ABSTRACT
BACKGROUND: Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions. METHODS: This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019. RESULTS: Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases. CONCLUSION: This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement.
ABSTRACT
Acute tonsillitis is a common disease. The tonsillar infection can be uni- or bilateral with a high rate of spontaneous recovery. In some cases, a peritonsillar cellulitis or abscess can occur, characterized by an inflammatory reaction of the peritonsillar space. The red flags consist of a gradually worsening odynodysphagia, an ipsilateral swelling of the soft palate, a trismus (infrequent in children) and in some cases a change of voice (« hot potato voice ¼). A needle puncture of the swollen soft palate is then required. If pus is found, a surgical drainage by either hot tonsillectomy or incision under local anesthesia with an appropriate antibiotic therapy must be carried out.
L'amygdalite aiguë représente un motif de consultation fréquent. Elle est caractérisée par une infection amygdalienne uni ou bilatérale de résolution spontanée dans la majorité des cas. Dans certaines situations, celle-ci se complique d'un phlegmon ou d'un abcès périamygdalien caractérisés par respectivement une réaction inflammatoire ou du pus dans l'espace périamygdalien. Les signes d'alerte sont une odynodysphagie sévère latéralisée, une tuméfaction ipsilatérale du voile du palais, un trismus (rare chez l'enfant) et une modification de la voix. L'examen complémentaire comprend une ponction de la tuméfaction du voile à la recherche de pus. En cas d'abcès avéré, un drainage chirurgical en urgence par amygdalectomie à chaud ou incision sous anesthésie locale est préconisé en plus d'une antibiothérapie adéquate.
Subject(s)
Peritonsillar Abscess , Child , Humans , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/therapyABSTRACT
OBJECTIVE: Supraglottic stenosis (SPGS) is a rare condition and little is known about its optimal management. Its etiologies are varied and depend on the age group. Here, we review our institution's series of patients and propose treatment strategies for SPGS. METHODS: SPGS patients between 2013 and 2019 were retrospectively reviewed. We recorded their demography, clinical data and endoscopy. The patients were treated with either an endoscopic, open or a combined approach. Subsequently, we reviewed photo and video documents, medical sheets and long-term follow-up charts. RESULTS: The report includes 14 children having a mean age of 5.7 years (range 2 months-13 years). Seven children had undergone prior supraglottoplasty for laryngomalacia, three children had blunt neck trauma and four had iatrogenic plus post-intubation etiology. Five children received endoscopic treatment and are currently symptom free. Four patients received a combined repair with satisfactory results. Five children received an open repair, four of which are decannulated and feed orally without aspiration. Most children in this group required additional endoscopic interventions. CONCLUSION: Post supraglottoplasty stenosis can be treated optimally by an endoscopic approach. More severe supraglottic cicatrical sequelae with posterior glottic involvement may require a combined endoscopic and open approach. Transglottic stenoses with severe grades of multi-level stenoses require an extended cricotracheal resection.
