This article carries out a comprehensive review on otorhinolaryngologic-head and neck informatics, focusing on the definition, content and characteristics of otorhinolaryngologic informatics as well as the application of computer, communication and information technology in otorhinolaryngology-head and neck surgery. Otorhinolaryngologic informatics is the future development direction of otorhinolaryngology-head and neck surgery.
Objective To explore the feasibility and effectiveness of repairing surgical defect in pharyngo-laryngeal malignant cancer with free rectus femoris flap. MethodsThe clinical data of 34 patients with surgical defects in pharyngo-laryngeal malignant cancer who met the selection criteria between July 2014 and August 2024 were retrospectively analyzed. There were 25 males and 9 females, aged 25-82 years, with a median age of 54 years. The disease duration ranged from 2 months to 2 years, with a median of 7 months. The tumor locations included the oropharynx, hypopharynx, cervical esophagus, and larynx. Pathological types included squamous cell carcinoma (29 cases), myoepithelial carcinoma (2 cases), adenoid cystic carcinoma (1 case) and diffuse large B-cell lymphoma (2 cases). TNM staging: 16 cases of T4N1M0, 3 cases of T4N2M0, 3 cases of T4N0M0, 10 cases of T3N1M0, and 2 cases of T3N0M0. The 2017 American Joint Committee on Cancer (AJCC) staging was stage III in 2 cases and stage IV in 32 cases. The blood supply of the proximal rectus femoris muscle was observed by enhanced CT of the lower limb vessels before operation, and the surgical defects ranged from 3.0 cm×2.0 cm to 12.0 cm×8.5 cm. The blood supply and perforators of rectus femoris muscle were explored during operation, and the free rectus femoris flap pedicled with the direct vascular stem of rectus femoris muscle was used to repair the defect. For the patients with pharyngeal fistula or obvious neck swelling after operation, the blood supply of the flap was analyzed by vascular enhanced CT to determine the corresponding strategies of nutritional support, anti-infection, dressing change and drainage. Radiotherapy and chemotherapy were supplemented in 27 patients with lymph node metastasis after operation. Results All the 34 patients were followed up1-10 years, with an average of 3 years. The flap was found to be necrotic by fibrolaryngoscopy at 1 week after operation in 2 cases, and the incision healed after dressing change and nutritional support, and no reoperation was performed. The flap was in good condition at 1 week after operation in 4 cases, and the signs of gradual necrosis of the flap were found within 1 month after operation, of which 2 cases were healed after dressing change, 1 case was removed the necrotic tissue by reoperation, and 1 case was healed after pectoralis major myocutaneous flap was used to repair the pharyngeal tissue defect. The flaps survived in 28 cases, including 4 cases of pharyngeal fistula, which were healed by dressing change. Twenty-two cases achieved satisfactory results in swallowing or phonation. Two patients with total laryngectomy and voice reconstruction underwent reoperation to seal the voice tube because of postoperative aspiration. During the follow-up, 1 case had fistula recurrence, 2 cases had bone metastasis, and 1 case had bone and lung metastasis. Conclusion The free rectus femoris flap has good flexibility, the volume of the flap is easy to adjust, and the incision of the donor site is concealed, which is expected to become a new choice for the repair of the surgical defect in pharyngo-laryngeal malignant cancer.
Objective To investigate the feasibility and methods of surgical treatment for HIV/AIDS patients with otolaryngology diseases. Methods From January 2016 to February 2017, nineteen patients with HIV/AIDS who underwent otolaryngology surgery were included in this study. The demographic data of patients, including age, gender, course of disease, CD4+ T lymphocyte count before operation and disease type were collected and the clinical treatment methods were summarized. The curative effect was analyzed retrospectively. Results The operations of all the 19 patients were successful without occupational exposure among medical staff. One patient with papillary squamous cell carcinoma did not received further treatment. The other 18 patients recovered well and their life quality was significantly improved. Conclusions If HIV/AIDS patients with otolaryngological diseases are examined preoperatively and have no surgical contraindications, the operation shloud be performed by controlling the surgical indications strictly. The life quality of the patients may be improved and the patients’ life may be prolonged after the surgery.
Objective To evaluate the quality of randomized controlled trials in otorhinolaryngology in China and provide to comprehend the possibility of its contribution in providing reliable, evidence in clinical practice; thus providing evidence to elevate the clinical treatment level. Methods Five Chinese clinical otorhinolaryngology journals were searched and randomized controlled trials were identified and analyzed according to the standards of evidence-based medicine. Results Two hundred and eighty seven issues were referred to and eighty-one randomized controlled trials were identified and analyzed. Of these randomized controlled trials, 34.57% (28/81) had definite diagnostic standards, 38.27% (31/81) had inclusion standards and 33.33% (27/81) had exclusion standards; only 1.23% (1/81) got the approval of the participants; 40.74% (33/81) had moderate sample size; 3.70% (3/81) had large sample size and no one mentioned sample size estimation; 81.48% (66/81) didn’t report the method of randomization and 38.27% (31/81) had baseline comparison; 18.52% (15/81) didn’t define the control interventions and 8.64% (7/81) even didn’t explicate the experimental interventions; 32.10% (26/81) used blank comparison; 86.42% (70/81) didn’t use blindness; 37.04% (30/81) didn’t mention the adverse effects; 23.46% (19/81) used accredited standards to evaluate the outcomes; l l.11% (9/81) mentioned the loss of participants and only 1.23% (1/81) treated the loss with statistics methods. Conclusions The quantity and quality of the otorbinolaryngologic randomized controlled trials in present review can not meet the clinical need. Higher quality of randomized controlled trials are required to improve the level of prevention and the treatment of otorhinolaryngologic diseases.
ObjectiveTo explore the effect of lidocaine on postoperative pain management after throat surgery. MethodsSixty patients undergoing throat surgery between June 2011 and May 2013 were randomly divided into trial group and control group, with 30 in each group. Patients in the trial group accepted lidocaine for pain management, while the control group used dicaine. Pain management effect was observed and compared between the two groups. ResultsThe pain scores of patients at hour 0.5, 2.0, 6.0, and 24.0 after surgery were 2.7±0.8, 2.2±0.9, 1.7±0.8, and 1.5±0.3 in the trial group, and 4.7±1.1, 4.2±0.8, 3.4±0.7, and 2.9±0.5 in the control group, and the differences were significant (P<0.05). Postoperative incidences 6.7% in the trial group, and 30.0% in the control group, and the difference was also significant (P<0.05). ConclusionLidocaine can reduce the pain of patients in postoperative pain management after throat surgery, with such advantages as long-time functioning, no toxic side effect, and obvious effect, which is worth promoting.
Objective To investigate the diagnostic value of esophageal high-resolution manometry combined with salivary pepsin levels in laryngopharyngeal reflux disease (LPRD). Methods The patients with the chief complaint of “throat discomfort” for treatment at the Department of Otolaryngology, Head and Neck Surgery, the First People’s Hospital of Longquanyi District, Chengdu / West China Longquan Hospital Sichuan University between January and October 2022 was selected. According to the reflux findings score and refluxsymptomindex at admission, the enrolled patients were divided into LPRD group and non-LPRD group. The basic patient information, esophageal high resolution manometry, and salivary pepsin concentration of included patients were collected. Results A total of 112 patients were included. Among them, there were 68 cases (60.7%) in the LPRD group and 44 cases (39.3%) in the non-LPRD group. The LPRD group was significantly younger (P=0.007) , but the salivary pepsin concentration (P<0.001), upper esophageal sphincter (UES) resting pressure (P<0.001) and distal contractile integral (P=0.007) were all higher than the non-LPRD group. The results of multivariate logistic regression analysis showed that salivary pepsin concentration [odds ratio (OR)=1.077, 95%CI (1.035, 1.120), P<0.001] and UES resting pressure [OR=1.035, 95%CI (1.019, 1.052), P<0.001] were independent factors for the diagnosis of LPRD. The area under the working curve (0.971), specificity (0.99), and sensitivity (0.77) in the combined index were higher than those of saliva pepsin concentration and UES resting pressure. Conclusion Esophageal high resolution manometry and salivary pepsin are significant for the diagnosis of LPRD, and their combined application can improve the diagnostic value and also serve as an alternative method for the diagnosis of LPRD.