Pediatric Otolaryngology

Bilateral dacryocystoceles as a rare cause of neonatal respiratory distress: Report of 2 cases

January 21, 2014     Mélanie Lecavalier, MD; Lily H.P. Nguyen, MD, MSc, FRCSC
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Abstract

Although obstruction of the nasolacrimal duct is a fairly common finding in newborns, development of a dacryocystocele (nasolacrimal duct cyst) is uncommon. Bilateral dacryocystoceles that expand intranasally and cause respiratory distress in the newborn are rarer still. We present 2 cases of bilateral dacryocystoceles that caused neonatal respiratory compromise. Our first patient, a newborn girl, was managed successfully with probing of the nasolacrimal ducts and endoscopic marsupialization of the cysts. Our second patient, a newborn boy, responded well to conservative treatment with a nasal decongestant, lacrimal sac massage, and warm compresses. While bilateral dacryocystoceles are rare, they should be considered in cases of neonatal respiratory distress and concomitant nasal obstruction.

Tracheal bronchus in an 11-month-old infant

October 23, 2013     Robert Sprecher, MD, FACS, FAAP; Gary Josephson, MD, FACS, FAAP
article

The possibility of a tracheal bronchus should be entertained when a patient presents with recurrent right upper lobe pneumonia or right upper lobe collapse.

Infected sublingual hematoma: A rare complication of frenulectomy

July 21, 2013     Amal Isaiah, MD, DPhil; Kevin D. Pereira, MD, MS
article

Given the spectrum of potential poor outcomes, some consensus has emerged in favor of early surgical management of significant ankyloglossia.

Methicillin-resistant Staphylococcus aureus as a cause of neonatal suppurative parotitis: A report of two cases and review of the literature

June 11, 2013     Sean T. Donovan, MD; Grant T. Rohman, MD; John P. Selph, MD; Roy Rajan, MD; Rosemary M. Stocks, MD; and Jerome W. Thompson, MD, MBA
article

Abstract

Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.

Laryngeal plexiform neurofibroma in a child

June 11, 2013     Fikret Kasapoglu, MD; Talip Ozdemircan, MD; and Levent Erisen, MD
article

Abstract

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and “Lisch nodules.” Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.

Intrapharyngeal schwannoma in a pediatric patient

June 11, 2013     Nader Nassif, MD; Mariaelisabetta Cottelli, MD; Davide Farina, MD; and Marco Berlucchi, MD
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Abstract

Schwannomas are benign peripheral nerve neoplasms that arise from Schwann cells. They usually occur in the adult population. The most common site in the head and neck region is the parapharyngeal space. Intrapharyngeal schwannomas are extremely rare, and those that have been reported all occurred in adults. We report what to the best of our knowledge is the first case of an intrapharyngeal schwannoma in a pediatric patient. The patient, a 15-year-old boy, was treated successfully with surgical excision.

Airway management in an infant with alobar holoprosencephaly and cebocephaly associated with maternal diabetes mellitus

April 17, 2013     Rajanya S. Petersson, MD; William A. Carey, MD; Dana M. Thompson, MD
article

Abstract

We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents' goal was to bring their child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers' goals of care.

Congenital cholesteatoma in a 3-year-old

April 17, 2013     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
article

 When a congenital cholesteatoma is diagnosed early as a localized circumscribed mass, it can be resected with a very low risk of recurrence.

Bilateral mastoid subperiosteal abscesses in an infant

January 24, 2013     Hernan Goldsztien, MD; Kevin D. Pereira, MD
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The finding of bilateral acute mastoiditis in an infant should prompt a search for underlying predisposing causes.

Sphenoethmoid sinusitis in a child resulting in a disastrous intracranial sequela

October 31, 2012     Aye Jane Sow, MS(ORL-HNS); Jeevanan Jahendran, MS(ORL-HNS); Charng Jeng Toh, MS(Neurosurg); Thean Yean Kew, FRCR
article

Abstract

Localized sphenoethmoid sinusitis in children is a rare occurrence. It is usually overlooked because of the misconception that the sinuses are not developed. We describe a case of localized acute sphenoid and right posterior ethmoid sinusitis that presented as right frontobasal subdural empyema and multiple deep cerebral abscesses. Morbidity from subdural empyema in children is high. Early diagnosis and treatment based on recognition that the etiology might involve the paranasal sinuses affects the overall prognosis.

Tongue base cyst in a 6-week-old boy

October 8, 2012     Joel Y. Sun, BA; Ron B. Mitchell, MD; Seckin O. Ulualp, MD
article

After excision, a histologic finding of an epithelial lining without ectopic thyroid tissue confirms the diagnosis of a lingual thyroglossal duct cyst.

Spontaneous cervicofacial subcutaneous emphysema secondary to pneumomediastinum in an otherwise asymptomatic child

October 4, 2012     Tripti Maithani, MS; Debraj Dey, MS; Chandermohan Sharma, MS
article

Abstract

A 12-year-old boy presented with subcutaneous emphysema of the face, neck, and upper chest. He had no significant history that suggested any specific cause, and initial investigations revealed no underlying pathology. Computed tomography of the chest detected pneumomediastinum. The patient was managed conservatively, and he responded. He was discharged 7 days after admission with a complete resolution of the emphysema. To the best of our knowledge, this is the first reported case of spontaneous pneumomediastinum presenting as cervicofacial swelling in a child without any other symptoms.

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