[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of endoscopic surgery for advanced malignant tumors in the nasal cavity and paranasal sinuses.
A retrospective data analysis was performed on 49 patients with advanced sinonasal tumors undergoing either an exclusive endoscopic approach or with a complemental approach from January 2004 to October 2010. Forty-nine patients were considered eligible for the present analysis, among them, T3:T4a:T4b were 12:13:24 (T stage was assessed with the sixth editions of the UICC staging systems). The histotypes encountered were squamous cell carcinoma 20 cases, adenocarcinoma 12 cases, mucosal melanoma 8 cases, olfactory neuroblastoma 6 cases, others 3 cases. These patients were operated on either by an exclusive endoscopic endonasal approach or with a complementary external approach; 36 patients received adjuvant radiotherapy or/and chemotherapy. The data were analyzed by Kaplan-Meier method and Log-rank test.
The hemorrhage varied from 200 to 5000 ml during the operation, with an average of 600 ml. The post-operative complications were rare, 1 patient lost her sight after operation, and no patient got infected at the site of operation (nor intracranial infection). After full amount of radiotherapy, no cerebrospinal fluid rhinorrhea was found. Four patients (8.2%) lost to follow-up. Sixteen patients died during the follow-up period, only three of them were without craniocerebral or orbital invasion. Four in 9 patients in the other pathological group (with the pathology of olfactory neuroblastoma or glioma etc), which had a poor prognosis, died during the follow-up period, of them, 3 had definitive evidence of intracranial metastasis, and none of the nine patients had been followed-up beyond 25 months. The 2 and 3 year disease-free rates were 34.2% and 21.4%, and overall survival rates were 62.5% and 58.4% respectively. The T stage, margin status, and whether accepted post operative adjuvant therapy were significant factors in predicting disease recurrence (χ² were 7.7, 4.9, 6.8 respectively and P < 0.05).
Now the endoscopic techniques with or without complementary approaches is an effective way for complete tumor removal. With postoperative complementary therapy, it provides a satisfactory survival rate with few side effects and better quality of life.
No preview · Article · Jun 2011 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: Objective:
To introduce the experience of management of inverted papilloma in frontal sinus in hospital.
Six patients with inverted papilloma in frontal sinus treated between 1999 and 2006 were reported, with special emphasis on the clinical symptoms, surgical technique and prognosis.
Among 6 patients with frontal sinus involvement, there were 5 males and 1 female, aged between 24 and 66 years. All 6 patients were managed with endoscopic resection and additional open approach (glabellar nasal keyhole approach). Follow-up ranged from 2 -8 years. Five patients treated with this protocol remained disease free, and 1 patient died of tumor recurrence and malignant degeneration 16 years after the first surgical management of sinonasal inverted papilloma.
The appropriate management of inverted papilloma involving the frontal sinus is combined open/endoscopic approach. The tumor extended into the lateral, far superior, and anterior aspects of the frontal sinus is truly at the limits of current endoscopic instrumentation. In order to avoid recurrence, the tumor must be resected completely during the operation. Postoperative radiotherapy is not absolutely necessary.
No preview · Article · Oct 2008 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: To evaluate the safety and efficacy of transnasal endoscopic resection and craniofacial resection through an external approach for olfactory neuroblastoma (ONB).
Thirty two patients with ONB treated between 1987 and 2006 were retrospectively reviewed.
The patients were followed up for 8-135 months, the median follow-up time was 20 months. The longest follow-up time of patients treated by endoscope was 79 months, and patients treated by combined endoscope and transcranial surgery was 87 months. At Kadish stage B the 3-year survival rate of patients with transnasal endoscopic resection was 78.8% and at Kadish stage C it was 50.0%. At Kadish stage B the 3-year survival rate of patients with craniofacial resection through an external approach was 60.0% and at Kadish stage C it was 44.4%. The bleeding amounts in above two approaches were 140 ml and 450 ml. The average length of stay in hospital in transnasal endoscopic resection approach was markedly reduced (P < 0. 01).
Olfactory neuroblastoma can be safely and effectively excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. The time of stay in hospital can be reduced and the surgical trauma can be diminished.
No preview · Article · Mar 2008 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: To discuss the diagnosis and treatment of the diseases originated in the olfactory cleft.
Eight consecutive patients with the diagnosis of olfactory cleft diseases, encountered between December, 2003 and May, 2006, were included in this retrospective study. On the basis of case reports, the related anatomy, diagnosis and treatment of olfactory cleft diseases were discussed.
For the 8 patients with olfactory cleft diseases, the clinical and pathological diagnosis were as follows: adenocarcinoma, squamous cell carcinoma, inverted papilloma, glioma with cerebrospinal fluid (CSF) rhinorrhea, pyocyst of the superior turbinate, angiofibrosteoma, neurofibroma and hemangioma. All patients were treated by endoscopic surgery. Postoperative radiotherapy was given to two patients with malignant tumour.
The diseases in the olfactory cleft are not uncommon, which are often overlooked. In order to avoid misdiagnosis, (1) it is important to pay attention to this specific anatomic area; (2) the particularity of olfactory cleft diseases should be emphasized, especially in the cases of huge tumors. In that cases, the primary sites of olfactory cleft tumors can not be correctly judged preoperatively by CT scans, which can only be found during endoscopic surgery. For the treatment of olfactory cleft diseases, surgery under endoscope is the treatment of choice. If the tumor is malignant, postoperative radiotherapy should be added.
No preview · Article · Aug 2007 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of Mizolastine on quality of life (QOL) in patients with perennial allergic rhinitis.
A randomized, double-blind, placebo-controlled study was carried out with Mizolastine in sixty patients with perennial allergic rhinitis. QOL was measured by using the Medical Outcome Study Short-Form Health Survey (SF-36) questionnaire (Chinese version). Mizolastine (10 mg once daily, 26 patients), Cetirizine (10 mg once daily, 22 patients) or placebo (12 patients) was given for 3 weeks. The SF-36 questionnaire was administered at the start of treatment and after 1 and 3 weeks of treatment. Symptom-medication scores were measured daily during the study.
After the run-in period (baseline), there were no significant differences among the Mezolastine, Cetirizine and placebo groups in terms of symptoms or QOL scores. After 1 and 3 weeks of treatment, symptoms scores were significantly decreased and QOL scores significantly improved in the Mezolastine group and Cetirizine group in comparison with the placebo group ( both P < 0.001, chi2 test). All of the eight QOL dimensions were significantly improved (from P = 0.001 to P < 0.0001, F test) after 1 and 3 weeks of Mizolastine treatment compared with placebo. There was no improvement in the placebo group.
Mizolastine can not only decrease symptoms scores but also improve the QOL in patients with perennial allergic rhinitis. Placebo can relieve the symptoms but can not improve the QOL.
No preview · Article · Jul 2006 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: Surgery is the curative treatment for nasal dermoid cysts. Many different surgical incisions have been advocated. All approaches described have the advantage of either improved accessibility or improved patients'cosmetic satisfaction, but none is optimal. We designed a new transseptal endoscopic approach for the treatment of nasal dermoid sinus cyst and reported the result of a special case.
The diagnostic studies, the operative technique, and the result of 18 month follow-up were presented.
The patient, a 16 years old girl, remains free of disease 18 months after surgical treatment, most importantly without facial scar. CONLUSIONS: Transseptal endoscopic approach is an alternative surgical technique for selected nasal dermoid cysts. So far as we know, the operative method presented in the current report is the first surgical approach reported in the world literature.
No preview · Article · Mar 2006 · Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery
[Show abstract][Hide abstract] ABSTRACT: To discuss the feasibility and therapeutic efficacy of resection of sinonasal malignant tumours through endoscopic or endoscope-assisted surgery.
Since 1997, 11 cases of malignant tumours were resected under endoscope or by endoscope-assisted surgery. Among them, 5 patients were followed-up for more than 3 years, including one case of nasal septum squamous cell carcinoma; one case of ethmoid sinus squamous cell carcinoma; one case of maxillary sinus adenoid cystic carcinoma and two cases of olfactory neuroblastoma.
In the patients who were followed-up for more than three years, no local recurrence was found. There was only one case of cervical lymph node metastasis found on a patient with olfactory neuroblastoma 2. 5 years after resection. Four years after operation, this patient was suspected to have extensive metastasis in meninges, and only palliative treatment was suggested.
By endoscope or by endoscope-assisted surgery, some of selected sinonasal malignant tumours can be thoroughly resected. The advantages are mini-invasive and avoidance of facial scar so as to improve the quality of life (QOL) of patients. Large amount of cases, random clinical study with lone- term follow-up are still needed to verify the feasibility and efficacy of endoscopic or endoscope-assisted surgery.
No preview · Article · Oct 2004 · Zhonghua er bi yan hou ke za zhi
[Show abstract][Hide abstract] ABSTRACT: Through analysis of surgical treatment and repair methods for the skull base lesions, to summarize the type, sites, characters of the lesions and the methods of surgical treatment and repair, and to provide the beneficial experience for the surgeons.
Four hundred and thirty patients were hospitalized and treated surgically between Feb. 1982 and Dec, 2002, and their clinical data were analyzed.
Of 430 patients, 265 (61.6%) were male, 165 (38.4%) female. The mean age was 36. 1 years old (range from 2.5 to 76.0). In 173 cases (40.2%), the lesions were on the left side of the skull base, 178 cases (41.4%) on the right, 79 cases (18.4%) involving the central and both side of the skull base. In 116 cases (27.0%), the lesions were located in anterior skull base, 57 (13.3%) in central, 174 (40.5%) in lateral and posterior, and the remainder 83 cases (19.5%) in two or more regions. Of 430 cases, 283 (65.8%) were tumors, among them, 154 (35.8%) were benign, 129 (30.0%) malignant, 76 (17.7%) trauma, 42 (9.8%) congenital, 18 (4.2%) infection, 11 (2.6%) unknown. All patients were surgically treated. Of them, 43 cases were treated for 2 times, 5 cases for 3 times, 4 for 4 times, 1 for 5 times, 3 for 6 times. The total were 514 times. The bone defect was reconstructed in 95 cases (22.1%). The dura mater was repaired in 117 cases (27.2%). The postoperative complications occurred in 27 cases. Two cases died in 2 and 3 days after operation because of brain hernia with the ligation of common carotid artery and internal carotid artery for artery rupture. No death occurred during operation.
The majority of the skull base lesions were tumors. The male patients were more than female. Appropriate surgical approach and better perioperative treatment could harvest the satisfactory effect.
No preview · Article · Oct 2004 · Zhonghua er bi yan hou ke za zhi
[Show abstract][Hide abstract] ABSTRACT: To find out the prevalence of pneumatization of perpendicular plate of the ethmoid bone, and to discuss the diagnosis and management of perpendicular plate mucocele (nasal septal mucocele).
The CT data from 32 patients with septal deviation were reviewed, and an unusual case of perpendicular plate mucocele was reported.
Six cases (6/32, 18%) were found to have pneumatization of perpendicular plate of the ethmoid bone, with 2 located in the anterior portion (frontal-septal pneumatization), and 4 located in the posterior portion (spheno-septal pneumatization). A patient with perpendicular plate mucocele was treated by the technique of marsupialization under nasal endoscope. This patient was followed-up for 10 months without recurrence.
As a kind of variation of nasal septum, the clinical significance of pneumatization of perpendicular plate should be emphasized. We reported the first case of perpendicular plate mucocele, originated possibly from the pneumatization of perpendicular plate of the ethmoid bone. Marsupialization under endoscope was considered to be the initial management for this unusual disease.
No preview · Article · Sep 2003 · Zhonghua er bi yan hou ke za zhi