Application of fibreoptic endoscope evaluating of oropharyngeal swallowing in post-irradiated patients with nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective@#The aim of this study is to investigate the effect of fibreoptic endoscopic of sallowing （FEES） in the assessment of pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.@*Method@#Fifty-three NPC patients with post-irradiated underwent FEES and video fluoroscopy（VF）.The results were analyzed using the Bolus Residue Scale and Rosenbek's penetration aspiration scale.@*Result@#The agreement in the detection of penetration and aspiration between FEES and VF of liquid（κ=0.56, 95%CI 0.38-0.73） and porridge（κ=0.64, 95%CI 0.43-0.81） was "fair". The detection rates of penetration on FEES with liquid and porridge were 60% and 51%, the detection rates of aspiration on VF with liquid and porridge were 70% and 53%. There were no statistical differences. The agreement in the detection of pharyngeal residue between FEES and VF of liquid （κ=0.38, 95%CI0.12-0.62） and porridge （κ=0.66, 95%CI 0.44-0.86） was "fair". The detection rates of pharyngeal residue on FEES and VF with porridge were 43% and 45%, the difference was not statistically significant. The detection rates of pharyngeal residue on FEES and VF with liquid were 44% and 24%, and the difference was statistically significant.@*Conclusion@#FEES is an effective and valuable tool for evaluating pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.

Application of combined intracapsular and extracapsular hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in children with OSA / 临床耳鼻咽喉头颈外科杂志

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.

Application of combined intracapsular and extracapsular hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in children with OSA / 临床耳鼻咽喉头颈外科杂志

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.

Application of fibreoptic endoscope evaluating of oropharyngeal swallowing in post-irradiated patients with nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

The aim of this study is to investigate the effect of fibreoptic endoscopic of sallowing （FEES） in the assessment of pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma. Fifty-three NPC patients with post-irradiated underwent FEES and video fluoroscopy（VF）.The results were analyzed using the Bolus Residue Scale and Rosenbek's penetration aspiration scale. The agreement in the detection of penetration and aspiration between FEES and VF of liquid（κ=0.56, 95% 0.38-0.73） and porridge（κ=0.64, 95% 0.43-0.81） was "fair". The detection rates of penetration on FEES with liquid and porridge were 60% and 51%, the detection rates of aspiration on VF with liquid and porridge were 70% and 53%. There were no statistical differences. The agreement in the detection of pharyngeal residue between FEES and VF of liquid （κ=0.38, 95%0.12-0.62） and porridge （κ=0.66, 95% 0.44-0.86） was "fair". The detection rates of pharyngeal residue on FEES and VF with porridge were 43% and 45%, the difference was not statistically significant. The detection rates of pharyngeal residue on FEES and VF with liquid were 44% and 24%, and the difference was statistically significant. FEES is an effective and valuable tool for evaluating pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.

Clinical analysis of 27 cases with descending necrotizing mediastinitis / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM).@*Methods@#A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People’s Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis.@*Results@#ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ2=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ2=4.074, P=0.044) and necrotizing fasciitis (χ2=4.457, P=0.035) in died cases were significantly higher than those in cured cases.@*Conclusion@#DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.

Treatment of glottic cancer involving the anterior commissure by transoral CO2 laser surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To study the clinical outcome of transoral CO2 laser surgery for glottic cancer involving the anterior commissure.@*Methods@#Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO2 laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years.@*Results@#All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO2 laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) (Log Rank χ2=0.788, P=0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) (Log Rank χ2=9.504, P=0.002).@*Conclusion@#With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO2 laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

Glucocorticoid receptors mRNA expression in peripheral blood mononuclear cell in patients with obstructive sleep apnea hypopnea syndrome / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo study the mRNA expression of glucocorticoid receptor(GR) in peripheral blood mononuclear cells in patients with obstructive sleep apnea hypopnea syndrome(OSAHS) and its clinical significance. METHODSReal-time fluorescent quantitative PCR was used to detect GRα mRNA and GRβ mRNA exprssion in PBMC of 30 male patients with moderate to severe OSAHS and 27 healthy male subjects. The relationships between the expression of glucocorticoid receptor mRNA and the apnea hypopnea index, body mass index, neck circumference, waist circumference, the lowest oxygen saturation, the average oxygen saturation, the Epworth sleepiness scale(ESS) score, fasting blood glucose, heart rate and blood pressure were analyzed.RESULTSCompared with the control group, the expression level of GRα mRNA was lower in the OSAHS group(t=2.25,P0.05). We had not found the significant correlation between the expression of GRα mRNA and the clinical parameters above in OSAHS patients.CONCLUSIONThe expression of GRα mRNA in PBMC in moderate to severe OSAHS male patients have a downward trend compared with healthy group, but the mechanism remains unclear.

The preparation of recombinant adenovirus Ad-Rad50-GFP and detection of the optimal multiplicity of infection in CNE1 transfected hv Ad-Rad50-GFP / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The optimal multiplicity of infection (MOI) of the recombinant adenovirus Ad-Rad50-GFP carrying a mutant Rad50 gene expression region on the cell growth of nasopharyngeal carcinoma and the viral amplification efficiency of CNE1 cell infected by this adenovirus were studied.@*METHOD@#The biological titer of Ad-Rad50-GFP was measured by end point dilution method. The impact of recombinant adenoviral vector transfection on the growth of CNE1 cells was observed by cell growth curve. Transfection efficacy of recombinant adenoviral vector was observed and calculated through fluorescence microscope. The expression f mutant Rad50 in the Ad-Rad50-GFP transfected CNE1 cells with optimal MOI was detected by Western Blot after transfection.@*RESULT@#The biological titer of Ad-Rad50-GFP was 1.26 x 10¹¹ pfu/ml. CNE1 cell growth was not influenced significantly as they were transfected by recombinant adenoviral vector with MOI less than 50. Transfection efficacy of recombinant adenoviral vector was most salient at 24 hours after transfection, with the high expression of mutant Rad50, and the efficiency still remained about 70% after 72 hours.@*CONCLUSION@#Recombinant adenoviral vector Ad-Rad50-GFP could transfect CNE1 cells as well as result in the expression of mutant Rad50 in CNE1 cells effectively. MOI = 50 was the optimal multiplicity of infection of CNE1 cells transfected by recombinant adenoviral vector Ad-Rad50-GFP.

Application of enhanced CT in the differential diagnosis of peritonsillar abscess and intratonsillar abscess / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the application of enhanced CT in the differential diagnosis and treatment of peritonsillar abscess (PTA) and intratonsillar abscess (ITA).</p><p><b>METHODS</b>Thirty-eight in-patients with clinically suspected PTA from June 2011 to June 2013 were included in this study. All these patients underwent enhanced CT scan for the throat region. According to CT results, the location of abscess was determined, and the thickness of the posterior wall of abscess as well as its distance with the internal carotid artery was calculated.Incision and drainage were then guided with this information.</p><p><b>RESULTS</b>Twenty-six of the 38 patients (68.4%) met the diagnosis of PTA, demonstrating a hypodense collection with rim enhancement in the peritonsillar space, including 4 cases with multilocular abscess. Ten cases (26.3%) should actually be diagnosed as ITA, with a abscess collection located in the palatine tonsil tissue. Two cases(5.3%) were diagnosed as peritonsillar cellulitis (PTC), showing diffuse isodense lesion around the peritonsillar space. The 26 cases of PTA and 10 cases of ITA patients were all cured using incision and drainage under the precise guidance of CT, while the 2 cases of PTC only treated with medicine. The mean distance between the posterior wall of abscess and the carotid artery (X(-) ± s) were (0.76 ± 0.34) cm and (0.90 ± 0.37) cm for the two entities respectively, with no significant difference (P > 0.05).</p><p><b>CONCLUSIONS</b>Enhanced CT scan can clearly demonstrate the characters of PTA and ITA, and make identification. Moreover, it is helpful for the determination of therapy, improving the success rate of drainage and reducing the potential risk of large artery injury.</p>

Effects of tetrandrine on enhancing radiosensitivity of human nasopharyngeal carcinoma cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the effect and mechanism of tetrandrine (Tet) on enhancing radiosensitivity of human nasopharyngeal carcinoma cell lines in vitro.</p><p><b>METHODS</b>CNE1 and CNE2 were exposed to radiation with or without Tet, the DNA damage of the cells were evaluated by neutral comet electrophoresis, and cell cycle and apoptosis were analyzed by flow cytometry.</p><p><b>RESULTS</b>The mean tail movements (TM) of CNE1 treated with radiation or radiation plus Tet were (7.13 ± 3.70) (X(-) ± s) and (13.61 ± 5.45), respectively (t = 2.784, P < 0.05), and TM of CNE2 treated with radiation or radiation plus Tet were (11.52 ± 4.04) and (18.85 ± 6.18), respectively (t = 3.089, P < 0.05). With the exposure to radiation or radiation plus Tet, the percentages of CNE1 in G2 phases were (42.62 ± 2.07)% and (17.02 ± 1.87)%, respectively (t = 23.173, P < 0.01), and the percentages of CNE2 in G2 phases were (34.82 ± 2.74)% and (19.64 ± 4.82)%, respectively(t = 16.500, P < 0.01). There was no significant difference in the apoptosis rates between the cells treated with radiation or radiation plus Tet regardless of CNE1 (17.24 ± 0.99)% vs (19.11 ± 1.24)%, and CNE2 (16.68 ± 0.27)% vs (18.51 ± 2.41)% (P > 0.05).</p><p><b>CONCLUSIONS</b>Tet can enhance radiosensitivity of human nasopharyngeal carcinoma cell lines. The mechanism could be related to abrogation of radiation-induced G2/M arrest and reduction of double-strand break repair capacity.</p>

Effects of lentivirus-mediated epidermal growth factor-like domain 7 silencing on proliferation and invasion of human laryngeal carcinoma Hep-2 cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effects of epidermal growth factor-like domain 7 (EGFL7) gene silencing on the proliferation and invasion ablity of laryngeal carcinoma cells.</p><p><b>METHODS</b>A lentiviral vector expressing EGFL7 shRNA was constructed and transfected into human laryngeal carcinoma Hep-2 cells. The expressions of EGFL7 mRNA and protein were detected by Real-time PCR and Western blot, respectively. Cell proliferation was evaluated by CCK-8 assay, cell cycle and apoptosis were tested by flow cytometry, and cell invasion was detected by transwell invasion assay.</p><p><b>RESULTS</b>The relative expression level s of EGFL7 mRNA and protein in EGFL7-SuRNA group were svgnificantly lower than control group (P < 0.001). Western blot analysis proved that the relative expression of EGFL7 protein in NC group, Lenti-NC group and Lenti-EGFL7 group was (0.39 ± 0.12),(0.36 ± 0.14) and (0.07 ± 0.04), respectively. EGFL7 expression in Lenri-EGFL7 group was significantly inhibited than NC group (P < 0.001), which confirmed that the recombinant lentivirus was successfully transfected into Hep-2 cells. The proliferation of Hep-2 cells was significantly inhibited after transfection (P < 0.01). Compared with the NC group and Lenti-NC group, the proportion of cells in S phase was significantly increased in Lenti-EGFL7 group (P < 0.01), and the proportion in G1 phase was significantly decreased (P < 0.05). Cell apoptosis assay showed that the apoptotic rate in Lenti-EGFL7 group (66.2 ± 1.28) % was significantly increased in NC group (6.09 ± 3.28) % and Lenti-NC group (9.86 ± 2.13) %. In Transwell invision assay, the mean number of cells coming through the Metrigel in Lenti-EGFL7 group was significantly decreased than in the NC group and Lenti-NC group (P < 0.01).</p><p><b>CONCLUSION</b>The proliferation and invasion ablity of laryngeal carcinoma Hep-2 cells can be inhibited by siRNA mediated EGFL7 gene silencing.</p>

Clinical features and treatment of closed rupture of cervical trachea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical manifestations and treatments of closed injuries of the cervical trachea.@*METHOD@#We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted.@*RESULT@#Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness.@*CONCLUSION@#In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

Clinical features and treatment of closed rupture of cervical trachea / 临床耳鼻咽喉头颈外科杂志

Objective:To study the clinical manifestations and treatments of closed injuries of the cervical trachea.Method:We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted.Result:Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness.Conclusion:In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

Reconstruction with the anterolateral thigh flap interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the effectiveness of the anterolateral thigh flap in reconstruction for the tissue defects of hypopharyngeal and cervical esophageal tumor resection.@*METHOD@#Retrospective review of two clinical cases who underwent pharyngoesophageal reconstruction with the anterolateral thigh flap after tumor ablation.@*RESULT@#No flap failure, fistula and stricture occurred in two patients. Two patients tolerated a regular diet. An esophageal voice was progressively acquired with the help of speech therapy. With followup for 16 and 41 months two patients were alive without tumor evolution.@*CONCLUSION@#The higher success rate,lower complication, quick recovery, made the anterolateral thigh flap interposition is the ideal choice for pharyngoesophageal reconstruction.

Reconstruction with the anterolateral thigh flap interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the effectiveness of the anterolateral thigh flap in reconstruction for the tissue defects of hypopharyngeal and cervical esophageal tumor resection.Method:Retrospective review of two clinical cases who underwent pharyngoesophageal reconstruction with the anterolateral thigh flap after tumor ablation.Result:No flap failure, fistula and stricture occurred in two patients.Two patients tolerated a regular diet.An esophageal voice was progressively acquired with the help of speech therapy.With followup for 16 and 41 months two patients were alive without tumor evolution.Conclusion:The higher success rate,lower complication,quick recovery,made the anterolateral thigh flap interposition is the ideal choice for pharyngoesophageal reconstruction.