Daniel S. Samadi

Choanal Atresia: A Twenty‐Year Review of Medical Comorbidities and Surgical Outcomes

Objective To review medical comorbid conditions and surgical outcomes for children treated for choanal atresia (CA).

Trends in the management of pediatric chronic sinusitis: survey of the American Society of Pediatric Otolaryngology.

Background: The management of chronic sinusitis (CS) in children has yet to be fully elucidated. The objective of this study is to assess practice trends within the pediatric otolaryngology community for the management of children with CS.

Pediatric submandibular triangle masses: a fifteen-year experience.

The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes.

Pediatric Intraparotid Castleman's Disease

Castlemans disease (CD) is a rare, benign lymphoepithelial disease of unknown cause that presents most commonly in the mediastinum. There are 2 histologic types of CD: the hyaline vascular type and the plasma cell type. In the head and neck, 98% of these lesions are of the hyaline vascular type. The differential diagnosis of CD includes reactive lymphadenopathy, lymphoproliferative disorders, lymph node metastasis, and other conditions. Approximately 80 cases of CD have been reported in children; head and neck involvement in children is extremely rare. A case of a child with intraparotid CD is presented; the clinical course, histopathologic presentation, radiographic findings, and management of CD are reviewed.

Nuchal Fibroma: A Clinicopathological Review

Nuchal fibroma, or collagenosis nuchae, is a benign soft tissue tumor that arises from the posterior cervical subcutaneous tissue, with a predilection for the interscapular and paraspinal regions. Because of its benign clinical course and its close histopathologic similarity to other benign head and neck lesions, this lesion may be misdiagnosed and underreported. The purpose of this paper is to review the histopathologic and radiologic findings unique to nuchal fibroma, and compare and contrast it to the other soft tissue neoplasms within the clinical differential diagnosis. These include several benign (elastofibroma, lipoma, fibrolipoma, nodular fasciitis) and rare malignant entities (fibrosarcoma, liposarcoma, fibromatosis).

Cellular Neurothekeoma of the Maxilla

Neurothekeomas are uncommon benign soft tissue tumors of nerve sheath origin. They occur predominately in the head and neck or upper trunk of children and young adults. A 15-month-old boy presented with an enlarging mass of the right maxilla. Radiologic imaging demonstrated an expansile lesion of the nasomalar region. An incisional biopsy resulted in the diagnosis of neurothekeoma. This lesion should be considered as part of the differential diagnosis of pediatric soft tissue head and neck masses. We discuss the presentation, evaluation, and treatment of these rare benign lesions.

Pediatric subglottic granular cell myoblastoma.

A 7-year-old male presented with a history of a arking cough, shortness of breath on exertion, and rogressively worsening biphasic stridor over a -month period. The patient had a past medical history ignificant for asthma but was in otherwise good health. Physical examination was significant for biphasic tridor. There was no nasal flaring, suprasternal retracion, or cyanosis, and the vital signs were within normal imits. The remainder of his head and neck examination as unremarkable. Additional evaluation included a lateral neck radioraph, which revealed a soft-tissue density impinging n the posterior tracheal column between the fifth and ixth cervical vertebrae. CT and MRI (Fig 1) demontrated a 2-cm, round, solid, soft-tissue mass between he upper trachea and esophagus that appeared to be xtrinsic to the airway lumen. At direct laryngoscopy, bronchoscopy, and esophaoscopy, a rubbery submucosal mass was found in the osterior subglottic space (Fig 2, A). There was no nvolvement of either the trachea or esophagus. A layngofissure was performed to expose the mass (Fig 2, ), which was resected after elevating posterior sublottic mucosal flaps. Histopathological evaluation was onsistent with granular cell myoblastoma (Fig 3). ostoperatively, the patient remained intubated for 72 ours and was extubated without complication. The atient is currently doing well with no clinical recurence at 1-year follow-up.

Granulocyte transfusion in the management of fulminant invasive fungal rhinosinusitis.

Usually, fulminant, invasive fungal rhinosinusitis is observed in the immunocompromised patient and is associated with significant morbidity and mortality. A high index of suspicion and early diagnosis is imperative for optimizing outcome. Mainstays of treatment include antifungal agents and radical resection of necrotic tissue. Reversal of the underlying medical condition, when possible, is a critical part of the management. In the neutropenic population, granulocyte transfusion may represent an adjunct to current therapy. We provide the first report of a case of invasive fungal rhinosinusitis in which this intervention was used.

Adenovirus-Mediated Ex Vivo Gene Transfer of Human Vascular Endothelial Growth Factor in a Rabbit Laryngotracheal Reconstruction Model

Free autologous cartilage, which is used in laryngotracheal reconstruction (LTR), may undergo progressive necrosis as a result of delayed revascularization. Angiogenic growth factors, such as vascular endothelial growth factor (VEGF), promote angiogenesis in the ischemic environment. We studied the effect of ex vivo gene transfer of VEGF121 on cartilage angiogenesis and graft survival in a rabbit model of LTR. Sixty rabbits underwent LTR with auricular cartilage. The grafts were treated at 1 × 109 plaque-forming units with 1) VEGF121 (n = 20), 2) LacZ reporter gene (n = 20), or 3) saline solution (n = 20). Graft neovascularization and survival were histologically assayed at 1 and 10 weeks. Angiogenesis was enhanced at both 1 and 10 weeks after treatment with VEGF121 as compared to controls (p < .001). No statistical improvement in graft survival was evident after treatment with VEGF121. Ex vivo gene transfer to cartilage may be a promising gene therapy strategy to enhance revascularization — and, potentially, cartilage survival — under the proper conditions.