Computed tomographic images analysis of frontal recess anatomy based on three-dimension reconstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery.@*METHOD@#Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely.@*RESULT@#After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively.@*CONCLUSION@#This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.

A case of malignant melanoma on the left side of the maxillary sinus / 临床耳鼻咽喉头颈外科杂志

The clinical manifestations of the disease lacked specificity,and the clinical symptoms were nasal obstruction, any blood in snively and slightly swelling pain on face. The neoplasm with unsmooth surface looked taupe and maroon, and was brittle and easy blooding. Paranasal sinus CT:crumbly mass lesion within the shadow filled in the left side of the maxillary sinus,and the sinus stopped up,sinus wall bone was absorpt and thinned, front and rear wall and inner wall bone were boundedness broken off, knuckle partly to the nasal cavity. Direct reinforcement MRI:in addition to the result of paranasal sinus CT,enhance examination found obviously asymmetrical intensify of the focus. The pathological diagnosis of postoperation was malignant melanoma on the left side of the maxillary sinus.

3D computed tomographic analysis of frontal recess region / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of the study was to observe the three-dimensional (3D) CT imaging features of the frontal recess region with 3D reconstruction, and obtain the real image of the important anatomical structures of the region to conduct surgery.@*METHOD@#Five patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard 3D reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely.@*RESULT@#After the reconstruction, we get the 3D model very close to the true state of the nasal cavity--sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In this patient, the height, width and depth of the agger nasi and frontal sinus were 12.3 mm, 12.1 mm, 38.5 mm, respectively.@*CONCLUSION@#This study tried to develop the standardized techniques and measurements from 3D reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.

The expression of IL-23 in nasal mucosa of allergic rhinitis patients and its significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of interleukin (IL)-23 in the nasal mucosa of allergic rhinitis patients and its significance.@*METHOD@#mRNA and protein expression of IL-23 in inferior turbinate mucosa from 12 allergic rhinitis patients and 11 control patients was measured by means of real-time RT-PCR and immunohistochemistry, respectively.@*RESULT@#IL-23p19 mRNA relative expression level in nasal mucosa was significantly increased in allergic rhinitis patients compared with normal controls (P < 0.01). Immunohistochemical staining demonstrated that IL-23 protein was mainly expressed by infiltrating inflammatory cells in lamina propria and there was increased number of IL-23 positive cells in allergic rhinitis patients in comparison with normal controls. Correlation analysis showed that the mRNA and protein expression level of IL-23 was significantly positively correlated with the number of the inflammatory cells (r = 0.678 and 0.644, respectively; both P < 0.01) and the degree of subepithelial collagen deposition (r = 0.834 and 0.721, respectively; both P < 0.01). IL-23p19 mRNA relative expression level in nasal mucosa was significantly decreased in allergic rhinitis patients who used glucocorticoids compared with controls (P < 0.01).@*CONCLUSION@#IL-23 may contribute to the chronic inflammation and airway remodelling in allergic rhinitis.

Computed tomographic analysis of frontal recess region / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of the study was to observe the CT imaging features of the frontal recess regional.@*METHOD@#Eighty-two patients were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were made using standard triplanar reconstruction protocol on a computer workstation.@*RESULT@#The prevalence of agger nasi cell was 87.8% (144/164). One hundred and forty-five (89%, 145/164) uncinate processes had one superior attachment for each uncinate process. The others had two superior attachments for each uncinate process. The uncinate process' single superior attachment of into the surrounding structures was identified to have the following distribution: 90/164 (54.9%): to the lamina papyracea, 50/164 (30.5%) to the middle turbinate, and 5/164 (3.0%) to the skull base. Of all the frontal cells were identified in 144 (87.8%) sides of frontal recesses, the prevalence of type I II, type III IV, were 30.5% and 9.8% respectively.@*CONCLUSION@#T Agger nasi cell and uncinate process play an important role in endoscopic frontal sinus surgery.

Inhibitory Effects of Glucocorticoids on the Tenascin C Expression in Nasal Polyp / 华中科技大学学报(医学版)

Objective To investigate the effect of glucocortieoids on tenasein C(TNC) expression in nasal polyp tissues and airway epithelia,and explore the possible mechanism of glucocorticoids inhibiting remodeling of nasal polyp tissue.Methods The enzyme linked immunosorbent assay(ELISA) was used to detect the protein levels of tenascin C and transforming growth factor-β1(TGF-β1) in nasal polyp tissues from intranasal glucocorticoids (Budesonide,BUD) treated group and untreated group.The cell culture,real-time RT-PCR and in situ ELISA were employed to investigate the regulatory effects of budesonide on the TNC mRNA and protein expression in BEAS-2B immortalized human bronchial epithelial cells.Results The protein levels of TNC and TGF-β1 were decreased in nasal polyp tissues from intranasal BUD-treated group as compared with untreated group(P<0.01).There was a significantly positive correlation between TNC and TGF-β1 protein levels in nasal polyp tissues (r =0.68,P<0.01).After preincubation with BUD,TNC mRNA and protein expression induced by TGF-β1 in BEAS-2B cells was significantly decreased(P<0.01).Conclusion Glucocorticoids might participate in the regulation of tissue remodeling in nasal polyp by inhibiting the TGF-β1 expression in nasal polyp tissue and suppressing the induction of TGF-β1 to up-regulatie the TNC expression in airway epithelia.

Three-dimensional reconstruction of the optic canal-based on multislice helical CT: a comparison analysis with skull dissection of 40 postmortem cases.

Decompression operation of the optic canal via the nasal path under endoscope is widely used, but it is both a challenging and controversial method. Unsatisfactory results were largely associated with otolaryngologists' limited understanding of the real anatomical situations of the optic canal before operation. To provide otolaryngologists with the real situations and data preoperation, multislice helical CT was used to reconstruct the images of the optic canal. Using multislice helical CT-aided three-dimensional reconstructive methods in combination with direct anatomic measurement, we dissected and analyzed the shape of the optic canal and its anatomic relationship with the adjoining structures in 40 intact postmortem skull samples. The In-Space technique clearly showed the structure and the related region of the optic canal. The virtual endoscopy technique showed superbly the spatial appearance and topography of the inner optic canal and also gave the inner structure of the optic canal optically. There was no statistic difference in three-dimensional reconstructive data with that obtained by anatomical measurements and thus can be used to directly instruct the clinic operation. These results demonstrate that a combined In-Space technique with virtual endoscopy can accurately define the subtle structure and the related region of the optical canal. In conclusion, multislice helical CT-based three-dimensional reconstruction is of important value for clinical operations.

Endoscopic removal of ethmoid osteoma: report of 13 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To report 13 cases of ethmoid osteoma removed through an endoscopic approach and discuss the operative technique and clinical value.@*METHOD@#Thirteen cases with ethmoid osteoma were retrospectively reviewed in the study. All procedures were performed with CT image guidance-according to the site of attachment. The anterior ethmoid cell was resected, and the whitish osteoma found. A double blunt elevator was used to separate the osteoma from ethmoid cell, and to push the osteoma medially toward the nasal septum, and (or) inferiorly toward the middle meatus. This method was performed in 7 patients (8 sides), whose CT scan showed the osteoma bases were not attached to lamina papyracea, and (or) anterior skull base. The others were drilled out with a intranasal powered drill for its attached to lamina papyracea in 4 patients and to anterior skull base in 2 patients.@*RESULT@#Thirteen cases of ethmoid osteoma were removed completely through an endoscopic approach and there were no intraorbital or intracranial complication. Endoscopy showed normal epithelization at around 6 to 8 weeks after surgery.@*CONCLUSION@#Preoperative CT scans, including coronal and axial images, is very helpful to determine the sites of the osteoma attachment and plan the operation. Endoscopic removal of ethmoid osteoma is not only an ideal, less invasive surgical approach, but also no cosmetic alteration.

The investigation of efficacy and safety of Aerius to seasonal allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the efficacy and safety of Aerius to seasonal allergic rhinitis.@*METHOD@#Using randomized, controlled method, treatment group 40 cases, oral administration Aerius 5 mg/d for 12 days; control group 35 cases, oral administration Aerius 5 mg/d for 12 days, investigating their efficacy and safety.@*RESULT@#The total effective rate of treatment group was 92.50%, while control group was 85.71%, there was significant difference between them (P<0.05). Significant improvements of seasonal allergic rhinitis nasal obstruction were seen in treatment group after using Aerius (P<0.05). The incidence of side effect of treatment group was 2.50%.@*CONCLUSION@#Aerius is safe and can effectively reduction in nasal and nonnasal symptoms in patients with seasonal allergic rhinitis.

Prevalence of sensitization to allergens in patients with allergic rhinitis and respiratory disease in Qingshan of Wuhan / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of this study was to determine which allergens were prevalent in patients with allergic rhinitis and respiratory disease in Qingshan Wuhan.@*METHOD@#A total of 700 cases, which were diagnosed as allergic rhinitis and respiratory disease by history and clinical presentation, underwent ELISA test with 7 standardized allergens, and the most important sensitizing allergens were assessed. The samples were stratified on two age groups: AR and respiratory disease group and the positive rate of two main allergens in two groups were contrast analyzed.@*RESULT@#For patients with allergic rhinitis, the positive rate of the top seven aeroallergen were dermatophagoides (47%), herbs (19.7%), tree (18%), animal dander (8.9%), house dust (6.5%), mold (4.9%) and wormwood (3%). There was no significant difference in higher sensitivity to dust mite and ragweed between allergic rhinitis and respiratory disease group (P > 0.05).@*CONCLUSION@#Dust mite, Tree and Herbs are the most important three aeroallergens in Qingshan region of Wuhan.

The difference in some clinical and pathological characteristics between chronic sinusitis patients with and without nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the difference in some subjective symptoms, objective examination results, and pathological characteristics between chronic sinusitis patients with and without nasal polyps (CRSwNP and CRSsNP).@*METHOD@#Prospective data of 42 CRSsNP patients and 33 CRSwNP patients scheduled for surgery were collected and analyzed retrospectively. A visual analog scale (VAS) symptom score was completed. The preoperative computed tomography (CT) scans were graded according to Lund and Mackay. The preoperative nasal endoscopy was graded by assigning an endoscopy score according to Lanza and Kennedy. Blood was drawn to determine the number of peripheral eosinophils (EOS) by means of automated analysis. Surgical specimen was examined pathologically for the number of EOS per high-powered field. Interleukin (IL)-5 was determined by means of quantitative enzyme-linked immunosorbent assay.@*RESULT@#(1) As to the single VAS symptom score relating to overall symptom severity and the VAS score based on the sum of five sinonasal symptoms, there was no difference between CRSsNP and CRSwNP patients (P > 0.05). However, compared with CRSwNP patients, CRSsNP patients had higher VAS score of nasal discharge (P < 0.05) and lower score of hyposmia (P < 0.01); (2) Compared with CRSsNP patients, CRSwNP patients had higher CT and endoscopy scores, peripheral and mucosal EOS counts, and mucosal IL-5 level (P < 0.05); (3) The preoperative CT and endoscopy scores were positively correlated with peripheral and mucosal EOS counts and mucosal IL-5 level (P < 0.01).@*CONCLUSION@#There is no significant difference in overall symptom between CRSsNP and CRSwNP patients. However, CRSwNP patients have more severe inflammation in nasal and sinus cavity, which is related to eosinophilic inflammation in local mucosa.

Clinical observation on inhalation of pulmicort in patients with chronic rhinosinusitis after surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Whether inhalation of pulmicort into the sinus of chronic rhinosinusitis patients could improve reepithelization after endoscopic sinus surgery was assessed.@*METHOD@#Prospective study 60 patients with chronic rhinosinusitis after endoscopic sinus surgery were divided into 2 groups randomized, the one was treatment group, and the other was control group. The patients in treatment group received inhalation of pulmicort 2 ml plus 0.5% Aeuromycin solution 10 ml by oxygen driving force, once a day, persisting for 3 weeks. The patients in control group received Rhinocort. Besides the different therapies above mentioned above therapy was different, two groups received the same conventional route therapy. To observe the time of reepithelization under nasal endoscope, was observed, respectively.@*RESULT@#The average time of reepithelization in treatment group was (5.3333 +/- 0.9942) weeks. The other group was (6.6667 +/- 1.3476) weeks, the statistical difference between the two groups was very significant.@*CONCLUSION@#Inhalation of pulmicort into the sinus can promote reepithelization and shorten the time of treatment.

The perioperative glycemic control in chronic rhinosinusitis coexisting diabetes / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the method of the perioperative blood glucose control in chronic rhinosinusitis coexisting diabetes.@*METHOD@#Twenty-two cases of chronic rhinosinusitis coexisting diabetes were investigated retrospectively, including one case of type 1 diabetes and 21 cases of type 2 diabetes. The study cohort was divided into two groups, the one was complication group and the other was non-complication group. The patients in complication group were injected insulin to control blood glucose level, and the patients in non-complication group were prescribed oral medicine.@*RESULT@#Blood glucose levels below 9.0 mmol/L in complication group and below 7.0 mmol/L in non-complication group were both the surgical indication for the patients in this research cohort. Twenty-one cases were completely recovered and one case made progress significantly.@*CONCLUSION@#The detection of blood and urine glucose levels must be the routine item before the nasal endoscopic surgery. To control blood glucose levels in type 2 diabetes with non-complication, oral medicine is the first choice, in type 1 diabetes and type 2 diabetes with complication, insulin should be first considered.

Three dimensional reconstruction study of multi-slice helical CT imaging on optic canal area / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the accuracy and clinical application of multi-slice spiral CT imaging on optic canal area.@*METHOD@#Forty intact specimens of human corpse head were tested with three dimensional reconstruction of multi-slice spiral CT imaging. The results of radiology and anatomy were compared on adjacent structures of optic canal interior wall and its developmental relationship with sphenoid sinus.@*RESULT@#(1) The high spatial resolution of integrity could be obtained with dimensional processing technique. The anatomical structure of optic canal and its surrounding area could be demonstrated clearly. (2) With the technique of virtual endoscopy, the interior reconstruction of optic canal could demonstrate the inner topography of optic canal, the reconstruction image of which was identical to that of the control subjects. (3) There was no significant difference between the data of multi-slice spiral CT imaging and that of anatomy (P > 0.05).@*CONCLUSION@#Associated application of dimensional processing technique and virtual endoscopy, not only can the subtle structures of optic canal be demonstrated and measured, but also the detailed information on spatial relationships of optic canal area can be provided for operation.

Correlation between rhinosinusitis symptoms and objective sinus examinations / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the relationship between rhinosinusitis symptoms and objective sinus examinations.@*METHOD@#Prospective data of 75 patients with CRS scheduled for surgery were collected and analyzed retrospectively. The preoperative computed tomography (CT) scans were graded according to Lund and Mackay. The preoperative nasal endoscopy was graded by assigning an endoscopy score according to Lanza and Kennedy. A visual analog scale (VAS) symptom score was completed.@*RESULT@#(1) There was a significant correlation between preoperative CT and endoscopy scores (r = 0.88, P 0.05). Furthermore, a statistically significant but weak correlation was found between the VAS score based on the sum of five sinonasal symptoms and the Lund-Mackay CT scan score (r = 0.26, P 0.05).@*CONCLUSION@#There is no good correlation between CRS symptoms and objective examinations. In order to evaluate CRS patients' severity and select treatment properly, both symptoms and objective examinations must be considered.

Expression of tenascin and fibronectin in nasal polyps / 华中科技大学学报（医学）（英德文版）

To explore the role of tenascin (TN) and fibronectin (FN) in the pathophysiology of nasal polyps (NP), the expression of TN and FN in NP from 34 patients and inferior turbinates from 20 patients with deviation of nasal septum was immunohistochemically studied. In patients with NP, the relations between expression and histopathological features, eosinophils (EOS) infiltration, clinical staging and the size of NP were analyzed. Our study showed that the gray score of TN and FN expression was 163.10 +/- 10.54 and 163.24 +/- 11.52 in NP respectively, whereas it was 175.49 +/- 9.29 and 173.93 +/- 7.92 in inferior turbinates respectively. The difference between two groups was significant (P < 0.01). The expression of TN and FN in endematous type was significantly stronger than that in cystic and glandular type and fibrous type (P < 0.05). The association between FN expression and EOS infiltration was significant (r = -0.60, P < 0.01). The expression of TN and FN did not correlate with clinical staging and size (P > 0.05). It was suggested that abnormal ECM might contribute to proliferation of epithelia, accumulation of EOS and edema formation, thereby causing development of NP.

Expression of Proliferating Cell Nuclear Antigen and B-cell Lymphoma/Leukemia-2 Gene in Cholesteatoma and Its Clinical Implication / 华中科技大学学报(医学版)

The expression of proliferating cell nuclear antigen (PCNA) and B-cell lymphoma/leukemia-2 gene (Bcl-2) was detected in 25 cases of cholesteatoma tissues and 10 cases of normal skin by using immunohistochemical technique. The results showed that the PCNA index of cholesteatoma tissues was higher than that of normal skin, but Bcl-2 was not expressed in cholesteatoma tissues and normal skin. The PCNA index was correlated with the aggressiveness of cholesteatoma. It was suggested that PCNA could be considered to be a prognostic marker and an indicator of aggressive behavior in cholesteatoma. Although the cholesteatoma had a very high proliferating character, it wasn't a malignant tumor.

DNA character of the cholesteatoma DNA character of the cholesteatoma / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the DNA character with in cholesteatoma tissues with that in normal skin.Method:DNA content within 25 cholesteatoma tissues and 10 normal postauricular skin was measured with flow cytometry.Result:The content of cholesteatoma tissues and postauricular skin specimens are a normal euploid.The cell number during S phase of cholesteatoma(10.9±2.32)% was higher than that in normal skin(7.31±2.82)%.Conclusion:Although the cholesteatoma has a very high proliferating character,the result suggest it isn′t a malignant tumor.