原发性颈淋巴结结核的临床特征与治疗

目的：探讨原发性颈部淋巴结结核的临床特征和治疗方法。方法：回顾性分析32例原发性颈部淋巴结结核患者的临床资料。32例患者中29例活检前行CT检查，4例行细针穿刺针吸活检确诊，28例行手术病理检查确诊。27例行肿块全部切除或区域性颈部淋巴结清扫术，术后全身抗结核治疗6个月；5例确诊后行常规抗结核治疗1年。结果：CT显示肿块呈均匀或不均匀强化，部分肿块呈融合现象。全部病例治疗后均行随访，手术患者术后切口均Ⅰ期愈合，1例术后抗结核治疗3个月肿块增大，再次手术确诊为颈部淋巴结结核并发鼻咽癌颈部淋巴结转移，转肿瘤科治疗，其余31例患者均无颈部淋巴结结核复发和其他结核病表现。结论：原发性颈部淋巴结结核临床特征发生改变，颈部肿块为首发症状，多数位于颈后三角区。CT检查有助于本病的诊断和鉴别诊断。全身抗结核药物和手术切除淋巴结的联合应用能有效地治疗原发性颈部淋巴结结核。原发性颈部淋巴结结核的治疗应以手术为主，手术治疗能缩短治疗时间、减少药物用量及不良反应，防止冷脓肿及窦道形成。     

颈部血管滤泡淋巴组织增生病的诊断与治疗

目的探讨颈部血管滤泡淋巴组织增生病（Castleman disease,CD）的临床表现及诊治。方法回顾性分析我院收治的2例颈部CD患者的临床资料,分析其临床表现、临床及病理分型、影像学特征和治疗方案。结果2例颈部CD发病年龄分别为24岁和29岁,均以单发无痛性颈部肿块就诊,无其他特殊临床症状。临床分型符合局限型CD,病理分型均符合透明血管型CD。2例颈部肿块均完整手术切除,分别随访1年和半年无复发。结论颈部CD常为局限性病变,以单发无痛性肿块缓慢增大为主要表现,常无其他特殊临床症状。常见发病部位为颈部淋巴结,病理分型几乎全部为透明血管型。完整肿块切除是治疗颈部CD的最佳治疗方法。     

甲状旁腺癌的外科诊治

目的:探讨甲状旁腺癌(PTC) 的临床诊断、治疗方法及预后.方法:回顾性分析4例PTC患者的临床资料.4例均可触及颈部肿块.患者血钙为(3.25±0.53)mmol/L,甲状旁腺激素(PTH)水平为(1210.25±528.72)ng/L.仅1例术中冷冻明确诊断,3例术后石蜡病理及免疫组织化学确诊.3例行甲状旁腺切除术加患侧甲状腺次全切除术,1例接受内镜下甲状旁腺肿块切除术.结果:随访8～60个月患者血钙及PTH正常,无转移及复发.结论:PTC术前诊断困难,术前结合血钙、PTH血生化检查与超声、CT等影像学检查可能有助于提供诊断信息;术中冷冻病理价值有限.首次手术时根治切除是影响预后最重要的因素,手术治疗预后好.     

颅底及颈部脊索瘤11例临床分析

目的：探讨发生于耳鼻咽喉科手术部位的颅底及颈部脊索瘤的临床表现，组织学类型，影像学特点，手术方法及远期疗效。方法：回顾性分析11例颅底及颈部脊索瘤患者的临床资料，并介绍1例颈部巨大脊索瘤。11例均行手术治疗。结果：发生于颅底及颈部的脊索瘤临床表现复杂，首发症状以鼻塞、颈部包块、视力下降、耳鸣、耳聋及脑神经受损症状为主。组织学类型：典型脊索瘤8例，软骨性脊索瘤3例。影像学表现：8例行CT检查者表现为软组织肿块影，以膨胀性生长为主，颈椎或颅底多有骨质破坏，肿块与周围软组织边界清楚。2年复发率为36．4％，5年生存率为72．7％。结论：本病临床表现复杂，对颅底及颈椎以外的周围组织以膨胀性压迫为主，对颅底及颈椎骨质以侵蚀性破坏为主；手术治疗效果良好，应根据病变部位及肿瘤大小选择手术径路。复发者仍可再手术，彻底手术可减少复发率。     

以颈部淋巴结肿大为首发症状的局灶型Castleman病诊治体会

目的 总结颈部Castleman病的临床特征与诊治体会.方法 回顾性分析2000年5月至2008年10月期间8例以颈部淋巴结肿大为首发症状的Castleman病患者临床资料.肿物位于颈部Ⅰ区1例,Ⅱ区3例,Ⅲ区3例,Ⅳ区1例.8例病例均行常规CT检查表现为类圆形软组织肿块影,其中4例增强扫描后周围可见环性增强区.8例血常规检查大致正常,其中6例患者轻度贫血.结果 本组病例均为局灶型Castleman病,手术完整切除肿大淋巴结,肿大淋巴结呈椭圆形,大小约(2 cm×2 cm×3 cm)～(4 cm×3 cm×2 cm),界限清楚,与周围组织无明显粘连.病理类型为透明血管型.术后随访7～30个月未见复发.结论 局灶型Castleman病表现为单一部位的淋巴结肿大,CT等影像榆查可以提示诊断,手术切除疗效好.     

以慢性蝶窦炎为首发表现的鼻咽癌3例报告

鼻咽癌由于鼻咽癌部位隐蔽,症状比较复杂,如单侧头痛或复视、上颈部肿块,后吸性涕中带血,一侧分泌性中耳炎等,常可作为早期症状或首发症状单独出现,因此容易漏诊、误诊。此外,慢性上颌窦炎及慢性蝶窦炎亦可能是鼻咽癌患者的首发症状或表现。现将我科近年来收治的3例以慢性蝶窦炎为首发表现的鼻咽癌报告如下。     

99例颈部肿块的临床分析

目的回顾性分析99例因单纯颈部肿块住院并经病理确诊患者（排除常规甲状腺及涎腺肿物）的临床表现及诊治过程,以提高颈部肿块的诊断准确率,为正确制定手术方案提供经验与依据。方法99例患者中1例经颈部CT血管造影（CTA）确诊为颈动脉体瘤后放弃治疗出院,2例淋巴瘤经活检确诊后转科治疗,其余病例均采用手术切除治疗并经病理切片确诊,其中3例转移癌均行患侧颈廓清术,术后辅助放疗。结果所有手术患者术后均随访0．5—3年,其中3例神经鞘膜瘤患者出现声嘶和脑梗塞并发症;2例甲状舌管囊肿患者复发,再次手术;5例恶性肿瘤患者中1例手术后8个月死亡,余均未见复发或转移。结论颈部肿块病变形式多样,掌握其发病特点和规律,充分完善术前检查,可大大减少误诊,降低手术风险。     

头颈部嗜酸性淋巴肉芽肿诊断与治疗

目的 探讨头颈部嗜酸性淋巴肉芽肿(ELG）的病理、诊断及治疗。方法 回顾性分析10例ELG患者的临床、病理资料。结果 10例主要临床表现为颌下、面颊部、耳周腮腺区、耳后乳突区无痛性多发肿块,多发颈部淋巴结肿大,肿块处的皮肤瘙痒及色素沉着;外周血象中嗜酸性粒细胞比例和计数明显升高。其中合并有肾病综合征1例。10例患者均行手术治疗,术后病理诊断为嗜酸性淋巴肉芽肿。术后复发5例,予以放射治疗随诊3年未复发1例,予以再次手术治疗控制4例。结论 头颈部嗜酸性淋巴肉芽肿具有典型的临床和病理学特点,治疗包括外科手术切除、小剂量放射治疗以及类固醇类药物。     

60例鼻前庭肿块的临床分析

目的　总结鼻前庭肿块的临床诊治经验。方法　回顾性分析 1982年 5月～ 2 0 0 3年4月收治的 6 0例鼻前庭肿块患者的临床资料、手术方法及径路。结果　 6 0例鼻前庭肿块中良性肿瘤5 1例 ,炎性疾病 5例 ,恶性肿瘤 4例 ,均行手术治疗 ,术后无并发症 ,痊愈出院。 5 1例良性肿瘤和 5例炎性肿块患者中 ,37例随访 5个月～ 15年 (平均 97个月 )无复发和恶性变 ;2例复发再次手术治疗 ;6例死于其他疾病 ;11例失访。 4例恶性肿瘤患者中 ,2例恶性黑色素瘤分别于术后 1年、4年 10个月复发 ,再次行鼻侧切开肿瘤切除 ,分别于第 2次术后 1年 3个月和 6年 10个月死于复发和肝转移 ;乳头状瘤癌变和非霍奇金淋巴瘤患者已无瘤生存超过 17年和 5年 2个月。结论　鼻前庭解剖区域虽小 ,但各种性质的肿块均可发生 ,治疗以手术切除为主 ,手术途径根据肿块的位置、大小及性质而定。     

颈根部肿块的外科治疗(附26例报告)

目的:探讨颈根部肿块的外科治疗方法和疗效.方法:对26例颈根部肿块进行手术治疗,其中良性10例,恶性16例.根据病变的范围及性质采取"T"形及"L"形切口,必要时劈开锁骨,切除部分胸骨柄及胸锁关节.结果:10例良性肿块完整切除,其中术后发生乳糜瘘1例,喉返神经损伤1例;16例恶性肿瘤完整切除12例,部分切除4例.术中锁骨下静脉破裂2例,术后永久性臂丛损伤1例,纵隔气肿1例,气管瘘1例,膈神经损伤1例,术腔血肿2例.随访1～5年,良性组无复发及死亡患者,恶性组中术后存活5年者6例,3年者4例,2年者2例,余4例均在术后1年内死亡.结论:颈根部肿块的手术切除是可行的.此区的良性肿瘤手术治疗效果良好,恶性肿瘤手术后也有较好的效果.     

Pilomatricoma of the head and neck: a retrospective review of 179 cases

OBJECTIVE: To describe the clinical presentations and management of pilomatricoma, formerly known as pilomatrixoma, of the head and neck. DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: The study included 179 patients with a diagnosis of pilomatricoma of the head and neck. INTERVENTION: All patients underwent surgical excision for pilomatricoma of the head and neck between 1991 and 2002. RESULTS: Pilomatricoma occurred at any age (mean age, 29.8 years); 45.3% of the cases occurred in patients younger than 18 years. The female-male ratio was 0.97:1. The average size of the lesion was 1 cm. The most common sites of occurrence were the neck (30.2%), cheeks (16.8%), scalp (16.2%), and brow and periorbital area (14.0%). Multiple occurrence was found in 1 case. Two of 179 tumors recurred after surgical excision. CONCLUSIONS: Because preoperative diagnosis of pilomatricoma is usually incorrect, careful clinical examination and a high index of suspicion would result in a more accurate diagnosis. Complete surgical excision is the treatment of choice. Otolaryngologists should consider pilomatricoma in the differential diagnosis of neck masses.     

Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study

OBJECTIVE: To investigate a correlation between neck length and the incidence of complications after both percutaneous and surgical tracheotomy (ST) and to compare the relative safety of the two procedures at our institution. STUDY DESIGN: Prospective, randomized study of patients undergoing tracheotomy at a tertiary care center. METHODS: Forty-three patients evaluated for tracheotomy at our institution between the years 2003 and 2004 were enrolled in the study and were randomly assigned to receive either an ST or a percutaneous dilatational tracheotomy (PDT). All patients underwent standardized measurement of the cricosternal distance (CSD) in the neutral and extended positions before the procedure. Demographic and procedural variables were recorded, and the occurrence of postoperative complications was followed for 1 week. RESULTS: PDT was performed in 29 patients and ST in 14 patients. The mean CSD of 2.7 cm increased to 3.7 cm after extension with a shoulder roll. PDT required less time (mean 8 vs. 23 minutes) and resulted in less blood loss compared with ST. A trend toward a higher incidence of complications with PDT (40%) compared with ST (7%) and in the first half of our series (learning curve) was noted. This, however, did not reach statistical significance. There was no correlation between the incidence of complications and neck length as determined by the CSD in either group of patients. CONCLUSIONS: We failed to demonstrate a correlation between CSD and tracheotomy related complications. Patients with short necks may be at no higher risk during either a PDT or ST. Experience, awareness of complications, and a dedicated team approach are necessary for the safe performance of PDT.     

Treatment of Epidermoid and Undifferentiated Carcinomas from Occult Primaries Presenting in Cervical Lymph Nodes

We treated 83 patients with epidermoid or undifferentiated carcinoma in cervical neck nodes without an obvious primary at our institution between 1964 and 1979. All patients received radiotherapy and 29 patients had radical neck dissection (RND) or total excisional biopsy (TEB) as well. Actuarial survival was 38% at 5 years for the entire group and 25% at 10 years. Fifty-four patients with neck control had significantly better survival (p=.0001) at 5 and 10 years than those whose neck was uncontrolled. Factors associated with improved neck control were initial size of the neck mass and the addition of surgery (RND or TEB). Analysis of failures showed that 50% of patients failed only in the primary or neck and 50% developed distant metastases. Tumor was the major cause of death. We recommend more aggressive treatment with both XRT and neck dissection in patients with large resectable neck masses to prevent regrowth of tumor in the neck.     

Parotid involvement in cat scratch disease: a differential diagnosis with increased significance

BACKGROUND: Bartonella henselae is the causative agent of cat-scratch disease (CSD), an inflammatory infection of the lymph nodes. So far, only few cases of atypical manifestations in the head and neck, especially manifestations in the parotid gland have been reported. PATIENTS AND METHODS: Between January 1997 and June 1999 seven patients with manifestations of CSD in the parotid gland were observed at the ENT-department Freiburg. The positive diagnosis was confirmed serologically by an indirect immunofluorescence assay and by detection of Bartonella henselae-DNA with PCR-amplification and subsequent hybridization or sequencing. RESULTS: An intraglandular abscessed lymphadenitis was found in five patients, two of these cases were based on a Parinaud's oculoglandular syndrome. A diffuse affection of the parotid gland, initially misinterpreted as a parotid tumor, was seen in two patients. CONCLUSIONS: Antibiotic treatment is recommended in order to reduce the duration of the disease, in cases of pain and lymph node abscesses. In uncommon manifestations of CSD, the nosological assignment can be difficult on the basis of the heterogeneous symptomatic in the individual patient and the CSD diagnosis can only be confirmed by serology or PCR-based techniques. CSD should be considered in the differential diagnosis of all equivocal masses in the head and neck, even in unusual localisations like the parotid gland.     

异位甲状腺及其误诊误治

目的：探讨异位甲状腺的临床特征、诊断及治疗，以减少其误诊、误治。方法：报告4例异位甲状腺患者的临床资料，结合文献复习，对异位甲状腺的临床流行病学特点、诊断、治疗及其误诊、误治原因等进行分析。结果：4例异位甲状腺患者均被误诊为甲状舌管囊肿，其中3例发生良、恶性肿瘤。结论：耳鼻咽喉头颈外科医师对异位甲状腺的认识不足和缺少细致缜密的检查是导致其误诊、误治的主要原因。     

Surgical management of cervical ganglioneuromas in children

OBJECTIVE: To review the experience with ganglioneuromas in the head and neck of children including presentation, diagnostic testing, treatments, and outcomes. DESIGN: Case series. Retrospective chart review. SETTING: Tertiary care hospital. PATIENTS OR OTHER PARTICIPANTS: All patients with a history of ganglioneuroma of the neck in each authors practice were reviewed. All pathologically confirmed occurrences were eligible for inclusion, and five patients met these criteria. RESULTS: Five patients underwent surgical excision of head and neck ganglioneuromas between 1988 and 2004. There were no occurrences of secretory tumors, therefore all of the patients presented with enlarging masses. In all cases, the tumor arose from the cervical sympathetic chain, and thus, patients had subsequent ipsilateral Horner's Syndrome following resection. No synchronous tumors were noted, nor has a recurrent tumor been observed to this point. Complete excision was possible in all cases via a transcervical, or transoral approach, without mandibulotomy. CONCLUSIONS: Ganglioneuroma of the neck is a rare tumor that most commonly presents as an enlarging neck mass. Complete surgical excision is the treatment of choice, and in this series of children was possible with transcervical approach, and once via transoral approach. This tumor may be suspected in children who are otherwise asymptomatic, and present with long history of enlarging neck masses.     

Management of nasopharyngeal salivary gland malignancy

OBJECTIVE: The objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy. STUDY DESIGN: Retrospective case review at tertiary care skull base center. METHODS: Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan-Meier and Cox proportional hazards methods. RESULTS: Histological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a significantly poorer outcome (P =.035) with a relative risk of 4.6 compared with low-grade disease. Local control was seen to be 77% at 5 years. CONCLUSIONS: Planned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro-omental free flap.     

Treatment of the clinically negative neck in floor of the mouth carcinoma

A retrospective study of 61 consecutive patients with floor of mouth carcinoma and a clinically negative neck was done to determine the value of elective treatment to the neck. Subsequent histologically proven nodal disease was analyzed according to initial treatment modality (23 surgical, 38 irradiation), stage (29--T1,27--T2,5--T3), hemi-neck at risk (midline lesions placed both hemi-necks at risk), and primary control for a minimum of 2 years (50 patients, 78 hemi-necks at risk). Neck failures were classified by T stage, extent of neck treatment (upper neck or complete) and by primary control at the time of manifest neck metastasis. Of the hemi-necks at risk with the primary controlled, 10% (17% of patients) developed nodal disease without complete neck treatment; 86% (6/7) of these patients were salvaged. The occult positive node incidence, conservatively calculated by elimination of all patients treated with elective partial or total neck irradiation, was 10% for patients with T1 and T2 lesions (7% for hemi-necks at risk). Based on the clinical course of patients with primary control, only 1 patient (2%) might have benefited from initial complete elective neck treatment. These results suggest that elective neck treatment in early (T1 and T2, N0) floor of mouth carcinoma is of doubtful value. Supraomohyoid , rather than suprahyoid dissection, is recommended if surgical treatment of the neck is undertaken.     

Cytologic evaluation of surgical irrigation fluid following resection of head and neck squamous cell carcinoma.

INTRODUCTION: Historically, squamous cells exfoliated from head and neck carcinoma resection have been implicated in locoregional recurrence, but there have been few studies demonstrating the presence of these cells. This study was designed to evaluate the presence of exfoliated malignant cells in surgical irrigation fluid collected during head and neck cancer resection. METHODS: Thirty patients undergoing surgery for biopsy-proven squamous cell carcinoma had their surgical sites irrigated with 1,000 cc of normal saline. Surgical gloves and instruments were also washed. These samples were prepared and stained using standard squamous cell cytologic stains. All cases were reviewed by one cytopathologist. RESULTS: Eighteen patients (60%) had positive or suspicious cytology detected in at least one of the surgical samples. In patients with T0 and T1 tumours, all surgical samples were negative. Positive or suspicious cytology was detected in the primary site and glove and instrument irrigation in 40% of patients with T2 tumours, 42% of patients with T3 tumours, and 50% of patients with T4 tumours. This was statistically significant (p < .05). Positive or suspicious cytology was detected in the neck and glove and instrument irrigation in 29% of patients with an N0 neck, 31% of patients with an N1 neck, 39% of patients with an N2 neck, and 100% of patients with an N3 neck. Five of seven patients (71%) with previous radiation therapy had positive or suspicious cytology in at least one of the surgical samples. CONCLUSIONS: Higher tumour and nodal staging and a previous history of radiation therapy are associated with an increased incidence of positive or suspicious cytology in surgical irrigation fluid. These findings have implications for surgical protocols.