Browsing by Author "Lin, Yung-Song"

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Effect of carotid artery aberrancy on the distance between the vessel and nasopharyngeal subsites
(2014-05-01)
Lien, Ching-Feng
;
Weng, Hsu-Huei
;
Lin, Bor-Shyh
;
Liu, Ching-Feng
;
Wu, Tai-Ching
Background: Life-threatening hemorrhaging due to nasopharyngeal internal carotid artery (ICA) aberrancy may occur during routine nasopharyngeal surgery. To understand better the potential adverse effect of nasopharyngeal ICA aberrancy on routine nasopharyngeal surgery, we classified aberrant nasopharyngeal ICAs and analyzed the differences in mean distances from the ICA to nasopharyngeal subsites between aberrant and nonaberrant vessels. Methods: The courses of nasopharyngeal ICAs were examined and classified for an aberrant pathway. Various distances were measured on magnetic resonance brain scans. The mean values of the measured variables were compared using an unpaired two-sample t test. Results: The mean distances to the torus tubarius, the opening of Rosenmuller\'s fossa, and the posterior nasopharyngeal wall were 19.6 mm, 15.8 mm, and 16.7 mm, respectively, in the aberrant case group, and 23.1 mm (p < 0.001), 19.8 mm (p < 0.001), and 20.7 mm (p < 0.001) in the nonaberrant control group. Conclusion: The mean distances between the ICA and nasopharyngeal subsites were significantly shortened (by 15-21%) in the presence of aberrant nasopharyngeal segments, which may increase the risk of severe complications in common and uncomplicated nasopharyngeal surgery, such as adenoidectomy, eustachian tuboplasty, and nasopharyngeal biopsies. However, the mean distances were not shortened by the severity (kinking and coiling) of the aberrant nasopharyngeal carotid arteries. Copyright (C) 2014 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.
Increased risk of deep neck infection among HIV-infected patients in the era of highly active antiretroviral therapy-a population-based follow-up study
(2013-04-22)
Liu, Ching-Feng
;
Weng, Shih-Feng
;
Lin, Yung-Song
;
Lin, Chih-Sheng
;
Lien, Ching-Feng
Background: Deep neck infections (DNIs) in HIV-infected patients often produce severe complications, even death. Data on the incidence rates and risks of DNI among HIV-infected patients are scarce, particularly with the widespread use of highly active antiretroviral therapy (HAART). We evaluated the incidence rates and risks for DNI among HIV-infected patients and observed the long-term trends. Methods: A total of 9888 new HIV-infected patients diagnosed in 2001-2007 were included and matched with 49440 randomly selected subjects. The HIV-infected subjects were offered free access to HAART. All subjects were traced until December 2009. A Kaplan-Meier analysis generated the cumulative DNI incidence rate. The adjusted hazard ratio was computed using Cox proportional hazard regressions. Results: From the HIV-infected and comparison cohorts, 222 individuals (57.01 cases per 10000 person-years) and 735 individuals (35.54 cases per 10000 person-years) developed DNI, respectively. The log rank test indicated that patients with HIV had a significantly higher 8-year incidence rate of DNI than the control group (P < 0.0001). The adjusted hazard ratio for developing DNI after an HIV attack during the mean 3.94 years follow-up period was 1.59. The incidence rate and relative risk of DNI were 74.58 (per 10000 person-years) and 2.05 (P < 0.0001). Both figures were highest in the first follow-up year and decreased year-by-year thereafter. Conclusion: The risk of developing DNI is significantly elevated among HIV-infected patients, even with free access to HAART. Additional research is needed to examine the role of HAART in reducing the risk.
Radial forearm and forehead flap reconstruction following resection of a nasal arteriovenous malformation: A case report
(2016-10)
Lin, Chih-Shin
;
Lin, Yung-Song
;
Lin, Bor-Shyh
;
Lien, Ching-Feng
;
Liu, Ching-Feng
Arteriovenous malformation (AVM) is a structural vascular abnormality in which the arterial vasculature connects with the venous vasculature without capillary connections. AVM confined to the nasal cavity is considerably rare. Blurred vision can be one of the associated symptoms. A combined approach of complete surgical resection with prior superselective embolization is the treatment of choice. Following resection, the reconstruction of facial defects, particularly in the nasal area, is challenging. The present study reports the rare case of a patient with an AVM in the nasal cavity, in which embolization, resection and flap reconstruction were performed. Embolization and complete surgical resection were used to avoid recurrence. Subsequently, a combination of free radial forearm and forehead flaps was used for the reconstruction of the nasal defect, without prosthesis. To the best of our knowledge, this is the first report of AVM confined to the nasal cavity, managed by a combination of free radial forearm and forehead flap reconstruction following complete resection. The cosmetic results of the procedure were acceptable.
Risk factors for internal carotid artery injury in adults during simple nasopharyngeal surgeries
(2014-06-01)
Lien, Ching-Feng
;
Weng, Hsu-Huei
;
Liu, Ching-Feng
;
Lin, Bor-Shyh
;
Wu, Tai-Ching
The purpose of this study attempted to analyze the potential risk factors for internal carotid artery injury during simple nasopharyngeal surgeries with or without an endoscopic aid. One hundred and seventy magnetic resonance imaging scans (340 halves) of the brain were retrospectively reviewed and studied. Anatomic variations of carotid arteries were classified, and various distances from the internal carotid arteries to the nasopharyngeal subsites were directly measured on the scans. The mean distances between the internal carotid arteries and nasopharyngeal subsites were significantly shortened in patients with nasopharyngeal internal carotid artery aberrancy, female gender, and lower body weight. The distance to the posterior nasopharyngeal wall was also shortened with age. However, the severity of nasopharyngeal carotid artery variations (kinking and coiling) did not reflect the shortening of mean distances to nasopharyngeal subsites. In conclusion, from multiple linear regression analysis, we found that the risk of an internal carotid artery injury during simple nasopharyngeal surgeries with or without an endoscopic aid is greatest in adult patients with nasopharyngeal carotid artery aberrancy, followed by female gender, lower body weight, and increasing age.