Objective To evaluate treatment options of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and their curative effect. Methods In this study, there are 59 confirmed pediatric obstructive sleep apnea hypopnea syndrome cases diagnosed by polysomnography ( PSG). Among them, 54 cases were treated by tonsillectomy or/and adenoidectomy directed by transoral endoscopy. Continue positive airway pressure ( CPAP) was used for 2 cases in long-term. Three cases were treated with other conservative therapy. OSA-18 (quality of life for children with obstructive sleep apnea 18 items) was adopted as a disease-specific quality-of-life follow-up survey before and after treatment. Results During perioperation period, no postoperative bleeding or acute respiratory obstruction occurred . Follow-up sleep study was carried out 12-18 months postoperatively, no complications of velopharyngeal insufficiency, nasopharyngeal stenosis or residual adenoid were found. OSA-18 scores showed that quality of life had been significant improved after operation in 76.3% (45 cases), sleep disturbance in 88.1% (52 cases) and physical symptoms in 67. 8% (40 cases) . The pressure level of long-term CPAP in 2 cases was about 5. 6-7. 8 cmH2O. 3 cases were slightly improved treated with conservative therapy. Conclusions Surgical removal of upper airway obstruction caused by enlargement of tonsil and adenoid is one of the most effective treatment for pediatric OSAHS. Fibrous endoscopy and cephalometric analysis are helpful to confirm surgical indication. The advantages of transoral endoscopy directed adenoidectomy are as follows: clear and direct visualization, complete removal, without damaging of the peripheral structures.
OBJECTIVE To analyze retrospectively the outcome of 6 cases of cochlear reimplantation to summarize its experience. METHODS The operation method of cochlear reimplantation was similar to routine cochlear implantation. A "H" incision for the muscle-periosteum was used to shorten the operation time. RESULTS Of all the cases, the electrodes are successfully and totally inserted into the cochlea. The causes for revision are different. The electrode was found to be not in the proper situ of the cochlea after the first operation in one patient. The out part was ruptured because of trauma in another patient. The causes of the other four patients were unknown. CONCLUSIONS The incision should not be too small. The control electrode should be put beneath the periosteum. The site used to fix up the out part need be burnished. Unabsorbable suture should do not be used. It is important to insert the new electrode quickly after drawing the old one out. The time to accommodate the new electrode often needs 3-4 weeks.
OBJECTIVE:To investigate expression of connexin43 (Cx43) and E-cadherin (E-cad) and its relationship with the biological behavior in Laryngeal carcinomas. METHODS:Immunohistochemistry staining (PicTure two steps method) was used to detect connexin 43 and E-cadherin expression in 60 paraffin-embedded laryngeal carcinomas and 10 normal epithelia around tumors. All the patients were followed up more than five years. RESULTS:Cx43 and E-cad were expressed by normal epithelia with typical membranous staining 10 normal epithelia strongly expressed Cx43 and E-cad. The reduction rate of Cx43 expression in laryngeal carcinomas was 30.0%. The significant relationship was observed between low Cx43 expression and differentiation, lymph node metastasis and recurrence (chi2 = 15.09, 6.41, 3.86, P < 0.01, 0.05, 0.05), but there was no significance between low Cx43 expression and prognosis (chi2 = 2.65, P > 0.05). 41.7% laryngeal carcinoma showed reduced or no expression of E-cad. Tumor cell dedifferentiation correlated with reduced expression for E-cad (chi2 = 15.07, P < 0.01). Absent or low E-cad expression was observed more frequently in patients with local recurrence and lymph node metastasis and with less than 5-year survival period (chi2 = 5.35, 6.65, 5.14; P < 0.05, 0.01, 0.05). There was a positive relationship between the expression of Cx43 and E-cad in same sample (r = 0.63, P < 0.0001). CONCLUSIONS:Laryngeal cancer presented inactivation of Cx43 gene and E-cad gene and down regulation of Cx43 and E-cad proteins. The level of Cx43 and E-cad may be a sensitive predictor of differentiation, invasion, lymph node metastasis and recurrence. E-cad is also a prognostic factor for patients with laryngeal cancer.
人工耳蜗是帮助双侧极重度感音神经性听力损失患者改善听力和言语交流能力的一种模拟耳蜗功能的声电换能助听装置.1972年Haose成功地将第一例单道人工耳蜗植入人体,引起国际上的极大关注.1980年由北京协和医院研制成功的单道人工耳蜗装置,使全聋患者恢复了音感,但由于信息处理技术与封装工艺上的缺陷,效果并不理想,人工耳蜗植入手术在国内一度陷于停顿.
Objective: A small number of multichannel cochlear implant (CI) recipients require reimplantation. This study describes the causes of failure, surgical technique, and hearing outcomes in a consecutive series of 16 patients undergoing reimplantation of multichannel devices. We hypothesize that reimplantation is safe and that hearing results are at least as good as those measured following primary implantation, Study Design: Retrospective analysis of consecutive clinical series, Methods: Chart analysis of 191 consecutive CI operations performed at the University of Miami Ear Institute between 1990 and 1997 revealed 16 patients who received a second multichannel device. All but one had a minimum follow-up of 1 year after reimplantation, Ten of these patients had initial implantation performed by us, and six were initially operated on elsewhere. Main outcomes of the initial procedure were compared with those of the reimplantation, including electrode insertion length, number of channels programmed, and audiometric results. In addition, cause of failure and relevant surgical findings at the second procedure are described. Results: There were no surgical complications after reimplantation surgery. Device failure was the most frequent cause for reimplantation. Time between initial implantation and failure ranged from 0 to 46 months (mean, 22.4 mo; median, 23 mo). Common intraoperative findings include mastoid fibrosis, bone growth at the cochleostomy, and skin flap breakdown, Following reimplantation, mean length of insertion, number of channels actively programmed, and speech recognition scores were at least as good as findings before initial implant failure. Conclusion: CI reimplantation is safe and effective.
OBJECTIVE:To explore the relationship between the extent of enlarged oropharynx and efficiency through measuring the anterior-posterior and transverse diameter of oropharynx of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) before and after uvulopalatopharyngoplasty (UPPP). METHODS:Thirty eight patients with OSAHS were studied. The following indexes were measured before and after UPPP: width of uvula base, length of uvula, distance between uvula and posterior pharyngeal wall (DBUP), distance between anterior pillar (DBPP), apnea-hypopnea index (AHI), body mass index (BMI) and SaO2. RESULTS:The preoperative DBAP and DBPP were significantly less than those of normal adults (P < 0.05). DBUP, length of uvula and width of uvula base has no significant difference between preoperative patients and normal adults (P > 0.05). There was no significance difference in DBAP. DBPP and DBUP between postoperative patients and normal adults (P > 0.05). The preoperative AHI, IBM, minimal SaO2, mean SaO2, DBUP, DBPP, DBAP, length of uvula and width of uvula base has no significant difference between good responders and nonresponders (P > 0.1). CONCLUSIONS:Transverse diameter of OSAHS patients is shorter than that of normal adults but anterior-posterior diameter of OSAHS patients has no difference compared with normal adults. Transverse diameter could be enlarged by UPPP. Not only anatomical abnormality but also other factors will contribute to the effect of UPPP.
OBJECTIVE To evaluate the value of magnetic source imaging (MSI) in the functional localization of the primary auditory cortex. METHODS The M100 waves of cortical auditory evoked magnetic fields (AEFs) evoked by 0.5, 1, 2, 4 and 8 kHz pure tones in 5 subjects and by 2 kHz pure tones in 25 healthy young subjects were measured respectively (16 males and 14 females, with the age from 20 to 32 years old) using a whole head 306 channel magnetoencephalography (MEG) system. The MSI obtained by superimposing functional MEG data on structural magnetic resonance image (MRI) was used to localize the M100 sources on the auditory cortex. RESULTS The M100 waves of AEFs were clear and replicable in both hemispheres. The M100 sources were localized on the bilateral transverse temporal gyri in all 30 subjects. The localization of M100 on transverse temporal gyri varied with the changes of stimulus frequency. The localization of primary auditory cortex was asymmetrical between bilateral hemispheres, and the left hemisphere M100 dipoles were significantly posterior compared to the right M100 dipoles. The M100 responses appeared significantly earlier to the contralateral stimuli than that to the ipsilateral stimuli in both hemispheres. The dipole positions of M100 were independent of the side of the stimuli. CONCLUSIONS The functional localization of the primary auditory cortex could be determined precisely by magnetic source imaging (MSI) with high spatiotemporal resolution. MSI would hold great promise as a noninvasive tool for the fundamental and clinical research in otology.
OBJECTIVE:To investigate the relationship between susceptibility and prognosis of laryngeal cancer and genetic polymorphisms in CYP1A1 GSTM1.METHODS:The genetic polymorphisms of CYP1A1 exon-7 and GSTM1 were analyzed by polymorphism-polymerase chain reaction (PCR) technique in peripheral blood leukocytes of 89 laryngeal cancer cases and 164 non-cancer controls.RESULTS:Either in the frequency of CYP1A1 (W, MW, M) and GSTM1 negative individual of laryngeal cancer were significantly higher than that in the controls(P < 0.05). Combined genetype of CYP1A1 and GSTM1, that is CYP1A1 W/GSTM1 (-), CYP1A1 MW/GSTM1 (-), CYP1A1 M/GSTM1 (+), CYP1A1 M/GSTM1 (-) had higher risk than those combined genotypes, which ratios were 1.42 (0.62-3.22), 1.67 (0.7-4.03), 2.55 (1.0-6.54) and 4.02 (1.65-9.79), respectively. Statistic analysis suggested an interaction between smoking and CYP1A1 M/GSTM1 (-) genotypes polymorphisms which increase risk of laryngeal cancer. There was no significant difference in the frequency of CYP1A1, GSTM1 individual with the development and prognosis of laryngeal cancer.CONCLUSION:The present datas suggested that genetic polymorphisms of CYP1A1 and GSTM1 were susceptible to laryngeal cancer. Individuals with CYP1A1 M or GSTM1 (-) had increased risk of developing laryngeal cancer, but individuals with combined CYP1A1 M/GSTM1 (-) and smoking were more susceptible. Genetic polymorphisms of CYP1A1 and GSTM1 are not related with clinic process of laryngeal cancer.
OBJECTIVE To investigate the nasal expression of CYP2A proteins in human. METHODS Immunoblot analysis was used to detect fetal tissues at 96-185 days of gestational age and in surgical biopsy tissues from different regions of nasal cavity of 36 adult patients, and immunohistochemical methods were used to localize CYP2A proteins' cellular distribution. RESULTS In adults, CYP2A protein was detected in olfactory microsomes from 8 of 10 individual, but not in the respiratory nasal microsomes from 37 individual. Quantitative immunoblot analysis confirmed that CYP2A proteins were selectively expressed in the olfactory region in both adult and fetal tissues. Interestingly, the levels of CYP2A proteins in nasal microsomes were generally higher in fetuses than in adults. The CYP2A protein content in olfactory microsomes ranged from 0.1 to 1.1 pmol/mg among adult nasal microsomes, while among five fetuses ranged from 0.8 to 5.3 pmol/mg microsomal protein, with a trend of developmental increase in expression level. Immunohistochemical studies confirmed that the CYP2A proteins were expressed in the supporting cells in the olfactory epithelium and in the Bowman's glands in the lamina propria. CONCLUSIONS CYP2A proteins expression in human olfactory mucosa indicates that olfactory mucosa is metabolic target site of the xenobiotics. Also CYP2A has a relationship with olfaction. The prenatal expression of the CYP2A proteins in the OM suggests potential risks of developmental toxicity from maternally derived xenobiotics.
对依靠扩大或选择性扩大音响刺激强度改善听觉功能的设备无效的重度或极重度感音神经性聋病例,选用人工耳蜗植入治疗,已为耳科学界和患者普遍认同.全世界已有60 000多例,我国已有1600多例接受了电子耳蜗.越来越多的医院和医师将参加此项工作,将有更多患者因此受益,前景是很美好的.但是,医师和患者都应认识到以下的基本事实,即:听觉电生理的研究成果、微电子技术、生物相容材料的发展与计算机言语信号提取编码技术的日益成熟,是几十年来人工耳蜗由实验室走向临床实用的3个支柱;而围绕着人工耳蜗植入手术前后的一系列工作则是实现人-机结合的决定性步骤;随后而来是漫长的言语接受与表达能力的训练与学习,这是人工耳蜗成就其真正价值的终极印证.这是一个需要投入爱心、责任心与高技术的系统工程.
OBJECTIVE:To investigate the clinical characteristics, treatment and prognosis for poorly differentiated supraglottic carcinomas.METHODS:A retrospective study was conducted in 57 cases of poorly differentiated supraglottic carcinomas treated in our hospital from 1980 to 1998. The distribution of the patients according to UICC in 1997 was as follows: stage I 4, stage II 15, stage III 18, stage IV 30. Of the 57 patients, 25 were treated with surgery alone, 9 with irradiation alone, 14 with surgery following preoperative radiation, 7 with postoperative radiation following surgery and 2 with surgery following preoperative chemotherapy. Total laryngectomy was performed on 23 patients and partial laryngectomy on 25 patients. The concurrent neck dissections were undergone for 31 cases (17 unilateral side, 14 bilateral side) and the upper neck dissections for 12 cases.RESULTS:The overall 5-year survival rate, accumulated cervical metastasis rate, metastasis rate of bilateral side of neck, distant metastasis rate, cervical recurrent rate and locally recurrent rate were 47.4% (27/57), 63.2% (36/57), 24.6% (14/57), 21.1% (12/57), 28.1% (16/57) and 10.5% (6/57), respectively. In addition, the local recurrent rate for partial laryngectomy was 12% (3/25). 5-year survival rate for each TNM staging decreases gradually. The difference in 5-year survival rate between T1 + T2 and T3 + T4 and the difference between N0 + N1 and N2 + N3 were statistically significant (chi2 = 4.942, P = 0.026; chi2 = 4.306, P = 0.038). No evidence in our analysis was found about the difference in 5-year survival rate between surgery alone and surgery combined with radiotherapy. The effect of surgery combined with radiotherapy on patients at N2 and N3 was relatively superior to that of surgery alone.CONCLUSIONS:Poorly differentiated carcinomas of the supraglottic larynx had characteristics of the advanced stage in terms of earlier lymph node metastasis and a relatively high rate of cervical and distant metastasis. Surgery was still the primary treatment for this disease and it was feasible to perform partial laryngectomy on certain patients. For patients with T3 who need partial laryngectomy and patients with advanced N stage, the combination of surgery with radiotherapy was supposed to be a priority.
OBJECTIVE:To study the characteristics of the cervical lymph node metastasis in clinical N0 (cN0) patients with laryngeal carcinoma and its implication in clinical treatment.METHODS:76 patients with laryngeal carcinomas of T2-4cN0 category were divided into two groups in random: 21(22 sides) radical neck dissection(RND) and 55(60 sides) functional neck dissection(FND) were performed. Lymph nodes were studied histologically according to the levels.RESULTS:On an average, 29.6 lymph nodes were obtained in one side of neck in RND group, and 24.7 in FND group(F = 3.145, P = 0.068). The occult metastasis rates were 33.3% (7/21) in RND group and 34.5% (19/55) in FND group. 25 of 26 patients (96.2%) who had positive nodes involved only the levels II and III. 2130 lymph nodes were obtained in all samples, 59 of 60 positive nodes(98.3%) were located in the level II and III. The 5 and 10-year survival rates of the two groups were 71.4% (15/21), 76.4% (42/55) and 61.9% (13/21), 68.9% (31/45), respectively with no statistical difference(chi 2 = 0.2394, P > 0.5; chi 2 = 0.3143, P > 0.05). Ipsilateral cervical recurrence rates in two groups were 9.5% (2/21) and 7.3% (4/55), respectively with no statistical difference (chi 2 = 0.1059, P > 0.900). 10-year mortalities with negative and positive cervical lymph nodes were 16.7% (7/42) and 62.5% (15/24) respectively, which had statistically difference (chi 2 = 14.4375, P < 0.005).CONCLUSION:The lateral neck (level II, III and IV) dissection may be suitable for the treatment laryngeal carcinoma patients with T2-4cN0.
OBJECTIVE:The relationship between basic fibroblast growth factor (bFGF) and phosphatidylinositol 3-kinase/protein kinase B(PI 3-K/PKB) signal pathway was studied during the course of bFGF regulating carcinoma epithelioid cell lines- I (CNE- I ) nasopharyngeal carcinoma cell proliferation through altering time of bFGF treatment.METHODS:PKB activities were measured by advanced Takai method. C-fos expression was examined by Western Blot.RESULTS:bFGF (50 ng/ml) significantly stimulated PKB activity,After pretreatment of Wortmannin for 1 h, the PKB activity decreases to the basal levels(P < 0. 05),compared with control group. After treatment of bFGF (50 ng/ml) at various time, the expression of c-fos is increased. The expression of c-fos increases to the peak when the time of bFGF treatment is 30 min. After pretreatment of Wortmannin for 1 h, the expression of c-fos decreases 20% when the time of bFGF treatment was 30 min and when the time of bFGF treatment was 45 min, the expression of c-fos decreases 35%.CONCLUSIONS:1. PI 3-K and PKB mediate bFGF-induced signal transduction in CNE- I nasopharyngeal carcinoma cell line; PKB lies in downstream of PI 3-K. 2. bFGF induces the increased expression of c-fos through PI 3-K/PKB in CNE- I nasopharyngeal carcinoma cell line.
OBJECTIVE:To detect mutations of exon 5 and exon 8 of phosphatase and tensin homology deleted on chromosome10/mutated in multiple advanced cancer1/TGF-beta regulated and epithelial cell-enriched phosphatase (PTEN/MMAC1/TEP1 for short PTEN) gene in laryngeal squamous cell carcinoma (LSCC) and analyze the relationship between the mutation and LSCC.METHODS:Fresh tumor samples from 40 LSCC patients were examined using polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and direct DNA sequencing.RESULTS:The mutation of exon 5 and exon 8 occurred in supra-glottic laryngeal carcinoma and no mutation in the glottic laryngeal carcinoma was found. There were 6 cases of mutation for exon 5, and the mutation rate was 15%. In 2 cases, 1 base pair insertion TT-->TAT in codon 85, while in other two cases, 1 base pair deletion GCA-->GC in codon 86, and the two type mutation may result in frame shift mutation. One case had the above two type mutation simultaneously, which may result in missense mutation; 1 case had 1 base pair insertion TT-->TAT in 85 codon and 1 base pair deletion GCA-->GA, which may result in nonsense mutation. The pathology of 3/6 (50%) cases was low differentiation, and the others (3/6, 50%) were middle differentiation. Five cases had lymphatic metastasis, and the rate of which was 83.3%; the other one had no lymphatic metastasis, and the rate of which was 16.7%. There was only 1 case mutation for exon 8, and the mutation rate was 2.5%. One base pair deletion AAA-->AA in 276 codon as well as 1 base pair insertion CT-->CCT between the 336 codon and 337 codon may result in frame shift mutation. The pathology of the case was low differentiation.CONCLUSION:The codon 85,86 of PTEN gene in exon 5 may be "hot spots" in LSCC and the mutation of PTEN gene may be related with the lymphatic metastasis and middle or low differentiation.
OBJECTIVE To study the long-term result of patients with laryngeal carcinoma treated by surgery and the prognostic factors. METHODS The survival status of 1115 patients with laryngeal carcinoma which were treated in this department between 1983 and 1996 were retrospectively investigated. RESULTS Overall 5-year survival rate was 77%. Among them, 5-year survival rate for patients of stage I was 94%, stage II 89%, stage III 82%, stage IV 66%. Patients with glottic cancer had the best prognosis, followed by supraglottic, subglottic and transglottic cancer. Five years survival rate for patients with partial laryngectomy was 85%, whereas, for total laryngectomy was 68%. The causes of failure were local recurrence and metastasis(70%). 14% of dead was not clear. CONCLUSION Early diagnosis was the key for both larynx preservation and survival rates. Causes of dead were laryngeal recurrence and metastasis.
OBJECTIVE:To develop a new method, videomimicography (VMG), to evaluate facial motor function.METHODS:During VMG, 11 landmarks were placed on the face, and 5 movements (forehead lifting, eye closure, nose wrinkling, lip puckering and smiling) with maximal contraction were requested. A digital video film was recorded then fed in a computer to be analyzed. Ten normal subjects were used as normal control.RESULTS:Area measures were found better than distance measures in evaluating facial movements. The best measure for each movement was determined. Then a global index of facial motor function was derived from these measures. This index was found well correlated with the facial paralysis House-Brackmann grade in 48 patients with facial paralysis (r = -0.928).CONCLUSION:VMG is an objective, quantitative, relative simple method. It has good reproducibility. So it can be used in clinic for evaluating facial motor function.
OBJECTIVE:To explore the method of fabricating tissue engineered laryngeal cartilage.METHODS:The rib and articular cartilage of infant New Zealand white rabbits were harvested in sterile condition. The chondrocytes were separated by collagenase digestion and cultured in vitro for 3 passage. Serial steps of solution casting, extrusion molding and particulate leaching were used to make larynx-shaped biomaterial models with poly(3-hydroxybutyrate-co-3-hydroxyhexanoate, PHBHH). The chondrocytes were seeded onto PHBHH scaffolds to form cell-PHBHH composites, which were subsequently in vitro for one week. After that, the measure of filling inner space of cell-PHBHH composites together with wrapping total composites using either greater omentum (n = 9) or fascia flap and muscle (also n = 9) in experimental groups was taken to implant the larynx-shaped biomaterial models seeded with chondrocytes into the belly and the back of adult New Zealand white rabbits. Control groups (every group n = 3) were the same measure as experimental groups but without chondrocyte on PHBHH scaffolds. Finally, morphological observation, HE staining & special staining and immunohistochemical test were conducted to assess cartilage regeneration and its shape at different period following implantation.RESULTS:The rate of viable cell in the final cell suspension was (93 +/- 2)% after well-controlled prolongation of digestion trypsin. Similar to that by traditional procedures (94 +/- 2)% (P > 0.05). The larynx-shaped PHBHH models with edges and corners of laryngeal cartilage made by us appeared to be hollow half-trumpet shape and its porosity was more than 90%. It showed that chondrocytes equally attached to the surface of porous PHBHH and filled within porousness with scanning electron microscopic examination. Tissue engineered larynx-shaped specimens could alternatively be harvested with the above mentioned two different implantation measures. The specimens presented to be similar to that before implantation in gross shape. It was demonstrated to be cartilaginous tissue through histological and immunohistochemical examination. Furthermore, There was nearly no difference between two kinds of tissue engineered laryngeal cartilage with two measures of implantation in morphology and histology.CONCLUSIONS:The regeneration of tissue engineered cartilage in vivo is not influenced by the chondrocytes harvested by improvement of well-controlled prolonged digestion with trypsin during in vitro cell culture. It seems that PHBHH may be used as scaffold in cartilage tissue engineering and wrapping together with filling method with either greater omentum or fascia flap and muscle is appropriate for fabricating tissue engineered laryngeal cartilage.
近20年来,在全球新技术革命浪潮的推动下,基础医学和临床医学出现突飞猛进的发展局面.此间,循证医学的发展对疾病的诊断、治疗和卫生决策要求有充分的科学依据[1].在这一时期,鼻腔临床解剖学、病理生理学以及免疫学等方面的研究也得到了深入发展,形成了以鼻微创外科技术为代表的、有效推动鼻外科发展的技术体系.鼻内镜外科技术的日益普及完善,以及各种新型抗生素和局部糖皮质类固醇药物的开发和应用,使慢性鼻-鼻窦炎和鼻息肉等鼻科常见炎性疾病的治愈水平明显提高;鼻眼相关疾病和鼻颅底相关疾病的疗效也有了显著提高.目前,鼻科学已成为耳鼻咽喉-头颈外科领域最为活跃的三级学科.
OBJECTIVE:To evaluate the availability and our experience of intraoperative image-guidance in endoscopic nasal surgery.METHODS:Fifty-eight cases of endoscopic nasal surgery with intraoperative image-guidance were retrospectively reviewed, including 39 cases of chronic sinusitis with or without nasal polyp; 3 cases of necrotizing maxillary sinusitis; 6 cases of sphenoid sinus cyst; 2 cases of nasopharyngeal angiofibroma; 1 case of cranio-nasal meningioma; 1 case of traumatic cerebrospinal rhinorrhea; 1 case of traumatic optic nerve lesion. All patients were operated on with Brain Lab operation imaging navigation system and nasal endoscope.RESULTS:The preoperative preparatory time would take 10-20 minutes, including coordination, head holder localization, conventional instrument registration. In our cases, the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1.5 mm. The optic nerve and other anatomical points could be orientated accurately in intraoperative procedures. No complication occurred.CONCLUSIONS:Nasal endoscope combined with image-guidance systems provides accurate anatomical localization of nasal cavity, sinuses and anterior skull base with enlarged operation field. It is possible for surgeons to observe the surrounding important anatomical structures during endoscopic nasal surgery. It could increase the effectiveness and decrease surgical complications, especially in complicated cases.
