Objective To investigate the choices of the timing and methods of the surgical operation after traumatic injuries to the facial nerve, and to emphasize the importance of the excision of perineauial scar,technique of microsurgery with no injuries and the methods selected for nerve coaptation according to the morphologic feature of the injuried nerve.Methods From December 1993 to November 1997, by microsurgical technique, seven cases with traumatic injuries to the facial nerve were treated in two stages from three months to four months after the trauma. Different methods were used including facial nerve anastomosis and implantation of the sural nerve transplant into the muscle. Results All cases have been followed up for six months to two years. The results of functional rehabilitation were excellent. Conclusions Whenever possible, the authors emphasize that the early repair with microsurgical technique should be performed to all of facial nerve with injury. Facial nerve anastomosis is the best choice for repair of early facial nerve severance. Implantation of nerve transplant into muscle has a certain clinical value of and the indication for the treatment of nerve injury.

BACKGROUND: Facial nerve injury causes facial nerve paralysis (or facial palsy) and even results in psychosocial disturbances of the patients. Repair the injured facial nerve and reconstruction of the nerve function as early as possible have been the primary concern in clinical studies.OBJECTIVE: To investigate the timing and surgical approaches for repairing facial paralysis in order to provides evidences for its therapeutic and prognostic evaluation.DESIGN: Case analysis based on patients.SETTING: Hospital of Plastic Surgery of Chinese Academy of Medical Sciences.PARTICIPANTS: Nine patients with traumatic facial paralysis hospitalized in the Hospital of Plastic Surgery of Chinese Academy of Medical Sciences from December 1993 to November 2001.METHODS: Facial nerve anastomosis was performed microsurgically along with the implantation of the sural nerve graft into orbicular muscle of the eye 3 or 4 months after nerve injury in the 9 patients. The clinical data of the patients were retrospectively reviewed.MAIN OUTCOME MEASURES: The facial nerve function was evaluated with House-Brackmann scale and photographs of the patients' faces before and after surgical treatment were taken.RESULTS: In the follow-up of these patients lasting 6 months to 2 years,all the patients attained satisfactory outcome.CONCLUSION: Early operation is crucial for the treatment of traumatic facial paralysis,with facial nerve anastomosis as the primary choice. The implantation of the nerve graft into muscle is also indicated for repairing traumatic facial paralysis in some cases. The importance of individualized treatment choice is reiterated on the basis of cicatrectomy and the extent and specific features of the injury.

Objective:To investigate the clinical features, operative approach and method of petrous apex chol-esteatoma, to improve the effect of operation and to reduce surgical complications. Method:Two cases of patients with giant petrous apex cholesteatoma were treated by trans labyrinth approach,one of which was successfully operated with oto-endoscope-assisted surgery. Result; No cerebrospinal fluid leakage, infection, vertigo or disequilibrium was found in the two cases after operation. Conclusion:Temporal CT and MRI are of great importance in clinical diagnosis and choice of surgical approach. Surgery by trans-labyrinth approach paves way for removing cholesteatoma thoroughly, dealing with facial nerve and repairing cerebrospinal fluid leakage. Surgery is considered to be the only way to cure petrous apex cholesteatoma, while the key procedure to prevent recurrence lies in complete removal of lesion, long-time strict follow up and regular clearance of the surgical field.

Objective To investigate the diagnosis value of immunophenotype and karyotypes in newly diagnosed chronic lymphocytic leukemia (CLL).Methods To retrospect the flow cytometry (FCM) immunophenotype and karyotypes characteristics in newly diagnosed 70 CLL cases.Results In all cases,the positive rates of CD19,CD20,CD5,CD23,CD22 were 100 ％,88.5 ％ (54/61),77.1％ (54/70),67.6 ％ (23/34)and 51.9 ％ (27/52),respectively.And 6 were misdiagnosed,2 was CD+5CD+19(+),but CD20,CD22 were strongly positive,final diagnosed as mantle cell lymphoma (MCL) by FISH t(11;14) examination and CyclinDl; CD+5CD+19(-) CLL were 16 cases (22.9 ％),but 4 were misdiagnosed,the misdiagnosis rate was 25 ％,significantly higher than that of CD+5CD+19(-) CLL (P =0.030).59 cases were examined by conventional cytogcnetic (CC),and 13 cases were with abnormal karyotypes,positive rate was 22.0 ％,with complex karyotypes in 5 cases (8.5 ％); 10 cases combined with FISH abnormalities karyotype examination rate was 60 ％.Conclusion Typical CLL immunophenotypic characteristics were CD5,CD19,CD23 co-expression,and CD－5 CLL with higher misdiagnosis rate,combined with CD20 (,) CD22 expression and karyotype analysis helps to CLL and other B lymphoid proliferative diseases (B-LPD) identification.Conventional cytogenetic detection combined with FISH scan can improve the recognition ability of abnormal chromosome.

OBJECTIVEOn the basis of the concept of adhesive deformity from upper eyelid fold formation, the clinical results after using various methods to correct the adhesive deformities are summarized.

METHODSA total of 33 cases of adhesive deformity from upper eyelid fold formation have been treated using various corrective methods including taking off the sutures, shifting of the septal fat or the pre-septal orbicularis muscle, transferring of pretarsal orbicularis muscle, grafting of autogenous fat tissue, and repairing or/and shortening of the palpebral levator. Postoperative follow-up ranged from 3 months to 2 years.

RESULTSThe effective results have been got with the used methods except shifting of the pre-septal orbicularis muscle or transferring of pretarsal orbicularis muscle.

CONCLUSIONSThe suitable methods to correct the adhesive deformity from upper eyelid fold formation must be chosen according to the causes and the local situations.

Adult ; Eyelids ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Treatment Outcome

OBJECTIVE: To investigate the clinical features, operative approach and method of petrous apex cholesteatoma, to improve the effect of operation and to reduce surgical complications. METHOD: Two cases of patients with giant petrous apex cholesteatoma were treated by trans labyrinth approach, one of which was successfully operated with oto-endoscope-assisted surgery. RESULT: No cerebrospinal fluid leakage, infection, vertigo or disequilibrium was found in the two cases after operation. CONCLUSION Temporal CT and MRI are of great importance in clinical diagnosis and choice of surgical approach. Surgery by trans-labyrinth approach paves way for removing cholesteatoma thoroughly, dealing with facial nerve and repairing cerebrospinal fluid leakage. Surgery is considered to be the only way to cure petrous apex cholesteatoma, while the key procedure to prevent recurrence lies in complete removal of lesion, long-time strict follow up and regular clearance of the surgical field.
Cholesteatoma ; diagnosis ; diagnostic imaging ; surgery ; Endoscopy ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Petrous Bone ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: To explore the effective treatment regimen for osteoradionecrosis of temporal bone. METHOD: Twenty-seven patients with massive osteoradionecrosis in temporal bone were included and retrospectively analyzed, in which, 15 cases received surgery and the other 12 cases adopted non-surgical treatment. RESULT: In the surgery group, three cases died one year postoperatively and died of massive hemorrhage due to internal carotid blowout. One case died four years after surgery without clear cause of death, and two cases were lost to follow up. Out of the nine survivors, the follow up period ranged from four months to eight years (one was followed up eight years, one was followed up over four years, four were followed up two-three years, one was followed up over one year, one was followed up nine months, and one was followed up four months, respectively). Patients classified as the type III received best outcome, and patients of type V and IV without invasion of the internal carotid artery received good surgical effects, while patients classified as the type IV with internal carotid artery invasion presented low survival rate. Two cases in the non-surgical group died of internal carotid rupture, and the other ten cases presented with repeated infection and expansion of the osteoradionecrosis lesion. CONCLUSION The new classification criteria is helpful in diagnosis of location of lesions,and can serve as a guide for clinical therapy. Massive osteoradionecrosis in temporal bone responded unfavorably to conservative treatment, compared to that, surgery can effectively control the expansion of the lesion and markedly improve patient quality of life. Long-term follow up is necessary because of the slow development of osteoradionecrosis after surgery.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; classification ; pathology ; surgery ; Osteoradionecrosis ; classification ; pathology ; surgery ; Retrospective Studies ; Temporal Bone ; pathology