Ear, nose, & throat journal最新文献

Introduction: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, primarily found in the parotid gland. Recurrences often extend into the parapharyngeal space (PPS), complicating management. This report presents a case of a recurrent giant PA in the PPS following a limited excision. Case Description: A 45-year-old male presented with a gradually enlarging neck mass, dysphagia, and mild dyspnea, having previously undergone limited excision of a PA. Clinical examination revealed a firm mass in the right parotid region. Magnetic resonance imaging (MRI) showed a large mass in the right parapharyngeal space. Surgical excision was performed using a cervical-transparotid and mandibular swing approach. The patient was discharged after 7 days and later received radiotherapy. Discussion: Parapharyngeal space tumors (PPT) are rare neoplasms, with 70% to 80% being benign, primarily PAs. Symptoms include neck masses, swallowing difficulties, and potential cranial nerve involvement. MRI is crucial for assessing tumor extent. A combined transparotid-transcervical approach was employed. Postoperative radiotherapy was recommended. Conclusions: PPTs present significant clinical challenges, highlighting the need for meticulous surgical planning and complete excision of PAs to minimize recurrence risk. The close proximity of vital neurovascular structures requires careful preoperative evaluation and strategic surgical approaches.

Objective: This study aimed to compare the efficacy of continuous perfusion of underwater bone grinding combined with a Y-shaped incision versus a microscopic posterior ear incision in the treatment of attic cholesteatoma. Study Design: Clinical trials were prospective studies from the Northern Jiangsu People's Hospital. Research Object: Adult patients with middle ear cholesteatoma requiring ear surgery agreed to participate between September 2019 and September 2023 (age > 18). The procedure utilized hard otoendoscopy with diameters of 2.7 mm, and angles of 0°, 30°, 45°, and 75°, along with absorbable microstripping ions, attractive knives, and various microinstruments. The preoperative evaluation included high-resolution computerized tomography (CT) of the temporal bone, pure tone audiometry, and hard otoscopy. The main outcome measures included the diagnosis of residual or recurrent disease through clinical examination and/or magnetic resonance imaging consistent with cholesteatoma. Intraoperative operation time, postoperative complications, postoperative pain scores, and preoperative and postoperative hearing test results were recorded. Results: A total of 80 ears were included in the study (79 patients). The mean ages for the experimental and control groups were 46.70 ± 9.86 and 48.53 ± 11.63 years, respectively. All surgeries were performed under general anesthesia. The most common sites of cholesteatoma were the posterior superior tympanic chamber (n = 75, 94%), anterior superior tympanic chamber (n = 42, 53%), posterior middle tympanic chamber (n = 25, 31%), and tympanic antrum (n = 23, 28.7%). Intraoperative ossicular chain reconstruction was performed in 64 cases (86%). The follow-up period ranged from 13 to 48 months, with an average of 30 months. The recurrence rates of cholesteatoma were 5.26% (n ≤ 2) and 11.9% (n ≤ 5) in the experimental and control groups, respectively. Conclusions: Treatment of intramastoid cholesteatoma using otoscopic continuous perfusion underwater bone grinding combined with a Y-shaped incision offers several advantages over the removal of middle ear cholesteatoma via otomicroscopic incision. These advantages include better hearing recovery, shorter operative time, smaller incisions, faster postoperative recovery, less postoperative pain, and reduced surgical bleeding.

Kaposi's sarcoma (KS) is a tumor involving blood vessels and lymphatic tissue. It is caused by human herpes virus-8, typically in HIV infection in individuals with AIDS. There are 4 major types of KS including classic, endemic, immunosuppression, and AIDS-related. Endemic KS is unique among the different types as it is associated with patients with HIV-seronegative and can present either as an indolent tumor or as a fast-growing mass. The authors discuss a unique presentation of metastatic, endemic KS in a patient with HIV-negative, non-immunosuppression, which has yet to be described in the United States. A 38-year-old male with a history of same-sex partners, presented with a new oral lesion that had appeared 6 weeks ago. He was negative for human papillomavirus or HIV infection. A computed tomography (CT) scan demonstrated destructive lesions of the hard palate. The specimens obtained from biopsy were consistent with endemic KS. A Positron Emission Tomography - computed tomography (PET-CT) scan showed widely-metastatic disease. Case reports have described a rare subtype of HIV-seronegative KS in men who have sex with men. However, these are typically-indolent tumors with exclusively-cutaneous manifestation. This is a unique case of aggressive, widely-metastatic endemic KS metastatic in a patient with HIV-negative.

Background: Infraorbital ethmoidal air cells (IOEAc) are ethmoidal cells that pneumatizes inferior to the orbital floor and lateral to a line parallel to the lamina papyracea. Studies have shown considerable anatomical variation with different extensions in humans. Objectives: To identify and categorize the anatomical variations of the IOEAc creating a new, comprehensive variation classification system. Patients and methods: All included 1260 computed tomography of the nose and paranasal sinuses were reviewed to detect the presence or absence of IOEAc. All cases with IOEAc were evaluated for bilaterality, multiplicity, and shape and categorized according to its extensions to the maxillary infundibulum and its relations to the entire length of the inferior orbital wall. Results: IOEAc were identified in 173 (13.7%) scans. Bilaterality was observed in 99 patients (57.2%), while 50 patients (28.9%) had unilateral air cells on the right and 24 patients (13.9%) had unilateral air cells on the left. They were classified into 5 categories that were subclassified into subtypes. With 173 cases distributed as 26%, 17.9%, 3.5%, 9.8%, 24.9%, 10.4%, 2.3%, 1.7%, and 3.5% among the 5 categories, respectively. Conclusions: The new classification system provides a comprehensive classification of the described anatomical variations of the IOEAc. It allows the description and categorization of variants identified in past and future studies. It is applicable to current clinical practice.

Background: With serious oral and systemic implications, oral submucous fibrosis (OSMF) is a crippling disorder that is common in some areas, especially among areca nut chewers. A thorough investigation of the relationship between OSMF and hearing impairment is necessary due to the growing evidence that, despite its well-established effects on dental health, there may be a connection. Aim: To investigate the association between OSMF and hearing impairment, particularly the mechanisms behind Eustachian tube dysfunction (ETD) and auditory dysfunction in OSMF patients. Methodology: This systematic review aimed to assess the association between hearing impairment and OSMF using the PICOS framework. A comprehensive search of 1137 articles published between 2015 and 2024 across various databases was conducted, resulting in 18 studies meeting the inclusion criteria. Data on population demographics, audiological assessments, and outcomes were extracted independently by 3 reviewers. The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Risk of bias assessments was conducted to categorize studies as low, moderate, or high risk. Results: The review identified 18 studies examining the link between OSMF and hearing impairment, revealing a significant correlation between OSMF severity and hearing loss. Patient-reported hearing issues ranged from 27.69% to 76.7%. Conductive hearing loss was prevalent, particularly in advanced OSMF stages. Most studies employed pure tone audiometry and tympanometry, highlighting ETD as a common contributor. Quality assessments indicated that most studies had good methodological rigor, with several rated as very good, underscoring the need for comprehensive evaluations in understanding the audiological implications of OSMF. Conclusion: There is a substantial association between OSMF and hearing loss, particularly through ETD. Multidisciplinary management and early audiological screening are essential for improving outcomes in OSMF patients.

Pituitary macroadenomas are benign neoplasms that can cause a range of symptoms due to a mass effect on surrounding structures. This case report describes a 51-year-old male presenting with progressive bilateral hearing impairment and significant deterioration in speech discrimination over several years. Examination revealed normal tympanic membranes and no neurological deficits, while pure tone audiometry indicated mild to moderate sensorineural hearing loss. Magnetic resonance imaging identified a 6 × 5.5 × 7 cm pituitary macroadenoma extending into the suprasellar region and invading the sphenoid and right cavernous sinuses. The patient underwent a two-stage surgical intervention followed by gamma knife surgery. Postoperative follow-up showed mild deterioration in hearing with unmeasurable speech discrimination scores. This case underscores the importance of considering pituitary macroadenomas in the differential diagnosis of unexplained hearing loss and highlights the role of comprehensive audiological and imaging evaluations in achieving accurate diagnosis and optimal management.

Objective: To investigate the effect of Keystone Design Perforator Island Flap (KDPIF) in the repair of maxillofacial soft tissue defect. Methods: From June 2021 to June 2023, 16 patients with soft tissue defects caused by resection of maxillofacial tumor repaired by KDPIF were selected. Variants of KDPIF were designed according to the area of the defect, and the incision was parallel to the wrinkle as far as possible in the same facial cosmetic subunit. Postoperative follow-up was 3 months to 1 year. Results: One (6.3%) case of flap had dark red congestion and peripheral epidermal necrosis within 1 week. 1 week later, the skin flap blood flow was recovered, and the wound healed after 3 weeks. The other 15 (93.7%) cases of skin flap survived in the first stage. The postoperative follow-up showed that all flaps had good color and shape. There was no obvious scar contracture, the patient was satisfied with the facial shape and had no obvious facial function disorder. Conclusion: KDPIF is easy to operate, with a short operation time, a high survival rate of flap, and a good aesthetic effect, which is especially suitable for the repair of small and medium-sized maxillofacial soft tissue defects in the elderly.

Background: This study aims to investigate the diagnostic values of fine needle aspiration cytology (FNAC) and frozen section (FS) in evaluating parotid gland masses subjected to parotidectomy. Methods: A retrospective analysis of data from 274 patients who underwent parotidectomy for parotid gland masses was performed at the Department of Otolaryngology of the University Hospital between 2013 and 2019. We compared the preoperative FNAC and intraoperative FS records with the definitive histopathological diagnoses obtained from the surgical resection specimens. Results: The sensitivity, specificity, accuracy, positive predictive, and negative predictive value of FNAC in reaching the correct diagnosis were 65.1%, 94.1%, 88.7%, 77.1%, and 92.1%, respectively. The FS analysis values were 92.9%, 97.2%, 95.3%, 96.3%, and 94.6%, respectively. Additionally, the true-positive, true-negative, false-positive, and false-negative cases are documented and discussed. Conclusions: Although FNAC is a commonly used, easy, and reliable diagnostic method for parotid tumors, the diagnostic values observed in our study are low. FS analysis appears to be a more robust method. Therefore, we recommend a balanced use of these diagnostic tools, informed by clinical judgment, patient considerations, and available resources, to optimize outcomes in the management of parotid gland tumors.