Humans ; Otorhinolaryngologic Surgical Procedures ; instrumentation ; Postoperative Period ; Salivary Glands ; surgery

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Chin ; surgery ; Facial Injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Young Adult

Adolescent ; Adult ; Fistula ; congenital ; Humans ; Male ; Pyriform Sinus

OBJECTIVE: To assess the feasibility, risks and advantages of endoscope-assisted second branchial cleft cyst (SBCC) resection via the retroauricular hairline approach (RHA) by comparing with conventional trans cervical approach. METHOD: Using prospective clinical controlled study, in twenty five patients with SBCC, 13 cases underwent endoscope-assisted resection via the RHA, 12 cases underwent conventional transcervical approach resection. Preoperatively, the sizes, locations and adjacency of all lesions were evaluated by ultrasonography, CT or MRI. Pathologic diagnoses of all cases were identified as SBCC using fine needle aspiration biopsy. Two groups were compared at length of incision, operation time, bleeding, incision cosmetic result, complication etc. RESULT: All 25 operations were successfully performed. Length of incision and operation time in endoscopic group were significantly longer than that of the transcervical group (P < 0.05). After three months, the mean subjective satisfaction score of incision scar in the endoscopic group was significantly higher than that of transcervical group (P < 0.01). In endoscopic group, 1 cases (7.7%) with temporary numbness of earlobe and 1 case (7.7%) with a darkened color change of the flap margin at the incision angle were found postoperatively. However, they were recovered within 1 month. All the 25 patients were disease free with a follow-up from 18 to 36 months (median follow-up: 26 months). CONCLUSION Endoscope-assisted SBCC resection via RHA is feasible and safe for the treatment of SBCC. In comparison with the transcervical approach, this method can provide an invisible incision and better cosmetic re suits without significant complications.
Adolescent ; Adult ; Branchioma ; surgery ; Endoscopy ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVE: To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach (EASPRHA) and assess its feasibility and safety. METHOD: The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers (30 halves). The EASPRHA was performed on 5 human cadavers (10 halves). After the procedure, the related vascular and neural structures were evaluated. RESULT: The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia. On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve, the great auricular nerve and the external jugular vein. The bifurcation of great auricular nerve is(22.85 ± 2.01) mm from the bottom of earlobe. The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma. The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process, passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle, and enters the parotid gland. The bifurcation of facial nerve trunk is (19.10 ± 3.10)mm from the mastoidale and (39.49 ± 5.78) mm from the mandibular angle. Above the posterior belly of digastric muscle, the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk. In all endoscope-assisted operations, the partial superficial parotidectomy was successful without the need for an additional incision. No major neurovascular damage wasobserved. CONCLUSION A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.
Cranial Nerves ; anatomy & histology ; Endoscopes ; Endoscopy ; methods ; Facial Nerve ; anatomy & histology ; Fascia ; Feasibility Studies ; Humans ; Male ; Neck Muscles ; anatomy & histology ; Parotid Gland ; anatomy & histology ; surgery

OBJECTIVE: To evaluate the modified rhytidectomy incision in superficial parotidectomy. METHOD: Thirty-five patients with superficial parotid tumor were included in this study. A modified rhytidectomy incision often used in facial plastic surgery was used for superficial parotidectomy and subtotal superficial parotidectomy with preservation of facial nerve and great auricular nerve. The follow-up study included the exposed region, the cosmetic effect of this approach and the rate of complication. RESULT: All patients healed without salivary fistula, and were satisfied with this modified approach. Temporary paralysis of the marginal mandibular branch of facial nerve were found in five patients, and six patients felt insensible around earlobe after operation. They all recovered in 1 to 3 months after surgery, no recurrence was happened during follow-up in 36 to 60 months (median follow-up period was 48 months). CONCLUSION The modified rhytidectomy incision provided good exposure, had less complication and better cosmetic outcome.
Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parotid Neoplasms ; surgery ; Rhytidoplasty ; methods ; Young Adult

Objective To investigate the image features of congenital pyriform sinus fistula (CPSF). Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray (BSX), CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group (≤14 years old) and older age group (>14 years old). Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted from the pyriform. The overall PDR of BSX was 74.6%(47/63),wherein 46.2%(12/26)in young age group , 94.6%(35/37)in older age group, 52.9%(9/17) in inflammatory stage group ,and 82.6%(38/46)in quiescent stage group. The inter-group differences were statistically significant (χ2 were 18.911 and 5.766,both P<0.05). The PDR of CPSF with CT was 85.7%(36/42), MRI was 84.4%(27/32), BSX+CT was 87.5%(35/40). The courses of fistula or sinus were showed on CT and MRI. The presence of air bubbles at the inferomedial edge of cricothyroid joints or around the upper lobe of the thyroid gland, the changes of the morphology of thyroid grand as well as the inflammatory change along the fistula region were detected much clearly on CT and MRI. There was no statistical difference between CT and MRI groups(P>0.05).Conclusions BSX could be a screening method for suspected cases of CPSF in quiescent stage. However, the PDR could be affected by many factors (age and inflammation). CT and MRI could provide valuable information for diagnosis. An examination combined BSX and CT is preferred to improve the positive detective rate of CPSF.

OBJECTIVE: To summarize the clinical repairment experience of postoperative skin defects in head and neck cutaneous tumor. METHOD: From July 2002 to September 2006, 24 patients with head and neck cutaneous tumor were treated in our department. Every specimen and resection margin of all cases were monitored by intraoperative frozen section. Extents of operative skin defects were from 1.0 cm x 1.5 cm to 3.0 cm x 3.5 cm, all of which were repaired by rhomboid flap. RESULT: All the cases were primarily repaired, and followed up 6 month to 3 years. The repaired skins had the normal colour, without obviously scars or secondary deformations. CONCLUSION The rhomboid flap is reasonably designed, conveniently procured and manipulated. It is a better method to immediately repair the head and neck skin defects after radical excision of tumor.
Adult ; Aged ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin Neoplasms ; surgery ; Skin Transplantation ; methods ; Surgical Flaps

OBJECTIVE: To study the management of basic parameters related to individual piston shaping on malleostapedotomy by MDST 3D reconstruction and microanatomy and to assess the accuracy of MDST method. METHOD: Ten Chinese temporal bones without ear diseases were numbered randomly and scanned by GE Light Speed Ultra 64 rows of spiral CT. 3D structure of ossicular chain were reconstructed by MPR and VR methods in AW4. 1 workstation. Then measurements of distances between stapes head to stapes footplate (A line), and manubrium to stapes head (B line), and manubrium to stapes footplate (C line), angle between line A and line B (angle AB) are completed. After that, all samples of temporal bone were undergone canal wall down mastoidectomy under microscope and the relevant measurements were completed. RESULT: The MPR and VR technique of MDCT reconstructed ossicular chain clearly, and revealed the spatial relationship between every structure stereoscopically. Respectively, lengths of A, B, C line by MDST and microanatomy are (3.42 +/- 0.86) mm and (3.60 +/- 0.94) mm, (3.42 +/- 0.80) mm and (2.96 +/- 0.42) mm, (5.86 +/- 0.60) mm and (6.22 +/- 1.10) mm, while angle AB (141.05 +/- 30.07) degrees and (144.57 +/- 41.86) degrees. There are no statistically significant differences between two groups (P>0.05). CONCLUSION The MPR and VR technique of MDCT can clearly reconstructed the 3D shapes of the temporal bone and finish the exactly managements on A, B, C lines and AB angel which is crucial for shaping a individual piston on malleus-to-oval window surgery.
Adult ; Ear, Middle ; anatomy & histology ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Malleus ; anatomy & histology ; surgery ; Stapes ; anatomy & histology ; diagnostic imaging ; Temporal Bone ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed

OBJECTIVE: To evaluate the role of selective neck dissection in the treatment of recurrent branchial anomalies. METHOD: The clinical data of 18 patients with recurrent branchial anomalies were retrospectively analyzed. In accordance with the embryologic and anatomic features of branchial anomalies, different types of selective neck dissection were applied. With dissection and protection of important vessels, nerves and other structures, enbloc resection principles were applied to extirpate branchial lesions, scarrings and inflammatory granuloma during the operation. RESULT: Of all 18 patients, 16 cases were healed with primary healing, 2 cases with local incision infection were healed after dressing changes. A temporary facial nerve paralysis occurred in 1 case with recurrent first branchial cleft fistula postoperatively, and completely recovered 2 months after operation. A postoperative temporary vocal cord paralysis occurred in 1 case with recurrent fourth branchial cleft fistula, and totally recuperated 1 month after operation. No recurrences were found in all 18 cases with a follow-up period of 12-78 months (average 35 months). CONCLUSION Selective neck dissection is a safe and effective surgical procedure for the radical treatment of recurrent branchial anomalies.
Adolescent ; Branchial Region ; abnormalities ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Neck Dissection ; methods ; Retrospective Studies ; Treatment Outcome ; Young Adult