Search

Subcutaneous emphysema is a rare but well-defined surgical complication. However, emphysema of the supraglottic mucosa has not been described in the literature. We present a case of a 2-year-old male who suffered supraglottic emphysema secondary to fiber optic CO

Bipolar radiofrequency plasma ablation (Coblation) technology has recently been described in the treatment of airway stenosis. In these small case series and case reports, the mucosal and submucosal tissues have been removed. We describe a novel use of coblation technology, in which a coblation needle was used to submucosally ablate subglottic stenosis in a 9 month-old girl with grade II subglottic stenosis who had previously undergone multiple balloon dilations. This technique spared the overlying mucosa, similar to that utilized in coblation turbinoplasty. She experienced objective clinical improvement after the intervention and has not required additional airway interventions to date.

Subcutaneous emphysema is a rare but well-defined surgical complication. However, emphysema of the supraglottic mucosa has not been described in the literature. We present a case of a 2-year-old male who suffered supraglottic emphysema secondary to fiber optic CO2-laser use during laryngeal cleft repair. The patient required preemptive postoperative intubation; however, there were no long-lasting adverse effects at 6 and 12 weeks follow up. This report illustrates a rare CO2-laser complication and describes its sequela.

Tonsillectomy is a common procedure in the pediatric population, with subsequent microscopic examination of the specimen for cancer and other rare diagnoses occurring routinely. A 17 year-old female with a history of autoimmune vasculitis underwent adenotonsillectomy for severe obstructive sleep apnea. Pathology demonstrated small, medium and large lymphocytes and plasma cells obscuring the lymphoid follicles and germinal centers, with few Epstein-Barr virus positive lymphocytes. Tingible body macrophages were seen in the vaguely nodular areas. This reactive histologic pattern represents an atypical lymphoproliferative disorder never before documented in tonsils. Histopathologic images will be shown.

Objective Describe the pre-operative diagnosis correlation of pediatric neck masses with the final post-operative pathology reading. Evaluate if added imaging studies were associated with higher frequency of correct diagnosis. Study design Retrospective case series review. Setting Tertiary Academic Medical Center. Subjects and methods Data was collected from 281 pediatric patients with an undiagnosed neck mass that underwent open biopsy from January 1986 to December 2011. Data collection included pre-operative accuracy and relative contributions of clinical clues and imaging studies. Results Pre-operative and post-operative diagnoses match varied for each category of diagnoses. The difference in distribution of correct pre-operative diagnoses between 6 categories of neck masses was statistically significant. The highest number of cases with correct pre-op diagnosis was seen with congenital masses which were correctly diagnosed with 75% of cases (n = 109), followed by benign tumors which were diagnosed with 73.7% of cases (n = 19). When CT scans were included in the pre-op work up, it was associated with a non-significant trend toward a less frequent correlation between pre and post-operative diagnosis in congenital, nodal inflammatory and miscellaneous masses. However, with regards to the diagnosis of benign tumors, CT scan was associated with a trend toward higher proportion of correct pre-op diagnosis. In cases where US was included in the evaluation, we found a trend toward less frequent correlation with post op diagnosis in benign tumors, nodal inflammatory, non-nodal inflammatory and miscellaneous diagnoses and an increase in accuracy for congenital masses. Conclusion Certain types of pediatric neck masses are easy to diagnose likely due to their classic presentation. Failure to diagnose masses often occurs when the clinical picture is vague or non-specific. Ancillary imaging studies do not always correlate with increased accuracy of diagnosis, particularly when the clinical clues are typical.

Bronchopulmonary dysplasia (BPD) is a condition marked by prolonged ventilator and oxygen requirement due to underlying arrested lung development. Tracheostomy is a staple in long-term establishment of pediatric airways in this condition, and has many benefits. However, these children's airways can be very tenuous. We present a case of a child with severe BPD who developed extreme bronchospasm during tracheostomy. We also briefly review current literature in the management of such children's airways and potential directions for future management.

(1) Characterize risk factors for subsequent tonsillectomy in pediatric patients undergoing primary adenoidectomy for upper airway obstruction. (2) Compare rates of subsequent tonsillectomy between adenoidectomy patients with and without upper airway obstruction.Historical cohort study with a nested case-control study. Cohort data were analyzed using Kaplan-Meier plots and a multiple regression model. Case-control data were analyzed using logistic regression.Patients undergoing adenoidectomy without tonsillectomy at the University of Missouri between 1995 and 2010 were identified using billing records and selected chart review. A nested case-control study with detailed chart review was conducted to determine predictors of subsequent tonsillectomy in patients with upper airway obstruction.Of 1291 patients identified in the historical cohort, 7.8% later underwent tonsillectomy. Age younger than 3 years (P = .027), female sex (P.0001), and upper airway obstruction (P = .001) were found to be significant predictors of subsequent tonsillectomy. In the nested case-control study, potential predictors investigated included adenoidectomy indications, symptoms, smoke exposure, weight, comorbidities, and tonsil size at the time of adenoidectomy. Of these, only tonsil size was significant, with an increased odds of future tonsillectomy of 2.5 (P = .01) for each unit increase in tonsil size.Patients undergoing adenoidectomy for upper airway obstruction are likely to be at an increased risk of subsequent tonsillectomy when compared with those with other indications. Within this subgroup of patients with upper airway obstruction, young age, female sex, and large tonsil size may further increase the risk of subsequent tonsillectomy.

Nasoenteric tubes provide short-term nutrition support to patients unable to take an adequate oral diet. Bridling systems may be used to secure tubes to guard against displacement. We present the first case of an avulsed magnet from a bridling system to raise awareness of this potential complication. The primary methods of securing a nasogastric tube are reviewed, and comparative assessment of the 3 main systems is presented. Diagnosis and management of nasal foreign bodies relevant to this case are reviewed and prevention/safety considerations discussed.

Facial nerve paralysis in the pediatric population is rare. We describe a 2-year old child who was found with his head hanging between the railings of his bed. As a result he suffered a compression injury to his facial nerve; the only reported case that did not occur at the time of forceps delivery. The management of this type of injury is discussed, with a review of the literature. We find that this type of extratemporal injury to the facial nerve almost always results in complete recovery. The necessity of the generally accepted treatment of oral corticosteroid treatment is explored.

We present a unique case of metastatic follicular thyroid carcinoma to the hard palate and the maxillary sinus, a case that to our knowledge has not been reported before. Various malignant tumours that metastize to the maxilla are reviewed, and the therapeutic approach to follicular thyroid carcinoma metastasis to that area is also discussed. Follicular thyroid carcinoma should be included in the list of tumours that metastasize to the maxilla.

Ayoungboywasnotedduring routineadenotonsillectomytohave a large firm mass in the posteriolateral pharyngeal wall and was referredtoatertiarymedicalcenter.Postoperatively,hedevelopedmild velopharyngeal insufficiency.Onflexibleendoscopy,theposteriorpharyngeal mass was clearly visible. Magnetic resonance imaging (MRI) oftheneckrevealeda3 × 2 × 1-cmfusiformlesionattachedtothemedial aspect of the left carotid space, extending to the midline retropharyngealspaceatthe levelofC2toC4(Figure,A).Themassshowed homogenous enhancementwith gadolinium contrast (not shown). The patient was taken to the operating room, and a transoral approach via horizontal incision in the level of orohypopharynx was performed. The firm encapsulated mass was easily identified and dissected free from surrounding tissue (Figure, B). The mass showed a narrow extension to the carotid space. On gross examination, the mass was firm and encapsulated. Hematoxylin-eosin–stained slides at low power (original magnification ×40) revealed a Schwannian-like background of eosinophilic, spindle-shaped cells (Figure, C). At higher power (original magnification ×100), clusters of well-differentiated ganglion cells with large round nuclei, prominent nucleoli, and granular basophilic Nissle substance (endoplasmic reticulum and ribosomes present in the cytoplasm of neural cells) were seen (Figure, D). Postoperatively, the patient was noted to have unilateral mild drooping of his eyelid, and his left pupil was constricted (yet responded to light) on the side of the resected lesion. Repeated MRI 6 months later showed no recurrence. What is your diagnosis? A B

Objective: Diagnosing pediatric neck masses is challenging, often requiring open biopsy. Epidemiology and diagnostic tests utility have been described, but accuracy of clinicians’ judgment has not. We will describe/analyze preoperative diagnostic accuracy and identify the relative contributions from clinical, radiological, and pathological data.Method: Retrospective review of pediatric patients’ charts with an undiagnosed neck mass who underwent open biopsy from January 1986 to December 2011. 248 charts were reviewed, with approximately 30 more to review prior to presentation. Data collection identified preoperative accuracy and relative contributions of clinical clues, imaging studies, and FNA.Results: Preoperative accuracy varied for each category of diagnoses. Congenital masses were diagnosed with 76% (n = 98) accuracy. Nodal inflammatory masses were correct in 55% (n = 85) of cases, whereas non-nodal inflammatory were correct in only 13% (n = 8). Benign tumors were diagnosed in 71% (n = 17), yet only ...

Neuroblastoma is an uncommon cause of a mandibular mass. We describe an 8-month-old child who presented with loosening of his dentition, poor oral intake, and a large mandibular mass. Thorough radiographic study and subsequent biopsy of the oral lesion revealed the diagnoses of metastatic neuroblastoma. Ultimately, he was successfully treated with surgery and chemotherapy. The unusual presentation and pathophysiology of this malignancy will be reviewed. Neuroblastoma presenting as a mandible mass associated with natal teeth is rare, but it should be considered in the differential diagnosis of pediatric mandibular lesions.

Congenital lesions typically present in early childhood. Based on their location and presentation, the diagnosis and treatment is usually obvious. Because of the complexities and uniqueness of head and neck embryology, rare congenital lesions develop and this should be of interest to the otolaryngologist. In this report we present a rare case of a pharyngeal auricle that manifested itself as a polyp within the oropharynx of an infant.

Background: Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children. Methods: A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths. Results: In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases. Conclusion: This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care.(Otolaryngol Head Neck Surg 2000;123:495-500.)