Nasal fossae dimensions in the neonate and young infant: a computed tomographic scan study.

OBJECTIVE: To determine normal values in the size of nasal fossae to better delineate the concept of nasal stenosis in young infants with nasal obstruction and without choanal atresia. DESIGN: Case series. SETTING: Referral center. PATIENTS: Consecutive sample of 62 infants (aged 0 to 6 months) with no craniofacial anomalies who underwent conventional axial computed tomography scans for a neurologic disorder. INTERVENTION: From computer-stored images, the slices taken at the level of the nasal fossae floor and those just above were examined. The length and 10 measurements of the width of the nasal fossae were used to determine normal values. RESULTS: Most measurements, even the length of the nasal fossae, were positively correlated to the age of the patient (R = .44). In the age 0 to 2 months group, the median length was 29.35 mm (range, 21.3-40.4 mm). It was 31.5 mm in the age 4 to 6 months group (range, 25.3-36.9 mm). The anterior bony aperture seems to be the most accurate distance for the assessment of neonatal nasal fossae stenosis. Its median width was 13.5 mm (range, 8.8-17.2 mm). Large variations characterized the dimensions of the middle nasal fossae and the choanae: median values were 7.6 mm (range, 4.9-13.5 mm) and 14.3 mm (range, 10.8-19.0 mm), respectively. CONCLUSIONS: This study defined the normal range of variation for the main dimensions of the nasal fossae in the horizontal plane. These can be used as a basis for determining nasal stenosis in cases of neonatal obstruction.

Non-endoscopic techniques for the evaluation of the pediatric airway.

In children with stridor, a detailed evaluation of the airway is often required to assess precisely its anatomical and functional status. Various methods of assessment have been developed and airway management may include, as well as rigid and flexible endoscopy, the use of imaging techniques such as plain X-rays, a barium oesophagogram, ultrasound, a CT scan, a magnetic resonance image (MRI) and an angiogram, as well as respiratory function tests including acoustic rhinometry and flow volume loops or even pH monitoring. This article aims to highlight the valuable information these alternative techniques can provide.

[Recurrent thyroid abscess in children and malformations of the pyriform sinus]. / Abcès thyroïdiens récidivants de l'enfant et malformations du sinus piriforme.

Recurrent "abscesses" occurring in the thyroid area in children are due to branchial anomalies. Their origin is located close to the oesophageal inlet at the apex of the lateral hypopharyngeal process: the pyriform sinus. The key for the diagnosis comes from laryngohypopharyngoscopy. The true original anomaly is a controversial topic: the persistence of a canal originating from the 3rd or 4th branchial pouch. Anyhow, these anomalies sometimes build tracts or cysts in the deeper parts of the neck, down to the supraclavicular or thoracic areas. Most often, they are limited to the soft tissues surrounding the left thyroid lobe. In these cases, no cyst wall can be found. The 3 cases reported here allow us to ascertain that a pharyngeal infection is the trigger for the neck abscess. Furthermore, a mucosal opening can be the only found anomaly. After recovery from the infectious process, these anomalies have to be treated by a mucosal suture of the pyriform sinus. The recurrent laryngeal nerve should be first discovered and the removal of a small piece of cartilage can be required. If these diagnostic and therapeutic procedures are used at the first infectious episode, they may prevent the occurrence of repeated thyroid "abscesses" in children.

Is nasal polyposis in cystic fibrosis a direct manifestation of genetic mutation or a complication of chronic infection?

Cystic fibrosis (CF) is the most common autosomal recessive disease among Caucasians. It is characterized by abnormal transepithelial sodium and chloride transport. The clinical expressions of the disorder are highly variable including nasal polyposis. Some authors have found that CF children with nasal polyposis form a distinct subgroup of patients within the clinical heterogeneity of the disease with milder gastrointestinal and pulmonary symptoms. The aim of this prospective study was to verify whether the clinical manifestations in CF children with nasal polyposis are different from control CF patients, and to identify any correlation between a phenotype of nasal polyposis and a genotype. Sixty-six CF children, aged 1-25 years, consecutively underwent ENT examination including nasal endoscopy. Twenty-one had nasal polyposis. The remainder formed the control group. There was no statistical difference in the mode and age of presentation of the disease between the two groups. The clinical manifestations (Schwachman and Kulczycki score, colonization by Staphylococcus aureus and Pseudomonas aeruginosa) were comparable between the two groups. We found no statistical difference in the repartition of genotypes between the polyposis and the control groups. Nasal polyposis does not seem to be genetically dependent, but a larger sample of patients is needed to reach an accurate conclusion.

Outcome of laryngeal paralysis in neonates: a long term retrospective study of 113 cases.

Between 1985 and 1990, 113 children were diagnosed as having congenital vocal cord paralysis. Most of them were still being followed up in June 1994. Fifty two had bilateral paralysis, 61 had unilateral paralysis: 41 were on the left side and 20 on the right side. Forty two were idiopathic, 29 were associated with neurologic disorders, six were associated with heart malformations. Fifteen children were born after difficult delivery. Among the newborns with unilateral paralysis that occurred after an abnormal delivery, 73% recovered spontaneously; likewise 70% of the neurologic group and 74% of the idiopathic group recovered spontaneously. The prognosis of bilateral paralysis was worse with only 52% of spontaneous recovery in the neurologic disorders group and the idiopathic group. Seven percent of the children underwent a surgical procedure. They were all decanulated or extubated. In view of our experience the prognosis is poor for bilateral idiopathic laryngeal paralysis or those with neurological context.

[Tonsillectomy in a day care hospital. A socioeconomic study at the Robert Debré Hospital in Paris]. / L'amygdalectomie en hôpital de jour. Etude socio-économique à l'hôpital Robert-Debré de Paris.

Tonsillectomy as an outpatient procedure in children is a common practice in the United States and many other countries. In French public hospitals, it remains quite rare. A 6-month prospective study was conducted in order to check the procedure's feasibility in a large Paris university children's hospital, to describe the involved population and to search for the possible benefits which could be made by a public hospital from an increase in day surgery practice for tonsillectomy. In terms of quality of postoperative outcome, this study confirms the absence of major complications related to this procedure if the proper criteria are met for day surgery. In fact, medical and social findings from the involved patients tend to limit here a large extension of this procedure. For example, in the inpatients group, more than 43% of children had a tonsillar hypertrophy with significant airway obstruction and 47% did not have lodging conditions which would allow day surgery with the required safety. Only 20% of patients could be transferred to ambulatory surgery which leads to 2-3 additional cases each week here. Finally, the cost analysis shows no benefit in human resources at this hospital because the requested differential activity threshold would not be reached.

Unusual presentation of a first branchial cleft.

An atypical case of a first branchial cleft presenting with a cutaneous fistula and an epidermoid cyst of the external auditory canal is reported. The relevant embryology of the branchial apparatus is summarized, and variations of first branchial anomalies are discussed. The relationship with a congenital cholesteatoma is discussed.

[Mycoses of the maxillary sinus. Apropos of 40 cases]. / Les mycoses du sinus maxillaire. A propos de 40 cas.

Between 1985 and 1992, 40 patients with mycosis of the maxillary sinus were treated in the department at Hôpital Saint Michel and of otolaryngology, head-neck surgery at Hôpital Saint Michel and their charts retrospectively analysed. The clinical signs, radiological findings and etiopathological hypothesis are described. The authors report their experience of functional endoscopic sinus surgery for treatment of mycosis of maxillary sinus. A high rate of postoperative successes, a low rate of complications, the recovery of a normal intrasinusal aerial flow and the easy endoscopic follow-up lead them to adverate the use FESS in primary treatment for mycosis of the maxillary sinus.

[Intra- and extracranial nasopharyngeal fibroma. Contribution of imaging and study of local failure. Report on 34 patients]. / Les fibromes nasopharyngiens intra et extracrâniens. Apport de l'imagerie et étude de l'échec local. A propos de 34 patients.

Thirty-four patients with nasopharyngeal angiofibroma were treated between 1975 and 1990. Lesions were classed according to Sessions' classification. 17 showed intracranial extension. Treatment always associated embolization and surgical excision using a transfacial approach and, if necessary, neurosurgical techniques. A total of 13 patients (38.2%) developed recurrent lesions; these included 3 (17.6%) patients in the extracranial group and 10 (58.8%) patients in the intracranial group. Erosion of the clivus and displacement of the cavernous sinus seem to be 2 factors significantly associated with the development of recurrent lesions. Symptomatic recurrences were managed by surgery. Close clinical and radiological follow-up of patients with asymptomatic recurrent tumor made it possible to observe the stabilization, or even, the regression of the tumor. This study also underlines the importance of modern diagnostic and interventional imaging, which makes it possible to better determine tumor extension and to perform highly selective embolizations. Modern imaging also detects recurrences which once would have remained unknown because of their small size and the absence of symptoms. The techniques of embolization of the tumor branches from the internal and external carotid arteries are explained. Finally, our results are compared to those published in the literature.

[Neonatal laryngeal paralysis. Apropos of 116 cases]. / Paralysies laryngées néonatales. A propos de 116 cas.

The following study is based on a retrospective survey of 116 cases of neonatal vocal cord paralysis referred to out department over a period of 5 years. The purpose of this study is to better define the etiology, the evolution, and the prognosis of this affection in the newborn. The principal prognostic factors are: 1) unilateral versus bilateral involvement, 2) the etiological factors associated with the paralysis. Among 21 newborns with unilateral paralysis occurring after an abnormal or difficult delivery, 90% recovered spontaneously. In this form of vocal cord paralysis and in brachial plexus or facial nerve paralysis of obstetrical origin, the etiopathogenesis and prognosis are comparable. Unilateral vocal cord paralysis as the result of other etiological factors and bilateral paralysis as a group have a worse prognosis (76% and 74% spontaneous recoveries, respectively).