lead CRS to a constant and chronic process of inflammation.</p>

Long-term follow-up for outcomes of intranasal endoscopic dacryocystorhinostomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up and analyze the long-term follow-up outcomes of intranasal endoscopic dacryocystorhinostomy (IEDCR) in patients with chronic dacryocystitis. The related factors to clinical effects were discussed.</p><p><b>METHODS</b>The operative and postoperative data were collected in 275 patients (310 eyes, mean age 28.3 years; range 3 to 76 years) who were undergone IEDCR with chronic dacryocystitis. All patients conceived the preoperative dacryocystography. Surgical intervention was performed under general or local anesthesia and all were done by the same surgeon. The silicon intubation was used according to the size of lacrimal sac. The postoperative follow-up management included endoscopic cleaning, lacrimal duct irrigation and nasal corticosteroid spray.</p><p><b>RESULTS</b>The patients with follow-up period less than 1 year were excluded from this group. 211 cases (230 eyes) were followed up over 1 year and the results showed that 75.3% were cured, 11.7% improved and 13.0% had no effects. The natural lacrimal apparatus was found reopened in 9 cases while their lacrimal rhinostomies were closed with scar. There was no operative complications.</p><p><b>CONCLUSIONS</b>The long-term outcomes of IEDCR are good. The wide bony rhinostomy, less mucosal damage and closed follow-up debrided should benefit for getting a high operative success rate. After surgical drainage, the inflammation mucosa of lacrimal sac might return to normal and the function of nasolacrimal apparatus might recover.</p>

Endoscopic nasal lateral wall dissection approach to maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report a new approach to maxillary sinus without ablation of nasolacrimal duct and inferior turbinate by endoscopic nasal lateral wall dissection (ENLWD). The preliminary clinical application results, the operative technique and indications were discussed.</p><p><b>METHODS</b>Twelve hospitalized patients, aged from 42 years to 68 years, were enrolled in this paper, 9 patients were male and 3 were female. Among the 12 patients, 8 were inverted papilloma (IP), 2 were nasal polyps, 1 was Kubo's postoperative cyst of maxillary sinus (MS) and 1 was recurrent bone cyst of maxilla. Two IP patients were excluded from this group for the follow-up time was less than 12 months. Preoperative nasal endoscopy and CT scan were done in all patients, 6 patients with tumor also received MRI examination. The operation began with a mucosal incision in front of inferior turbinate (IT) and then the lacrimal duct (LD) was dissected, thus a IT-LD flap was formed. The MS lesion was removed under endoscope when the flap was replaced medially. The inferior antrostomy was performed when the flap was repositioned.</p><p><b>RESULTS</b>All 10 patients were unilateral lesion. Six MS IP patients were T3 Krouse stage. The tumor was found originating from the every part of the MS wall in the operation, especially from the anterior and medial wall. The same situation was seen in 2 patients with nasal polyps. The follow-up ranged from 7 months to 60 months (average 22 months). The shape of IT was good, and well-epithelized operative cavities were observed. Only 1 patients of IP had a local recurrence in its inferior antrostomy 6 months after operation and no recurrence was seen after local debridement. All of them had no epiphora and other complications.</p><p><b>CONCLUSIONS</b>ENLWD is a new and minimally invasive approach not only to MS, in which the lesion can be thoroughly removed, but also to orbital floor and pterygopalatine fossa without ablation of lacrimal duct and IT.</p>

Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the results of endoscopic transpterygoid intervention of nine patients with meningoencephalocele and cerebrospinal fluid (CSF) leaks within lateral recess of sphenoid sinus (LRSS). The diagnosis, operative techniques and their related problems were discussed.</p><p><b>METHODS</b>Nine hospitalized patients with meningoencephalocele and CSF leaks within lateral recess of sphenoid sinus (LRSS) were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia.</p><p><b>RESULTS</b>All the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months (mean 25. 6 months).</p><p><b>CONCLUSIONS</b>Endoscopic transpterygoid intervention for meningoencephalocele and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.</p>

Quality of life for adolescents and children with chronic sinusitis and its influencing factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the status of the quality of life for adolescents and children with chronic sinusitis and its influencing factors.</p><p><b>METHODS</b>Eighty-six patients were measured with the General Information Questionnaire and Chronic Sinusitis Quality of Life Scale. Six months after operation, the Chronic Sinusitis Quality of Life Scale was retested. T-test and stepwise regression were used to study the improvement and influencing factors of quality of life.</p><p><b>RESULTS</b>The preoperative and postoperative quality of life scores showed a significant difference ( all P < 0. 01 ). The main factors influencing the quality of life included symptom scores (P = 0. 003) , family economic status(P = 0. 003) , parents' attitude(P = 0. 009) , extents of pathological changes(P = 0. 019) , regional disparity ( P = 0. 010) and parents' educational level (P = 0. 048).</p><p><b>CONCLUSION</b>The children's subjective symptoms should be viewed as an important aspect for surgery selection. The quality of life in adolescent and children was influenced significantly by family economic status, their parents' attitude and the difference of education.</p>