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Significance of modified radical neck dissectionin papillary thyroid carcinoma

An HU ; Xiaojie JIN ; Minfei QIAN ; Ming ZHOU ; Jiping LI ; Jiadong WANG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(18):828-831. doi:10.3969/j.issn.1001-1781.2009.18.005

Objective:To investigate the recurrence of the neck and survival incidence of clinically possible pos-itive lateral cervical nodes in patients with well-differentiated papillary thyroid cancer and the essentiality of the performation of modified radical neck dissection. Method: Retrospective datum of 267 cases of papillary thyroid car-cinoma were collected and ananlyzed. They were divided into two groups with time; selective neck dissection with VI area was performed in 151 cases of group A and selective neck dissection was performed without VI area in 116 cased of group B. They were received the same treatment in the thyroid-total thyroidectomy on initial part and subtotal thyrodectomy on the other, and total thyroidectomy on both parts if both were invated. Incidence of posi-tive lateral cerivcal nodes of VI area in group A and the recurrence in the neck and survival incidence in groups B were analyzed. Result: Fiftynine patients in group A were treated with the modified radical neck dissection, and 22 patients of them were found metastasis in lateral cervical nodes with Ⅵ area. The other 92 patients were treated with neck dissection of Ⅱ,Ⅲ,Ⅳ,Ⅵ VI area, and 31 patients weren't metastasis, 33 patients were metastasis in both Ⅵ area and the others(35.8%), 17 patients were metastasis only in Ⅵ area(18.4%), 11 patients weren't metastasis only in Ⅵ area(11.9%). Thus, the incident of metastasis in Ⅵ area was 47.70% in group A(72/151). 47 patients in group B had metastasis in lateral cervical nodes though without performing VI area neck dissection (40.5%), and the survival rate of 5 years was 99.3%. The recurrence rate in the neck of group two was 6.0% (7/116). The metastasis rate of neck lymph node was higher in group A (54.9%) than group B(40.5%). Conclu-sion : Pretracheal and peripheral recurrent nerve lymph node are very susceptible to the metastasis of well-differenti-ated papillary thyroid cancer. The neck dissection of VI area could be performed as routine.

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Application of the displacement of the ventricular bands-epiglottis mucosalflap in the surgical management of glottis carcinoma

Lili CHEN ; Zhaojun QIN ; Changwen DAI

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(18):826-827. doi:10.3969/j.issn.1001-1781.2009.18.004

Objective:To investigate the plastic method of glottis carcinoma in surgery. Method:Retrospectly analyzed 29 patients with T_2 ,T_3 glottis carcinoma who admited in our department From 1996 to 2004. All of them were treated with the displacement of ventricular bands-epiglottis mucosal flap in the surgical management of glot-tis carcinoma. The tumour was primarily from vocal cords, and not exceeded 2cm. Result: All cases were success-fully renovated laryngeal cavity with the displacement of ventricular bands-epiglottis mucosal flap and followed up for 5 years after operation. Three years survival rate was 86.2% ,5 years survival rate was 78.9% ,and tube draw-ing rate was 100%. Conclusion: With this method, surgery would be simplified and the patients would keep the voiced function and swallowing function.

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A study of intratumor microvessel density and lymph node micrometastasesof pN0 supraglottic laryngeal squamous cell carcinoma

Binghua LI ; Yaping XU ; Lizhong SU ; Mingyuan CHEN

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(18):824-826. doi:10.3969/j.issn.1001-1781.2009.18.003

Objective:To investigate the correlation between intratumor microvessel density (IMVD) and lymph node micrometastases. Method: IMVD and lymph node micrometastases were stained with CD105 and CK19 antibody by immunohistochemical method of SABC respectively. Result:IMVD marked with CD105 antibody corre-lated with T stage and lymph node micrometastases(P<0.01). Conclusion: The result show that IMVD marked with CD105 antibody highly correlated with lymph node micrometastases. It could be a index to evaluate the prog-nosis of patients with pN_0 supraglottic laryngeal squamous cell carcinoma.

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Reconstruction of laryngotracheal defect using the musculo-periosteum flapof the sternocleidomastoideus with clavicular periosteum

Zhi LIU ; Wenxian CHEN ; Pengcheng CUI ; Pengfei GAO ; Jiasheng LUO ; Limei ZHONG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(18):821-823. doi:10.3969/j.issn.1001-1781.2009.18.002

Objective:To investigate the effect of the musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum on the reconstruction of extensiveness laryngotracheal defect. Method: Retrospectively studied 49 patients, who admited in our department from 1996 to 2005 years for severe laryngotracheal defect. There were 28 males and 21 females aged from 15 to 69 years old (mean age was 47 years old). The causes of laryngotracheal defect were laryngotracheal stenosis(31 cases) and surgery for thyroid carcinoma invading trachea (18 cases). All of 49 cases were treated with the graft of musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum and placed a silicon T-tube stenting for 3 to 6 months. Result; All of 49 cases were successfully decannulated with recuperative normal airway patency and effective phonation. The follow up ranged from 2 to 10 years, and the effect of operation was steady. Conclusion:The musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum is an ideal graft for the reconstruction of cervical extensiveness tracheal defect.

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Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children

Youzhong LI ; Yongde LU ; Anquan PENG ; Jihao REN ; Xinming YANG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(15):697-699. doi:10.3969/j.issn.1001-1781.2009.15.009

Objective:To study the clinical manifestations and treatment of the primary cervical tracheal malig-nant tumor of children. Method:Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscope and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy. Result:Five cases were followed up for three to eight years, and no recurrence was found. Conclu-sion: There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable dignosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

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Diagnosis and treatment of infantile congenital subglottic hemangioma

Lan CHENG ; Qi HUANG ; Hao WU ; Jun YANG ; Li CHEN ; Zhihua ZHANG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(15):693-696. doi:10.3969/j.issn.1001-1781.2009.15.008

Objective: To discuss the diagnosis and treatment of infantile congenital subglottic hemangioma. Method:Nine patients with recurrent stridor,feeding difficulties and laryngeal obstruction were diagnosed as con-genital subglottic hemangioma with bronchia endoscopy. The lesions were unilateral in 7 cases and bilateral in 2 ca-ses. Eight cases were treated by intralesional Pingyangmycin injection after tracheotomy. Patients were discharged with metal trachea and were followed up endoscopically 2 weeks thereafter. A second treatment would be required if the tumor reduced in size but not disappeared completely. Plugging tubes and extubation would be done when the tumor disappeared completely. One case with unilateral lesion underwent power-assisted tumor resection with-out tracheotomy. Result: Hemangioma vanished completely in 6 patients with unilateral subglottic hemangioma who were treated with single stage procedure. Tumor size was found reduced significantly after one procedure and van-ished completely after a second procedure in 2 cases with bilateral subglottic hemangioma. All of the 8 cases were extubated successfully. The patient recovered thoroughly in two weeks after power-assisted tumor resection. Con-clusion: Intralesional Pingyangmycin injection after tracheotomy can relief the airway obstruction quickly, shorten the nature course of hemangioma, shorten the period of wearing trachea, has no complication such as subglottic stenosis and is thought to be a safe and effective therapy for large size hemangioma. Power-assisted tumor resec-tion under good total anesthesia without tracheotomy combined with well hemostasis is effective, less injure, and suitable for small size hemangioma.

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Clinic and pathological analysis the larynx leukoplakia in 74 cases

He YU ; Xiaotian LI ; Yan WANG ; Huaian YANG ; Xing GUO ; Zimin PAN ; Xuejun JIANG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(15):688-689. doi:10.3969/j.issn.1001-1781.2009.15.006

Objective: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. Method: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. Result: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six ca-ses were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recured, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. Conclusion:Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epitheli-al dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

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Long-term culture of utricular sensory epithelial cell of rats and expression of the hair cell characteristic markers

Jun LIU ; Weijia KONG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(19):889-893. doi:10.3969/j.issn.1001-1781.2009.19.009

Objective:To investigate the generative or regenerative hair cell and studes of molecular and genetic in the inner ear,the long-term culture systems of utricular sensory epithelial cell of the rats were established.Method:Utricular sensory epithelial of postnatal day 1 rats was isolated by mechanical dissociation.The explants were digested by thermolysin,then transfrred to an aliquot containing trypsin and collagenase for incubation to harvest the pure utricular sensory epithelial cell. USEC wes cultured in Dulbecco modified Eagle medium(DMEM) and passaged.USEC of the 25 passages observed by inverted microscope and ultrastrctural examination with transmission electron microscope.Immunocytochemical method with cytokeratin 18 ,vimentin,Brn3.a and Calretinin; reverse transcription PCR with mRNA of AchRa9 and Myosin Ⅶa.The markers of hair cells were used identify the characteriztion of USEC of the 25 passages.Result:USEC have been cultured for more than 6 months and passaged 25 passages.USEC of the 25 passages showed a large,flat,polygonal epichlial morphotype with big,round neuclei.The cells grew into monolayer,cobblestone-likeappearance and showed Dome formation. The cells expressed cytokeratin 18 , not expressed vimentin,has rich microvilli and complex tight junction,which indicated the epithlial origination of USEC.Coexpressed of the hair cell characteristic markers Brn3.a,Calretinin and mRNA of AchRa9,Myosin Ⅶa was identified the culture cell that may represent rat progenitor hair cell.Conclusion:The long-term culture systems of utricular sensory epithelial cell of the rats were successfully established. The long-term culture USEC coexpressed the characteristic markers of the hair cell ,which identified the culture cell may represent progenitor cell of rats hair cell .It may provide valuable cell sources for in-depth investigation the mechanisms of hair cell generation or regeneration and studes of molecular and genetic in the inner ear.

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Changes in nasal airway resistance before and after intranasal contact point headaches

Zhengcai LOU

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(19):884-885. doi:10.3969/j.issn.1001-1781.2009.19.007

Objective:To study the influence of endoscopic sinus surgery(ESS)on nasal airway resistance(NAR) of intranasal contact point headaches.Method:The NAR and nasalairflow sensation were measured with anterior rhinomanometry in 20 patients(40sides) before and after the ESS.Result:A telephone follow-up six months after operation,16(85%)cases were cured,3(15%)were improved and 1(5%)had no response and the effective rate was 95%. NAR decreased significantly after the operation. The change ratesin NAR before and after the decongestion were there was a significant difference(P<0.05).Conclusion:The improvement of nasal functions by ESS is due to thealteration of the anatomic structure of the nasal cavity and the amelioration of mucosal edema. The rhinomanometry can be used as a useful clinical tool in determining nasal patency.

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Expression of COX-2 and VEGF-C in papillary thyroid carcinoma and their relationship to cervical lymph metastases

Ailin MIAO ; Meizhen WAN ; Lei CHENG

Journal of Clinical Otorhinolaryngology Head and Neck Surgery.2009;(19):881-883. doi:10.3969/j.issn.1001-1781.2009.19.006

Objective:To investigate the expression of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor-C (VEGF-C) in papillary thyroid carcinoma and their relationship to cervical lymph metastases.Method:In this study, the expressions of COX-2 and VEGF-C were examined by immunohistochemistry in papillary thyroid carcinoma tissues of 40 patients, and analysis was performed on the correlation of cervical lymph metastases with COX-2 and VEGF-C expression.Result:Positive expressions of COX-2 and VEGF-C were 70.0%(28/40)and 75.0%(30/40)respectively in papillary thyroid carcinoma. The positive rates of COX-2 and VEGF-C expression were 80.8%(21/26)and 84.6%(22/26)respectively in patients with cervical lymph metastases, and 50.0%(7/14)and 57.1%(8/14)respectively in patients without cervical lymph metastases, with a statistically significant difference between two groups(P<0.05, all). COX-2 was positively correlated to VEGF-C expression in papillary thyroid carcinoma(r=0.378, P<0.05).Conclusion:The results suggest that COX-2 and VEGF-C were highly expressed in papillary thyroid carcinoma, with possible interaction of their expressions, and may play a critical role in the cervical lymph metastases of papillary thyroid carcinoma.

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