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Resume Introduction Les anti-inflammatoires non steroidiens (AINS) sont connus pour inhiber le chimiotactisme, l’explosion oxydative et la phagocytose, la bactericidie dans les granulocytes et pour inhiber l’agregation ou la degranulation des neutrophiles et perturber la fonction des lymphocytes. D’autre part, l’ibuprofene est largement prescrit en pediatrie pour ses puissants effets analgesiques et antipyretiques. A notre connaissance, aucune publication anterieure ne decrit la relation entre l’ibuprofene et un risque accru de complications intracrâniennes et/ou orbitaires dans les sinusites fronto-ethmoidales aigues chez l’enfant. Objectif Rechercher une relation entre l’ibuprofene et l’apparition de complications intracrâniennes et/ou orbitaires de sinusite fronto-ethmoidale aigue en pediatrie. Patients et methodes Les dossiers medicaux des patients de moins de 18 ans admis dans les services ORL de 4 CHU pendant 2 annees consecutives pour sinusite fronto-ethmoidale ont ete revus retrospectivement. La prise d’ibuprofene, l’apparition de complications (orbitaires ou intracrâniennes) ainsi que les donnees demographiques habituelles ont ete notees. Une analyse statistique a ete effectuee afin de determiner s’il existe une relation entre la prise d’AINS et l’apparition d’une complication intracrânienne et/ou orbitaire. Resultats La prise d’ibuprofene semble etre un facteur de risque de complications intracrâniennes ou de complications orbitaires et surtout intracrâniennes en cas de sinusite fronto-ethmoidale aigue chez l’enfant. Ni le sexe, ni l’âge, ni l’intensite initiale de la douleur n’etaient statistiquement lies a l’apparition des complications. Conclusion Cette etude retrospective multicentrique semble suggerer que l’ibuprofene augmente le risque de complications orbitaires et/ou intracrâniennes en cas de sinusite fronto-ethmoidale aigue dans la population pediatrique. Par consequent, nous recommandons de ne pas prescrire d’ibuprofene si l’on soupconne une sinusite aigue chez un enfant ou un adolescent.

International audience; Importance: Non-steroidal anti-inflammatory drugs (NSAIDs) are known to inhibit chemotaxis, oxidative burst and phagocytosis, bacterial killing in granulocytes as well as inhibiting neutrophil aggregation or degranulation, thereby interfering with the function of lymphocytes. On the other hand, ibuprofen is widely prescribed in pediatrics for its powerful analgesic and antipyretic effects. To our knowledge, no previous publication outlines the relationship between Ibuprofen therapy and an increased risk of intracranial and/or orbital complications of acute fronto-ethmoidal sinusitis in childhood. Objective: To look for a relationship between ibuprofen and occurrence of intra-cranial and/or orbital complications of acute fronto-ethmoidal sinusitis in pediatrics. Setting and methods: The medical charts of patients younger than 18 years admitted into the E.N.T. departments of 4 academic care centers during 2 consecutive years for fronto ethmoidal sinusitis were reviewed retrospectively. The history of ibuprofen intake, the occurrence of complication (orbital or intracranial) as well as the usual demographic data were noted. A statistical analysis was performed in order to ascertain whether a relationship between taking NSAIDs and the onset of an intracranial and/or orbital complication exists. Results: Intake of ibuprofen appeared to be a risk-factor of intracranial complications or associated orbital and intracranial complications of acute fronto-ethmoidal sinusitis in children. Neither gender nor age nor initial pain intensity were statistically related to the onset of complications. Conclusion and relevance: This retrospective multicenter cohort study appears to suggest that ibuprofen increases the risk of orbital and/or intracranial complications of acute fronto-ethmoidal sinusitis in childhood. Therefore, we recommend not prescribing ibuprofen if one suspects an acute sinusitis in a child or adolescent.

Purpose The purpose of this work was to determine the epidemiology and the predictive factors of success of the surgical management of fourth branchial anomalies. Methods This is a multicentric retrospective review from 1998 to 2016 of patients who presented with an endoscopically-confirmed fourth branchial pouch anomaly. Data were analyzed according to sex, age, clinical features, number of recurrences, treatment modalities (endoscopic and/or cervicotomy), post-operative complications and follow-up. Results Fifty-two children have been included. The average age at diagnosis was 4.5 years. Among them, 73.1% were female, 11.4% were neonatal forms; 94.2% of lesions were left-sided; 75% of patients presented a cervical abscess as first symptom, and 7.7% of children presented with dyspnea. Average time between first symptoms and management was 9.5 months. Management was endoscopic in 73.1% of patients (laser in 84.2%, coagulation in 15.8%) with about a third of recurrence after one procedure. Overall success of endoscopic procedures reached 84.2%. A cervical open surgery was performed in 26.9% as first line treatment. Overall success of cervicotomy reached 85.7%. No complications of endoscopic surgery have been identified. There were 35.7% complications of cervicotomy (2 recurrent nerve palsy, 2 keloid scars, 1 pharyngostoma). An association was proved between recurrences and initial abscess (OR = 2.44), and with age between 3 and 5 (OR = 4). Conclusion Endoscopic treatments appear to be effective in first line approach in the management of fourth branchial anomalies, offering an excellent efficiency with rare complications. We identified two risk factors of recurrence: age between 3 and 5 years old and history of cervical abscesses. Level of evidence IV.

Objectives Nasal obstruction is a highly subjective symptom. It can be evaluated by combining clinical examination, imaging and functional measurements such as active anterior rhinomanometry (AAR). In pediatrics, AAR is often impossible because it requires the participation of the child. Airflow modeling by Computational Fluid Dynamics (CFD) has been developed since the early 1990s, mostly in adults. This study is the first to describe a methodology of “numerical rhinomanometry” in children using CFD and to evaluate the feasibility and the clinical interest of this new tool. Materials and methods Five children aged from 8 to 15 years, complaining of nasal obstruction, underwent routine management including clinical evaluation, AAR, and CT-scanning. CT acquisitions were used for CFD calculations and numerical rhinomanometry. Results and conclusions In the 5 children, the results of CFD were concordant with clinical complaints and examination. In 3 children, AAR and CFD were concordant. In one patient, CFD corrected the results of AAR. In one patient, AAR was not feasible, unlike CFD, which contributed to diagnosis. This study highlighted the feasibility of CFD in children and that it can support or refute diagnosis of nasal obstruction with good reliability. These results indicate that CFD modeling could be widely used for functional exploration in pediatric rhinology.

Objective The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation. Methods Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement. Results Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P = 0.03). The odds ratio for risk of > 14 procedures in 3-level involvement was 20.43 (P = 0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P = 0.16). Conclusions RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.

Objectives To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. Methods Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. Results Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. Conclusions Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.

Objective This study presents results for a pediatric series of tympanoplasty using the butterfly-cartilage technique, with comparison to literature reports. Methods A retrospective study included patients aged between 2 and 12 years receiving tympanoplasty performed by a single senior surgeon in our department between 2003 and 2012, for whom pre- and postoperative tympanum imaging was complete. Results were analyzed at a minimum 10 months’ follow-up in terms of graft healing and auditory data, with pre- and postoperative audiograms and calculation of mean hearing loss. Results Twenty-eight tympanoplasties were performed in 27 children: 16 males, 11 females; in 1 case, perforation was bilateral. Perforation location was inferior or antero-inferior in 14 cases (50%), antero-superior in 9 (32.1%) and anterior in 5 (17.9%). Perforation size on otoscopy ranged from 11.1% to 36.4% of tympanum area (mean, 26.3%). Mean follow-up was 25 months. Closure of the perforation was achieved in 87.7% of cases. Mean hearing loss was 20.2 dB (range, 10–31.25 dB) preoperatively and 14 dB (range, 5–31.25 dB) postoperatively. Discussion We analyze our results and compare them with the international literature to refine indications for this technique of tympanic repair. Conclusion Tympanoplasty using the butterfly-cartilage technique was reliable and easy to perform. It should be included in the therapeutic armamentarium for moderate non-marginal tympanic perforation. In the present series, the technique was reserved to perforations involving less than 40% of tympanum area.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 135 - N° 1 - p. 81-82

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.

Objectives The aim of this study was to assess quality of life in children fitted with cochlear implants, using combined self- and parental assessment. Materials and methods Thirty-two children, aged 6 to 17 years, with prelingual hearing loss and receiving cochlear implants at a mean age of 22 months, were included along with their families. The KIDSCREEN-27 questionnaire was implemented, in face-to-face interview, in its parents and children-adolescents versions, with 27 items covering physical well-being (“physical activities and health”), psychological well-being (“general mood and feelings about yourself”), autonomy & parents (“family and free time”), peers & social support (“friends”) and school environment (“school and learning”). Parent and child responses were compared with a general population database, and pairwise. Results Global scores were compared against the general population on Cohen d effect-size. For child self-assessment, the results were: physical well-being, 72.81 ( d = 0); psychological well-being, 78.13 ( d = −0.4); autonomy & parents, 63.84 ( d = −0.2); peers & social support, 61.72 ( d = −0.4); and school environment 73.83 ( d = 0). For parent assessment, the respective results were 62.66 ( d = −0.8), 74.89 ( d = −0.3), 57.37 ( d = −1.2), 51.56 ( d = −0.8), and 68.95 ( d = −0.4). Half of the children could not answer the questionnaire, mainly due to associated disability. Schooling and language performance were poorer in non-respondent than respondent children. Quality of life was comparable between implanted and non-implanted children: Cohen d , 0 to 0.4. Early cochlear implantation in children with pre-lingual hearting loss provides quality of life comparable to that of the general population.

Summary Introduction Ossifying fibroma (OF) is a rare benign fibro-osseous tumor, mainly located in the head and neck region. Most often, it affects the mandible but rare involvement of paranasal sinuses has been reported, associated with more locally aggressive behavior. Case report We report the case of an 8-year-old boy with OF of the middle turbinate, revealed by ethmoiditis. Total resection was performed on an endoscopic approach. The patient was free of clinical or radiological recurrence at 3 years’ follow-up. This was the youngest patient with OF of the middle turbinate so far reported in the international literature. Discussion Presumptive diagnosis is established by clinical examination and CT scan (location, oval-shaped mass, heterogeneous tumor with a thin bony rim). Definitive diagnosis is founded on histological examination (psammomatous bodies, osteoblastic rim, trabecular bone). Treatment in paranasal sinus OF is surgical, preferentially on an endoscopic approach. Resection should be as complete as possible to minimize risk of recurrence, especially in sinonasal locations, known to be more aggressive. Ethmoiditis in an unusual age-range should suggest tumoral etiology.

To assess the potential benefit of the MXM auditory brainstem implant for patients with neurofibromatosis type 2.Retrospective case review.Tertiary referral centers.Fourteen patients with neurofibromatosis type 2 and bilateral acoustic neuromas underwent implantation with the MXM auditory brainstem implant during surgery to remove the second-side tumor.There were no complications related to the auditory brainstem implantation. Auditory sensations were present for 12 of 14 patients (86%). Global results indicated an improved quality of life for the patients receiving auditory sensations, in part because of their auditory orientation within the environment. Eighty-nine percent of patients tested with an open-set sentence test demonstrated enhancement of speech understanding as a result of lip-reading improvement when auditory brainstem implant sound was combined with lip-reading. A few patients (36%) had some speech understanding in sound-only mode. One patient was able to have limited phone conversations.These results indicate that significant auditory benefit can be derived from the MXM auditory brainstem implant.

Objectives The purpose of this study was to assess the postoperative complications related to cochlear implants and to discuss the differences observed between adult and paediatric populations. Cochlear implant complications were defined as any pathological events observed during the postoperative period, whether or not they were directly related to the surgical technique. We therefore recorded all complications, in the broad sense of the term, ranging from acute otitis media to cochlear explantation. Study design Retrospective analysis of cochlear implant patients. Material and methods All surgical procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median age at the time of implantation: 51.9 years), and 235 children (median age at the time of implantation: 4.5 years). All postoperative complications were classified as either major (requiring surgical revision or hospital management) or minor (requiring conservative management). Results The global complication rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor complications (60 cases). This complication rate was significantly higher in the adult population ( P = 0.004). Conclusion Cochlear implantation is a safe hearing rehabilitation surgical technique associated with a low complication rate. However, surgeons must be familiar with these complications in order to ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following revision surgery or device failure. Only the minor complication rate was significantly higher in the adult population.

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(®), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(®) is about 96%. BAHA(®) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(®) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.

Summary Sensorineural hearing loss is the most common form of sensory impairment in children. As a precise aetiological diagnosis has major prognostic and management implications, it is useful to evaluate the contents of the aetiological investigation of sensorineural hearing loss in France. This article presents a retrospective review of professional practices by comparing the aetiological investigation of hearing loss in children with a cochlear implant and children without a cochlear implant. Patients and methods One hundred and seven children under the age of 18 years with unilateral or bilateral sensorineural hearing loss attending the paediatric ENT department for the first time between January 2007 and January 2009 were included in the study. Data from the clinical interview and all complementary investigations were analysed. Results The various aetiologies of hearing loss were classified as genetic, acquired, or unknown in each of the two populations. Hearing loss was of unknown origin in 52% of the 87 non-implanted children and 15% of the 20 children with a cochlear implant. Conclusion This study demonstrates the heterogeneous practices in terms of aetiological investigation of sensorineural hearing loss as a function of the target population. A more systematic aetiological investigation was performed in children fitted with a cochlear implant, requiring multidisciplinary management. This study indicates the need to define a standard aetiological investigation for all children with sensorineural hearing loss.

Palatal myoclonus is an uncommon, rhythmic, "shock-like" involuntary movement of the muscles of the soft palate, throat, and other structures derived from the branchial arcs. Objective tinnitus is frequently neglected in review articles about childhood tinnitus. Our aim was to present the case of a 7-year-old girl with bilateral objective tinnitus due to palatal myoclonus without hearing impairment (normal hearing thresholds between 250 Hz and 8 kHz) but with otherwise normal hearing thresholds (250 Hz-8 kHz) and no evidence of intracerebral or systemic disorders. No treatment was useful.

International audience; Considering on the one hand the important histological differences that exist between newborn and adult vocal folds and on the other hand the specifical subglottal pressure at birth, the sound production in a newborn larynx is studied. The laryngotracheal airflow has been numerically modelled in order to evaluate its role in voice production by the larynx in newborn. The FFT spectrum of the pressure signal acquired just above the vocal folds was calculated and compared to the spectrum of a sound generated by an excised larynx. It can be determined that first, the computed pressure signal has a fundamental frequency close to that obtained experimentally with an excised larynx, and second the FFT spectra are qualitatively similar to one another. Third, the computed pressure fluctuation is strong enough to be detected by the human ear. The conclusion is that the airflow and the aerodynamical phenomena observed in a rigid geometry are, by themselves, able to produce a sound and consequently, are one of the several elements leading to sound production in the newborn larynx. #

Objectives To assess whether a classification system for congenital cholesteatoma (CC) can be derived from analysis of a large clinical sample of cases and to assess whether such a classification system is a reliable guide for surgical intervention, reexploration, and hearing outcome. Design A retrospective review of clinical and surgical records of 119 patients with CC. Setting Four tertiary care children's hospitals. Patients One hundred nineteen children with CC (age range, 2-14 years). Results Congenital cholesteatomas in the anterior mesotympanum were treated successfully with exploratory tympanotomy. Congenital cholesteatomas involving the posterior superior quadrant and the attic usually had concurrent involvement of the incus and stapes and often required a canal wall up tympanomastoidectomy and a second look for its control. Congenital cholesteatoma involving the mastoid usually involved all of the ossicles, was inconsistently controlled with canal wall up tympanomastoidectomy, and had a poor prognosis for restoration of conductive hearing loss. The mean ± SD age of children with CC was 5.6 ± 2.8 years, while that of children with acquired cholesteatoma was 9.7 ± 3.3 years. Conclusions The sequence of spread of CC, involving 3 sites, suggests a natural classification system. The CC usually originates in the anterior superior quadrant, but does not consistently remain there, and may variably occupy the middle ear and mastoid and result in ossicular destruction and conductive hearing loss. The location of CC and the involvement of the ossicles is an accurate predictor of the type of surgery necessary for its control and for the success of hearing restoration.

Objectives To describe the natural history of congenital cholesteatoma (CC) and to determine whether such a description provides clues about the origins and end points of these lesions. Design A retrospective qualitative analysis of intraoperative illustrations of 34 consecutive patients with 35 CCs (1 bilateral). Setting Two tertiary care children's hospitals. Patients Thirty-four children with CC, mean age, 5.6 years (range, 2-13 years). Results Congenital cholesteatoma originates generally, but not universally, in the anterior superior quadrant. The progression of growth is toward the posterior superior quadrant and attic and then into the mastoid. Contact with the ossicular chain generally results in loss of ossicular continuity and in conductive hearing loss. Conclusions Congenital cholesteatoma appears to have a predictable trajectory of growth, starting as a small pearl in the middle ear, eventually growing to involve the ossicles and mastoid, and causing varying degrees of destruction and functional impairment. The clinical picture of a young child with otorrhea, conductive hearing loss, tympanic membrane perforation in a nontraditional location, and a mastoid filled with cholesteatoma may represent the end point in the natural history of CC, despite the fact that this type of lesion is outside the accepted definition of CC.

Objective To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. Design Retrospective review of files from January 1983 to September 1998. Setting Pediatric otolaryngology departments from 2 referral centers. Patients Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. Interventions Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. Main Outcome Measures Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. Results The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. Conclusions Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.

Objective To evaluate the effects of a partial resection of the anterior cricoid arch on the growth of the laryngotracheal complex in an animal model and to study the lumen caliber and cross sectional surface area following resection as the animals are allowed to grow. Laryngeal, subglottic, and tracheal measurements in the infant and pediatric larynges in autopsy specimens are also investigated. Design A controlled animal study was done comparing the operated rabbit group to the nonoperated group. Twenty-nine infant rabbits were compared to a control group of ten rabbits. In addition, autopsy dissections were performed on infant and pediatric larynges to obtain measurements of various laryngeal and cricoid relationships. Methods Thirty-nine pasteurella-free New Zealand white female rabbits between the ages of 8 and 11 weeks were used in this study. In the experimental group, cricotracheal resections were performed by removing the anterior cricoid cartilage and the first tracheal ring. A primary anastomosis was then performed. The animals were kept alive for 4 months and then humanely euthanized. The laryngeal complex was then removed and histological sections of the cricotracheal region were mounted on glass slides and stained with H&E. Measurements were taken of the cricoid and upper tracheal lumen and cross-sectional area. Results Twenty-seven of the study group survived until the time of sacrifice. All of the control group survived during the study period. The two groups were comparable in regard to weight, lumen size, and cross-sectional area. There were no statistical differences between the groups. Conclusions The e-perimental data support the hypothesis that partial cricotracheal resections can be performed safely and effectively in young rabbits. The potential clinical significance is described in light of the autopsy data.

Objective To review cricotracheal resection (CTR) in children weighing less than 10 kg. Design and Setting Retrospective study of 17 patients (mean follow-up, 23 months) from 3 ear, nose, and throat pediatric centers. Patients Seventeen children (10 boys and 7 girls; mean age, 14.6 months; and mean weight, 7.6 kg) undergoing CTR from June 1995 to March 2003. Main Outcome Measures Decannulation rates and endoscopies. Results The cause was congenital subglottic stenosis in 2 children (12%) and acquired subglottic stenosis in 15 (88%). All but 1 had grade 3 or 4 stenosis. The mean hospitalization duration was 34 days. Single-stage CTR was performed in 11 children (65%), with peroperative decannulation in 7. Extubation of these patients occurred between days 3 and 9. Decannulation of the other 6 patients was performed after a median of 15 days. Sixteen (94%) of the 17 children were decannulated. Four patients required additional carbon dioxide laser treatment for subsequent glottic or subglottic edema or granulomas, but no reintubation was necessary. One child could not be decannulated because of bronchopulmonary disease, and subglottic stenosis recurred. Long-term tracheotomy was avoided in all other patients. Another child died of cardiac disease. All other patients remained free of significant subglottic stenosis at follow-up. Conclusions Cricotracheal resection in small children weighing less than 10 kg was a safe and effective procedure for severe subglottic stenosis. To our knowledge, this is the first reported attempt of CTR in this weight category, providing results comparable to those published in older children.

Objectives To describe the clinical presentations and discuss the guidelines for surgical management of pilomatrixoma involving the head and neck in children. Design Retrospective study. Setting A tertiary care center. Patients Thirty-three patients, with a mean age of 4.5 years, underwent surgical treatment for pilomatrixoma (n=38) between 1989 and 1997. Intervention All patients were treated surgically. In 34 cases, a direct approach was used to achieve complete removal of the lesion with (n=11) or without (n=23) skin resection. In the remaining 4 cases, an indirect approach via a parotidectomylike incision was used. Results In 88% of cases, the presenting symptom was a hard, slow-growing, subcutaneous tumor. The lesion was associated with pain and inflammation in 7 cases (18%) and abscess or ulceration in 4 cases (11%). Twenty-nine patients presented with single nodules and 4 presented with multiple occurrences. The lesions were located on the face (cheek, eyelid, or forehead) in 20 cases (53%), on the neck in 8 cases (21%), in the parotid region in 8 cases (21%), and on the scalp in 2 cases (5%). Conclusions Pilomatrixoma is a rare, benign skin tumor, but practitioners should be aware of its clinical features. Diagnosis is usually easy based on clinical findings, but computed tomographic scan is helpful, especially in cases involving tumors located in the parotid region. Spontaneous regression is never observed. Complete surgical excision, including the overlying skin, is the treatment of choice.

Objectives To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft. Design Retrospective study. Setting Three tertiary care centers. Patients Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996. Intervention All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed. Results Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases. Conclusions Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.

Histologic analysis of lymph node biopsy specimens may verify diagnosis of this disease., We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.