Patel Vijay A, Pool Christopher D, Dunklebarger Mitchell, Schaefer Eric, Goyal Neerav
1 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
2 The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
Ann Otol Rhinol Laryngol. 2019 Sep;128(9):811-818. doi: 10.1177/0003489419839410. Epub 2019 Apr 23.
Total laryngectomy (TL) results in complete abolition of nasal airflow, with notable pathologic alterations of the intranasal mucosa, mucociliary clearance, and nasal cycle. Despite these observed morphological changes, it remains unclear whether this subpopulation of patients experiences clinically significant sinonasal disease. The goal of this study was to identify rhinosinusitis in TL patients using radiographic imaging.
An Institutional Review Board-approved retrospective review (January 2005-July 2017) identified 50 patients who underwent radiographic imaging before and after TL. The Lund-Mackay Staging System (LM) was applied to 197 surveillance computed tomography scans. Surveyed patients also underwent investigation of current sinonasal symptomatology using the SNOT-22 questionnaire. Simple linear regression was modeled to LM scores; tests of statistical significance were estimated via the method of Kenward and Roger.
The mean age was 62.4 years, with a 5:1 male-to-female ratio. The mean SNOT-22 score was 27.4 (range, 5-33). A median of 3 scans was obtained, 49% within 12 months after TL. The mean (± standard deviation) postoperative LM score was 2.7 ± 3.97 points (range, 0-19). For every 1 month after TL, postoperative LM was +0.01 point ( = .49). Conversely, for every +1 point in preoperative LM, postoperative LM was +1.08 points ( < .001). Two patients required functional endoscopic sinus surgery after TL for persistent sinonasal disease.
Preoperative sinonasal disease burden likely plays an important role in the development of clinically significant rhinosinusitis in TL patients. Correlating radiographic findings to validated outcome measures remains a critical aspect of determining optimal surgical candidates; this arena is still under investigation in this unique patient cohort.
全喉切除术（TL）导致鼻腔气流完全消失，鼻黏膜、黏液纤毛清除功能和鼻周期出现显著的病理改变。尽管观察到了这些形态学变化，但尚不清楚这一亚组患者是否患有具有临床意义的鼻-鼻窦炎。本研究的目的是使用影像学检查确定全喉切除术患者的鼻窦炎情况。
一项经机构审查委员会批准的回顾性研究（2005年1月至2017年7月）确定了50例在全喉切除术前后接受影像学检查的患者。Lund-Mackay分期系统（LM）应用于197次监测计算机断层扫描。接受调查的患者还使用SNOT-22问卷对当前的鼻-鼻窦症状进行了调查。对LM评分进行简单线性回归建模；通过Kenward和Roger方法估计统计学意义检验。
平均年龄为62.4岁，男女比例为5:1。SNOT-22平均评分为27.4（范围5-33）。平均获得3次扫描结果，49%在全喉切除术后12个月内。术后LM平均（±标准差）评分为2.7±3.97分（范围0-19）。全喉切除术后每过1个月术后LM增加0.01分（P = 0.49）。相反，术前LM每增加1分，术后LM增加1.08分（P < 0.001）。两名患者在全喉切除术后因持续性鼻-鼻窦疾病需要接受功能性鼻内镜鼻窦手术。
术前鼻-鼻窦疾病负担可能在全喉切除术患者发生具有临床意义的鼻窦炎中起重要作用。将影像学检查结果与经过验证的结局指标相关联仍然是确定最佳手术候选人的关键方面；在这个独特的患者群体中，这一领域仍在研究中。
