The transoral approach to the cervical spine.

The transoral surgical approach is useful for operating on structures at the base of the brain and the upper cervical spinal cord. For example, this route has been used for resecting spinal tumors and clipping vertebrobasilar aneurysms. In the past, this surgical approach was not advocated due to concerns about exposure and infection. However, the availability of the microscope, computed tomography, computed myelotomography, magnetic resonance imaging and intraoperative radiography as well as more effective techniques have improved the diagnosis of pathology of the craniovertebral junction and surgical performance. An understanding of the operative procedures involved with this approach assists the neuro-science nurse in preoperative teaching and anticipating potential postoperative complications.     

Craniovertebral junction tuberculosis: a case report and review of the literature

Craniovertebral junction tuberculosis (CVJ TB) is a rare disease, potentially causing significant neurological deficits and even death. We report on a 80-year-old woman presenting with CVJ TB without pulmonary involvement. The diagnosis was made by biopsy of the cervical lymph node showing granulomatous caseation necrosis. Despite extensive erosion of the clivus, C1, and C2, and spinal cord compression, the patient was effectively managed with antituberculous drug therapy and conservative neck stabilization. Neck pain resulting from cervical spondylosis is common in elderly people. However, even if there is no obvious pulmonary involvement, CVJ TB should be considered in the differential diagnosis, especially in patients with painful neck stiffness. The most useful method available for evaluating this region is a combination of CT scan and MRI study. CVJ TB can be managed conservatively, except for a selected few cases, regardless of the extent of bony destruction.     

经口腔前庭入路腔镜术对单侧甲状腺癌患者美容效果及远期预后的影响

目的探讨经口腔前庭入路腔镜术对单侧甲状腺乳头状癌(PTC)患者美容效果及远期预后的影响。方法选取2017年11月至2019年12月郑州大学附属洛阳中心医院甲状腺乳腺外科收治的80例单侧PTC患者,男17例,女63例,年龄(52.35±5.44)岁,年龄范围为33~67岁。采用随机数表法将患者随机分为全乳晕入路组与经口腔前庭入路组,每组40例。经口腔前庭入路组采用经口腔前庭入路腔镜术,全乳晕入路组采用全乳晕入路腔镜术,比较两组患者的临床指标、美容效果及远期预后。结果两组患者的住院时间、术中出血量、手术时间及中央区淋巴结清扫数量比较,差异无统计学意义(P>0.05);经口腔前庭入路组患者的美容效果满意度[97.5%(39/40)]高于全乳晕入路组[75.0%(30/40)],差异有统计学意义(P<0.05);两组患者的永久性喉返神经损伤、永久性甲状腺功能损伤、癌转移及癌复发的发生率比较,差异无统计学意义(P>0.05)。结论单侧PTC患者采用经口腔前庭入路腔镜术具有良好的临床效果及远期预后,且美容效果更好。     

经口咽入路行环枢融合术对脊髓功能恢复的疗效观察

Objective To present the operative results of 17 patients with atlantoaxial diseases using transoral approach.Methods 17 patients received operation of atlantoaxial fusion using transoral approach.The average age is 27 years old(12～ 47 years).Results All patients had achieved primary healing without any complications.The fusion rate was 100% .The average recovery rate (JOA score system) of myelopathy was 48% .Conclusions Transoral approach was an ideal approach for upper cervical diseases.The infection rate could be lowered down to the minimum if the patients were properly managed perioperatively.Atlantoaxial fusion could be achieved through this approach without instrumentation.     

经口腔前庭及经乳晕入路腔镜甲状腺切除术治疗甲状腺结节的疗效对比

目的 探究经口腔前庭与经乳晕入路腔镜甲状腺切除术治疗甲状腺结节患者的临床效果及安全性。方法 选择该院收治的69例甲状腺结节患者,以2017年2月－2020年6月在该院接受经乳晕入路腔镜甲状腺切除术的33例作为经乳晕组,以同期接受经口腔前庭腔镜甲状腺切除术治疗的36例作为经口腔组。比较两组患者手术指标［手术时间、术中出血量、术前术后疼痛视觉模拟评分（VAS）、术后住院时间、术后引流量］,采用嗓音障碍指数（VHI）、吞咽障碍评分量表（SIS）评估手术前后两组患者嗓音和吞咽功能变化,手术前后采用90项症状自评量表（SCL-90）评估两组患者心理状况,生活质量调查问卷（EORTC QLQ-C30）评估两组患者生活质量,并比较两组患者并发症发生率。结果 经口腔组手术时间较经乳晕组长,术中出血量、术后引流量、瘢痕长度明显少于经乳晕组（P < 0.05）,术后两组患者VAS评分较术前均明显升高（P < 0.05）,但术后经口腔组VAS评分较经乳晕组低（P < 0.05）。与同组术前比较,术后两组患者VHI评分、SIS评分明显降低（P < 0.05）,但术后两组患者VHI评分、SIS评分比较,差异无统计学意义（P > 0.05）。与术前比较,术后两组患者SCL-90评分明显降低,且经口腔组明显低于经乳晕组,两组患者术后EORTC QLQ-C30评分明显增高,且经口腔组明显高于经乳晕组（P < 0.05）。经口腔组并发症发生率较经乳晕组略低,且两组患者中双侧切除者并发症发生率略高于单侧切除者,但差异无统计学意义（P > 0.05）。结论 与经乳晕入路腔镜甲状腺切除术相比,经口腔前庭入路腔镜甲状腺切除术治疗甲状腺结节的组织损伤小、术后疼痛轻、无瘢痕,更利于维持患者术后心理健康和良好的生活质量,且后者手术安全性更高。     

经口寰枢椎复位内固定术围手术期护理研究现状

Transoral atlantoaxial reduction plate (transoral atlantoaxial reduction plate TARP) system is on the anterior cervical surgical instruments in recent years domestic self-developed, set loose, decompression, reduction and fixation function in a body, in the treatment of cervical deformity, basilar invagination and irreducible atlantoaxial dislocation has unique advantages the [1]. TARP operation by transoral approach, anatomical structure is complex, difficult surgery, perioperative nursing has its unique requirements and the difficulty of [2]. early, many studies have confirmed the perioperative and postoperative nursing And closely related to the occurrence, but there is no related research abroad, domestic research is less. The purpose of this study was to the transoral atlantoaxial reduction plate internal fixation of perioperative nursing were reviewed, the clinical application and provide reference for TARP perioperative nursing.     

内窥镜辅助复位内固定治疗下颌角骨折的临床研究

目的探讨内窥镜技术在手术切开复位内固定治疗下颌角骨折中的应用。方法34例（37侧）下颌角骨折患者中,22侧单线不利型骨折,13侧复杂性骨折,2侧粉碎性骨折。术中经LI内入路,在内窥镜监视下复位移位的骨折段,并在外斜线上方和采用穿刺套管或侧壁电钻在下颌下缘处固定一个小型钛板。结果34例（37侧）下颌角骨折,在内窥镜辅助下完成手术复位和内固定。术后除粉碎性骨折外,所有患者均实现解剖复位。术后复查与随访骨折复位固定良好、无并发症。结论经口内入路内窥镜辅助手术复位和小型钛板两板固定临床可用于沿外斜线单板固定稳定性不足的下颌角骨折,如不利型的单线骨折、复杂性骨折、具有严重移位的骨折等;该手术方式具有微创和美观等优点。     

Transoral sonographic diagnosis of submandibular duct calculi

We present a case of submandibular duct calculi diagnosed using transoral sonography. Sonography is the first‐line imaging modality of salivary gland calculi. However, it is performed via a transcutaneous approach, which is limited in identifying small salivary duct calculi. Using an intraoral transducer, transoral sonography can visualize the submandibular duct and detect the presence of small calculi, thus overcoming the limitations of transcutaneous sonography. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :125–128, 2014     

Minimally invasive transoral robotic surgery for hiloparenchymal submandibular stone: Technical note on Flex Robotic System

Flex Robotic System allows a minimally invasive approach for transoral removal of submandibular salivary stones.     

Basilar Invagination,Basilar Impression,and Platybasia: Clinical and Imaging Aspects

The congenital and acquired deformities of the craniovertebral junction (CVJ), such as basilar invagination, basilar impression, or platybasia, can present in the form of slowly progressive or acute neurologic deterioration. In many cases, an insidious headache is the only symptom and can be a diagnostic challenge for the neurologist. Proper imaging studies as well as recognizing often associated neurologic or systemic conditions are required for early diagnosis and effective therapy. In the current report, the primary focus will be on clinical aspects of these CVJ abnormalities; the pathologic and radiologic aspects, such as developmental and pathophysiologic background or radiographic analysis, will be discussed briefly, confined to clinically relevant data.     

Contrast-Enhanced Ultrasound Guided Transoral Core Needle Biopsy: A Novel,Safe and Well-Tolerated Procedure for Obtaining High-Quality Tissue in Patients with Oral Cancer

The aim of the prospective study described here was to compare the tolerability, safety and diagnostic value of contrast-enhanced ultrasound-guided transoral core needle biopsy (CEUS-CNB) with that of conventional US-guided transoral CNB (US-CNB) and standard incisional biopsy in patients with oral masses. Between June 2017 and November 2019, consecutive patients with oral masses referred for biopsy were randomly assigned to undergo incisional biopsy, US-CNB or CEUS-CNB. Procedure time, intra‑operative blood loss volume, diagnostic performance and pain level before and after the procedure assessed by visual analogue score (VAS) were recorded and compared among the three procedures. Finally, 238 patients with pathology confirmation were analyzed: 80 patients underwent incisional biopsy, 78 patients US-CNB and 80 patients CEUS-CNB. In this study, no significant difference was found in biopsy time between CEUS-CNB, US-CNB and incisional biopsy (75 ± 11 s vs. 73.6 ± 12 s vs. 77 ± 13 s, p = 0.24). CEUS-CNB achieved the highest sensitivity (CEUS-CNB: 100%, US-CNB: 88.5%, incisional biopsy: 84.3%), negative predictive value (CEUS-CNB: 100%, US-CNB: 81.3%, incisional biopsy: 78.4%) and accuracy (CEUS-CNB: 100%, US-CNB: 92.3%, incisional biopsy: 90%). The VAS score for incision biopsy was higher (p = 0.01) and the amount of bleeding was larger (p < 0.001), yet there was no significant difference between CEUS-CNB and US-CNB. Our results indicate CEUS-guided transoral CNB is an efficient, safe and well-tolerated procedure, with biopsy time comparable to and diagnostic performance better than those of conventional US-guided transoral CNB and incisional biopsy.     

Robotic transoral vestibular parathyroidectomy: Two case reports and review of literature

Advances in preoperative localization studies and demands for scarless surgery have promoted the investigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral vestibular parathyroidectomy (RTVP) in four patients with primary hyperparathyroidism. The surgery was performed with the Da Vinci system through three trocars introduced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.     

Anatomical study of surgical approaches for minimally invasive transoral thyroidectomy: eMIT and TOPP

Objective: Anatomical study of surgical approaches of endoscopic minimally invasive thyroidectomy (eMIT) and transoral partial parathyroidectomy (TOPP) was conducted to evaluate their safety and feasibility. Material and methods: After performing an eMIT- and TOPP-procedure on fresh frozen human cadavers, a layer-by-layer dissection of the floor of the mouth and the anterior cervical region was carried out in five specimens. The blood vessels, nerves and muscles related to the surgical approach were exposed. Results: The anterior region of the neck can be reached through the midline of the mouth floor and the suprahyoid muscles. No important nerves and vessels were found in the approach of eMIT. TOPP set up the space at the dorsal side of the thyroid gland and adjacent to the trachea. The hypoglossal nerve and the lingual nerve as well as their accompanying blood vessels were anatomically related to the approach and could be injured during the procedure. The surgical space is much limited in TOPP (<20 mm in diameter) and current surgical instruments still did not match the requirement of this technique. Conclusions: This study demonstrated that the transoral approach of eMIT is anatomically safer and more feasible than that of TOPP.     

经口与经鼻导尿管球囊扩张术治疗脑干卒中后环咽肌失弛缓症的影响

目的比较经口与经鼻导尿管球囊扩张术治疗脑卒中后环咽肌失弛缓症患者的疗效。 方法选取脑卒中后环咽肌失弛缓患者30例,按随机数字表法将其分为经口扩张组和经鼻扩张组,每组患者15例。2组均给予常规吞咽康复训练,在此基础上,经口扩张组通过口腔置管行导尿管球囊扩张术,经鼻扩张组给予经鼻腔插管行导尿管球囊扩张术。记录2组患者在行扩张治疗时监测患者心率变化,并于每次治疗结束后观察2组患者鼻黏膜出血、水肿、疼痛等并发症的发生情况。采用吞咽疗效评分和视频吞咽造影检查（VFSS）对2组患者治疗前、后的吞咽功能进行评估和比较。 结果治疗后,经口扩张组的藤岛一郎吞咽疗效评分为（7.26±2.52）分,经鼻扩张组为（7.18±2.64）分,分别与组内治疗前比较,差异均有统计学意义（P<0.05）,2组间差异无统计学意义（P>0.05）;治疗后,2组患者的VFSS评分分别为（2.26±0.46）分和（2.19±0.53）分,分别与组内治疗前比较,差异均有统计学意义（P<0.05）,2组间差异无统计学意义（P>0.05）。治疗过程中,经口扩张组心率较组内治疗前增加（9.12±1.4）次,明显低于经鼻扩张组的（18.6±2.9）次,差异有统计学意义（P<0.05）,且经口扩张组治疗接受率为98.2%,明显高于经鼻扩张组80.1%,差异有统计学意义（P<0.05）。经口扩张组患者发生黏膜出血、喉头水肿、疼痛等并发症分别为1例、1例、（1.0±0.7）分,分别与经鼻扩张组的9例、7例、（3.1±0.4）分比较,差异均有统计学意义（P<0.05）。 结论导尿管球囊扩张术是脑卒中后环咽肌失弛缓所导致吞咽障碍的有效治疗方法,经口腔置管行球囊扩张术的患者的鼻黏膜水肿、喉头水肿、疼痛等并发症均优于经鼻置管行球囊扩张术的患者,且患者接受率更高。     

Carbon dioxide embolism during transoral endoscopic thyroidectomy: A case report and literature review

The creation of the surgical space in transoral endoscopic thyroid surgery may put the anterior jugular vein at risk for injury and possibly lead to carbon dioxide (CO₂) embolism. Although rare, CO₂ embolism is potentially fatal. We report a case of a 67-year-old female who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) for a benign thyroid disease. Intraoperatively, the anterior jugular vein was inadvertently lacerated. The end-tidal (Et)CO₂, O₂ saturation, heart rate, and blood pressure suddenly decreased. The patient eventually became asystole. Cardiopulmonary resuscitation was performed with a return of spontaneous circulation (ROSC). We successfully ligated the injured vessel and terminated the procedure. A literature review of CO₂ embolism during transoral thyroid surgery is presented, focusing on presentation, management, and prevention. Since TOETVA is still in preliminary clinical application, especially in developing countries, CO₂ embolism may not be uncommon during the initial phase of the learning curve. Surgeons and anesthesiologist should be aware of this possibility.     

颈伸位下头颈三维重建在甲状腺手术中的应用

  目的  探究在颈伸位下三维重建头颈结构在甲状腺手术中的应用价值。  方法  选择20例已经由病理结果证实的甲状腺疾病患者在颈伸位下的平扫CT图像,应用三维重建软件3DVWorks,对甲状腺、甲状腺结节、甲状软骨、下颌骨、锁骨、皮肤等组织进行三维重建,测量多个空间角度及径线以评估疾病及治疗方案。  结果  通过在头颈三维重建模型中对下段气管所在的不同平面与甲状腺手术相关解剖结构的角度与距离测量,综合评估后在甲状腺结节 < 3 cm的11例患者中有3例患者不适合行经口腔镜术式,可行其他腔镜等术式;3例患者不适合行经口、经胸乳腔镜术式及经腋窝等腔镜手术,仅适合开放手术;1例患者因结节分期较高,不推荐行腔镜手术;另外4例患者各类手术均可施行。通过构建胸廓入口及以此平面准确分割巨大甲状腺体积,对6例含有结节 > 3 cm的巨大甲状腺进行预评估后发现均未达经颈胸联合切除甲状腺的指标要求,6例患者行传统单纯经颈切口即可完整切除甲状腺。对有残留甲状腺的3例患者,预评估显示3例残余甲状腺均可准确定位并能指导手术切除。  结论  通过在颈伸位下三维重建头颈结构并建立评估指标,对腔镜手术方式选择、巨大甲状腺肿诊治、残余甲状腺术中定位有独特优势,有助于形成良好的手术策略,更有益于医患交流。      

Hypophysectomy; ground breaking treatment for acromegaly in cats - an overview of cutting edge surgery

Acromegaly is a condition caused by a pituitary somatotroph adenoma which causes an over production of somatotropin (hypersomatotropism). This can cause the patient to become insulin resistant and therefore suffer from uncontrolled diabetes. The hypophysectomy is a ground breaking surgery. It can effectively treat feline acromegaly caused by a pituitary somatotroph adenoma by removing the pituitary using a transoral transphenoidal approach (through the roof of the mouth).     

影响经口寰枢椎术后肺部并发症发生因素的调查分析

目的 探讨经口寰枢椎术后肺部并发症(postoperative pulmonary complications,PPCs)的影响因素和预防措施.方法 选择2005年1月～2011年12月的14l例经口寰枢椎手术患者,依据术后是否发生肺部并发症分为PPCs组与非PPCs组,采用t(x2)检验及logistic回归模型分析PPCs的影响因素.结果 本组141例患者中20例出现PPCs,发生率14.18％.PPCs组与非PPCs组比较结果显示,低蛋白血症、脊髓损伤程度(Frankle分级)、气管导管留置时间3个因素为经口寰枢椎术后患者PPCs发生的独立危险因素(P＜0.01).结论 经口寰枢椎术后PPCs发生率高,临床上对于血清清蛋白＜35g/L、脊髓损伤、气管导管留置时间＞4d的患者应高度重视,给予相应的预防措施,减少PPCs的发生.     

经口寰枢椎术后肺部并发症防治的前瞻性研究

目的 探索围术期规范化防治措施对经口寰枢椎术后肺部并发症发生的干预作用.方法 对广州军区广州总医院2005-01-2009-06经口寰枢椎术患者(A组)104例进行回顾性分析,并对2009-06-2010-06行围术期规范化防治措施的经口寰枢椎术患者(B组)33例进行前瞻性研究,比较两组患者术后肺部并发症发生率的差异.结果 改进并规范了围术期防治措施后,术后肺部并发症的发生率明显下降,两组差异有统计学意义(P＜0.05).结论 经口寰枢椎术后肺部并发症发生率高,但只要重视围术期的处理,可明显降低术后肺部并发症的发生率.     

寰枢椎病变植入物内固定：口咽入路的优势

背景：经口咽入路是治疗寰枢椎病变的传统方法,一直以来都是脊柱外科研究的热点和难点。目的：为经口咽入路到达颅颈交界区提供直观操作路径,并提供安全操作的解剖学数据。方法：对尸体标本进行经口咽入路逐层外科解剖,观察解剖层次、组织结构以及相互之间的毗邻关系,以门齿为标志点测量各主要解剖结构与其之间的距离,并测量椎动脉与中线之间的距离以及寰枢椎的形态学结构。结果与结论：经口咽前入路能直接显露从斜坡中下段至C3椎体上缘的范围,双侧椎动脉到中线的距离C1水平左侧为20．72—29.70mm、右侧为20．36—28．98mm,C2水平左侧为13．10-23．00mm、右侧为13．85—24．02mm。前结节、齿突前面、齿突后面、硬脊膜、脊髓以及C2椎体前缘和C3椎体前缘与门齿之间的距离分别为69．24—88．16mm、74．95—96．27mm、84．77-107．39mm、87．65—111．45mm、91．38—116．11mm、76．21—92．77mm和78．53—105．13mm。寰椎长度为（19．8±2．3）mm,齿突高度为（15．9±1．9）mm,最大横径为（10．5±0．6）mm,最大矢状径为（11．5±1．9）mm;枢椎最大横径为（15．1±1。6）mm,最大矢状径为.17．7±1．3）mm,上关节面外缘到中线的距离为（26．1±1.7）mm,横突孔入口与上关节面之间的距离为（8．1士1．3）mm。颅颈交界区的解剖结构复杂,经口咽入路在解剖安全范围内处理颅颈交界区病变存在优势。