Laryngoscope Investigative Otolaryngology最新文献_第10页

Extranodal extension in laryngeal squamous cell carcinoma 喉鳞状细胞癌的结节外扩展

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-25 DOI: 10.1002/lio2.1232

Aman M. Patel BS, Sudeepti Vedula MD, Ariana L. Shaari BA, Hannaan S. Choudhry BA, Andrey Filimonov MD, PharmD

Objective

Although large retrospective database studies have associated extranodal extension (ENE) with worse survival in several head and neck cancers, the prognostic significance of ENE in laryngeal squamous cell carcinoma (LSCC) remains unclear. Our study examines ENE and overall survival (OS) in LSCC.

Methods

The 2006–2017 National Cancer Database was queried for patients with LSCC undergoing surgical resection and neck dissection, with or without adjuvant therapy. Kaplan–Meier and multivariable Cox regression survival analyses were implemented to identify the independent impacts of pathologic nodal (pN) classification and ENE on OS.

Results

Of 4208 patients satisfying inclusion criteria, 2343 (55.7%) were pN0/ENE-negative, 1059 (25.2%) were pN1-2/ENE-negative, and 806 (19.2%) were pN1-2/ENE-positive. The 5-year OS of pN0/ENE-negative, pN1-2/ENE-negative, and pN1-2/ENE-positive patients was 62.8%, 56.7%, and 32.9%, respectively (p < .001). Among pN1-2/ENE-positive patients undergoing no adjuvant therapy, adjuvant radiotherapy alone, and adjuvant chemoradiotherapy, 5-year OS was 24.1%, 30.7%, and 36.7%, respectively (p < .001). After adjusting for patient demographics, clinicopathologic features, and adjuvant therapy, ENE-positivity was associated with worse OS than ENE-negativity (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.53–2.02, p < .001). pN1/ENE-positivity (aHR 1.82, 95% CI 1.31–2.54) and pN2/ENE-positivity (aHR 1.89, 95% CI 1.49–2.40) were associated with worse OS than pN1/ENE-negativity (p < .001). Microscopic (aHR 1.83, 95% CI 1.54–2.18) and macroscopic ENE-positivity (aHR 1.75, 95% 1.35–2.26) were associated with worse OS than ENE-negativity (p < .001).

Conclusion

ENE-positivity has prognostic significance in LSCC and is associated with worse OS than ENE-negativity. pN classification did not have prognostic significance independent of ENE. ENE should be carefully considered when determining the prognosis of LSCC and selecting adjuvant therapy.

Level of Evidence

4.

目的尽管大型回顾性数据库研究发现，结节外扩展（ENE）与多种头颈部癌症的生存率降低有关，但ENE在喉鳞状细胞癌（LSCC）中的预后意义仍不明确。我们的研究探讨了ENE和LSCC的总生存率（OS）。方法查询了 2006-2017 年全国癌症数据库中接受手术切除和颈部清扫术的 LSCC 患者，无论是否接受辅助治疗。采用 Kaplan-Meier 和多变量 Cox 回归生存分析来确定病理结节（pN）分类和 ENE 对 OS 的独立影响。结果在符合纳入标准的4208例患者中，2343例（55.7%）为pN0/ENE阴性，1059例（25.2%）为pN1-2/ENE阴性，806例（19.2%）为pN1-2/ENE阳性。pN0/ENE阴性、pN1-2/ENE阴性和pN1-2/ENE阳性患者的5年OS分别为62.8%、56.7%和32.9%（p <.001）。在未接受辅助治疗、仅接受辅助放疗和辅助化放疗的pN1-2/ENE阳性患者中，5年生存率分别为24.1%、30.7%和36.7%（p <.001）。在对患者人口统计学、临床病理特征和辅助治疗进行调整后，ENE阳性比ENE阴性与更差的OS相关（调整后危险比[aHR] 1.76，95% 置信区间[CI] 1.pN1/ENE阳性（aHR 1.82，95% CI 1.31-2.54）和pN2/ENE阳性（aHR 1.89，95% CI 1.49-2.40）比pN1/ENE阴性与更差的OS相关（p <.001）。与ENE阴性相比，微观ENE阳性（aHR 1.83，95% CI 1.54-2.18）和宏观ENE阳性（aHR 1.75，95% 1.35-2.26）与较差的OS相关（p <.001）。在确定 LSCC 的预后和选择辅助治疗时，应仔细考虑 ENE。证据级别4。

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引用次数: 0

Characterization of cerebral radiation necrosis following the treatment of sinonasal malignancies 鼻窦鼻腔恶性肿瘤治疗后脑辐射坏死的特征描述

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1200

Eric L. Wu MD, Atur Patel MD, Mary C. McGunigal MD, Stephanie Y. Johng MD, Armin Mortazavi MD, Ann K. Jay MD, Peter H. Ahn MD, Amjad N. Anaizi MD, Timothy R. DeKlotz MD

Objectives

Our study aims to determine the incidence and potential risk factors for cerebral radiation necrosis (CRN) following treatment of sinonasal malignancies.

Methods

One hundred thirty-two patients diagnosed with sinonasal malignancies over an 18-year period were identified at two institutions. Forty-six patients meeting inclusion criteria and treated with radiation therapy were included for analysis. Demographic and clinical-pathologic characteristics were collected and reviewed. Post-treatment magnetic resonance imaging (MRI) at least 1 year following treatment was reviewed to determine presence or absence of CRN.

Results

CRN was identified on MRI in 8 of 46 patients (17.4%) following radiation treatment. Patients with a history of reirradiation were more likely to develop CRN (50% vs. 10.5%, p < .05). The BEDs of radiation were also higher in CRN patients compared to non-CRN patients, but this difference was not significant (p > .05). CRN patients had a higher proportion of tumors with skull base involvement than non-CRN patients (100% vs. 57.9%, p = .037). Demographics, comorbidities, pathology, primary tumor subsite, chemotherapy use, and stage of disease demonstrated no significant increase in risk of CRN.

Conclusions

Reirradiation and tumor skull base involvement were significant risk factors associated with CRN. Higher average total prescribed and BEDs of radiation were seen in the CRN groups, but these differences were not statistically significant. Gender, comorbidities, tumor subsite, tumor location, and treatment type were not significantly different between groups.

Level of evidence

Level 3.

目的我们的研究旨在确定鼻窦恶性肿瘤治疗后脑辐射坏死（CRN）的发生率和潜在风险因素。方法在两家医疗机构确定了 132 名在 18 年间被诊断为鼻窦恶性肿瘤的患者。符合纳入标准并接受放射治疗的 46 例患者被纳入分析。研究人员收集并审查了人口统计学和临床病理学特征。对治疗后至少 1 年的磁共振成像（MRI）进行复查，以确定是否存在 CRN。结果 46 例患者中有 8 例（17.4%）在放疗后的磁共振成像中发现了 CRN。有再次放射史的患者更容易出现 CRN（50% vs. 10.5%，p < .05）。与非 CRN 患者相比，CRN 患者的放疗 BED 也更高，但这一差异并不显著（p > .05）。与非 CRN 患者相比，CRN 患者的肿瘤累及颅底的比例更高（100% vs. 57.9%，p = .037）。人口统计学、合并症、病理学、原发肿瘤亚部位、化疗使用和疾病分期均未显示出 CRN 风险的显著增加。结论再次放疗和肿瘤累及颅底是与 CRN 相关的重要风险因素。CRN组的平均总放射剂量和放射床面积较高，但这些差异没有统计学意义。各组间的性别、合并症、肿瘤亚部位、肿瘤位置和治疗类型无明显差异。证据级别 3 级。

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引用次数: 0

Efficient management of benign laryngeal symptoms in an endoscopy outpatient clinic 内窥镜门诊中喉咙良性症状的高效管理

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1223

Pia Järvenpää MD, PhD, Teemu Kinnari MD, PhD, Petra Pietarinen MD, PhD, Taru Ilmarinen MD, PhD

Objectives

A globus and thick mucus in the throat are common reasons for referral to an ear, nose, and throat (ENT) specialist. ENT outpatient appointments focus on nasolaryngoscopy examinations, patient education, and reassurance. An endoscopic outpatient clinic (EOC) was established to efficiently manage patients with benign laryngeal symptoms.

Methods

Patients referred between February 2022 and June 2023 due to a globus and/or thick mucus in the throat were immediately contacted via post. The contact letter included patient education about the potential underlying reasons for their symptoms and self-care instructions. A 15-min outpatient visit was scheduled for an ENT examination and nasolaryngoscopy. Patients completed a questionnaire about their current symptoms and whether they had followed the self-care instructions just before visiting the EOC and 1-month following their appointment.

Results

In total, 203 patients examined in the EOC were included in the study. Before the EOC visit, most patients (89.2%) considered the information letter useful, it relieved concerns in 44.2% of patients, and 73.2% patients had already followed the self-care instructions. After the 1-month follow-up period, symptoms diminished significantly (p < .001).

Conclusions

Instructions for self-care and encouragement relieved concerns among patients with benign laryngeal symptoms. Moreover, symptoms improved significantly after a 1-month follow-up period.

Level of evidence

4.

目标喉咙发炎和有浓稠粘液是转诊至耳鼻喉科（ENT）专科医生的常见原因。耳鼻喉科门诊主要进行鼻咽镜检查、患者教育和安抚。为了有效管理良性喉部症状患者，我们开设了内窥镜门诊（EOC）。方法在2022年2月至2023年6月期间，我们会立即通过邮寄方式与因喉咙出现球状物和/或浓粘液而转诊的患者取得联系。联系信的内容包括对患者进行教育，使其了解症状的潜在原因，并提供自我护理指导。患者将在 15 分钟的门诊时间内接受耳鼻喉科检查和鼻咽镜检查。患者在就诊前和就诊后 1 个月内填写了一份调查问卷，内容包括目前的症状以及是否遵循了自我护理指导。结果共有203名在平机会接受检查的患者参与了研究。在前往平机会就诊前，大多数患者（89.2%）认为资料信很有用，44.2%的患者的担忧得到了缓解，73.2%的患者已经遵照自我护理指导进行了自我护理。随访 1 个月后，症状明显减轻（p < .001）。结论自我护理指导和鼓励缓解了良性喉部症状患者的担忧。此外，随访 1 个月后症状明显改善。证据等级 4。

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引用次数: 0

Prognostic factors of palatal adenoid cystic carcinoma: A single-center analysis of 85 cases 腭腺样囊性癌的预后因素：对 85 个病例的单中心分析

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1236

Baoxin Gu DDS, Yanting Chi MDS, Wenjie Wu DDS, Yiwei Zhong DDS, Jianyun Zhang DDS, Jie Zhang DDS, MD

Objective

The purpose of this retrospective study was to describe the clinicopathological characteristics of primary adenoid cystic carcinoma (ACC) of the palate and to identify the factors affecting prognosis.

Methods

The medical records of 85 patients with primary ACC of the palate treated with surgery, with or without adjuvant radiotherapy/chemotherapy, from 2009 to 2019 were reviewed. The relationship of different clinical parameters with locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) were analyzed.

Results

Median follow-up time was 44.6 months. LR and DM rates were 24.7% and 25.9%, respectively, and the 5-year OS and disease-free survival (DFS) rates were 85.9% and 55.1%, respectively. Multivariate analysis showed that positive margins were independently associated with the risk of LR (p < .001). Positive margins (p = .001) and high histological grade (p = .031) were significantly associated with shorter OS.

Conclusion

Positive surgical margins are a strong adverse prognostic factor affecting LR and OS in patients with ACC; apart from that, high histopathological grade is an independent predictor of poor OS.

Level of Evidence

Level 3 (Prognosis – Cohort study).

目的本回顾性研究旨在描述腭部原发性腺样囊性癌（ACC）的临床病理特征，并确定影响预后的因素。方法回顾性分析2009年至2019年期间85例接受手术治疗的腭部原发性腺样囊性癌患者的病历，无论患者是否接受辅助放疗/化疗。分析了不同临床参数与局部复发（LR）、远处转移（DM）和总生存期（OS）的关系。结果中位随访时间为44.6个月。LR和DM率分别为24.7%和25.9%，5年OS和无病生存（DFS）率分别为85.9%和55.1%。多变量分析显示，边缘阳性与 LR 风险独立相关（p <.001）。阳性边缘（p = .001）和高组织学分级（p = .031）与较短的OS显著相关。结论手术切缘阳性是影响ACC患者LR和OS的一个强有力的不良预后因素；除此之外，组织病理学分级高也是不良OS的一个独立预测因素。证据等级3（预后-队列研究）。

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引用次数: 0

Pain control is comparable between opioid versus non-opioid management after otolaryngology procedures 耳鼻喉科手术后阿片类药物与非阿片类药物治疗的疼痛控制效果相当

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1229

Ashwini Sarathy BS, Clemens An BS, Ty Bever BS, Peter Callas PhD, Mayo H. Fujii MD, Mirabelle Sajisevi MD

Objective

The current study aims to measure patient-reported satisfaction with pain control using opioid and non-opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy.

Materials and Methods

A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient-reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non-opioid users.

Results

Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being “very satisfied” or “satisfied” with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were “very satisfied” or “satisfied” with pain control. In the non-opioid usage group, all patients (n = 7/7, 100%) reported they were “satisfied” with pain control. There was no statistically significant difference in patient-reported satisfaction with pain control between opioid and non-opioid users for any of the procedures listed.

Conclusion

The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures.

Level of Evidence

IV.

目的本研究旨在衡量患者对接受以下耳鼻喉科手术后使用阿片类和非阿片类药物控制疼痛的满意度：甲状旁腺切除术、甲状腺叶切除术、甲状腺全切除术和双侧扁桃体切除术。材料与方法一家学术医疗中心开展了一项前瞻性队列研究，包括电话问卷调查和病历审查。研究记录了阿片类药物的处方、使用情况和患者报告的疼痛结果。使用双变量分析比较阿片类药物使用者和非阿片类药物使用者。结果在接受耳鼻喉科手术的 107 名患者中，49 人（45.8%）术后使用阿片类药物止痛，58 人（54.2%）未使用。在 81 名接受内分泌手术（甲状旁腺切除术、甲状腺全切除术/甲状腺叶切除术）的患者中，无论是否使用阿片类药物（n = 27/30，90%），大多数患者都表示对疼痛控制 "非常满意 "或 "满意"（n = 50/51，98%）。在接受双侧扁桃体切除术的 26 名患者中，19 人（73%）获得了阿片类药物处方，其中大多数人（n = 17/19，89%）表示对疼痛控制 "非常满意 "或 "满意"。在未使用阿片类药物组中，所有患者（n = 7/7，100%）均表示对疼痛控制 "满意"。使用阿片类药物和不使用阿片类药物的患者对疼痛控制的满意度在统计学上没有明显差异。结论我们的研究结果表明，与甲状腺、甲状旁腺和扁桃体切除术后使用阿片类药物的患者相比，未使用阿片类药物的患者对疼痛控制的满意度相似。考虑到阿片类药物危机的严重性，医疗机构应重新评估某些耳鼻喉科手术后是否需要开具阿片类药物处方。证据等级 IV。

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引用次数: 0

Hypoxia-inducible factor-1α contributes to the proliferation of cholesteatoma keratinocytes through regulating endothelin converting enzyme 1 expression 缺氧诱导因子-1α通过调节内皮素转换酶 1 的表达促进胆脂瘤角质形成细胞的增殖

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1233

Nie Chen MM, Lei Xu MM, Zhi Bi MM, Jian Wu MM

Objective

Cholesteatoma is a hyperproliferative, pseudoneoplastic lesion of the middle ear characterized by aggressive growth and bone destruction. Hypoxia-inducible factor-1α (HIF-1α, also known as HIF1A) is a key transcription factor that enters the nucleus and upregulates many genes involved in cancer progression in the oxygen-free environment. This study is designed to explore the role and mechanism of HIF1A in the progression of cholesteatoma.

Methods

HIF1A and endothelin converting enzyme 1 (ECE1) levels were determined using real-time quantitative polymerase chain reaction. The protein levels of HIF1A, Cyclin D1, proliferating cell nuclear antigen, and ECE1 were measured using western blot. Cell viability, proliferation, and cell cycle progression were analyzed using cell counting kit-8, Colony formation, 5-ethynyl-2′-deoxyuridine, and flow cytometry assays. Binding between HIF-1α and ECE1 promoter was predicted by Jaspar and verified using Chromatin immunoprecipitation and dual-luciferase reporter assays.

Results

HIF1A and ECE1 were highly expressed in cholesteatoma patients and keratinocytes. Moreover, HIF1A knockdown might suppress the cell viability, proliferation, and cycle progression of cholesteatoma keratinocytes. Furthermore, HIF1A upregulated the transcription of ECE1 through binding to its promoter region.

Conclusion

HIF1A might expedite cholesteatoma keratinocyte proliferation partly by increasing ECE1 expression, providing a possible therapeutic target for the cholesteatoma treatment.

目的胆脂瘤是中耳的一种过度增生性假肿瘤病变，其特点是侵袭性生长和骨质破坏。缺氧诱导因子-1α（HIF-1α，又称 HIF1A）是一种关键的转录因子，它能进入细胞核，在无氧环境中上调许多参与癌症进展的基因。本研究旨在探讨 HIF1A 在胆脂瘤进展过程中的作用和机制。方法采用实时定量聚合酶链反应测定 HIF1A 和内皮素转换酶 1（ECE1）的水平。用 Western 印迹法测定 HIF1A、细胞周期蛋白 D1、增殖细胞核抗原和 ECE1 的蛋白水平。使用细胞计数试剂盒-8、菌落形成、5-乙炔基-2′-脱氧尿苷和流式细胞仪分析细胞活力、增殖和细胞周期进展。Jaspar 预测了 HIF-1α 和 ECE1 启动子之间的结合，并使用染色质免疫共沉淀和双荧光素酶报告实验进行了验证。结果 HIF1A 和 ECE1 在胆脂瘤患者和角质形成细胞中高表达。此外，敲除 HIF1A 可抑制胆脂瘤角朊细胞的活力、增殖和周期进展。此外，HIF1A 通过与 ECE1 启动子区域结合，上调了 ECE1 的转录。结论 HIF1A 可通过增加 ECE1 的表达来加速胆脂瘤角质形成细胞的增殖，为胆脂瘤的治疗提供了一个可能的靶点。

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引用次数: 0

Acute myeloid leukemia: An unusual manifestation of the trachea 急性髓性白血病气管的不寻常表现

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1231

Joseph Celidonio BS, Rohini Bahethi MD, Raj Malhotra BA, Kenneth Yan MD, PhD

Objective(s)

Hematologic malignancy involving the trachea is rare. It is even less common for tracheal involvement to be the initial manifestation of this disease. We present a case report highlighting an unusual diagnosis of acute myeloid leukemia (AML) that first presented with prominent tracheal manifestations. There have been only three other published case reports of extramedullary AML with involvement of the trachea.

Methods

We discuss direct laryngoscopy and bronchoscopy findings, including pinkish-white irregular lesions, which were similar to findings described in the available literature for tracheal AML.

Results

Laboratory findings from our case are reported, including peripheral smear demonstrating 57% blasts and bone marrow biopsy confirming the diagnosis of AML, and the relevance of these findings is discussed.

Conclusion

In patients with unusual airway lesions, laboratory testing and a comprehensive airway evaluation including biopsy are necessary to narrow the differential diagnosis.

Level of Evidence

5.

目的涉及气管的血液恶性肿瘤非常罕见。以气管受累为首发表现的情况更是少见。我们提交的病例报告强调了急性髓性白血病（AML）的不寻常诊断，该病最初表现为突出的气管症状。目前已发表的髓外急性髓细胞白血病累及气管的病例报告仅有三例。方法我们讨论了直接喉镜和支气管镜检查结果，包括粉白色不规则病变，这些病变与现有文献中描述的气管急性髓细胞白血病病变结果相似。结果报告了我们病例的实验室检查结果，包括显示 57% 血细胞的外周血涂片和确诊为急性髓细胞白血病的骨髓活检，并讨论了这些结果的相关性。结论对于气道异常病变的患者，有必要进行实验室检测和包括活检在内的全面气道评估，以缩小鉴别诊断的范围。证据等级 5。

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引用次数: 0

The cavernous sinus: An anatomic study with clinical implication 海绵窦：具有临床意义的解剖学研究

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1226

Myles L. Pensak MD

Objective

The management of lesions involving the cavernous sinus remains a formidable challenge. To optimize care for patients with tumors extending into this skull base region a detailed understanding of the surrounding osteology as well as neural and vascular relationships is requisite. This thesis examines the gross anatomy of the region and highlights important surgical implications drawn from these as well as previously published studies.

Methods

A review of the historical scientific, anatomic, clinical, and surgical literature extending to the present (1992) relating to the cavernous sinus has been performed and discussed. Additionally, the author has performed and described cadaveric dissections revealing novel details about the macroscopic (dural and neurovascular anatomic relationships) and microscopic structure of the cavernous sinus. A series of cases of cavernous sinus pathologies that were addressed in an interdisciplinary surgical approach at the author's institution is also reported.

Results

Included in this report is a comprehensive review of the embryology of the cavernous sinus and its associated neurovascular structures. Cadaveric dissections have also revealed novel details about dural/meningeal compartments of the cavernous sinus as well as well as associated arterial, venous, and neural relationships. Microscopic observations also reveal novel fundamental insights into the components and structure of the cavernous sinus. Clinical examples from 20 patients illustrate the critical importance for clinical application of cavernous sinus anatomic knowledge to the surgical treatment of pathologies in this region.

Conclusion

The cavernous sinus is a tripartite venous osteomeningeal compartment intimately neighboring vital structures including the optic tracts, pituitary gland, cranial nerves III, IV, V, V, VI, and the internal carotid artery. Surgical management of cavernous sinus lesions has and continues to evolve with increasing anatomic and clinical study as well as advancements in diagnostic and surgical methodologies.

Level of Evidence

NA.

目的涉及海绵窦病变的治疗仍然是一项艰巨的挑战。为了优化对颅底区域肿瘤患者的治疗，必须详细了解周围的骨学以及神经和血管关系。本论文研究了该区域的大体解剖结构，并强调了从这些研究和以前发表的研究中得出的重要手术意义。方法回顾了与海绵窦有关的历史科学、解剖学、临床和外科文献，并对其进行了讨论。此外，作者还对尸体进行了解剖和描述，揭示了海绵窦宏观（硬膜和神经血管解剖关系）和微观结构的新细节。此外，还报告了作者所在机构采用跨学科手术方法治疗的一系列海绵窦病理病例。结果本报告全面回顾了海绵窦的胚胎学及其相关的神经血管结构。尸体解剖也揭示了海绵窦硬膜/脑膜区的新细节，以及相关的动脉、静脉和神经关系。显微镜观察也揭示了海绵窦组成和结构的新的基本观点。来自 20 名患者的临床实例说明了海绵窦解剖学知识在该区域病理手术治疗中的临床应用的重要性。结论海绵窦是一个三方静脉骨膜区，与视束、垂体、颅神经 III、IV、V、V、VI 和颈内动脉等重要结构紧密相邻。随着解剖学和临床研究的不断深入以及诊断和手术方法的进步，海绵窦病变的手术治疗也在不断发展。证据级别 NA。

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引用次数: 0

A 22-year single institution review of 119 cases of salivary duct carcinoma 22 年来对 119 例唾液腺导管癌的单一机构审查

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1234

Ethan J. Han BS, Laith A. Mukdad MD, Yazeed Alhiyari PhD, Morcos N. Nakhla BS, Dipti P. Sajed MD, Maie A. St. John MD, PhD

Objective

Salivary duct carcinoma (SDC) is a rare and aggressive salivary gland malignancy. Herein, we present the largest single-institution review of SDC to date.

Methods

This is a retrospective cohort study of all histologically confirmed cases of SDC seen at our institution from January 1, 2002, to August 1, 2022. Patient demographics, treatment, histological characteristics, tumor staging, and outcomes were extracted from the electronic medical record. Kaplan-Meier and Cox regression survival analyses were performed.

Results

This study included 119 patients with a mean age of 66.2 years. Most primary tumors arose from the parotid gland (72.3%), and 23.5% were noted to be carcinoma ex-pleomorphic adenoma. 57.1% of patients presented with regional lymph node metastasis, whereas 23.5% presented with distant disease. Kaplan–Meier analysis demonstrated a 62.4% 5-year overall survival (OS) and a 69.0% 5-year disease-specific survival (DSS). Univariate analyses indicated that presence of regional lymph node disease (p<.001), distant metastasis (p<.001), perineural invasion (p = .027), and lymphovascular invasion (p = .018) were predictive of decreased OS and DSS. Trastuzumab administration was not associated with survival in HER-2-positive patients receiving chemotherapy. Multivariate analyses demonstrated that presence of nodal disease (HR 30.337, 95% CI 2.782–330.851, p = .005) and carcinoma ex pleomorphic adenoma (HR 5.54, 95% CI 1.024–29.933, p = .047) were associated with decreased OS.

Conclusion

Our patients had more favorable survival rates compared to prior studies, which may be due to lower incidence of nodal disease. Factors associated with worse survival included nodal and distant metastases, perineural invasion, lymphovascular invasion, and tumor size.

Level of Evidence

Level 3.

目的唾液腺导管癌（SDC）是一种罕见的侵袭性唾液腺恶性肿瘤。在此，我们对迄今为止最大的单个机构 SDC 病例进行了回顾性研究。方法这是一项回顾性队列研究，研究对象为 2002 年 1 月 1 日至 2022 年 8 月 1 日在我院就诊的所有经组织学确诊的 SDC 病例。研究人员从电子病历中提取了患者的人口统计学特征、治疗方法、组织学特征、肿瘤分期和预后。进行了卡普兰-梅耶（Kaplan-Meier）和考克斯回归生存分析。结果本研究共纳入 119 名患者，平均年龄为 66.2 岁。大多数原发性肿瘤来自腮腺（72.3%），23.5%为腮腺腺瘤癌。57.1%的患者出现区域淋巴结转移，23.5%的患者出现远处转移。卡普兰-梅耶尔分析显示，5年总生存率（OS）为62.4%，5年疾病特异性生存率（DSS）为69.0%。单变量分析表明，存在区域淋巴结疾病（p< .001）、远处转移（p< .001）、神经周围侵犯（p = .027）和淋巴管侵犯（p = .018）可预测OS和DSS的下降。在接受化疗的HER-2阳性患者中，曲妥珠单抗的应用与生存率无关。多变量分析显示，结节性疾病（HR 30.337，95% CI 2.782-330.851，p = .005）和多形性腺瘤外癌（HR 5.54，95% CI 1.024-29.933，p = .047）与OS下降有关。结论与之前的研究相比，我们的患者生存率更高，这可能是由于结节病的发生率较低。与生存率降低相关的因素包括结节和远处转移、神经周围侵犯、淋巴管侵犯和肿瘤大小。证据级别 3 级。

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引用次数: 0

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study 腭裂修复技术与听力结果之间的关系：回顾性队列研究

IF 1.9 4区医学

Laryngoscope Investigative Otolaryngology

Pub Date : 2024-03-23 DOI: 10.1002/lio2.1237

Tayebeh Kazemi MD, Sara S. Nabavizadeh MD, MPH, Nasser Nadjmi MD, DDS, Alireza Ahmadkhani MD, Parvin Ghaemmaghami PHD, Ardavan Kafaei MD, Ali Faramarzi MD

Objective

Otitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes.

Methods

In this retrospective-prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration.

Results

The mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90–1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20–16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: −6.58 [95% CI: −10.43 to −2.73], p-value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: −1.10; 95% CI: −1.85 to −0.36, p-value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings.

Conclusions

Although the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes.

Level of Evidence

3b.

目的中耳炎伴流脓是腭裂患儿的常见病。本研究旨在探讨腭部闭合技术与听力结果之间的关系。方法在这项回顾性-前瞻性队列研究中，我们考察了腭裂儿童腭裂修复技术与听力结果之间的关系。从 2017 年到 2022 年，设拉子医科大学唇腭裂科对 95 名唇腭裂患者的 190 只耳朵进行了研究。评估的变量包括手术技术、唇裂严重程度、听性脑干反应（ABR）阈值和鼓室构造。结果平均 ABR 从腭裂术前的 39.51(11.62) 分贝 (dB) 提高到腭裂术后的 26.61(11.60) dB（Cohen's d：1.12 [95% CI；0.90-1.34]）。最初，87.9% 的研究耳出现鼓室测量异常，但手术后这一比例显著下降至 47%（风险比：4.43 [95% CI；1.20-16.43]）。与 Sommerlad 镫骨内显露成形术相比，Nadjmi 改良 Furlow 腭成形术的平均 ABR 明显更低（β：-6.58 [95% CI：-10.43 至 -2.73]，p 值 = .001），鼓室测量异常的频率也更低（几率比 [OR]：-1.10；95% CI：-1.85 至 -0.36，p 值 = .004）。腭裂成形术前 ABR、腭裂严重程度、性别和综合征等因素并不影响这些结果。结论虽然 Nadjmi 改良 Furlow 腭成形术的效果更好，但我们的研究结果表明，两种技术的 ABR 和鼓室测量结果都有显著改善。建议今后开展随机对照试验，以证实腭部闭合技术对听力结果的影响。证据等级 3b。

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引用次数: 0