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简介：AbstractThe Hoffa fracture is an uncommon fracture. There is a lot of confusion about its diagnosis and management with several conflicting reports in literature. We reported a 25-year-old patient with non-union of Hoffa fracture, and meanwhile tried to develop an algorithm-based treatment for Hoffa fractures. A systematic review of the available literature was performed. Medline, Embase, the Cochrane Library and PubMed were searched for relevant articles. Fifty-five articles were reviewed, and the clinical knowledge base was summarized. The understanding of the mechanism of trauma has become more nuanced. The literature has also evolved to classify the fracture with the purpose of surgical management in mind. This can be used to plan approach and fixation with preservation of blood supply. Classification can also prognosticate the outcomes in Hoffa fracture.

简介：AbstractUmbilical cord (UC) embolism is a rare, life-threatening complication of pregnancy. The exact cause of this condition is not yet known. Women with more than one UC abnormality are at risk of UC obstruction; this condition can lead to stasis, ischemia, and in some cases, thrombosis. However, many women with UC abnormalities remain undetected and may not be recognized until after birth. Here, we present a case involving the prenatal diagnosis and successful treatment of umbilical artery embolism in the third trimester with good maternal and fetal outcomes. The risk of UC embolism increases when more than one UC abnormality is identified in a single case. Ultrasound examination in the third trimester of pregnancy should be able to verify the existence of two arteries and one vein in the UC. If necessary, these results can be compared with ultrasound imaging acquired during the first trimester of pregnancy.

简介：AbstractObjective:Dog bite injuries remain a public health concern for two key reasons: the physical threat to health following attack and the infective sequelae a canine bite can incur. Facial bite injuries can result in significant emotional, psychological and physical trauma to victims involved. This narrative review elucidates the current presentation and management of dog bite injuries to the face.Data Sources and Methods:A literature search was conducted electronically using the search terms "dog bite" and "face" and "management" using the National Library of Medicine (Pubmed) and the Cochrane Library. There were no time nor language restrictions. A total of 79 studies were initially retrieved using the search algorithm. After screening of the titles and abstracts, 9 full texts were retrieved, and a total of 7 studies included.Results:The number of patients included in each study following a dog bite ranged from 40 to 223. The percentage of children included in each study (aged <18 years old) ranged from 27.5% to 100%. The majority of dog bite injuries to the face were managed by primary repair, ranging from 56.3% to 100%. Prophylactic antibiotics were used in most studies for dog bite injuries, ranging from 81% to 100%. The secondary infection rate following a dog bite ranged from 0 to 35%.Conclusion:This review highlights that children are disproportionately affected by canine bite injuries to the face relative to adults. The dog involved in the attack is typically known to the victim, with the lips, the cheek and the nose representing the most common sites of facial injury. More units are managing such injuries with primary repair and prophylactic antibiotics. Reconstructive procedures most commonly involve a local or advancement flap, a full thickness skin graft or a split skin graft. These are typically performed by Plastic Surgery and Maxillofacial Surgery specialists.

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简介：Waardenburgsyndromeisararediseasecharacterizedbysensorineuraldeafnessinassociationwithpigmentarydefects.Dependingonadditionalsymptoms,WShavebeenclassifiedintofourtypes.Waardenburgsyndrometype4,alsocalledasWaardenburgShahSyndromeisaveryrarecongenitaldisorderwithastoundingvariableclinicalexpression,characterizedbypigmentaryabnormalitiesofthehair(Awhiteforelockofhair,prematuregraying)andpigmentarychangesoftheirissuchasheterochromiaorhomochromiairides,sensorineuraldeafnessandHirschsprungdisease.ThreegeneshavebeenbestowedsofarinconsociationwithEDNRB,EDN3,andSOX10genes.ThepatternofinheritanceismultifariouswiththeSOX10mutationaffiliationwithautosomaldominantinheritancewhereastheEDNRBandEDN3genesarepasseddowninanautosomallyrecessivepattern.

简介：AbstractBackground:Endolymphatic sac tumor (ELST) is one of neuroectodermal tumor which arising from endolymphatic sac and duct. It is actually quite rare, with less than 200 cases reported. Although ELST presents benign appearance in histopathology, it can present aggressive destructive behavior in clinical. The cornerstone of treatment for ELST is complete surgical excision. However, it is almost impossible to completely resect the advanced stage tumor. There is still controversy about other treatments, such as radiotherapy and gamma knife surgery.Case presentation:A 47-year-old man was admitted in The First Affiliated Hospital of Fujian Medical University with a 7-year history of progressive hearing loss and near 6-month repeated attacks of headache. Preoperative CT revealed a massive intracranial lesion and associated hydrocephalus. MR scanning demonstrated a 7.2 cm × 4.6 cm × 4.2 cm bulky mass located in left-sided posterior cranial fossa and temporo-occipital region which showed hyperintensity on T1-weighted images and mixed signal intensity on T2-weighted images. There was no neither clinical manifestation nor family history of Von Hippel-Lindau syndrome (VHL).Due to the mass that was large and invading the bone of skull base, it was difficult to extirpate surgically, so the ventriculoperitoneal shunt combined with local biopsy was performed. The postoperative pathology and immunohistochemical findings confirmed the lesion was an endolymphatic sac tumor. After operation, the patient regularly received radiotherapy.Conclusion:The widely accepted management of ELST is complete surgical resection. However, it is difficult for surgeons to achieve radical resection with late-stage ELST. Currently, there is much dispute about the role of radiotherapy for the management of ELST in academic circles. In this case where the mass cannot be surgical removed, radiotherapy has the curative effect for ELST in terms of disease control and quality of life.

简介：A78-year-oldwomanpresentedwithfever,severeabdominalpain,anddistension.Shehadbeeninstitutionalizedfordepressionandseniledementia.Laboratoryexaminationsdisclosedaleucocytosis(WBC:12500/μL)andelevatedlevelsofserumC-reactiveprotein(2.8mEq/L).Diagnosisofacutececalvolvuluswasmadefroma'coffeebeansign'onanabdominalcomputedtomographyanda'beaksign'onagastrographinenema.Anemergentlaparotomyconfirmedthediagnosisandanileo-colectomywithprimaryanastomosiswascarriedout.Thepatientrecoveredafterintensiverespiratorycareandfluidtherapy,andthenreturnedtoherformerinstitution.AreviewofJapaneseliteraturedisclosedthat:(1)amarkedincreaseofagedpatientswithmentaldisabilitypresentingwithcecalvolvulus,(2)adoptionofileo-colectomyasthestandardsurgicalprocedure,and(3)improvedsurvivalofthepatients,wereobservedinthelastdecade.

简介：AbstractWe describe the case of a nine-month-old patient with a nasopharyngeal choristoma. The case presented includes the retrospective review of the historical, radiological, surgical and histological assessment of this pathology as well as a literature review of this entity. This case was presented in an infant with difficulty feeding, nasal obstruction and failure to thrive, evaluated with flexible nasal endoscopy, CT and MRI. The lesion was then surgically removed without complications. Nasopharyngeal choristoma is a rare congenital non-malignant mass, which may present within a range of symptoms and severity according to its size, growth and location.

简介：AbstractTraumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield. Penetrating trauma and blunt trauma are the most common forms of vascular injuries. Besides, iatrogenic arterial injury (IAI) is another pattern of vascular trauma. The management of peripheral vascular injuries has been improved in different environments and wars. There are different types of vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects, etc. The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia. Ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are most valuable for assessment of peripheral vascular injuries. Angiography remains the gold standard for diagnosing vascular trauma. Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment. There are many operative treatment methods for vascular injuries, such as vascular suture or ligation, vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts. Embolization, balloon dilation and covered stent implantation are the main endovascular techniques. Surgical operation is still the primary treatment for vascular injuries. Endovascular treatment is a promising alternative, proved to be safe and effective, and preferred selection for patients. In summary, rapid diagnosis and timely surgical intervention remain the mainstays of the treatment. However, many issues need to be resolved by further studies.

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简介：Globaldemographicchangesrelatedtolongevityareleadingtoincreasingnumbersoftheelderly,forwhomhearinglossisasignificantcauseofmorbidityanddisability.Oncemetwithreticence,severelyhearingimpairedolderadultsareincreasinglybeingconsideredforcochlearimplantation(CI).SignificantdataindicatethatCIintheelderlypopulationissafe,well-tolerated,andeffective.RisksfromCIsurgeryandanesthesiaarelowandgenerallycomparabletoratesinotheragegroups.OutcomesstudiesregardingCIinolderadultshaveshownexcellentimprovementstospeechperception,qualityoflife,andevencognition.Overall,currentlyavailabledatasuggeststhatadvancedageshouldnot,initself,beconsideredabarriertoimplantation.ThisreviewpaperwillhighlightselectedarticlesfromrecentmedicalliteratureregardingthesafetyandefficacyofCIintheelderlypopulation.

简介：Facialparalysiscanbeclassifiedascentralorperipheralfacialparalysisbasedonthelocationoftheunderlyinglesion,bothofwhichdemonstratefacialmotordysfunction.Inthecurrentlyreport,apatientadmittedtothedepartmentofotology,FirstPeople’sHospitalofQinhuangdao,presentedwithfacialasymmetryastheinitialsymptomofacerebralinfarctionandwasfirstmisdiagnosedasperipheralfacialparalysis.Thecaseisreportedasfollows.

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简介：尖锐胰腺炎是能触发全身的inammatory回答的本地织物损害描绘的inammatory疾病。胰腺炎的那么脉管的复杂并发症是病态和死亡的一个主要原因。在尖锐胰腺炎的肺的栓塞被报导了很稀罕。我们与尖锐胰腺炎报导了肺的栓塞的一个案例。一个38岁的女人爆发了没有明确的动机的上面的腹部疼痛。她没有恶心并且呕吐，发烧，呼吸困难，咳嗽和咳痰，胸疼痛。病人在本地医院里与尖锐胰腺炎被诊断了。病人与抗菌素和质子泵禁止者被对待，并且腹部疼痛稍微被减轻。但是病人向前来了有一点血的咳嗽和咳痰，进步呼吸困难。腹部的计算tomographic扫描揭示了胰腺炎。胸的随后的计算机断层摄影术angiography揭示了肺的栓塞(两个都击倒恰好肺的动脉的肺的动脉，左肺的动脉和分支)。病人的呼吸困难与thrombolytic治疗和anticoagulation治疗变好。肺的栓塞是胰腺炎的稀罕却潜在地致命的复杂并发症。对这复杂并发症的熟悉将帮助它的早诊断，治疗并且阻止肺的栓塞，稀罕却灾难的现象。

简介：AbstractThe philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%—90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.

简介：AbstractThe field of drug-induced sleep endoscopy (DISE) has grown considerably over the last 10~15 years, to now include its use in pediatric patients. In this review article, we outline our approach to the use of this technology in Children with Airway Obstruction, most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.

简介：AbstractObjective:To review the role of adjuvant hyperbaric oxygen therapy (HBOT) in the treatment of malignant otitis externa (MOE).Data sources:PubMed, Scopus, Web of Science, Science Direct, and Cochrane Library were searched for the following concepts: "hyperbaric oxygen" and "malignant or necrotizing otitis externa."Methods:Studies were included if they contained (1) patients with reported evidence of MOE, (2) employment of adjuvant HBOT, (3) details on patients’ medical condition, and (4) documented survival outcomes. Extracted information included patient demographics, underlying medical conditions, infectious etiology, signs and symptoms, medical and surgical treatments, duration of medical treatment, mean follow up time, HBOT setting, number of HBOT sessions, complications, survival rate, and all-cause mortality.Results:A total of 16 studies comprising 58 patients (mean age 68.0 years) were included. Diabetes was present in 94.7% of cases and Pseudomonas spp (64.3%) was the most common infectious agent. Cranial nerve VII was involved in 55.2% of cases. Overall, the disease cure rate with adjuvant HBOT was 91.4% and all-cause mortality was 8.6%. Among those who had cranial nerve VII involvement, 72.0% had return of function and 93.8% of them survived.Conclusion:HBOT may be an effective treatment option for refractory or advanced MOE but its efficacy remains unproven due to lack of strong scientific evidence. However, its therapeutic value should not be underestimated given good results and few adverse events reported in this study.

简介：AbstractWe present an unusual and, until now, unreported case of vesicoallantoic cyst associated with multiple malformations in a fetus. A differential diagnosis is discussed, including the hypothesis of a genetic disorder.

简介：AbstractObjective:Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID-19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID-19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need.Data Sources:PubMed, Ovid/Medline, and ScopusMethods:A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English-language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID-19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.Results:A total of 41 papers met inclusion criteria and were organized into 5 categories ('General Recommendations for Otolaryngologic Surgery’, 'Equipment Shortage Solutions’, 'Airway Procedures’, 'Nasal Endoscopy and Skull Base Procedures’, and 'Otologic Procedures’). Articles were summarized, highlighting the innovations created and evaluated during the COVID-19 pandemic. Creative solutions such as application of topical viricidal agents, make-shift mask filters, three-dimensional (3-D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID-19 transmission.Conclusions:Persistent risk of COVID-19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID-19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.