OBJECTIVES:With the assistance of 3D visualization and real-time navigation technologies, the tumors in the parapharyngeal and lateral skull base should be removed through oral the approach with endoscopy.METHODS:The preoperative CT data of eight patients with parapharyngeal or lateral skull base soft tissue tumors were modeled, and the anatomical position relationship between the tumor and surrounding blood vessels and other important structures was reconstructed using 3D visualization technology, and preoperative design was performed. The intraoperative oral approach and real-time navigation guidance were adopted in the endoscopic resection of soft tissue tumors in the parapharyngeal and lateral skull base, and the clinical application value of this method was evaluated.RESULTS:The blood loss during the operation was controlled within 150 mL, and the average blood loss was approximately 125 mL. The incidence of postoperative complications was low, and patients could recover well through functional training. The oral approach did not leave any wounds nor scars on the patient's facial skin after the operation and had no effect on the patient's appearance.CONCLUSIONS:The combination of 3D visualization technology, intraoperative real-time navigation, and endoscopy provides a beautiful, safe, and minimally invasive surgical method for patients with parapharyngeal or lateral skull base tumors.

Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

目的 制备应用于表面增强拉曼光谱检测口腔鳞状细胞癌组织表皮生长因子(EGFR)表达的特异性纳米探针.方法 通过化学还原法制备纳米Au颗粒,并在表面修饰高分子及EGFR抗体,制备特异性探针.检测特异性探针的光谱性能、细胞毒性,将其应用于小鼠鳞状细胞癌肿瘤组织内EGFR的表达检测,绘制肿瘤组织内EGFR拉曼光谱图像.结果 通过化学还原法可以成功的将高分子巯基苯甲酸(MBA)、α-硫基-ω-羧基聚乙二醇(PEG)及EGFR抗体修饰于纳米Au粒子表面,构建纳米探针.该探针无细胞毒性,可以检测肿瘤组织内EGFR表达情况.结论 MBA、PEG及EGFR抗体修饰的纳米探针可以应用于表面增强拉曼光谱检测口腔鳞状细胞癌肿瘤组织内EGFR表达.

目的 采用多元复合声治疗耳鸣,观察其疗效和安全性.方法收集80例持续时间>6个月的原发性耳鸣患者和40例听力正常且无耳鸣症状的成年人,实验共分为3组:80例耳鸣患者随机分为两组:耳鸣治疗组40例(接受多元复合声治疗)和耳鸣对照组40例(无任何治疗),其余无耳鸣者设为正常对照组.对所有研究对象进行THI评分,并进行耳鸣指导性咨询,观察整个治疗过程中是否存在不良反应,患者临床症状、耳鸣残疾量表(tinnitus handicap inventory,THI)评分有无减轻.结果耳鸣治疗组的多元复合声治疗有效率(78.95％)与耳鸣对照组的有效率(2.7％)相比,差异具有统计学意义(χ2=44.94,P=0.000).耳鸣治疗组中,将治疗前、治疗10 d后、治疗20 d后和治疗30 d后的THI得分比较,差异具有统计学意义(F=219.22,P=0.000),且THI得分逐渐减少.正常对照组中测试前后的THI得分均为0.结论多元复合声治疗持续性原发性耳鸣有效,且耳鸣症状随着疗程而逐渐减轻;多元复合声安全可靠,无不良反应.

目的 应用拉曼光谱及支持向量机技术鉴别诊断口腔黏膜鳞状细胞癌,为拉曼光谱技术的临床应用提供理论基础.方法 收集手术切除口腔黏膜鳞状细胞癌组织56例、上皮重度异常增生组织50例及正常口腔黏膜组织32例,应用拉曼光谱仪进行检测,获取不同组织的特征拉曼光谱.比较不同组织间拉曼光谱谱峰差异,并应用支持向量机技术对光谱数据进行分析,建立鉴别诊断模型.结果 口腔黏膜不同组织间拉曼光谱差异主要集中在640、713、957、1 002、1 077、1 306、1 445和1 653 cm-1等处,主要反映组织中蛋白质、核酸及脂类等生物大分子变化.支持向量机建立鉴别诊断模型的诊断准确率达94.3％～100.0％.结论 口腔黏膜鳞状细胞癌组织、上皮重度异常增生组织及正常口腔黏膜组织间拉曼光谱存在差异,应用支持向量机建立诊断模型可以很好地鉴别诊断不同组织的光谱数据.

Objective To analyze the clinical characteristics and explore the treatment method of Madelung’s disease.Methods The analysis was made on the clinical manifestations, CT imaging examination, diagnosis, treatment, and prognosis of 1 patient with Madelung’s disease, along with literature review. Results The manifestations of the patient were diffuse fatty mass in the upper body, neck deformity, restricted motion, drinking habit, and several internal medicine diseases, such as alcoholic liver disease, hypertension, hyperuricemia, and hypothyroidism. After surgery and medical treatment, the patient recovered well without recurrence and malignant transformation. Conclusion The CT imaging of Madelung disease shows the feature of accumulated fat deposited at subcutaneous sites of the anterior or posterior of the neck, the lower occipitalia and the upper back. The density and signal intensity of the excess fat are similar as normal fat. Comprehensive treatments can be applied for the treatment including temperance, combination liposuction and lipectomy, and active medical therapy. That can benefit patient’s outlook, decrease the recurrence and complications, and get favourable prognosis.

OBJECTIVE To evaluate the hearing characteristics of children with cleft palate,by comparing their hearing examinations with that of normal children.METHODS 60 children with cleft palate(120 ears) and 76 normal ones(152 ears) were performed both the brainstem auditory brainstem response(ABR) and acoustic impedance test.RESULTS Significant higher ABR thresholds were observed among the cleft palate children less than 1 year old,compared with that of 1-2 years or 2-6 years old cleft palate patients(S =5.927,S =6.020 respectively,P0.05).The cleft palate children showed significant higher ABR thresholds(t =8.588,5.436,7.003,P 0.001) and longer latencies of I,III and V peaks compared with normal children of the same ages(t =9.388,4.727,2.398 in 1 year group;t =5.386,6.218,5.255 in 1~2 years group;t =7.038,7.282,7.308 in 2-7 years group;P 0.05).There were mild and moderate hearing loss in the high frequence of children with cleft palate,but no severe or extreme hearing loss.A statistic difference(χ 2=14.20,P0.01) was observed in constituent ratio of hearing loss degree.Among three different age groups of the cleft palate children(≤1,1-2 and 2-6 years old),no statistic differences(P 0.05) were observed in abnormality rate of threshold,tympanogram,and acoustic stapedius reflex,as well as prevalence of secretory otitis media.CONCLUSIONSecretory otitis media should be considered in the preschool children with cleft palate when the following symptoms occur simultaneously:tympanogram curves are B or C type;acoustic stapedius ref lex disappears;the auditory threshold in the ABR test increases mildly or moderately;the latency prolongation of peak I,III,V and no interpeak latencies prolongation is observed in the ABR test.So it is recommended that cleft palate patients with secretory otitis media need to be performed cleft palate repair and grommet insertion simultaneously.

Objective To explore the value of clinical application about hearing examinations for cleft palate children by analyzing the characteristics of tympanograms,acoustic stapedius reflex and auditory brainstem response (ABR) . Methods 40 cleft palate children (80 ears) were examined for tympanograms,acoustic stapedius reflex and ABR. Results The test results of tympanograms for the 80 ears showed that 37 ears (46. 25%) were B type,10 ears (12.5%) were C type,22 ears (27.5%) were A type and 11 ears (13.75%) were As type. The test results of acoustic stapedius reflex showed that 16 ears ( 20%) had reflex and the other 64 ears (80%) had no reflex. The ABR results showed that 58 ears (72.5% ) had latency prolongation of peak V and 41 ears (51.25%) had hearing impairment. In the 41 ears with hearing defect,21 ears (51.22%) had mild hearing loss and 20 ears(48.78%) had moderate hearing loss. And in the 41 ears, 25 ears were B type and 9 ears were C type. There were no ears examined with severe or extreme hearing loss. Conclusion Anatomic and physiological characteristics of cleft palate children can raise the rate of incidence of otitis media. Secretory otitis media need to be diagnosed when the following symptoms occurre simultaneously: tympanogram curves are B or C type; auditory threshold of peak V in the ABR test was reduced mildly or moderately; and the latency prolongation of peak V is observed in ABR test. Diagnosis of secretory otitis media in time will help the cleft palate patients significantly in their daily lives.

OBJECTIVE:To explore the effect of surgical treatment for compound fracture of nasal bone and frontal process of maxilla with endoscopy and small local incision. METHOD:Twenty-two cases with compound fracture of nasal bone and frontal process of maxilla were treated with surgery, and the postoperative effect were analysed. RESULT:Twenty-two cases healed well. CONCLUSION:CT scan and 3D reconstruction before operation can help the diagnosis. Corresponding incision and assisted endoscopy can make good surgical field and achieve surgical success. Rigid internal fixation is also the key for surgical success.

OBJECTIVE:To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap.METHODS:Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2NIM0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm x 2 cm to 12 cm x 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases.RESULTS:The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8).CONCLUSION:For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.

Objective To summarize the clinical experience of repairing oral and maxillofacial defects with radial forearm free flap. Methods The clinical records of 75 cases received oral and maxillofacial recon-struetion with radial forearm free flap were analyzed. Results Forearm free flap healed well in 74 out of the 75 cases. With the overall success rate of 98.7%. 1 case of failure. That with latero radical neck dissection occurred blood vessel articulo in postop, missed rescue time and flap failure. Conclusion The radial forearm free flap characterized by the anatomical consisteney, ideal thickness, flexibility and long pedicle,is feasible in the recon-struction of soft tissue defects in oral and maxillofacial region.

目的探讨严重口腔颌面外伤中窒息的分型及气管切开术救治的应用。方法分析我科15例严重口腔颌面创伤引起呼吸道阻塞患者的致伤原因、窒息类型和紧急救治中出现的问题,探讨此类病人救治中气管切开的必要性。结果15例患者各种窒息的总体发生率为,吸入性窒息13例,占86.7%;脱位性窒息12例,占80.8%;狭窄性窒息9例,占60.0%;阻塞性窒息6例,占40.0%。其中4种窒息类型并存者5例,占33.3%;2种以上窒息类型并存者14例,占93.3%;均实施气管切开术,成功救治14例,死亡1例,抢救成功率93.3%。结论严重口腔颌面创伤常出现两种以上的复合窒息因素,早期实施气管切开术是救治成功的关键。

目的:通过大量临床病例的观察,探讨难治性咽异感症的病因。方法:对260例难治性咽异感症患者,行耳鼻咽喉常规检查及纤维鼻咽喉镜、纤维食管胃镜、副鼻窦CT、茎突X线摄片、颈部和甲状腺B超等检查以及相关治疗。结果:260例患者中,患返流性食管炎110例(42.31%),慢性鼻窦炎48例(18.46%),更年期综合征25例(9.62%),慢性扁桃体炎17例(6.54%),疑癌症10例(3.85%),亚急性甲状腺炎和甲状腺肿瘤6例(2.31%),茎突过长症3例(1.15%),其他41例(15.87%)。所有患者根据检查结果行病因治疗,随访6个月,有效率达84.62%。结论:咽异感症病因较多,应重视返流性食管炎、慢性鼻窦炎等,特别是返流性食管炎与咽异感症关系密切。

目的 探讨纳米炭混悬注射液在口腔鳞癌颈淋巴清扫术中的指导作用.方法 术前对45例口腔鳞癌患者肿瘤边缘黏膜下注射纳米炭混悬液,术中根据淋巴结黑染情况作为标记来指导颈淋巴结清扫术.结果 术中可见颈淋巴结有广泛不同程度的黑染,术后病理证实注碳组黑染及未黑染的淋巴结转移比率无显著差异.注碳组平均每侧颈部清扫43.5个淋巴结,对照组平均29.5个淋巴结,有显著性差异(P<0.01).结论 术前肿瘤周围黏膜下注射纳米炭混悬液对口腔鳞癌颈淋巴清扫术有指导意义.

1资料与方法 1.1临床资料 2004-01～2006-12门诊就诊的咽异感症患者800例中病程在6个月以上,且半年来门诊就诊3次以上者260例,男90例,女170例,年龄23～68岁,平均40.2岁.所有患者主要症状为咽部阻塞感、紧缩感、压迫感、烧灼感、梗阻感、异物感等,常位于舌骨至胸骨上窝咽中线上或偏于一侧.本组病例不包括咽喉明显病变而容易诊断的患者,如扁桃体角化症、咽旁肿瘤、会厌囊肿、下咽部异物、下咽肿瘤、鼻咽癌、食道癌等.