RESUMEN
The aim of this study was to evaluate the short and medium-term effects of radiofrequency (RF) and potassium titanyl phosphate (KTP) and neodymium-yttrium-aluminum garnet (Nd:YAG) laser treatment on the inferior turbinate mucosa in a porcine model. Following randomization, the inferior turbinates were treated either with RF submucosally or with the KTP or the Nd:YAG laser on the surface under videoendoscopic control. Tissue samples were taken at the end of postoperative weeks 1 and 6, and were evaluated macroscopically and histopathologically. Scanning electron microscopy was implemented to demonstrate the morphological changes in the respiratory epithelium. Six weeks following the RF procedure, the mucosa was intact in all cases, and the volume of the inferior turbinates was reduced in the majority of the cases. Although a volume reduction occurred in both laser groups, more complications associated with the healing procedure were noted. With hematoxylin and eosin and periodic acid-Schiff staining, intact epithelium, and submucosal glands remained after the RF procedures at the end of postoperative week 6. Following the KTP-laser intervention, necrotizing sialometaplasia and cartilage destruction occurred, and squamous metaplasia was also apparent in the Nd:YAG group. In both laser groups, dilated glands with excess mucus were seen. The scanning electron microscopic findings demonstrated that cilia were present in all cases. In conclusion, the medium-term macroscopic results were similar in all 3 groups, but the postoperative complications were less following the RF procedure. RF procedure is minimally invasive due to the submucosal intervention that leads to a painless, function preserving recovery.
Asunto(s)
Láseres de Estado Sólido , Ondas de Radio , Cornetes Nasales/patología , Cornetes Nasales/efectos de la radiación , Animales , Microscopía Electrónica de Rastreo , Distribución Aleatoria , Porcinos , Cornetes Nasales/ultraestructuraRESUMEN
BACKGROUND & OBJECTIVE: Although intracavitary irradiation (ICI) is usually applied to enhance dose in radiotherapy for early stage nasopharyngeal carcinoma (NPC), its use in parapharyngeal enhancing dose is limited because of dislocation and poor repetition of conventional catheterization. This study was to evaluate the application of a new technique, interstitial brachytherapy via parapharynx involvement transnasal approach, to enhance dose in radiotherapy for NPC. METHODS: Twenty-three naive and recurrent NPC patients with tumor residue of more than 1 cm under nasopharyngeal mucosa or restricted tumor residue in the parapharyngeal space received interstitial brachytherapy between Sep. 2005 and Aug. 2006 via parapharynx involvement transnasal approach under the guidance of sinus endoscopy. The 3-dimensional (3D) planning system was used to delineate target volume, optimize dose distribution, and perform interstitial brachytherapy after CT scan. The depths of catheters under mucosa on the moment of inserting and pulling out were measured. The efficacy and complications were assessed. RESULTS: All catheters were intubated into tumors successfully; the veracity of catheter location was 100%. The submucosa depths of catheters were (9.59+/-2.72) mm when inserted and (9.43+/-2.30) mm when pulled out, without significant difference (t = 0.23,P > 0.05); the shift length was (0.75+/-0.75) mm. The patients were followed up from 3 to 15 months (median, 6 months), and no one dropt out. Three cases of irradiation-associated turbinate adhesion occurred and were cured after lysis; no infection, serious bleeding, palatal perforation, nasopharyngeal necrosis, and other serious complications occurred. All tumors disappeared in 3 months after treatment. No local recurrence and distant metastasis occurred. CONCLUSIONS: The nasopharyngeal and parapharyngeal catheterization with sinus endoscopy guidance is accurate, steady, safe, and feasible. Interstitial brachytherapy is effective for tumor residue in the nasopharynx or parapharyngeal space of NPC patients after radiotherapy without serious complications.
Asunto(s)
Braquiterapia/métodos , Radioisótopos de Iridio/uso terapéutico , Neoplasias Nasofaríngeas/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Adulto , Braquiterapia/efectos adversos , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Radioisótopos de Iridio/administración & dosificación , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/patología , Dosificación Radioterapéutica , Cornetes Nasales/efectos de la radiaciónRESUMEN
BACKGROUND: Inferior turbinate hypertrophy is one of the most common causes of nasal airway obstruction in children. Medical treatment often produces very little improvement. Radiofrequency therapy has recently been shown to be safe and effective in volumetric tissue reduction of the turbinates in adults, but no report has been published about its use in children. We prospectively evaluated the safety and effectiveness of radiofrequency volumetric tissue reduction (RVTR) for the treatment of nasal obstruction caused by inferior turbinate hypertrophy in children. METHODS: We followed up 93 children less than 9 years of age who underwent RVTR over 12 months. This surgery was performed with other procedures, such as tonsillectomy with or without grommet insertion (57 patients), tympanoplasty (10 patients), or grommet insertion alone (26 patients). Clinical examination, a medical questionnaire, and scores recorded pre- and postoperatively using Gertner-Podoshin plates were used to assess treatment outcomes 1 month, 6 months and 1 year after surgery. RESULTS: No adverse effects were encountered. One primary bleed due to tonsillectomy was the only complication in this group. Eighty-seven children (94%) had significantly improved nasal breathing postoperatively. CONCLUSIONS: The results of this study demonstrate that RVTR is a safe, effective method for the treatment of turbinate hypertrophy in children. In addition, our data demonstrates good patient acceptance over a period of 1 year.
Asunto(s)
Obstrucción Nasal/radioterapia , Cornetes Nasales/patología , Cornetes Nasales/efectos de la radiación , Niño , Preescolar , Estudios de Seguimiento , Humanos , Hipertrofia/complicaciones , Hipertrofia/radioterapia , Obstrucción Nasal/etiología , Obstrucción Nasal/patología , Tamaño de los Órganos/efectos de la radiación , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation.