Other ENT Topics

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Airway characteristics of infants with Pierre Robin sequence who undergo mandibular distraction osteogenesis

August 26, 2015     Paul Hong, MD, FRCSC; Donald Kearns, MD, FAAP
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Abstract

Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be managed with conservative and surgical interventions. Mandibular distraction osteogenesis has been used to relieve micrognathia associated with severe airway obstruction. We conducted a retrospective chart review to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis during a 2-year period. Our study group was made up of 16 infants-11 boys and 5 girls, aged 21 to 112 days (mean: 55.9). In addition to demographic data, we compiled data on their baseline characteristics, airway characteristics, pre- and perioperative findings, and postoperative airway outcomes. Although most patients experienced documented improvements in Cormack-Lehane laryngoscopy grades postoperatively, the severity of micrognathia and airway obstruction did not always correlate with the higher grades. As well, the degree of improvement on laryngoscopic findings was not always evident, even though patients experienced a clinical benefit. All patients who had undergone a preoperative tracheostomy were decannulated successfully. We found that mandibular distraction osteogenesis was a safe and effective intervention for newborns with severe micrognathia and airway obstruction in our study population. It is interesting that the degree of micrognathia was not always correlated with the degree of airway compromise and laryngoscopy grades.

The incidence of postoperative aspiration among children undergoing supraglottoplasty for laryngomalacia

August 26, 2015     Lauren C. Anderson de Moreno, MD; Sarah J. Burgin, MD; Bruce H. Matt, MD, MS
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Abstract

We conducted a retrospective study to determine the incidence of aspiration after supraglottoplasty at Riley Hospital for Children in Indianapolis. We reviewed the charts of 468 patients-281 males and 187 females, aged 2 days to 20 years-who had undergone supraglottoplasty for the treatment of laryngomalacia; most patients (69.9%) were aged 28 days to 2 years. A total of 47 patients (10.0%) experienced aspiration after supraglottoplasty; the overall association between supraglottoplasty and aspiration was not statistically significant (p = 0.25). Aspiration was positively correlated with age younger than 18 months, the performance of a revision procedure, the presence of an underlying neuromuscular disorder (n = 20), and the need for a postoperative gastrostomy tube (p < 0.001 for all). When the 20 patients with a neuromuscular disorder were excluded from our data analysis, the incidence of aspiration after supraglottoplasty fell to only 5.8% (27/468). We conclude that supraglottoplasty is a safe and effective procedure for the treatment of laryngomalacia. It does not significantly increase the overall incidence of aspiration in children, and thus the risk of aspiration should not be considered a deterrent to surgery, even in children with neuromuscular problems.

Fetal rhabdomyoma of the tongue in a newborn

July 20, 2015     Nicole L. Aaronson, MD; Julia C.D. Toman, MD; Michael Z. Lerner, MD; Eric D. Baum, MD
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Most extra-cardiac rhabdomyomas in the oral cavity arise in the floor of mouth,

A novel method for reconstruction of severe caudal nasal septal deviation: Marionette septoplasty

June 4, 2015     Gurkan Kayabasoglu, MD; Alpen Nacar, MS; Mahmut Sinan Yilmaz, MD; Aytug Altundag, MD; Mehmet Guven, MD
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Abstract

We conducted a retrospective study to compare open and endonasal (closed) approaches to extracorporeal reconstruction of severe caudal septal deviations. From January 1, 2010, through December 31, 2013, 78 patients with severe caudal septal deviation underwent corrective surgery at our hospital. Of this group, 33 patients (mean age: 32 yr) underwent extracorporeal septoplasty via an open approach, and 45 patients (mean age: 35 yr) underwent treatment with a new procedure that we developed: subtotal extracorporeal septoplasty through a closed approach, which we call “marionette septoplasty.” In addition to demographic data, we compiled information on surgical time, the duration of postoperative edema, the degree of postoperative pain, and differences between pre- and postoperative nasal function and tip support in both groups. We found that our marionette septoplasty procedure required significantly less surgical time and resulted in a significantly shorter duration of postoperative edema than did open septoplasty, while there was no statistically significant difference between the two procedures in the degree of pain. Following surgery, nasal function in both groups improved significantly, without any significant difference between the two. Finally, we documented improved tip support in all 78 patients. Our results show that marionette septoplasty produces the same functional results as does open septoplasty while requiring less surgical time and shortening the healing period.

Sleep problems of adolescents: A detailed survey

June 4, 2015     Nuray Bayar Muluk, MD; Selda Fatma Bulbul, MD; Mahmut Turgut, MD; Gulsah Agirtas, MD
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Abstract

We investigated the sleep problems and sleep habits of adolescents at three public primary schools and two high schools. Our study included 428 Turkish school children (244 girls and 184 boys). We used a questionnaire to determine the time they went to sleep at night; waking time in the morning; incidence of nightmares, snoring, daytime sleepiness, and intrafamilial physical trauma; concentration difficulty in class; and school success. The students were divided into age-related groups (group 1 = 11 to 13 years of age; group 2 = 14 to 15 years; group 3 = 16 to 18 years). The time they went to sleep was mostly between 10 and 11 p.m. in groups 1 and 2, and 11 to 12 p.m. in group 3. Difficulty in falling asleep was reported by 16.8 to 19.6% of the students in the three groups. Difficulty in waking up in the morning was reported by 12.7% of group 1, 16.0% of group 2, and 16.8% of group 3. Snoring was present in 12.1% of females and 22.0% of males. The occurrence of one nightmare in the preceding 3 months was reported by 11.3% of the students; 17.9% of the students reported having nightmares several times. Daytime sleepiness was present in 65.1%, and concentration difficulty was present in 56.8% of the students. We conclude that difficulty in falling asleep, snoring, and daytime sleepiness may be seen in adolescents who are in both primary and high schools. Watching inappropriate programs and movies on television and intrafamilial physical trauma may cause nightmares and sleeping problems in these adolescents. Students and families should be educated about the importance of sleep in academic performance. Countries' public health policies should address sleep problems and related educational activities.

Neuropathic pain from a nasal valve suspension suture

June 4, 2015     Tyler P. Swiss, DO; Douglas S. Ruhl, MD, MSPH; Scott B. Roofe, MD, FACS
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Surgeons should maintain a high index of suspicion when a patient who has undergone nasal valve suspension complains of postoperative neuropathic pain.

Use of tragal cartilage grafts in rhinoplasty: An anatomic study and review of the literature

April 27, 2015     Amr N. Rabie, MD; Jerry Chang, MD; Ahmed M.S. Ibrahim, MD; Bernard T. Lee, MD; Samuel J. Lin, MD
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Abstract

We conducted a cadaveric study to determine the size of cartilage grafts that can be taken from the tragus without distorting tragal anatomy. Our subjects included 7 fresh cadavers-3 male and 4 female (age at death: 61 to 87 yr). Tragal cartilage grafts were harvested while leaving the lateral 3 mm of the tragal cartilage in situ to preserve the anatomic shape of the tragus. The grafts were measured and their dimensions recorded. The craniocaudal dimensions of the tragal cartilages ranged from 15 to 30 mm (mean: 21.6), and the width of each specimen ranged from 10 to 23 mm (mean: 15.3). The thickness of the cartilage was approximately 1 mm. The grafts were slightly curved along their long axis. We also review the literature regarding the dimensions of different grafts used in rhinoplasty, knowledge of which can help in preoperative planning. Tragal cartilage grafts have been used as shield, alar contour, alar batten, lateral crural onlay, dorsal onlay, and infratip lobule grafts. When a straight and/or thick graft is needed, two strips of tragal cartilage can be sutured in a mirror-image configuration.

Distortion-product otoacoustic emissions testing in neonates treated with an aminoglycoside in a neonatal intensive care unit

April 27, 2015     Iosif Vital, MD; George Psillas, MD; Nikolaos Nikolaides, MD; George Kekes, MD; Stavros Hatzopoulos, MD; John Constantinidis, MD
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Abstract

We evaluated the ototoxic effect of aminoglycosides on the outer hair cells of newborns in a neonatal intensive care unit (NICU) by means of distortion-product otoacoustic emissions (DPOAE) testing. Our study population was made up of 164 newborns who were divided into three groups: group A consisted of 105 infants who were given aminoglycoside therapy (either gentamicin or amikacin, or a combination of the two) as treatment for suspected or proven bacterial infection and septic states; group B included 30 newborns who were not given an antibiotic or who were given an antibiotic other than an aminoglycoside; group C, a control group, was made up of 29 healthy neonates who were hospitalized in the well-baby nursery. All the neonates underwent DPOAE testing in both ears (the f2 primary tone was presented at 2.0, 2.5, 3.2, and 4.0 kHz). We found that 41 patients in group A (39.0%) and 13 in group B (43.3%) failed the DPOAE test in one or both ears; the difference between these two groups was not statistically significant (p = 0.673). In group C, the DPOAE fail rate was 13.8% (4 newborns). In group A, there was no statistically significant association between the pass/fail rate and the specific aminoglycoside that was administered, or in the duration of antibiotic treatment, the number of doses, and the size of the mean daily dose and the mean total dose. In clinical practice, DPOAE testing is a sensitive method of evaluating the integrity of the outer hair cells in the basal turn of the cochlea after exposure to ototoxic drugs such as aminoglycosides. However, our study did not demonstrate that the aminoglycosides had any ototoxic effect on the hearing of neonates in the NICU.

Unexpected cholesteatoma in a very young child with a congenital aural duplication anomaly

April 27, 2015     Moo Kyun Park, MD
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Cholesteatoma can develop in very young children with congenital aural stenosis and a duplication anomaly, and physicians should consider this condition in affected children with otalgia and otorrhea.

The paramedian forehead flap for nasal lining reconstruction

March 2, 2015     Joshua D. Rosenberg, MD; Nikita Gupta, MD
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The importance of reconstructing nasal lining defects cannot be overstated, especially for composite defects also involving the framework and skin soft-tissue envelope.

Cherubism

January 19, 2015     Lester D.R. Thompson, MD
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When there is significant infraorbital maxillary involvement, the inferior rim of the sclera is more prominent, resulting in the classic “eyes to heaven” appearance.

Unusual presentation of a midline neck mass

January 19, 2015     Yann-Fuu Kou, MD; Gopi Shah, MD, MPH; Ronald Mitchell, MD; Larry L. Myers, MD
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Venous malformations are usually visible at birth, although deeper lesions may have normal overlying skin or a bluish discoloration. They grow proportionately with the child and can expand in adulthood.