Objective To study the technique and clinical effect of naso-endoscopic surgery for cerebrospinal fluid(CSF)rhinorrhea.Methods From June 2002 to May 2007,14 patients with spontaneous CSF rhinorrhea and 28 patients with traumatic or iatrogenic CSF rhinorrhea were treated by naso-endoscopy.The CSF fistula was exposed via different surgical routes by naso-endoscopy according the sites of the lesions(including the cribriform plate or fovea ethmoidalis,sphenoid sinus,and frontal recess).Middle turbinate mucosa,fascia lata,and abdominal fat were used to repair the fistulae by using multilayer "underlay","overlay" or "Bath-plug" techniques.Results Thirty-four cases(81.0%)were cured at the first operation,4 were healed at the second attempt,and 4 were treated successfully at the third attempt.The success rate of the first operation in the patients with a fistula orifice larger than 10 mm in diameter was significantly lower than that in the patients who had a fistula orifice less than 10 mm in diameter(53.8%,7/13 vs 93.1%,27/29;?2=6.606,P=0.010).Two patients developed complications after the endoscopy(intracerebral infection in one,and hydrocephalus another),and were cured afterwards.Totally 42 patients achieved a 6-to 36-month(mean,14 months)follow-up,none of them had recurrence during this period.Conclusions Naso-endoscopic surgery is a safe,effective,and microinvasive treatment for patients with CSF rhinorrhea.Measures should be done to prevent and control the complications of the surgery.The outcomes of the treatment depend on the size of the fistula orifice.Autologous fat tissues are recommended for the repair of the fistulae larger than 10 mm in diameter.

Objective To explore the efficacy of nasal septal perferation with three layers of grafts under nasal endoscope. Methods From June 2002 to June 2007,15 cases of nasal septal perforation were repaired by three laryers of grafts using the perpendicular plate of the ethmoid bone or quadrangular cartilage covered by fascia lata of the thigh. The course of the disease ranged from 6 months to 5 years (mean,1.8 years) and the diameter of the perforation ranged from 0.8 to 1.6 cm (mean,1.2 cm). A 1-2 mm new surface was made along the margin of the perforation,and then the nasal septum was separated by means of submucos correction. Afterwards,a perpendicular plate of the ethmoid bone or quadrangular cartilage covered by fascia lata of the thigh was used to form a three-layer graft for seal of the perforation. Then,the nasal cavities were filled with expansive sponge,which was expanded by injecting lyophilized recombinant bovine basic fibroblast growth factor for external use. Results The surface of the graft was completely covered by nasal mucosa in 6 to 12 weeks after the surgery.Afterwords,the patients were followed up for 6 to 12 months (mean,8.2 months),during which no recurrence occurred. Conclusions It is effective to repair nasal septal perforation with three-layer graft under nasal endoscope.

Objective To evaluate the value of endoscopic endonasal approach in the surgical treatment of skull base lesions. Methods From May 2002 to December 2006, 112 patients with skull base lesions were treated by endoscopic endonasal surgery. Among them, 39 cases had cerebrospinal fluid (CSF) leak, 4 pituitary adenoma, 3 meningoencephalocele, 9 sphenoethmoidal cyst, 2 sphenoiditis complicated with ploypi, 12 fungal sphenoiditis, 11 inverted papilloma, 6 nasopharyngeal fibroangioma, 2 ossifying fibroma, 2 fibrous dysplasia, 7 chordoma, 2 craniopharyngioma, 10 squamous cell carcinoma, 1 undifferentiated carcinoma, and 2 papillomatous change. Results Follow-up ranged from 6 to 60 months. All the operations were completed under an endoscope. In 20 cases including 8 patients with squamous cell carcinoma, 1 undifferentiated carcinoma, 7 chordoma, 2 craniopharyngioma, and 2 fibrous dysplasia, the lesion was removed subtotally. In the 39 patients with CSF leak, the lesion was cured after the first operation in 31 patients (79.5%), after the second operation in 4, and the third in 4; the final success rate was 100%. One of the patients with meningoencephalocele showed recurrence complicated CSF leakage 2 months after the operation, and then was cured by re-operation using endoscopy. In the 11 patients with inverted papilloma, 1 had recurrence 11 months after the operation, and was re-treated by lateral rhinotomy. One of the patients who had fungal sphenoiditis developed recurrence 4 month after the operation and received endoscopic endonasal surgery for the second time. One patient who had CSF leak before the operation developed intracranial infections after the endoscopic surgery. Conclusion Endoscopic endonasal surgery is a safe, effective, and minimally invasive approach to treat skull base lesions. Clinicians should understand the operation indications precisely, especially for malignant tumors.

OBJECTIVE: To investigate the treatment for benign tumor of external auditory canal by carbon dioxide laser under microscope. METHOD: Ten cases of benign tumor of external auditory canal were treated by carbon dioxide laser under microscope. The curative effects and complications were observed. RESULT: Ten cases of benign tumor of external auditory canal were satisfied after operation without any complications. There were no recurrences during 3 months to 2 years of follow up. CONCLUSION The operation for benign tumor of external auditory canal by carbon dioxide laser under microscope was easy, safe and effective.
Ear Canal ; pathology ; Ear Neoplasms ; therapy ; Humans ; Laser Therapy ; methods ; Lasers, Gas ; Microscopy ; Neoplasm Recurrence, Local ; Neoplasms

OBJECTIVE: To investigate the clinical feature, diagnosis and endoscopic surgery of choanal polyps (CP) from posterior ethmoid sinus. METHOD: Eleven cases with CP from posterior ethmoid sinus treated by endoscopic endonasal surgery between January 2002 to June 2007 were retrospectively reviewed. Clinical manifestation, intranasal and intrasinus lesions, methods and attentions of endoscopic surgery and therapeutic effects were analysed. RESULT: All cases were treated by endoscopic surgery and CP were found originated from posterior ethmoidal ostium. Lesions in posterior ethmoid sinus included 3 (27.3%) cyst, 5 (45.4%) polyp and 3 (27.3%) mucosal edema. No operation complications were observed. The follow-up period ranged from 6 months to 3 years (mean 1.2 years) and no recurrence was founded. CONCLUSION Most of CP originated from posterior ethmoidal ostium and its formation might be related to the cyst in the sinus. Endoscopic surgery represents a minimally invasive and highly successful procedure, complete removal of CP and lesions in the sinus can reduce the recurrence.
Adult ; Endoscopy ; Ethmoid Sinus ; pathology ; Female ; Humans ; Male ; Nasal Polyps ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Young Adult

OBJECTIVE: To evaluate the effect of over-under myringoplasty technique on repairing tympanic membrane perforation regarding with the rate of perforation closure, the frequency of postoperative complications occurrence and the level of hearing improvement. METHOD: In this retrospective study, a total of 74 patients (77 ears) underwent myringoplasty and had been followed up for over 6 months, which was performed by means of the underlay technique in 44 patients (45 ears) and over-under technique in 30 patients (32 ears) from Jan 2002 to Jan 2007. In the underlay group, the grafted membrane was placed medial to the remaining drum and the manubrium of the malleus. In the over-under group, the grafted membrane was placed under the remaining drum and over the malleus. Comparatively evaluate the effect of the underlay technique and that of the over-underlay technique on repairing tympanic membrane perforation. RESULT: The rate of perforation closure and hearing improvement in the underlay group of 45 ears was 89.0% and 57.5% respectively, while that in the over-under group of 32 ears were 87.5% and 71.9% respectively. The air-bone gap decreased by 4.9 dB in the underlay group, while it decreased by 9.7 dB in over-under group. After more than 6 months of following-up, the frequency of postoperative atelectasis of the underlay group and the over-under group was 17.8% and 6.25% respectively. Meanwhile, the frequency of postoperative reperforation of these two groups was 5.9% and 6.25% respectively. Blunting of the anterior angle of the tympanic membrane occurred in 3 ears in the over-under group. Lateralization of the graft was not observed in either group. CONCLUSION Over-under technique could reduce the occurrence of the adhesions between the grafted membrane and promontorium tympani by placing the grafted membrane between the remaining drum and the malleus. Furthermore, the level of hearing improvement in over-under group was higher than that in underlay group. Over-under myringoplasty is a more effective technique as comparison to underlay myringoplasty for repairing middle to large tympanic membrane perforations.
Adolescent ; Adult ; Hearing ; Humans ; Middle Aged ; Myringoplasty ; methods ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; surgery ; Young Adult