Pediatric Otolaryngology

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.

Congenital epulis

June 30, 2010     Arnaud Bewley, MD, Jason D. Bloom, MD, Safeena Kherani, MD, and Bruce R. Pawel, MD
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Pediatric tracheotomy in special populations: Comparison of operative times and survival

May 31, 2010     Catherine A. Craig, MD, Ashley Brooke Robey, MD, and Debora W. Goebel, MD
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Abstract

We conducted a retrospective study to analyze various aspects of tracheotomy in children with abnormal laryngotracheal anatomy, a congenital cardiac anomaly, both, or neither. Our study population consisted of 53 children who had undergone tracheotomy performed by a single otolaryngologist; 12 patients had abnormal laryngotracheal anatomy and 9 had a cardiac anomaly. Mean operative times were significantly longer in both of these groups than they were in children with normal anatomy (69 vs. 50 min; p < 0.0001) and in children with no cardiac anomaly (65 vs. 53 min; p < 0.05). Post-tracheotomy survival at 1 and 2 years for children with a cardiac anomaly was significantly worse than survival for those without (44 vs. 91%; p < 0.001). Likewise, children who had been intubated for 10 days or more had significantly worse survival than did those who were intubated for less than 10 days (55 vs. 95%; p < 0.001). Finally, we found that the patients with prolonged intubation, respiratory failure, and a cardiac surgical history had higher mortality rates associated with tracheotomy.

Stahl ear deformity associated with Finlay-Marks syndrome

May 31, 2010     Young S. Paik, MD and C.W. David Chang, MD
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Endoscopic view of an ethmoid mucocele in a pediatric patient

May 31, 2010     Joseph P. Mirante, MD, FACS, MBA, Dewey A. Christmas, MD, and Eiji Yanagisawa, MD, FACS
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Neurilemmoma presenting as a midline nasal mass in a pediatric patient

April 30, 2010     Gary D. Josephson, MD, Sapna A. Patel, MD, Laurie Duckworth, PhD, Melissa Kress, DO, and Jeffrey Goldstein, MD
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Abstract

We report a case of a neurilemmoma presenting as a midline nasal mass in a 13-year-old girl. To the best of our knowledge, this is the first report of a nasal neurilemmoma in a pediatric patient. Although this neoplasm is benign in nature, surgical resection is warranted to prevent recurrence, and it is the sole means of treatment. The overall prognosis is excellent, as was the case for our patient. We discuss the diagnosis and management of neurilemmomas and urge physicians not to exclude nasal neurilemmoma from the differential diagnosis in a pediatric patient who presents with a nasal mass.

Nasopharyngeal glioma causing respiratory distress in a neonate: Transoral endoscopic excision

April 30, 2010     Young Hak Park, MD, Sung Won Kim, MD, PhD, Seung Ho Cho, MD, and Yong Woo Choi, MD
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Abstract

Nasal gliomas are rare, benign, congenital midline tumors made up of heterotopic neuroglial tissue. They have the potential for intracranial extension. They are commonly seen in newborns and children, and rarely in adults. Preoperative diagnostic imaging is essential to delineate the exact location, limits, and extensions of the tumor and thus to determine the appropriate surgical approach. Endoscopic surgery is considered appropriate for the removal of an intranasal glioma without intracranial extension. We describe a rare case of nasopharyngeal glioma in a newborn who presented with early respiratory distress, and we include a review of the literature.

Ectopic thymic tissue presenting as a neck mass in children: A report of 3 cases

April 30, 2010     Estie Meyer, MBChB, FCORL(SA), Wakisa Mulwafu, MBChB, FCORL(SA), Johannes J. Fagan, MBChB, FCS(SA), MMed(Otol), Robin A. Brown, MBChB, DCH(SA), FRCS(Edin), and Kathryn Taylor, MBChB, DCH(SA), MMed(Anat Path)
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Abstract

The presentation of ectopic cervical thymic tissue as an anterior neck mass is rare. We report 3 similar cases in 3 boys-2 who had a thymic cyst and 1 who had an ectopic cervical thymus. We discuss the radiographic presentation on ultrasound and magnetic resonance imaging in these cases. We also review the typical histologic picture; histology is the only way of diagnosing this condition.

Dermoid of the nasopharynx: An unusual finding in an older child

March 31, 2010     Eyal Russo, MD, Hananya Vaknine, MD, and Yehudah Roth, MD
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Esophageal hamartoma as an unusual cause of neonatal apnea and bradycardia

March 1, 2010     Jeffrey Coury, DO, Jonathan Steinfeld, MD, David Zwillenberg, MD, and Seth Zwillenberg, MD
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Abstract

Esophageal hamartoma is a rare entity, as only 7 cases have been previously reported in the English-language literature. Common symptoms include dysphagia, weight loss, and vomiting. Life-threatening airway obstruction can also occur. Because of the nonspecific nature of the symptoms, patients with these dangerous polyps are often misdiagnosed as having more common entities such as gastroesophageal reflux, peptic ulcer disease, or achalasia. Most of these tumors are missed on esophagoscopy and radiologic studies, and they can go undiagnosed for years. We diagnosed an esophageal hamartoma in an infant girl who had first presented when she was 8 days old with symptoms of apnea and cyanosis. The patient had undergone a multitude of tests since her birth, and she was eventually diagnosed with episodic bradycardia. When the patient was 6 weeks old, we discovered a polyp on nasopharyngolaryngoscopy, and we removed it by microdirect laryngoscopy and esophagoscopy. This patient was the youngest of the 8 who have now been reported to have been diagnosed with a hamartomatous polyp, and she was the only one to have presented with apnea (secondary to airway obstruction) and bradycardia. We recommend microdirect laryngoscopy and esophagoscopy to remove these pedunculated cervical esophageal lesions. A transcervical approach is warranted for sessile distal esophageal polyps. Esophageal polyps are an interesting entity in view of their rarity and intriguing presentations. Because esophageal obstructions can be life-threatening, further evaluation by laryngoscopy, bronchoscopy, and esophagoscopy is warranted when symptoms of dysphagia, vomiting, intermittent apnea, bradycardia, and weight loss persist despite conventional treatment.

Myxoma of the temporal bone: An uncommon neoplasm

March 1, 2010     Deepika Sareen, MBBS, Ashwani Sethi, MS, Sumit Mrig, MBBS, Sonu Nigam, MD, and A.K. Agarwal, MS
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Abstract

We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature.

Successful treatment of cutaneous hemangioma of infancy with topical imiquimod 5%: A report of 3 cases

March 1, 2010     Andrew J. Senchak, DO, Michael Dann, MD, Benjamin Cable, MD, and Glenn Bessinger, MD, PhD
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Abstract

Hemangioma of infancy is the most common benign tumor of childhood. Most of these tumors spontaneously regress over several years. However, many parents seek treatment for children with cutaneous hemangiomas because of the potential for disfigurement and the attendant psychosocial effects. We report our use of the nightly application of topical imiquimod 5% cream as an alternative to traditional management in 3 infants who presented with rapidly growing facial hemangiomas. After approximately 3 to 5 months of treatment, all 3 patients had experienced a near-complete resolution of their lesions without significant side effects. Based on our experience, we believe that topical imiquimod may be an important tool for the otolaryngologist who treats cutaneous hemangiomas.

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