The diagnosis of nontuberculous cervicofacial lymphadenitis: A systematic review.

BACKGROUND: Nontuberculous mycobacterial cervicofacial lymphadenitis (NTMCL) is an uncommon condition detected in young immunocompetent children who typically present with a nontender neck mass. Various tests have been proposed to assist in the work-up of suspected NTMCL, with varying diagnostic utility. This systematic review investigates the sensitivity of the various diagnostic methods used in the work-up of pediatric NTMCL. METHODS: A systematic review in accordance with PRISMA guidelines was performed using the Pubmed, EMBASE, and Web of Science databases. Searches were filtered for English language studies published prior to 05/10/22. Studies meeting criteria included studies featuring 15+ pediatric patients with confirmed or suspected NTMCL. Studies with any reported diagnostic methodology used in the workup of NTMCL were included. RESULTS: Of 836 abstracts/articles reviewed, 21 studies met inclusion criteria. Diagnostic methods included culture(n = 11 studies), PPD-Tb(Tuberculin)(n = 12), PPD-Scrofulaceum, -Avium, or -Kansasii(n = 6), staining techniques(n = 4), IGRA(n = 3), and ultrasound(n = 2). All studies had an overall low risk of bias. Among patients confirmed to have NTMCL based on PCR and/or culture, the most sensitive tests were PPD-A(0.94, 95 % CI 0.91 to 0.97; n = 210 patients) and PPD-S(0.75, 95 % CI 0.68 to 0.81; n = 171). Auramine and Ziehl-Neelsen staining techniques had moderately high sensitivity(0.85 and 0.60 respectively), though were limited by low patient numbers(n = 20). PPD-Tb(0.45, 95 % CI 0.39 to 0.50; n = 300) and IGRA(0.02; 95 % CI 0 to 0.06; n = 48) demonstrated poor sensitivity. Among patients suspected to have NTM lymphadenitis based on global assessment, the most sensitive tests included combined PPD-S + A + K(0.92, 95 % CI 0.86 to 0.98; n = 85), PCR(0.82, 95 % CI 0.75 to 0.88; n = 136), and PPD-A(0.72, 95 % CI 0.62 to 0.81; n = 84). Culture showed a sensitivity of 0.54(95 % CI 0.50 to 0.58; n = 494). PPD-K, PPD-S, IGRA, and staining techniques demonstrated lower sensitivity. CONCLUSIONS: This systematic review is the largest study investigating the sensitivity of the various diagnostic methods used in the work-up of pediatric NTMCL. Patients with clinical suspicion for NTMCL and a positive PPD-Tb should first have tuberculous lymphadenitis ruled out with IGRA. Patients with a positive PPD-Tb and negative IGRA and high clinical suspicion for NTMCL can undergo presumptive surgical intervention. Patients with a negative PPD-Tb can undergo NTM antigen skin testing if available, or if high clinical suspicion exists, surgical intervention to reduce tissue burden and elicit additional tissue data.

Pediatric Subcutaneous Scalp Mass: A Case Report and Review.

Infantile myofibroma is a unique fibrous tumor encountered in the head and neck. Although the majority of cases are solitary nodules that require only conservative management, awareness of the possibility of multicentric disease is important considering its substantial morbidity. A 3-month-old girl presenting with an enlarging 2.5-cm firm, mobile, nontender subcutaneous scalp mass was evaluated with magnetic resonance imaging and biopsy, revealing a diagnosis of infantile myofibroma. The literature was reviewed for supporting evidence of recommended management in a disease with no official treatment guidelines. Histological, genetic, and imaging characteristics are reviewed. Although biopsy is mandatory, conservative management can be employed for cases without multicentric involvement. Although there are no official guidelines for the evaluation of visceral involvement, skeletal radiograph and abdominal ultrasound are recommended. Infantile myofibroma is a distinct clinical entity with predilection for the head and neck. Its unique immunohistopathology and clinical course should be well understood and should be included in the differential diagnosis of infantile skin and subcutaneous masses.

Prevalence of Renal and Cervical Vertebral Anomalies in Patients With Isolated Microtia and/or Aural Atresia.

OBJECTIVE: The objective of this study was to determine whether patients with isolated microtia or aural atresia have an increased prevalence of renal or cervical vertebral anomalies. DESIGN: The study design was a retrospective medical record review. SETTING: The setting was the following four distinct institutions: an urban tertiary care children's hospital, two urban academic medical centers, and a staff-model health maintenance organization. PARTICIPANTS: Patients diagnosed with microtia, aural atresia, or oculoauriculovertebral spectrum were identified. Patients with facial asymmetry, craniofacial microsomia, and other craniofacial abnormalities or syndromes were excluded. MAIN OUTCOME MEASURES: Main outcome measures were the number of patients with isolated microtia or aural atresia who underwent a renal ultrasound or cervical spine X-ray, the results of those studies, and further evaluation or treatment for any abnormalities found. STATISTICAL ANALYSIS: A binomial analysis using a one-sided 95% confidence level was performed. RESULTS: A total of 514 patients with isolated microtia and/or aural atresia were identified. Of these patients, 145 (28%) had undergone a renal ultrasound and 81 (16%) had undergone cervical spine X-rays. A total of 3 patients (2%) had minimal renal pelviectasis, all of which had resolved on repeat ultrasound and required no treatment. There were no structural renal abnormalities identified, and there were no cervical spine abnormalities identified. CONCLUSIONS: The data suggest that there is no increased prevalence of structural renal or cervical vertebral anomalies in patients with isolated microtia and/or aural atresia. Therefore, these patients do not require routine screening renal ultrasound or cervical spine X-rays.

Treatment of upper airway obstruction in infants with micrognathia using mandibular distraction osteogenesis.

Mandibular distraction osteogenesis has become an accepted alternative treatment for infants and children with upper airway obstruction associated with micrognathia. Several reports exist that purport the efficacy of mandibular distraction in these patients, such as preventing tracheostomy or facilitating tracheostomy removal. However, the majority of these studies are retrospective reviews with small cohorts and relatively short-term follow-up. Consequently, the ideal indications, pre- and postoperative evaluation, timing, and treatment are subject to controversy and not currently well established. Significantly less attention has been given to short- and long-term complications of mandibular distraction, such as effects on the developing tooth buds, impact on future mandibular development, and temporomandibular joint abnormalities. This article reviews the basic principles of distraction osteogenesis, summarizes the outcomes of recent literature involving pediatric mandibular distraction including this author's experience, and discusses the known and potential adverse sequelae of mandibular distraction. Before a clearly defined role of mandibular distraction in the treatment of infants with micrognathia-associated upper airway obstruction can be established, additional prospective studies are necessary to delineate its benefits and limitations.

Skeletal volume enhancement: implants and osteotomies.

PURPOSE OF REVIEW: Facial plastic surgeons are concerned with improving or restoring function and form. Most surgeons perform primarily soft tissue procedures, which alone are often sufficient. However, deficiencies in the underlying craniomaxillofacial skeleton must also be addressed. Facial skeletal augmentation remains an essential aspect of cosmetic and reconstructive surgery. This article reviews the basic alloplastic biomaterials available for facial volume enhancement, discusses the zygomatic sandwich osteotomy for malar augmentation, and describes recent applications of distraction osteogenesis in the craniomaxillofacial region. An update in tissue engineering and computer modeling is also provided. RECENT FINDINGS: High-porosity expanded polytetrafluoroethylene has been developed to provide a softer feel with less shrinkage and migration because of better biointegration and cellular ingrowth. Long-term results with porous polyethylene have demonstrated superior biocompatibility and minimal complications. Hydroxyapatite cement has been associated with an immunoguided delayed inflammatory reaction that leads to thinning of the overlying skin and exposure of the implant.Applications of distraction osteogenesis are rapidly expanding and include deformities of the mandible, midface, and cranium. There has been a trend toward the use of internal hardware, and internal devices are being developed to deliver a greater degree of vector control. Biodegradable devices have been developed to eliminate the second surgical procedure necessary for hardware removal. In the future, successful tissue engineering could eliminate many of the drawbacks associated with implants and osteotomies. The ability to stimulate stem cells to generate autogenous bone has been demonstrated in the laboratory. A novel application of computer technology that integrates laser surface scanning and digitizing with computer-aided design and manufacturing to produce facial prostheses has been described. SUMMARY: An abundance of alternatives exist for skeletal volume enhancement including alloplastic implants, standard osteotomies, and distraction osteogenesis. The surgeon must evaluate the pros and cons of each technique in the context of each individual patient to determine the most appropriate option. Technologic advances in biomaterials, distraction hardware, computer modeling, and tissue engineering will continue to supply the surgeon's repertoire with improved methods to augment and restore the craniomaxillofacial skeleton.

Thickness and histologic and histochemical properties of the superior pharyngeal constrictor muscle in velocardiofacial syndrome.

BACKGROUND: Velocardiofacial syndrome (VCFS) is one of the most common multiple anomaly syndromes in humans. Pharyngeal hypotonia, one of the most common findings in VCFS, contributes to hypernasal speech, which occurs in approximately 75% of individuals with VCFS. OBJECTIVE: To evaluate the thickness and histologic and histochemical properties of the superior pharyngeal constrictor (SPC) muscle in patients with VCFS to determine whether a muscle abnormality exists that might contribute to the hypotonia seen in these patients. Subjects The SPC muscle thickness in 26 VCFS patients (18 male and 8 female; age range, 3-29 years) was compared with SPC muscle thickness in age- and sex-matched controls using magnetic resonance images. The histologic and histochemical properties of the SPC muscle in 9 VCFS patients (6 male and 3 female; age range, 4-12 years) were compared with SPC muscle in 3 adult cadavers without VCFS (all male; age range, 80-86 years) using specimens obtained during pharyngeal flap surgery. RESULTS: The thickness of the SPC muscle was significantly less in patients with VCFS (2.03 mm) than in patients without VCFS (2.85 mm). The SPC muscle contained a significantly greater proportion of type 1 fibers in patients with VCFS (27.7%) than in adults without VCFS (17.9%), and the diameter of the type 1 fibers was significantly smaller in patients with VCFS (21.6 micro m) than in adults without VCFS (26.6 micro m). CONCLUSIONS: Differences in the thickness and histologic and histochemical properties of the SPC muscle found in patients with VCFS compared with individuals without VCFS may offer insight into the cause of pharyngeal hypotonia and hypernasal speech seen in these patients.

Microtia reconstruction: an update.

Reconstruction of the microtic ear remains one of the most challenging procedures encountered by the reconstructive surgeon. The use of autogenous rib cartilage continues to be the gold standard for microtia repair. Numerous refinements and modifications in the original technique described by Tanzer have paved the way for exceptional results in experienced hands. However, ideal results are not always achieved, and there continue to be drawbacks with the standard approach to reconstruction with autogenous rib cartilage. In an attempt to circumvent these shortcomings, surgeons have developed alternative or adjuvant techniques to repair the microtic ear, including the use of tissue expansion, alloplastic implants, and osseointegrated prostheses. Finally, greater emphasis is being placed on early atresia repair in appropriate candidates.