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Objective: To study the prevention and treatment of postoperative diabetes insipidus after removal of pituitary tumor through transsphenoidal operation, to decrease the incidence of postoperative complications and improve the treatment of pituitary tumor., Methods: The clinical data of 86 cases of transsphenoidal resection of pituitary tumor in recent 8 years were retrospectively reviewed, including 35 endoscopic operation and 51 microscopic operation. The incidence, prevention and treatment of diabetes insipidus were statistically analysed., Results: There were 18 cases of postoperative diabetes insipidus in total of 86 operations, including 15 acute cases, 3 delayed cases. Twelve were temporary , which recovered within 1 week. After prompt treatment, 14 recovered within 1 week, 4 recovered within 2 weeks. No persistent diabetes insipidus was found., Conclusions: The key points to prevent postoperative diabetes insipidus lay in the improvement of operative skills, careful protection during operation and avoidance of unnecessary injury. In case of diabetes insipidus occurred, rational use of antidiuretics and correction of electrolyte balance were effective in the treatment of postoperative diabetes insipidus.

Objective: To study the pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscles in OSAHS pathogenesis was discussed., Methods: Thirty OSAHS patients receiving uvulopalatopharyngoplasty selected, and ten normal subjects without snoring as the control group. The successive longitudinal sections of palatopharyngeal muscle were stained for observing Troponin-I's content. All specimens were examined with transmission electronmicroscopy (TEM) and light microscopy., Results: Twenty nine of 30 specimens obtained from OSAHS patients evaluated with TEM showed pathologic changes of different degrees. While 2 among 10 specimens in control group showed mild myofibril edema or hypertrophy, no pathologic changes shown in other specimens. Immunohistochemistrial results of all specimens sections stained for observing Troponin-I antibody have shown that negative grey degree value is 146.30 +/- 10.72 in study group and 107.50 +/- 4.81 in control group respectively. There is significant difference between these two groups (P < 0.05). The negative grey degree value of study groupl and study group2 are 143.12 and 148.80 respectively , no statistical difference (P > 0.05)., Conclusions: Palatopharyngeal myelofibrosis may affect pharyngeal dilator muscles function, this could be one mechanism of upper airway collapsibility.

Objective: This study is aimed to observe the natural draining state of maxillary sinus, to search for the key draining location (KDL) in the natural ostium, to investigate the relation between maxillary sinus draining and sinus inflammation, and to guide the treatment of maxillary sinus opening in endoscopic sinus surgery (ESS)., Methods: Methylene blue was used as tracer agent in this study. Fifteen cases with or without light maxillary sinus inflammation (without any treatment) were selected to observe the natural draining state and the key draining location in maxillary sinus fontanel. Eighty-nine cases with chronic rhinosinusitis, but without nasal polyp, were selected, of which the maxillary sinus mucosa restored well 6 months after ESS, to observe the draining state and modes in maxillary sinus. All patients were followed up for 12 months to evaluate the inflammation state of mucosa, and to analyze the relations between the draining mode and mucosa inflammation., Results: The KDL for maxillary sinus was located in the posterior-inferior portion of the natural ostium, close to the attachment of caudal end of the uncinate process. The draining flowed along it from maxillary sinus to nasopharynx. After conventional transnasal endoscopic operation, 15 cases showed relatively normal drainage, others displayed abnormal state and mode,including reverse draining (maxillary sinus-ethmoid sinus) , multiphase draining (outflow from front, back and lower wall of natural ostium), draining failure (with cilia transporting function of maxillary epithelium mucosae), cistern like change (maxillary sinus and ethmoid sinus formed one operation cavity, secretion accumulated in maxillary sinus) and mucosa disfunction (loss of cilia transporting function of maxillary epithelium mucosae). Inflammation was observed in 33.7% of the patients 12 months after ESS, especially in those with mucosa disfunction, draining failure and reverse draining., Conclusions: The KDL for maxillary sinus may be located in the posterior-inferior portion of the natural ostium, close to the attachment of caudal end of the uncinate process, and the drainage mode is not affected by gravity and posture. The KDL lesion after ESS results in abnormal draining of maxillary sinus, and excessively large maxillary sinus opening may aggravate mucosa inflammation of maxillary sinus. The abnormal draining state and mode may be related with the incidence of mucosa inflammation after operation. Preserving caudal end of uncinate process and avoiding injury of KDL would be beneficial to the restoration of mucosa and lessen the incidence of inflammation recurrence.

Objective: To explore the health-related quality of life (QOL) status of patients with chronic rhinosinusitis and nasal polyps., Methods: One hundred and twenty patients with chronic rhinosinusitis and nasal polyps and two hundred individuals passing health examination were enrolled by random and their QOL scores were assessed by using QOL instruments including existing SF-36 questionnaire (Chinese version ) and SNOT-20 questionnaire translated into Chinese, of which clinimetric and psychometric properties were tested., Results: The feasibility, reliability, validity, and responsibility of Chinese version of SNOT-20 questionnaire all passed the test. By the assessment of SF-36 questionnaire, it revealed that scores of six domains such as physical functioning, role physical, bodily pain, mental health, vitality, and general health from patients with chronic rhinosinusitis and nasal polyps were lower than that of control group except social functioning and role emotional (P < 0.05). It showed by Chinese version of SNOT-20 questionnaire that patients exceeded healthy individuals in the scores of twenty items of three domains including physical problems, functional limitations, and emotional consequences, of which the most five important items affecting health status were respectively need to blow nose, thick nasal discharge, lack of a good night's sleep, dizziness, and post-nasal discharge (P < 0.05)., Conclusions: QOL instruments such as Chinese version of SF-36 and SNOT-20 questionnaires can effectively differentiate the QOL status between patients with chronic rhinosinusitis and nasal polyps and healthy individuals. The negative impact of chronic rhinosinusitis and nasal polyps on patients' QOL includes physical functioning, role physical, bodily pain, mental health, vitality, general health, and emotional consequences. The problems of nasal discharge, sleep, and dizziness should be sufficiently emphasized in clinical treatment.

Objective: To investigate the efficacy and the surgical techniques of transnasal endoscopic procedure for juvenile nasopharyngeal angiofibroma (JNA)., Methods: Twenty-one nasopharyngeal angiofibroma patients were treated using transnasal endoscopic approach. They were divided into group A (without intracranial extension) and group B (minimal intracranial extension) according to the staging of Sessions. The patients were treated mostly with endoscopic surgery. In two midfacial operations cases, endoscopy was also used. The staging, average blood loss during surgery, tumor residual, and (or) recurrent tumor were evaluated., Results: Group A (19 cases) had an average blood loss of 1000 ml. Nineteen patients had no residual or recurrent tumor over a follow-up of 8-24 months. Group B (2 cases) had an average blood loss of 1500 ml. One of the patients had minimal residual tumor around the cavernous sinus, but showed no progression over a follow-up of 2 years. Another patient had no residual or recurrent tumor over a follow-up of 8 months., Conclusions: The data suggests that transnasal endoscopic surgical techniques can be used to treat JNA which either limited to nasal and nasopharyngeal cavities or and the tumor with sphenoid and ethmoid invasions and even minimal intracranial extension.

Objective: This study was aimed to explore the necessity of nasal endoscopic operation for bilateral traumatic optic neuropathy., Methods: Four patients with complete blind resulted from traumatic impairment of bilateral optic nerves were selected to receive a combined treatment of nasal endoscopic optic nerve decompression (NEOND) with all-around medication., Results: The vision of all patients was improved except one who lost vision immediately after trauma. Thirty days after injury, patient 1 was treated with NEOND, and the vision of left eye was restored to 1.5, however, the vision of right side was just from light perception (LP) to hand motion (HM). Patient 2 was treated with NEOND 3 days after injury, and the vision was improved from LP to 0. 2 in left side, no change in right eye. The operation of patient 3 was performed 6 days after injury, but no improvement was observed in both visions. Patient 4 received NEOND 28 days after injury, the vision was improved in both sides with left eye from NLP to 0. 8 and right eye from NLP to 0.2., Conclusions: NEOND can be regarded as an effective treatment for bilateral traumatic blindness, even delayed NEOND may be effective. Both gradual vision loss and residual vision should be the indications for an effective NEOND, but immediate blindness after injury might be the index for poor result of NEOND.

Objective: To investigate the bacteriological character and pH value in nasal cavity and observe the efficacy following 8 week treatment with Budesonide aqueous nasal spray in chronic nonallergic rhinitis., Methods: Forty-two patients with chronic nonallergic rhinitis were treated with Budesonide aqueous nasal spray (256 microg once daily intranasal) for 8 weeks. Bacteriological character was measured before and 8 weeks after treatment All the swab specimens were obtained from the inferior meatus, bacteriologic outcome was determined by general cultures. Nasal pH value was measured by using a probe sited under the inferior turbinate before and after treatment. Efficacy was evaluated by measurement of nasal symptom scores and sign scores before and 8 weeks after treatment., Results: The bacterial growth was present in 37 of 42 cases (88%) before the treatment (group 1), including 53 aerobic bacteria. The bacterial growth was present in 38 of 42 cases (90.47%) 8 weeks after treatment (group 2), including 46 aerobic bacteria. There was no significant difference in the bacterial distribution between group 1 and group 2 (chi2 = 0.416, P > 0.05). Budesonide aqueous nasal spray reduced pH value from 7.90 +/- 0.39 to 7.70 +/- 0.23 (t = 2.72, P < 0.05). All the parameters of symptoms were improved after treatment, including nasal obstruction, nasal secretions, itchy feeling of the nose, closed rhinolalia and headache., Conclusions: Glucocorticoid aqueous nasal spray could be used safely for eight weeks and does not increase the risk of aerobes and fungi infection and reduce the pH in chronic nonallergic rhinitis. It is effective in relieving symptoms of patients with chronic nonallergic rhinitis.

Objective: To investigate the clinical relevant factors causing laryngeal stenosis after partial laryngectomy., Methods: A retrospective study was carried out to review the history clinical data from 138 patients of partial laryngectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 1994 to October 2004. The clinical relevant factors causing laryngeal stenosis were included as follows: age, sex, TNM stage, tumor site, extension of thyroid cartilage defect, extension of larynx parenchyma defect, reconstruction method, laryngeal dilator, duration of using antibiotics, postoperative radiotherapy, lung infection, gastroesophageal reflux, diabetes. Multivariate stepwise logistic regression model was used for the analysis., Results: Of 138 cases after partial laryngectomy, stenosis developed in 25 cases. The occurrence rate was 18.1%. In multivariate analysis, it was confirmed that the following factors correlated to laryngeal stenosis, i. e, extension of thyroid cartilage defect (chi2 = 4.323, P = 0.038), postoperative radiotherapy (chi2 = 6.002, P = 0.014), lung infection (chi2 = 4.220, P = 0.040), and gastroesophageal reflux (chi2 = 5.614, P = 0.018)., Conclusions: The clinical relevant factors causing laryngeal stenosis after partial laryngectomy were multiple. Statistical analysis showed that extension of thyroid cartilage defect, postoperative radiotherapy, lung infection and gastroesophageal reflux were the risk factors which may cause laryngeal stenosis.

Objective: To investigate the infiltration of T lymphocytes with CD3 expression as surface marker and the activation of T lymphocytes with CD69 expression as activation marker., Methods: Nasal polyp tissue samples and peripheral blood were obtained from 21 patients. The normal inferior turbinate mucosa and peripheral blood were obtained as comparison. Flow cytometry was adopted to detect the expression of CD3 and CD69 of T lymphocytes., Results: Nasal polyp tissue consisted of abundant T lymphocytes. Activation marker CD69 was expressed in T lymphocytes of nasal polyps (36.96 +/- 2.50)% and peripheral blood (4.66 +/- 0.18)% from the same patient. The expression rates of CD69 after a short-term stimulation (5 h) in response to PDB were (59.88 +/- 2.59)% and (92.76 +/- 0.55)% respectively. While T lymphocytes was rarely detected in normal inferior turbinate and the expression of CD69 was low in peripheral blood from normal human but almost all T lymphocytes were activated after stimulation., Conclusions: There were generous of T lymphocytes infiltrating in nasal polyps. The expression of CD69 in T lymphocytes was abnormally high, which indicated that T lymphocytes infiltrating in nasal polyps were in activated state immunologically.

Objective: The recurrence of chronic frontal sinusitis after endoscopic surgery is mainly due to the mismanagement of frontal recess and frontal sinus orifice. The aim of this study is to investigate the characteristics of chronic frontal sinusitis and to advance the clinical therapeutic efficacy., Methods: Different methods were used to manage different local diseases in frontal sinus orifice or frontal recess in 58 cases (96 sides) with chronic frontal sinusitis by nasal endoscopic surgery., Results: Different degree of middle meatal obstruction was seen in all cases at operation. The situation of frontal sinus ostium and frontal recess was as follows: 38 sides obstructed by swollen mucosa, polypoid mucosa or polyps, no cell obstruction at frontal sinus orifice; 34 cases constricted by over development of agger nasi cells, ethmoid bulla or terminal cell at frontal recess; 15 cases obstructed completely by over development cells at frontal recess; osteal stenosis at frontal sinus orifice in 9 cases. The situation in frontal sinus was as follows: pus accumulation in 18 sides, mucosal swollen in 21 sides, mucosal congestion in 49 sides, no obvious mucosal diseases in 8 cases. Follow-up for 6-20 months showed that 69 sides (71.9%) were cured, 17 sides (17.7%) better and 10 cases (10.4%) recurrent., Conclusion: Obstruction of osteomeatal complex and frontal recess is the main causes of chronic sinusitis. There are four pathologic states in obstruction of frontal recess and frontal ostium. Different operative methods should be taken according to different pathological changes. The operative effects is still needed to improve.

Objective: To explore the method of reducing bleeding during endoscopic sinus surgery for chronic sinusitis and nasal polyp., Methods: Bleeding during surgery and the effective rate of two groups patients with chronic sinusitis and nasal polyp were compared (68 cases in group A with preoperative treatment, 30 cases in group B without preoperative treatment)., Results: The effective rate between group A(91.2%) and group B (80%) is of significant difference (F = 8.617, P = 0.026); The volume of bleeding during surgery between group A that is (53.2 +/- 41.8) ml and group B that is (97.2 +/- 59.0) ml is of significant difference (F = 27.946, P = 0.002)., Conclusions: Controlling the inflammatory reaction of chronic sinusitis and nasal polyp by preoperative treatment is the most important factor to reduce bleeding while undergoing endoscopic sinus surgery. However, the followings are also important factors to reduce bleeding in endoscopic sinus surgery, such as adequate use of vasoconstrictor in the middle nasal meatus during surgery, the use of deliberate hypotension during surgery, controlling the high risk factors by preoperative treatment and reducing trauma during surgery, etc.

Objective: To study the auxo-action of Merogel (hyaluronic acid) for operative cavity epithelialization after endoscopic sinus surgery (ESS)., Method: Sixteen patients (32 sides) were observed, in which all sinuses(maxillary, frontal, ethmoid and sphenoid) were operated on by ESS. For the purpose of control study, the left nasal side was used as Merogel group, and right side contrast group. The patients were followed-up for 12 weeks., Results: In Merogel group, the curative rate was 93.75%, improvement rate 6.25%, and average time of epithelialization was 3.4 weeks. In contrast group, the curative rate was 87.50%, improvement rate 12.50%, and average time of epithelialization was 8.3 weeks. It was distinct that in Merogel group, the epithelialization time was shorter than that in contrast group., Conclusion: Merogel has auxo-action for operative cavity epithelialization after ESS.

Objective: To inquire into the feasibility of transnasal endoscopic surgery for endonasal encephalomeningocele, and to put forward the basic management guidelines., Method: Five cases of endonasal encephalomeningocele were managed by transnasal endoscopic surgery. Different surgical techniques were applied according to the size and shape of skull base defect. At the same time, one-stage repair of skull base defect was achieved by applying muscle, fascia, cartilage and bone., Results: All 5 patients were successfully treated without complication and relapse during 1-5 year follow-up., Conclusion: Endonasal type encephalomeningocele can be managed by transnasal endoscopic surgery. If the skull base defect is less than 0.5 cm, it can be repaired by packing muscle and fascia. If the defect is larger than 0.5 cm, the cartilage or bone should be used to repair the skull base.

Objective: To explore the values of the application of needle endoscope in pediatric nasal cavity and skull base surgery., Method: Using a kind of needle endoscope with the diameter of 1.9 mm and digital video image system, 8 cases of pediatric nasal cavity and skull base examination and surgery were performed., Result: Of 3 cases of congenital choanal atresia, one improved, the others recovered. One case (2.5 years old) of traumatic cerebrospinal fluid (CSF) fistulae was successfuly repaired under the 1.9 mm needle endoscope. There were 2 cases of congenital meningoencephalocele. One was 1 month newborn. When the diagnosis was confirmed by needle endoscopy and CT scan, the operation was postponed. The other got endoscopic operation and had recovered. Of 2 cases of skull base malignant tumour, the diagnosis was confirmed by intranasal biopsy under needle endoscope., Conclusion: With the application of needle endoscope, the pediatric skull base surgery and examination can be performed in the narrow nasal cavities and sinuses with less invasion and good result.