Pediatric Teratoma and Dermoid Cysts OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2015; 48 (1): 121-?
Teratomas and dermoid cysts are germ cell neoplasms. This article focuses on cervical and craniofacial teratomas. Presentation of these neoplasms varies in degree of severity, from cosmetic deformities to airway distress requiring emergent intervention. Nasal lesions (particularly if suspicious for a nasal dermoid) require imaging before biopsy to assess for intracranial extension. Treatment consists of airway management if respiratory distress is present, and early surgical intervention. Postoperative follow-up is required to monitor for recurrence.
View details for DOI 10.1016/j.otc.2014.09.009
View details for Web of Science ID 000346951600009
View details for PubMedID 25439551
The Transpalatal Approach to Repair of Congenital Basal Skull Base Cephaloceles JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE 2014; 75 (2): 96-103
Basal skull base herniations, including meningoceles and encephaloceles, are rare and may present with characteristic facial and neurologic features. The traditional craniotomy approach has known morbidity, and nasal endoscopy may not allow for control of large posterior basal defects, especially in newborns. We present two cases of successful repair of basal transsphenoidal meningoceles using an oral-transpalatal approach. The first patient with an intact palate presented with respiratory distress, and a palatectomy was performed for access to the skull base. The second patient had a large basal herniation that was reduced through a congenital midline cleft palate, and a calvarial bone graft was used to repair the defect. A literature search revealed 10 previous successful cases using the transpalatal repair, which allows for excellent access, low morbidity, and a team-oriented method to skull base surgery.
View details for DOI 10.1055/s-0033-1358374
View details for Web of Science ID 000333671900003
View details for PubMedID 25072006
Pediatric button battery injuries: 2013 task force update INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2013; 77 (9): 1392-1399
Over the last 10 years, there has been a dramatic rise in the incidence of severe injuries involving children who ingest button batteries. Injury can occur rapidly and children can be asymptomatic or demonstrate non-specific symptoms until catastrophic injuries develop over a period of hours or days. Smaller size ingested button batteries will often pass without clinical sequellae; however, batteries 20mm and larger can more easily lodge in the esophagus causing significant damage. In some cases, the battery can erode into the aorta resulting in massive hemorrhage and death. To mitigate against the continued rise in life-threatening injuries, a national Button Battery Task Force was assembled to pursue a multi-faceted approach to injury prevention. This task force includes representatives from medicine, public health, industry, poison control, and government. A recent expert panel discussion at the 2013 American Broncho-Esophagological Association (ABEA) Meeting provided an update on the activities of the task force and is highlighted in this paper.
View details for DOI 10.1016/j.ijporl.2013.06.006
View details for Web of Science ID 000324363400003
View details for PubMedID 23896385
Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: Inter-observer correlation and comparison with awake endoscopy INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2013; 77 (5): 752-755
Evaluate the inter-observer correlation of sleep endoscopy findings in children with persistent obstructive sleep apnea (OSA) with awake office fiber-optic endoscopy.retrospective case series; blinded review.tertiary care children's hospital.Children with persistent obstructive sleep apnea.Both awake and drug induced sleep endoscopy were performed. Endoscopy video recordings were mixed at random on a DVD. Two pediatric otolaryngologists and two pediatric pulmonologists independently scored each recording using an upper airway endoscopy scoring survey.reviewers scored the following parameters: each structure's contribution (nose, nasopharynx, lateral pharyngeal walls, tongue base, supraglottis) to the obstruction, the main site in which the obstruction occurs, the severity of OSA (mild, moderate, severe), the level of confidence of endoscopy findings (poor, fair, good).When reviewing sleep endoscopy recordings for the upper airway obstruction site, the highest correlation among the four observers was found for the nasopharynx and the supraglottis (Kappa score: 0.6 and 0.5, respectively). Compared to awake endoscopy, sleep endoscopy demonstrated more cases of airway obstruction caused by collapse of lateral pharyngeal walls and base of tongue (McNemar test for symmetry, P value<0.05). Level of confidence among the four observers was higher in older children and lower in children with severe OSA.Sleep endoscopy is a consistently reliable tool for identifying the site of obstruction in children with persistent OSA. Though anesthetic induced sleep is not a perfect model for real sleep, the technique demonstrably guides further therapy better than awake endoscopy.
View details for DOI 10.1016/j.ijporl.2013.02.002
View details for Web of Science ID 000318384000026
View details for PubMedID 23433922
Effect of Obesity and Medical Comorbidities on Outcomes After Adjunct Surgery for Obstructive Sleep Apnea in Cases of Adenotonsillectomy Failure ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2012; 138 (10): 891-896
To evaluate the effect of body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and medical comorbidities on outcomes after lingual tonsillectomy and supraglottoplasty performed for obstructive sleep apnea syndrome (OSAS) caused by lingual tonsillar hypertrophy and occult laryngomalacia.Retrospective case review seriesAcademic tertiary referral centerChildren with persistent OSAS after adenotonsillectomy who underwent surgery to correct obstruction at the level of the lingual tonsils and/or supraglottis identified on sleep endoscopy.All children underwent lingual tonsillectomy, supraglottoplasty, or both.Change in polysomnographic parameters, including apnea-hypopnea index (AHI), number of nighttime apneas, and lowest oxygen saturation level.We analyzed the medical records of 84 children with persistent OSAS after adenotonsillectomy who underwent either lingual tonsillectomy (n = 68), supraglottoplasty (n = 24) or both (n = 8). Compared with children with lingual tonsillar hypertrophy, children with occult laryngomalacia were younger, had lower BMI, and were more likely to have a medical comorbidity. Overall, both operations significantly improved the AHI; however, children with comorbidities had significantly higher postoperative AHIs after supraglottoplasty than those without, and overweight children had significantly higher postoperative AHIs after lingual tonsillectomy than those of normal weight. The BMI z-score and age had direct, though weak, correlations with postoperative AHI among all children undergoing either technique of adjunct airway surgery.Lingual tonsillar hypertrophy and occult laryngomalacia are 2 important causes of residual OSAS after adenotonsillectomy. However, they tend to affect distinct populations of children, and though appropriate surgical correction can improve AHI, cure rates are significantly worse for overweight children undergoing lingual tonsillectomy and for children with medical comorbidities undergoing supraglottoplasty.
View details for Web of Science ID 000309916600001
View details for PubMedID 23069817
The "Postcricoid Cushion" Observations on the Vascular Anatomy of the Posterior Cricoid Region ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2012; 138 (6): 562-571
To describe the cyclical vascular enlargement that occurs in the postcricoid region during the expiratory phase on an infant's cry, and to consider the anatomic, physiologic, and clinical implications of this phenomenon, which we term the "postcricoid cushion."A total of 125 consecutive office fiber-optic laryngoscopic examinations in children and infants were reviewed for engorgement and vascular discoloration of the postcricoid region. Presence of a postcricoid cushion in relation to patient age was reviewed. A comprehensive literature review was also performed.Tertiary care pediatric hospital.Patients from newborns to 17 years old undergoing laryngoscopy for any reason.Sixty-one percent of the videos showed a postcricoid cushion with cyclical enlargement during crying. Eighty-eight percent of children younger than 24 months had presence of a cushion compared with only 38% of children 24 months or older (P < .001). Twenty-five percent of the cushions had violaceous discoloration that resembled a vascular malformation.Anatomic studies have demonstrated a rich venous plexus in the postcricoid region of the larynx. During the expiratory phase of an infant's cry, there is a cyclical engorgement, occasionally with vascular discoloration, in the postcricoid region at the same level of the venous plexus-the "postcricoid cushion." We propose that during crying, with acute elevation in intrathoracic pressure, there is a filling of the plexus, causing apposition of the postcricoid cushion against the posterior pharyngeal wall, which may serve as a protective barrier to emesis in infants. Our observations relate and differentiate this normal physiologic phenomenon from the rare cases of postcricoid vascular anomalies.
View details for Web of Science ID 000305415600006
View details for PubMedID 22710508
Sleep endoscopy as a diagnostic tool in pediatric obstructive sleep apnea INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2012; 76 (5): 722-727
Ten to twenty percent of children have persistent obstructive sleep apnea (OSA) after adenotonsillectomy (T&A). We hypothesize that sleep endoscopy, a flexible fiberoptic examination of the pharynx under anesthesia, is an effective tool for identifying sites of persistent obstruction.In this retrospective cohort study, we reviewed records of children who had symptoms consistent with OSA and a positive polysomnogram (PSG) who underwent sleep endoscopy followed by sleep endoscopy directed surgery. Data collection included age, BMI and co-morbidities. Apnea-hypopnea index (AHI) was compared to pre and post surgery for each child using a paired t-test.Of the 80 children who underwent sleep endoscopy followed by directed surgery, 65% were male, mean age was 6 years (SD 3.75 years), average BMI was 19 (SD 0.43 years) and 28% had co-morbidities. For the 51% of patients who had persistent OSA after T&A, the mean AHI after sleep endoscopy directed surgery was significantly lower then before surgery (7.9 vs. 15.7, p<.01). For the 49% of patients who had never undergone surgery for OSA, or who were surgically nave, and underwent sleep endoscopy directed surgery, the mean AHI was significantly lower then before surgery (8.0 vs. 13.8, p<.01).Sleep endoscopy is a consistently reliable tool for identifying the sites of obstruction in both surgically naive children and those with persistent OSA after T&A.
View details for DOI 10.1016/j.ijporl.2012.02.028
View details for Web of Science ID 000303901400021
View details for PubMedID 22421163
Surgical Reconstruction of Tracheal Stenosis in Conjunction With Congenital Heart Defects ELSEVIER SCIENCE INC. 2012: 1266-1273
Surgical reconstruction is the primary method of treating airway obstruction in children. Tracheal stenosis is frequently associated with congenital heart defects, which may further complicate the overall management strategy. The purpose of this study was to review our experience with surgical reconstruction of airway obstruction in conjunction with congenital heart defects.This was a retrospective review of our surgical experience with tracheal stenosis from February 2003 to August 2011. Twenty-seven patients were identified in our database. Six patients had isolated, congenital tracheal stenosis, and 21 had tracheal stenosis in association with congenital heart defects. There were two identifiable subgroups. Thirteen patients had airway stenoses identified concurrently with congenital heart defects and underwent combined repair. The second group comprised 8 patients who had previous correction of their congenital heart defects and experienced delayed presentation of tracheal (n = 6) or bronchial (n = 2) obstruction.The median age at surgery was 9 months. There were 2 postoperative deaths, both in children with single ventricle. The median duration of follow-up for the entire cohort of 25 surviving patients was 4 years. None of the patients have required reoperations on the trachea; 5 have had minor reinterventions.The data demonstrate that tracheal obstruction is frequently found in conjunction with congenital heart defects. Nearly one third of our patients had delayed presentation of airway obstruction that was identified subsequent to previous congenital heart defect repair. Tracheal reconstructive techniques were effective regardless of the cause of the airway obstruction.
View details for DOI 10.1016/j.athoracsur.2011.12.063
View details for Web of Science ID 000302120200049
View details for PubMedID 22381444
Sleep endoscopy in the evaluation of pediatric obstructive sleep apnea. International journal of pediatrics 2012; 2012: 576719-?
Pediatric obstructive sleep apnea (OSA) is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible.
View details for DOI 10.1155/2012/576719
View details for PubMedID 22518178
Surgical reconstruction of Tracheal Stenosis in Conjunction With Ann Thoracic Surg 2012; 93: 1266- 1273
Supraglottoplasty for Occult Laryngomalacia to Improve Obstructive Sleep Apnea Syndrome ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2012; 138 (1): 50-54
To evaluate the polysomnographic outcomes after supraglottoplasty (SGP) performed for obstructive sleep apnea syndrome (OSAS) associated with occult laryngomalacia.Retrospective case series with medical chart review.Tertiary pediatric medical center.Twenty-two patients aged 2 to 17 years met the inclusion criteria of polysomnography-proven OSAS and occult laryngomalacia seen on flexible fiber-optic sleep endoscopy. Infants with congenital laryngomalacia were excluded.Carbon dioxide laser SGP was performed either alone or in conjunction with other operations for OSAS.Preoperative and postoperative nocturnal polysomnographic data were paired and analyzed statistically.Supraglottoplasty for occult laryngomalacia resulted in statistically significant reduction in the apnea-hypopnea index (AHI) (from 15.4 to 5.4) (P <.001). Subgroup analysis of children who underwent either SGP alone or in combination with other interventions showed comparable reductions in AHI. Medical comorbidities were associated with worsened postoperative outcomes, although still significantly improved compared with baseline. Overall, 91% of children had an improvement in AHI, and 64% had only mild or no residual OSAS after SGP.Supraglottoplasty is an effective technique for the treatment of OSAS associated with occult laryngomalacia.
View details for Web of Science ID 000299131300009
View details for PubMedID 22249629
The use of botulinum toxin for pediatric cricopharyngeal achalasia (vol 75, pg 830, 2011) INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2011; 75 (9): 1210-1214
Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, postoperative need for nasogastric tube placement, and swallow studies.A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.
View details for DOI 10.1016/j.ijporl.2011.07.022
View details for Web of Science ID 000295116400033
View details for PubMedID 21972448
Choanal atresia: current concepts and controversies CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY 2009; 17 (6): 466-470
Choanal atresia is a common and widely recognized craniofacial disorder characterized by obliteration of the posterior nasal aperture. Given the long time since its original description, controversy persists regarding pathogenesis and optimal surgical techniques. This review addresses current literature on choanal atresia and identifies areas of debate and future opportunities in research.Recent molecular mechanisms in retinoic acid receptor development have been described in the pathogenesis of choanal atresia. Whereas surgical treatment is generally believed to be effective in alleviating respiratory symptoms, consistent data confirming efficacy are scarce regarding best surgical approach with and without endoscopic sinus techniques, adjuvant use of stents, use of antiproliferative agents and laser-assisted surgery. Recent studies regarding each technique are discussed.Despite vigorous research, the pathogenesis remains elusive and unproven. Many surgical techniques have been advocated; however, there is no dominant approach. Trends in treatment are directed towards the use of highly advanced endoscopic approaches with the use of microdebriders, small drill bits and telescopes to minimize traumatic injury that leads to postoperative scarring and restenosis.
View details for DOI 10.1097/MOO.0b013e328332a4ce
View details for Web of Science ID 000272507300013
View details for PubMedID 19779346
Persistent pediatric obstructive sleep apnea and lingual tonsillectomy OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2009; 141 (1): 81-85
To describe a new method and the indications for lingual tonsillectomy with endoscopy and coblation, and to document its utility for treating children with persistent obstructive sleep apnea after previous tonsillectomy and adenoidectomy.Case series with chart review in a tertiary pediatric medical center.Twenty-six patients aged 3 to 20 met the inclusion criteria of polysomnography-proven persistent obstructive sleep apnea after tonsillectomy and adenoidectomy, as well as diagnosis of lingual tonsillar hypertrophy made by flexible fiberoptic sleep endoscopy. Endoscopic-assisted coblation lingual tonsillectomies were performed between June 2005 and January 2008. Preoperative and postoperative nocturnal polysomnogram data were paired and analyzed statistically.Statistically significant reductions in the respiratory distress index (RDI) were seen when preoperative and postoperative data were compared (mean, 14.7 vs 8.1). There were similar reductions in the number of obstructive apneas and hypopneas. The mean minimum O2 saturation did not change. Two patients in this series developed adhesions between the epiglottis and tongue base; there appeared to be no consequence for airway or feeding issues.Endoscopic-assisted coblation lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea in some children.
View details for DOI 10.1016/j.otohns.2009.03.011
View details for Web of Science ID 000267404900018
View details for PubMedID 19559963
Update on hemangiomas and vascular malformations of the head and neck EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY 2009; 266 (2): 187-197
Although the current classification systems of vascular malformations and hemangiomas are increasingly accepted, there are nonetheless several aspects that show us how special and at the same time difficult it is to diagnose, evaluate, and treat some of those diseases. Close interdisciplinary cooperation of all involved disciplines is essential; the discussion of the adequate individual procedure must be performed in angioma boards, as it is already well established in the context of tumor boards. The interface of angioma therapy and tumor therapy seems to be very close, which is certainly true for the aspect of angiogenesis and of course for the inhibited proliferation as promising therapeutic approach of complex vascular malformations. This leads to another obvious necessity of intensifying experimental scientific research on vascular malformations and hemangiomas, which is a precondition for optimizing or elimination of different current problems and deficits in the mentioned field.
View details for DOI 10.1007/s00405-008-0875-6
View details for Web of Science ID 000261750000005
View details for PubMedID 19052764
Airway management in Nager Syndrome LARYNGOSCOPE 2009; 119: S179-S179
Pediatric Tracheal Stenosis OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2008; 41 (5): 999-?
Tracheal stenosis is a rare, potentially life-threatening condition described as innate narrowing of the tracheal lumen. The causes of tracheal stenosis vary widely. The most common forms result from prolonged intubation, although congenital causes usually involve complete tracheal rings or compression from cardiovascular malformations. The condition historically has harbored a poor prognosis, but significant advances in radiologic diagnosis, cardiac bypass, and endoscopic and surgical treatments have led to a range of options, better overall survival, and reduced morbidity. The complex, long-term manifestations of tracheal stenosis point to the need for individualized treatment as well as multidisciplinary care.
View details for DOI 10.1016/j.otc.2008.04.006
View details for Web of Science ID 000259874600013
View details for PubMedID 18775347
Pathology quiz case 1 - Diagnosis: Foregut duplication cyst ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2007; 133 (9): 946-?
The evolution of tonsil surgery and rethinking the surgical approach to obstructive sleep-disordered breathing in children JOURNAL OF LARYNGOLOGY AND OTOLOGY 2006; 120 (12): 993-1000
Within the last 10 to 15 years, a significant amount of research in tonsil surgery has focused on reduction of post-operative pain and recovery time. In order to minimize or avoid morbidity, a number of otolaryngologists in the United States and Europe have revived a historical procedure, previously known as 'tonsillotomy', specifically for those patients with obstructive sleep-disordered breathing (OSDB) due to adenotonsillar hypertrophy. More recently, surgeons have used terms such as partial tonsillectomy, partial intracapsular tonsillectomy or subtotal tonsillectomy to describe their procedure and have employed a variety of modern instrumentation. This return to a 'partial' procedure has generated a debate similar to that which occurred amongst tonsil surgeons about 100 years ago, when tonsillotomy was the most commonly performed procedure. Today, concerns about regrowth and problems with infection of the remaining tonsillar tissue have been raised. Such concerns, combined with an incomplete understanding of why the 'partial' procedure was abandoned in the early twentieth century, may explain why tonsil surgeons hesitate to change their approach to patients with OSDB due to adenotonsillar hypertrophy. These issues can be addressed in a meaningful way only through a detailed review of the evolution of tonsil surgery, which is presented here. This information, along with a summary of the last 10 years' experience with these techniques, supports the use of a 'partial' procedure in children with OSDB due to adenotonsillar hypertrophy. Future areas of research are also discussed.
View details for DOI 10.1017/S0022215106002544
View details for Web of Science ID 000243738900002
View details for PubMedID 16923328
3.5-year follow-up of intralesional cidofovir protocol for pediatric recurrent respiratory papillomatosis INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2006; 70 (11): 1911-1917
Intralesional injection of cidofovir has been described as an adjunctive treatment for pediatric recurrent respiratory papillomatosis (RRP). However, questions remain regarding the optimal dosing schedule and side-effect profile. The objective of this study was to describe patient outcomes following a standardized cidofovir protocol.Eleven pediatric patients originally treated with a standardized stepped-dose protocol of intralesional cidofovir for RRP were followed for an extended observational period. Additional interventions, disease severity, and adverse outcomes were recorded.Five of 11 patients have required no further treatments following the original cidofovir protocol. Two patients initially achieved remission but have subsequently required additional treatment for recurrent disease. Four patients never achieved remission and have undergone multiple additional interventions. Mean follow-up time for all patients from the conclusion of the original study was 30.2 months (10-45). No adverse outcomes were noted.Intralesional injection of cidofovir may have some potential as an adjunct in the treatment of RRP. Response to cidofovir is unpredictable. Further study of cidofovir is necessary to more clearly define whether the favorable responses observed represent a true treatment effect or simply reflect the natural history of the disease. Perhaps as important is to refine treatment protocols and informed consents that reflect the concern about the carcinogenic potential of cidofovir and to better characterize the drug's side-effect profile.
View details for DOI 10.1016/j.ijporl.2006.06.018
View details for Web of Science ID 000241932800010
View details for PubMedID 16919339
Anterior and posterior cartilage graft dimensions in successful laryngotracheal reconstruction ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2006; 132 (6): 631-634
To describe the dimensions of cartilage grafts used for successful laryngotracheal reconstruction, with the goal of establishing appropriate sizes for "off-the-shelf" tissue-engineered cartilage grafts.A retrospective review of prospectively maintained operative illustrations of a single surgeon's experience.Two tertiary children's hospitals.A consecutive sample of 54 patients (tracheotomized or intubated) with a diagnosis of subglottic stenosis.Each patient underwent anterior (n = 30), posterior (n = 3), or anterior and posterior (n = 22) laryngotracheal reconstruction. Rib cartilage was used in 51 patients and thyroid cartilage was used in 3 patients.Successful or failed extubation.Of the 54 patients, 48 (89%) were successfully decannulated. The mean +/- SEM length of the anterior graft was 20.7 +/- 10.3 mm, and the mean width of the anterior graft was 7.7 +/- 2.5 mm. The mean length of the posterior graft was 13.9 +/- 2.9 mm, and the mean width of the posterior graft was 4.2 +/- 0.9 mm.With the prospect of tissue-engineered cartilage implants becoming available for laryngotracheal reconstruction, the most appropriate templates for designing these implants should be based on the geometric dimensions of grafts carved from native tissues in cases that have been successfully decannulated. Based on our analysis, the use of 2-mm increments for the posterior grafts suggests a set of molds that are 2, 4, and 6 mm wide and 22 mm long. Using 2 x 2-mm increments for the anterior grafts indicates that 36 mold sizes will be sufficient for 90% of predicted cases.
View details for Web of Science ID 000238261300009
View details for PubMedID 16785408
Cost-effectiveness of tonsillectomy for recurrent acute tonsillitis ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY 2006; 115 (5): 365-369
We used a retrospective case series to perform a preliminary study to determine the clinical effectiveness and cost-effectiveness of tonsillectomy for recurrent acute tonsillitis.We studied 25 children and 16 adults who had tonsillectomy for recurrent acute tonsillitis. The adult patients and the children's caregivers were asked to respond to a questionnaire regarding the efficacy of their tonsillectomy. The cost of medical care and the work disability cost for tonsillitis and for tonsillectomy were calculated. We then applied the technique of break-even time analysis to assess when the total health care cost savings from surgery overtook the total cost of tonsillectomy.In children, the overall economic costs (medical costs and work-related costs) were recovered at 1.6 years after tonsillectomy (break-even point). In adults, the overall economic costs (medical costs and work-related costs) were recovered at 2.5 years after tonsillectomy (break-even point).Tonsillectomy for recurrent acute tonsillitis is both clinically effective and cost-effective for children and adults in Japan.
View details for Web of Science ID 000237604600009
View details for PubMedID 16739669
PHACE syndrome: Report of a case with a glioma of the anterior skull base and ocular malformations INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2006; 70 (3): 561-564
PHACE syndrome consists of the constellation of manifestations including Posterior fossa anomalies of the brain (most commonly Dandy-Walker malformations), Hemangiomas of the face and scalp, Arterial abnormalities, Cardiac defects, and Eye anomalies. We present the case of a patient who presented with respiratory distress at birth secondary to a large nasal glioma. She was subsequently found to have a ventricular septal defect (VSD), a facial hemangioma, and a malformation of the eye and optic nerve head. The nasal glioma, which extended to the cribriform plate, has not been described in this syndrome. The tumor was resected through a coronal incision, midline nasal bone osteotomy, and a retrograde dissection from the nasal bones to the anterior skull base. Glioma of the skull base is a novel and serious manifestation of this uncommon condition.
View details for DOI 10.1016/j.ijporl.2005.047.014
View details for Web of Science ID 000235354700025
View details for PubMedID 16144720
Surgical management of cervical ganglioneuromas in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2006; 70 (2): 287-294
To review the experience with ganglioneuromas in the head and neck of children including presentation, diagnostic testing, treatments, and outcomes.Case series. Retrospective chart review.Tertiary care hospital.All patients with a history of ganglioneuroma of the neck in each authors practice were reviewed. All pathologically confirmed occurrences were eligible for inclusion, and five patients met these criteria.Five patients underwent surgical excision of head and neck ganglioneuromas between 1988 and 2004. There were no occurrences of secretory tumors, therefore all of the patients presented with enlarging masses. In all cases, the tumor arose from the cervical sympathetic chain, and thus, patients had subsequent ipsilateral Horner's Syndrome following resection. No synchronous tumors were noted, nor has a recurrent tumor been observed to this point. Complete excision was possible in all cases via a transcervical, or transoral approach, without mandibulotomy.Ganglioneuroma of the neck is a rare tumor that most commonly presents as an enlarging neck mass. Complete surgical excision is the treatment of choice, and in this series of children was possible with transcervical approach, and once via transoral approach. This tumor may be suspected in children who are otherwise asymptomatic, and present with long history of enlarging neck masses.
View details for DOI 10.1016/j.ijporl.2005.06.020
View details for Web of Science ID 000235091600015
View details for PubMedID 16102846
Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2006; 70 (1): 99-105
The "starplasty" technique of pediatric tracheostomy was introduced in 1990 as an alternative pediatric tracheostomy technique associated with several advantages. The only apparent drawback of this technique is the higher incidence of persistent tracheocutaneous fistula following decannulation. Several methods have been proposed for closure of persistent tracheocutaneous fistula in children, including fistulectomy with primary closure and fistulectomy with healing by secondary intent. Some authors advocate placement of a drain at the time of primary closure. We present our experience with closure of persistent tracheocutaneous fistula following starplasty in children over the past 15 years.Ninety-six starplasty procedures were performed on 96 children from 1990 to present, all by the senior author or under the guidance of the senior author. Twenty-eight of these children have been decannulated. Three fistulas closed spontaneously following decannulation. Of the remaining 25 children, 13 have undergone surgical closure of the tracheocutaneous fistula by the senior author. All tracheocutaneous fistula closures were performed as a fistulectomy with primary closure in three layers. Drains were not used in any of the patients.There were three minor complications in the postoperative period (wound infection and airway granuloma) and no major complications. None of the patients have experienced any degree of airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good."Starplasty" is a safe, reliable pediatric tracheostomy technique that has been shown to decrease the incidence of perioperative morbidity and mortality. The only drawback appears to be a high incidence of postoperative tracheocutaneous fistula. Our method of persistent tracheocutaneous fistula closure following starplasty is safe and effective, with no major complications and no incidence of postoperative airway narrowing.
View details for DOI 10.1016/j.ijporl.2005.05.024
View details for Web of Science ID 000234767800015
View details for PubMedID 15979730
Tonsillitis index: An objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2005; 69 (11): 1515-1520
This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TI> or =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TI> or =8 were significantly decreased compared to those with TI was less than 8 (TI<8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TI> or =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.
View details for DOI 10.1016/j.ijporl.2005.04.007
View details for Web of Science ID 000233098700009
View details for PubMedID 15979731
Prolonged infusion of dexmedetomidine for sedation following tracheal resection PEDIATRIC ANESTHESIA 2005; 15 (7): 616-620
Dexmedetomidine is a centrally acting alpha-2 adrenergic agonist that is currently approved by the US Food and Drug Administration for short-term use (< or = 24 h) to provide sedation in adults in the ICU. This drug has been shown to be efficacious in adult medical and surgical patients in providing sedation, anxiolysis, and analgesia. Dexmedetomidine has been associated with rapid onset and offset, hemodynamic stability, and a natural, sleep-like state in mechanically ventilated adults. To date, there are few publications of the use of this drug in children, and prolonged infusion has not been described. We report our use of dexmedetomidine in a child during a 4-day period of mechanical ventilation following tracheal reconstruction for subglottic stenosis.
View details for DOI 10.1111/j.1460-9592.2005.01656.x
View details for Web of Science ID 000229803900015
View details for PubMedID 15960649
Laryngotracheal consequences of pediatric cardiac surgery ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2005; 131 (4): 336-339
To determine the incidence and character of clinically significant laryngotracheal anomalies in pediatric patients undergoing surgical repair of congenital cardiac defects at a tertiary care center.Single-center retrospective review.The charts of pediatric patients who required surgical treatment for congenital heart disease over a 4-year period were reviewed. Forty-eight of 1957 patients were seen in inpatient consultation by the otolaryngology service. The parameters studied included cardiac diagnosis, reason for consultation, findings on examination, and follow-up.There were 16 (33%) cases of subglottic stenosis, which were graded according to the Cotton-Myer classification system as follows: grade 1 (n=8); grade 2 (n=3); and grade 3 (n=5). Three of the 16 patients with subglottic stenosis required tracheotomy and 4 required laryngotracheal reconstruction. Nine (19%) of the 48 patients were diagnosed as having unilateral true vocal cord paralysis and 3 (6%) as having bilateral paralysis. With the exception of 1 patient, all patients with true vocal cord paralysis on the left side had undergone repair of the aortic arch.Pediatric patients with congenital cardiac disease are predisposed to laryngeal anomalies owing to (1) frequent intubation, (2) prolonged ventilatory support, and (3) recurrent laryngeal nerve injury. In our patients, subglottic stenosis was the most common laryngeal abnormality. When recognized early, in the eschar phase, most of these cases can be managed with sequential endoscopic debridement, which is conceptually similar to debridement that is performed after functional endoscopic sinus surgery. Established stenosis requires more vigorous intervention, the invasive degree of which depends on the length and circumference of the narrowing. Unilateral vocal paralysis tends to be a self-limited problem, while an elegant solution to bilateral paralysis remains elusive.
View details for Web of Science ID 000228227100009
View details for PubMedID 15837903
Safety and efficacy of powered intracapsular tonsillectomy in children: a multi-center retrospective case series INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2005; 69 (1): 21-26
To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample.Multi-center retrospective case series.We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I. DuPont Hospital for Children, and the New York Otolaryngology Institute. For comparison, we reviewed the outpatient and inpatient records of all children who underwent conventional tonsillectomy performed by the same surgeons at the Children's Hospital at the Cleveland Clinic and Alfred I. DuPont Hospital for Children during the same period. No comparison group was available for the New York Otolaryngology Institute group. Three outcome measures were recorded: regrowth, bleeding and re-admission for dehydration rates. All statistical analyses were performed using SAS, and P < 0.05 was considered statistically significant.We identified 870 children that underwent PIT at three different institutions. In addition, 1121 children underwent conventional tonsillectomy at two of the three institutions. The mean follow-up for the PIT group was 1.2 years (range, 0.1-2.6 years) and 1.5 years (range, 0.1-3.0 years) for the conventional tonsillectomy group. The incidence of and 95% CI for the outcome measures were as follows regrowth 0.5% (0%, 1.4%), delayed post-operative bleeding 0.7% (0%, 1.9%), re-admission for dehydration 1.3% (0.05%, 2.6%), and overall major complications 0.46% (0.009%, 0.9%). When comparing conventional tonsillectomy to PIT, the bleeding rate, re-admission for dehydration, and the overall incidence of major complications were significantly lower in the PIT group (P = 0.001, P = 0.002, and P < 0.001, respectively).PIT is a safe and effective technique in the management of obstructive sleep disordered breathing in children. PIT has the advantages of decreased pain, dehydration and post-operative bleeding, and with a mean follow-up of 1.2 years, a low incidence of tonsillar regrowth thus far.
View details for DOI 10.1016/j.ijporl.2004.07.006
View details for Web of Science ID 000226571700003
View details for PubMedID 15627442
High-frequency ultrasound in the measurement of pediatric craniofacial integrity OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2004; 131 (6): 851-855
This study evaluates the use of high-frequency ultrasound in the measurement of the material nature of the pediatric craniofacial skeleton.Three desiccated human skulls, aged 1 year, 5 years, and adult, underwent ultrasonic evaluation at 6 sites on each hemicranium.The overall mean signal reflection coefficients for the infant, child, and adult skulls are 98.8 mV (13.75 mV SD), 172 mV (24.5 mV SD), and 230 mV (23.5 mV SD), respectively. The mean signal reflection coefficient is positively correlated with increasing chronological age. Comparison of intrasubject signal patterns suggests bone density fields, which vary as a function of growth.High-frequency ultrasound provides accurate measurements of the osseous impedance of the craniofacial skeleton. Pattern analysis suggests increases in skull density with greater growth and age.Although further testing must be performed in vivo, high-frequency ultrasound may accurately measure the osseous impedance of the pediatric craniofacial skeleton.C.
View details for DOI 10.1016/j.otohns.2004.08.010
View details for Web of Science ID 000225725200010
View details for PubMedID 15577779
Ultrasonic detection of middle ear effusion - A preliminary study ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2004; 130 (12): 1407-1410
To assess the ability to detect and characterize middle ear effusion in children using A-mode ultrasonography.Prospective nonblinded comparison study.Tertiary children's hospital.Forty children (74 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement.Before myringotomy, ultrasound examination of the tympanic membrane and middle ear space was performed on each ear. Afterward, myringotomy was performed and the type of effusion (serous, mucoid, or purulent) was recorded. Pressure equalization tubes were then placed.Comparison of ultrasound findings with the visual assessment of the type of middle ear effusion present.Of the 74 ears tested, 45 (61%) had effusion on direct inspection. The effusion was purulent in 8 ears (18%), serous in 9 ears (20%), and mucoid in 28 ears (62%). Ultrasound identified the presence or absence of effusion in 71 cases (96%) (P = .04). Ultrasound distinguished between serous and mucoid effusion with 100% accuracy (P = .04). The probe did not distinguish between mucoid and purulent effusion.Ultrasonography is an accurate method of diagnosing middle ear effusion in children. Moreover, it can distinguish thin from mucoid fluid. Further refinements in probe design may further improve the sensitivity of fluid detection and allow differentiation of sterile vs infectious effusion.
View details for Web of Science ID 000225606400008
View details for PubMedID 15611400
Postcricoid hemangioma presenting as dysphagia - A report of 4 cases ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2004; 130 (12): 1420-1422
Hemangiomas involving the postcricoid region of the hypopharynx are rare. This report reviews our experience with 4 cases of postcricoid hemangioma, including a set of twin siblings. All patients underwent panendoscopy. All patients were managed nonsurgically. Three patients did well with dietary modification. One patient, with multiple medical problems, remains partially dependent on her gastrostomy tube. To our knowledge this report represents the largest series in the literature and the first to describe similar lesions in twin siblings. This report highlights the importance of a complete fiberoptic office examination of children who present with symptoms of dysphagia or aspiration.
View details for Web of Science ID 000225606400011
View details for PubMedID 15611403
Starplasty: Revisiting a pediatric tracheostomy technique OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2004; 131 (5): 717-722
To determine the efficacy the "starplasty" pediatric tracheostomy technique in reducing the incidence of major complications and tracheotomy-related death.Retrospective chart analysis of all the cases of starplasty performed at 2 tertiary care centers between 1990 and 2002.There were 94 children in our cohort ranging in age from 2 days to 14 years. Of the patients, 47 (50%) were females and 47 (50%) were males and 60 of the children (64%) were younger than 1 year of age. Forty-one patients (44%) had neurologically related airway problems as their primary indication for tracheostomy, 34 (36%) had upper airway obstruction, and the remainder had pulmonary diseases, prolonged intubation, or metabolic-related airway problems. There were 41 short-term complications including 5 cases of tracheal tube dislodgement. There were no instances of pneumothorax or tracheostomy-related death. There were 26 long-term complications. There were no cases of clinically relevant suprastomal collapse that compromised decannulation and no instances of tracheal stenosis. Twenty-six patients underwent decannulation, all of whom developed a tracheocutaneous fistula (TCF). Two patients had spontaneous closure of the TCF; 9 patients underwent surgical repair of their fistulas, 53 patients remain tracheostomy-dependent, and 8 patients died of their primary disease.The need for pediatric tracheotomy has increased as a consequence of our success in treating chronically ill children. Starplasty reduces the incidence of major complications, including pneumothorax and death from accidental decannulation. Its major drawback is the need for secondary reconstruction of a tracheocutaneous fistula. EBM rating: C.
View details for DOI 10.1016/j.otohns.2004.04.022
View details for Web of Science ID 000225047200027
View details for PubMedID 15523453
The age dependent facial fractures and relationship between skull fractures Craniomaxillofacial Advanced Symposium ELSEVIER IRELAND LTD. 2004: 87781
Cervical presentations of thymic anomalies in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2004; 68 (7): 909-914
To better define the clinical manifestations, radiologic imaging and the surgical management of cervical thymic lesions in children.Multi-center retrospective case review.The charts of all children with pathologically confirmed thymic lesions at six children's hospitals (1990-2002) were reviewed for demographics, physical findings, X-ray findings, operative outcomes and pathology.There were a total of 15 children, 2 of whom had ectopic cervical thymus and 13 who had thymic cysts. They ranged in age from 1 month to 18 years. Thymic lesions were more common in males. Ectopic cervical thymus was best defined by MRI whereas thymic cyst had a more consistent appearance on CT. All children had successful surgical resection with no recorded complications or recurrences.Cervical thymic lesions are rare. Ectopic cervical thymus tends to be found primarily in infants whereas thymic cysts occur in a wider age range. Radiologic imaging is important but is not histologically specific. Definitive diagnosis and cure requires complete surgical excision.
View details for DOI 10.1016/j.ijporl.2004.02.012
View details for Web of Science ID 000222141500007
View details for PubMedID 15183582
The age dependent relationship between facial fractures and skull fractures. International journal of pediatric otorhinolaryngology 2004; 68 (7): 877-881
To provide clinical evidence to support the age dependent relationship between facial fractures and skull fractures.Retrospective chart review of all children and adults admitted with combined facial fractures and skull fractures and skull fractures alone between January 1991 and November 1997.The Albany Medical Center Hospital, a tertiary level-one trauma center.Two hundred and one children, ages 1 month to 17 years, with skull fractures (frontal, parietal, or temporal), and 41 children with concurrent facial fractures were included in this study. One hundred and thirty-nine adults, ages 18-90 years, with skull fractures, and 70 adults with concurrent facial fractures were also studied.The gender, age, skull fracture, facial fracture, Glasgow coma score (GCS), mechanism of injury, and outcome of all patients admitted with frontal, parietal, or temporal fractures with or without facial fractures.There are a significantly greater (P < 0.001) number of facial fractures associated with skull fractures among adults as compared to children. Moreover, there is an exponential rise in facial fractures associated with skull fractures between infancy and adolescence. The GCS of children with combined facial and skull fractures is significantly lower than in those with skull fractures only (P < 0.001).The spectrum of craniofacial injuries is related to the specific developmental stage of the craniofacial skeleton. This is demonstrated by the variable pattern of combined facial and skull fractures observed clinically in children and adults.
View details for PubMedID 15183577
Obstructive sleep apnea in children AMERICAN FAMILY PHYSICIAN 2004; 69 (5): 1147-1154
Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenotonsillectomy is curative in most patients. Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.
View details for Web of Science ID 000220104300012
View details for PubMedID 15023015
Thyroglossal duct cysts: presentation and management in children versus adults INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2003; 67 (12): 1285-1290
To determine if the clinical presentation of thyroglossal duct cysts (TGDC) varies between children and adults and whether this knowledge helps optimize the surgical management.We retrospectively identified all patients with TGDC managed in our department between 1992 and 2002. We reviewed the patients' charts and recorded their gender, age at diagnosis, clinical presentation, radiologic imaging, surgical management, post-operative complications, and recurrence rate and compared the variables between the children and adults.Twenty-one children and 41 adults were treated for TGDC. Of the children, 57% were male and 43% were female, whereas 49% of the adults were male and 51% were female (P = 0.53). The average age was 6 +/- 5 years in children and 45 +/- 16 years in adults, which demonstrates a bimodal distribution. Forty-three percent of children and 42% of adults presented with an infected neck mass (P > 0.99). Among our patients, 96% of the adults and 100% of the children underwent a Sistrunk operation. Four children developed a wound infection that resolved with antibiotics. One adult developed a haematoma and another developed a wound seroma. There was one recurrence among adults and one among children, both of whom were treated with a second Sistrunk procedure.There appears to be a bimodal distribution for age at presentation of TGDC. Since the differential diagnosis among adults is broader, the opportunity for misdiagnosis is greater. However, once the correct diagnosis is made, the surgical management and post-operative outcome between adults and children is the same.
View details for DOI 10.1016/j.ijporl.2003.07.006
View details for Web of Science ID 000187400700001
View details for PubMedID 14643470
Capsule sparing in tonsil surgery: The value of intracapsular tonsillectomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2003; 129 (12): 1357-1357
Intracapsular tonsillar reduction (partial tonsillectomy): Reviving a historical procedure for obstructive sleep disordered breathing in children OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2003; 129 (5): 532-538
We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery.We conducted a retrospective case series at a tertiary children's hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB.Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery.Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.
View details for DOI 10.1016/S0194-5998(03)00727-7
View details for Web of Science ID 000186440100010
View details for PubMedID 14595276
Stepped-dose protocol of cidofovir therapy in recurrent respiratory papillomatosis in children ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2003; 129 (8): 841-846
To evaluate a stepped-dose protocol for intralesional injection of cidofovir in children with recurrent respiratory papillomatosis (RRP).Prospective, nonrandomized case series.Tertiary care children's hospital.Eleven children undergoing evaluation for RRP from June 1, 2000, through December 31, 2001.Intralesional injection of cidofovir was performed after microlaryngoscopy and carbon dioxide laser treatment. Patients received 4 monthly injections at a concentration of 5 mg/mL and returned 1 month after the last injection for follow-up. Patients with recurrent or recalcitrant disease then started a series of 4 monthly injections at a concentration of 10 mg/mL.Papilloma stage (0-3) documented at multiple subsites by means of serial microlaryngoscopy. We calculated a severity score by summing the scores at all affected subsites.The severity score decreased in each of the 11 patients during the course of therapy, from a mean +/- SD of 13.7 +/- 6.0 at enrollment to 2.1 +/- 3.4 at 1-month follow-up. Six patients experienced complete resolution (stage 0) and 4 others had mild disease (stage, =5) after 4 treatments at the 5-mg/mL concentration. Five patients with residual or recurrent RRP subsequently started a series of 4 cidofovir treatments at a concentration of 10 mg/mL, with a mixed response.Intralesional injection of cidofovir seems to reduce the burden of disease in children with RRP. Patients with persistent or recurrent disease may benefit from an increased cidofovir concentration of 10 mg/mL, although some aggressive papillomatous disease remains refractory to cidofovir treatment.
View details for Web of Science ID 000184620100007
View details for PubMedID 12925342
Infectious indications for tonsillectomy PEDIATRIC CLINICS OF NORTH AMERICA 2003; 50 (2): 445-?
Tonsillectomy is the most common major surgery performed on children in the United States. Recurrent throat infections of either bacterial or viral etiology can cause significant morbidity and decreased quality of life, and potentially lead to life-threatening complications. When performed in the proper patient, tonsillectomy can be a highly effective procedure. Recent clinical trials have sought to better define the appropriate infectious indications for surgery. Despite the improved understanding gained from these studies, the decision to operate always must be made on an individual basis with the primary care physician, surgeon, patient, and family all involved in the decision-making process.
View details for DOI 10.1016/S0031-3955(03)00030-0
View details for Web of Science ID 000183417100011
View details for PubMedID 12809333
Nasal deformity in neonates and young children PEDIATRIC CLINICS OF NORTH AMERICA 2003; 50 (2): 459-?
Pediatric nasal deformities comprise a broad range of congenital and acquired pathologies. The congenital deformities are rare and often require specific surgical interventions. The acquired deformities are more common, and in the majority of cases surgical intervention is not necessary. The decision to operate is based primarily on the extent of the functional impairment and the severity of the aesthetic deformity.
View details for DOI 10.1016/S0031-3955(03)00036-1
View details for Web of Science ID 000183417100012
View details for PubMedID 12809334
Occult supraglottic lymphatic malformation presenting as obstructive steep apnea INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 2003; 67 (3): 293-296
Sleep disordered breathing and obstructive sleep apnea is commonly encountered in the pediatric population. In many cases, it is the result of oropharyngeal obstruction secondary to adenoidal or adenotonsillar hypertrophy. We describe an unusual case of a child with adenoidal hypertrophy who had an occult supraglottic lymphatic malformation that manifested as obstructive sleep apnea. The management of this lesion is discussed including the use of endoscopy, carbon-dioxide laser, and the decision to avoid a tracheotomy. Occult supraglottic lymphatic malformations (LMs) are a rare cause of obstructive sleep apnea, the diagnosis of which will be missed without fiberoptic laryngeal examination. They are challenging to manage because of the airway involvement and propensity to recur.
View details for Web of Science ID 000181722200013
View details for PubMedID 12633931
Anatomical variations of the facial nerve in first branchial cleft anomalies ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2003; 129 (3): 351-355
To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve.Case series.Tertiary care center.Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams.Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case.The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly.Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence.The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.
View details for Web of Science ID 000181522400014
View details for PubMedID 12622548
Indications for tracheotomy in the pediatric intensive care unit population - A pilot study ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2002; 128 (11): 1249-1252
To define the indications for tracheotomy in patients requiring prolonged intubation (>1 week) in the pediatric intensive care unit (PICU).Retrospective chart review and follow-up telephone survey.A tertiary care center PICU.Tracheotomy or extubation.All patients older than 30 days in the PICU intubated for longer than 1 week between 1997 and 1999.During the study, 63 total admissions required intubation for longer than 1 week. A tracheotomy was necessary in 14% of admissions (n = 9). The mean length of intubation before the tracheotomy was 424 hours, whereas the mean length of intubation without the need for tracheotomy was 386 hours. Length of intubation, age, and number of intubations did not increase the probability of having a tracheotomy. Of those requiring a tracheotomy, 2 had tracheomalacia, 1 had subglottic edema, 1 had plastic bronchitis, 1 had Down syndrome with apnea resulting in right heart failure, 3 required long-term ventilation after cardiopulmonary collapse, and 1 had mitochondrial cytopathy. Of these 9 children, 7 were successfully decannulated, 1 patient died of underlying disease, and 1 patient remained cannulated secondary to the mitochondrial cytopathy. Twenty families of the patients who did not undergo a tracheotomy were reached by telephone after discharge. Most of the families reported that their children were free of stridor and hoarseness after extubation.Children tolerate prolonged intubation without laryngeal complications. The consideration for tracheotomy in the PICU setting must be highly individualized for each child.
View details for Web of Science ID 000179148100004
View details for PubMedID 12431164
Intracapsular partial tonsillectomy for tonsillar hypertrophy in children LARYNGOSCOPE 2002; 112 (8): 17-19
To review our experience with intracapsular tonsillectomy using powered instrumentation in the management of tonsillar hypertrophy causing obstructive sleep-disordered breathing in children.Retrospective case series.Intracapsular tonsillectomy, a form of partial tonsillectomy performed with an endoscopic microdebrider, preserves the tonsillar capsule as a barrier to exposure of the pharyngeal muscles. Results in 150 children who underwent this procedure were compared with those in 162 children who had standard tonsillectomy.Children who underwent intracapsular tonsillectomy had significantly less pain throughout the recovery period than those who had standard tonsillectomy. There was no significant difference between the two groups in intraoperative blood loss, and no episodes of immediate postoperative bleeding occurred in either group. Six patients who had the standard operation and one patient who had the intracapsular procedure had delayed hemorrhage requiring hospital readmission. Five children in the standard group and one in the intracapsular group were readmitted because of dehydration. Thus, in all, 11 readmissions were necessary among children who underwent standard tonsillectomy, whereas 2 were required among those who had intracapsular tonsillectomy.Intracapsular tonsillectomy is as effective as standard tonsillectomy in relieving obstructive sleep-disordered breathing but produces less postoperative pain and fewer episodes of delayed hemorrhage and dehydration.
View details for Web of Science ID 000177337900006
View details for PubMedID 12172232
Power-assisted adenoidectomy: Total and partial resection LARYNGOSCOPE 2002; 112 (8): 29-31
To describe the surgical technique for power-assisted adenoidectomy and review the safety and effectiveness of the procedure.Retrospective review.Power-assisted adenoidectomy uses a curved microdebrider shaver blade that conforms to the nasopharynx. The action of the shaver is controlled through visualization using a laryngeal mirror. Power-assisted adenoidectomy is started high in the nasopharynx, with resection beginning in the most superior aspect of the adenoid pad and moving inferiorly to the base of the pad. The cutting edge of the microdebrider remains in view continuously.Between 1998 and 2001, we performed power-assisted adenoidectomy in 677 children and conducted both retrospective and prospective reviews of our experience. No instances of excess intraoperative blood loss (>150 mL), postoperative hemorrhage, velopharyngeal insufficiency, or other complication associated with adenoidectomy have occurred.We have consistently demonstrated that power-assisted adenoidectomy is precise, rapid, and safe.
View details for Web of Science ID 000177337900010
View details for PubMedID 12172236
The natural history of congenital cholesteatoma ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2002; 128 (7): 804-809
To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions.A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral).Two tertiary care children's hospitals.Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years).Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss.Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.
View details for Web of Science ID 000176714300014
View details for PubMedID 12117340
Congenital cholesteatoma - Classification, management, and outcome ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2002; 128 (7): 810-814
To assess whether a classification system for congenital cholesteatoma (CC) can be derived from analysis of a large clinical sample of cases and to assess whether such a classification system is a reliable guide for surgical intervention, reexploration, and hearing outcome.A retrospective review of clinical and surgical records of 119 patients with CC.Four tertiary care children's hospitals.One hundred nineteen children with CC (age range, 2-14 years).Congenital cholesteatomas in the anterior mesotympanum were treated successfully with exploratory tympanotomy. Congenital cholesteatomas involving the posterior superior quadrant and the attic usually had concurrent involvement of the incus and stapes and often required a canal wall up tympanomastoidectomy and a second look for its control. Congenital cholesteatoma involving the mastoid usually involved all of the ossicles, was inconsistently controlled with canal wall up tympanomastoidectomy, and had a poor prognosis for restoration of conductive hearing loss. The mean +/- SD age of children with CC was 5.6 +/- 2.8 years, while that of children with acquired cholesteatoma was 9.7 +/- 3.3 years.The sequence of spread of CC, involving 3 sites, suggests a natural classification system. The CC usually originates in the anterior superior quadrant, but does not consistently remain there, and may variably occupy the middle ear and mastoid and result in ossicular destruction and conductive hearing loss. The location of CC and the involvement of the ossicles is an accurate predictor of the type of surgery necessary for its control and for the success of hearing restoration.
View details for Web of Science ID 000176714300015
View details for PubMedID 12117341
The impact of airbags and seat belts on the incidence and severity of maxillofacial injuries in automobile accidents in New York state ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 2001; 127 (10): 1189-1193
To evaluate the effect driver-side and passenger-side airbags have had on the incidence and severity of maxillofacial trauma in victims of automobile accidents.Retrospective analysis of all automobile (passenger cars and light trucks) accidents reported in 1994.New York State.Of the 595910 individuals involved in motor vehicle accidents in New York in 1994, 377054 individuals were initially selected from accidents involving cars and light trucks. Of this subset, 164238 drivers and 62755 right front passengers were selected for analysis.Each case is described in a single record with approximately 100 variables describing the accident, eg, vehicle, safety equipment installed and utilized or deployed, occupant position, patient demographics, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses, and procedural treatments rendered. A maxillofacial trauma severity scale was devised, based on the ICD-9-CM diagnoses.Individuals using airbags and seat belts sustained facial injuries at a rate of 1 in 449, compared with a rate of 1 in 40 for individuals who did not use seat belts or airbags (P<.001). Those using airbags alone sustained facial injuries at the intermediate rate of 1 in 148, and victims using seat belts without airbags demonstrated an injury rate of 1 in 217 (P<.001).Use of driver-side airbags, when combined with use of seat belts, has resulted in a decrease in the incidence and severity of maxillofacial trauma.
View details for Web of Science ID 000171444100005
View details for PubMedID 11587598
Comparison of power-assisted adenoidectomy vs adenoid curette adenoidectomy AMER MEDICAL ASSOC. 2000: 845-849
To compare the safety and efficacy of power-assisted adenoidectomy (PAA) vs adenoid curette adenoidectomy (ACA).A prospective randomized study.Children's hospital of a tertiary care medical center.Ninety patients (aged 1-13 years) underwent PAA, and 87 patients (aged 1-12 years) underwent ACA.The parameters evaluated were operative time, blood loss, completeness and depth of resection, injuries to surrounding structures, short- and long-term complications, surgeon satisfaction with the procedure, and parents' assessment of the patient's postoperative recovery period.The PAA was 20% faster (P<.001) and had 27% less blood loss (P<.001) than the ACA. It provided a more complete resection(P<.001) and better control of the depth of resection (P<.05). Surgeon satisfaction was greater with PAA (P<.001). There was no difference in the recovery period or parent satisfaction. One patient in the PAA group returned to the operating room for control of postoperative bleeding, and 1 child in the ACA group returned to the hospital for postoperative dehydration.The PAA provides a faster, dryer, more complete, and more surgically satisfying resection than the ACA.
View details for Web of Science ID 000088105000004
View details for PubMedID 10888996
Familial occurrence of acinic cell carcinoma of the parotid gland ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE 1999; 123 (11): 1118-1120
We report the familial occurrence of acinic cell carcinoma involving the parotid gland, the first such report of which we are aware. The familial occurrence of any salivary gland neoplasm is rare. Several reports are present in the literature, including pleomorphic adenoma, Warthin tumor, carcinoma of the submandibular gland, and malignant lymphoepithelial lesion. We report the case of a 35-year-old man who underwent excision of a left parotid gland acinic cell carcinoma. Eight years later, his daughter presented at the age of 16 years with a nontender parotid gland mass that was excised and found also to be acinic cell carcinoma. The histologic features of both neoplasms were typical of acinic cell carcinoma. While this may represent a coincidental event, the possibility that this familial occurrence is a manifestation of common genetic or environmental risk cannot be excluded.
View details for Web of Science ID 000083584000031
View details for PubMedID 10539921
Evaluation of orbital stress dissipation in pediatric and adult skulls using electronic speckle pattern interferometry AMER MEDICAL ASSOC. 1999: 765-773
To measure and quantitatively compare the degree of force dissipation in pediatric and adult skulls subjected to similar dynamic forces.An anatomical study using electronic speckle pattern interferometry, which allows generation of displacement vectors after application of a force.Five human skulls (3 pediatric and 2 adult).Each skull was subjected to a reproducible and quantifiable force created by a steel ball pendulum striking a precise periorbital focus: (1) infraorbital foramen, (2) supraorbital notch, (3) malar eminence, and (4) nasofrontal suture. Electronic speckle pattern interferometry was used to construct interferogram fringe patterns to determine skull regions with the greatest degree of displacement.Interferogram analysis revealed that the adult skull has a tendency to dissipate force with minimal resultant displacement. In contrast, the pediatric skulls demonstrated greater displacements (ie, increased fringe density) at the same periorbital foci.The pediatric skull dissipates periorbital stress differently than the adult skull, as illustrated by quantitative interferogram analysis. This finding parallels clinical data that demonstrate a varying pattern of fractures in pediatric and adult skulls related to craniofacial development.
View details for Web of Science ID 000081416800008
View details for PubMedID 10406314
Starplasty - A new technique of pediatric tracheotomy ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1998; 124 (10): 1105-1111
To report a new technique of pediatric tracheotomy that reduces the problems of pneumothorax and recannulation after accidental decannulation in a recently performed tracheotomy.Retrospective chart review for 1990-1997.Sixty-eight children aged between 2 days and 14 years.The starplasty procedure is based on the geometry of a 3-dimensional Z-plasty. The technique of the procedure is described and illustrated in detail.There were 27 short-term complications, including 4 accidental decannulations. There were no instances of pneumothorax or tracheotomy-related deaths. There were 25 long-term minor complications. There were no instances of tracheotomy-related death, suprastomal collapse, or tracheal stenosis. Thirty-eight children remain tracheotomy tube dependent, 17 underwent decannulation, 7 died of primary disease, and 6 were lost to follow-up. All 17 children who underwent decannulation have a persistent tracheocutaneous fistula.I conclude that starplasty reduces the incidence of major complications and death. Its only drawback seems to be persistent tracheocutaneous fistula.
View details for Web of Science ID 000076363100004
View details for PubMedID 9776188
Safety of powered instrumentation for adenoidectomy INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 1998; 44 (2): 149-153
A recent study established the utility of an endoscopic shaver for adenoidectomy in children by the transoral approach and showed that power assisted adenoidectomy (PAA) was significantly faster with a trend toward decreased blood loss. The purpose of this study was to demonstrate the safety of power assisted adenoidectomy in a large cohort of patients. A retrospective review was performed of 329 patients who had adenoidectomy by powered instrumentation. Postoperative complications were documented and compared with a similar group that had curette adenoidectomy. Complications watched for included prolonged recovery, postoperative hemorrhage, readmission for dehydration, velopharyngeal insufficiency, and nasopharyngeal stenosis. No postoperative complications were seen in the power assisted adenoidectomy group. This review confirms the safety of power assisted adenoidectomy.
View details for Web of Science ID 000075284200007
View details for PubMedID 9725531
First branchial cleft anomalies - A study of 39 cases and a review of the literature ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1998; 124 (3): 291-295
To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft.Retrospective study.Three tertiary care centers.Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996.All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed.Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases.Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.
View details for Web of Science ID 000072607600007
View details for PubMedID 9525513
Pediatric mandibular fractures. Facial plastic surgery 1998; 14 (1): 31-44
Over the last 20 years, a revolution in the management of facial fractures has taken place. Refinements in biocompatible materials of great delicacy and strength along with advances in our understanding of biomechanics of the face, have rendered complex injuries consistently amenable to accurate 3-dimensional reconstruction. Furthermore, with the availability of education in the techniques of internal rigid fixation, these advanced techniques have become routine practice in adults. However, the suitability of rigid internal fixation for children remains controversial. There are many concerns about the effect of implanted hardware in the mandible of a growing child. In addition, some evidence suggests that the elevation of functional matrix off of bone may result in alterations in development. The goal is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. However, in children the treatment of bony injuries is most easily accomplished by techniques that may adversely effect craniofacial development. While it is not entirely possible to resolve this dilemma, there exists an extensive body of experimental and clinical information on the appropriate management of pediatric mandibular fractures which can be used to formulate a rational treatment plan for most cases. This paper presents an overview of the contemporary understanding and application of these treatment principles.
View details for PubMedID 10371892
Power-assisted adenoidectomy AMER MEDICAL ASSOC. 1997: 685-688
To quantify that the use of powered instrumentation for adenoidectomy is an improvement over traditional techniques.Retrospective case series of 40 consecutive children undergoing power-assisted adenoidectomy compared with 40 consecutive children undergoing conventional transoral adenoidectomy with a curet.Tertiary care center.Operative time, blood loss, length of hospitalization, and complications.With power-assisted adenoidectomy, the mean operative time was significantly faster (11 minutes vs 19 minutes for the conventional method), mean blood loss was not significantly different (22 mL vs 32 mL for the conventional method), mean length of hospitalization after the procedure was not significantly different (2.95 hours vs 2.8 hours for the conventional method), and there were no surgical complications with either technique.In comparison with conventional techniques, power-assisted adenoidectomy provides significant advantages that are subjectively apparent but can also be objectively measured.
View details for Web of Science ID A1997XL47900003
View details for PubMedID 9236585
p53 protein expression in benign lesions of the upper respiratory tract ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1997; 123 (3): 297-300
p53 is a tumor suppressor gene that is lost or mutated in most forms of human malignancy. There are, however, very few studies evaluating p53 expression in normal epithelium or benign lesions.We screened for p53 protein expression in a variety of benign epithelial lesions of upper respiratory tract using monoclonal antibody DO-1 on paraffin-embedded material.We studied a total of 109 cases: 16 cases of juvenile and 36 cases of adult laryngeal papillomatosis, 10 cases each of laryngeal nodules and laryngeal polyps, 17 cases of inverted papilloma, and 20 cases of nasal polyps.Nuclear immunoreactivity for p53 protein was demonstrated in 14 (88%) of 16 cases of juvenile laryngeal papillomatosis, 33 (92%) of 36 cases of adult laryngeal papillomatosis, 4 (40%) of 10 cases of laryngeal nodules, 8 (80%) of 10 cases of laryngeal polyps, 7 (41%) of 17 cases of inverted papilloma, and 2 (10%) of 20 cases of nasal polyps. These results pertained only to the basal epithelial layer in all cases of laryngeal nodules, laryngeal polyps, and nasal polyps. Intermediate layer cells were also positive for p53 in the majority of the cases of both juvenile (69%) and adult (75%) laryngeal papillomatosis and in a minority of the cases of inverted papilloma (18%).Overexpression of p53 protein is commonly demonstrable in benign epithelial lesions of the upper respiratory tract. This observation suggests that p53 protein accumulation may occur in the absence of mutation of the p53 gene and may correlate with epithelial proliferative activity.
View details for Web of Science ID A1997WN50200008
View details for PubMedID 9076236
Management of facial trauma in children PEDIATRIC CLINICS OF NORTH AMERICA 1996; 43 (6): 1253-?
In today's fast-paced society, many children sustain severe maxillofacial injuries that require surgical reconstruction. The factor that differentiates the treatment of pediatric facial fractures from those of adults is facial growth. Anticipation of mandibular growth facilitates repair because most injuries can be treated with intermaxillary fixation. Midfacial injuries, on the other hand, may be more sensitive to alterations of facial growth, and complex cases require more sophisticated correction. The techniques of three-dimensional reconstruction of complex facial fractures has been facilitated greatly by the use of a rigid plating system, wide craniofacial exposure, and bone grafting. These techniques have sound theoretic and practical applications in severe pediatric facial trauma.
View details for Web of Science ID A1996VY94300008
View details for PubMedID 8973512
ORBITAL FRACTURES IN CHILDREN ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1995; 121 (12): 1375-1379
To determine if the pattern of orbital fractures may be influenced by the changing craniofacial ratio of the growing child, as the orbit is the boundary between the face and the cranium.Retrospective case series of 40 patients between the ages of 1 year and 16 years with orbital fractures.The Albany (NY) Medical Center Hospital, a tertiary level 1 trauma center.The sex, age, site, and mechanism of injury, associated injury, and treatment methods for children admitted to the Albany Medical Center Hospital with orbital fractures between July 1986 and June 1992.Fourteen children had fractures of the orbital roof, 10 children had fractures of the orbital floor, 14 children had mixed fractures, and two children had fractures of the medial wall. The mean age (4.8 +/- 3.3 years) of the 14 patients with roof fractures was significantly less than the mean age (12.0 +/- 4.2 years) of the 26 children with other orbital fractures. Logistic regression demonstrated that the age at which the probability of lower orbital fractures exceeds the probability of orbital roof fractures is 7.1 +/- 1.0 years. Orbital roof fractures had a significantly greater likelihood of associated neurocranial injuries. The need for surgical repair was significantly lower among children with roof fractures as well as among children 7 years of age and younger.Orbital roof fractures are a type of skull fracture that occur primarily in younger children as a consequence of the proportionally larger cranium and the lack of frontal sinus pneumatization. Lower orbital fractures are a type of facial fracture that occur primarily in older children as a consequence of the increased vulnerability of the face due to growth and the pneumatization of the paranasal sinuses.
View details for Web of Science ID A1995TJ64500006
View details for PubMedID 7488366
ACOUSTIC FEATURES OF NORMAL-HEARING PRETERM INFANT CRY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 1995; 33 (3): 213-224
Acoustic features of expiratory cry vocalizations were studied in 125 pre-term infants prior to being discharged from a level-3 neonatal intensive care unit. The purpose was to describe various phonatory behaviors in infants in whom significant hearing loss could be ruled out. We also compared these results with normal-hearing full-term infants, and evaluated whether linkage exists among acoustic cry features and various anthropometric, diagnostic and treatment variables obtained throughout the peri- and neonatal periods. Our analysis revealed that cry duration was significantly related to total days receiving respiratory assistance. The occurrence of other complex spectral and temporal aspects of acoustic cry vocalizations including harmonic doubling and vibrato also increased in infants receiving some form of respiratory assistance. The presence of harmonic doubling also depended on weight and conceptional age at test. The discussion focuses on the implication of these relationships and directions for future research.
View details for Web of Science ID A1995TC77800003
View details for PubMedID 8557478
Rigid fixation of facial fractures in children. The Journal of cranio-maxillofacial trauma 1995; 1 (2): 32-42
This article presents a retrospective analysis of a selective use of rigid fixation among 62 children with facial fractures, treated at a Level I trauma center over a 5-year period (1986-1991). There were 21 mandible fractures, 11 orbital fractures, 11 zygomaticomalar complex fractures, 7 nasal fractures, 5 maxillary fractures, 3 pan-facial fractures, 2 nasal-orbital-ethmoidal complex fractures, and 2 frontal sinus fractures. Only 18 children had rigid fixation of their injuries. Complications of Le Fort upper facial fractures repaired with rigid fixation involved perioperative sinusitis; one case required oral antibiotics, the other ethmoidectomy and maxillary antrostomy. One child with a Le Fort fracture had delayed exposure of a zygomaticomalar buttress plate, which required surgical removal. Permanent enophthalmos occurred in two children with Le Fort fractures. The authors conclude that traditional conservative management is appropriate in most cases. However, in children aged 13 and older with mandible fractures and children with complex mid- and upper facial fractures, a judicious use of rigid fixation has advantages over the traditional techniques.
View details for PubMedID 11951461
TREATMENT OF EXPERIMENTAL FROSTBITE WITH PENTOXIFYLLINE AND ALOE VERA CREAM ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1995; 121 (6): 678-680
To compare the therapeutic effects of systemic pentoxifylline and topical aloe vera cream in the treatment of frostbite.The frostbitten ears of 10 New Zealand white rabbits were assigned to one of four treatment groups: untreated controls, those treated with aloe vera cream, those treated with pentoxifylline, and those treated with aloe vera cream and pentoxifylline.Tissue survival was calculated as the percent of total frostbite area that remained after 2 weeks.The control group had a 6% tissue survival. Tissue survival was notably improved with pentoxifylline (20%), better with aloe vera cream (24%), and the best with the combination therapy (30%).Pentoxifylline is as effective as aloe vera cream in improving tissue survival after frostbite injury.
View details for Web of Science ID A1995RC17400015
View details for PubMedID 7772322
TRANSSPHENOIDAL HYPOPHYSECTOMY THROUGH THE EXTERNAL RHINOPLASTY APPROACH MOSBY-YEAR BOOK INC. 1994: 197-200
The external rhinoplasty approach is a refinement of the well-recognized sublabial transseptal technique for transsphenoidal hypophysectomy first introduced by Cushing in 1910. This article relates our experience with 111 cases of transsphenoidal hypophysectomy performed during a 10-year period (1982-1992) and includes a detailed description of our use of the external technique. Fifty-one patients were male, and 60 were female. Ages ranged from 12 years to 80 years, with an average of 46 years. One hundred one patients had pituitary adenomas, four had craniopharyngiomas, two had inverting papillomas, and there was one each of lymphoma, metastatic prostate cancer, pituitary abscess, and posttraumatic cerebrospinal fluid leak. Nine of the operations were for recurrent adenomas. Complications included 8 symptomatic anterior septal perforations and 13 asymptomatic posterior perforations. Five had transient cerebrospinal fluid rhinorrhea, five had perioperative hemorrhages, two had minor postoperative columellar deformities, and one had injury to the internal carotid artery requiring embolization. We have found the external technique for transsphenoidal hypophysectomy to be a reliable and facile means for nasal exposure of the sphenoid sinus and pituitary gland without loss of nasal tip projection or significant cosmetic deformity.
View details for Web of Science ID A1994PG59700005
View details for PubMedID 8084625
EFFECTS OF AIR-POLLUTION ON THE UPPER RESPIRATORY-TRACT OF CHILDREN MOSBY-YEAR BOOK INC. 1994: 9-11
The impact of the environment on the upper respiratory tract of children has become an issue of recent interest. Sulfur dioxide causes nasal congestion in children as well as an increase in both mast cells and lymphocytes in nasal lavage fluids. Chlorpheniramine blocks the effect of sulfur dioxide on the nasal mucosa. Ozone exposure results in nasal congestion, increased levels of histamine, neutrophils, eosinophils, and mononuclear cells in nasal lavage fluid. No data are available on the effects of nitrogen dioxide or wood-burning stoves on the upper respiratory tracts of children. Formaldehyde in sufficient concentrations causes upper airway irritation; however, no data are available on its long-term effects. Detriments in air quality cause adverse changes in the lower respiratory tracts of susceptible individuals. The effects on the upper respiratory tract are more difficult to document. There may be a causal relationship, but definitive proof of whether air pollution results in significant increases in pediatric otitis media, sinusitis, rhinitis, and pharyngitis has yet to be demonstrated.
View details for Web of Science ID A1994NX93600004
View details for PubMedID 8028949
Lateral cervical radiographs and adenoid size: do they correlate? Ear, nose, & throat journal 1992; 71 (12): 638-642
Clinicians have questioned the value of lateral soft tissue neck x-ray (LSTN) in assessing adenoid size. Elaborate cephalometric assays have been devised to measure degree of nasopharyngeal obstruction secondary to adenoid hypertrophy. This study prospectively studied 73 children, aged 11 months to 13 years, with clinical evidence of adenoid hypertrophy to assess how well a LSTN correlates with direct intraoperative observation of adenoid size and nasopharyngeal obstruction. We found a relatively weak correlation (Pearson coefficient r = 0.34) between x-ray and operative observations. We conclude that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy. However, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.
View details for PubMedID 1483401
The external rhinoplasty approach for rhinologic surgery. Ear, nose, & throat journal 1992; 71 (9): 408-412
The technique of external rhinoplasty has enjoyed a renaissance over the last ten years, primarily for cosmetic and functional septorhinoplasty, and we have found this to be an effective method for nasal reconstruction. Moreover, we have recognized the versatility of this approach for a variety of rhinologic problems and have utilized it for transsphenoidal hypophysectomy, sphenoidotomy, unilateral choanal atresia, septal perforation, nasal valvuloplasty and rhinophyma. We describe our technique and the rationale for employing it. We conclude that the enhanced exposure provided by the cutaneous decortication of the nose facilitates surgery of both the soft tissues and the supportive architecture of the nose.
View details for PubMedID 1425380
SWALLOWING DISORDERS IN A POPULATION OF CHILDREN WITH CEREBRAL-PALSY INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY 1992; 24 (1): 63-71
One of the disabilities in patients with cerebral palsy (CP) is dysphagia. To establish the prevalence of dysphagia in a population of children with CP, and to determine if any factors are related to dysphagia, we studied 56 CP patients, 5-21 years, enrolled in a primary school for the disabled. Fifteen patients (27%) had either radiographic or clinical evidence of dysphagia. These 15 patients were compared to the remaining 41 patients without dysphagia. Using data obtained from chart review and interviews with speech pathologists, several factors that contributed to dysphagia were found. These included: bite reflexes, slowness of oral intake, poor trunk control, inability to feed independently, anticonvulsant medication, coughing with meals, choking, and pneumonia. We also noted trends in the following factors: presence of tongue thrusting, presence of drooling, severity of CP, poor head control, severity of mental retardation, seizures, and speech disorders. Factors not related to the presence of dysphagia include: subject age, cause of CP, and type of CP. Early, aggressive work-up and identification in CP patients with the risk factors outlined above can reduce the associated pulmonary complications.
View details for Web of Science ID A1992JG39000008
View details for PubMedID 1399305
TRACHEAL AGENESIS ANNALS PUBL CO. 1992: 560-566
Tracheal agenesis is a catastrophic congenital anomaly that invariably results in death. Forty-seven cases have been previously reported in the literature. We add five additional cases, including two type 1 cases, two type 2 cases, and one type 3 cases, based on Floyd's classification scheme. We describe the features of this unusual anomaly at the time of diagnosis. We discuss a rational approach to the management of this difficult problem on an emergent basis that allows for the maintenance of the infant's life until all of the implications of this fatal condition can be assessed. While we do not advocate reconstructive surgery for this anomaly, which has been universally fatal, we discuss the potential rearrangement of the anatomy, which may offer some hope in future cases. The concomitant congenital anomalies associated with these cases are reviewed, and autopsy specimens are presented for their anatomic interest.
View details for Web of Science ID A1992JD33900004
View details for PubMedID 1626901
THE EXTERNAL RHINOPLASTY APPROACH FOR RHINOLOGIC SURGERY IN CHILDREN ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1992; 118 (4): 401-405
The external rhinoplasty is a versatile approach for exposing nasal anatomy in children and has been utilized for a variety of rhinologic problems (N = 35). These have included septal deviation (11), cleft lip nasal deformity (10), unilateral choanal atresia (five), nasal dermoids (four), and problems of the sphenoidal sinus (five). For children with septal deformities, the external approach allows complete intranasal visualization, providing access for careful and conservative reconstruction. In children with cleft lip nasal deformity, decortication allows for direct sculpting of the alar cartilages. For unilateral choanal atresia, the external technique provides exposure of the posterior vomer as in the transpalatal approach, but without the risk to palatal growth. For nasal dermoids, the open rhinoplasty offers wider exposure with more control over the medial osteotomies, a better view of the cribriform plate, and enhanced cosmesis. For problems of the sphenoid, the external route utilizes the guiding midline intranasal structures for rapid and direct entry into the sinus. In our study, the age range of the children was between 7 months and 18 years. The range of follow-up was between 6 months and 5 years. The techniques for the individual procedures are described, along with a rationale for their employment. There were no postoperative complications, and no long-term problems associated with the use of the external technique. In conclusion, the enhanced exposure provided by the external rhinoplasty approach in children facilitates rhinologic procedures on the soft tissues of the nose and the nasal architecture, as well as in the central core of the face.
View details for Web of Science ID A1992HN29900011
View details for PubMedID 1554470
CHLAMYDIA-TRACHOMATIS IN THE ETIOLOGY OF ACUTE OTITIS-MEDIA ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY 1991; 100 (8): 616-619
In an effort to show that Chlamydia trachomatis (CT) may be involved in the causation of acute otitis media (AOM), we performed three experiments. In the first, we inoculated the tympanic bullae of 6 chinchillas with CT. Five of the 6 inoculated animals developed CT AOM. In the second experiment, we sprayed the nasopharynx of 10 chinchillas with CT. Of these, 8 developed both pharyngitis and AOM, and in 6, live CT was cultured from the middle ear and pharynx. In the third experiment, 5 chinchillas had their conjunctiva inoculated with CT. Three developed CT conjunctivitis. Of these, 2 developed CT pharyngitis and 1 developed CT AOM. We concluded that CT will cause AOM in the chinchilla by direct inoculation into the middle ear as well as indirectly by infection of the nasopharynx and conjunctiva.
View details for Web of Science ID A1991GA48900003
View details for PubMedID 1872510
External rhinoplasty approach to transsphenoidal hypophysectomy. Ear, nose, & throat journal 1991; 70 (7): 438-440
The external rhinoplasty approach is a modification of the well recognized transseptal transsphenoidal hypophysectomy technique first introduced by Cushing in 1910. Our approach has been used successfully in 75 cases over a six year period, demonstrating its efficacy and safety. It provides a simple, reliable, rapid technique for exposing the septum and the floor of the nose with excellent exposure to the sphenoid sinus and pituitary gland. There has been no loss of nasal tip projection or other cosmetic deformity.
View details for PubMedID 1914964
Applied nasal anatomy & embryology. Ear, nose, & throat journal 1991; 70 (7): 416-422
The embryology & anatomy of the nose as it is applied to rhinoplasty is surveyed so that the surgeon in training can develop a basis from which to review the literature. This review demonstrates the need for the consolidation and clarification of the nomenclature associated with the complex anatomy of the nasal pyramid.
View details for PubMedID 1914961
The external rhinoplasty for the correction of unilateral choanal atresia in young children. Ear, nose, & throat journal 1991; 70 (7): 450-453
The external rhinoplasty approach has been utilized in three young children for the correction of unilateral choanal atresia. It has been demonstrated to be technically feasible to utilize this technique in young children. It provides excellent exposure of the atresia plate with the ability to correct the atresia in a precise and confident way. This technique is an elegant alternative to transnasal puncture and transeptal resection.
View details for PubMedID 1914966
ENDOSCOPIC REPAIR OF SUPRAGLOTTIC LARYNGEAL CLEFTS ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1991; 117 (3): 273-278
We describe the technique of endoscopic diagnosis and endoscopic surgical repair used in the management of supraglottic interarytenoid laryngeal clefts in 11 children seen between 1981 and 1988 at the Hospital for Sick Children, London, England. Six of the children had primary type I clefts that required endoscopic repair. The symptoms included inspiratory stridor, choking during eating, and aspiration. Five of the children had previous transcervical repair of type II clefts that had partial breakdown in the interarytenoid area causing symptoms of aspiration, which required secondary repair endoscopically. All the patients had successful microlaryngoscopic closure; in two children, however, the breakdown of the repair necessitated repeated endoscopic correction. The only complication occurred in a case of postoperative supraglottitis, which was successfully managed with intubation and antibiotics. We conclude that endoscopic repair is a useful and reliable technique and an elegant alternative to the open transcervical approach for the closure of supraglottic laryngeal clefts.
View details for Web of Science ID A1991FA77000004
View details for PubMedID 1998565
EARLY COMPLICATIONS OF AIRWAY MANAGEMENT IN HEAD-INJURED PATIENTS LARYNGOSCOPE 1990; 100 (9): 958-961
Head-injured patients are frequently young, healthy individuals whose excellent medical condition is suddenly altered by trauma. The purpose of this study is to evaluate the early complications of airway management which occur in head-injured patients and to determine if these are different from what has been reported in patients with chronic illnesses (i.e., diabetes, atherosclerosis, or immunosuppression). Chart review of 52 head-injured patients reveals an early complication rate of 61% for endotracheal intubation and 20% for tracheotomy. Discriminant analysis shows that increasing duration of intubation is the most significant factor in predicting airway management complications (P less than 0.008). The incidence of complications seen in head-injured patients is similar to that of the chronically ill. Complications of endotracheal intubation are judged to be more severe than those of tracheotomy. Data from this study supports the early tracheotomy of severely head-injured patients who are likely to require prolonged airway management.
View details for Web of Science ID A1990DW72100009
View details for PubMedID 2395405
BACTERIAL-ANTIGENS AND NEUTROPHIL GRANULE PROTEINS IN MIDDLE-EAR EFFUSIONS ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1990; 116 (3): 335-337
Otitis media with effusion is a significant cause of hearing loss in young children. We hypothesized that persistent bacterial antigens in middle ear effusions (MEEs) might act as chronic inflammatory stimuli causing release of neutrophil proteins. Concentrations of neutrophil lactoferrin and a 37-kd cationic bactericidal protein (CAP 37) were measured in 47 MEEs collected from 27 children at the time of tympanostomy tube placement. Antigens of Streptococcus pneumoniae were detected by latex particle agglutination and those of Haemophilus influenzae by dot-blot assay. Bacterial antigens were detectable in 24 (51%) of MEEs: S pneumoniae in 10 (21%), H influenzae in 12 (26%), and both antigens in 2 (4%). Concentrations of lactoferrin and CAP 37 in H influenzae antigen-positive MEEs were significantly higher than in either S pneumoniae antigen-positive or antigen-negative MEEs. We conclude that H influenzae antigen causes a greater middle-ear inflammatory response, as judged by neutrophil products, than does S pneumoniae antigen.
View details for Web of Science ID A1990CT42600014
View details for PubMedID 2306352
PREDICTIVE VALUE OF THE GLASGOW COMA SCALE FOR TRACHEOTOMY IN HEAD-INJURED PATIENTS ANNALS PUBL CO. 1990: 38-41
Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.
View details for Web of Science ID A1990CH25500006
View details for PubMedID 2294831
STERNOMASTOID TUMOR OF INFANCY ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY 1989; 98 (12): 955-959
Sternomastoid tumor of infancy (SMTI) is the most common cause of neck mass in the perinatal period. We present seven children with this disorder, six studied prospectively. Ages at presentation ranged from 1 week to 4 weeks. Five had a history of birth trauma. Torticollis with facial asymmetry was seen in two. In six the diagnosis of SMTI was made clinically, and these patients were managed conservatively with massage and controlled stretching of the neck. Resolution of the neck mass, the torticollis, and the facial asymmetry occurred in all patients. Pathologic and radiographic findings are presented. We conclude that careful clinical assessment precludes the necessity of biopsy and emphasize the importance of conservative management of this transient problem.
View details for Web of Science ID A1989CD49300007
View details for PubMedID 2589764
COMPARISON OF COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE IMAGING IN CHRONIC OTITIS-MEDIA WITH CHOLESTEATOMA ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1989; 115 (10): 1231-1233
We prospectively studied 10 patients with chronic otitis media suspected of having cholesteatoma with computed tomography and magnetic resonance imaging to assess which imaging modality would be most specific in predicting the presence of cholesteatoma. The interpretation of images was then correlated with the operative findings. In 9 of the 10 cases, computed tomography accurately predicted the extent and destructiveness of the disease but did not consistently differentiate between cholesteatoma and associated granulation tissue. In 2 of the 10 cases, the T1-weighted magnetic resonance imaging demonstrated high signal, suggestive of cholesteatoma. In one case, magnetic resonance imaging predicted cholesteatoma on the basis of bony destruction. However, in 7 of 10 cases the scan was nonspecific for cholesteatoma. We conclude that high-resolution computed tomography remains the primary imaging modality for chronic otitis media.
View details for Web of Science ID A1989AT78600023
View details for PubMedID 2789780
The story of the laryngoscope. Ear, nose, & throat journal 1989; 68 (7): 494-502
Three dimensional imaging in otolaryngology. ENTechnology 1988: 6-19
Otitis media in the immunosuppressed child. Ear, nose, & throat journal 1988; 67 (2): 88-?
NONINVASIVE IMAGING OF THE NORMAL TEMPORAL BONE - COMPARISON OF SAGITTAL SURFACE COIL MAGNETIC IMAGING AND HIGH-RESOLUTION COMPUTED-TOMOGRAPHY ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1988; 114 (1): 60-62
High-resolution computed tomography (HRCT) is a noninvasive technique for evaluating the middle ear for primary and recurrent cholesteatoma. However, a limitation of HRCT is that it cannot differentiate between cholesteatoma and granulation tissue. Magnetic resonance imaging (MRI) is a noninvasive, nonradiologic technique that has been effective in demonstrating histochemical differences between various soft tissues. We present images from a normal living subject's temporal bone in the sagittal plane obtained with both HRCT and MRI. Anatomic correlates in the same cut planes are presented. The HRCT provided excellent detail of the bony landmarks within the temporal bone and was used as the reference for the MRI. The soft-tissue structures such as cranial nerves, cochlea, vestibule, and semicircular canals were identified.
View details for Web of Science ID A1988L520200008
View details for PubMedID 3334820
AIRWAY COMPLICATIONS FROM LARYNGOSCOPY AND PANENDOSCOPY ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY 1987; 96 (6): 691-694
Laryngoscopy and panendoscopy can cause airway complications. To determine the risk to the airway from reintubation following general anesthesia in otolaryngology patients, we examined recovery room and anesthesia records at the Albany Veterans Administration Medical Center covering a 10-year period. From this information we determined the incidence of recovery room reintubation and studied airway risk factors associated with otolaryngologic endoscopy. From 1975 to 1984, 10,060 surgical patients were intubated at the Albany VA Medical Center. Only 17 patients (0.17%) required reintubation. Of 1,365 otolaryngology patients intubated during the same period, 324 had laryngoscopy and 302 had panendoscopy. Significantly, four laryngoscopy patients (1.2%) and nine panendoscopy patients (3%) required recovery room intubation. Nine endoscopy patients needed reintubation within 1 hour of extubation. We conclude that the risk of postoperative airway compromise is significantly greater among patients who underwent diagnostic laryngoscopy and panendoscopy than among patients who had general anesthesia for other reasons.
View details for Web of Science ID A1987L280800016
View details for PubMedID 3688760
3-DIMENSIONAL CT RECONSTRUCTION FOR THE EVALUATION AND SURGICAL PLANNING OF FACIAL FRACTURES OTOLARYNGOLOGY-HEAD AND NECK SURGERY 1986; 95 (1): 10-15
Despite advances in radiology--including CT scanning--the three-dimensional (3D) nature of facial fractures must still be inferred by the spatial imagination of the physician. A computer system (Insight Phoenix Data Systems, Inc., Albany, N.Y.) uses CT studies as substrate for 3D reconstructions. We have used the Insight computer for the evaluation and surgical planning of facial fractures of 16 patients with complex injuries. We present five illustrative cases, directly photographed from the computer monitor. Images can also be manipulated in real time by rotating or planar sectioning (functions best appreciated on video). The ability to cybernetically extract the facial skeleton from living subjects provides precise anatomic data previously unobtainable. The images are valuable for an accurate assessment of the relationship between the injured and uninjured sections of the face. We conclude that 3D reconstruction is an important advance in the treatment of facial fractures.
View details for Web of Science ID A1986D194500003
View details for PubMedID 3106883
Vertigo and perilymph fistula. Ear, nose, & throat journal 1986; 65 (6): 264-266
Three-dimensional interactive analysis of craniofacial and spinal computed tomography. Acta radiologica. Supplementum 1986; 369: 703-705
Three-dimensional interactive display of CT data from 23 cases of craniofacial and spinal pathology using a solids processing computer system was compared with conventional two-dimensional CT display. Three-dimensional display gave a more complete perspective of complex displacement patterns of facial and spinal fractures, and more clearly defined surface anatomy of osseous tumors and malformations. In 7 cases however, processing algorithms for three-dimensional display caused subtle anatomic features and non-displaced fractures to be obscured. These false negatives were clinically significant in cases of petrous bone pathology and in non-displaced spinal fractures that affected stability.
View details for PubMedID 2980601
THE PECTORALIS MYOCUTANEOUS FLAP FOR SALVAGE OF NECROTIC WOUNDS LARYNGOSCOPE 1985; 95 (2): 146-150
The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.
View details for Web of Science ID A1985ABH5600004
View details for PubMedID 3968947
PSEUDOMONAS-AERUGINOSA IN CHRONIC MAXILLARY SINUSITIS LARYNGOSCOPE 1985; 95 (1): 34-37
Pseudomonas aeruginosa (Ps. Au.) infection of the maxillary sinus has been reported as an incidental finding on routine antrostomy; however, it has also been noted in several studies as the significant organism in the etiology of chronic sinusitis. Four case reports of culture verified Ps. Au. maxillary sinusitis are presented. The therapeutic modality used in two of the cases was a Caldwell-Luc operation and in two, an intranasal antrostomy. In all cases, multiple irrigations through the surgically created nasoantral windows were done postoperatively, as was the instillation of gentamicin ophthalmic drops intranasally. In all four cases the infection cleared with this combined surgical and medical therapy.
View details for Web of Science ID A1985AAM4800010
View details for PubMedID 3917521
EXTERNAL RHINOPLASTY APPROACH TO TRANS-SPHENOIDAL HYPOPHYSECTOMY ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY 1985; 111 (7): 456-458
The history of transsphenoidal hypophysectomy demonstrates the soundness of the basic concept of approaching the sella turcica in a midline fashion through the nose. Conceptually, it has not been eclipsed since first evolved by Cushing in the early part of this century. The surgical advances since Cushing's time have been major refinements in instrumentation and minor refinements of his basic technique. The external rhinoplasty approach is such a refinement. We have used this technique in a two-year period between June 1982 and June 1984 on 14 patients. We have found this technique for transsphenoidal hypophysectomy to be a simple, reliable, rapid technique for exposing the septum and the floor of the nose. It provides excellent exposure to the sphenoid sinus and pituitary gland without loss of nasal tip projection or other cosmetic deformity.
View details for Web of Science ID A1985AKZ8400010
View details for PubMedID 4015499
NOSE BLEEDS IN THE HEMATOLOGICALLY AND IMMUNOLOGICALLY COMPROMISED CHILD LARYNGOSCOPE 1984; 94 (8): 1114-1115
EVALUATION OF 3 CYANOACRYLATE GLUES FOR OSSICULAR RECONSTRUCTION ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY 1983; 92 (1): 29-32
We evaluated and compared the separate effects of ethyl, isobutyl, and fluoroalkyl cyanoacrylate on the promontory mucosa and surgically disarticulated incudostapedial joint in the adult cat middle ear. The animals were sacrificed at 10-, 30-, and 60-day intervals after glue application. All three cyanoacrylates elicited a chronic inflammatory response when placed directly on the promontory mucosa. The use of ethyl and isobutyl cyanoacrylate resulted in persisting discontinuity of the incudostapedial joint with erosion of the incus. Fluoroalkyl cyanoacrylate maintained incudostapedial continuity without ossicular erosion. Ethyl and isobutyl cyanoacrylate are probably not appropriate for middle ear surgery. The less toxic fluoroalkyl cyanoacrylate may be useful as an ossicular adhesive in selected cases. Our findings are further contrasted with those obtained in similar studies with methyl and butyl cyanoacrylate. The effects of each of the five cyanoacrylates are reviewed in the continuing search for a safe and effective ossicular adhesive.
View details for Web of Science ID A1983QC40300006
View details for PubMedID 6824276
DERMAL GRAFT FOR PROTECTION OF THE PHARYNGEAL SUTURE LINE IN CANCER-SURGERY OF THE HEAD AND NECK OTOLARYNGOLOGY-HEAD AND NECK SURGERY 1981; 89 (2): 260-263
We studied the effect of free buried dermal grafts to primary pharyngeal closures among 24 nonirradiated patients undergoing radical head and neck surgery to determine if this technique would reduce the incidence of postoperative pharyngocutaneous fistula. For a control group we selected 23 patients who had undergone similar operations as the patients in the study group, but who did not have dermis used for pharyngeal protection. Our results indicate that dermal grafts do not alter the incidence of fistulization following cancer surgery of the head and neck.
View details for Web of Science ID A1981LQ10900016
View details for PubMedID 6787522
A 1ST BRANCHIAL CLEFT ANOMALY WITHIN THE PAROTID-GLAND OTOLARYNGOLOGY-HEAD AND NECK SURGERY 1980; 88 (1): 44-48
Although the parotid glands are affected more frequently by cysts and congenital lesions than other salivary glands, the benign multigerminal cyst arising from a duplication anomaly of the first branchial cleft within the parotid gland is extremely rare. Forty-two cases of this unusual cause of parotid swelling have been reported in the literature. An example of a first branchial cleft anomaly appearing clinically as a parotid tumor is reported.
View details for Web of Science ID A1980JM05200011
View details for PubMedID 7393602