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Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature 放射性骨坏死消融手术后前颅底重建:病例报告及文献复习
Pub Date : 2019-07-27 DOI: 10.1177/0003489419865558
Katya Chapchay, J. Weinberger, R. Eliashar, N. Adler
Introduction: Osteoradionecrosis is one of many potentially severe complications of radiotherapy for nasopharyngeal carcinoma. Osteoradionecrosis of the skull base is life-threatening due to the critical proximity of the pathological process to vital structures, for example, the intracranial cavity, the upper spine, and major blood vessels. Reconstructive options following surgical debridement of the anterior skull base and upper spine osteonecrosis have been scarcely described in the literature. Case presentation and management: We present a rare case of osteoradionecrosis of the clivus and cervical vertebrae C1-C2 in a patient previously treated with chemoradiotherapy for nasopharyngeal carcinoma, presenting as severe soft tissue infection of the neck. Aggressive surgical debridement and reconstruction with a two-paddle free anterolateral thigh flap was performed using a combination of transcervical and transnasal endoscopic approaches. A novel endoscopic procedure in the sphenoid sinus enabled flap anchoring in this complex area. Discussion: Surgical modalities for osteoradionecrosis of the skull base and upper spine are discussed and review of the literature is presented. Conclusion: Reconstruction of the anterior skull base with a well-vascularized free flap following ablative surgery should be considered in management of life-threatening osteoradionecrosis of the area. Endoscopic opening of the sphenoid sinus and creating a funnel-shaped stem is a newly described technique that guarantees precise placement of the flap and is a valuable adjunct to the reconstructive armamentarium.
导言:放射性骨坏死是鼻咽癌放射治疗的许多潜在严重并发症之一。颅底骨放射性坏死是危及生命的,因为病理过程非常接近重要结构,例如颅内腔、脊柱上部和主要血管。前颅底和脊柱上部骨坏死手术清创后的重建选择在文献中几乎没有描述。病例介绍和处理:我们报告一例罕见的斜坡和颈椎C1-C2骨放射性坏死病例,患者先前接受过鼻咽癌放化疗,表现为颈部严重的软组织感染。采用经颈和经鼻内镜联合入路,采用双桨游离股前外侧皮瓣进行积极的手术清创和重建。在蝶窦的一个新的内窥镜程序使皮瓣锚定在这个复杂的区域。讨论:讨论了颅底和脊柱上部骨放射性坏死的手术方式,并对文献进行了回顾。结论:前颅底消融术后血管充足的游离皮瓣重建是治疗危及生命的放射性骨坏死的有效方法。内窥镜打开蝶窦并形成漏斗状茎是一种新描述的技术,可以保证皮瓣的精确放置,是重建设备的宝贵辅助设备。
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引用次数: 15
Unsupervised Learning Techniques for the Investigation of Chronic Rhinosinusitis 研究慢性鼻窦炎的无监督学习技术
Pub Date : 2019-07-18 DOI: 10.1177/0003489419863822
A. Walker, P. Surda
Objectives: This article reviews the principles of unsupervised learning, a novel technique which has increasingly been reported as a tool for the investigation of chronic rhinosinusitis (CRS). It represents a paradigm shift from the traditional approach to investigating CRS based upon the clinically recognized phenotypes of “with polyps” and “without polyps” and instead relies upon the application of complex mathematical models to derive subgroups which can then be further examined. This review article reports on the principles which underlie this investigative technique and some of the published examples in CRS. Methods: This review summarizes the different types of unsupervised learning techniques which have been described and briefly expounds upon their useful applications. A literature review of studies which have unsupervised learning is then presented to provide a practical guide to its uses and some of the new directions of investigations suggested by their findings. Results: The commonest unsupervised learning technique applied to rhinology research is cluster analysis, which can be further subdivided into hierarchical and non-hierarchical approaches. The mathematical principles which underpin these approaches are explained within this article. Studies which have used these techniques can be broadly divided into those which have used clinical data only and that which includes biomarkers. Studies which include biomarkers adhere closely to the established canon of CRS disease phenotypes, while those that use clinical data may diverge from the typical “polyp versus non-polyp” phenotypes and reflect subgroups of patients who share common symptom modifiers. Summary: Artificial intelligence is increasingly influential in health care research and machine learning techniques have been reported in the investigation of CRS, promising several interesting new avenues for research. However, when critically appraising studies which use this technique, the reader needs to be au fait with the limitations and appropriate uses of its application.
目的:本文综述了无监督学习的原理,无监督学习是一种新技术,越来越多地被报道为慢性鼻窦炎(CRS)研究的工具。它代表了一种范式转变,从传统的研究CRS的方法转变为基于临床公认的“有息肉”和“没有息肉”的表型,而是依赖于复杂数学模型的应用来推导亚组,然后可以进一步检查。这篇综述文章报告了这种调查技术的基本原理和一些在CRS中发表的例子。方法:本文综述了不同类型的无监督学习技术,并简要阐述了它们的应用。然后,对无监督学习的研究进行了文献综述,为其使用提供了实用指南,并提出了一些由他们的发现提出的新的研究方向。结果:鼻科学研究中最常用的无监督学习技术是聚类分析,聚类分析可进一步分为分层和非分层方法。本文将解释支撑这些方法的数学原理。使用这些技术的研究大致可分为仅使用临床数据的研究和包括生物标志物的研究。包括生物标志物的研究密切遵循CRS疾病表型的既定标准,而使用临床数据的研究可能偏离典型的“息肉与非息肉”表型,并反映具有共同症状调节剂的患者亚组。摘要:人工智能在医疗保健研究中的影响力越来越大,机器学习技术在CRS的研究中得到了报道,为研究提供了一些有趣的新途径。然而,当批判性地评价使用这种技术的研究时,读者需要了解其应用的局限性和适当的用途。
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引用次数: 8
Ectopic Thymus: An Unusual Case of Subglottic Mass 异位胸腺:声门下肿块一例
Pub Date : 2019-07-18 DOI: 10.1177/0003489419863828
Irene Paraboschi, F. Fati, F. Rizzo, O. Sacco, N. Stagnaro, G. Mattioli, A. Simonini, Oscar Mazzei, M. Torre
Objectives: The aim of our study is to report a case of a child with subglottic thymus that was suspected during diagnostic work-up for severe airway obstruction, excised surgically and confirmed with final histopathological examination. Moreover, we performed a narrative literature review to outline clinical and diagnostic features of this rare condition and to report suggestions for the management of subglottic masses. Methods: We report the case of a 7-month-old boy who was admitted to our Pediatric Airway Team Unit due to a history of worsening biphasic stridor and recurrent episodes of upper airway obstruction. The successful diagnostic work-up and a narrative literature of analogous cases of subglottic thymus were reported. Results: Ectopic thymus is a very rare condition in which thymic tissue is found outside the normal pathway of its embryonic migration. It usually presents as a cystic or, more rarely, solid mass, showing an indolent course toward spontaneous involution. In some cases, however, it becomes symptomatic exerting compression on surrounding vital structures. Due to its rarity, the initial diagnosis is normally mistaken with inflammatory diseases or malignancies and the definitive diagnosis is only achieved after histological examination of the excised specimen. To our knowledge, only four other cases of subglottic ectopic thymic tissue have been reported in the English literature so far and the diagnosis has never been suspected preoperatively. Conclusion: It is mandatory to consider ectopic thymic tissue in the differential diagnosis in children presenting with airways obstruction in order to prevent unnecessary, extensive, and exploratory surgery.
目的:我们研究的目的是报告一个患有声门下胸腺的儿童,在诊断过程中被怀疑为严重的气道阻塞,手术切除并通过最终的组织病理学检查证实。此外,我们进行了叙述性文献综述,概述了这种罕见疾病的临床和诊断特征,并报告了处理声门下肿块的建议。方法:我们报告了一个7个月大的男孩,他因两相性喘鸣加重和反复发作的上气道阻塞而被送入我们的儿科气道小组。本文报道了声门下胸腺的成功诊断和类似病例的叙述文献。结果:异位胸腺是一种非常罕见的胸腺组织在其胚胎迁移的正常途径之外被发现的情况。它通常表现为囊性或更罕见的实性肿块,表现为自发性复发的惰性过程。然而,在某些情况下,它会对周围的重要结构施加压力。由于其罕见,最初的诊断通常被误认为是炎症性疾病或恶性肿瘤,只有在切除标本的组织学检查后才能得到明确的诊断。据我们所知,迄今为止在英文文献中仅报道了4例声门下异位胸腺组织,并且从未在术前怀疑其诊断。结论:小儿气道梗阻的鉴别诊断必须考虑胸腺组织异位,以避免不必要的、广泛的、探索性的手术。
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引用次数: 4
The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients 内窥镜鼻窦手术对慢性鼻窦炎患者声音特征的影响
Pub Date : 2019-07-17 DOI: 10.1177/0003489419861124
Danny B. Jandali, Ashwin Ganti, I. Husain, P. Batra, B. Tajudeen
Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.
目的:功能性内窥镜鼻窦手术(FESS)是慢性鼻窦炎(CRS)患者治疗失败的标准治疗方式。然而,FESS需要修改上呼吸道,这可能改变发音共振并产生声音变化。FESS对CRS患者术后语音特征的影响尚未定量评估。方法:前瞻性纳入2017年5月至10月在三级保健转诊中心接受FESS治疗的严重CRS患者。使用共识听觉感知评价(CAPE-V)和语音障碍指数(VHI)分别定量评价语音特征和生活质量。比较每位患者术前和术后CAPE-V和VHI评分。还获得了鼻结果测试(SNOT-22)评分,以评估患者症状的变化。结果:18例CRS患者接受FESS治疗。术前Lund-Mackay平均评分为14分,表明基线严重CRS。术后评估显示CAPE-V评分(45-27,p = 0.005)和VHI评分(10-4.7,p < 0.001)降低具有统计学意义。这些与SNOT-22评分有统计学意义的降低相关(42-13,p < 0.001)。结论:经FESS治疗后,CRS患者的声音特征和生活质量均有显著改善。此外,这似乎与自我报告的疾病严重程度的显著降低有关。这些发现可能会将FESS的潜在好处的讨论扩展到语音质量的一个新的潜在领域。
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引用次数: 3
Transoral Tubed Supraglottoplasty: A New Minimally Invasive Procedure for Aspiration 经口喉上管成形术:一种新的微创误吸方法
Pub Date : 2019-07-17 DOI: 10.1177/0003489419862581
Yue-bing Ma, M. Naunheim, Jill K Gregory, P. Woo
Objectives: We describe a new procedure for aspiration called tubed supraglottoplasty (TS). TS is a transoral procedure that approximates the aryepiglottic (AE) folds and arytenoids. This narrows the laryngeal inlet. This procedure has been used to improve swallowing and reduce aspiration in patients with vocal fold paralysis. We describe the technical aspects of TS and report on 11 patients. Methods: TS is done by oral intubation followed by suspension laryngoscopy. An incision is made along the AE fold into the posterior commissure and then continued to the opposite AE fold. Dissection within this incision creates two mucosal flaps, one based on the laryngeal surface and the other on the pharyngeal surface. Two 1-cm releasing incisions are made at each end of the AE fold. The laryngeal mucosal flap is approximated using a 3-0 self-locking running suture. The pharyngeal mucosal flap is approximated as a second layer. This double-layered mucosal V-Y advancement flap builds up the posterior laryngeal height. It narrows and “tubes” the supraglottis. Results: All patients tolerated TS without airway complications. Ten of the 11 patients reported improved swallowing function with less aspiration. Six of the 8 patients with prior G-tubes had their gastrostomy tube removed. Postoperative laryngoscopy showed a narrowed “tubed” supraglottis with a higher posterior wall preventing spillover and aspiration. An improved Functional Oral Intake Scale was recorded in ten of eleven patients. Conclusion: TS is a minimally invasive procedure that can improve swallowing and reduce aspiration.
目的:我们描述了一种称为管状声门上成形术(TS)的吸进新方法。TS是一种经口手术,近似于房颤(AE)褶皱和类房颤。这使喉入口变窄。该手术已被用于改善声带麻痹患者的吞咽和减少误吸。我们描述了TS的技术方面,并报告了11例患者。方法:经口插管后行悬吊喉镜检查。沿着AE褶开一个切口进入后连合然后继续到对面AE褶。在这个切口内切开形成两个粘膜瓣,一个基于喉表面,另一个基于咽表面。在AE折叠的两端各做两个1厘米的释放切口。喉粘膜瓣近似使用3-0自锁运行缝线。咽粘膜瓣近似为第二层。这种双层粘膜V-Y推进皮瓣建立喉后高度。它使声门上腔变窄并“管”起来。结果:所有患者均耐受TS,无气道并发症。11例患者中有10例报告吞咽功能改善,误吸减少。8例先前使用g管的患者中有6例切除了胃造口管。术后喉镜检查显示狭窄的“管状”声门上炎,后壁较高,防止外溢和误吸。11例患者中有10例记录了功能性口服摄入量表的改善。结论:TS是一种微创手术,可改善吞咽,减少误吸。
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引用次数: 3
Make-Up Therapy for Patients With Facial Nerve Palsy 面神经麻痹患者的化妆疗法
Pub Date : 2019-07-15 DOI: 10.1177/0003489419841396
Keishi Fujiwara, Y. Furuta, W. Aoki, Y. Nakamaru, S. Morita, Kimiko Hoshino, Atsushi Fukuda, A. Homma
Objectives: To investigate the effectiveness of make-up therapy for patients with facial nerve palsy. Methods: Seven female patients with facial nerve palsy who received specialist make-up therapy were enrolled. The objective of the make-up therapy was to obtain a symmetrical facial appearance. Results: Overall score for the Facial Clinimetric Evaluation (FaCE) scale was significantly improved after make-up therapy. There was a tendency for symptoms of depression to be improved among patients after make-up therapy. Conclusion: Make-up therapy to improve the symmetry of facial appearance could afford a noninvasive and low-cost treatment for patients with facial nerve palsy, especially in terms of patient quality of life and psychological condition.
目的:探讨化妆疗法治疗面神经麻痹的疗效。方法:选取7例面神经麻痹女性患者进行专科化妆治疗。化妆疗法的目的是获得对称的面部外观。结果:化妆治疗后面部临床评定量表(FaCE)总分显著提高。患者在接受化妆治疗后,抑郁症状有改善的趋势。结论:通过化妆疗法改善面部对称性是一种无创、低成本的治疗面神经麻痹的方法,尤其在改善患者的生活质量和心理状况方面效果显著。
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引用次数: 55
Book Review: Thieme MedOne Otolaryngology 书评:《耳鼻喉科学》
Pub Date : 2019-05-29 DOI: 10.1177/0003489419851031
Danielle M. Bottalico
This all-inclusive website represents a great resource for otolaryngology residents and practitioners alike. It features easy connectivity via web browsers and even mobile devices via the MedOne app. It provides access to more than 180 e-books, 6 Thieme-published e-journals, several case presentations with associated questions, and numerous procedures with step-by-step instructions. Users may also view and download over 70,000 images, videos, and audio via the media section. The book and e-journal section include educational material and references for every subspeciality of otolaryngology. The latest edition of Handbook of Otolaryngology serves as a quick, concise pocket reference for general otolaryngology. Another great reference is Head and Neck Trauma: An Interdisciplinary Approach, which is helpful for diagnosing and treating common head and neck traumatic injuries. Additionally, there is an excellent radiographic atlas, Imaging for Otolaryngologists, which reviews the imaging modality of choice for various pathologies. The e-journal section is less expansive, but provides access to International Archives of Otolaryngology, Annals of Otology and Neurotology, Journal of Neurological Surgery Part B Skull Base, as well as 3 others. As a junior resident, I found the cases and procedures sections invaluable. Cases are organized into 14 subspecialties. Each subspecialty includes multiple topics with a total of nearly 100 case examples. There is a search bar where you can specify the topic of interest. Each case starts with a presentation and then discusses the differential diagnosis, medical, and surgical management as well as recommendations for follow-up. At the end, questions reinforce learning, and suggested readings further elucidate the topic discussed. Procedures are similarly organized with more than 100 detailed procedures. Each procedure begins by explaining the surgical principle, indications, contraindications, and informed consent before detailing the surgical technique with supporting images. Every procedure concludes with postoperative care. Indications for certain procedures are more detailed than others, but overall the procedure section is very comprehensive. Moreover, MedOne Otolaryngology offers an overwhelming number of resources in one organized, userfriendly platform. Users have the ability to personalize the website by selecting frequently accessed topics as a favorite for quick reference. Additionally, being able to access this platform from a mobile device adds to the convenience of this interface. Regardless of one’s level of training, this website offers educational material for all. 851031 AORXXX10.1177/0003489419851031Annals of Otology, Rhinology & LaryngologyBook Review book-review2019
这个包罗万象的网站为耳鼻喉科居民和从业者提供了一个伟大的资源。它的特点是通过网络浏览器,甚至通过MedOne应用程序的移动设备轻松连接。它提供访问超过180本电子书,6个tim出版的电子期刊,几个案例演示与相关问题,以及许多步骤与一步一步的指导。用户还可以通过媒体部分查看和下载超过70,000张图片、视频和音频。书籍和电子期刊部分包括耳鼻喉科的每个亚专业的教育材料和参考资料。最新版的耳鼻咽喉手册作为一个快速,简洁的口袋参考一般耳鼻咽喉。另一本很好的参考书是《头颈部创伤:跨学科的方法》,它有助于诊断和治疗常见的头颈部创伤性损伤。此外,还有一本优秀的放射学图集,《耳鼻喉科影像学》,回顾了各种病理的影像学选择。电子期刊部分不太广泛,但提供访问国际耳鼻喉科档案,耳鼻科和神经学年鉴,神经外科杂志B部分颅底,以及其他3。作为一名初级住院医师,我发现案例和程序部分非常宝贵。病例分为14个亚专科。每个子专业包括多个主题,总共有近100个案例。有一个搜索栏,您可以在其中指定感兴趣的主题。每个病例都以陈述开始,然后讨论鉴别诊断、医学和外科治疗以及随访建议。最后,问题加强了学习,建议阅读进一步阐明了讨论的主题。程序也同样有100多个详细的程序。每次手术都以解释手术原理、适应症、禁忌症和知情同意开始,然后用辅助图像详细说明手术技术。每个手术都以术后护理结束。某些手术的适应症比其他手术更详细,但总的来说,手术部分非常全面。此外,MedOne耳鼻喉科在一个有组织的、用户友好的平台上提供了大量的资源。用户可以通过选择经常访问的主题来个性化网站,以便快速参考。此外,能够从移动设备访问这个平台增加了这个界面的便利性。无论一个人的培训水平如何,本网站都为所有人提供教育材料。851031 aorxxx10 .1177/0003489419851031耳鼻喉科学年鉴
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引用次数: 0
Book Review: Clinical Esophagology and Transnasal Esophagoscopy 书评:临床食管学和经鼻食管镜检查
Pub Date : 2019-05-16 DOI: 10.1177/0003489419851032
M. Lerner
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引用次数: 0
Book Review: Rapid Interpretation of Balance Function Tests, First Edition 书评:平衡函数测试的快速解释,第一版
Pub Date : 2019-04-02 DOI: 10.1177/0003489419836746
Juliette O Flam
Rapid Interpretation of Balance Function Tests provides a review of vestibular physiology and pathology followed by an overview of diagnostic vestibular testing before diving into the specifics of individual tests. Illustrations, flow diagrams, summary tables, and sample test results are provided throughout, thereby strengthening important concepts and allowing one to not only understand but also interpret balance function tests. An accompanying DVD also demonstrates the eye movements associated with those tests. The book provides an overview of balance function tests but does not provide any clinical vignettes, making it difficult for an otolaryngologist in training to understand which balance function tests are most relevant when assessing individual patients. In that sense, this book is more geared toward otolaryngologists in practice and other health care professionals who wish to gain more insight into the interpretation of balance function tests. 836746 AORXXX10.1177/0003489419836746Annals of Otology, Rhinology & LaryngologyBook Review book-review2019
快速解释平衡功能测试提供了前庭生理学和病理学的回顾,随后是前庭诊断测试的概述,然后再深入到个别测试的细节。插图、流程图、汇总表和样本测试结果贯穿始终,从而加强了重要的概念,并允许人们不仅理解而且解释平衡功能测试。随附的DVD还演示了与这些测试相关的眼球运动。这本书提供了平衡功能测试的概述,但不提供任何临床小插曲,使其难以培训耳鼻喉科医生了解平衡功能测试是最相关的评估个体患者时。从这个意义上说,这本书更适合耳鼻喉科医生在实践和其他卫生保健专业人士谁希望获得更多的洞察平衡功能测试的解释。836746 AORXXX10.1177/0003489419836746Annals of耳鼻喉科学年鉴
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引用次数: 0
Book Review: Neck Dissection 书评:《颈部解剖》
Pub Date : 2019-04-02 DOI: 10.1177/0003489419842086
Karen Y Choi
Neck Dissection is a comprehensive text that reviews the preoperative workup and anatomy, surgical considerations and techniques, and postoperative recovery and rehabilitation of patients undergoing neck dissections. There are a total of 28 chapters that cover the assessment of cervical lymphadenopathy and anatomy as well as surgical techniques of the neck dissections of all levels and indications for each surgery. This text also covers adjuvant treatment considerations as well as novel techniques such as sentinel node dissection and robotic neck dissection. Each chapter is clearly outlined with nice flow of content and high-quality intraoperative photos highlighting anatomical landmarks as well as clear illustrations and tables that expertly supplement the text. Furthermore, each chapter ends with a comprehensive list of citations as an additional resource to the reader. This text is a wonderful resource for head and neck surgeons at all levels of training. It provides a thorough review of the anatomy with both illustrations and intraoperative photos that nicely bridge textbook learning with hands-on experience. The subject matter is a good combination of practical clinical knowledge and academic evidence-based literature, which is presented in a manner that makes it easy to digest. This text will serve as a nice adjunct to other anatomy texts and surgical atlases. 842086 AORXXX10.1177/0003489419842086Annals of Otology, Rhinology & LaryngologyBook Review book-review2019
颈部解剖是一个全面的文本,回顾术前工作和解剖,手术的考虑和技术,术后恢复和康复的患者接受颈部解剖。共有28章,涵盖了颈部淋巴结病的评估和解剖,以及各级颈部解剖的手术技术和每个手术的适应症。这篇文章还涵盖了辅助治疗的考虑,以及新技术,如前哨淋巴结清扫和机器人颈部清扫。每一章都有清晰的概述,内容流畅,高质量的术中照片突出解剖地标,以及清晰的插图和表格,熟练地补充了文本。此外,每章结尾都有一个全面的引文列表,作为读者的额外资源。这篇文章是一个美妙的资源,为头颈外科医生在各级培训。它提供了解剖学的全面审查插图和术中照片,很好地桥教科书学习与实践经验。主题是临床实践知识和学术循证文献的良好结合,以易于消化的方式呈现。这个文本将作为一个很好的辅助其他解剖学文本和外科地图集。842086 aorxxx10 .1177/0003489419842086耳鼻喉科学年鉴书评
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引用次数: 0
期刊
Annals of Otology, Rhinology & Laryngology
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