ABSTRACT
OBJECTIVE@#To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments.@*METHODS@#A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.@*RESULTS@#①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05).@*CONCLUSION@#Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.
Subject(s)
Middle Aged , Humans , Aged , Intervertebral Disc Displacement/surgery , Retrospective Studies , Lumbar Vertebrae/surgery , Diskectomy, Percutaneous/methods , Treatment Outcome , Endoscopy/methods , Diskectomy/methodsABSTRACT
Background:Tonsillectomy is one of most commonly performed surgical procedure in otorhinolaryngology. In past, various surgical techniques for tonsillectomy have been de veloped. And coblation tonsillectomy is one of the latest techniques developed. We carried this study to check feasibility of powered instrument (coblator) in view of patient and surgeons benefit with advantages and disadvantages for tonsillectomy. Material And Methods:We carried out this study in randomly selected total 125 patients who presented to our ENT department with chief complain of recurrent tonsillitis. All patients underwent coblation techniques and were analysed for total time consumption during operation, amount of bloodloss during operation, immediate postoperative pain, postoperative haemorrhage whether primary or secondary, time needed to return back to the normal activity and diet ,total percentage of healing post operatively. Each patient had preoperative blood investigation to exclude any coagulation disorder and anemia. Postoperative analgesics and broad spectrum antibiotics were administered. Result:Mean operation time was 12±2.45 minutes in coblation group. Intraoperative blood loss turned out to be 20.00±5.0 ml for the coblation. Mean return to normal diet period was significantly shorter (5.00±1.50). Otherwise, return to normal behaviour was significantly earlier with coblation(10.50±2.00 ). Postoperative we have not seen any case of primary hemorrhage or secondary hemorrhage in our study.Conclusion:We found that coblation technique for tonsillectomy offers considerable advantages in the operation time and intra operative blood loss. Coblation is related with timely return to routine activities and normal adequate diet. To endorse its significance over conventional tonsillectomy warrants further study.
ABSTRACT
Objective:To investigate the efficacy and feasibility of radiofrequency resection of supraglottic laryngeal carcinoma under a multifunctional opener.Methods:The clinical data of four cases of supraglottic laryngeal carcinoma (type T1N1M0 in two cases, T2N1M0 in one case, and T1N0M0 in one case) who received treatment in the Affiliated Hospital of Jining Medical University during January-June 2019 were retrospectively analyzed. Radiofrequency resection of supraglottic laryngeal carcinoma under a multi-functional opener combined with bilateral neck II-IV region lymph node dissection was performed. Swallowing, breathing and phonation were observed and analyzed based on references.Results:Among the four cases, two cases had a normal diet at 3 days after surgery, one case had a normal diet at 7 days after surgery, and one case had a normal diet at 16 days after surgery. Tracheotomy was not performed in any case. After surgery, breathing and speech communication were not affected.Conclusion:Radiofrequency surgery under a multifunctional opener can be used for treatment of early supraglottic laryngeal cancer. It is an effective treatment with minimal trauma, mild postoperative pain and promotes the early recovery of normal swallowing function.
ABSTRACT
The aim of this study is to explore the application and advantages of combined intrathecal and extrathecal hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in OSA children. We retrospectively reviewed 726 cases who were diagnosed as OSA. All patients were divided into two groups according to the surgical method: 320 cases by total tonsillectomy and 406 cases by combined extracapsular and intracapsular tonsillectomy. The intro operative bleeding volume, post operative haemorrhage data as time, location and degree in the two groups were compared. There was no statistical difference in the intro operative bleeding volume in the two groups [（9.3±4.6） mL]vs [（7.6±3.5） mL], =12.687, =0.235. Two patients who underwent combined extracapsular and intracapsular tonsillectomy presented with post operative haemorrhage, the total post operative haemorrhage rate was significantly decreased that in the total tonsillectomy group（14 cases）（χ²=10.779, =0.001）. The 2 patients in combined extracapsular and intracapsular tonsillectomy group were secondary haemorrhage, with location in the upper pole and medium, grade A haemorrhage; while in the 14 cases in in the total tonsillectomy group, there were 2 cases presented with primary haemorrhage and 12 cases with secondary haemorrhage; with regard to location of haemorrhage, 1 in the upper pole, 2 in the medium, 11 in the lower pole; 5 cases presented with grade A haemorrhage, 8 with grade B haemorrhage and 1 with grade C haemorrhage. The haemorrhage rate at 7 days after surgery （χ²=5.697, =0.017）, at the lower pole（χ²=11.961, =0.001） and grade B（χ²=8.097, =0.004） were all significantly decreases in the combined extracapsular and intracapsular tonsillectomy group. Plasma tonsillectomy combined with intrathecal and extrathecal hypothermic tonsillectomy is a safe and effective method, which has obvious advantages in reducing the postoperative hemorrhage, especially the secondary hemorrhage of Subtonsillar Pole.
ABSTRACT
Objective@#The aim of this study is to explore the application and advantages of combined intrathecal and extrathecal hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in OSA children. @*Method@#We retrospectively reviewed 726 cases who were diagnosed as OSA. All patients were divided into two groups according to the surgical method: 320 cases by total tonsillectomy and 406 cases by combined extracapsular and intracapsular tonsillectomy. The intro operative bleeding volume, post operative haemorrhage data as time, location and degree in the two groups were compared. @*Result@#There was no statistical difference in the intro operative bleeding volume in the two groups [（9.3±4.6） mL]vs [（7.6±3.5） mL], t=12.687, P=0.235. Two patients who underwent combined extracapsular and intracapsular tonsillectomy presented with post operative haemorrhage, the total post operative haemorrhage rate was significantly decreased that in the total tonsillectomy group（14 cases）（χ²=10.779, P=0.001）. The 2 patients in combined extracapsular and intracapsular tonsillectomy group were secondary haemorrhage, with location in the upper pole and medium, grade A haemorrhage; while in the 14 cases in in the total tonsillectomy group, there were 2 cases presented with primary haemorrhage and 12 cases with secondary haemorrhage; with regard to location of haemorrhage, 1 in the upper pole, 2 in the medium, 11 in the lower pole; 5 cases presented with grade A haemorrhage, 8 with grade B haemorrhage and 1 with grade C haemorrhage. The haemorrhage rate at 7 days after surgery （χ²=5.697, P=0.017）, at the lower pole（χ²=11.961, P=0.001） and grade B（χ²=8.097, P=0.004） were all significantly decreases in the combined extracapsular and intracapsular tonsillectomy group. @*Conclusion@#Plasma tonsillectomy combined with intrathecal and extrathecal hypothermic tonsillectomy is a safe and effective method, which has obvious advantages in reducing the postoperative hemorrhage, especially the secondary hemorrhage of Subtonsillar Pole.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical effects of percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy and investigate its mechanism of action.</p><p><b>METHODS</b>Form January 2015 to January 2017, 21 patients with cervical spondylotic radiculopathy were treated by percutaneous coblation nucleoplasty, including 8 males and 13 females with an average age of 49.6 years old ranging from 43 to 61 years old. The course of disease was for 1 to 6 months with a median age of 4 months. Three cases were single segment, 9 cases were double segments, 7 cases were three-segment, 2 cases were four-segment. Intervertebral disc pressure, VAS were compared before and after operation. Angular displacement(AD) and horizontal displacement(HD) were measured by image data and in order to evaluate the cervical stability. Modified MacNab criteria was used to assess clinical effects.</p><p><b>RESULTS</b>All the patients were followed up from 1 to 12 months with an average of 8.6 months. Preoperative intervertebral disc pressure was (32.0±5.26) cmH2O and immediately after operation was (21.0±7.18) cmH2O, there was statistical significance between before and after operation(=0.003). Preoperative angular displacement and horizontal displacement was (3.85±1.26) ° and (1.23±0.58) mm, six months after operation was (4.18±1.31) ° and (1.69±0.46) mm, respectively. There was no statistical significance before and after operation(>0.05). Preoperative VAS scores were 7.49±0.53, postoperative at 3 days, 3, 6 months were 3.51±0.49, 2.63±0.61, 2.56±0.71, respectively, and postoperative obtained obvious improvement(<0.05). According to modified MacNab criteria, 6 cases obtained excellent results, 7 good, 4 fair 3 poor at 3 days;10 cases obtained excellent results, 5 good, 3 fair, 2 poor at 3 months; 12 cases obtained excellent results, 6 good, 1 fair, 1 poor at 6 months after operation. Postoperative clinical effect at 6 months was better than 3 d, and 3 months(<0.05), and postoperative at 3 months was better than 3 d(<0.05).</p><p><b>CONCLUSIONS</b>Percutaneous coblation nucleoplasty in treating cervical spondylotic radiculopathy can effectively relieve the pain of neck, shoulder and upper limb and can also relieve some associated symptoms such as headache and dizziness.</p>
ABSTRACT
Objective@#To evaluate the imaging features, clinical presentation, operative methods complication and the surgical outcomes of the congenital pyriform sinus fistula(CPSF). @*Methods@#The clinical data of 185 patients with CPSF treated from January 2013 to October 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. @*Results@#The lesions were predominantly on the left side(170/185). Among 185 cases, 146 cases received endoscopic coblation cauterization, 27 cases had traditional open surgery, 8 cases underwent endoscopic coblation cauterization plus traditional open surgery, 2 cases for endoscopic chemocauterization, and 2 cases for endoscopic electrosection. Twenty-eight cases recurred, with a recurrence rate of 15.1%. Postoperative hoarseness occurred in 22 cases, disappeared within 0.5-6.0 months later. @*Conclusions@#Patients with a history of recurrent cervical abscess should be highly suspect the existence of CPSF. Endoscopic coblation cauterization is a kind of surgical method with minimal injury, with low recurrence rate and low operative risk.
ABSTRACT
Objective@#To explore the key technique and outcome of transoral radiofrequency ablation microsurgery for early stage of glottic carcinoma with anterior commissure involvement (ACI).@*Methods@#A retrospective analysis was conducted on 31 patients, who were diagnosed as early stage glottic carcinoma during January 2010 to March 2016 in ENT Department. According to whether the anterior commissure was involved or not, two groups were divided. There were eleven cases with ACI (stages T1a, T1b, and T2). Twenty cases without ACI (stages Tis, T1a, and T2). All the patients received transoral radiofrequency ablation microsurgery and followed up closely.Only one case received radiotheraphy after surgery. SPSS19.0 software was used to analyze data.@*Results@#The follow-up time was 12-67 months, and the median follow-up time was 30 months. Nine among 11 cases with ACI obtained good oncologic outcomes, initial local recurrence was identified in 2/11 cases, including 2 cases of T2. Two cases ultimately required salvage total laryngectomy. Meanwhile, initial local recurrence was identified in 2/20 cases without ACI, including 1 case of T1a and 1 case of T2. One case underwent elective neck dissection, and another one received salvage total laryngectomy.Compared to the patients without ACI, it seemed that the cases with ACI always accomponied with a little higher initial local recurrence and lower overall laryngealpreservation, but the difference had no significance (P>0.05).@*Conclusions@#Transoral radiofrequency ablation microsurgery is an effective treatment for glottic carcinoma with ACI. Its advantages, such as more flexibility and deformability, make it more feasible to operate at the narrow space of anterior commissure assisted with laryngeal endoscopy.Good oncologic outcomes can be obtained by this technique with lower initial local recurrence as well as higher overall laryngeal preservation rate.
ABSTRACT
OBJECTIVE To evaluate the effect of intravenous infusion of methylprednisolone on postoperative recovery and complications after coblation tonsillectomy.METHODS Eighty three patients who were scheduled for coblation tonsillectomy from December 2015 to December 2016 were included in this study.Firstly,they were divided into 2 groups,i.e.,the younger group (＜12 years) and the older group (≥12 years old).Secondly,these two groups were further divided into experimental group and control group by the prospective,double-blind and randomized method.The experimental group was treated with methylprednisolone and antibiotics for 3 days.Then,the postoperative reactions such as the pain,activity,pharyngeal edema,body condition,exfoliation time of the tunic albuginea,post-tonsillectomy hemorrhage were observed.RESULTS 1.From the third day to fifth day,using methylprednisolone can alleviate pain (Z=4.42,P=0.00),increase the activity(Z=2.64,P=0.00)and reduce pharyngeal edema(Z=2.84,3.10,all P=0.00) in younger group.2.After operation,in the younger group,the incidence rate of gastrointestinal discomfort in control group was higher than that in experimental group(x2=4.97,P=0.03).In the older group,the incidence rate of gastrointestinal discomfort(x2=5.24,P=0.02) and sleep disturbance(x2=5.03,P=0.03) in control group was higher than those in experimental group.3.In the older group,exfoliation average time of the tunic albuginea in experimental group was longer than that in control group(t=2.16,P=0.04).4.Secondary bleeding rate was not statistically significant in the two groups(x2=1.29,P=0.26).CONCLUSION Intravenous infusion of methylprednisolone after coblation tonsillectomy is beneficial,especially in the relief of pain,gastrointestinal discomfort and pharyngeal edema.
ABSTRACT
Objective:To report one case of renal clear cell carcinoma transferred to the nasal cavity and sinuses treated by low temperature coblation assisted nasal malignant tumor resection under nasal endoscopye, and to review the associated literatures.Methods: Under nasal endoscope, the tumor was removed along the lateral wall of the nasal cavity with bipolar electrocautery and coblation.The vaseline gauze was used to stop bleeding, and the tumor was completely removed.Results: The intraoperative frozen section showed a capillary hemangioma.The patient was diagnosed as metastatic renal cell carcinoma to the nasal cavity and sinuses by the results of pathology and immunohistochemical staining.The postoperative recovery was uneventful and the nasal packing was removed 3 d after operation.Conclusion: Renal clear cell carcinoma transferred to the nasal cavity and sinuses is rare;under nasal endoscope, surgical resection is a good procedure to control metastasis.
ABSTRACT
Objective@#To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.@*Methods@#A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.@*Results@#The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.@*Conclusions@#New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.
ABSTRACT
Objective@#To introduce the method of transoral coblation-assisted endoscopic minimally invasive surgery for superficial tongue base tumour.@*Methods@#A total of 15 patients treated with transoral coblation-assisted endoscopic minimally invasive surgery from Mar. 2006 to Aug. 2016 were retrospectively reviewed. There were 9 patients with malignant tumors, 6 patients with benign neoplasms. Adjuvant postoperative radiation therapy was applied in three cases of squamous cell carcinoma, neck was performed in four cases of cancer. One case of non-Hodgkin lymphoma received postoperative chemotherapy.@*Results@#One case with ectopic thyroid gland was treated by subtotal resection and one case with squamous cell carcinoma changed into open surgery because of major lingual artery bleeding. The En bloc resection under edoscope was achieved in 92.86%(13/14)of patients. Fifteen cases of neoplasms were followed-up for 8-50 months(median 20 months), one patient with Cowden syndrome was lost to follow-up because of appendical carcinoid combined pulmonary metastasis, one patient with non-Hodgkin lymphoma died of recurrence in other head neck areas 2 years after chemotherapy.@*Conclusion@#Transoral coblation-assisted endoscopic surgery can successfully treat for the patients with superficial tongue base tumours.
ABSTRACT
Objective@#To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation(RFC).@*Methods@#Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled. Among these patients, 15 suffered from pyriform sinus carcinoma, 4 suffered from postcricoid carcinoma, and 3 suffered from posterior hypopharyngeal wall carcinoma. According to the AJCC 2002 guideline, the tumor stages were T1N0M0 for 3 patients, T2N0M0 for 9 patients, T1N1M0 for 1 patient, T1N2M0 for 1 patient, T2N1M0 for 4 patients, and T2N2M0 for 4 patients respectively. All patients with N+ underwent concurrent neck dissection; 2 patients underwent concurrent prophylactic tracheotomy; 17 underwent post-operative radiotherapy for 50-66 Gy. The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.@*Results@#All patients except 2 underwent the TOS successfully, while the two patients were treated with open approach surgery due to unsure safe margin. Most patients returned to oral feeding within one week. Among the 18 patients with complete follow up data, 3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence, multiple primary esophageal carcinoma, and distant metastasis 4 years after surgery (5.6%). According to the Kaplan-Meier method, the 5-years local control rate and survival rate were 57.8% and 67.5% respectively. All patients had no disorders in speech, swallowing and respiration during the follow up.@*Conclusions@#The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage, which is useful in lowering the operation difficulty. The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.
ABSTRACT
The intervertebral disc disease is a group of clinical diseases with complex etiology, various clinical symptoms and poor conservative treatment effect. The traditional treatment methods include conservative treatment, local injection and open surgery. In recent years, minimally invasive spine surgery has made great progress and development, and its clinical effect has been fully affirmed. Coblation nucleoplasty (CN) has been mainly used in the treatment of contained disc herniation since it has been used in clinical treatment. Its application is not favorable because of narrow indications, uncertain clinical efficacy and other reasons. At present, the application of CN in the intervertebral disc diseases has been reported in many literatures, and its working principle, operation safety, indications and efficacy have been analyzed and extended. Those literatures play an important role in its clinical application. Therefore, in this paper, the application status of CN in the intervertebral disc diseases is reviewed.
ABSTRACT
Objective To compare the curative effects between radiofrequency coblation and CO2 Laser in treat-ment of vocal leukoplakia. Methods Clinical data of 29 patients with vocal leukoplakia were retrospectively ana-lyzed. 14 of them were using radiofrequency ablation, the other 15 were using CO2 laser as treatment. Then compare the postoperative pain, postoperative wound healing, the first operation control rate of local recurrence between the two groups. Results Postoperative pain between the two groups has no statistically significance. The mucosal recov-ery of radiofrequency group in 1 month after surgery was better than CO2 laser group. In radiofrequency group, 5 cases suffered recurrence, the recurrence rate was 35.71%; In CO2 laser group, only 1 case suffered recurrence, the recurrence rate was 6.67%. Conclusions Laser and radiofrequency ablation were minimally invasive treatment for vocal cord leukoplakia, while CO2 laser as treatment has lower recurrence rate.
ABSTRACT
Objective To investigate the effect of CT guided percutaneous targeted coblation nucleoplasty in treatment of cervical intervetebral disc herniation.Methods Fifty patients who were diagnosed with cervical intervetebral disc herniation by CT or MRI were received the treatment of CT guided percutaneous targeted coblation nucleoplasty and the follow-up check after operation.The effects according to Macnab therapeutic criteria and VAS method were evaluated and recorded before operation and after operation at the third day,2 weeks,3 months.Results All patients accepted follow-up three months after operation.The effects were assessed by Macnab therapeutic criteria:1 9 cases were excellent (37.5%),29 cases good (58.3%),2 cases bad (4.2%),and the effective rate was 92.5%.The VAS scores in three months after operation were significantly lower than that before operation (P <0.05 ). Conclusion Computed tomography guided percutaneous targeted coblation nucleoplasty is a safe,effective and minimally invasive method for treating cervical intervetebral disc herniation.
ABSTRACT
Objective To investigate the clinical application of the coblation in the treatment of the infant with sleep-disordered breathing. Methods The clinical data were reviewed from 161 infants, who had the cobtilaon tonsillectomy and/or adenoidectomy sugeries in our hospital from January , 2008 to June, 2012. Among the 161 SDB cases, there were 85 obstructive sleep apnea hypopnea syndrom cases and 76 primary snoring cases. After 12 months, the follow-up visit is cut off in January, 2013. Successful follow-ups had been done to 161 infant with SDB. And the clinical efficacy and the occurrence of the complications were investigated. Results the intra-operative blood loss was 10 mL or less. 2(1.24%) were delayed hemorrhage with less pain afteroperation. One year after the surgery, there were 141 cured (87.6%), 15 with apparent effects (9.3%), 3 with effective results (1.9%), 2 with no effect(1.2%)and the total effective rate is 98.8%. Conclusion It is minimally invasive, safe and effective to use coblation to remove tonsil and adenoid in the treatment of infants with sleep-disordered breathing.
ABSTRACT
Objective To study the out come of coblation arytenoidectomy combined with true and false pos-terior cordectomy for treatment of bilateral vocal cord paralysis (BVFP) .Methods The group included 17 patients (8 incomplete BVFP and 9 complete BVFP) .All the patients had waited more than 6 months before surgery with no spontaneous recovery .The patients underwent arytenoidectomy combined with true and false posterior cordecto-my using coblation under video suspension laryngoscope .Electric fibrolaryngoscope was performed before and after operation to evaluate the size of the glottis .The patients'voices were recorded before and after operation and evalua-ted by 3 laryngologists through GRBAS .Results Preoperational laryngoscope showed that in the incomplete BVFP ,the vocal folds were close to the middle line with limited abduction .In the complete BVFP ,the vocal folds failed in adduction and abduction and the size of the glottis was 2 -3mm .3 of the patients had underwent tracheotomy . Post operational electric fibrolaryngoscope showed proximate triangulate breathing space which was more than 4mm in the posterior glottis .The patients were followed up 6 to 44months .15 of the 17 were allowed for decannulation . One patient among them underwent posterior cordectomy and arytenoidectomy on the contralateral side respectively after the first operation because of dyspnea owing to scar diathesis .Two patients bunged up the canula but did not de-cannulate .Among them one was a 8-year old boy diagnosed as congenital heart disease .One was thyroid cancer with stiff neck due to radiology .The only postoperative complication was the appearance of granulations in the operation region in 2 patients ,which were disappeared spontaneously .Quality of the voice improved in 2 patients ,unchanged in 10 and worsened in 5 .Conclusion This study demonstrates that arytenoidectomy associated with posterior cord-ectomy is a satisfactory surgical treatment of bilateral vocal fold paralysis because it leads to a considerable and stable enlargement of the breathing space and preserved the voice quality .
ABSTRACT
BACKGROUND AND OBJECTIVES: Tonsillectomy remains to be an ordinary operative process in otorhinolaryngology. The aim of this study is to evaluate four current tonsillectomy techniques, conventional dissection, electrocautery tonsillectomy, laser tonsillectomy, coblation tonsillectomy, comparing operation time, postoperative pain, postoperative otalgia and postoperative hemorrhage. SUBJECTS AND METHOD: From March 2012 to December 2012, a total of 61 patients between the ages of 10 years and 58 years scheduled for tonsillectomy were randomly assigned to conventional dissection, electrocautery, laser, coblation groups. All tonsillectomies were performed under general anesthesia. RESULTS: Coblation tonsillectomy technique produced the shortest total surgical time, averaging 19.1 minutes. Electrocautery was the most painful method and postoperative pain was less in laser and coblation, but there was no statistically significant difference between the two. The incidence of primary and secondary hemorrhage was statistically insignificant between the surgical methods. CONCLUSION: This study found that coblation tonsillectomy led to statistically shorter surgical time. However, the four techniques showed no statistically significant difference in the postoperative pain, postoperative otalgia and hemorrhage. Coblation tonsillectomy and laser tonsillectomy are found to be both useful in patients who are sensitive to postoperative pain.
Subject(s)
Humans , Anesthesia, General , Earache , Electrocoagulation , Hemorrhage , Incidence , Methods , Operative Time , Otolaryngology , Pain, Postoperative , Postoperative Hemorrhage , TonsillectomyABSTRACT
OBJECTIVES: Coblation is operated in low temperature, so it is proposed that tonsillectomy with coblation involves less postoperative pain and allows accelerated healing of the tonsillar fossae compared with other methods involving heat driven processes. However, the results of the previous studies showed that the effect of coblation tonsillectomy has been equivocal in terms of postoperative pain and hemorrhage. Though, most of the previous studies which evaluated coblation tonsillectomy were performed in children. Recently, electrocautery tonsillectomy has been used most widely because of the reduced intraoperative blood loss and shorter operative time compared to other techniques. This prospective study compared intraoperative records and postoperative clinical outcomes in adolescents and adults following coblation and electrocautery tonsillectomies. METHODS: Eighty patients over 16 years of age with histories of recurrent tonsillitis were enrolled. The patients were randomly allocated into coblation (n=40) and electrocautery tonsillectomy groups (n=40). All operations were performed by one surgeon who was skilled in both surgical techniques. Intraoperative parameters and postoperative outcomes were checked. RESULTS: Postoperative pain and otalgia were not significantly different between the two groups; however, there was a tendency towards reduced pain and otalgia in the coblation group. More cotton balls for swabbing the operative field were used introoperatively in the electrocautery group (P=0.00). There was no significant difference in postoperative hemorrhage, wound healing, commencement of a regular diet, and foreign body sensation between the groups. CONCLUSION: Only cotton use, which represented the amount of blood loss, was less in the coblation tonsillectomy group. Coblation tonsillectomy warrants further study with respect to the decreased postoperative pain and otalgia.