Learning curve of CT-guided localization with medical glue for single pulmonary nodule before video-assisted thoracic surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the learning curve of CT-guided medical glue localization for pulmonary nodule before video-assisted thoracic surgery (VATS). Methods    The clinical data of the patients with pulmonary nodules who underwent CT-guided medical glue localization before VATS in our hospital from July 2018 to March 2021 were retrospectively analyzed. The patients were divided into 3 groups: a group A (from July 2018 to August 2019), a group B (from September 2019 to June 2020) and a group C (from July 2020 to March 2021). The localization time, morbidity, complete resection rate and other indexes were compared among the three groups. Results    A total of 77 patients were enrolled, including 24 males and 53 females aged 57.4±10.1 years. There were 25 patients in the group A, 21 patients in the group B, and 31 patients in the group C. 77 pulmonary nodules were localized. There was no significant difference among the groups in the basic data (P>0.05). The localization time in the group C was 10.6±2.0 min, which was statistically shorter than that in the group A (15.4±4.4 min) and group B (12.9±4.3 min) (P<0.01). The incidence of complications in the group C was lower than that in the group A and group B (25.8% vs. 52.0% vs. 47.6%, P=0.04). The success rate of localization of the three groups was not statistically different (P=0.12). Conclusion    There is a learning curve in CT-guided medical glue localization for single pulmonary nodule before VATS. After the first 46 cases, the operation time can be shortened, and the incidence of complications can be decreased.

Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.

The impact of resection of skull base tumor via an endoscopic endonasal approach on the visual function of vision impaired patients and the analysis of factors affecting their visual recovery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the visual outcomes of patients with visual impairment after resecting skull base tumor via an endoscopic endonasal approach, and to analyze the factors affecting visual recovery.@*Methods@#One hundred and fifty-three patients with skull base tumor who suffered from preoperative visual impairment from Skull Base Surgery Center of Xuanwu Hospital were operated through an endoscopic endonasal approach. Both preoperative and postoperative visual function outcomes as well as factors that might have affected their visual recovery were analyzed retrospectively by Chi square test and Logistic regression analysis.@*Results@#Complete resection was achieved in 85.6% of the patients using this technique. The rate of postoperative visual recovery in the female group (86.1%) was higher than that in the male group (73.9%), the benign group (90.2%) higher than the malignant group (20.0%), the group without optic atrophy (97.1%) higher than the one with (51.2%), and the acute group (96.6%) higher than the chronic group (80.0%). Significant differences were found between the abovementioned groups (χ2 value was 5.849, 87.860, 79.757, 4.745, respectively, all P<0.05). The degree of optic atrophy and the property of tumors were significantly associated with visual improvement after treatment (Wold χ2 value was 18.597 and 35.623, all P<0.001).@*Conclusions@#Our results indicate that endoscopic endonasal surgery shows its ability both to resect skull base tumors and to improve visual function in the majority of patients. The timing of treatment for patients suffered from preoperative visual impairment should be selected in early stage before optic atrophy occurs.

Clinical analysis of head and neck basal cell adenoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyze disease-related clinical features and therapeutic effects of basal cell adenoma in head and neck. METHODS Clinical data of 9 patients with pathologically diagnosed basal cell adenoma in head and neck between Mar 2007 and Jan 2016 in our department were analyzed retrospectively. The ratio of male 3 to female 6 was 1:2. The median age of the patients was 48.9 years old(22 to 65 years). 5 cases affected parotid gland, 1 occurred in left maxillary sinus and infratemporal fossa, 1 involved nasopharyngeal and pterygopalatine fossa, 1 originated from nasal vestibule and 1 derived from nasal septum. RESULTS 8 of the patients underwent surgical treatment, while one patient with tumor involving the left maxillary sinus and infratemporal fossa was given a transnasal surgery for concurrent rhinosinusitis and subsequently confirmed by pathology. The postoperative follow-up period was between 1 and 10 years. One patient with tumor affecting infratemporal fossa recurred 1.5 years after surgery, while the rest shown no signs of recurrence and complication. CONCLUSION Basal cell adenoma in head and neck is a rare kind of disease. Clinical features and imaging helped to differenced basal cell adenoma in head and neck from other diagnoses, but definite diagnosis relies on the pathological tests.Surgery may provide good effects and prognosis on patients with basal cell adenoma.

Effect of treatment of allergic rhinitis on quality of life in patients with asthma / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effect of the treatment of allergic rhinitis on the quality of life of patients with bronchial asthma.METHODS Fifty-three patients with moderate-severe allergic rhinitis and mildmoderate asthma were included in this study and all of them had not yet received treatment for allergic rhinitis.There were 20 males and 33 females with an age ranged from 18 to 76 years.They had been treated with Salmeterol/Fluticasone propionate(seretide) 50/100 μg twice a day and combined with Ventolin if needed.On this basis,they were treated with loratadinel0 mg and Fluticasone proplonate nasal spray 200 micrograms once daily for 12 weeks.The visual analog scale,the asthma control test and Juniper's asthma quality of life questionnaire were recorded before and after treatment.RESULTS After treatment of allergic rhinitis,the rate of full asthma control was 28％,the rate of partial asthma control was 63％,and the rate of uncontrolled asthma was 9％.There was a significant improvement in asthma control after treatment of allergic rhinitis(P＜0.05).The scores after treatment were higher than that before treatment in all dimensions of asthma quality of life questionnaire(P＜0.01).CONCLUSION Allergic rhinitis and bronchial asthma are two closely related diseases,treatment of allergic rhinitis is benefit to bronchial asthma control and can improve the quality of life of the patients.

Clinical efficacy of endoscopic nasopharyngectomy for initially diagnosed advanced nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical efficacy in patients who underwent endoscopic nasopharyngectomy for primary advanced nasopharyngeal carcinoma (NPC).@*Methods@#Forty-five patients who underwent endoscopic nasopharyngectomy for primary advanced NPC encountered between Aug. 2007 and Sep. 2015 were retrospectively reviewed. Twenty-seven patients were male (60.0%), and 18 patients were female (40.0%), the ratio of male to female was 3∶2. The median age was 53 years old (ranged from 13 to 75 years old). The median onset time was 5 months (ranged from 1 to 72 months). TNM stage: 16 cases were at stage Ⅲ (35.6%), 29 at stage Ⅳ (64.4%); T3 16 cases (35.6%), T4 29 cases (64.4%); N0 38 cases (84.4%), N2 7 cases (15.6%). No patients were found to have distance metastasis. All patients underwent endoscopic resection of lesions. Postoperatively all the patients were treated with radiotherapy or chemoradiotherapy. Using SPSS 19.0 software, Kaplan-Meier and Log-rank test were done for the assessmen of survival rate; Cox proportional hazards model was used for the univariate analysis of prognostic factors.@*Results@#The median follow-up was 36 months (ranged from 6 to 97 months), with 36 cases surviving (80.0%), 9 cases died (20.0%); 15 cases relapsed (33.3%). The overall 1 year survival rates (SR), 3 year SR, 5 year SR was 90.6%, 81.0%, 76.0%, respectively. The survival univariate analysis indicated the recurrence and metastasis were correlated with the survival (χ2 value was 16.644, 6.451, respectively, all P<0.05).@*Conclusion@#The patients who undergo endoscopic nasopharyngectomy for primary advanced NPC have better survival rate with lower recurrent rate and metastatic rate.

The involvement of IL-1β/p38MAPK/NF-κB signal transduction pathway in regulating the expression of glucocorticoid receptor isoformsin human nasal epithelia in vitro / 实用医学杂志

Objective To explore the possible upstream signal transduction mechanisms responsible for the decrease of glucocorticoid receptor (GR)α/GRβ in chronic rhinosinusitis (CRS) in vitro. Methods The GRα/GRβ decrease cell model was established by IL-1β-induced human nasal epithelia (HNE) in vitro. Changes in the protein and mRNA expression of GRα, GRβ and the key enzymes in the p38MAPK and NF-κB pathways were measured respectively, before and after being induced with different doses of IL-1β and specific inhibitors of p38MAPK and NF-κB. Analysis of variance (ANOVA) was used to analyze the data. Results With IL-1β-induction, the GRα/GRβ ratio declined in both a time-dependent manner and a concentration-dependent manner in HNE, which demonstrated the successful establishment of a GRα/GRβ decrease model in vitro. After cultured HNE were induced with the same set of IL-1β, the p38MAPK and NF-κB signal pathways were also activated. Either a specific inhibitor (SB203580) of the p38MAPK pathway or a specific inhibitor (PDTC) of the NF-κB pathway increased the GRα/GRβ ratio at the meantime of inhibiting their pathways. The expressions of phospho-NF-κBp50 and phospho-NF-κBp65 were significantly decreased by SB203580. PDTC had no influence on the expression of the key enzymes in the p38MAPK. Conclusion The decrease of GRα/GRβ ratio in HNE induced by IL-1β in vitro is induced through the p38MAPK/NF-κB signal pathways.

Endoscopic endonasal biopsy for a tumor at the cavernous sinus and pons.

Lesions at the cavernous sinus and brainstem can be detected by radiologic studies, but a definitive diagnosis depends on histopathologic analysis. We present the case of a 75-year-old woman with symptoms including cranial nerve palsy, hydrocephalus,seizures, and long-term coma caused by squamous cell carcinoma at the cavernous sinus and ventral pons, which was confirmed by an endoscopic endonasal biopsy.

Endoscopic endonasal surgery for anterior and middle skull base neuroendocrine carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the optimal treatment strategy with endoscopic endonasal approach (EEA) and the prognostic factors of anterior and middle skull base neuroendocrine carcinoma (NEC).</p><p><b>METHOD</b>Fourteen patients with anterior and/or middle skull base NEC, admitted to Xuanwu Hospital between November 2006 and June 2014, were reviewed retrospectively. All patients were treated with EEA. Four cases received surgery onle. Two cases received radiotherapy and one case received chemotherapy before surgery. One case received adjuvant radiotherapy and 6 cases received chemoradiation after surgery. Survival analysis was performed by Kaplan-Meier method.</p><p><b>RESULT</b>Complete resection was achieved in 12 cases, while subtotal resection was achieved in 2 cases. There was no surgical complication. Three cases were diagnosed as well-differentiated NEC, 2 cases were moderately differentiated NEC and 9 cases were small cell NEC. The patients were followed up for 6 to 97 months. Three patients died and one patient lost to follow-up. The 5-year survival rate in this group was 64.3%.</p><p><b>CONCLUSION</b>Pure EEA or EEA combined with multimodality therapy, which was applied depending on the pathological type, was a feasible treatment strategy for anterior and middle skull base NEC.</p>

Early experience of radiofrequency ablation-assisted resection of skull base tumor through an endoscopic endonasal approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To describe the early experience of resecting skull base tumor via a radiofrequency ablation-assisted endoscopic endonasal approach, investigate the safety and feasibility of the technique, and to assess its preliminary treatment outcomes.</p><p><b>METHODS</b>Ten patients with skull base tumor who were admitted between September and November 2013 were operated on through a radiofrequency ablation-assisted endoscopic endonasal approach in Xuanwu hospital of capital medical university. In this study, the operative technique was described, and the degree of resection, complications and the early clinical outcomes was presented.</p><p><b>RESULTS</b>Complete resection was achieved in all patients using this technique. No patient in the series experienced a new neurological deficit, cerebrospinal fluid leak or meningitis after surgery. No recurrence and death related to skull base tumor were found in the follow-up period (16-18 months). The volume of intraoperative blood loss was 60 to 1 000 ml (medium 285 ml). The duration of operations was from 42 to 150 min (medium 95 min). The hospital stay was from 14 to 19 d (average 15.7 d).</p><p><b>CONCLUSION</b>Our limited experience indicates that this technique is feasible and safe for the complete resection of some skull base tumors in selected cases.</p>

Involvement of MAPK signal transduction pathways in regulating the expression of glucocorticoid receptor isoforms in nasal polyp epithelia in vitro / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the upstream signal transduction mechanism responsible for the decrease of the ratio of the two glucocorticoid receptor (GR) subunits (GRα and GRβ) in nasal polyp in vitro.</p><p><b>METHODS</b>The GRα/GRβ decrease cell model was established by lipopolysaccharide (LPS)-induced human nasal epithelia (HNE) of nasal polyp in vitro. Changes in the protein and mRNA expression of GRα, GRβ and the key enzymes in the p38MAPK, ERK and JNK signal pathways were measured, respectively, before and after being induced with different doses of LPS and specific inhibitors of p38MAPK, JNK and ERK. SPSS 16.0 software (Analysis of variance, ANOVA) was used to analyze the data.</p><p><b>RESULTS</b>With the LPS induction, the GRα/GRβ ratio declined in both a time-dependent manner and a concentration-dependent manner in HNE, which demonstrated the successful establishment of a GRα/GRβ decrease model in vitro. After cultured HNE were induced with the same set of LPS, the p38MAPK, ERK and JNK signal pathways were also activated. The mRNA expression of p38MAPK and JNK in each LPS-induced group (17.14 ± 1.50, 22.34 ± 2.78, 30.12 ± 1.07; 2.51 ± 0.13, 3.79 ± 0.67, 4.41 ± 0.83; 25.62 ± 1.77, 31.33 ± 1.97, 37.25 ± 2.46) was significantly higher than that (7.39 ± 0.31, 2.04 ± 0.34, 2.38 ± 0.35) in the control group (χ² value was 15.347, 18.331, 14.671, all P < 0.01). Either a specific inhibitor (SB203580) of the p38MAPK pathway or a specific inhibitor (SP600125) of the JNK pathway increased the GRα/GRβ ratio at the meantime of inhibiting their pathways. SB203580 exhibited a much stronger increase effect on GRα/GRβ ratio than SP600125. The specific inhibitors (PD98059) of ERK had no influence on the expression of GR isoforms.</p><p><b>CONCLUSIONS</b>The above results demonstrated that the decrease of GRα/GRβ ratio in HNE induced by LPS in vitro is mediated through the p38MAPK and JNK signal pathways. It is possible to improve the treatment effect of GC resistance in nasal polyp by targeting these specific signal pathways.</p>

Surgical anatomy, technique and application of endoscopic endonasal transpterygoid approach in skull base surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To identify the landmarks of transpterygoid approach and to report its application in a series of cases.</p><p><b>METHODS</b>Two silicon-injected adult cadaveric heads(4 sides) were dissected by performing an endoscopic endonasal transpterygoid approach after CT scanning for imaging guidance. High-quality pictures were obtained. This approach was used to treat twelve patients with skull base lesions including 3 spontaneous cerebrospinal fluid (CSF) leaks in the lateral recess of the sphenoid sinus, 2 neurofibromas and 2 Schwannomas involving the pterygopalatine fossa and infratemporal fossa, 1 dermoid cyst involving the middle fossa and infratemporal fossa, 1 invasive fungal sinusitis invading the middle fossa base, 1 basal cell adenoma in the upper parapharyngeal space, 1 chondrosarcoma in the parasellar region and 1 adenoid cystic carcinoma. Clinical records were reviewed.</p><p><b>RESULTS</b>In terms of approach dissection, important landmarks, such as the sphenopalatine foramen and artery, vidian canal and nerve, foramen rotundum and maxillary branch of trigeminal nerve, foramen ovale and mandibular branch of trigeminal nerve, as well as pterygoid segment of Eustachian tube were identified. In terms of clinical data, three patients with spontaneous CSF leak underwent repair. Six patients with benign lesions underwent complete tumor resection. In the patient with invasive fungal disease, thorough debridement was undertaken and antifungal drug was administered for one month. For these benign skull base lesions, there was no recurrence during the follow-up period. In the patient with chondrosarcoma, most of the tumor was removed in the first operation, and was followed by two endoscopic operations because of fast growth of the tumor. Final control was achieved with chemotherapy and radiation. In the patient with adenoid cystic carcinoma, tumor recurred five years after surgery, and was reoperated.</p><p><b>CONCLUSION</b>An understanding of the landmarks of the transpterygoid approach is paramount for surgically dealing with disease located within and adjacent to the region of the pterygoid process of the sphenoid bone. The endoscopic endonasal transpterygoid approach is feasible and safe in selected patients with skull base lesions.</p>

Resection of the intracavernous sinus tumors using a purely endoscopic endonasal approach.

Resection of the cavernous sinus (CS) lesions has been a surgical challenge because the anatomy of the CS presents a high grade of complexity. This report describes the feasibility of the purely endoscopic endonasal approach to the CS. Twenty-five patients with intracavernous sinus tumors were treated with a purely endoscopic endonasal approach. The indications, efficacy, surgical techniques, and complications of this approach were discussed. Gross total resection occurred in 19 cases (76%), subtotal resection occurred in 2 cases (8%), and partial resection occurred in 4 cases (16%) including pituitary adenoma in 10 cases (total 70%; subtotal 10%; partial 20%), meningioma in 6 cases (total 66.6%; subtotal 16.7%, partial 16.7%), schwannoma in 5 cases (100%, total 5), malignant tumor in 4 cases (total 75%; subtotal 25%). All patients experienced resolution or improvement of symptoms. No patient experienced intraoperative complication and new neurological deficit. Only 1 case of postoperative cerebrospinal fluid leakage repaired via endoscopic endonasal approach on the 14th day after the surgery. The purely endoscopic endonasal approach to the CS in appropriately evaluated patients can be used to address a wide variety of benign and malignant tumor pathology with favorable outcomes and a low incidence of complications.

Diagnosis and endoscopic therapy for lateral sphenoid sinus recess lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To highlight concepts critical to achieving successful diagnosis and endoscopic therapy for lateral recess of the sphenoid sinus (LRSS) lesions, operative techniques, and avoiding complications in the treatment were discussed.@*METHOD@#Pathology within a lateral recess of a widely pneumatized sphenoid sinus is difficult to access with the use of traditional open and current endoscopic surgical approaches. A new surgical procedure, the endoscopic tranapterygoid approach, directly accesses this region. A clinical experience over several years with this approach is reported as well as a refined and updated description of the technique. Twenty-six patients with LRSS lesions were retrospectively studied, from 2008 to 2013, 11 males and 15 females. Ages ranged from 21 to 68 years (mean 43 years). Radiological investigations consisted of computed tomography (CT) scan and magnetic resonance images (MRI) in all cases. An endoscopic tranapterygoid approach was performed in all patients under general aneasthesia, 4 to resect a middle fossa meningoencephalocele and repair the CSF leak and associated skull base defect.@*RESULT@#All the operations were successful. Patients tolerated the approach well and no significant complications occurred. Post operative pathology made definite diagnosis. Meningoencephalocele 4 cases, sphenoid sinus cyst 10 cases (4 cases only were subtotal resected for it's tight adhesions with optic nerve or internal carotid artery) , fungal sinusitis 5 cases (non-invasive fungal sinusitis, pathogenic funga was aspergillus) chronic sphenoid sinusitis 5 cases. Nine patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia, not given treatment, gradually relieved after 6 months. No recurrence was found during follow-up for 6 to 53 months (mean 23.8 months).@*CONCLUSION@#It had very important implications for high resolution CT combined with MRI in diagnosis of LRSS lesions. In selected cases, the endoscopic tranapterygoid approach enables the otolaryngologist to meet modern demands to treat conditions in the lateral sphenoid using minimally invasive techniques that are well-tolerated by patients. The endoscopic transpterygoid approach is an excellent approach for dealing with LRSS lesions.

Endoscopic skull base surgery under the guidance of image navigation technology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of image navigation technology in endoscopic skull base surgery.</p><p><b>METHODS</b>This study consisted of 75 patients who underwent the endoscopic operations with the help of the image navigation system by the same surgeon between March 2010 and March 2013. The time to prepair image navigation system, identifying anatomical structure, complications, tumor resection, and follow-up results were analysed.</p><p><b>RESULTS</b>The application of image navigation technology in the endoscopic skull base operations was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors, such as internal carotid artery, optic canal, comb, saddle bottom, foramen rotundum, foramen ovale, foramen lacerum, jugular foramen, cerebral dura mater. The tumor was removed completely, subtotally, or partially. All patients were successfully registered with accuracy, and the preoperative time was 8-15 minutes for preparation, 11 minutes in average. The target error was less than or equal to 1.5 mm. With guidance of the image navigation system, all patients were successfully operated on without serious complication. There were 13 cases with anterior skull base tumor, all were removed completely. There were 28 cases with sella region tumor, 21 totally resected, 7 subtotally resected. There were 20 cases with petroclival region tumor, 12 totally resected, 5 subtotally resected, 3 partially resected. There were 14 cases with pterygopalatine fossa and/or infratemporal fossa region tumor, 11 totally resected, 3 subtotally resected. All patients were available for follow-up (mean = 26 months) except 6 cases.</p><p><b>CONCLUSION</b>Image navigation technology can be applied in endoscopic skull base operations with advantages of accurately locating, clearly marking, significantly decreasing incidence of complications, and maximally removing the lesions.</p>

Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction.

STUDY DESIGN: Clinical study. OBJECTIVE: To investigate the feasibility of the transoral endoscopic odontoidectomy without occipitocervical fusion. SUMMARY OF BACKGROUND DATA: Endoscopic transnasal resection of the odontoid process is less invasive than the conventional transoral odontoidectomy. However, the endonasal approach has a much longer working distance compared with the transoral approach to the craniovertebral junction and usually the endonasal approach needs a previous occipitocervical posterior fusion. METHODS: From July 2007 to June 2010, 5 patients (3 males and 2 females, age range, 25-41 yr) with irreducible cervicomedullary junction compression were subjected to endoscopic transoral odontoidectomy without occipitocervical posterior fixation and bone fusion. RESULTS: A purely endoscopic transoral odontoidectomy for decompression of the cervicomedullary junction without the occipitocervical fusion was achieved successfully in 5 patients. None of the patients underwent tracheotomy and postoperative gastrostomy tube placement. The patients were started on liquids on the third postoperative day and advanced to a regular diet on the fourth postoperative day. There was no postoperative velopharyngeal insufficiency, cerebrospinal fluid leakage, regional infection, or meningitis. The patients were discharged in 10 to 12 days after the surgery. There were no evidence of instability at the craniovertebral junction at 12 to 47 months of follow-up and remarkable improvement in neurological function was observed in each patient. CONCLUSION: The endoscopic transoral approach may be a more direct route to C1 and the odontoid than the endoscopic endonasal approach. This approach allows complete resection odontoid to decompress the cervicomedullary junction without increasing the risk of complications such as wound infection, meningitis, and velopharyngeal insufficiency. Usually, the occipitocervical posterior fusion and tracheotomy is less necessary in this approach.

Anatomy of the petrous apex as related to the endoscopic endonasal approach.

The endoscopic endonasal approach (EEA) has been reported to be an efficient approach for treating lesions of the petrous apex. However, there have been only limited anatomic studies for the EEA. Furthermore, most of the relevant distances for EEA cannot be measured easily on a cadaveric skull. Two fresh adult cadaver heads and five formalin-fixed adult cadaver heads were dissected using the EEA to identify groups of landmarks for safe guidance during this approach. The distances between these landmarks were then measured by CT angiography by using three-dimensional software. The EEA to the petrous apex can be divided into five phases. In each phase, a group of landmarks, rather than a single landmark, can be identified easily for guiding the next phase of the approach. There was no significant difference between males and females in any of the distances reported in the present study. The EEA can be performed to manage a petrous apex lesion more safely by referring to multiple landmarks and the distances between them.

Clinical study of chronic invasive sinusitis caused by dematiaceous fungi / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the clinical presentation, diagnostic criterion and treatment principle of chronic invasive sinusitis caused by dematiaceous fungi.@*METHOD@#One patient was diagnosed as chronic invasive sinusitis based on history, headache, especially eye symptoms without fever, sinus CT and MRI, endoscopic and cytological findings in the nasal cavity. Surgical debridement was performed, and the patient was administered with systemic anti-fungi treatment.@*RESULT@#Alternaria was identified on culture. The patient was proved of tissue invasion histopathologically through biopsy. The patient survived after treatment without recurrence.@*CONCLUSION@#Extensive and aggressive surgical debridement, prompt and adequate dosage of intravenous antifungal therapy , together with controlling of the underlying disease, all contribute to a complete resolution of the disease.

A preliminary study on the regulation mechanism of p38MAPK on MUC5AC in allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the effect of p38 mitogen activated protein kinase (p38MAPK) and cyclooxygenase-2 (COX-2) on the expression of mucin5AC (MUC5AC) in human nasal mucosa induced by histamine in vitro, and to investigate the pathogenesis of mucus hypersecretion in allergic rhinitis (AR).@*METHOD@#Western blot was performed to detect the protein expressions of p38MAPK, COX-2 and MUC5AC in nasal mucosa induced by histamine or blocked by selective inhibitors of p38MAPK and COX-2 of different concentration gradient.@*RESULT@#Weak expressions of p38MAPK. COX-2 and MUC5AC were detected in normal nasal mucosa in vitro. The protein expressions of p38MAPK. COX-2 and MUC5AC increased in nasal mucosa induced by histamine in a dose-dependent manner. The histamine induced protein expressions of COX-2 and MUC5AC were dose-dependently attenuated by selective inhibitor of COX-2, namely NS-398. No apparent influence of NS-398 on the expression of p38MAPK was observed. The histamine induced protein expressions of p38MAPK, C()X-2 and MUCbAC dose-dependently decreased after nasal mucosa was treated by selective inhibitor of p38MAPK, namely SB203580. And no significant change of MUC5AC protein expression induced by NS-398 or SB203580 was observed.@*CONCLUSION@#Our findings indicated that the histamine-induced increased expression of MUC5AC by activated p38MAPK/COX-2 may be a possible pathogenesis of mucus hypersecretion in AR.

Transclival cerebrospinal fluid rhinorrhea as the initial presenting symptom of a tiny intradural chordoma.

We report a patient with a tiny intradural clival chordoma, which was identified following presentation with cerebrospinal fluid (CSF) rhinorrhea as the initial symptom. The transclival dural defect and the intradural tumor were successfully localized by both radiological investigation and intraoperative endoscopic inspection. The tumor was totally resected and the CSF fistula was repaired by an endoscopic endonasal approach. The diagnosis, possible mechanisms and management of this rare condition are discussed. The role of endoscopy in identifying and treating the clival CSF rhinorrhea is emphasized. To our knowledge, this is the first report of a clival fistula secondary to a tiny intradural chordoma.