David Andrade

Down syndrome: otolaryngological effects of rapid maxillary expansion.

OBJECTIVE Phenotypical Down syndrome includes pharyngeal and maxillary hypoplasia and, frequently, constricted maxillary arch with nasal obstruction. STUDY DESIGN This clinical trial assessed the effects of rapid maxillary expansion on ENT disorders in 24 children with Down syndrome randomly allocated to receive either rapid maxillary expansion or not. Each group received ENT and speech therapy assessments before expansion and after the device had been removed. RESULTS In the rapid maxillary expansion group, the yearly ENT infection rate was reduced when assessed after device removal (p < 0.01). The parents of rapid maxillary expansion children reported a reduction in respiratory obstruction symptoms. Audiological assessment revealed improvements in the rapid maxillary expansion group (p < 0.01). Cephalometry showed increased maxillary width in the rapid maxillary expansion group. CONCLUSIONS Rapid maxillary expansion resulted in a reduction in hearing loss, yearly rate of ENT infections and parentally assessed symptoms of upper airway obstruction, compared with no treatment. These findings are probably related to expanded oronasal space, due to rapid maxillary expansion.

Endoscopic endonasal surgery for resection of benign sinunasal tumors

Abstract Objectives: The use of endoscopic surgery for nasal and sinus pathologies has revolutionized our approaches to the disease of the areas. In this retrospective study we would like to summarize our experience with endoscopic surgery in benign tumors and tumor-like condition of nose and paranasal sinuses. Methods: The medical records of 107 patients with benign sinonasal tumors that underwent endoscopic surgery for removal of their neoplasm between 1997 to 2003 were analyzed. These include 32 patients with juvenile nasopharyngeal angiofibroma, 24 with inverted papilloma, 23 of benign fibroosseous lesions, 18 with pyogenic granuloma, 6 with intranasal hemangioma, 2 with pleomorphic adenoma, and benign fibrohistiocytoma and orbital pseudolymphoma each in 1 case. Results: The period of follow-up ranges from 9 to 73 months (medium, 41 month). In this time period and with close observation (serial endoscopy and yearly CT scan), we had 8 cases of recurrent tumor (2 angiofibroma, 4 inverted papilloma, 1 fibrous dysplasia, and 1 osteoma) that were managed endoscopically or with combined (endoscopic and Caldwell-Luc) approach in 4 recurrent inverted papilloma patients. The major complications that we encountered were 2 cases of cerebrospinal fluid leakage that were sealed intraoperatively with local tissue flaps without further squeals. Conclusion: Endoscopic surgery can be valuable for removal of benign tumors of nose and paranasal sinuses in the hands of an experienced surgeon.

P147: Down syndrome: Rapid Maxillary Expansion and ENT Evolution

OBJECTIVES: 1. Learn an effective method of endotracheal intubation of a patient with a difficult airway due to the anatomical manifestations of Klippel-Feil syndrome. 2. Understand the relevant anatomical features of Klippel-Feil syndrome. METHODS: A case report was prepared of an intubation event that took place in August 2005. It describes a single use of a Seldinger technique of flexible bronchoscopic intubation of a child with Klippel-Feil syndrome. The outcome was successful intubation after other attempts using standard techniques had failed. RESULTS: Under flexible nasotracheal bronchoscopic guidance, an endotracheal tube was successfully passed over a guidewire into the subglottic airway of an eight-year-old child with Klippel-Feil syndrome. The technique is straightforward and uses materials readily available in an operative suite. The case report describes the technique as well as features of the Klippel-Feil syndrome. In addition, the case report includes a review of previously reported intubations of patients with Klippel-Feil syndrome and previous reports of similar Seldingertype intubation techniques. CONCLUSIONS: Anatomical features of the upper airway in patients with Klippel-Feil syndrome make endotracheal intubation by standard techniques difficult or even impossible. The technique described may be successful in other patients with Klippel-Feil syndrome or with similar anatomical features.

Rapid maxillary expansion and nasal patency of the down syndrome pediatric population

Abstract Objectives: Down syndrome (DS) is the most common aneuploid disorder at birth. Phenotypic characteristics include general axial hypotonia and maxillary hypoplasia with relative macroglossia contributing to constricted maxillary arch and nasal obstruction. This prospective study assesses the effect of rapid maxillary expansion (RME) on nasal permeability of DS children using acoustic rhinometry (AR) data. To our knowledge this is the first such study performed in a DS population. Methods: AR have been performed in 24 DS children aged between 5 and 12 years (who were randomly allocated to RME and control groups) prior to expansion (T0), immediately after maximum expansion (approximately 1 month) (T1) and after a 5-month period of retention (T2); the data between the 2 groups were compared. Results: On average, RME children showed a significant increase in the nasal volume from T0 to T1, which persisted through T2. A significant difference was noticed in the evolution of the minimal cross-sectional area (MCA) for RME children. Children in the control group did not show any significant improvement. The distance from the MCA does not show any significant difference with time in both groups. Nevertheless, in the RME group a noticeable change is observed, becoming more anterior, between T0 and T1, with almost no change at the last stage (T2); in contrast, results from the control group are not consistent with time. Conclusion: Rapid maxillary expansion produced a significant augmentation of nasal volume, P