Objective:To evaluate the effectiveness of the anterolateral thigh flap in reconstruction for the tissue defects of hypopharyngeal and cervical esophageal tumor resection.Method:Retrospective review of two clinical cases who underwent pharyngoesophageal reconstruction with the anterolateral thigh flap after tumor ablation.Result:No flap failure, fistula and stricture occurred in two patients.Two patients tolerated a regular diet.An esophageal voice was progressively acquired with the help of speech therapy.With followup for 16 and 41 months two patients were alive without tumor evolution.Conclusion:The higher success rate,lower complication,quick recovery,made the anterolateral thigh flap interposition is the ideal choice for pharyngoesophageal reconstruction.

Objective:To study the clinical features of histiocytic necrotizing lymphadenitis. Method: Eleven pa-tients with histiocytic necrotizing lymphadenitis were collected to analyze the clinical features, pathological features of biopsy lymph nodes,diagnosis and treatment. Result:Lymph node swelling of neck and persistent fever were de-tected in all patients. The leukocyte reduction and swiftness of ESR in serum were detected in most patients. The final diagnosis of histiocytic necrotizing lymphadenitis was confirmed by biopsy investigation of the pathology. The pathological features included distinctive necrosis, loss of lymph node structure, infiltration with histiocytes and lymphocytes, absence of neutrophils. All patients were treated with glucocorticoid for 2 to 4 months. The patients improved significantly and were not recurrence during follow up visit. Conclusion: There was no specific clinical manifestation of histiocytic necrotizing lymphadenitis and which easy to misdiagnose. Diagnosis of histiocytic ne-crotizing lymphadenitis relies on the pathological examination of enlarged lymph nodes.

Objective:To investigate the imaging and clinical feature of leukoencephalopathy with hearing loss first complaint.Method:The head MRI and clinical feature of 7 cases leukoencephalopathy with hearing loss first complaint were retrospectively analysed,including their place,shape,range and blood plasma very-long-chain fatty acid(VLCFA).Result:The head MRI of 2 cases shows symmetry distributed long T_1 and T_2 signal like butterfly aliform in white matter beside both cornu posterious ventriculi lateralis.The head MRI of 5 cases shows abnormal long T_1 and T_2 signal in different part in Alba.The pathological changes often located in white matter of frontal lobe and secondly beside both eornu posterious ventriculi lateralis.The shape shows little patching in 7 cases.The range only shows beside cornu posterious ventriculi lateralis in 2 cases.The range only shows in frontal lobe in 1 cases.Two or more than two parts shows in the rest 5 cases.The result of VLCFA is normal in 3 cases.The rest 4 cases refused to have examination of VLCFA. Conclusion:The patient who firstly complained of hearing loss should be routinely done head MRI.The head MRI imaging could clearly show abnormal white matter in order to avoid omitting existent pathological changes.

Objective:To analyze the result of smooth pursuit test(SPT) in unilateral vestibular peripheral vertigo and investigate its influencing factors.Method:Smooth pursuit test (SPT) and spontaneous nystagmus (SN)were examined in one hundred and eighty-five patients with unilateral peripheral vertigo(case group) and 51 normal persons(control group) by Video-Nystagmography (Synapsys, France), and the gain of SPT and SN were selected as the observation parameters in order to analyze the waveform and gain of SPT and the relativity between SN and the gain of SPT.Result:Of the 185 patients, 105(56.8%),72(38.9%) and 8(4.3%) cases producedⅠ,Ⅱ and Ⅲ waveforms respectively. Of these patients, 58(31.4%) demonstrated SN and none had Ⅳ waveform. While of 51 normal persons, 38(74.5%), 13(25.5%) persons producedⅠand Ⅱwaveforms repectively and there were no Ⅲ, Ⅳ waveforms or SN. There was statistical significance between the stong and weak gain of SPT in these two groups. Weak gain was significantly different between two groups. The stong and weak gain of SPT in case group were 0.86±0.06,0.80±0.06; 0.78±0.09, 0.65±0.1; 0.68±0.13, 0.45±0.12. The relativity between SN and the gain of SPT was positive when they had same direction(r_s=-0.63,P＜0.05)and negative when opposite (r_s=0.34,P＜0.05).Conclusion:Ⅰ,Ⅱ,Ⅲ three waveforms of SPT could appear in unilateral vestibular peripheral vertigo and the corresponding gains are gradually decreasing.SN is the influencing factor of SPT.

Objective:To develop and evaluate the improved Chinese hearing questionnaire for school children(CHQS)for mass epidemiology study on hearing impairment in China.Method:Using the probability proportion to size(PPS) method, 8 412 residents were investigated in 40 clusters in Jiangsu province with the WHO ear diseases and hearing disorders survey protocol.87.9% of the residents aged 7 years and over answered the questionnaire and accepted the pure tone audiometry.Result:The prevalence of hearing impairment was 12.9% by the questionnaire. Compared with golden standard(pure tone audiometry), Sen=58.5%, Spe=96.7%, PV+=78.9%, PV-=91.7%, overall accuracy=90.0% . The sensitivity for women was higher than men.Conclusion:The questionnaire produced high efficiency and specificity values.It could be used in mass hearing screening, particularly in remote and rural area, although the sensitivity was as low as most questionnaires.

Objective:To evaluate the clinical advantage and disadvantage of anatomical landmark registration(ALR) and surface registration(SR) in computer-assisted endoscopic sinus surgery(CAESS).Method:Twenty-six patients were selected for the CAESS, the preparatory times and mean target registration errors (TRE) were recorded in order to compare the difference between them two, their convenience and their value were also analyzed.Result:CAESSs were successfully used in 26 cases without complications. The average preparation time of SR was(8.5±1.9)minutes, that of ALR was(6.5±1.7)minutes. In the SR group, the TRE of naso-labial angle was(1.43±0.26)mm, that of front end of middle turbinate was(1.92±0.47)mm, that of front end of inferior turbinate was (1.82±0.49)mm, and that of back end of inferior turbinate was (2.03±0.42)mm. Them in ALR group were (1.58±0.35)mm,(2.05±0.37)mm,(1.92±0.31)mm and (2.48±0.64)mm ,respectively.24 cases (92.2%) were not affected or were slightly affected by the navigation system. The value of navigation was affirmative in 22 cases (84.6%), and its value was mainly related to TRE.Conclusion:The accuracy of surface registration was superior to that of anatomical landmark registration, but the anatomical landmark registration was more convenient and need less preparation time. The value of navigation system is its accuracy, convenience and no disturbance to surgery. The navigation system is more valuable in the complex cases than that in the general case.

Objective:To evaluate the clinical effect of laryngofissure without tracheotomy.Method:One hundred and sixteen cases of laryngofissure without tracheotomy in our department were analyzed retrospectively.Result:Of 116 cases, 101 cases had the laryngeal carcinoma; 9 cases had laryngeal stenosis; 6 cases had benign tumor of larynx. All the incisions were healed by first intention; and postoperative duration of hospital stay were 7 to 20 days. Three cases recurred in 101 cases of laryngeal carcinoma (2.97%), and underwent reoperation,the 5 year survival rate was 100%. One case recurred in 9 cases of laryngeal stenosis, and underwent reoperarion of laryngoplasty with T-tube implanted. No recurrence in 6 cases of benign tumor of larynx.Conclusion:Laryngofissure without tracheotomy have the advantage of less trauma , fast rehabilitation and no destroying the normal respiratory functions. It is completely feasible so long as surgeons grasp the adaption of operation strictly and select suitable cases.

Objective:To investigate the reason for the adhesion of vocal cord after CO_2 Laser laryngeal surgery.Method:One hundred and nineteen patients who were untaken CO_2 Laser laryngeal microsurgery.Result: Among 119 cases,9 cases of bilateral vocal cord paralysis, 42 cases of vocal cord polyps and 3 cases of precancerous laryngeal lesions did not show vocal cord adhesion after CO_2 Laser laryngeal microsurgery.Contrarily, one of 5 cases with laryngeal stenosis, 5 of 41 cases with laryngeal papilloma and 6 of 19 cases with laryngeal carcinoma shew the adhesion of vocal cord after CO_2 Laser laryngeal microsurgery.Conclusion:Through selecting the appropriate patient and surgery spot, processing correctly during and after surgery, using the suitable dosage of laser and reducing the heat radiation, the adhesion of vocal cord can be avoided after CO_2 Laser laryngeal surgery.

Objective:To study the expression of SKP2 and MRP-1/CD9 protein in glottic cancer and adjacent tissues,and to analyze its significance for a safe surgical margin.Method:Thirty-eight cases of glottic squamous cell carcinoma were studied for its cancer tissue, tissue 2 mm, 5 mm , and 10 mm away from cancer ,and 10 cases of vocal cord polyp were served as control. SKP2 and MRP-1/CD9 protein were examined by immunoh istochemical method.Result:The positive expression of SKP2 proteins decreased in sequence of polyp mucosa, those adjacent to carcinoma (10 mm, 5 mm, 2 mm ) and cancer tissue, and there was significant difference between them(P<0.05);On the contrary, the positive expression of the MRP-1/CD9 proteins increased in sequence of polypusmucosa, those adjacent to carcinoma (10 mm,5 mm, 2 mm) and cancer tissue,and there was significant difference between them (P<0.05).Conclusion:SKP2 and MRP-1/CD may act as the reference index for judging the biological speciality of LSCC. It is appropriate to regard 5 mm or above 5 mm away from tumors as a safe margin for surgical treatment of glottic carcinoma.

Objective: To investigate the relationship between the pathogenesis of sudden sensorineural hearing loss (SSHL) and the disorder of blood circulation in inner ear. Method :Blood dynamics of the ophthalmic artery were studied quantitatively using color doppler imaging in 34 patients with SSHL. Result:Compared with 34 self-controls and 15 normal controls, 28 patients (82.4％) with SSHL had significantly lower blood flow velocities and higher resistance indices (P＜0.05),and there was no significant difference between the selfcontrol group and the normal control group (P＞0.05). Conclusion: The study suggested that the blood situations－the decreased blood flow velocities and perfusion and increased resistance of ophthalmic artery in patients with SSHL maybe play a role in the pathogenesis of SSHL.