ABSTRACT
Six cases of aggressive fibromatosis occurring in the head and neck in children are described. Fibromatosis is a rare, benign but locally infiltrative condition. Primary excision is not always possible in the head and neck areas. It is not always appropriate to treat children using the same modalities as adults due to associated growth problems. The case histories illustrate the management difficulties that can be encountered when treating the paediatric population.
Subject(s)
Fibromatosis, Aggressive/diagnosis , Head and Neck Neoplasms/diagnosis , Child, Preschool , Diagnosis, Differential , Female , Fibroblasts/pathology , Fibromatosis, Aggressive/surgery , Head and Neck Neoplasms/surgery , Humans , Infant , Male , Neoplasm Invasiveness , Palatine Tonsil/pathology , Palatine Tonsil/surgery , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Day surgery is increasing to improve the efficient use of NHS resources and it is vital that the quality of patient care is not compromised. The Audit Commission has recommended that there should be a systematic appraisal of the patient's views to monitor quality of day care. A survey of parental satisfaction with paediatric day-case surgery provides valuable information for those providing day surgery. A specific area of dissatisfaction previously identified is inadequate pain control following discharge. It is also suggested that day surgery may incur higher costs for the general practitioner. A retrospective study to investigate parental satisfaction with 100 paediatric otorhinolaryngology cases was performed. This study found 96 per cent of parents were happy with the treatment their child received, 89 per cent were satisfied with self-administered simple analgesia and no patients visited their general practitioner on the day following surgery. It is concluded that with careful selection and adequate support the degree of satisfaction with day surgery is high for a wide variety of procedures.
Subject(s)
Ambulatory Surgical Procedures/standards , Attitude to Health , Otorhinolaryngologic Surgical Procedures/standards , Parents/psychology , Adolescent , Adult , Age Distribution , Child , Child, Preschool , England , Family Practice , Humans , Infant , Pain, Postoperative/drug therapy , Patient Satisfaction/statistics & numerical data , Postoperative Hemorrhage/etiology , Retrospective StudiesABSTRACT
Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.
Subject(s)
Bronchial Diseases/etiology , Laryngeal Diseases/etiology , Polychondritis, Relapsing/complications , Tracheal Diseases/etiology , Adult , Airway Obstruction/etiology , Anti-Inflammatory Agents/therapeutic use , Carbon Dioxide , Edema/etiology , Erythema/etiology , Female , Humans , Laryngeal Diseases/drug therapy , Laryngeal Diseases/surgery , Laryngeal Mucosa/pathology , Laser Therapy , Middle Aged , Patient Care Planning , Polychondritis, Relapsing/physiopathology , Prednisolone/therapeutic use , Tracheal Diseases/drug therapy , Tracheal Diseases/surgery , Tracheal Stenosis/etiologyABSTRACT
Pharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management. We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non-accidental injury of the child must be seriously considered in all cases.
Subject(s)
Accidents , Child Abuse/diagnosis , Pharynx/injuries , Child , Endoscopy , Female , Humans , Infant , Male , Wounds and Injuries/diagnosis , Wounds and Injuries/etiologyABSTRACT
The differential diagnosis of stridor in an infant depends on a careful history and examination, followed by radiological and endoscopic investigations. Currently a chest, lateral neck and antero-posterior, high kilovolt (Cincinnatti) view radiographs in association with a diagnostic barium swallow are performed prior to the definitive diagnostic procedure of microlaryngobronchoscopy. Our impression was that some of the routinely ordered radiological investigations were of limited value in the differential diagnosis. We undertook a retrospective audit study to determine the value of radiological investigations in the pre-endoscopic assessment of infants with stridor. The radiological and endoscopic information of 100 infants presenting over the three-year period 1991-1993 at Great Ormond Street Hospital, London (a tertiary referral centre) was collected. It was found that only five out of 65 barium swallow investigations performed had consistent positive findings at diagnostic microlaryngobronchoscopy. The lateral neck and Cincinnatti views identified many of the more gross pathologies of the larynx and trachea e.g. the space occupying lesions, which occur infrequently. The more common diseases e.g. laryngomalacia or subglottic stenosis are rarely identified radiologically. Our results confirmed that radiology had a limited screening role and that in a child presenting with stridor the initial radiological assessment should be a chest radiograph with further imaging and a barium swallow only if an abnormality is found at microlaryngobronchoscopy.
Subject(s)
Esophagus/diagnostic imaging , Larynx/diagnostic imaging , Respiratory Sounds , Barium Sulfate , Diagnosis, Differential , Gastroesophageal Reflux/diagnostic imaging , Humans , Infant , Infant, Newborn , Laryngeal Diseases/diagnostic imaging , Laryngoscopy , Radiography , Respiratory Sounds/etiology , Retrospective Studies , Tracheal Diseases/diagnostic imagingABSTRACT
Within the cheek, wedged between masseter and buccinator, is a biconvex pad of fatty tissue, the corpus adiposum buccae, or buccal fat pad (of Bichat). It contributes significantly to the prominence of the cheek of the newborn infant and is sometimes encountered in surgical procedures in the region of the ramus of the mandible or the maxillary tuberosity. This paper reviews the history of the study of the buccal pad of fat, its anatomical location, blood supply, and comparative anatomy. We have also reviewed the pathology of the buccal pad of fat, including traumatic herniation. The fat pad is of interest surgically as it can be used as a free or pedicled graft to close maxillary defects after excision of tumors.
