Pediatric Otolaryngology

Postaural inflammatory pseudotumor: An extremely unusual complication of trauma in a child

March 1, 2011     Ashwani Sethi, MS, Vikas Malhotra, MS, Deepika Sethi, MS, and Sonu Nigam, MD
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Abstract

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.

Characteristics of osteoma of the temporal bone in young adolescents

February 1, 2011     Borlingegowda Viswanatha, MS, DLO
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Abstract

The author conducted a retrospective review of the clinical presentation, management, and complications of temporal bone osteoma in young adolescents. The study population was made up of 9 patients-5 girls and 4 boys, aged 12 to 15 years at presentation (mean: 13.7)-who had been seen for radiologically and histopathologically proven temporal bone osteoma at the author's institution over a 9-year period. Of this group, 5 patients had extracanalicular osteoma (3 in the mastoid portion of the temporal bone, 1 in the squamous portion, and 1 in the mastoid antrum) and 4 patients had osteoma of the external auditory canal. Six of the 9 patients underwent surgical treatment; of the remainder, 1 refused surgery and 2 were managed conservatively with ongoing observation. All patients were followed for a minimum of 1 year, and no recurrences and no complications were observed during that time.

Traumatic hemorrhage and rapid expansion of a cervical lymphatic malformation

January 1, 2011     Nishant Bhatt, MD, Helen Perakis, MD, Tammara L. Watts, MD, PhD, and Jack C. Borders, MD
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A unique case of multiple sites of pneumatization of the sinonasal bony framework in a pediatric patient

October 31, 2010     Georgios Giourgos, MD, Elina Matti, MD, Paolo Carena, MD, and Fabio Pagella, MD
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Abstract

Anatomic variations of the sinonasal bony framework in the pediatric population are quite common. In children with such variations, however, bony pneumatization is uncommon. Moreover, pneumatization of the inferior turbinate in children is extremely rare; to the best of our knowledge, only 3 cases have been previously reported in the literature-none of which involved additional pneumatization variations of the sinonasal skeleton. Herein we present a new pediatric case that was unique in that an inferior concha bullosa coexisted with rarely seen pneumatized anatomic structures.

Differential diagnosis of pediatric tumors of the nasal cavity and paranasal sinuses: A 45-year multi-institutional review

October 31, 2010     F. Christopher Holsinger, MD, Adam C. Hafemeister, MD, M. John Hicks, MD, PhD, Marcelle Sulek, MD, Winston W. Huh, MD, and Ellen M. Friedman, MD
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Abstract

We conducted a retrospective case-series review to identify the various diagnoses of neoplasms of the nasal cavity and paranasal sinuses in a pediatric population. Our study group was made up of 54 children-23 boys and 31 girls, aged 8 months to 16 years (mean: 9 yr). All patients had been diagnosed with a tumor of the nasal cavity or paranasal sinuses between Jan. 1, 1955, and Dec. 31, 1999, at one of four university-based, tertiary care referral centers. We compiled data on tumoral characteristics (location, size, and histopathology), morbidity and mortality, and rates of recurrence. Lesions included adnexal neoplasm, ameloblastic fibro-odontoma, basal cell carcinoma, benign fibrous histiocytoma, blue nevus, chondrosarcoma, compound nevus, epithelioma adenoides cysticum, esthesioneuroblastoma, Ewing sarcoma, fibrosarcoma, giant cell granuloma, granulocytic sarcoma, hemangioma, hemangiopericytoma, Langerhans cell histiocytosis, lymphangioma, lymphoma, melanoma, neuroblastoma, neurofibroma, ossifying osteofibroma, osteochondroma, osteosarcoma, port wine stain, rhabdomyosarcoma, Spitz nevus, and xanthogranuloma. To the best of our knowledge, this is the largest such study of its kind to date. We believe that the large size of this study and the data on disease incidence will allow clinicians to be better informed of the differential diagnosis of neoplasms of the nasal cavity and paranasal sinuses in the pediatric population.

Neonatal suppurative parotitis

September 30, 2010     Alba Miranda, MD and Kevin D. Pereira, MD
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The presentation and management of fibromatosis colli

August 31, 2010     Kristen C. Lowry, BA, Judy A. Estroff, MD, and Reza Rahbar, DMD, MD
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Abstract

We conducted a systematic chart review to identify all infants with fibromatosis colli who had been seen at Children's Hospital in Boston from January 1999 through December 2004. We found 7 such cases, which involved 4 boys and 3 girls, aged 1 to 3.5 weeks at presentation. We compiled information on each patient's birth history, presenting signs and symptoms, significant medical history, imaging findings, management, follow-up, and outcome. Six of the 7 patients presented with a neck mass, and the remaining patient presented with neck “fullness.” Five patients developed torticollis at some point. All patients were treated conservatively with physiotherapy. Five patients experienced a complete resolution of signs and symptoms, and the other 2 experienced improvement. Based on our findings, we recommend that early management of fibromatosis colli include observation and physiotherapy to prevent or reverse torticollis and the craniofacial asymmetry that can result. Similarly attractive is the opportunity that physiotherapy provides for parents to involve themselves in the care of their newborn. It is important, therefore, to quickly identify fibromatosis colli as such in order to avoid unnecessary expenditures of resources and to promptly begin conservative treatment.

Pediatric neck abscesses caused by methicillin-resistant Staphylococcus aureus: A retrospective study of incidence and susceptibilities over time

August 31, 2010     Parker A. Velargo, MD, Emily L. Burke, MD, and Evelyn A. Kluka, MD
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Abstract

Since the early 2000s, studies have shown that the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in the pediatric population has been increasing. Moreover, studies also have indicated a trend toward increased resistance to commonly used antibiotics over time. However, few studies have specifically focused on such trends in pediatric neck abscesses. We undertook a retrospective study of 109 patients to compare the incidence of pediatric neck abscesses caused by MRSA during two separate 5-year periods at Children's Hospital of New Orleans in an attempt to determine if the incidence was indeed increasing. We also analyzed differences in MRSA susceptibility to various antibiotics over the same two time periods-January 1997 through December 2001 (n = 22) and January 2002 through December 2006 (n = 87). We found a statistically significant increase in the incidence of MRSA between the first 5-year period and the second-from 25 to 70.3% (p = 0.0388). We did not find any significant difference in antibiotic susceptibility patterns between the two 5-year periods.

Delayed facial paresis following tympanomastoid surgery in a pediatric patient

July 31, 2010     Marc C. Thorne, MD, Brian P. Dunham, MD, and Lawrence W.C. Tom, MD
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Abstract

Despite the presence of normal facial nerve function in the immediate postoperative period, patients may develop facial nerve dysfunction anywhere from several hours to several days after otologic surgery. This delayed facial paresis, following a broad range of otologic surgeries, has been well described in adults but not in pediatric patients. Viral reactivation is increasingly implicated as the underlying etiology of delayed facial paresis. We present a case of delayed facial paresis in a pediatric patient with a clinical course consistent with viral reactivation.

Congenital epulis

June 30, 2010     Arnaud Bewley, MD, Jason D. Bloom, MD, Safeena Kherani, MD, and Bruce R. Pawel, MD
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Anatomic changes related to laryngeal descent from birth to 1 year of age: Do they play a role in SIDS?

June 30, 2010     Robert E. Stephens, PhD, Austin Bancroft, DO, Alan G. Glaros, PhD, and Lisa H. Lowe, MD
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Abstract

We conducted a retrospective study to measure laryngeal descent in human infants and to determine if there is any correlation between the associated anatomic changes and the timing of the peak incidence of sudden infant death syndrome (SIDS), which is 2 to 4 months of age. We performed a computerized search of hospital records at our institution to identify magnetic resonance imaging (MRI) scans of the head and neck and plain radiographs of the lateral neck in patients younger than 1 year of age (range: 1 to 357 days). After unusable images were excluded, 79 head and neck MRI scans and 111 lateral neck x-rays were suitable for study. Two measurements were taken from each image: one from the tip of the epiglottis to the uvula and one from the tip of the epiglottis to the center of the sella turcica. These measurements were then graphed against the subject's age. SPSS statistical software was used to determine growth curves of the various measurements. The first derivative of these curves was calculated to determine the rate of laryngeal descent at a given age. We found that most subjects did not have an overlapping epiglottis and uvula during the first few months of life. The rate of laryngeal descent, based on measurements of the distance between the epiglottis and uvula, gradually increased in a near-linear fashion from as low as 0.005726 mm/day at day 1 of life to as high as 0.028366 mm/day at 300 days of age. We found no sharp increase in the rate of descent at 2 to 4 months of age, and thus no support for our hypothesis that there might be a correlation between anatomic changes and the peak incidence of SIDS.

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