Daniela Carvalho

Imaging and surgical approach of nasal dermoids

OBJECTIVE Determine the most accurate and cost effective radiographic evaluation for nasal dermoids. Determine the best surgical approach for excision of nasal dermoids. DESIGN Retrospective chart review. SETTING Division of Pediatric Otolaryngology, Childrens Hospital and Health Center, San Diego, California. PARTICIPANTS All patients with nasal dermoids evaluated and treated from 1990 to 2000. INTERVENTION Preoperative radiographic evaluation and surgical excision. OUTCOME MEASURES Accuracy of CT and MRI correlated with surgical findings and results. RESULTS Ten patients were identified with the diagnosis of nasal dermoid. The age at diagnosis ranged from 0 to 24 months, with a mean of 3 months. Six children presented with masses located at the glabella, three patients presented with masses located at the nasal dorsum and one presented with a mass at the nasal tip. Six children underwent a computed tomogram with contrast of the head. Seven children underwent a MRI study of the head. Three children underwent an initial CT followed by MRI. Twenty percent of children were found to have intracranial extension. CT scan accurately diagnosed intracranial extension in one case, was indeterminate in a second case and falsely positive in a third case. MRI correctly diagnosed intracranial extension in two cases and had no false positive or false negative results. No children were found to have associated intracranial anomalies. In the early years of the review, a simple excision was made over the mass with blunt and sharp dissection for removal. (An external rhinoplasty incision is now used with better exposure and improved cosmetic results.) In cases with intracranial communication, a combined approach of external rhinoplasty and craniotomy was used. CONCLUSIONS MRI alone is the most cost effective and accurate means of evaluating nasal dermoids and is essential for preoperative planning. The surgical approach of choice is external rhinoplasty for both cosmetic reasons and exposure of nasal dermoids with and without intracranial extension.

An atypical presentation of Kawasaki disease resembling a retropharyngeal abscess

Kawasaki disease is an acute systemic inflammatory disease, which occurs in children less than 10 years of age. The etiology of the disorder is unknown. Diagnosis is based upon clinicians recognition of a symptom pattern that includes high fevers, oral cavity changes, polymorphous rash, conjunctival injection, and cervical adenopathy. Most feared are the cardiac manifestations of Kawasaki syndrome, which result in an overall mortality rate of 2% in patients. Because of the common presenting symptoms, the otolaryngologist often plays a central role in early diagnosis of the disorder. The following case report describes a patient with Kawasaki disease whose initial presentation mimicked a retropharyngeal abscess. A literature review details the common and atypical early signs and symptoms of Kawasaki disease.

Unilateral choanal atresia in identical twins:: case report and literature review

Choanal atresia is postulated to be secondary to an abnormality of the rupture of the buccopharyngeal membrane during the embryological period. This condition usually occurs sporadically, but has been described in siblings and successive generations. The genetics remain unclear. We present monozygotic twins with identical findings of unilateral choanal atresia and no other associated anomalies. To our knowledge, this is the first report of such an occurrence.

International Pediatric Otolaryngology Group (IPOG) consensus recommendations : Hearing loss in the pediatric patient

OBJECTIVE To provide recommendations for the workup of hearing loss in the pediatric patient. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group. RESULTS Consensus recommendations include initial screening and diagnosis as well as the workup of sensorineural, conductive and mixed hearing loss in children. The consensus statement discusses the role of genetic testing and imaging and provides algorithms to guide the workup of children with hearing loss. CONCLUSION The workup of children with hearing loss can be guided by the recommendations provided herein.

Preoperative cerebral magnetic resonance imaging and white matter changes in pediatric cochlear implant recipients

INTRODUCTION Preoperative magnetic resonance imaging (MRI) can yield valuable information regarding the status of the inner ear in pediatric cochlear implant (CI) candidates. Incidentally, cerebral white matter changes are at times noted on these MRI scans. They may indicate post-infectious/postinflammatory changes or progressive neurodegenerative processes. OBJECTIVE To evaluate the clinical significance of cerebral white matter changes in pediatric CI patients. METHODS Retrospective chart review of pediatric CI recipients with preoperative MRI between March 2004 and January 2009 was performed. MRI reports along with postoperative audiology and speech and language outcomes were assessed. RESULTS Fifty-seven patients were included in the study. There were 29 females and 28 males. Mean age was 58 months (range of 12-194 months). Abnormal MRI with varying degrees of white matter changes was noted in 10 (18%) children. Neurological assessments did not reveal any serious central nervous system diseases. Two of the 10 patients demonstrated significant delays and difficulties with postoperative CI performance. CONCLUSIONS Cerebral white matter abnormalities are not uncommon incidental findings in preoperative MRI scans in pediatric CI candidates. These changes may reflect remote or active pathology which may require neurological assessment. The significance of these findings is still uncertain and should be better clarified as we study more patients.

Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children With Cleft Palate

Objective The purpose of this study was to assess the effect of ventilation tube (VT) placement on long-term hearing outcomes in children with cleft palate. Study Design Case series with chart review. Setting Genetic and dysmorphology database at Rady Childrens Hospital–San Diego (RCHSD). Patients Children with cleft palate diagnosis who underwent surgery at RCHSD between 1995 and 2002. Main Outcome Measure The primary outcome studied was hearing acuity at 10 years of age. Independent variables studied included gender, age at palate repair and first VT placement, total number of VTs, number of complications, and presence of tympanic membrane perforation. Results An increased number of tubes was associated with a greater incidence of hearing loss at age 10, even after adjusting for total number of otologic complications. The timing of initial tube placement did not have a significant effect on long-term hearing outcome in this study. Conclusions While children with worse middle ear disease are more likely to receive more tubes and have long-term conductive hearing loss as a result of ear disease, the results of this study suggest that multiple tube placements may not contribute to improved long-term hearing outcomes. Further research focusing on long-term outcomes is needed to establish patient-centered criteria guiding decision making for ventilation tube placement in children with cleft palate.

Lipofibroma of the neck in children : An unusual diagnosis with special surgical implications

Lipofibromas are uncommon and distinctive pediatric lipomatous neoplasms that have a predilection for extremities, usually involving deep fascia and tendons of the hand or foot with only 1 case of neck involvement. We describe 2 cases of lipofibroma of the neck in children that presented with cervical extension and attachment to deep tegumentary structures. Informed consent for publication was obtained from the patients’ parents.

Management of Large-Volume Subperiosteal Abscesses of the Orbit: Medical vs Surgical Outcomes

Objectives To compare clinical variables and outcomes for children with subperiosteal abscesses of the orbit (SPAO) managed medically vs surgically to identify clinical prognosticators. Study Design Case series with chart review. Setting Tertiary children’s academic institution. Subjects and Methods The study included 48 children between the age of 1 month and 14 years, with SPAO from 2003 to 2013. Variables included age, sex, physical examination findings, laboratory results, computed tomography (CT) findings, hospital length of stay, length of antibiotic therapy, and placement of a peripherally inserted central catheter (PICC). Intended methods for comparison were the Student t test for continuous variables and Fisher’s exact test for categorical variables, and a forward stepwise multiple logistic regression. Results Thirty-two (67%) children were successfully treated with antibiotic therapy only, and 16 (33%) required surgery. Abscess volume, abscess width, and the presence of gaze restriction were statistically different between the 2 groups. A multivariate analysis found abscess volume as the only predictor for surgical intervention. A subgroup analysis including only patients with an abscess volume of ≥500 mm3 (n = 26) was performed. Eleven patients were treated medically and 15 treated surgically, with the medical group having longer hospital stays (P = .048), duration of antibiotic therapy (P = .035), and higher incidence of PICC placement (P = .005). Conclusions This is the first study to report that abscess volume has clinical implications, as children with SPAO volume ≥500 mm3 treated medically have longer inpatient admissions, antibiotic therapy durations, and PICC placement. When children present with an abscess ≥500 mm3, early surgical intervention should be strongly considered, even in the absence of other surgical criteria, to shorten duration of hospitalization and accelerate clinical improvement.

Nasolaryngoscopy or laryngotracheoscopy: which is the best exam for assessing the airways of children?

UNLABELLED It is not uncommon to find children with respiratory distress. In these cases airway endoscopy is usually required. Doubts about which examination should be used are frequent. AIM to establish which examination is the best to assess the airways of children. MATERIAL AND METHODS a retrospective study assessing 16 children with a history of respiratory distress at the Children Airway Unit of the Pediatric Otolaryngology Department at UNICAMP. All patients underwent nasolaryngoscopy and laryngotracheoscopy between March 2001 and March 2004. Data was analyzed and compared. RESULTS during this study 16 children were assessed; the most frequent indication of exams were: evaluation of prolonged tracheostomy in 10 patients (62%), and subglottic stenosis (31.3%). CONCLUSION assessing airways in children with respiratory distress is essential for a diagnosis. In our study, we concluded that all children with upper airway disease must undergo nasolaryngoscopy, an easy, economic and useful exam that provides information about larynx function. However, if subglottic or traqueal disease issuspected, or if nasolaryngoscopy findings are in conflict with the physical examination, laryngotracheoscopy should be undertaken.

Nasolaringoscopia ou laringotraqueoscopia: qual o melhor exame para avaliação da via aérea infantil?

E comum criancas com quadro de desconforto respiratorio alto, sendo importante uma avaliacao atraves de endoscopia da via aerea. OBJETIVO: Avaliar qual o melhor exame para via aerea infantil. MATERIAIS E METODOS: Estudo retrospectivo com 16 criancas do ambulatorio de via aerea infantil do Setor de Otorrinolaringologia Pediatrica da UNICAMP, com historia de stress respiratorio, submetidas a nasolaringoscopia e laringotraqueoscopia de marco de 2001 a marco de 2004. Dados coletados foram equiparados e comparados. RESULTADOS: Foram avaliadas 16 criancas, sendo a indicacao mais comum do exame avaliacao de traqueotomia prolongada em 10 pacientes (62%), seguida de avaliacao de estenose subglotica em tres casos (31,3%). Em 44% dos exames houve falha da NL em mostrar lesoes em subglote. CONCLUSAO: A avaliacao endoscopica da via aerea infantil em criancas com dificuldade respiratoria e essencial para o diagnostico. Concluimos que todas as criancas com patologia de via aerea superior devem ser submetidas a nasolaringoscopia inicialmente, a qual e um exame barato, de facil execucao e que fornece dados importantes inclusive a respeito da funcionalidade da laringe. No entanto, se houver suspeita de patologia subglotica ou traqueal, ou ainda quando os dados nasolaringoscopia nao sao condizentes com exame fisico, e essencial a realizacao da laringotraqueoscopia.