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Table of Content

    16 October 2011 Volume 25 Issue 5
      
    Articles
    Endoscopic near total thyroidectomy followed by radioiodine remnant ablation in differentiated thyroid carcinoma
    FAN Lin-jun1, MING Jia1, HUANG Ding-de2, FAN Zi-yi1, ZHAO De-long3, ZHANG Yi1, YANG Xin-hua1, JIANG Jun1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  11-16. 
    Abstract ( 1302 )   PDF (992KB) ( 1142 )   Save
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    Objective   To explore the effect of endoscopic near total thyroidectomy followed by radioiodine remnant ablation (RRA) in differentiated thyroid carcinoma. Methods   Between January 2008 and March 2011, 27 cases of differentiated thyroid carcinoma, with the diameter of smaller than 4cm, without obvious lymph nodal metastases and extraglandular invasion, underwent endoscopic operation followed by RRA. Results   The endoscopic near total thyroidectomy was finished in all of 27 patients. Among them, the chest and breast approach was used in 17 cases, and the axillary and breast approach was used in 10 cases. The operation time was 60-180min, with the mean time of 105min. Blood loss was 10~80mL (mean, 20mL). Post-operative hospital stays were 4~8 days (mean, 5.6 days). Temporality injury of recurrent laryngeal nerve occurred in 2 cases and healed after 3 months. No recurrence or metastases were found in all of patients after a follow-up of 4~38 months (mean, 12 months). TG stimulated by TSH was more than 10ng/mL in 2 cases, while 0~7.74ng/mL (mean, 2.36ng/mL) in other cases. All patients were satisfied with the neck appearance. Conclusions   Considering the high safety, radical efficacy and favorable cosmetic outcome, endoscopic near total thyroidectomy followed by RRA is suitable for those patients with lowrisk differentiated thyroid carcinoma absenting obvious nodal metastases.

    Surgery by a retrosigmoid keyhole approach in treatment of trigeminalneuralgia,  hemifacial spasm  and glossopharyngeal neuralgia
    MA Zhao-xin1, LI Ming2, CAO Yi2, CHEN Xu-hui2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  23. 
    Abstract ( 1300 )   PDF (836KB) ( 1211 )   Save
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     Objective   The aim of the study was to describe and evaluate the efficacy of the keyhole microsurgery to manage patients with trigeminal neuralgia (TN),  hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN). Methods   Two hundred and seven patients underwent microvascular decompression (MVD) and neurotomy via retrosigmoid keyhole approach in our department clinic: MVD for trigeminal neuralgia 169 cases,  hemifacial spasm 31 cases,  glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases. There was no serious complication such as deaths or infarction in the cerebellum or the brainstem. Results  Complete and partial symptoms relief was obtained in 160 (94.7%) cases and failure 9 (5.3%) cases with MVD for trigeminal neuralgia, postoperatively. Meanwhile,  complications occurred in one  case with cerebellar hematoma only. The postoperative results of MVD for hemifacial spasm with symptoms relief was noted in 29 (93.5%) cases and failure 2 (6.5%) cases. Postoperative complications occurred in one case with moderate hearing loss,  another three cases complained of transient facial paralysis. Symptoms relief achieved in all 7 (100%) cases undergone MVD or neurotomy for glosspharyngeal neuralgia. Postoperative complications occurred in  one case with moderate vocal paralysis. Conclusion   We think that microsurgery via retrosigmoid keyhole approach is safe and eVective for CPA hyperactive  cranial nerve dysfunction syndromes.

    Status of anxiety in the patients with facial paralysis ( 56 cases report)
    WANG Yan-hong
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  28-30. 
    Abstract ( 1445 )   PDF (306KB) ( 1393 )   Save
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    Objective   To explore the anxiety of the patients with Bell′s facial paralysis and its influencing factors. Methods   56 patients with Bell′s facial paralysis were rated with Hamilton anxiety scale. All the patients were grouped by relevant factors, and the differences among the groups were compared. Results   There were 49 patients(87.7%)  with obvious symptoms of anxiety, which was related with gender, age and the course of disease. The proportion of the female patients suffering from anxiety was higher than the males. Patients less than 30 years old showed more severe anxiety than those over 30. No correlation was found between the severity of facial paralysis and anxiety. Conclusion   Anxiety was common in the Bell′s facial paralysis patients, especially in the young women. The patients with mild facial paralysis may accompnay with severe symptoms of anxiety. More attentions should be paid to the psychological problems of such Bell′s facial paralysis patients.

    Subciliary and endocanthion approach endoscopic-aided repair of orbital fractures
    TANG Jun1, LI Shanxiang2, XIAO Jianxin1, ZHANG Chao1, SHI Sisi1,
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  54. 
    Abstract ( 1282 )   PDF (342KB) ( 1263 )   Save
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    Objective   To assess the validity and accuracy of endoscopically aided subciliary and inner canthus approach repair of orbital fractures. Methods   Two patients with orbital fractures were treated with titanium mesh under complete endoscopically aided visualization, through a subciliary and inner canthus approach graft that was placed over the defect under complete visual control using endoscopes. Results   One operated case had satisfactory results, both functionally and cosmetically. The other was still diplopia and enophthalmos,but his visual acuity was improved from 0.25 to 0.6. Conclusion   Subciliary and endocanthion approach endoscopic-aided repair of orbital fractures is better visualization of the fracture and less complication occurre.

    The clinical significance of acoustic rhinometry in nasal septum perforation
    ZHANG Tian-zhen,ZHANG Qing-quan,WANG Qiang, CHEN Xiu-mei ,
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  56. 
    Abstract ( 1350 )   PDF (641KB) ( 1351 )   Save
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     Objective   To analyze the clinical characteristics of the acoustic rhinometry with nasal septum perforation. Methods    18 cases of nasal septal perforation were received acoustic rhinometry before and after surgery and also were evaluated nasal obstruction score by visual analogue scale(VAS) the SPSS16.0 software underwent a t test paired data before and after surgery, also were analyzed the correlation among VAS score, NCV2-7 and NMCA. Results   Pre-operative NCV2-7, NMCA, and VAS scores were respectively 8.25±1.12cm3, 0.54±0.08cm2, and 3.46±1.02, post-operative were 6.45±0.98cm3, 0.48±0.07cm2, 1.74±0.64, preoperative, and post-operative NCV2-7 and VAS score showed significantly difference (P<0.01), NMCA showed no significant difference before and after surgery (P>0.05). the correlation coefficients of the pre-operative and post-operative VAS scores and NMCA were 0.762, 0.814, pre-operative and post-operative correlation coefficients of the VAS score and NCV2-7 were 0.384, 0.432, pre-operative and post-operative correlation coefficients of the NCV2-7 and NMCA  were 0.234, 0.316, pre-operative and post-operative VAS scores and NMCA's relationship showed statistical significance (P<0.01), pre-operative and post-operative VAS scores and NCV2-7 showed no statistically significant correlation, the correlation between pre-operative and post-operative NMCA and NCV2-7 showed no statistical significance. Conclusion   The acoustic rhinometry graph of nasal septum perforation has typical characteristics:Corresponding to the perforated parts of the bilateral nasal acousticrhinometry graph showing significantly higher changes in symmetry, and the symmetry can indirectly reflect some distance from the front to the back perforation, for judging the perforation location, size, forensic, therapeutic decision, finding occult perforation,  surgical side of the nasal cavity, surgical approach, operative procedures have certain significance.

    Effect of the kamel classification system of nasal inverted papilloma on operative approach
    MIAO Bei-ping1, ZHANG Rui-shi2, GAO Ya-na1,YANG Wen-na3,LIN Feng1, LU Yong-tian1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  60-63. 
    Abstract ( 1204 )   PDF (853KB) ( 1106 )   Save
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    Objective   To investigate the clinical classification of NIP and to show how to use this classification in planning surgery and evaluating results. Method   a retrospective study with fifty cases of NIP patients. The lesions were classified into type I (30 cases), originating from the nasal septum or lateral nasal wall (LNW), and type II (25 cases), originating from the maxillary sinus.  Results   We performed with conservative transnasal endoscopic excision (30 cases) in Type I and with performed conservative transnasal endoscopic excision (4 cases), radical transnasal endoscopic medial maxillectomy (11 cases), combined approach (10 cases). In Type I recurrence was 6.7%(2/30).and 16.0%(4/25) in Type Ⅱ, 10.9%(6/55) in all cases. The recurrence of all cases were compared to the reported, The difference was not statistically significant. Conclusion    We performed with conservative transnasal endoscopic excision in Type I and with performed radical transnasal endoscopic medial maxillectomy and combined approach in Type Ⅱ. The difference was not statistically significant in the recurrence when compared to the reported. So, it proves that this Kamel′s classification has a role in planning surgery and evaluating results, and transnasal endoscopic excision of NIP is a good choice.

    Clinical analysis of 48 cases of three-line reduce tension septorhinoplasty
    WEI Cen, HUANG Shan-jian, PAN An-ni, HUANG Bing-hu, HUANG Yao-jin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  64. 
    Abstract ( 1487 )   PDF (488KB) ( 1457 )   Save
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    Objective   To evaluate the advantages of nasal septum deviation with three-line reduce tension septorhinoplasty under endoscopy. Methods   Three-line reduce tension septorhinoplasty was performed on 48 cases. Results   Followed up from 3 months to 1 year, all clinical symptoms were remedied, and no complications happened. Conclusions   Septorhinoplasty of three-line reduce tension is easy to do and has advantages of micro-invasion, safety and effectiency, and is favorable in recovering nasal cavity sinuses physiological functions.

    Endoscopic surgery for fungal sphenoid sinusitis
    WANG Hai-ying1, ZHANG Shi-yong2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  66. 
    Abstract ( 1986 )   PDF (356KB) ( 1049 )   Save
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    Objective   To investigate the operative skill and therapeutic effect of sinus surgery under nasal endoscope for fungal sphenoid sinusitis. Methods   A total of 32 cases of fungal sphenoid sinusitis were enrolled from June 2006 to June 2009. The image features and clinical manifestations were summarized, and the points of operation and therapeutic effectiveness were analyzed. Results   CT scanning showed apparent reflection of calcification with high density of spots or strips in the lumen of the sphenoid sinus, which were the specific features. The main clinical manifestation included headache and bloody nasal discharge. All these cases treated under nasal endoscope were cured without nasal adhesion and relapse during a follow-up period of 12-18 months after the surgery.  Conclusions   Sinus CT examination can improve the diagnostic rate of fungal sphenoid sinusitis. Nasal endoscopic surgery is a preferred procedure for the treatment of fungal sphenoid sinusitis, with advantages such as clear surgical vision field,minimal invasive, much less bleeding and high security.

    Therapeutic efficacy of fluticasone propionate nasal spray in peri-operative endoscopic sinus surgery
    LI Chen, HUANG Jian-min
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  69-71. 
    Abstract ( 1407 )   PDF (363KB) ( 1389 )   Save
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    Objective   To explore the therapeutic efficacy of fluticasone propionate nasal spray in the perioperative endoscopic sinus surgery. Methods   Chronic rhinosinusitis and  nasal polyps patients were randomized into the control group(96 cases) and the treatment group(94 cases).  The control group was routinely treated by antibiotic and mucus discharged drugs (gelomyrtol forte). Besides routine treatment, topical corticosteroids application in nasal cavity (fluticasone propionate nasal spray) was added in the treatment group. Results  The results of operative bleeding duration, post-operative sinus clean duration, post-operative sinus epithelialize duration and therapeutic efficacy were in favor of the treatment group when compared with the control group (P<0.05). Conclusion  Topical corticosteroids application in nasal cavity (fluticasone propionate nasal spray) can improve and consolidate the therapeutic efficacy of endoscopic sinus surgery.

    Determination of corneal thickness, topography, and the posterior corneal surface changes using the Pentacam rotationg scheimpflug camera
    LI Ying, LI Yue, LUO Yan, JIN Yu-mei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  82. 
    Abstract ( 1986 )   PDF (1194KB) ( 1555 )   Save
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    Objective   To verify the consistency between the results of Pentacam and ultrasonic pachymetry, and between that of Pentacam and traditional corneal topography; to evaluate the influence of surgery type, AD, AD/CT, RBT and IOP on the changes of posterior cornear after excimer laser photorefractive keratectomy by Pentacam. Methods  Choose myopic patients who underwent excimer laser refractive surgery during January 2010 to June 2010 in our hospital. Certain amount was included for each group of analysis. Pentacam, ultrasonic pachymetry, traditional corneal topography and other tests necessary for the surgery like IOP were taken. Patients were divided into the LASIK and LASEK groups according to the type of surgery. For every patient during the surgery, AD and RBT were documented and AD/CT was calculated. 8~12 weeks after the surgery, Pentacam was redone. Results   ① Consistence rate of Pentacam and ultrasonic pachymetry for CCT was 97.62%,and poisson correlation coefficient was 0.96;② Consistence rate of Pentacam and traditional corneal topography for AverK was 100%,and poisson correlation coefficient 0.98; ③ Mean value of posteror cornea elevation for patients underwent LASIK surgery was 2.46μm,while that of patients underwent LASEK was 0.6μm. In both groups forward shift rised with the increase of AD and AD/CT, declined with the increase of RBT, and showed no correlation with IOP. Conclusions   ① Pentacam is consistent with ultrasonic pachymetry for measuring CCT. As a noninvasive novel inventure, Pentacam is suitable for pre-operative tests for excimer laser photorefractive keratectomy. ② For healthy patients, Pentacam could replace traditional corneal topography. More results of the anterior segment of the eye could be got other than K vales by using Pentacam. ③ Minor posteror cornea elevation exists after both LASEK and LASIK. And the former is more subtle. ④ The degree of posteror cornea elevation is in positive relation with AD and AD/CT, negative with RBT, and no relation with IOP.

    Compound trabeculectomy on secondary glaucoma following anterior uveitis
    DING Feng-kui1, SU Wan-yuan2, LI Qiao-yun1, LI Chuan-bao2
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  105. 
    Abstract ( 1021 )   PDF (358KB) ( 1350 )   Save
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    Objective   To investigate the clinical efficacy of compound trabeculectomy combined with sodium hyaluranate on secondary glaucoma following anterior uveitis. Methods  During the process of compound trabeculectomy, sodium hyaluranate was injected into the anterior chamber and under the sutured scleral flaps in 37 cases (37 eyes) of the experimental group. The other 29 cases (29 eyes) in control group were injected with B.S.S. solution. Visual acuity,intraocular pressure,thickness and angle of anterior chamber and the type of blebs in the two groups were recorded and statistically analyzed. Postoperative follow-up ranged from 9 to 15 months. Results   A significant difference in the success rate was found between the two groups(P<0.05). The incidences of functional filtration blebs and filtration patency were significantly higher in the experimental group than in the control group(P<0.05). The incidence of flat anterior chamber was significantly lower in the experimental group than in the control group(P<0.05). No significant difference was found in the visual acuity improvement between the two groups (P>0.05). Conclusion   A small amount of sodium hyaluranate injected into anterior chamber and under sutured scleral flap can restrain filtration adherence and raise surgery quality of compound trabeculectomy on secondary glaucoma following anterior uveitis.

    Internal limiting membrane peeling for treatment of foveoschisis in high myopia
    CAI Ke-bo
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2011, 25(5):  108-110. 
    Abstract ( 1502 )   PDF (541KB) ( 1424 )   Save
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    Objective   To evaluate the efficacy and safety of internal limiting membrane(ILM) for treatment of foveoschisis in high myopia. Methods   25 high-myopia patients (25 eyes) with foveoschisis from March 2008 to October 2010 were divided two groups: the treatment group (14 eyes) were treated with vitrectomy combined with ILM peeling, and the control group (11 eyes) were treated only with vitrectomy.The best spectacle-correction, foveoschisis reattachment and dysmorphopsia were measured preoperatively and 3 months after surgery. Results   The improvement of foveoschisis reattachment and dysmorphopsia in the treatment group was significantly better than those in the control group(P<0.05).There was no significant difference in the improvement of visual acuity between the two groups(P>0.05). Conclusion   The vitrectomy with ILM peeling is more effective for treatment of foveoschisis in high myopia. It can improve foveoschisis reattachment and dysmorphopsia, but it can not significantly improve visual outcomes.