Thyroid Nodule/Differentiated Thyroid Carcinoma in the Pediatric Population.

Symptoms of thyroid nodules and differentiated thyroid cancer include those of hypo- or hyperthyroidism, voice changes, difficulty breathing when supine, globus sensation, dysphagia, and cervical adenopathy. Surgery has been the first-line mainstay treatment option for large thyroid nodules and thyroid carcinomas. This article highlights thyroid carcinoma in the pediatric population and reviews the current testing and management options. [Pediatr Ann. 2020;50(7):e282-e285.].

Cleft lip and palate.

Cleft lip with or without cleft palate is the most common congenital malformation of the head and neck. Orofacial clefting could significantly affect the quality of life of the child and requires multiple steps of care to obtain an optimal outcome. Each patient should be evaluated for congenital anomalies, developmental delay, neurologic disorders, and psychosocial concerns. A multidisciplinary team is necessary to ensure that every aspect of the child's care is appropriately treated and coordination between providers is achieved. This article discusses the assessment and treatment recommendations for children born with cleft lip and/or cleft palate.

Velopharyngeal dysfunction in children with Prader-Willi syndrome after adenotonsillectomy.

INTRODUCTION: Prader-Willi syndrome (PWS) is a rare genetic disorder with an incidence rate of 1 in 10,000-30,000. Patients with PWS typically have symptoms related to hypotonia, obesity, and hypothalamic dysfunction. A high rate of obstructive sleep apnea (OSA) is found among this population of patients. Adenotonsillectomy has been advocated as a first line approach for treatment of OSA in patients with PWS. Velopharyngeal dysfunction (VPD) is a known complication of adenotonsillectomy. VPD can also be present in patients with global hypotonia, such as those with PWS. The objective of this study is to review the occurrence of VPD in patients with PWS after adenotonsillectomy for OSA. METHODS: A retrospective review was performed of all patients with PWS and OSA from a tertiary pediatric hospital between the years of 2002 and 2012. Pre- and post-operative sleep studies and sleep disordered breathing symptoms, post-operative VPD assessment by the speech-language pathologist (SLP), and VPD treatments were evaluated. RESULTS: Eleven patients (five males and six females), fitting the inclusion criteria, were identified. The age of the patient at the initial otolaryngologic evaluation ranged from 2 to 9 years. All patients underwent adenotonsillectomy for sleep disordered breathing. Four patients were diagnosed with post-operative hypernasality after assessment by a speech-language pathologist. The hypernasality ranged from mild to moderately severe. Of the four patients with hypernasality, two were found to have structural issues requiring surgery (pharyngeal flap). Both of the surgical patients experienced significant improvement in their VPD after surgery. The remaining two patients were found to have articulation error patterns that were considered more developmental in nature and both responded to speech therapy. All patients, except one, had improvement in their polysomnogram or sleep symptoms after adenotonsillectomy. However, three patients continue to require continuous positive airway pressure at night. CONCLUSION: Velopharyngeal dysfunction may occur after adenotonsillectomy in patients with Prader-Willi Syndrome. Families should be counseled of this risk and the potential need for operative intervention to correct it.

Update on surgery for velopharyngeal dysfunction.

PURPOSE OF REVIEW: To review journal articles discussing surgery for velopharyngeal dysfunction over the past year. All articles ascertained by a PubMed search relevant to this topic were reviewed. RECENT FINDINGS: Articles evaluated from the past year discussed the variations, effectiveness, and feasibility of multiple surgical techniques for velopharyngeal dysfunction, including the Furlow palatoplasty, sphincter pharyngoplasty, pharyngeal flap procedure, and other less known novel surgical options. Outcomes, comparisons, and complications were a focus of the majority of the studies. Combinations of the above procedures are also assessed. Nonsurgical options, such as prosthetic devices and pharyngeal augmentation, are mentioned. SUMMARY: Multiple surgical options exist to assist patients with velopharyngeal dysfunction. The majority of the surgical options can be highly successful. A multispecialty team is critical in providing patients with the most appropriate treatment for their specific situation. Standardized speech and velopharyngeal dysfunction outcome measures are necessary to allow accurate preoperative and postoperative comparisons, intrasurgeon comparisons, and multi-institutional comparisons. Unfortunately, there is a lack of standardization in speech outcome measures among the studies published over the last year. The risk of postoperative obstructive sleep apnea must be assessed and discussed prior to surgery for any patient scheduled to undergo surgery for velopharyngeal dysfunction. Future studies promise to improve our understanding of velopharyngeal dysfunction and provide further guidance as to the best surgical options to assist these patients.

Treatment of oral cavity venous malformations with the Nd:YAG laser using the underwater technique.

Mucosal involvement of venous malformations can cause bleeding, pain, and functional impairment. Treatment options include surgery, sclerotherapy, or laser therapy. Neodymium:yttrium aluminum garnet (Nd:Yag) laser therapy has been used to treat mucosal disease, but few studies have focused purely on the oral cavity. We present a retrospective review of 4 patients (5 subsites) with oral cavity venous malformations treated with the Nd:YAG laser using an underwater technique. Photographs of the venous malformations before and after treatment were evaluated by 2 blinded physicians. A visual analog scale was used to rate the treatment. The medical record was reviewed to assess change in symptoms and to note complications. Four sites were rated as having "significant improvement" and 1 site as "some improvement." Our study demonstrates that the Nd:YAG laser can be a feasible option in the treatment of venous malformations of the oral cavity.

Perioperative strategies to improve sinus surgery outcomes in patients with cystic fibrosis: a systematic review.

OBJECTIVES: Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF). DATA SOURCES: PubMed and the Cochrane Library. REVIEW METHODS: A systematic review of the literature was performed. Articles from 1990 to 2012 were searched using the terms sinus surgery and cystic fibrosis with studies limited to the English language and human subjects. Abstracts were reviewed to identify relevant original manuscripts. Bibliographies of relevant articles were examined to identify additional manuscripts. RESULTS: The initial PubMed search identified 169 articles. One additional article was identified through the Cochrane Library. After reviewing the abstracts, 41 selected studies were examined in further detail, and 22 articles were ultimately selected for suitability for this review. The bibliographies of these articles were reviewed and no additional articles were identified. Perioperative strategies included postoperative medical therapies, intraoperative techniques and image guidance, intranasal corticosteroid injection, dornase alfa, gene therapy, and second-look procedures. Most studies were limited to case series with relatively small numbers of patients. Very few randomized controlled studies were identified. CONCLUSION: Despite the prevalence of recurrent sinonasal disease after FESS in patients with CF, evidence for definitive perioperative management in this population is lacking. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in patients with CF are warranted.

Factors of the langugage of pain in patient and volunteer groups.

An empirical determination of the nature and minimum number of dimension necessary to describe responses to the McGill Pain Questionnaire, and a comparison of groups, experiencing clinical or experimentally induced pain, on the dimensions were carried out. Eighty-five patients referred to a low back pain diagnostic clinic and groups of 129 volunteer students exposed to electric shock to pain threshold and pain tolerance levels described their pain using the McGill Pain Questionnaire's descriptive words. An incomplete principle component factor analysis of subjects' ratings suggested that 5 factors should be retained. These factors were judged to reflect: (I) immediated anxiety, (II) perception of harm, (III) somesthetic pressure, (IV) cutaneous sensitivity, and (V) sensory information. Canonical Analysis of Variance and univariate comparisons of back pain, threshold, and tolerance groups on these dimensions were conducted and implications for clinical and laboratory research discussed.