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Objective To review the presentation and associated congenital abnormalities of laryngeal cleft and present guidelines for its evaluation and management. Design A 10-year retrospective study (1994-2004) with institutional review board approval. Setting Two pediatric tertiary care medical centers. Patients Twenty-two pediatric patients (mean age, 21 months) with laryngeal cleft. Intervention Surgical repair of laryngeal cleft. Main Outcome Measures Sex, age, symptoms, other associated abnormalities, method of evaluation, type of laryngeal cleft, method of surgical repair, treatment outcome, complications, and long-term follow-up. Results All 22 patients underwent surgical repair for laryngeal cleft. Airway endoscopy confirmed the following types of laryngeal clefts: type 1 (n = 3), type 2 (n = 10), and type 3 (n = 9). Surgical repair techniques included an open approach with or without interposition graft (n = 16) and an endoscopic approach (n = 6). Conclusions Early diagnosis and proper repair of laryngeal cleft are essential to prevent pulmonary damage and associated morbidity. Each patient should be assessed properly, and the surgical approach should be individualized based on the symptoms, other associated findings on airway endoscopy, and type of cleft.

Embryologic remnants of thyroid tissue often line the thyroglossal duct tract and may commonly become cystic. Calcification in such a cyst is thought to be a specific marker for malignancy, which may develop in 1% of thyroglossal duct cysts. We describe a 3-year-old boy with a midline neck mass that showed radiologic calcification. Pathologic evaluation revealed psammomatous calcification in association with a benign thyroglossal duct cyst. These findings, not previously reported (to our knowledge), expand the radiologic differential diagnosis of calcified neck masses and broaden the spectrum of pathologic findings seen in association with benign thyroglossal duct cysts.

Objectives To evaluate the clinical, audiologic, and temporal bone computed tomograpic findings in patients with hemifacial microsomia and to use the OMENS (each letter of the acronym indicates 1 of the following 5 dysmorphic manifestations: O, orbital asymmetry; M, mandibular hypoplasia; E, auricular deformity; N, nerve involvement; and S, soft tissue deficiency) grading system to assess possible correlations between the severity of dysmorphic features with the type of abnormalities in the temporal bone and with degree of hearing deficit. Design Retrospective study. Setting Tertiary care children's hospital. Patient Forty patients with hemifacial microsomia. Result Mandibular hypoplasia and auricular abnormalities were the most common clinical manifestations, present in 39 patients (97%) and 38 patients (95%), respectively. Conductive hearing loss was noted in 35 patients (86%) and sensorineural hearing loss in 4 patients (10%). Facial nerve weakness was present in 20 patients (50%). Twenty patients had unilateral aural atresia, 12 patients had unilateral aural stenosis, and 7 patients had bilateral anomalies. Moderate hypoplasia or atresia of the middle ear was noted in 36 patients (90%) and ossicles were malformed in 30 patients (75%). Hypoplasia of the oval window was the most common inner ear abnormality. Conclusions Severity of craniofacial features (total OMENS score) significantly correlated with the degree of temporal bone abnormality, but no correlation was noted with the degree or type of hearing loss. We recommend the following: (1) use of the OMENS classification system for documentation and analysis of dysmorphic finding in hemifacial microsomia; (2) complete audiologic evaluation in all patients with hemifacial microsomia regardless of the type of craniofacial abnormalities; and (3) temporal bone computed tomography for further evaluation of hearing deficit.

Objective: To examine the use of hyoid as a readily available autologous grafting material for the anterior cricoid split (ACS) procedure. Design: Prospective analysis of 20 patients undergoing ACS with hyoid interposition grafting for subglottic stenosis over a 3-year period. The patients received at least 1 year of follow-up after surgery. Setting: Tertiary care children's hospital. Patients: Twenty infants (age range, 2-9 months) with endoscopically confirmed acquired and congenital subglottic stenosis. Presenting symptoms included stridor, failure to extubate, and recurrent atypical croup. All 20 children underwent ACS with hyoid interposition grafting. Results: All 20 patients exhibited improvement in their symptoms of airway obstruction. All 12 patients in whom extubation had previously failed subsequently underwent successful extubation. The 8 patients with symptoms of stridor and atypical croup showed marked improvement in their symptoms. Serial bronchoscopy revealed mucosal healing and incorporation of the hyoid grafts. Conclusion: Hyoid provides a readily available and reliable grafting material for interposition grafting in the ACS procedure for neonates and infants. Arch Otolaryngol Head Neck Surg. 1997;123:1277-1280

• Lymphatic malformations of the upper aerodigestive tract can present therapeutic challenges. Symptoms associated with these lesions include bleeding, dysphagia, changes in speech, and dyspnea. Surgical therapy is recommended, which often leads to functional interference and cosmetic deformities. Laser photocoagulation of these malformations can control symptoms and may be repeated as necessary, preserving tissue and function. The results in four patients treated with the carbon dioxide laser and in five patients treated with the neodymium-YAG laser were reviewed. Reduction of bulk and improvement of symptoms were achieved in all patients, most of whom required multiple treatments. The average duration of each procedure was 30 minutes. All patients were discharged from the hospital on the same day or 1 day after laser therapy with minimal morbidity. The indications, evolving technique, and results of laser therapy are discussed. (Arch Otolaryngol Head Neck Surg.1992;118:205-208)

• The role of surgery in the treatment of rhabdomyosarcoma of the head and neck has diminished during the past 25 years. Treatment of this tumor in the pediatric population has involved radical radiation therapy and chemotherapy with little or no role for surgery. However, the potential effect of irradiation on facial growth and the appearance of secondary irradiation-induced tumors has raised the question as to whether surgery may once again play a role in the treatment of these patients. Advances in skull base and reconstructive surgery and microsurgical techniques have permitted a reconsideration of initial ablative surgery. The head and neck surgical team must be prepared to respond in those patients in whom craniofacial development is at risk or recurrence has occurred after radical chemotherapy and/or radiation therapy. ( Arch Otolaryngol Head Neck Surg . 1991;117:1185-1188)

• Considerable controversy surrounds the subject of tympanoplasty in children. Conflicting opinions about the indications, patient selection, timing, and technique of surgery are supported by various published series of cases. The records of 64 consecutive tympanoplasty procedures performed at the Boston (Mass) Children's Hospital over a recent 6-year period were reviewed. The study was limited to cases of repair of uncomplicated perforation of pars tensa that did not require ossiculoplasty or mastoidectomy. Surgery was successful in 73% of cases. A number of factors that are postulated to affect the outcome of surgery have been analyzed to assess their utility in selecting successful surgical candidates. Only patient age at the time of surgery was found to have statistical significance. We conclude that tympanoplasty for repair of perforation is warranted for children 8 years of age and older. (Arch Otolaryngol Head Neck Surg. 1990;116:35-40)