OBJECTIVE An understanding of the complex anatomy of the anterior skull base is crucial for the surgeon doing endoscopic surgery. The anatomic data of the olfactory sulcus and adjacent structures in Chinese patients were defined using 3-dimensional reconstruction images. The surgeon is encouraged to develop a detailed pre-operative surgical plan by utilizing these dynamic anatomical observations to avoid intracranial injury. METHODS The paranasal sinus CT scanning images of 100 adults were reconstructed for observation using EBW2.0 software and multiplanar reformation. All data obtained were in the coronal plane from the anterior point of the olfactory sulcus. The cribriform plate depth as compared to the ethmoid roof and adjacent structures, was measured bilaterally. Data obtained on adjacent structures include the vertical height of the lateral lamella of olfactory sulcus, the horizontal distance between the cribriform plate and the orbital lamella, the length of the middle turbinate, the height of the orbit, and the vertical distance between the cribriform plate and the nasal floor. RESULTS The olfactory sulcus was classified into three types: platform type (60 %), sloping type (17 %) and mixed type(23 %), as distinguished from Keros classification. In this study the vertical height of the lateral lamella of olfactory sulcus was (5.03 ± 0.17) mm (R) and (5.39 ± 0.19) mm (L) in platform type, and (2.79 ± 0.49) mm (R) and (4.72 ± 0.49) mm (L) in the mixed type. There were statistically significant differences between the right side and the left side in these two types (P＜0.01). The horizontal distance between the cribriform plate and the orbital lamella on the same side was significantly different between the platform type and the mixed type of olfactory sulcus. A similar result was observed for the vertical distance between the cribriform plate and the nasal floor. Gender differences exist in the horizontal distance between the cribriform plate and orbital lamella on the same side and the vertical distance between the cribriform plate and the nasal floor. CONCLUSION Different types of olfactory sulcus have distinct characteristics, hence care which must be taken into account when doing endoscopic surgery.

OBJECTIVE The aim of our study was to evaluate the significance of the frequency of microsatellite instability (MSI) and its relationship to mismatch repair gene (MMR) in laryngeal squamous cell carcinoma.METHODS We investigated the expression frequency and clinical significance of MSI and MMR in 50 laryngeal squamous cell carcinoma (LSCC) patients from Beijing Tongren Hospital. The status of MSI was evaluated using microdissection - polymerase chain reaction (PCR) - single strand length polymorphism (SSLP) - silver staining.Five markers on chromosomes 1p, 3p, 5q, 9p, 17p, which were adjacent to BCAR3 (breast cancer anti-estrogen resistance 3), FHIT, APC, CDKN2A (p16), TP53 respectively, were used. Two of the six components of MMR -hMLH1 and hMSH2- were investigated by an immunohistochemical approach because of the high frequency of their downregulation in head and neck tumors. RESULTS The informative case number of the five markers (D17S796, D3S3544, D5S656, D1S375, D9S162) were 44, 42, 45, 44 and 40 respectively. The incidence of MSI was lower than the frequency of loss of heterozygosity (LOH). The incidence of MSI on D17S796 (TP53)was 20.5% (9/44),on D3S3544 (FHIT) was 14.3 % (6/42), on D5S656 (APC) was 31.1% (14/45), on D1S375 (BCAR3) was 20.5 % (9/44), and on D9S162 (CDKN2A) was 15.0 % (6/40). Though there was no relationship between MSI status and age, gender, smoke history, tumor location, tumor differentiation and T stage (P＞0.05),there was a strong correlation between MSI and relapse condition (P＜0.01). Also, MSI status correlated with MMR expression to some degree (P＜0.01), but it was common for negative and positive staining of MMR to coexist on the same slide. CONCLUSION Microsatellite instability and abnormal mismatch repair may contribute to the carcinogenesis of a subset of laryngeal squamous cell carcinoma. Microsatellite instability may be a characteristic signal of tumor recurrence.

A case of a fibrous histiocytoma (FH) of the larynx in a 54-year-old male is reported. Laryngeal fibrous histiocytoma is uncommon. The case recurred several times over 4-year period. Its pathology is described including arguments on potential malignancy and the way of management.

Two Chinese versions of the Hearing In Noise Test (HINT) were developed for assessing speech understanding ability of Cantonese and Mandarin speakers - the Cantonese Hearing In Noise Test (CHINT) and the Mandarin Hearing In Noise Test (MHINT). A total of 168 subjects with normal hearing thresholds participated in the studies. Sentence materials that represent daily conversational speech were created and recorded. These sentences were equated for difficulty by adjusting their presentation levels in noise. Twelve 20-sentence lists with equal phonemic content were created. Using these lists, Reception Thresholds for Sentences (RTSs), defined as the signal-to-noise ratio at which sentences were repeated correctly 50 % of the time,were obtained. RTSs were measured under headphones in quiet and in three noise conditions. For the noise conditions,speech was presented from the front and noise was processed to simulate origination from the front,the right and the left. The noise was fixed at 65 Db (A) and the speech level was adjusted adaptively. Interlist or test-retest reliability was high,suggesting that consistent results can be obtained using any list. Confidence intervals were measured and reported. Norms obtained using the CHINT and MHINT are comparable to those for the English HINT.

Objective:To evaluate the clinical significance of expression of proliferation cell nuclear antigen(PCNA),P16 and P27genes in adenoid cystic carcinoma of salivary glands.Methods:The expressions of PCNA,P16and P27were detected by immunohistochemical staining (SP)in 55 patients with adenoid cystic carcinoma of salivary glands.Results:The higher and lower expressions of PCNA were 45.5%(19/55) and 65.5%(35/55) respectively;of P16 were 45.5%(25/55) and 54.5%(30/55)respectively.And the positive and negative expressions of P27 were 34.5%(19/55) and 65.5%(36/55),respectively.The correlation of expression of PCNA gene with local recurrence and tumor site showed significant (P=0.0317,P=0.0186);but the expression of P16was no any significant correlation in all of the variables.The expression of P27 was significant on the regional lymph node metastaisis (P=0.0083).When higher expression of P16was 45.5%(25/55),the P27positive expression was 56.0%(14/25),which showed a significant positive correlation (P=0.0025).Conclusion:In adenoid cystic carcinoma of salivary glands,the PCNA gene should be one of the biological target predicting local recurrence,and P27gene should be one of the biological target justifying regional lymph node metastasis.

Objective:To investigate the value of the three-dimensional CT reconstruction by computer photo process system for laryngeal carcinoma and control study with pathologic feature. Methods: Fifty patients with laryngeal carcinoma were scanned by helical CT which photos were three-dimensionally reconstructed with a photo processing system,and the images were compared with pathologic feature.Results:Clear three-dimensional photo of the laryngeal was obtained through the reconstruction of the helical CT.The images could be circular fully around the axis of X,Y and Z in order to find the best view of the diagnosis.Ninety-six percentage of the TNM stage of patients according to the images of three-dimensional reconstruction were consistent with the TNM stage after operation.The safe edge was obtained in 98% of the surgery for patients.Good correlations were showed in the images of the three-dimensional reconstruction of the larynx and pathologic specimens.Conclusion:Good consistent of the three-dimensional images of the larynx with pathologic specimen were useful for diagnosis,operation design and education.

Objective:To evaluate the value of CT findings in the diagnosis of laryngeal carcinoma infiltration extent.Method:The data of comparison of CT findings and clinico-pathologic stages on 61 patients with laryngeal carcinoma were analyzed from 1995 to 1999.There were 58 males and 3 females ,ranging in age from 37 to 83 years old which stages were T1N0M0 in 11,T2N0M0 in 21,T2N1M0 in 9,T2N2M0 in 1,T2N3M0 in 1,T3N0M0 in 10,T3N1M0 in 2,T4N0M0 in 4 and T4N1M0 in 2,respectively.And the supraglottic cancer was 11(18.0%,11/61),glottic cancer 47(77.1%,47/61),transglottic cancer 3(4.9%,3/61),respectively.The CT examination and surgical treatment were made in all 61 patients.Results:The correct rate at CT findings was 91.8%(56/61),and the accurate rate of clinical stage was 73.8%(45/61).These results showed different significance (P＜0.05).Conclusion:The CT findings showed valuable in the diagnosis to infiltration extent of laryngeal carcinoma and clinical significance for surgical treatment of patients with laryngeal carcinoma.

Objective:To study the curative effects of hypopharyngeal carcinoma by treatment of pharyngectomy and repairment surgery.Methods:Sixty-four patients with hypopharyngeal squamous cell carcinoma were treated by pharyngectomy and repaired the defect of pharynx from 1989 to 1995.There were 58 males and 6 females,ranging in age from 37 to 73 years old.There were stages T1 in 3(T1N0M0 1,T1N2M0 2),T2 in 12(T2N0M0 4,T2N1M0 5,T2N2M0 2,T2N3M0 1),T3 in 29(T3N0M0 7, T3N1M0 14,T3N2M0 6,T3N3M0 2),and T4 in 20 (T4N0M0 2, T4N1M0 3,T4N2M0 8,T4N3M0 7).Among 64 patients,26 cases were treated by surgery of laryngeal function preservation (group A,stages T1,2,3),38 cases did not laryngeal function preservation (group B,stage T4).Results:The swallow function was returned to normal in all 64 patients after treatments,and the complications were 26/64(40.6%)most of those was pharyngeal fistula.The rate of decannulation was 53.8%(14/26) in the group A,and the 3-year and 5-year survival rate were 65.4% (17/26) and 50.0% (13/26) respectively. In the group B, the 3\|year and 5\|year surviral rates were 52.6%(29/38)and 44.7%(17/38)respectively.There were no significant differences in the 3 or 5-year survival rate between two groups (P＞0.05).Conclusion:The indications of those procedure of laryngeal function preservation were stages T1,2,3of patients with hypopharyngeal carcinoma,which were no affection on the 3 or 5-year survival rates,and the survival quality of patients were improved.

Objective:To evaluate the effects of modified neck dissection (MND)preserving jugular vein on patients with supraglottic laryngeal carcinoma,the clinical data of 88 cases were analyzed retrospectively.Methods:There were 48 males and 40 females,ranging in age from 37 to 72 years old who were diagnosed supraglottic laryngeal squamous cell carcinoma.The clinical stages were T18,T2 30,T3 28,T4 22,cN1 38,cN2 48,cN3 2;pN0 11,pN1 21,pN2 54 and pN3 2,respectively.Among 146 lateral neck dissections in 88 cases (bilateral 58 cases,one lateral 30 cases),106 were MND,40 being radical neck dissections (RND).Of 106 MND,64 were simultaneously performed bilateral neck dissections (18 cases preserved bilateral jugular veins,14 cases preserved on side jugular veins),52 subsequently bilateral neck dissections(first time was RND ,and the second time was all MND).One side MND was performed in 30 cases,which preserved jugular veins.Results:The 3-year survival rate was 81.5%(22/27)in the simultaneous bilateral neck dissection,60.9%(14/23)in the subsequent neck dissection,75.0%(15/20)in the one lateral neck dissection.The 5-year survival rate was 61.5%(16/26),40.9%(9/22),70.6%(12/17)respectively.The recurrent rate of lymph node postoperative was 12.9%(11/85)in the lymph node less than 3cm in diameter,47.6%(10/21)more than 3cm in diameter.The recurrent rate of lymph node was 22.5%(9/40)in the group of RND,19.8%(12/106)in the group of MND.Conclusions:Because the neck lymph node metastasis often occurred in supraglottic carcinoma,the bilateral neck dissection is necessary during which one side jugular vein must be preserved.Results suggested that if the metastasis lymph node was less than 3cm in diameter and had not adhered to jugular vein,the jugular vein should be preserved,which could lesson complications and get better life quality.

Twenty-four patients with parapharyngeal space tumors were treated from 1964 to 1999.There were 11 males and 13 females,ranging in age from 10 to 71 years old.Among 24 patients, benign tumors were 17(70.8%),malignant tumors 7(29.2%).The diagnosis of these tumors were biopsy and CT scaning .Pathologic results showed that the original tumors were salivary gland tissue in 11(45.8%),cranial nerve in 7(29.2%),vascular tissue in 2(8.3%)and the unidentified in 4(16.7%).The surgical approaches for these tumors were neck side incision in 19,through mouth in 5.Results showed that 4 malignant tumors were died in one year,3 cases did not clear;the prognosis of 17 benign tumors were well.