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Laryngeal mobility disorder after a pediatric heart surgery is common (between 5 and 10% of cases), and has important consequences on swallowing, breathing and speaking. After reviewing the literature, the recovery rate is variable and the postoperative follow-up is often done on a short time frame. The primary objective of the study is to describe the recovery from laryngeal mobility disorder with a follow-up time of at least 5 years. The secondary objective is to describe of the quality of life of the child in terms of phonation and swallowing, and to identify potential risk factors for a lasting laryngeal mobility disorder.We collected data (morphological characteristics and details of the procedures and medical care) on children who had undergone a heart surgery with risks of complications, between 2010 and 2015, and with a laryngeal mobility disorder detected after the surgery through nasal flexible laryngoscopy. During a follow-up consultation, carried at least 5 years after the surgery, we performed a nasal flexible laryngoscopy to assess whether or not the patient had recovered a full mobility of the larynx. Two questionnaires were also given to the patients, the pVHI and the PEDI EAT-10, to assess respectively the quality of their speech and of their swallowing function.The recovery rate for a laryngeal mobility disorder more than 5 years after surgery was found to be 65% (9 children out of the 14 included in the study). We identified a risk factor for the persistence of a laryngeal mobility disorder after surgery: the presence of an associated genetic syndrome, p = 0.025. Children with persistent laryngeal mobility disorder have an impaired quality of life score, using the pVHI scale, which correlates well with the flexible laryngoscopy findings, p = 0.033.Children with a lasting laryngeal mobility disorder have disabling respiratory and vocal symptoms in their daily lives. Nasal flexible laryngoscopy should therefore be systematically performed postoperatively after a surgery carrying risks. For improved patient management, early detection of these disorders by pharyngolaryngeal nasal flexible laryngoscopy in the aftermath of high-risk cardiac surgery is strongly advised, with prolonged follow-up.

Introduction A foreign body aspiration is a risky situation, common in pediatric emergency. The “gold standard” to rule out a foreign body or proceed to its extraction, is rigid bronchoscopy (RB) under general anesthesia. However, RB is an intrusive exam with possible complications. Depending on authors, RB in emergency is a procedure at risk of complications in 4–17% of cases. Advances in radiology allow CT-scanners of fast acquisition and high definition, which could be used as an alternative to RB. Materials and methods This is a retrospective analysis of 6 years from May 2010 to May 2016, in a tertiary referral center. All children that presented a foreign body aspiration suspicion and had a cervical-thoracic CT with multiplanar reconstruction were analyzed. Results 200 children were included. The average age was 30 months. 132 were considered normal and 68 pathological. Among the 68 RB performed for pathological scanner, a foreign body was found in 59 cases, and we had 9 cases of false positives. Among the 132 considered normal, 27 have had a RB despite this, due to persistent symptoms, all were negative; 105 were discharged home without endoscopy with monitoring instructions. 1 child was reviewed three months later for asthma, without second choking event reported. A new CT-scan found a foreign body that was removed by RB. Due to the nature of the foreign body it is very unlikely to link it to the first choking event, but retrospectively we cannot be certain. Considering this case as the only false negative, the negative predictive value (NPV) of CT was 99.2% and positive predictive value (PPV) of 83.8%. Conclusion The use of CT -scan with multiplanar reconstruction in suspected foreign body aspiration is a reliable alternative to endoscopy under general anesthesia, especially in asymptomatic patients, avoiding too many negative endoscopies.

Objectives: Report a rare congenital salivary gland tumor and its clinical, radiological and histopathologic aspects. Discuss the differential diagnosis and treatment. Methods: A case report is described. A literature review of the incidence, disease course, radiological and histopathologic aspects and treatment are presented. Results: This case report presents a neonate with an asymptomatic left cervical mass. Ultrasounds and MRI showed a circumscribed soft tissue mass measuring 60mm×42mm×52mm and extending from the left parotid region to the left submandibular region, but radiological exams could not lead to a diagnosis. A biopsy demonstrated a sialoblastoma. The treatment consisted in a surgical resection with no adjuvant therapy. One year after surgery there is no clinical nor radiological sign of recurrence. Conclusion: Sialoblastomas are rare congenital epithelial salivary tumors and have been reported to occur predominantly in the parotid gland. They are locally aggressive with a high recurrence rate needing a prolonged follow up. When they are completely resectable, surgical resection is the mainstay for treatment of these tumors and no adjuvant therapy is needed.

To specify the characteristics of the thulium laser and to evaluate the advantages and possibilities of treatment with this laser in laryngotracheal diseases in children.Fiber-based lasers have facilitated a new style of surgery. When performing therapeutic airways endoscopies there is the possibility of good control of lesions and adequate visualization of the surgical field using the telescope. Different types of laser may be used but the 2013-nm thulium laser shows promise as a laser that is efficient in soft tissues with the advantages of the other lasers without their problems. The thulium laser has been described in treating urinary tract abnormalities and recently airways diseases in adults, but there are no reports of other uses for this technique in the pediatric airway.The thulium laser appears to be an interesting tool in the management of laryngotracheal diseases such as subglottic stenosis, tracheal granuloma and laryngomalacia. The use of this laser in laryngotracheal diseases in children will probably progress in the future.

Objective To evaluate the efficiency of diffusion-weighted magnetic resonance imaging (MRI) and high-resolution computed tomographic (CT) scan coregistration in predicting and adequately locating primary or recurrent cholesteatoma in children. Design Prospective study. Setting Tertiary care university hospital. Patients Ten patients aged 2 to 17 years (mean age, 8.5 years) with cholesteatoma of the middle ear, some of which were previously treated, were included for follow-up with systematic CT scanning and MRI between 2007 and 2008. Interventions Computed tomographic scanning was performed on a Siemens Somaton 128 (0.5/0.2-mm slices reformatted in 0.5/0.3-mm images). Fine cuts were obtained parallel and perpendicular to the lateral semicircular canal in each ear (100 × 100-mm field of view). Magnetic resonance imaging was undertaken on a Siemens Avanto 1.5T unit, with a protocol adapted for young children. Diffusion-weighted imaging was acquired using a single-shot turbo spin-echo mode. To allow for diagnosis and localization of the cholesteatoma, CT and diffusion-weighted MRIs were fused for each case. Results In 10 children, fusion technique allowed for correct diagnosis and precise localization (hypotympanum, epitympanum, mastoid recess, and attical space) as confirmed by subsequent standard surgery (positive predictive value, 100%). In 3 cases, the surgical approach was adequately determined from the fusion results. Lesion sizes on the CT-MRI fusion corresponded with perioperative findings. Conclusions Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases.

The database revealed severity factors relating to human papillomavirus (HPV) type and age at diagnosis. While not exhaustive, the database is easy to use and could serve for a European multicentre epidemiological study.To propose a database as a starting point for a national registry and to estimate prognostic factors in recurrent respiratory papillomatosis (RRP).This was a retrospective study carried out in a tertiary care teaching hospital. From January 2005 to July 2007, epidemiological, clinical and treatment information on patients undergoing endoscopy for RRP in the department was entered in a database. Data were collected on three forms: the first comprised information about disease history before assessment in the department, the second about the disease and its treatment in the department, and the third about evolution after treatment.Data on 72 patients were entered into an RRP database between January 2005 and July 2007. In all, 82% had already been treated for RRP in a different centre; 24 had juvenile-onset (JORRP) and 48 adult-onset (AORRP) papillomatosis. Cidovir injections had been administered to 91% of the patients. Histology found nine cases of dysplasia, one of carcinoma in situ and one of invasive carcinoma. Subglottic and tracheal locations were significantly more frequent in JORRP than in AORRP, as were the maximum Derkay scores and annual numbers of endoscopies. Patients with type 11 HPV had significantly more endoscopies per year than those with type 6.