阻塞性睡眠呼吸暂停（OSA）是在睡眠期间，由于上气道完全或部分阻塞而反复出现呼吸暂停或低通气状态的一种疾病。舌骨及其周围的肌肉在维持OSA患者上气道稳定性中发挥重要作用，因此舌骨在OSA上气道塌陷的发病机制中扮演着重要角色，且舌骨的位移与OSA的发生、发展密切相关。本文将围绕舌骨及其附着肌肉的解剖学、舌骨位置影像测量及其形态与OSA的相关性研究进展进行综述。
Objective: To investigate the clinical characteristics of Kawasaki disease (KD) in children who initially present with symptoms of deep neck infections (DNIs). Methods: A retrospective analysis was conducted on the clinical data of 14 children with KD initially presenting with DNI symptoms, who were admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2020 and June 2025. Their clinical features, diagnosis, and treatment process were analyzed. The cohort included 11 males and 3 females, aged from 1 year to 10 years and 11 months. SPSS 25.0 was used for statistical analysis. Results: All patients were initially diagnosed with suppurative lymphadenitis or cervical abscess. Subsequent KD manifestations appeared. Two patients showed mild tricuspid and mitral regurgitation on cardiac ultrasound examination on the 3rd and 4th days of illness, respectively. The average time from onset to definitive KD diagnosis was (7.35±3.15) days. Two patients underwent incision and drainage for neck abscess before diagnosis, and one underwent retropharyngeal incision and drainage. All patients received the standard KD treatment regimen [intravenous immunoglobulin (IVIG) and oral aspirin] after diagnosis. Symptoms of the deep neck infection resolved in all cases, and no coronary artery dilation was observed. Conclusion: In children presenting with symptoms of DNIs, e.g., neck swelling, pain, or mass, accompanied by persistent fever, clinicians should maintain a high index of suspicion for non infectious diseases such as KD. Timely cardiac ultrasound examination, early recognition, and prompt initiation of IVIG therapy are essential to avoid unnecessary invasive procedures.
Objective: To systematically evaluate postoperative facial nerve function outcomes and to identify prognostic factors in patients with petrous apex cholesteatoma(PBC) through meta-analysis. Methods: Literatures published publicly from the establishment of databases to September 2025 regarding peripheral facial paralysis secondary to petrous bone cholesteatoma (PBC) were retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Medical Journal Full-text Database, PubMed, EMBASE, Web of Science, and Cochrane Library. Meta-analysis was performed on studies meeting the inclusion criteria to explore postoperative facial nerve function and its prognostic influencing factors of PBC patients. Statistical pooled analyses were conducted using Stata 17 and RevMan 5.3 software. Results: A total of 742 literatures were initially retrieved in this study, among which 50 eligible studies were finally included after screening, consisting of 26 English articles and 24 Chinese articles. The pooled improvement rate of postoperative facial nerve function in patients with peripheral facial paralysis secondary to PBC was 53% (95%CI: 44%-62%), and the postoperative deterioration rate of facial paralysis was 2% (95%CI: 0%-5%). For PBC patients with preoperative House-Brackmann (HB) grade I facial nerve function, the retention rate of HB grade I facial nerve function after surgery reached 91% (95%CI: 85%-97%).Patients with a facial paralysis duration of ≥1 year had a significantly lower improvement rate of facial nerve function compared with those with a disease duration of <1 year (OR=0.06, 95%CI: 0.03-0.11, P<0.01). Patients with severe preoperative facial paralysis showed a markedly lower rate of postoperative recovery to HB grade Ⅲ or higher than those with mild-to-moderate preoperative facial paralysis (OR=0.36, 95%CI: 0.18-0.71, P=0.003). The postoperative facial nerve improvement rate was significantly lower in PBC patients with incomplete facial nerve integrity than in those with intact facial nerves (OR=0.07, 95%CI: 0.02-0.30, P=0.000 3). No statistically significant difference was observed in the postoperative facial nerve improvement rate after PBC resection between patients with facial nerve lesions at the labyrinthine segment and above and those with lesions below the labyrinthine segment (OR=0.84, 95%CI: 0.18-3.88, P=0.83). Conclusions: Among patients with PBC-induced peripheral facial paralysis, the postoperative facial nerve improvement rate was 53%, facial paralysis aggravation rate 2%, and grade I facial nerve preservation rate 91%. Prognostic risk factors for postoperative facial nerve function following PBC resection included paralysis duration ≥ 1 year, severe preoperative facial paralysis, and facial nerve discontinuity.
目的:探索Provox Vega辅助发音管Ⅰ期植入手术操作注意事项及后续辅助放疗对安全性与发声效果的影响。方法:前瞻性研究2024年8—9月在复旦大学附属眼耳鼻喉科医院行Provox Vega发音管Ⅰ期植入的3例喉癌患者的临床资料。对照组1例，男70岁，术后未放疗；试验组2例，男48岁及女68岁，术后均放疗。分析术后放疗对各类并发症发生情况及发声效果的影响。结果:3例患者均未出现明显的发音管周围穿刺窦道感染及脓肿形成，未出现气管食管共同壁穿刺引起的气管食管瘘，未出现发音管移位脱落、内陷嵌顿等并发症。手术后患者通过发音管发声练习均能正常发声，放疗组2例患者在放疗过程中甚至放疗后3个月，因局部组织放射性炎症而惧怕发声练习导致发声效果差，但是放疗结束后15个月，该组患者局部炎症明显消退后发声效果基本恢复，与对照组患者相比发声效果无明显差异。结论:Provox Vega发音管Ⅰ期植入手术需要注重操作细节，术后放疗不会增加发音管穿刺植入相关的感染及气管食管瘘等并发症的发生概率，对于长期发声效果也无明显影响。
本文报道1例扁桃体腺样体切除术后寰枢关节脱位的病例，患儿扁桃体腺样体切除术后1周内出现颈部间歇性疼痛，伴转头受限，活动时加重，术后颈椎CT提示寰枢关节旋转半脱位，此例患儿颈托制动1个月左右，辅用镇痛消炎、抗生素和解痉药物，症状好转。
甲状腺癌是青少年中第二常见的恶性肿瘤，其中甲状腺乳头状癌（PTC）占比超90%。 RET基因与伙伴基因的融合实现不依赖配体的二聚化和构成型激活，持续激活MAPK等信号通路驱动致癌过程。儿童及青少年 RET融合阳性PTC表现出极强的侵袭性，具有确诊时肿瘤体积更大、极易发生甲状腺外侵犯、高频淋巴结及远处转移的特点，但其长期预后依然极佳。当前治疗以手术及术后选择性放射性碘（RAI）治疗为主。随着下一代测序（NGS）技术的普及，基于 RET融合等分子特征的风险分级逐步确立，为精准制订个体化手术范围及安全实施碘治疗策略提供了关键依据。同时，针对晚期及RAI难治性患儿，以高度选择性RET抑制剂为代表的靶向治疗已取得突破性进展。本文旨在综述近年来儿童及青少年 RET融合阳性PTC在临床特征、分子风险分层及精准靶向治疗方面的最新进展。
全球约有4.3亿人遭受致残性（中度及以上）听力损失的困扰，其中包括3 400万儿童 ［1］。作为最常见的感觉障碍，耳聋不仅影响言语沟通，而且制约患者的认知、教育与社会融入。传统干预手段如助听器和人工耳蜗等声电辅助设备，虽能部分补偿听觉功能，却始终无法从分子层面修复内耳病变、恢复自然听觉。近年来，随着精准医学的发展，内耳疾病的病因和分子机制日益明晰，有效推动了耳聋基因治疗由实验室研究迈向临床转化 ［2, 3, 4］。
本文报道1例下咽癌气管切开拔管后气管切开处继发性形成表皮样囊肿病例。患者男，56岁，因“发现颈部包块2个月”入院。既往史：下咽恶性肿瘤切除术后放化疗后11年，气管套管拔管后6年。彩超发现胸骨上窝皮下低回声团，CT显示颈根部气管前方边界清楚的圆形肿块。全麻下行胸骨上窝肿块完整切除。肿瘤呈单房囊性，内壁光滑，病理组织学显示为含角化物的囊性病变，囊壁衬覆鳞状上皮，结合气管切开病史诊断为继发性表皮样囊肿。提示有气管切开病史的胸骨上窝囊性病变患者，需要考虑这一诊断。
Objective: To systematically investigate the detailed anatomical characteristics of the nasal cartilaginous framework in Chinese adults via anatomical observation, histological analysis and micro-magnetic resonance imaging (μMRI), and to clarify its clinical significance for functional rhinoplasty. Methods: A total of 16 adult Chinese cadaveric nasal specimens (9 formalin-fixed specimens and 7 fresh frozen specimens), including 5 female specimens, were subjected to anatomical observation. The dorsal septal cartilages (DSC) were completely dissected to observe their structural configuration and morphology, as well as the clefts between the dorsal margin of the upper lateral cartilages (ULCs) and the quadrangular cartilage (QC), which were analyzed by heminasal unit. Another 7 formalin-fixed male nasal specimens underwent μMRI scanning followed by hematoxylin-eosin staining, Masson's trichrome staining and elastic fiber staining. Morphological features of coronal μMRI sections and the structural and cellular characteristics of histological slices were observed. Statistical analysis was performed using SPSS 24 software. Results: Anatomical observations revealed that the DSC represented an integrated anatomical structure composed of the QC and alar ULCs extending bilaterally from its dorsal margin. Although clefts between the caudal ends of ULCs and QC were observed in 62.5% (20/32) of heminasal specimens, their cephalic segments presented as continuous cartilage tissue, which confirmed that the DSC functioned as a single integrated unit. Based on the included angle between ULCs and QC, the ULCs in this study were classified into the adducted wing type (included angle<45°, 6/16) and the abducted wing type (included angle>45°, 10/16). Histological findings identified two proliferative patterns of adult nasal cartilage: chondrocyte mitosis and chondrogenic differentiation of perichondrial cells. Chondrocytes in the dorsal region of the QC were smaller and less metabolically active, indicating this region may serve as a proliferative center; by contrast, ventral chondrocytes exhibited stronger metabolic activity and extracellular secretory capacity. Statistically significant differences were found in cell size and isogenous group density between the two regions (all P<0.05). Four connection patterns were identified between ULCs and lower lateral cartilages (LLCs): end-to-end contact (1/7), curled overlapping (2/7), interlaced overlapping with fibrous adhesion (1/7), and sesamoid cartilage-mediated connection (3/7). The medial crura of LLCs overlapped or formed end-to-end junctions with the caudal margin of the QC, which shaped the nasal tip morphology of Chinese individuals. Conclusion: This study systematically elaborates the unique anatomical features of the nasal cartilaginous framework in Chinese adults, particularly the dynamic wing-shaped integrated DSC structure, which acts as the anatomical basis for nasal contour and nasal valve function.
Objective: To compare different administration routes of adipose-derived stem cell exosomes (ADSC-Exos) in mice with allergic rhinitis (AR) and, after identifying the optimal route, as well as to evaluate the effects of different ADSC-Exo concentrations on regulatory T cell (Treg)-mediated immunosuppression. Methods: ADSC-Exos labeled with the fluorescent dye DiR were administered to AR mice via intranasal microneedle injection (n=7), tail-vein injection (n=7), or intranasal instillation (n=7). The distribution and retention of ADSC-Exos at different time points were monitored using a small-animal in vivo imaging system. Serum levels of interleukin (IL)-4, IL-5, IL-10, and transforming growth factor-β (TGF-β) were measured by enzyme-linked immunosorbent assay (ELISA). The mRNA expression levels of IL-4, IL-5, and forkhead box P3 (Foxp3) in the nasal mucosa were determined using reverse transcription quantitative polymerase chain reaction (RT-qPCR). The proportion of Treg cells and the mean fluorescence intensity of Foxp3 in peripheral blood were assessed by flow cytometry. Histopathological changes in the nasal mucosa were evaluated using hematoxylin and eosin (H&E) staining. After the optimal administration route had been identified, the therapeutic effects of ADSC-Exos at concentrations of 10, 50, and 100 μg/ml were further compared. Results: Among the three administration routes, intranasal microneedle injection resulted in the strongest fluorescence signal in the nasal region and the longest retention time. Intranasal microneedle injection was also superior to the other routes in alleviating symptoms, regulating inflammatory cytokine levels and related gene expression, increasing the proportion of Treg cells and enhancing their suppressive function, and improving nasal mucosal histopathological changes. The 100 μg/ml group (the high-concentration group) exhibited the most pronounced immunomodulatory effects, including the greatest improvement in symptoms, greater reductions in proinflammatory cytokine levels, and marked increases in anti-inflammatory cytokine levels (all P<0.05). In addition, Foxp3 mRNA expression was significantly upregulated, the proportion of Treg cells was significantly increased, their suppressive function was enhanced, and eosinophilic infiltration was reduced. Conclusion: Intranasal microneedle administration of ADSC-Exos at 100 μg/ml can effectively enhance Treg cell-mediated immunosuppression and ameliorate immune imbalance in AR mice, providing experimental evidence for the clinical application of ADSC-Exos in the treatment of AR.
Objective: Perineural invasion (PNI) is a critical determinant of poor prognosis in laryngeal squamous cell carcinoma (LSCC), but its underlying mechanisms remain unclear. This study aimed to investigate whether LSCC-derived exosomes induce axonal growth by delivering neuroactive molecules, thereby contributing to tumor perineural invasion. Methods: Clinical data from the laryngeal cancer cohort of The Cancer Genome Atlas Head and Neck Squamous Cell Carcinoma (TCGA-HNSC) dataset were analyzed. Propensity score matching (PSM) and Cox regression were used to evaluate the prognostic value of nerve density, and these findings were validated using 35 pairs of laryngeal cancer and adjacent normal tissue specimens collected at Yantai Yuhuangding Hospital between 2022 and 2026 to assess neural morphological changes. Exosomes were isolated from the human LSCC cell line AMC-HN-8, characterized by quality-control assays, and co-cultured with PC12 cells. A rescue experiment using GW4869, a specific inhibitor of neutral sphingomyelinase, was performed to confirm the exosome-dependent effect. Neurite outgrowth was evaluated by immunofluorescence, and the expression of axonal growth-related genes was measured by RT-qPCR. Targeted metabolomics was employed for the absolute quantification of neuroactive metabolites within the vesicles and for pathway enrichment analysis. Results: After PSM adjustment, high nerve density was identified as an independent poor prognostic factor in LSCC patients (HR=2.10, P=0.035), with particularly pronounced prognostic value in the early-stage node-negative (N0) subgroup (HR=4.07, P=0.001). Pathological sections showed high expression of the neural markers βIII-tubulin and PGP9.5 in LSCC tissues (βIII-tubulin: t=2.234, P<0.05; PGP9.5: t=2.575, P<0.05). Exosomes were successfully isolated from AMC-HN-8 cells and passed quality control. In vitro assays showed that LSCC-derived exosomes significantly promoted neurite extension and branching in PC12 cells (t=4.147, P<0.000 1) and upregulated core axonal growth genes, including GAP-43, NEFL, and NEFM (GAP-43: t=3.698, P<0.05; NEFL: t=5.113, P<0.01; NEFM: t=5.263, P<0.01); this effect was completely reversed by the exosome-release inhibitor GW4869 (t=3.535, P<0.001). Targeted metabolomics revealed a specific enrichment of 12 neurotransmitters and metabolites within LSCC exosomes, centered on glutamine (83.411 μmol/L, FC=1.88) and glutamate (18.461 μmol/L, FC=1.21), which were significantly enriched in signaling pathways such as "central carbon metabolism in cancer" and "glutamatergic synapse". Conclusion: Nerve density is a potential adverse prognostic factor in patients with LSCC. LSCC-derived exosomes can directly induce axonal growth in neuron-like cells, suggesting that tumor cells actively remodel the neural microenvironment and drive axonal growth through exosome-mediated long-range signaling.
Objective: To evaluate the value of a prediction model based on infrared thermography (IRT) features combined with a support vector machine (SVM) algorithm for the preoperative non-invasive diagnosis of cervical lymph node metastasis in oral squamous cell carcinoma (OSCC), with particular attention given to its potential application in clinically node-negative (cN0) patients. Methods: Clinical data of 150 patients with OSCC admitted to the First Affiliated Hospital of Bengbu Medical University from January 2021 to December 2024 were retrospectively reviewed, including 85 males and 65 females, with a mean age of (59.0±12.6) years. Preoperative cervical IRT data were analyzed, and features such as temperature, texture and vascular morphology were extracted to calculate the differences in features between the affected side and the contralateral healthy side. Analysis of variance (ANOVA) and LASSO regression were used to screen core variables for the construction of a SVM prediction model. All subjects were randomly divided into a training set (105 cases) and an internal test set (45 cases) at a ratio of 7∶3, and propensity score matching (PSM) was performed to balance the baseline characteristics of the training set. Ten-fold cross-validation was used to optimize the model hyperparameters. A total of 30 prospectively recruited OSCC patients were included as the independent validation set. The diagnostic performance of the model was assessed in both the internal test set and independent validation set, and the diagnostic efficacy was further compared with contrast-enhanced computed tomography (CECT). Results: Five variables were ultimately selected for modeling: clinical T stage, primary tumor location in the hard palate, maximum temperature difference (ΔTmax), contrast difference (ΔContrast), and depth of invasion (DOI)>10 mm. In the test set, the SVM model achieved an accuracy of 84.4%, sensitivity of 91.7%, specificity of 76.2%, and an AUC of 0.931. In the prospective validation set, it showed an accuracy of 83.3%, sensitivity of 88.9%, specificity of 75.0%, and an AUC of 0.852. Compared with CECT, there was no statistically significant difference in diagnostic efficacy (χ2=0.115, P>0.05), and the SVM model showed potential as an effective auxiliary tool to enhance the diagnostic performance of CECT. Conclusion: The combination of infrared thermography and an SVM model can effectively predict cervical lymph node metastasis in OSCC, demonstrating high diagnostic efficacy and good clinical applicability. This can serve as a non-invasive auxiliary tool for preoperative assessment of lymph node metastasis status.
