ABSTRACT
Infantile subglottic hemangiomas are rare congenital lesions of the larynx that are difficult to manage. Our experience with 10 cases was reviewed. All patients presented with stridor at birth, or shortly after. The minimum follow-up was 6 months, with an average of 44 months. The patients were classified and treated according to the size of the hemangioma. The treatment included expectant management, systemic steroids, CO2 laser excision, and tracheostomies. Overall, eight patients were cured, one developed subglottic stenosis, and one died due to unrelated causes. We recommend that (1) patients with small lesions (< 25% of lumen) be treated expectantly, (2) patients with moderate lesions (25-60% of lumen) be treated with systemic steroids initially, and CO2 laser excision if steroids fail, and (3) patients with large lesions (> 60% of lumen) be treated with tracheostomies initially, and staged CO2 laser excision.
Subject(s)
Glottis/pathology , Hemangioma/surgery , Laryngeal Neoplasms/surgery , Combined Modality Therapy , Dexamethasone/therapeutic use , Female , Follow-Up Studies , Hemangioma/drug therapy , Hemangioma/pathology , Humans , Infant , Laryngeal Neoplasms/drug therapy , Laryngeal Neoplasms/pathology , Laser Therapy , Male , Prednisone/therapeutic use , Survival Rate , Tracheostomy , Treatment OutcomeABSTRACT
The relationship between cystic fibrosis (CF) and sinus disease has been appreciated since at least 1959. Unfortunately the standard methods used to treat sinus disease have been very unrewarding in the CF patients. We evaluated the long-term results achieved on 17 patients with CF that underwent FES surgery between July 1988 and January 1991. This group consisted of 16 pediatric and 1 adult patients with previously diagnosed CF, documented chronic sinus disease and nasal polyposis that had failed long-term maximal medical management. The patients, or their parents, were contacted and asked to rate the severity and frequency of their symptoms associated with chronic sinus disease, pre- and postoperatively. The specific symptoms evaluated were nasal obstruction, nasal discharge, postnasal drip, halitosis and cough. In addition, we attempted to measure the number of hospitalizations and the presence and frequency of headaches. We were able to show that, while there was no change in the relative health of patients as measured by the number of hospitalizations, there was a significant improvement in the quality of life. There was a marked decline in the frequency of nasal obstruction, nasal discharge and postnasal drip and a high level of patient satisfaction with the procedure. No changes were seen in the frequency or nature of the cough, halitosis or headache.
Subject(s)
Cystic Fibrosis/complications , Endoscopy , Paranasal Sinuses/surgery , Adolescent , Adult , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Nasal Polyps/complications , Nasal Polyps/surgery , Postoperative Complications , Sinusitis/complications , Sinusitis/surgeryABSTRACT
Children with cystic fibrosis universally have involvement of the paranasal sinuses, and endoscopic management of this sinus disease with its attendant benefits may help them. Ten children with cystic fibrosis underwent examination and computed tomographic scans of their sinuses in 1987 and 1988. All had sinus disease demonstrated and seven went on to undergo endoscopic surgery in the same period. All children had repeated examinations and computed tomographic scans in 1990. All had recurrence or persistence of their sinus disease. However, when the patients and their parents were asked about the subjective value of the surgery all believed there were benefits. I conclude that endoscopic sinus surgery does not eradicate sinus disease in children with cystic fibrosis but that it is of value for symptomatic relief of nasal disease.
Subject(s)
Cystic Fibrosis/complications , Paranasal Sinus Diseases/surgery , Adolescent , Child , Child, Preschool , Endoscopy , Follow-Up Studies , Humans , Paranasal Sinus Diseases/etiology , Treatment OutcomeABSTRACT
This is a case presentation of a neonate with McKusick-Kaufman Syndrome (hydrometrocolpos, polydactyly and congenital heart disease) accompanied by a complete tracheal ring in the distal trachea. This undiagnosed anomaly caused acute respiratory failure after another surgical procedure. Emergent bronchoscopy revealed the diagnosis and the ring was successfully dilated. This is the only known survivor of a complete tracheal ring associated with this syndrome.
Subject(s)
Respiratory Insufficiency/etiology , Trachea/abnormalities , Tracheal Stenosis/complications , Female , Heart Defects, Congenital/pathology , Humans , Infant, Newborn , Syndactyly/pathology , Syndrome , Uterine Diseases/pathology , Vaginal Diseases/pathologyABSTRACT
Children from the University of Alberta Cystic Fibrosis Clinic were evaluated for nasal polyposis and sinusitis. The results of office examination, coronal CT scanning, and functional endoscopic sinus surgery are compared. Sinonasal disease was found to be ubiquitous in children with cystic fibrosis evaluated with coronal CT scanning. Coronal CT scanning was found to be an accurate predictor of sinonasal disease, and useful for defining the complex anatomy of this region. Outpatient endoscopic sinus surgery, after pre-op assessment by a pediatric pulmonologist, was found to be a safe procedure, with lesser morbidity, than conventional sinus surgery.
Subject(s)
Cystic Fibrosis/complications , Nasal Polyps/complications , Sinusitis/complications , Adolescent , Adult , Child , Child, Preschool , Endoscopy , Female , Humans , Male , Nasal Polyps/diagnosis , Physical Examination , Sinusitis/diagnosis , Tomography, X-Ray ComputedABSTRACT
Treatment of angiofibromata is both controversial and challenging. The two major treatment modalities are surgery and radiation. Adjuvant treatment with chemotherapy or embolization can be used as well. The major treatment options and adjuvant therapy will be discussed and two illustrative case studies will be presented.
Subject(s)
Histiocytoma, Benign Fibrous/therapy , Nasopharyngeal Neoplasms/therapy , Paranasal Sinus Neoplasms/therapy , Child , Combined Modality Therapy , Embolization, Therapeutic , Histiocytoma, Benign Fibrous/radiotherapy , Histiocytoma, Benign Fibrous/surgery , Humans , Male , Nasopharyngeal Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/surgery , Paranasal Sinus Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/surgeryABSTRACT
Sixteen children with indwelling tracheostomy tubes or Montgomery T-tubes were cared for at home under the supervision of the Respiratory Home Care Program. The infants and children ranged in age from five months to 15 years and required tracheostomy for various forms of pathology. There was one unexpected death at home, but it did not appear to be caused by tracheostomy tube problems. We believe that home tracheostomy care in the pediatric patient is safe and is a great benefit to the wellbeing of the patient.
Subject(s)
Home Care Services , Home Nursing , Tracheotomy/nursing , Alberta , Child, Preschool , Evaluation Studies as Topic , Humans , Infant , Quality of Life , RiskABSTRACT
It is well documented that prolonged endotracheal intubation can lead to subglottic trauma and stenosis. Newborn infants with hyaline membrane disease often require assisted ventilation for prolonged periods of time. We examined 11 such children ranging in age from four months to 4.25 years by endoscopy. Some abnormality was found in every child, and in nine there was minor narrowing of the airway.
