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Objective: To determine the feasibility, safety and efficacy of intravenous home hydration for pediatric postoperative adenotonsillectomy patients. Method: Nonrandomized control trial of two groups of pediatric patients following adenotonsillectomy—one with (H) and one without postoperative home intravenous hydration (WH). Setting: A tertiary care, university-based children's hospital. Intervention: Administration of 25 cm3 kg−1 of Lactated Ringer's solution once a day for 3 days via an intravenous catheter. Results: Three of 22 patients in the (WH) group and none of the 25 patients in the (H) group required an emergency room admission for dehydration. Difficulty swallowing and activity level were found to be statistically different based on χ2-analysis (P

Objective: Many surgical techniques to manage ranulas have been described in the literature. These techniques include excision of the cyst with or without excision of the ipsilateral sublingual gland, marsupialization, cryosurgery, and CO2 laser excision. Few studies have described the approach toward management in pediatric patients. Methods: Six patients were treated for intraoral ranulas. Two patients had spontaneous resolution of their lesions. Four patients required dissection of the submandibular duct and lingual nerve to completely excise an oral cavity ranula and an ipsilateral sublingual gland. Results: There were no recurrent lesions. One patient developed a lingual nerve injury but no numbness. The 2 patients with spontaneous resolution did not develop a subsequent lesion. Conclusion: Optimal management of pediatric oral cavity ranulas may include observation for 5 months for spontaneous resolution. If the lesion does not resolve or recurs repeatedly, surgical treatment is recommended. Submandibular duct dissection with relocation appears to enhance exposure to the floor of mouth. The pseudocyst and entire sublingual gland should be removed. Identification of the lingual nerve is necessary to accomplish this goal. (Otolaryngol Head Neck Surg 2002;127:115-118.)

Objective: Determine the effect of harvesting autogenous thyroid cartilage on subsequent laryngeal growth and stability in a kitten model. Study Design: Prospective controlled trial in animals. Methods: Seventeen kittens were divided into three groups. Group one (n = 5) included kittens that underwent a unilateral thyroid cartilage resection. Group two (n = 5) included kittens that underwent a bilateral cartilage resection. Group three (n = 7) comprised kittens that did not undergo any surgical procedure (controls). All animals underwent endoscopic examination followed by the surgical procedure designated for that group. Kittens were then assessed daily for 2.5 months. At the end of that period the now “adolescent” cats were examined endoscopically then euthanized. The larynx was removed for gross and histopathologic analysis. Results: All kittens tolerated the surgical procedure without airway compromise. Subsequent endoscopic examination 2.5 months after surgery revealed normal vocal cord function. Measurements of the true vocal cord and aryepiglottic and subglottic diameter did not differ significantly (one-way analysis of variance, P = .05) with respect to the side or the group. Histopathologic evaluation of the laryngeal sections indicated a patent airway, stable and viable thyroid cartilage, and no evidence of cartilaginous regrowth. Conclusions: The removal of unilateral and bilateral superior thyroid alar cartilage can be performed in kittens without postoperative respiratory or wound problems. The harvesting of autogenous thyroid cartilage has no apparent effect on subsequent laryngeal growth and stability in a kitten model.

Endobronchial tuberculosis is a form of pulmonary tuberculosis, thought to result from rupture of an infected node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. With the presence of multidrug resistant isolates of TB, and its incidence in an increasing number of foreign-born persons immigrating to the US, otolaryngologists must be aware of its often subtle presentation. The following case is an unusual presentation of endobronchial tuberculosis initially diagnosed as an airway foreign body.

With the introduction of endoscopic techniques and powered instrumentation for pediatric sinusitis, one would expect that the definitive treatment of congenital choanal atresia has been established. An international survey of pediatric otolaryngologists and the plethora of surgical approaches in the literature, however, indicate that there is still much controversy in its management. This article addresses this controversy between endoscopic and traditional approaches to neonatal bilateral bony choanal atresia and proposes guidelines for optional treatment.

Objective To evaluate and compare the use of autogenous thyroid cartilage with that of auricular and costal cartilage in laryngotracheoplasty (LTP). Design A blinded comparison of LTP techniques using anterior thyroid, auricular, or costal cartilage as graft material in a rabbit model. Histological and anatomical analyses were performed on the laryngeal specimens 1, 4, and 6 weeks after surgery. The following factors were analyzed in each specimen: graft viability, cartilage proliferation, perichondrial viability, degree of necrosis, inflammatory response, and degree of epithelialization. Subjects Fifty-seven New Zealand adult male rabbits, aged 6 months, were divided into 3 study groups (19 animals in each group) initially and equally into the 3 time periods. Results No episodes of respiratory compromise occurred in any of the animals in the 3 study groups. Gross inspection of the laryngotracheal complex in the thyroid cartilage group revealed no evidence of laryngeal structural compromise. There was no statistical difference between the 3 types of cartilage used for reconstruction for the variables of graft or perichondrial viability, degree of necrosis, or inflammatory response at 1, 4, or 6 weeks. Cartilage proliferation in the thyroid cartilage group was decreased compared with that in the other 2 groups at 1 week. The amount of proliferation increased in this group and was equal to the amount present in the other 2 groups 4 and 6 weeks after surgery. Complete epithelialization of the graft material was present in all 3 groups at 4 and 6 weeks after reconstruction. Conclusions The use of autogenous thyroid cartilage for LTP compares favorably with that of other methods of reconstruction that use either auricular or costal cartilage in the rabbit model. This technique is a viable alternative for single-stage LTP and has the added advantage of using a single incision.

There are a number of surgical treatments for tracheostomal collapse of the pediatric airway. The techniques include tracheoplasty with costal cartilage graft, the placement of a tracheostomy tube and partial tracheal resection and primary tracheal anastomosis to name a few. Since each child may possess unique medical and social factors in additional to the tracheal pathology, the surgical approach must be individualized. A case history of a 1-year-old Vietnamese child with a tracheostomal collapse is presented. In this case, an endoluminal Palmaz stent was placed endoscopically to support the collapsed tracheal segment for 3 months. After 3 months, the stent was removed, and the child has done well without any airway intervention for 2 years. The indications for this novel approach, the technique of insertion and removal of the stent are the focus of this paper.

Head and neck lipomas in the pediatric population are rarely described in the literature. Two patients who presented to the Hospital for Sick Children with rapidly enlarging head and neck lipomas are presented. Radiographic imaging, including CT and MRI, as well as fine needle aspiration implicated a lipoma as the probable diagnosis. Both patients were treated by surgical excision. The clinical behavior, diagnostic work-up and treatment of these rare lesions are the focus of this study.

Kawasaki syndrome (KS) is a systemic disorder of unknown etiology that can lead to coronary artery aneurysm and thrombosis in a significant number of children. It is defined by a number of clinical guidelines set by the Centers for Disease Control (Rauch, A.M., Hurwitz, E.S. (1985) Centers for Disease Control (CDC). Case Definition for Kawasaki syndrome. Pediatr. Infect. Dis. 4, 702–703). Many of the symptoms of this illness may lead the patient to the otolaryngologist. These criteria include injected or fissured lips, injected pharynx, strawberry tongue and cervical lymphadenopathy. When administered in the first 10 days of the illness, gamma globulin has been demonstrated to reduce the prevalence of coronary artery abnormalities (Newburger, J.W., Takahashi, M., Burns, J.C. et al. (1986) Treatment of Kawasaki syndrome with intravenous gamma globulin. N. Engl. J. Med. 315, 341–347). Unfortunately, when a diagnosis of KS is not considered or if a patient presents with unusual symptoms that are not consistent with the CDC guidelines, the diagnosis and treatment of KS can be delayed or even missed. We present a series of patients with KS to illustrate its patterns of presentation.

Sneezing or sternutation is usually the physiologic response to nasal irritation. The reflex follows a very complicated pathway requiring coordinated communication between the trigeminal and nervus terminalis afferent impulses as well as from glottic and inspiratory muscles in the efferent limb. When the reflex pathway is unbalanced, sneezing can increase in frequency and severity to the extent that some patients become disabled. We present the clinical examination, differential diagnosis, and treatment modalities for the case of an adolescent male who experienced debilitating intractable sneezing for more than one year. As for many of the patients described with this elusive diagnosis, our patient appears to have a functional etiology.

OBJECTIVE: To review our experience with esophageal disc battery requiring endoscopic retrieval and describe a protocol for management. DESIGN: Retrospective medical chart review. PATIENTS: Pediatric patients who underwent endoscopic retrieval of an esophageal disc battery over a 10-year period. RESULTS: Ten pediatric patients had ingested an esophageal disc battery that required endoscopic removal. Three patients had minimal esophageal damage; the other 7 sustained severe and extensive esophageal damage involving the muscularis (n = 5) or developed a perforation (n = 2). One of these patients had an extensive injury that extended into the trachea resulting in a tracheoesophageal fistula. Two case reports are presented, outlining the management approach to esophageal perforations from esophageal battery ingestion. CONCLUSIONS: Severe injury can occur rapidly following disc battery ingestion. A high index of suspicion for an esophageal disc battery is necessary to expeditiously diagnose this condition. Emergency endoscopic removal is necessary. We outline a protocol for the management of this hazardous problem. Language: en

The CHARGE syndrome is a distinct pattern of malformation consisting of retinal colobomas, heart malformations, choanal atresia, growth/developmental retardation, genital defects, and ear abnormalities, including sensorineral deafness. Formerly called an association, CHARGE is a discrete enough pattern to be considered a syndrome in the true sense of the term. Recently mutations of the CHD7 gene have been discovered to account for the majority of patients with this phenotype. Also of note, recent proposals of diagnostic criteria have included vestibular dysplasias, especially absence of the semicircular canals, as a cardinal feature, and have emphasized the inner ear findings of CHARGE. We have evaluated 2 infants with CHARGE who have absence of the cochlear nerve on MRI. The purpose of this paper is to present and discuss these patients. Documentation of these findings helps expand the spectrum on inner ear dysplasias of the syndrome. The 2 unrelated patients, a boy and a girl, both presented to the NICU with multiple congenital anomalies and met criteria for CHARGE: retinal colobomas (2/2), heart malformations (2/2: ASD and ASD/VSD/coart), severe-profound congenital hearing loss (2/2), absence of the semicircular canals (2/2), characteristic external ear (2/2), and micropenis in the boy. Both had normal HRB chromosomes and FISH22 studies. The 2 patients were ascertained as part on the Hearing Assessment Team and are enrolled in the CDC-funded Etiology of Hearing Loss Study. MRI of the temporal regions showed absence of the cochlear nerve (unilateral in 1 patient and bilateral in the other). While cochlear dysplasias and absence of the semicircular canals are well known in CHARGE, cochlear nerve deficiency is not well documented. This finding, along with the other inner ear findings, can support the diagnosis. The otologic manifestations of CHARGE are unique as most syndromes involve the external/middle ear or the inner, not both. Understanding the role of CHD7 in the pathogenesis of the phenotype may provide insights into inner ear development.