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Objective: To evaluate the relationship and strength of association for alcohol drinking and tea consumption with the riskS of nasopharynx cancer among Chinese population so as to provide control rationales for nasopharynx cancer in China., Methods: A systematic search of 3 Chinese electronic databases (CNKI, VIP, Wanfang) and 3 English databases (Pubmed, ScienceDirect and SpringerLink) up to March 2013 was performed. Two reviewers independently conducted the literature search, examined eligibility and performed data extraction and quality evaluations. Pooled odd ratio (OR) value and 95%CI value were calculated with random-effects model weighted with inverse of variances., Results: A total of 14 studies (including 3 cohort and 11 case-control) involving 6559 cases of nasopharynx cancer and 10 567 controls from 6 provinces were included. The pooled OR between alcohol drinking and risks of nasopharynx cancer was 1.12 (95%CI: 0.98-1.26; I(2) = 44.5%, P = 0.037). Compared with the non-drinkers, the risks of nasopharynx cancer for regular drinkers and occasional drinkers were 1.18 (95%CI: 1.00-1.38; I(2) = 0.0%, P = 0.578) and 0.76 (95%CI: 0.65-0.89; I(2) = 33.4%, P = 0.212). And the association of tea consumption with the risks of nasopharynx cancer was 0.53 (95%CI: 0.43-0.60; I(2) = 17.9%, P = 0.301)., Conclusions: In China, occasional alcohol drinking may decrease the risks of nasopharynx cancer while regular drinking elevates the risks. And there is significantly protective effect for tea consumption on the risks of nasopharynx cancer.

Objective: To compare the differences between clinical diagnosis and laboratory diagnosis of fungal sinusitis., Methods: One hundred cases of fungal sinusitis were reviewed in this study. The clinical characters including symptoms, physical signs, images and intraoperative signs were the main aspects of clinical diagnosis. The results of clinical diagnosis, pathology, direct observation of the nasal and sinus samples with microscope and the fungal culture were compared., Results: The numbers of fungal ball, allergic fungal sinusitis, acute fulminant invasive fungal sinusitis, and chronic invasive fungal sinusitis were 82, 10, 6, and 2 respectively. The positive rates of clinical diagnosis, pathology, direct observation with microscope and the fungal culture were 95%, 61%, 78%, and 74% respectively. There was significant difference among the positive rates of above methods (P < 0. 01)., Conclusion: Clinical diagnosis can be used as the preliminary method for fungal sinusitis diagnosis. The demonstrative diagnosis needs to combine all above methods. The culture was the main method for confirm the types of pathogenic fungus.

Objective: The endoscopic management of inverted papilloma has gained increasing popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined., Methods: We performed a retrospective review of the results of the patients with inverted papilloma in the Otolaryngology Head and Neck Surgery department, Beijing Tongren Hospital from 2004 to 2007 to identify the patients with lesions involving frontal sinus and its drainage pathway. By its appearance on nasal endoscopic examination and CT scanning, the tumors were defined using Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection. And their clinical outcomes were analyzed., Results: A total of nine patients (8 males and one female) with inverted papilloma who had frontal sinus and its drainage pathway involvement were identified. All tumors were defined as T3 lesions. Preoperative and postoperative pathologic examinations revealed inverted papilloma as the diagnosis. Four cases with lateral wall of frontal recess attachment underwent endoscopic Draf II A frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf II B procedure. Two cases with either posterior wall of frontal recess and frontal infundibulum attachment or medial, lateral and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf III procedure. All patients remain disease free with an average follow-up of 13 months., Conclusions: Extensive inverted papilloma (Krouse T3 lesions) can be treated successfully with an endoscopic approach.

Objective: The purpose of this study was to determine the prevalence of frontoethmoidal cells in normal Chinese subjects., Methods: Two hundred and two Chinese subjects without symptoms of frontal sinus disease were undergone spiral computed tomography (CT). The multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation., Results: There were 121 males and 81 females. The mean age was (39.4 +/- 13.5) years. Of all the frontal cells identified in 159 sides (39.4%) of frontal recesses, the prevalence of type I, type II, type III and type cells were 24.3% (98 sides), 6.9% (28 sides), 8.2% (33 sides) and 0% (0 side) respectively. Suprabulbar cell, supraorbital ethmoid cells, and frontal bulbar cell were identified in 148 sides (36.6%) Jian-hu, 22 sides (5.4%), and 36 sides (8.9%) respectively. While the interfrontal septal cells was found in 25 patients (12.4%). The prevalence of agger nasi cell was 94. 1% (380 sides). Two hundred and forty-four uncinate processes (60.4%) had one superior attachment for each uncinate process; the other 160 uncinate processes (39.6%) had two superior attachments for each uncinate process. The single superior attachment of the uncinate process into the surrounding structures was identified to have the following distribution: 53.0% (n=214) to the lamina papyracea, 5.2% (n=21) to the middle turbinate, 2.2% (n=9) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (27.5%, n=111) or into the lamina papyracea and the middle turbinate (8.7%, n=35). The other 14 uncinate processes (3.5%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 89.1% (n=360)., Conclusion: The result demonstrated the normal frontal recess pneumatization patterns in normal Chinese.

Objective: To evaluate the efficacy of topical steroid treatment of nonpolypoid chronic sinusitis., Methods: Two cohorts of adult and children with nonpolypoid chronic sinusitis were investigated. The first cohort consisted of 11 pediatric patients [mean age, (11.8 +/- 3.2) years] with a mean Lund score of 10.3 +/- 5.7 (x +/- s). The second cohort consisted of 13 adult patients [mean age, (36.7 +/- 11.0) years] with a mean Lund score of 12.2 +/- 5.7. The mean duration of the nasal budesonide (Rhinocort) treatment was (7.5 +/- 3.2) weeks for adult patients (256 microg/d) and (7.0 +/- 3.4) weeks for pediatric patients (128 microg/d). Each Lund score and the patient's assessment of nasal symptoms were evaluated after treatment., Results: The average Lund score was significantly decreased to 6.5 -/+ 7.5 (t = 3.82, P < 0.01) in adult patients and to 2.6 +/- 3.7 (t = 5.08, P < 0.01) in pediatric patients after treatment. Thirty-eight percent of the adult patients and 73% of the pediatric patients were cured on CT images. The patient's self-assessment of efficacy was positively correlated with pretreatment Lund score in adult patients (r = 0.676, P < 0.05), but not so in pediatric patients., Conclusions: These findings demonstrate that most of patients with nonpolypoid chronic sinus did well with topical steroid treatment. Therefore, surgery was required in few patients.

Objective: The purpose of the study was to determine the prevalence of frontal recess cells in Chinese patients who did not have frontal sinus disease related symptoms., Methods: Forty-nine Chinese patients without frontal sinus disease symptoms were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation., Results: The prevalence of agge rnasi cell was 94% (92/98). Sixty-four uncinate processes (65%, 64/98) had one superior attachment for each uncinate process, the other thirty-four uncinate processes (35%, 34/98) had two superior attachments for each uncinate process. The uncinate process' single superior attachment into the surrounding structures was identified to have the following distribution: 53% (52/98) to the lamina papyracea, 9% (9/98) to the middle turbinate, 3% (3/98) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (24%, 23/98) or into the lamina papyracea and the middle turbinate (10%, 10/98). Only one uncinate process (1%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 87% (85/98). Of all the frontal cells identified in 32 sides (33%) of frontal recesses, the prevalence of type I, type II, type II and type IV cells were 23% (23 sides), 2% (2 sides), 7% (7 sides) and 0% (0 side) respectively. Supra bullar cell, frontal bullar cell and interfrontal septal cell were identified in 30 sides (31%), 7 sides (7%) and 7 patients (14%) respectively., Conclusions: The result characterized normal frontal recess pneumatization in Chinese. That, together with the variations of the uncinate process' superior attachment emphasized the roles of agger nasi cell and the uncinate process in endoscopic frontal sinus surgery.

Objective: To understand the anatomy of the supraorbital ethmoid cell and its relationship with the frontal sinus drainage pathway., Methods: Five patients (5 sides) who had supraorbital ethmoid cell underwent endoscopic frontal sinus surgery. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal sinus ostium and the supraorbital ethmoid cell were endoscopically identified respectively., Results: On coronal CT scans, the supraorbital ethmoid cell was a separate cell lateral to the frontal sinus. And on axial CT scans, it was lateral and posterior to the frontal sinus drainage pathway. Under endoscope, its opening was lateral and posterior to the frontal sinus ostium., Conclusions: The supraorbital ethmoid cell extended superolateral the boundaries of the lamina papyracea and the roof of the ethmoid to pneumatize the orbital plate of the frontal bone.

Objective: To investigate the anatomical interaction between uncinate process and agger nasi cell to better understand the anatomy of the frontal sinus drainage pathway by endoscopy, spiral computed tomography (CT) and sectioning., Methods: Twenty-one skeletal skulls (forty-two sides) and one cadaver head (two sides) were studied by spiral CT together with endoscopy and collodion embedded thin sectioning at coronal plane. The sections with the thickness of 100 microm were stained with hemotoxylin and eosin., Results: Under endoscopy, a leaflet of bone to the middle turbinate, which is given off by uncinate process, forms the anterior insertion of the middle turbinate onto the lateral nasal wall. The middle portion of the uncinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 78.6% of the skeletal nasal cavities. On CT scans, the agger nasi cell is present in 90.5% of the skeletal nasal cavities. While the lateral wall of the agger nasi cell is formed by lacrimal bone, the medial wall of the agger nasi cell is formed by uncinate process. And the anterior wall is formed by the frontal process of the maxilla. The superior portion of the uncinate process forms the medial, posterior and top wall of the agger nasi cells. The superior portion of the uncinate extends into the frontal recess and may insert into lamina papyracea (33.3%), skull base (9.5%), middle turbinate, combination of these (57.2%)., Conclusions: The agger nasi cell is the key that unlocks the frontal recess.

Objective: To evaluate the access to the frontal recess by identifying the agger nasi cell and uncinate process., Methods: Forty-seven patients (85 sides) who underwent endoscopic frontal sinus surgery in our department constituted the study population. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal ostium was identified by using agger nasi cell approach or identifying the uncinate process., Results: The frontal sinus ostium was identified in 100% of patients (85 sides). After an average follow-up of 9 months, 41 sides of 49 sides (84%) had endoscopically healed sinuses by using agger nasi cell approach. And 21 sides of 36 sides (81%) had endoscopically healed sinuses by identifying the uncinate process., Conclusions: The agger nasi cell approach to the frontal recess gives an access and allows identification of the frontal ostium. In addition, it provides direct visualization with a 0 degree endoscope into the frontal recess.

Objective: To evaluate the advantages and disadvantages of different type of image-guidance system in endoscopic sinus surgery., Methods: Fifty-three endoscopic sinus surgery were performed under different type of image-guidance system, there were 24 chronic sinusitis with or without nasal polyp, 4 juvenile nasopharyngeal angiofibroma, 8 pituitary adenoma, 9 ethmoid ossifying fibroma, 2 nasopharyngeal mixed tumor, 1 nasal leiomyoma, 3 fungal sinusitis, and 2 inverting papilloma., Results: In all cases, the preoperative time was 15-30 minutes, the registration rate were 1.3-2.0, the localization accuracy was within 1 mm. Compared with the traditional endoscopic sinus surgery, the operating time was similar, without obvious difference. No complication occurred., Conclusion: All types of image-guidance system could work well with endoscopic system, each of them had its own shortages. Every type of image-guidance system could identify the borders and critical anatomical structures in the corresponding CT data, especially in cases in which anatomical landmarks were no longer present, with anatomical variation, intranasal and anterior skull base tumor. Combined with endoscopic surgery, the image-guided endoscopic surgery provided accurate tumor resection while preserving normal tissue, increased surgical effectiveness, decreased overall surgical complications. It is believed that the image-guidance system is a useful tool for endoscopic sinus surgery.

Objective: To explore the different surgical choices for treating the ossifying fibroma of the sinuses. To summarize the management and characteristics of each surgical operation., Methods: A retrospective evaluation of thirty-five patients with ossifying fibroma of the sinuses from August 1994 to July 2001 was presented., Results: Among 22 patients operated by nasal endoscopic management, complete ossifying fibroma removed was achieved in 8 cases, and the majority part of tumor removed in 14 cases. Six patients were operated through a lateral rhinotomy with radical operation in 4 cases. Five ossifying fibromas were removed with a coronal incision. Two cases underwent Caldwell-Luc' surgery. The clinical symptoms, location of ossifying fibroma, and surgical procedures were analyzed. All patients outcomes were successful, no serious complication from the surgical technique occurred. Thirty-three cases were followed-up for 1 to 8 years with an average of three and half years. Fourteen patients had no recurrence, fourteen cases lived with the remains of ossifying fibroma, and five cases recurred., Conclusions: The choice of surgical operations on ossifying fibroma of the sinuses was mainly decided by the location of ossifying fibroma, in the meanwhile, the organ function, the cosmetology, the surgical degree of difficulty, and the doctor's experience were taken into account.