汶川地震后部分地区耳鼻咽喉头面部伤情调查与分析

目的 调查分析强烈地震灾害造成的耳鼻咽喉头面部的伤情及救治.方法 对2008年5月12日四川汶川地震后第二军医大学医疗队所在安县、茂县、江油县及汶川县三江镇收治的、及巡诊的受伤人数进行调查,重点对伤员的耳鼻咽喉、颌面及头颈部的伤情、致伤原因、救治方法进行分析.结果 本组患者为地震3 d后存活人群中的耳鼻咽喉头面部伤227例,多是轻伤或伴有复合伤,其中185例头面部软组织伤,13例鼻骨或鼻窦骨折,18例鼻出血,7例颅底骨折,4例耳廓撕裂伤.根据救护所及医院的不同医疗条件进行诊断和治疗,对软组织损伤采用清创换药缝合,骨折尽可能复位.对伴有复合伤的危重伤员急救稳定后送至有条件的医院进一步治疗.救护所救治的46例中除3例复合伤或可疑视神经损伤的重伤员后送外,43例5～10 d痊愈.医院救治181例中除3例有颅底骨折的复合伤转院后送外,住院31例至5月26日痊愈出院26例,留院治疗的5例均为复合伤未愈者;147例未留院患者中除1例耳廓撕裂伤感染再次清创延期愈合外,146例软组织伤痊愈并拆,骨折患者在愈合中,未见并发症.结论 对地震后的耳鼻咽喉头面部伤应尽早清创缝合、骨折复位,注意合理用药,危重伤员及时后送,可以减少并发症的发生,降低死亡率.     

汶川大地震后耳鼻咽喉专业地震伤情谱分析

目的 分析汶川地震灾害后地震伤员耳鼻咽喉专业相关伤情特点及伴发伤特点,为日后处理类似灾害事件提供资料.方法 收集汶川地震灾区绵阳市城区及其周边4个5·12受灾严重的区市县11家大中型医院(含外援医疗队)诊治地震伤员耳鼻咽喉科相关伤病情况,对其人群特点及受伤部位等进行综合分析.结果 11家医院共诊治耳鼻咽喉专业相关患者289例,其中有资料记录者217例,耳部损伤及头颈部伤为主要症状者较多(79例),鼻部面部损伤及骨折者亦常见(43例),咽喉气管损伤较少(2例).伴发伤多为骨折、全身多处软组织伤及皮肤擦伤等,颅脑损伤者及颅骨骨折也常发生,尚可合并眼眶骨折、眼球损伤等.结论 不同灾害造成的损伤各有不同,建立灾害后相关专业伤病情况谱,对于在处理类似情况中更积极有效抢救患者生命及安排人员物资等有重要意义.     

耳鼻咽喉科处理地震伤急诊病人的体会

绵阳地区是5.12汶川大地震的重灾区,灾害发生后大量地震伤患者送来我院.此时,面对大量以复杂性外伤为主的地震伤员,外科医师严重短缺.为了让广大伤员在第一时间获得基本医疗救助,我院耳鼻咽喉科在医院领导的统一部署下,担当了大量专科和非专科伤员的紧急救治工作.     

耳鼻咽喉科医师对地震伤的处理策略

5.12汶川大地震是建国以来破坏性最强、波及范围最广、救灾难度最大的一次地震。绵阳市中心医院做为重灾区最大的一所综合性医院,在短时间内收治了大量的地震伤伤员,主要来自北川、安县和平武等重灾区,伤员大多为各种骨折伤,但因骨科病区无法接收如此大量伤员,故除专科伤员外,耳鼻咽喉科还收治了大量骨伤伤员,共计89例,现报道如下。     

鼻内镜下鼻窦前颅底骨折整复术

鼻窦、前颅底颌面部多发性骨折是耳鼻咽喉科常见疾病,因其位置由浅至深,涉及眼眶、颅底,周围关系复杂,而出现不同的并发症和相关病变。2000~2004年,我们对46例外伤性鼻窦、前颅底、颌面部骨折的病人通过鼻内镜下行鼻窦、前颅底骨折整复,效果良好,现报道如下。1临床资料1.1一般资料46例病人中,男34例,女12例;年龄12~66岁,平均32.5岁。外伤原因:车祸33例,工伤7例,斗殴伤3例,跌伤3例。外伤后就诊时间:2 h至4周,平均4 d。均经CT扫描及专科检查确定骨折部位:单纯上颌窦(前、上壁)骨折16例;筛窦骨折4例;鼻筛骨折12例(3例伴嗅觉障碍);额筛骨折4例(…     

耳鼻喉颌面伤合并颅脑损伤500例

目的 明确耳鼻喉颌面伤合并颅脑损伤患者群体的性别差异、年龄分布、主要致伤原因,探讨二者伤情之间的关系,统计颅脑损伤情况与伤情判断、治疗的方法和效果。方法 总结1265例耳鼻喉颌面损伤合并有颅脑损伤患者500例(39.60%)的病历资料,回顾性分析并加以统计学研究。结果 1265例中耳鼻喉颌面损伤部位在鼻听线平面及以上者388例(30.67%),损伤部位在鼻听线平面以下者112例(8.85%),鼻听线上下两部位损伤合并颅脑损伤发生率差异有统计学意义(P<0.01);耳鼻喉颌面伤合并颅脑损伤500例中,男女比例4.1∶1;高峰年龄为20～49岁间计392例(78.40%);交通事故居致伤原因首位239例(47.80%);脑震荡、脑挫裂伤、颅内血肿分别占59.40%、11.80%、6.20%;按GCS伤情评分,轻型88.40%;按GOS预后评分,良好95.4%。结论 耳鼻喉颌面损伤合并颅脑损伤是现代创伤中常见复合伤,男性多于女性,发病患者群以青壮年为主,交通事故为致病主要原因,鼻听线对诊断有参考价值,患者损伤程度比较轻,只要及时诊断,正确救治,治疗效果好,致残率、死亡率低。     

新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染已被纳入《中华人民共和国传染病防护法》规定的乙类传染病,并采取甲类传染病预防控制措施。耳鼻咽喉头颈外科急症食管异物、呼吸道异物、鼻出血、喉阻塞合并呼吸困难及头颈部外伤发病率相对较高,部分可迅速危及生命的急症需紧急手术。本文根据新型冠状病毒肺炎诊疗方案(试行第五版),在疫情蔓延地区结合华中科技大学同济医学院附属协和医院耳鼻咽喉科急诊手术处理的经验,现总结制订了新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议,以期在新型冠状病毒防控期间提高耳鼻咽喉头颈外科急症的救治成功率及减少或避免围手术期医护人员新型冠状病毒感染可能。     

头颈外科

980898颅底斜坡区外面观的应用解剖/张秋航…//中华耳鼻咽喉科杂志一1997,32(5)一3 17980899颈部外伤48例救治小结/方瑜//临床耳鼻咽喉科杂志一1997,n(9)一415一417 对救治的48例颈部外伤进行小结,其中开放性伤35例,钝挫伤13例,多合并有不同程度颈部软组织、血管、甲状腺、神经等受损。体会是:为避免漏诊和误诊,对此类外伤病人的检查可分3步进行:①数分钟内迅速作出初步诊断;②在抢救的同时抓紧完成关键性检查;③病情相对稳定后需仔细检查,先全身,后局部。救治时,对于开放性喉外伤,应首先畅通呼吸,妥善止血,纠正失血性休克,仔细清创。对于颈…     

筛骨垂直板气化合并囊肿感染的临床诊断和治疗分析

目的:针对临床罕见的筛骨垂直板(亦称筛骨正中板)气化合并囊肿感染的患者,探讨该疾病的临床特点和治疗方法.方法:2000-2009年间中国医科大学附属第一医院耳鼻咽喉-头颈外科收治的4例儿童筛骨垂直板囊肿患者,回顾分析其症状,CT影像学检查,病理回报及临床治疗过程.结论:筛骨的畸形发育带来的解剖学及病理学紊乱,最终会导致筛骨气化合并囊肿感染.其气化的程度和大小决定了该病的临床症状和治疗方式.结论:CT检查在该疾病的诊断中起到重要作用,通常情况下应采用损伤小且有效的鼻内镜介入手术治疗.术后定期复查可防止复发并提供长期疗效观察.     

喉科学

20011632石油勘探船上人员喉外伤19例救治体会/李宝源…//耳鼻咽喉一头颈外科一2001,8(2)一123一124 在船上发现急性喉外伤病人,首先抢救呼吸道梗阻、大出血及休克三大急症。对于开放性喉外伤病人,在检查患者神志、呼吸、心率、血压等生命体征的同时,要对损伤部位进行初步处理,立即用吸引器清除呼吸道内的血性分泌物,并给氧气吸入,静脉滴入糖皮质激素及抗生素,肌注抗破伤风血清及适量镇静药物;如失血过多,则给予输血;如病人出现严重呼吸困难,则须作低位气管切开;对伤情时间较长者酌情清创伤口,尽可能保留断裂组织,为送返陆地医院继续治疗创…     

艾滋病的耳鼻咽喉表现

目的总结艾滋病患者在耳鼻咽喉的临床表现.方法10例艾滋病的临床资料回顾性分析.结果10例艾滋病患者,有卡波氏肉瘤8例,颈部肿块8例,皮肤、口腔咽喉黏膜溃疡4例,上呼吸道梗阻行气管切开术2例,单侧慢性化脓性中耳炎者1例.结论艾滋病患者以咽喉、口腔部卡波氏肉瘤及黏膜溃疡出现最早,应引起高度警惕及重视.     

Head and neck manifestations of Wegener's granulomatosis

Wegener's Granulomatosis (WG) is a necrotizing granulomatous angiitis that presents the classic ELK triad of ear, nose, throat (E), lung (L), and kidney (K) involvement. Its potential rapid and fatal outcome makes the early recognition--before irreversible organ involvement occurs--mandatory. The aetiology is still unknown. Today, immunosuppressive therapy makes WG a treatable disease with a chronically relapsing course. The otorhinolaryngologist plays an important role in early diagnosis of WG, because in up to 95% of the patients initial WG symptoms are observed in the head and neck region. The majority of these patients show nasal or sinunasal involvement. Common manifestations are sinusitis, crusting of the nose, and development of saddle nose deformity. Other head and neck problems are middle and inner ear symptoms and subglottic stenosis. Follow up and activity assessment of the disease are also important roles to play for the otorhinolarygologist.     

Studies on significance of sentinel lymphadenectomy in pharyngeal and laryngeal carcinoma

BACKGROUND: Management of the suspected N0-neck (sonography and CT) in squamous cell carcinoma (SCC) of the head and neck is discussed controversially. The question arises whether the sentinel node (SN) concept as it is performed in different areas of clinical oncology is applicable to ear, nose, and throat medicine. METHODS: Nine male patients with SCC were studied (4 oropharynx, 2 hypopharynx, and 3 larynx) in whom different lymph node status was diagnosed clinically (5 x N0, 2 x N1, 2 x N2c). After intraoperative scintillation probe detection, the histological examination of the SN with neck dissection (ND) specimen followed. RESULTS: In 7 of 9 cases SN detection was successful. In 4 of 5 cases of clinical N0 status, SN, and ND specimens were free of tumor histologically, while in one patient radiolabel-identified SN showed tumor cells in histological examination. In 2 patients with clinical N1 neck, SN, and ND were histologically tumor-free in one patient and contained one single tumor metastasis located in the SN in the other patient. In 2 patients with clinically and histologically proven N2c neck, lymph nodes located in regions II and III showed metastasis including capsular rupture. In both cases no lymph node radioactivity was detectable during the operation. CONCLUSIONS: The results suggest that sentinel lymphonodectomy may be suited for ear, nose, and throat medicine. Before it is applied to clinical practice, further problems must be resolved. These include the short distance between the primary injection side and lymph nodes and the influence of intranodal tumor metastasis on the uptake of the radiolabeled tracer.     

Infections of the ears, nose, and throat in children with primary immunodeficiencies.

Children who suffer from primary immunodeficiencies have long been thought to be subject to infections of the ears, nose, and throat due to unusual or resistant organisms. A retrospective chart review was undertaken at Children's Hospital of Pittsburgh from 1979 to 1989 to determine the types and frequency of infections of the ears, nose, and throat, and the bacteriologic findings from cultures of the sinuses, ears, and head and neck abscesses, when obtained. Seventy-five patients were identified with primary immunodeficiencies, and 80% suffered from infections of the ears, nose, and throat. Cultures obtained from 33% of the group showed the majority of the organisms commonly seen in ear and sinus infections. We conclude from this study that children with primary immunodeficiencies who require hospitalization frequently have an infection of the ears, nose, and throat, and that the infection is usually caused by community acquired bacteria. Empiric treatment may therefore be directed to common organisms causing these infections.     

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.     

Nasal air conditioning in patients before and after septoplasty with bilateral turbinoplasty

OBJECTIVE: Septoplasty is one of the most frequently performed surgical procedures by ear, nose, and throat surgeons. Yet the objective control of success concerning septal surgery still is very difficult and causes controversy. Data concerning one of the main functions of the nose, namely the heating and humidification of inspired air, before and after nasal surgery, are still missing. Therefore, the aim of this study was to compare intranasal air temperature and humidity values before and after septoplasty with bilateral turbinoplasty. METHODS: Sixteen patients were included in this prospective study. Intranasal temperature and humidity were measured in the anterior turbinate area close to the head of the middle turbinate. A miniaturized thermocouple and a humidity sensor were applied for continuous intranasal detection. RESULTS: Significant differences between temperature and humidity values before and after septoplasty could be observed, including absolute temperature, increase in temperature, absolute humidity, and increase in humidity. The postoperative values were significantly higher than the preoperative ones (P < .05). CONCLUSIONS: According to the results of our study, patients seem to profit from septoplasty as heating and humidification as one of the most important nasal functions are restored and even improved after surgery. We therefore conclude that properly performed septoplasty is able to main its importance within the variety of nasal surgical procedures ensuring improved nasal function as well as patient contentment.     

Management of war-related neck injuries during the war in Croatia, 1991–1992

From 1 September 1991 to 31 December 1992, a total of 7,043 wounded patients were treated in the War Hospital in Slavonski Brod. Seven hundred and twenty eight patients with head and neck injuries were treated in the Department of Otorhinolaryngology and Cervicofacial Surgery. Of this number, 187 had neck injuries. Ninety-two (49.2%) of them were treated in outpatient facilities and 95 (50.8%) as inpatients. Immediate exploration was done in 84 patients with penetrating neck injuries. Vital structures were involved in 49 patients: major blood vessels (40 cases), larynx (17 cases), pharynx (8 cases), trachea (5 cases), thyroid gland (3 cases) and esophagus (2 cases). Definitive treatment was given to all of these injuries. Primary wound closure was performed upon exploration in 74 patients who were treated within the first 6 h after trauma. Secondary wound closure was performed in 10 patients with neck exploration performed more than 6 h after injury, and in those with extensive defects of tissue requiring the use of larger local flaps or free flaps. The mortality among patients with neck injuries was 2.1 %.     

Extramedullary plasmacytomas in the head and neck region

Extramedullary plasmacytoma (EMP) arises outside the bone marrow, particularly in the head and neck region (nasopharynx, nose cavity, sinuses, and tonsils), and can be associated with multiple myeloma (MM). Three cases of EMP in the head and neck region are described: a first case describes an EMP of the subglottis 3 years after treatment of MM, a second case of an EMP solitary in the middle ear presenting as a jugular foramen syndrome, and a third case of an EMP localised at the epiglottis, recurring at the floor of the nose cavity. Treatment of each EMP was surgical. We reviewed literature about aetiology, clinical course, diagnostics, treatment and prognosis. Important presenting symptoms vary from epistaxis, rhinorrhoea, a sore throat, dysphonia to haemoptoea. Association with MM must be confirmed or excluded. Histopathological examination, with immunological staining or flow cytometry confirms the diagnosis. CT and MRI are useful in staging EMP. The treatment of EMP is surgery and/or radiotherapy. The prognosis depends on tumour size (>5 cm) and nodal involvement. The 10-year survival rate is 50-80%.