OBJECTIVE: To summarize the diagnostic and therapeutic experience of primary cricopharyngeal achalasia and introduce new operandi modus. METHOD: Report the two cases we treated in 2008 and integrate published literature, and approach its diagnostic and therapeutic experience and make use of new operandi modus. RESULT: The diagnosis of primary cricopharyngeal achalasia is difficult, and we must apply exclusive diagnosis according to the examinations of fibrolaryngoscopy, esophagoscopy and barium meal et al. CONCLUSION Surgical treatment is the best option. Partial resection of cricopharyngeal muscle and upper esophageal ring-shaped muscle is superior to simple cricopharyngeal myotomy.
Aged ; Esophageal Achalasia ; diagnosis ; surgery ; Female ; Humans ; Middle Aged ; Pharyngeal Diseases ; diagnosis ; surgery ; Pharyngeal Muscles ; physiopathology

OBJECTIVE: In order to improve the postoperative effect of modified UPPP, removing the partial pharyngeal muscle in surgery, we investigate the postoperative effect, the characteristics of pharyngeal cavity and the potential complications in OSAHS patients. METHOD: To choose 82 OSAHS patients with obstructive oropharyngeal plane diagnosed by Apneagraphy (AG), Fibre nasopharyngoscope combined with Müller examination and nasopharyngeal 3D-CT, which had completed clinical data inpatients in the anesthesia underwent of the partial pharyngeal muscles in the postoperative, divided into a control group of 26 cases, operating the H-UPPP surgery which did not remove partial pharyngeal muscle; The experimental group of 56 cases did a H-UPPP surgical which removed partial pharyngeal muscle of possible concurrent symptoms such as nasal regurgitation, Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease. Patients were evaluated the sleepiness by ESS(Epworth sleepiness scale) in 6 months after the surgery, compared with the preoperative ESS scores, do a t test for statistical analysis. AG can be used to evaluate effects of the UPPP after 6 months. By measuring uvula length (L1), extent from free edge of soft palate to postpharyngeal (L2) and stenosis of nasopharynx width (L3) mean, we investigate the characteristics of pharyngeal cavity using the multiple linear regression to do the hypothesis test and evaluate the association between measuring mean and effect. Using SPSS19.0 software do the preoperative contrast analysis. RESULT: After 6 months in surgery, 56 cases in the experimental group, effect in 50 cases (89.29%), effective in 6 cases (10.71%); ESS score: Preoperative 11.74 +/- 2.48, after the first 6 months 3.84 +/- 2.05. Twenty-six cases in control group,effect in 19 cases (73.08%), effective in 7 cases (26.92%); ESS score: Preoperative 11.91 +/- 2.40, after the first 6 months 6.92 +/- 2.47, t-test P value of less than 0.05 between the experimental group and the control group; There are no ear fullness, hearing loss, increase their own sound which reflect eustachian tube dysfunction and other complications in two groups; The function of pharyngeal cavity could be recovered normal lever after 6 months; After 6 months of the operation, in the experimental group and the control group L1 mean was respectively (5.91 +/- 3.38) mm and (6.20 +/- 3.76) mm (P>0.05); L2 mean was respectively (15.70 +/- 3.29)mm and (15.35 +/- 1.44) mm (P> 0.05); L3 mean was respectively (20.54 +/- 3.33) mm and (16.43 +/- 2.21) mm (P<0.05). Nasal fauces pitch mean was significantly widened. By the multiple linear regression analysis, the postoperative effect has the linear correlation between L2 and 1,3 residual mean with the negative correlation. Due to the standardized coefficient, L3 residual mean has the most influence on the postoperative effect. CONCLUSION Modified UPPP surgery removing the partial pharyngeal muscle is in favor of upgrading the postoperative effect with significantly increasing the width of postoperative nasal pharyngeal isthmus area, then there are not occur the eustachian tube dysfunction, the soft palate function, swallowing and articulation function disabled.
Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Palate, Soft ; surgery ; Pharyngeal Muscles ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula ; surgery ; Young Adult

The main problem after total laryngectomy is permanent loss of voice. Current methods of vocal rehabilitation after total laryngectomy include development of esophageal speech, use of artificial larynx, tracheoesophageal shunt operations and more recently surgical restoration of the voice with prosthesis. Primary voice restoration using Blom- Singer voice prosthesis after total laryngectomy and pharyngeal myotomy was performed in 187 patients between October 1992 and July 2000. There were 184 male and 3 female patients of average age 63.7 years (range 42-76). Mean follow up period was 62 months. Satisfactory speech was achieved in 156 patients (83.5%). During the follow-up period, we experienced complaints of insufficient voice in 31 (16.5%) patients, due to partial spasm in 17 and total spasm in the pharyngoesophageal segment in 14. Furthermore, 24 (12.8%) patients preferred esophageal speech or electro larynx because of low socioeconomic level. The overall success rate was 70.7%. In this study the results of the surgical technique and prosthesis insertion, as well as the associated complications and socioeconomic levels of the patients, are discussed.
Adult ; Aged ; Carcinoma, Squamous Cell/surgery ; Female ; Human ; Laryngeal Neoplasms/surgery ; Laryngectomy/*adverse effects ; *Larynx, Artificial/adverse effects ; Male ; Middle Aged ; Pharyngeal Muscles/surgery ; Voice Disorders/etiology/*surgery

OBJECTIVETo find out the nasendoscopic changes of velopharyngeal configuration and movement after palatoplasty with or without velopharyngeal muscle reconstruction.

METHODSThe nasendoscopy was taken in forty-one patients with palatoplasty, 22 repaired by velopharyngeal muscle reconstruction and 19 with modified von Langenbeck's procedure (non-reconstructive group).

RESULTSIn patients with velopharyngeal muscle reconstruction, the velopharyngeal ports are smooth and full with a definite reduction in size than patients without velopharyngeal muscle reconstruction. During phonation, the complete and marginal velopharyngeal competence rate in reconstructive group (90.91%) is higher than the group of non-reconstruction (37.31%) The major velopharyngeal closure is circular movement in reconstructive group, otherwise coronal closure in nonconstructive group.

CONCLUSIONSBased the observation of nasendoscopy, the velopharyngeal muscle reconstruction in palatoplasty has more definite improvement to velopharyngeal closure than non-reconstructive procedure. Palatoplasty with velopharyngeal muscle reconstruction could reduce the size of velopharyngeal port and make the complete velopharyngeal closure easier.

Adolescent ; Child ; Child, Preschool ; Cleft Palate ; surgery ; Endoscopy ; methods ; Humans ; Infant ; Nose ; surgery ; Pharyngeal Muscles ; abnormalities ; surgery ; Reconstructive Surgical Procedures ; methods

Adult ; Aged ; Female ; Fistula ; surgery ; Humans ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Pharyngeal Diseases ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps

OBJECTIVETo explore the method that use combined pectoralis major muscle flap and intermediate split thickness skin graft to reconstruct giant cervical pharyngeal fistula.

METHODSUse pectoralis major muscle flap combined with intermediate split thickness skin graft to reconstruct giant cervical pharyngeal fistula caused by malignant tumor surgical treatment and radiotherapy.

RESULTSIn this group, 11 flaps survived after operation, while 2 of them got delayed union after proper treatment. The following -up showed good function and shape, all the flaps remain alive. The patients' swallowing function were recovered and got good contours.

CONCLUSIONSPectoralis major muscle flap has enough volume and vascular pedicle length. Intermediate split thickness skin is easy to survive and has stable colour. Through this combined reconstructive methods, we got good clinical results to treat giant cervical pharyngeal fistula.

Adult ; Aged ; Cutaneous Fistula ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Pharyngeal Diseases ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps

OBJECTIVE: To discuss the effect of reducing the cricopharyngeal dysfunction on the Groningen prosthesis voice restoration following total laryngectomy and the effect of different methods. METHOD: Fifty-six patients were implanted with Groningen voice prostheses to rebuild voice after total laryngectomy. The clinical data were analyzed retrospectively. RESULT: Of 56 patients, 412 patients successes in voice restoration. The success rate of amputating pharynx plexus nerves group was 60.0%, amputating cricopharyngeal muscle group was 62.5%, and the amputating pharynx plexus nerves and cricopharyngeal muscle group was 96.0%. CONCLUSION The combination of pharynx plexus nerves resection and cricopharyngeal myotomy can make higher success rate of voice restoration.
Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Larynx, Artificial ; Male ; Middle Aged ; Pharyngeal Muscles ; physiopathology ; Retrospective Studies

OBJECTIVETo evaluate the feasibility and the results of the procedure of maxillomandibular advancement combined with uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODSNine cases of obese patients with severe OSAHS [age (47.8 +/- 9.7); body mass index (BMI) (35.3 +/- 2.5) kg/m(2); apnea and hypopnea index (AHI) (88.7 +/- 6.7) per hour] underwent the procedure of maxillomandibular advancement (MMA) combined with uvulopalatopharyngoplasty (UPPP). The patients were monitored by polysomnography (PSG) before operation and 3, 6, 12 months after operation, and cephalometric analysis and velopharyngeal closure function were evaluated at the same time.

RESULTSThe maxilla was advanced by (8.3 +/- 1.3) mm and the mandible and chin were advanced by (23.0 +/- 2.2) mm. AHI was (2.1 +/- 1.1) per hour post-operation. All patients had no speaking problem and swallowing difficulty and had a good appearance and occlusions. The OSAHS in this group of patients was cured.

CONCLUSIONSGood short-term effects were observed with UPPP and MMA in the treatment of obese patients with severe OSAHS. It did not cause the velopharyngeal closure insufficiency and maxillary necrosis. A long-term follow-up is needed.

Adult ; Follow-Up Studies ; Humans ; Male ; Mandibular Advancement ; methods ; Middle Aged ; Obesity ; complications ; surgery ; Osteotomy, Le Fort ; Palate, Soft ; surgery ; Pharyngeal Muscles ; surgery ; Sleep Apnea, Obstructive ; complications ; surgery ; Treatment Outcome ; Uvula ; surgery

Three patients had cervical draining sinus communicating with the pyriform sinus and one patient had acute suppurative thyroiditis resulting from infection through the pyriform sinus. There was a moderate to severe perithyroidal inflammation in all 4 cases. The age of onset ranged from 7 to 18 years old (mean; 12) but that of confirmation 9, 15, 18 and 67 years of age. Three of the patients were male and 3 of the cases involved the left side. All patients had suffered from several recurrences of cervical abscess, ranged from 2 to 7 times (mean; 4). Characteristic clinical features included 1) onset at a young age 2) frequent recurrence unless the fistula was extirpated completely 3) presenting with cervical draining sinus after repeated incision and drainage. It is supposed that the fistula is a route of infection mainly in the perithyroidal space and subsequently into the thyroid gland. When the fistula communicates directly with the thyroid gland, it can cause primary acute suppurative thyroiditis. Chronic cervical draining sinus with histories of repeated incision and drainage may be the clue to the diagnosis. A barium paste swallow study is the radiologic procedure of choice and complete removal of the fistula is the treatment of choice.
Adult ; Aged ; Case Report ; Child ; Female ; Fistula/radiography/radionuclide imaging/*surgery ; Human ; Male ; Neck Muscles ; Pharyngeal Diseases/radiography/radionuclide imaging/*surgery ; Radionuclide Imaging ; Thyroid Diseases/radiography/radionuclide imaging/surgery ; Tomography, X-Ray Computed