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Background Preoperative planning of open laryngotracheal surgery is important for achieving good results. This study examines the surgeon’s perception of the importance of using life size 3D printed models of the pediatric airway on surgical decision making. Methods Life-size three-dimensional models of the upper airway were created based on CT images of children scheduled for laryngotracheal-reconstruction and cricotracheal resection with anastomosis. Five pediatric airway surgeons evaluated the three-dimensional models for determining the surgical approach, incision location and length, graft length, and need for single or double-stage surgery of seven children (median age 4.4 years, M:F ratio 4:3). They rated the importance of the three-dimensional model findings compared to the direct laryngoscopy videos and CT findings for each domain on a validated Likert scale of 1–5. Results The mean rating for all domains was 3.6 ± 0.63 (“moderately important” to “very important”), and the median rating was 4 (“very important”). There was full agreement between raters for length of incision and length of graft. The between-rater agreement was 0.608 (“good”) for surgical approach, 0.585 (“moderate”) for incision location, and 0.429 (“moderate”) for need for single- or two-stage surgery. Conclusion Patient-specific three-dimensional printed models of children’s upper airways were scored by pediatric airway surgeons as being moderately to very important for preoperative planning of open laryngotracheal surgery. Large–scale, objective outcome studies are warranted to establish the reliability and efficiency of these models. Graphical abstract

STUDY OBJECTIVES: Body position during sleep has been related to breathing in adults with obstructive sleep apnea (OSA). While sleep-disordered breathing is common, little information is available on the relation between sleep position and maternal breathing in pregnancy. We examined associations between the supine position, maternal breathing, and perinatal outcomes. METHODS: Women with a singleton, uncomplicated pregnancy were recruited and underwent an ambulatory overnight sleep study between 33 to 36 weeks using the Watch-PAT device. Their medical records were also reviewed. RESULTS: A total of 148 pregnant women were recruited (mean age: 33 ± 4 years; mean body mass index: 27.6 ± 4.0 kg/m(2)). They spent approximately one-half of their sleeping time in a supine position. The group’s mean apnea-hypopnea index (AHI) was 3.6 events/h in the supine position and 2.9, 2.6, and 2.1 events/h for the prone, right, and left positions, respectively. Median AHI and oxygen desaturation index were higher and SpO(2) nadir was lower in the supine versus nonsupine position (P < .0001, P < .0001, and P = .006, respectively). Peripheral oxygen saturation nadir was associated with the percentage of time spent sleeping in the supine position (P = .02). No correlations were found between supine sleep position and perinatal outcomes. There were no differences in the distributions of body positions between women with and those without OSA. CONCLUSIONS: Women in the third trimester of pregnancy with or without OSA spent large proportions of sleeping time in a supine position. Supine position was associated with more respiratory events and more and deeper oxygen desaturation events. They were not associated with perinatal outcomes. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Fetal Outcome of Sleep Disordered Breathing During Pregnancy; URL: https://clinicaltrials.gov/ct2/show/NCT00931099; Identifier: NCT00931099. CITATION: Dunietz GL, Sever O, DeRowe A, Tauman R. Sleep position and breathing in late pregnancy and perinatal outcomes. J Clin Sleep Med. 2020;16(6):955–959.

Introduction The currently available questionnaires based on parental reporting of OSA symptoms include large number of items and are not sufficient to the diagnosis and assessment of OSA severity. We aimed to evaluate a simple 2-item questionnaire regarding parental concern as a predictor of the severity of OSA in children as measured by polysomnography. Methods Prospective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child’s breathing. Results Ninety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Significant correlations were found between the need for surgery score and the apnea-hypopnea index (r=0.22, P = .029), as well as the mean SpO2 levels (r=-0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score and the child’s age were the only predictors for moderate-severe OSA (P = .01 and P = .043, respectively). Conclusion Querying parents on their perception of their child’s need for surgery is a sensitive, practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG. Support

Subglottic stenosis is considered one of the most complex and challenging aspects of pediatric otolaryngology, with the most common etiology being prolonged endotracheal intubation. The surgical treatment of SGS can be either endoscopic or open, but recent advances have pushed the limits of the endoscopic approach so that in practice an open laryngotracheal surgical approach is considered only after failed attempts with an endoscopic approach. In this review we discuss these advances, along with current concepts regarding the diagnosis and treatment of subglottic stenosis in children.. How to cite this article Wasserzug O, DeRowe A. Subglottic Stenosis: Current Concepts and Recent Advances. Int J Head Neck Surg 2016;7(2):97-103.

Introduction Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the “gold standard” for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods Comprehensive literature review. Results Extensive intracranial–intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.

Background Enlarged tonsils and adenoids are the major etiology of obstructive sleep apnea (OSA) in children. Lymphatic hyperplasia is common to both OSA and celiac disease. We aimed to investigate the effect of a gluten-free diet on OSA symptoms in children with celiac disease. Methods Children with celiac disease aged 2–18 years were prospectively recruited before the initiation of a gluten-free diet. Children with negative celiac serology who underwent gastrointestinal endoscopies for other indications served as controls. All participants completed a validated OSA-related symptoms questionnaire and the pediatric sleep questionnaire (PSQ) at baseline and 6 months later. Results Thirty-four children with celiac disease (mean age 6.6 ± 3.5 years) and 24 controls (mean age 7.3 ± 4.6 years, P = 0.5) were recruited. There were no significant differences in gender, body mass index or season at recruitment between the two groups. The rate of positive PSQ scores was higher (more OSA-related symptoms) in the control group compared to the celiac group, both at recruitment and at the 6-month follow-up (33.3% vs. 11.8%, P = 0.046, and 16.7% vs. 0, P = 0.014, respectively). PSQ scores improved significantly in both groups at the 6-month follow-up (P

A 2-year-old boy presented with varices and a neck mass. Imaging studies revealed internal jugular vein aneurysm. Gradual increasing of the mass, potential thrombus formation and cosmetical considerations were indications for surgery. At surgery aneurysms of both the external and internal jugular veins were found and resected.