Nasal surgery in children: a personal perspective.

OBJECTIVE: To comment on the experience gained from completing 518 nasal procedures in 480 children over the 21-year period from 1986 to 2006 inclusively. DESIGN: Prospective, nonblinded, nonrandomized study. SETTING: Tertiary care pediatric academic otolaryngology-head and neck surgical practice. METHODS: Material was gathered from analysis of an Excel database used to record patient data as surgical procedures were completed. MAIN OUTCOME MEASURES: Type and extent of procedure completed, age at which the procedure was completed, and history of previous nasal surgery. RESULTS: Nasal function improved, and nasal growth was not impacted significantly. CONCLUSION: It is crucial to do an operation on the growing nose (ie, the nose of a child) that will address the pathology present and not adversely affect continued growth.

Preoperative characteristics and postoperative outcomes following adenoidectomy in children.

OBJECTIVES: (1) To describe various preoperative and diagnostic findings of children undergoing adenoidectomy and (2) to evaluate quality of life outcomes following adenoidectomy in children. METHODS: This was a prospective observational study. Patients who were candidates for adenoidectomy at The Hospital for Sick Children were evaluated with respect to preoperative symptoms, flexible nasal endoscopy (FNE) findings, and nasal airflow (NAF) studies. Following surgery, a quality of life questionnaire was administered to all available patients and an attempt was made to repeat the NAF study. RESULTS: Fifty-seven patients were included in the study (31 females and 26 males). The average age of the patient at surgery was 10.1 years. Thirty patients (52.6%) had a significant NAF study, whereas FNE revealed an average nasopharyngeal obstruction of 73.2%. We did not find any correlation between preoperative symptoms, FNE findings, or NAF study results. The degree of symptom reduction was the only predictor of how satisfied a patient would be in the postoperative period (p<.05). CONCLUSION: In our study of adenoidectomy patients, clinical signs and symptoms appear to be more predictable than the objective tests of NAF and FNE. As such, following these symptoms in the postoperative period is important in determining a patient's satisfaction following surgery.

Saliva control issues in the neurologically challenged. A 30 year experience in team management.

OBJECTIVE: The objective of this paper is to report the experience of a multidisciplinary team (otolaryngologist, speech-language pathologists, pediatric dentist, and social worker) functioning at a pediatric rehabilitation center have had in the management of 1487 neurologically challenged individuals with saliva control issues assessed from 1976 to the end of 2004. METHOD: The role of each team member is outlined. Management decisions have consisted of no treatment, utilization of oral-motor training program, elimination of contributing situational factors, utilization of medication, surgery and Botox injections of the major salivary glands. RESULTS: Oral-motor programs to improve oral-motor function is essential initially if there is patient compliance. Surgery was recommended in the majority of patients. Submandibular duct relocation with simultaneous sublingual gland excision remains the procedure of first choice for persistent significant drooling. Aspiration is much less common than drooling and is more problematic to treat. Simultaneous ligation of the submandibular and parotid ducts (aka 4-duct ligation) is promising. A recent initiative to inject the major salivary glands with Botox is being evaluated. CONCLUSIONS: Team evaluation with consensus decision making has worked well in this patient population with complex medical conditions.