Adrián Zanetta

Quiste sacular congénito de laringe: una causa rara de estridor en neonatos y lactantes

Stridor is a noise caused by the passage of turbulent air through a diminished airway caliber. Laryngomalacia is the most common congenital anomaly of the larynx and the principal cause of stridor in children under 6 months. A less common etiology of stridor and respiratory distress in newborns and infants is congenital laryngeal saccular cyst. This entity should be considered in the differential diagnosis of stridor. Early recognition and proper treatment are essential because it can cause life-threatening airway obstruction. We describe our experience with 4 patients with this disease, 3 of them successfully treated with microsurgical resection of the cyst, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child exhibiting stridor with an unexpected evolution to determine the causal lesion.

Nuevo stent laríngeo en el tratamiento de la estenosis subglótica en niños

We present a 3-year-old, preterm, male patient, who suffered bronchopulmonary dysplasia and was tracheostomised, giving rise to Cotton grade III subglottic stenosis (SS) secondary to prolonged intubation, which was subsequently treated by laryngotracheofissure with a posterior cricoid split and interposition of anterior costal cartilage and placement of a new suprastomal stent (Fig. 1). The laryngeal stent employed was created from a number 8 T-shaped tube. After measuring the distance from the anterior commissure to the superior margin of the tracheal stoma, we cut the internal branch to the correct length, separating it from the rest of the T tube. The proximal and distal ends were covered with rounded silicone seals. The stent was placed in a suprastomal position by the laryngofissure and fixed by a double transfixing point at the level of the cricoid cartilage with a support of silicone buttons in the subcutaneous tissue of the neck. The correct position was confirmed by observation through the tracheal stoma and also orally (Fig. 2).

Septal perforation in children due to button battery lodged in the nose: Case series

Nasal foreign bodies are common in children. Button batteries deserve particular interest due to the severity and precocity of the injuries they cause. The button battery represents a growing danger. Its small size and brilliant appearance make them attractive to children, often being introduced in the nose, ear or mouth. It is imperative that the community and physicians are aware of the risks it poses. Early diagnosis and immediate removal is essential. Their delay can lead to necrosis of the nasal mucosa and septal perforation. We report 10 cases of septal perforation due to button battery. We emphasize the dangers of nasal impaction and the need for quick removal to avoid long-term complications.

Cornaje del recién nacido por estenosis congénita de la apertura piriforme: serie de casos

: Stertor is a noise generated by the disturbance of the air flow passing through the nose. Its main cause -in newborns and infants- is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent. Congenital stenosis of the pyriform aperture is a rare etiology of nasal obstruction in the neonates. Early diagnosis and appropriate treatment are essential because of their exclusive nasal breathing. Suspicion might arise when a difficulty or even an impossibility to pass a probe of 2.8 mm (K30 tube) through anterior nares, exists. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic behavior will depend on the severity of symptoms. We describe our experience with nine patients with this condition whose surgical correction was successful.

Reconstrucción laringotraqueal con aloinjerto de aorta criopreservada como rescate de una complicación de resección cricotraqueal en pediatría

Paciente de sexo femenino, traqueotomizada con estenosis laringotraqueal severa, secundaria a intubacion prolongada, es tratada a los 4 anos con reseccion cricotraqueal (RCT) extendida con split del chaton cricoideo e interposicion de cartilago posterior de ala tiroidea y colocacion de tubo en T n.◦ 8. La reseccion involucro la cara anterior del cricoides y los 3 anillos traqueales comprometidos, conservandose la mucosa de la pared posterior traqueal (fig. 1). Evoluciono con abundantes secreciones mucosas, nauseas y vomitos. Al octavo dia presento dehiscencia parcial de la sutura, y ante la imposibilidad de reanastomosis termino-terminal, incluso despues de realizar maniobras de liberacion suprahioidea y toracica, se realizo reconstruccion laringotraqueal (RLT) con aloinjerto de aorta criopreservado de 10 cm de longitud, como tecnica de rescate (fig. 2). Se cubrio injerto con un colgajo timopericardico. Se dejo tubo nasotraqueal. A los 20 dias se coloco canula de traqueotomia y una endoprotesis supraestomal.

Paquioniquia congénita con compromiso laríngeo

We present the case of a 2-year-old male patient, with subungual hyperkeratosis and thickening and yellowish-brown discoloration of the ungual plate of his 20 digits, along with lingual leukoplakia from the first months of life. The patient came for consultation to the Respiratory Endoscopy Service for dysphonia present from the age of 10 months (Fig. 1). His maternal great-grandmother, maternal grandmother, mother, uncle and sister all present pachyonychia congenita (PC). The patient is the youngest of the 6 members of the family with this disorder, which includes 4 generations. There is no history of consanguinity. There are no dental or hair abnormalities, nor cystic lesions. The patient does not present other medical problems and his growth and development are normal. The results of mycological tests of nail scrapings and whitish oral mucosal plaques were negative. Fibre laryngoscopy with topical anaesthesia revealed leukoplakia that involved the posterior commissure, interarytenoid mucosa and upper face of both vocal folds. Direct laryngoscopy was carried out under general anaesthesia general with biopsy of the lesion (Fig. 2A). The diagnosis of dysphonia secondary to PC was based on the clinical and endoscopic findings, as well as on the anatomical pathology. The latter evidenced thickening of the epithelium with dyskeratosis, parakeratosis and

Estenosis subglótica postintubación en niños. Diagnóstico, tratamiento y prevención de las estenosis moderadas y severas

INTRODUCTION AND OBJECTIVES Subglottic stenosis is one of the most common causes of upper airway obstruction. Almost 90% of them result from endotracheal intubation. Therapy depends on the degree of stenosis, among other factors. Therapeutic approaches range from watchful waiting, in mild stenosis, to complex surgery for severe cases. We report our experience on the surgical management of post-intubation subglottic stenosis in children, emphasising the need for recognition and prevention of predisposing factors of post-intubation stenosis. METHODS We retrospectively evaluated 71 patients with moderate to severe post-intubation subglottic stenosis, operated in the Respiratory Endoscopy Service in a period of eight years. The clinical variables analysed were age at surgery, degree of stenosis, surgical technique, complications and outcome. RESULTS In 84.5% of patients, only 1 surgical approach was required to achieve decannulation. Three surgical techniques were implemented as therapy: laryngotracheal reconstruction, partial cricotracheal resection and anterior cricoid split. Decannulation was achieved in 70 cases. In 71.8%, ventilation, swallowing and voice qualities were good; 23.9% presented dysphonia; and 2.8% presented a mild respiratory distress. One patient died. CONCLUSION In patients with subglottic stenosis, selection of the most accurate treatment is the key to success, reducing the number of surgeries and preventing complications.

Unilateral nasal obstruction in children: Pai syndrome

Unilateral obstruction of the nasal cavity in children is mainly caused by the introduction of foreign bodies further stated with rhinorrhea and fetid odor. Less commonly, it can be traumatic, neoplastic, due to congenital malformation or iatrogenic. Symptoms of congenital intranasal mass may present at birth, or go unnoticed and be a finding in a routine pediatric examination. Patient evaluation should include imaging studies to guide the diagnosis and rule out intracranial extension. A syndrome associated with congenital nasal tumor should be suspected when other abnormalities are present. Pai syndrome is a rare genetic disorder. Its manifestations are craniofacial being congenital nasal polyp his main marker. We present a patient with unilateral nasal respiratory failure secondary to congenital nasal lipoma, with craniofacial anomalies belonging to Pai syndrome. Nasal obstruction was successfully surgically resolved.

Tratamiento quirúrgico de la estenosis traqueal en pediatría

Veinte pacientes con estenosis de traquea fueron intervenidos quirurgicamente entre julio de 2005y mayo de 2008, diez con estenosis congenita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congenita.De los diecisiete sobrevivientes, quince se encuentran asintomaticos; dos pacientes operados por estenosis congenita requieren controlesperiodicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadia hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongenita necesitan, generalmente, masde un procedimiento terapeutico y presentan mayor mortalidad.