William S. Crysdale

Management of drooling in individuals with neurodisability: a surgical experience.

From 1975 to 1 January 1999, 1103 neurologically involved patients (mean age 13.2 years; 686 males, 417 females) referred with problematic drooling, or sialorrhea, were assessed at a pediatric rehabilitation center by a team consisting of an otolaryngologist, speech pathologist, and a dentist. The initial standard treatment for persistent sialorrhea (in the compliant or aware patient) is oral‐motor training. A group of 522 patients with persistent significant drooling after a minimum of 6 months of oral‐motor training, or profuse drooling in the presence of a low cognitive level, underwent surgery, usually when over 6 years of age. From 1978 to 1 January 1998, the operation of first choice was submandibular duct relocation (SDR), and was completed in a total of 226 patients. Midway through 1988, sublingual gland excision was also completed at the time of submandibular duct relocation (SDRSGE); 249 of these procedures have been completed to January 1st 1999. Those patients who had SDRSGE had significantly fewer complications that required additional surgery than those that had SDR only. However, the impact of surgery on the drooling as evaluated in subsets of both groups (SDR n=115, SDRSGE n=106) was statistically similar. The study of 11 children with salivary gland radionuclitide scans to determine the effect of submandibular duct surgery on gland function was inconclusive. The pattern of oral‐motor function in 26 children studied after SDRSGE surgery suggested that those children with severe impairment of volitional motor function and profuse drooling tended to have a poorer outcome following surgery compared to those with milder impairments.

Maxillary myxoma in children

Myxoma of the maxilla is a rare, slowly growing, benign mesenchymal tumor. Pathologically, it may be difficult to differentiate from other tumors with myxoid stroma and is occasionally misinterpreted as malignant. This tumor is particularly uncommon in children; in a search of the literature, we were able to document only 17 cases of myxomas in the maxilla in patients aged 14 years or less. This report on two children with myxoma of the maxilla emphasizes the importance of including myxoma in the differential diagnosis of children with maxillofacial tumors, and underlines the difficulties in making a correct diagnosis.

Subglottic stenosis in children. A management protocol plus surgical experience in 13 cases

Subglottic stenosis in young children represents a formidable management problem. The role of radiological evaluation, endoscopy, endotracheal intubation, tracheotomy, decannulation and surgery in the overall approach to this group of patients is discussed. Experience with laryngotracheal reconstruction in 13 patients is related; decannulation was achieved in 11 children. In general, 3 types of surgical procedures for laryngotracheal reconstruction have been described in the literature. Surgery is indicated in a minority of children with persistent significant subglottic stenosis. Specific contraindications to surgery are delineated. Appropriate management of endotracheal tubes and avoidance of aggressive endoscopy will minimize the development of subglottic stenosis.

Nasal obstruction in children with craniofacial malformations

The etiology, patient evaluation and management of nasal obstruction in children with craniofacial malformations is broadly discussed. Specific reference is made to the experience by the senior author (WSC) with respect to nasal surgery in 29 of these patients during the 12 years from 1987 to January 1st, 1998.

Preoperative Characteristics and Postoperative Outcomes Following Adenoidectomy in Children

OBJECTIVES (1) To describe various preoperative and diagnostic findings of children undergoing adenoidectomy and (2) to evaluate quality of life outcomes following adenoidectomy in children. METHODS This was a prospective observational study. Patients who were candidates for adenoidectomy at The Hospital for Sick Children were evaluated with respect to preoperative symptoms, flexible nasal endoscopy (FNE) findings, and nasal airflow (NAF) studies. Following surgery, a quality of life questionnaire was administered to all available patients and an attempt was made to repeat the NAF study. RESULTS Fifty-seven patients were included in the study (31 females and 26 males). The average age of the patient at surgery was 10.1 years. Thirty patients (52.6%) had a significant NAF study, whereas FNE revealed an average nasopharyngeal obstruction of 73.2%. We did not find any correlation between preoperative symptoms, FNE findings, or NAF study results. The degree of symptom reduction was the only predictor of how satisfied a patient would be in the postoperative period (p<.05). CONCLUSION In our study of adenoidectomy patients, clinical signs and symptoms appear to be more predictable than the objective tests of NAF and FNE. As such, following these symptoms in the postoperative period is important in determining a patients satisfaction following surgery.