Laryngeal dyskinesia as a cause of stridor in infants.

OBJECTIVE: To describe 9 cases of stridor attributed to the failure of the vocal cord to abduct during inspiration. DESIGN: Case series. SETTING: Pediatric otolaryngology referral center. PATIENTS: Nine hospitalized infants, aged 1 to 13 months, presented over a 3-year period for exploration of inspiratory stridor that was attributed to a condition that we have termed laryngeal dyskinesia. RESULTS: A consistent clinical presentation was noted in all cases. The laryngeal dyskinesia occurred during calm breathing, crying, or sleep and was associated with gastroesophageal reflux in 8 cases (diagnosed clinically and/or with pH monitoring). In addition, 3 infants suffered from fainting spells associated with vagal hypertonia that was confirmed by 24-hour Holter monitoring. True paralysis of the abductor muscles was ruled out in all infants because of the presence of normal glottic motion during calm breathing or induction of anesthesia. The stridor resolved between the ages of 4 and 13 months in 7 of the patients. Improvement was progressive and had no clear relationship to treatment for gastroesophageal reflux. CONCLUSION: Laryngeal dyskinesia in infants seems to be a distinct clinical entity, frequently associated with gastroesophageal reflux.

Sarcoidosis of the upper respiratory tract in children.

Sarcoidosis is a multisystemic granulomatosis of unknown etiology which mainly affects young adults. It is characterized primarily by bilateral hilar adenopathies, a pulmonary infiltrate and cutaneous and ocular lesions. It rarely occurs in children under the age of 16. Localization in the upper respiratory tract (URT) is infrequent and sarcoidosis of the URT in children is exceptional, with only 13 cases reported in the literature. In the present report we describe the clinical, diagnostic explorations, histological and therapeutic aspects of 2 new cases in children.

[Fixed retraction pockets and cholesteatoma in children. Authors' experience with 199 cases]. / Poches de retraction fixées et cholestéatomes de l'enfant. Notre expérience à propos de 199 cas.

Cholesteatoma is more destructive in the child than in the adult, but few studies have examined the outcome as a function of age. The authors evaluated retrospectively their experience in 199 cases of cholesteatomas or uncontrollable fixed retraction pouches in children under the age of 15. Mean follow-up was 2 and a half years and the anatomic and functional results are detailed. Reasons for performing first intention or second intention canal wall up or down procedures were analyzed as a function of age. Residual cholesteatomas were particularly frequent in whatever the initial surgical procedure. Cholesteatomas and retraction pouches in the child under 5 (n = 24) were particularly aggressive and destructive, often requiring a canal wall down operation. Residual cholesteatomas were also very frequent and involved both bony and functional element of the petrus. The clinical course of cholesteatoma in the young child appears to be very different, becoming less destructive as the child reaches adulthood.

[Current therapeutic approach to cervicofacial lymphangiomas in children]. / Attitude thérapeutique actuelle devant les lymphangiomes cervico-faciaux de l'enfant.

Twenty-four cases of cervicofacial lymphangioma treated between 1984 and 1991 are reported. The therapeutic approach is discussed. Because the therapeutic problem depends on whether or not the airways are involved, an endoscopic evaluation and a CT scan study should be included in the workup. In the five patients with limited lymphangiomas, complete surgical exeresis was feasible and yielded good results. Sclerosing injections are an alternative to surgery in this situation. In patients with pharyngeal or laryngeal infiltration or involvement of the mediastinum, the prognosis is extremely grim and surgery is still the mainstay of therapy despite the potential for recurrence due to the fact that only incomplete exeresis can be performed. Tracheostomy was required in two patients.

[Therapeutic strategy for cervicofacial lymphangioma in children]. / Attitude thérapeutique devant les lymphangiomes cervico-faciaux de l'enfant.

The authors report a series of 22 cervicofacial lymphagiomas treated from 1984 to 1990, and try to define a therapeutic strategy. In 11 cases, facial, laryngeal or pharyngeal extension was observed, and 1 cas showed mediastinal extension. These cases are not easily treated, and it is impossible to perform complete surgery, thus leading to recurrence. Tracheotomy was necessary in two cases. In 5 cases, the extension was limited to the cervical area and surgical exeresis was considered complete. Sclerosing injections gave variable results.

[Value of cricoid split in congenital subglottic stenoses]. / Intérêt de la laryngofissure antérieure (cricoid split) dans les sténoses sous-glottiques congénitales.

The authors report about the cases of two infants less than 5 weeks old, who presented with congenital subglottic stenosis and in whom a cricoid split produced good results. This procedure, which is classically reserved for difficult extubation of infants due to acquired subglottic stenosis, is compared with the other surgical techniques used in the congenital condition. It may be useful in the latter case owing to its simplicity and to the possibility of performing laryngoplasty later in case of failure.