Chinese journal of otorhinolaryngology head and neck surgery最新文献

Objective: To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer. Methods: This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO₂ laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results: All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant (Z=-2.827,P<0.05). Conclusions: The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.

Objective: To investigate the clinical and genetic characteristics of nonsyndromic sensorineural hearing loss caused by STRC biallelic variation. Methods: A child with hearing impairment who was diagnosed at Gansu Provincial Maternal and Child Health Hospital on May 2022 and was selected as the research object. Peripheral blood of the child and her parents was collected, genomic DNA was extracted. IDT The xGen Exome Research Panel v2.0 whole exome capture chip was used to capture and sequence. Bioinformatics and clinical information analysis technology were used to analyze genetic data. The suspected pathogenic mutations were verified by quantitative polymerase chain reaction(QPCR)and Sanger sequencing. Results: The child had moderate hearing loss at about 1 year and 10 months, and now she is 3 years and 6 months, the hearing loss has not worsened. Whole exome sequencing(WES) testing revealed that the child carried the STRC gene with a deletion in EXON:1-29 and variants c.4561(exon24) _c.4562(exon24)insC, inherited from the mother and father, respectively. According to the relevant guidelines of the American Society for Medical Genetics and Genomics (ACMG), they were determined to be likely pathogenic variant and pathogenic variant. Conclusion: The discovery of c.4561(exon24) _c.4562(exon24)insC enriched the STRC variation spectrum, and provided a theoretical basis for the diagnosis and genetic counseling to the children.

Objective: To study the laryngeal functional characteristics of patients with amyotrophic lateral sclerosis (ALS)disease diagnosed at the voice clinic. Methods: A retrospective analysis(case series study) was conducted on the laryngeal functional characteristics of 7 patients [2 males, 5 females, age ranged from 43 to 76(60.85±13.18)]with motor neuron disease who visited the voice clinic and were ultimately diagnosed by neurologists. The data included laryngostroboscopy, fiberoptic endoscopic examination of swallowing(FEES), acoustic analysis and laryngeal electromyography(LEMG). Descriptive methods were used for analysis. Results: ①There were 2 males and 5 females, with an average age of (60.85±13.18) years. They had previously visited the otolaryngology department more than twice, visit frequency with an average of 3.57 and an average diagnosis time of 12.28 months. The main complaints of the patient at the time of treatment were voice change, dysphagia or vocal fatigue. ②LEMG: Among 7 cases, 4 cases demonstrated neurogenic damage, all of which were bilateral, and 3 cases showed normal findings on examination. Spontaneous potentials (SP) were present in three cases for more than 6 months, with the longest duration being 24 months. Three cases exhibited the coexistence of spontaneous potential and reinnervated motor unit potentials (MUPs), and two cases showed bundle tremor potential.③Laryngostroboscopy revealed bilateral vocal fold asymmetry and glottic insufficiency in 7 cases, and decreased vocal cord movement in 4 cases, and vocal cord atrophy in 5 cases. FEES showed that 7 patients presented with mild to severe swallowing dysfunction, 3 cases had soft palate insufficiency and mild to severe food residues in the epiglottic valley and pyriform fossa. 1 case showed leakage and 1 case showed aspiration. Conclusions: Patients presenting with initial symptoms of abnormal laryngeal function should be vigilant for the possibility of motor neuron disease, especially when laryngostroboscopy reveals abnormal vocal fold movement and swallowing dysfunction. LEMG examination reveals bilateral neurogenic damage, prolonged spontaneous potential, coexistence of spontaneous potential and reinnervated MUPs, and the appearance of bundle tremor potential, which is beneficial for early detection of motor neuron disease.

Objective: To establish a novel laryngopharyngeal reflux model in Bama minipigs excluding concurrent gastroesophageal reflux through endoscopic cricopharyngeal myotomy. Methods: Twelve 8-month-old male Bama minipigs were randomly assigned to three groups: Group 1 underwent cricopharyngeal myotomy alone, Group 2 underwent combined cricopharyngeal and lower esophageal sphincter myotomy, and Group 3 served as the control group. Following a one-week acclimatization period, the respective surgical procedures were performed. At 2 weeks postoperatively, laryngopharyngeal pH monitoring was conducted on all pigs. At 8 weeks, histopathological assessment using hematoxylin and eosin (HE) staining, transmission electron microscopy of the laryngopharyngeal mucosa, and quantification of pepsin in the laryngopharyngeal and distal esophageal mucosa were performed to analyze intergroup differences and to elucidate the occurrence and pathologic featuresof LPR. Results: Two weeks postoperatively, experimental groups exhibited laryngopharyngeal reflux episodes with pH<5.0, in contrast to the control group. HE staining at 8 weeks revealed inflammatory changes in the laryngopharyngeal mucosa of Groups 1 and 2, accompanied by increased intercellular spaces and decreased desmosome density under electron microscopy, indicating a pathogenic mechanism involving disruption of intercellular junctions by refluxate. Statistically significant differences in pepsin expression ofthe vocalcords mucosal were observed among groups(F=88.427,P<0.001).Group 2 exhibited elevated pepsin expression in the distal esophageal mucosa than Groups 1 and 3, suggesting concurrent GERD only occured in Group 2. Conclusion: Endoscopic cricopharyngeal myotomy induces LPRD in Bama minipigs without concurrent GERD by reducing upper esophageal sphincter pressure, thereby offering a model that closely resembles the clinical features of LPRD.