Combined approach for paediatric recurrent antrochoanal polyp: a single-centre case series of 27 children.

OBJECTIVE: To compare functional endoscopic sinus surgery with a combined approach (functional endoscopic sinus surgery plus Caldwell-Luc procedure) for the treatment of paediatric antrochoanal polyp, in terms of antrochoanal polyp recurrence and safety. METHOD: This retrospective case series comprises 27 paediatric patients with recurrent antrochoanal polyp, treated from January 2010 to January 2018. RESULTS: The average age of the patients at the time of diagnosis was 10.4 ± 2.49 years. The recurrence rate after functional endoscopic sinus surgery alone was 72.9 per cent, compared with 12.5 per cent after functional endoscopic sinus surgery plus the Caldwell-Luc procedure (p < 0.00001). No complications were reported during surgery or follow up. CONCLUSION: The correct identification of the origin of the antrochoanal polyp and an adequate returning of maxillary ventilation by widening the ostium can prevent recurrences. Although functional endoscopic sinus surgery continues to be the 'gold standard' for antrochoanal polyp treatment, in cases of revision surgery, a combined approach could ensure the complete removal of the polyp through the two openings.

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique.

INTRODUCTION: Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall. CASE SUMMARY: We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event. DISCUSSION: Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.