ABSTRACT
OBJECTIVES: To review the outcomes of endoscopic, open or a combination of both surgical modalities for laryngotracheal stenosis and establish which factors influence results. METHODS: Records of all children undergoing laryngotracheal procedures (excluding laryngomalacia and aspirated foreign bodies) by the Department of Otolaryngology at The Children's Hospital at Westmead between January 2003 and November 2011 were reviewed. Specific data on population, intervention, covariates and outcomes were recorded and analysed. RESULTS: A total of 104 patients undergoing 277 procedures were included. 211 (76%) of the procedures were endoscopic, remaining 66 (24%) open. Patients undergoing open surgery were more likely to have significant co-morbidity, prior intubation, require ICU admission or tracheostomy and have a longer hospital stay. 57 (54.8%) patients were successfully treated with a single procedure (48 endoscopic and 9 open). Of the endoscopic patients requiring further surgery, 16 were managed with multiple endoscopic procedures, whilst 12 underwent subsequent open procedures. Open surgery was performed on 66 patients, 63.6% (42/66) of all open procedures required further endoscopic intervention and 45.2% (19/42) of these avoided further open surgery. CONCLUSIONS: Both open and endoscopic surgery have a role in laryngotracheal stenosis, and many patients benefit from a combination of both. Ultimately the decision depends on experience of the treating team, social considerations, and institutional capabilities. A multi-centre prospective data collection would be a useful tool to further investigate optimal management approach.
Subject(s)
Endoscopy , Laryngostenosis/surgery , Patient Outcome Assessment , Tracheal Stenosis/surgery , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Intensive Care Units, Pediatric , Length of Stay , Male , Patient Admission , Respiration, Artificial , TracheostomyABSTRACT
OBJECTIVES: To describe a multimodality approach to the management of pediatric head and neck lymphatic malformations using surgery, sclerotherapy, or both and to review the outcomes of these approaches. DESIGN: Retrospective case series. SETTING: A single pediatric tertiary care referral center. PATIENTS: Ninety-seven pediatric patients (aged 1 month to 16 years) diagnosed as having lymphatic malformations of the head and neck during a 7-year period. Follow-up ranged from 3 months to 7 years. INTERVENTIONS: All of the patients underwent clinical and radiologic (magnetic resonance imaging) assessment. Treatment modality was selected according to disease location, cyst size, and parental preference. Treatments included surgery (open excision, tongue reduction, electrocautery, and laser treatment), sclerotherapy with OK-432 (Picibanil) or a fibrosing agent (Ethibloc), and a combination of modalities. MAIN OUTCOME MEASURES: Clinically determined responses to treatment, complications, and number of treatments required. RESULTS: All isolated neck disease had complete or near-complete responses, with no nerve palsies sustained. Although most patients achieved complete or near-complete responses, disease with parotid, laryngopharyngeal, or oral components had poorer outcomes and frequently required multiple treatments. Significant long-term neural injury was sustained in 3 of 6 surgical patients for mediastinal disease and in only 4% (n = 4) of other surgical procedures. CONCLUSIONS: Surgery retains an important role in the treatment of pediatric head and neck lymphatic malformations despite the advent of sclerotherapy. Isolated neck disease has an excellent outcome with either modality. Treatment decisions were made via a problem-based approach and were individualized according to anatomical location and disease classification.
Subject(s)
Lymphatic Abnormalities/therapy , Sclerotherapy , Adolescent , Antineoplastic Agents/therapeutic use , Child , Child, Preschool , Combined Modality Therapy , Diatrizoate/therapeutic use , Drug Combinations , Electrocoagulation , Fatty Acids/therapeutic use , Female , Humans , Infant , Infant, Newborn , Laser Therapy , Male , Picibanil/therapeutic use , Postoperative Complications , Propylene Glycols/therapeutic use , Retreatment , Retrospective Studies , Sclerosing Solutions/therapeutic use , Ultrasonography, Interventional , Zein/therapeutic useABSTRACT
Angiosarcoma is a rare tumour of endothelial cell origin whilst malignant skull base tumours are highly unusual in paediatric patients. This case reports an angiosarcoma involving the clivus and basi-sphenoid region of the skull base, in a 1-year-old boy. This tumour is extremely rare in childhood, particularly in this site. The histological features were consistent with a high-grade haemangioendothelioma, categorised as an angiosarcoma. The characteristics of this rare malignancy and the challenges in its management are discussed. This is the youngest reported patient, to our knowledge, with an angiosarcoma of the skull base.
Subject(s)
Hemangiosarcoma/diagnosis , Skull Base Neoplasms/diagnosis , Fatal Outcome , Hemangiosarcoma/drug therapy , Hemangiosarcoma/pathology , Humans , Infant , Magnetic Resonance Imaging , Male , Skull Base Neoplasms/drug therapy , Skull Base Neoplasms/pathologyABSTRACT
Acquired pediatric laryngotracheal stenosis almost always results from prolonged intubation for prematurity. An understanding of the process by which this occurs helps in prevention and treatment. Before deciding to perform cartilage augmentation procedures, more limited techniques such as medical therapy or endoscopic surgery need to be considered. Careful assessment of the patient and the stenosis aid the decision-making process for the right operation at the right time. Despite this assessment, patients with a severe or complete stenosis have a poorer prognosis, and cricotracheal resection may be a better option.
