[Morphology of cricopharyngeal muscle under suspension laryngeal endoscope].

OBJECTIVE: To observe the morphologic features of cricopharyngeal muscle (CPM) under suspension laryngeal endoscope. METHODS: This prospective study was conducted on a series of 100 consecutive patients who undergone endoscopic microlaryngeal surgery with intubation general anesthesia. The suspension laryngoscope was introduced down to postcricoid area approaching esophageal inlet. By lifting the larynx with the laryngoscope, the mucosa-covered cricopharyngeal muscle was easily identified as the mound of tissue just at the posterior pharyngeal wall. The image of cricopharyngeal muscle under the laryngoscope was saved. RESULTS: In 94 out of 100 patients, CPM could be visualized with laryngoscope. In the other 6 patients, both CPM and glottic could not be exposed because of cervical vertebra stiffness and obesity. According to the image of CPM under the laryngoscope, the shape of the CPM was divided into three types. It was named for flat type in which there was no mound of tissue visible at the posterior pharyngeal wall and esophageal cavity could be visible completely, semi-bar type in which there was a bar at the posterior pharyngeal wall and partial esophageal cavity could be visible and full-bar type in which the bar contact esophageal anterior wall and esophageal cavity could not be visible. There were 14(14.9%) patients as flat type, 59(62.8%) as semi-bar type and 21(22.3%) as full-bar type. No significant difference was found between adults group and the aged (≥ 65 years old) group (χ(2) = 1.224, P = 0.747) and reflux associated group and non-reflux associated group respectively (χ(2) = 5.252, P = 0.072). CONCLUSIONS: The CPM could be well exposed in most of the patients with suspension laryngeal endoscope. It provides anatomy basis for endoscopic cricopharyngeal myotomy.

Otoendoscopic treatment of hidden lesions in otomastoiditis.

BACKGROUND: Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery. METHODS: We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip. RESULTS: All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold's abscess, hyperplastic granulation tissue developed at the antrum. CONCLUSIONS: Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recurrence.