Chinese journal of otorhinolaryngology head and neck surgery最新文献

Objective: To explore the application of spiral tracheoplasty in the repair of large tracheal defects after the resection of trachea invaded by thyroid cancer. Methods: A retrospective analysis was performed on the clinical data of 11 patients, including 4 males and 7 females, aged from 36 to 67 years old, with large tracheal defects after tracheal resection due to thyroid papillary carcinoma invading the trachea in the Department of Otorhinolaryngology Head and Neck Surgery, Second Xiangya Hospital, Central South University from January 2019 to January 2022. The range of tracheal defects, time of tracheal reconstruction, postoperative complications and airway were recorded, and the patients were followed up for more than 24 months. Results: All patients underwent total thyroidectomy and tracheal resection and spiral reconstruction, and 2 of the cases underwent cricoid cartilage resection on the invaded side of cartilage. The tracheal defect accounted for 40%-60% of the circumference, and the lengths of the tracheal defects were 5.0 cm×7.5 cm and 6-9 tracheal rings, with 2 cases combined with partial defects of the cricoid cartilage. The reconstruction time was 30-60 min, with an average of 41.81 min. Among the 11 patients, 3 had recurrent laryngeal nerve paralysis, and 2 underwent tracheotomy. Four patients presented with hypocalcemia within one month after the operation. Followed up for 24-60 months, no tracheal stenosis occurred, the 2-year survival rate was 100%, the 2-year local control rate of the trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. Conclusion: Spiral tracheoplasty is a safe and effective method that can reduce the tension at the tracheal anastomosis and expand the tracheal cavity, which can be used for tracheal reconstruction after extensive resection of trachea invaded by locally advanced thyroid cancer.

Objective: To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy. Methods: From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance. Results: At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups (P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer (P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery (P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant (P<0.05). Conclusion: Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.

Objective: To investigate the clinical characteristics, treatment, and efficacy of spontaneous cerebrospinal fluid rhinorrhea (CFR) combined with aspiration pneumonia. Methods: In this case series study, a total of 8 patients diagnosed with spontaneous CFR combined with aspiration pneumonia were admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Yuhuangding Hospital Affiliated with Qingdao University from March 2020 to March 2022. There were 3 males and 5 females, with ages ranging from 45 to 57 years. Endoscopic repair of CFR was performed for all patients. Retrospective analysis was conducted on the symptoms, chest CT findings, the leak location of CFR, and laboratory virological test results. The healing of the operative cavity and the recovery of pulmonary inflammation were followed up. Results: All the 8 patients had obvious postnasal cerebrospinal fluid drip with different degrees of dry cough, which was aggravated when lying flat and sleeping. Bone defects of CFR were predominantly located in the sphenoid sinus, lamina cribrosa and ethmoid roof. Chest CT scans upon admission showed multiple flocculent ground glass opacities and inflammatory changes in both lungs. Tests for TORCH (TOX, RV, CMV, HSV), EB (Epstein-Barr) virus nucleic acid, nine respiratory pathogens, 2019-nCoV oropharyngeal swab, and serum immunoglobulin(Ig)M/IgG were all negative. Seven patients were cured after endoscopic repair of CFR. CFR occurred again in one patient due to head trauma, and no recurrence was observed for 3 months after reoperation. Postoperative chest CT scans confirmed the resolution of aspiration pneumonia in all 8 patients. Conclusions: Aspiration pneumonia may arise from the aspiration of cerebrospinal fluid in patients with spontaneous CFR. Early diagnosis and timely repair of CFR contribute to the recovery of aspiration pneumonia.

Objective: To investigate the feasibility and safety of endoscopic surgery for the treatment of primary hyperthyroidism with goiter. Methods: A total of 140 patients with primary hyperthyroidism and different degrees of thyroid enlargements were included who underwent endoscopic surgeries via a trans breast approach in the Second Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2023, including 137 females and 3 males, aged from 16 to 49 years old. Thirty-one cases had normal thyroid size, 25 cases had Grade Ⅰ enlargement, 56 cases had Grade Ⅱ enlargement, and 28 cases had Grade Ⅲ enlargement. Demographic characteristics, operative time, intraoperative blood loss, and postoperative complications were described, analyzed, and compared among groups. Student's t-test, Mann-Whitney U test, chi-square test, Fisher exact test or one-way analysis of variance (ANOVA) were used for statistical analyses. Results: The patients with Grade Ⅲ enlargement were younger compared to other groups (F=5.58, P<0.01), and also had significantly longer operative time (F=2.81, P=0.04). The probability of conversion to open surgery in the Grade Ⅲ enlargement group was 10.7% (3/28), significantly higher than other groups (0/31, 0/25, 1/56, χ²=8.11, P=0.04). There were no significant differences among the four groups in terms of other demographic indicators and the incidences of postoperative complications (including recurrent laryngeal nerve injury, hypocalcemia, and surgical site infection). There was no significant difference in the probability of temporary hypoparathyroidism among the 4 groups. One patient with permanent hypoparathyroidism appeared respectively in the normal size group and Grade Ⅱ enlargement group. The average follow-up time was 4.2±3.7 years and 14 cases were lost to follow-up, and the patients had high satisfaction with"no neck scar"but with mild chest discomfort. Conclusion: The risk of endoscopic thyroid surgery in the treatment of primary hyperthyroidism with goiter is controllable, and patients with hyperthyroidism combined with Grade Ⅲ enlargement should be especially vigilant against the risk of conversion to open surgery.