A Rare Case of Pediatric Oropharyngeal Schwannoma.

This is a case of a male child who presented with a progressively enlarging oropharyngeal mass, hyponasal voice, and symptoms of obstructive sleep apnea. Computed tomography imaging of the head and neck revealed a well-circumscribed low-density area of polypoid morphology arising from the left lateral pharyngeal wall, filling most of the posterior oropharynx and extending to a pedicle at the lateral nasopharynx. Histopathological evaluation following surgical excision revealed Antoni A tissue and S100 immunoreactivity. The presentation and diagnosis of benign schwannoma neoplasms are discussed.

Langerhans Cell Histiocytosis of the Skull.

This is a case of a pediatric male who presented with a postauricular mass and pain. Computed tomography and magnetic resonance imaging suggested a diagnosis of Langerhans cell histiocytosis. Characteristic imaging findings and initial workup for Langerhans cell histiocytosis are described.

Gastrostomy tube placement in neonates undergoing tracheostomy: an opportunity to coordinate care?

OBJECTIVES: To describe variations in timing of gastrostomy tube (GT) placement for neonates undergoing tracheostomy. METHODS: Database study of neonates undergoing tracheostomy and GT placement using the Pediatric Health Information System (2012-2015). The primary outcome was timing of GT relative to tracheostomy. Logistic regression evaluated associations of patient- and hospital-level characteristics with GT timing. RESULTS: Of 1156 patients undergoing GT and tracheostomy placement, 42.4% had concurrent GT placement, 23.3% GT placement prior to tracheostomy, and 34.3% GT placement after tracheostomy. The proportion of patients undergoing concurrent placement ranged from 0 to 80% among 47 hospitals. Neonates born at 31-35 weeks, having cardiovascular comorbidities, history of diaphragmatic hernia repair, or gastroesophageal reflux disorder were more likely to receive GT placement prior to tracheostomy. CONCLUSION: Significant variability exists in the timing of neonatal tracheostomy and GT placement. Opportunities may exist to optimize coordination of care for neonates and reduce anesthetic exposure and hospital resource utilization.

The ubiquity of asymptomatic respiratory viral infections in the tonsils and adenoids of children and their impact on airway obstruction.

BACKGROUND: Airway obstruction due to enlargement of tonsils and adenoids is a common pediatric problem resulting in sleep disordered breathing. The cause for the relatively abnormal growth of tonsils and adenoids is poorly understood. METHODS: Non-acutely ill children undergoing tonsillectomy and adenoidectomy (T&A) for various reasons were enrolled prospectively in a study to determine the frequency of asymptomatic respiratory viral infections in each lymphoid tissue and to relate the number and types of virus to the degree of airway obstruction. Molecular techniques were used to detect 9 respiratory viruses while Brodsky scores and measurements of percentages airway obstruction were used to estimate the degree of airway compromise due to the tonsil and adenoid, respectively. RESULTS: Viruses were detected in 70.9% of tonsils and 94.7% of adenoids, p < 0.001. Adenovirus was the most common virus detected at 71.1%. Adenoids had an average of 2.4 viruses compared to 0.92 for tonsils, p < 0.001. Higher Brodsky scores were only associated with EBV in tonsils, p = 0.03, while greater percentages of airway obstruction in the adenoids were associated with adenovirus, EBV, corona virus, parainfluenza virus and rhinovirus, p ≤ 0.005. CONCLUSIONS: Asymptomatic viral infections are common and directly related to the degree of airway obstruction significantly more often in adenoids than tonsils.

Salivary botulinum toxin injection may reduce aspiration pneumonia in neurologically impaired children.

OBJECTIVES: Neurologically impaired children often drool and aspirate saliva leading to recurrent aspiration pneumonia and frequent hospitalizations. Salivary botulinum toxin injection is known to reduce sialorrhea. This study evaluates whether this intervention affects the frequency and duration of respiratory infections including aspiration pneumonia and hospitalizations in neurologically impaired children. METHODS: Retrospective review of patients treated with salivary botulinum toxin at a tertiary care pediatric hospital from January 2009 to December 2013. Each patient was their own control and 180 day pre-injection and post-injection time periods were compared. Outcomes evaluated included: number of hospital days, intensive care unit days, days of antibiotic treatment, chest X-rays, and infiltrates on chest X-ray. RESULTS: 13 patients accumulated 539 hospital days. All children were gastrostomy tube dependent. 54% were tracheostomy tube dependent. Amongst all patients, the total hospital days decreased from 385 to 154 (P=0.02), the mean days treated with antibiotics decreased from 214 to 47 (P=0.02), and the number of chest X-ray confirmed infiltrates decreased from 20 to 6 (P=0.02) after injection. CONCLUSION: In this review, there was a decrease in hospitalized days, antibiotic usage, and chest X-ray infiltrates after the salivary botulinum toxin injection. A prospective study is needed to evaluate whether this treatment can prevent aspiration pneumonia in neurologically impaired children.

Head and neck dog bites in children.

OBJECTIVES: 1) Demonstrate patterns of dog bite injury to the head and neck in children. 2) Identify treatment outcomes of dog bite injuries to the head and neck. STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: Children aged 0 to 19 years, treated for head and neck dog bites at our tertiary care children's hospital (1999-2007), were included. Demographics, dog breed and ownership, seasonal incidence, wound location, characteristics, management, and complications were recorded. RESULTS: Eighty-four children, aged 10 months to 19 years (mean, 6.19 years) underwent primary repair of head and neck dog bite injuries. The cheek (34%) and lips (21%) were involved most commonly. Average wound length was 7.15 cm. Dog bite incidence peaked during summer months. Infection occurred in 10.7 percent. Pulsed dye laser was used to improve cosmesis. CONCLUSIONS: Children are vulnerable to head and neck dog bite injuries. Wound healing is excellent despite a contaminated wound. Infections occur infrequently. Pulsed dye laser improves cosmesis.

A new technique (the NOW test) for the detection of Streptococcus pneumoniae in the effusions of otitis media.

The presence of Streptococcus pneumoniae in chronic otitis media was determined with a new antigen detection kit, the NOW test. The NOW test was originally designed as a urinary antigen test but was adapted to middle-ear effusions for the present study. Middle-ear effusions from 52 children were studied. Streptococcus pneumoniae was cultured from 10 per cent of the effusions. The NOW test was positive in 23 per cent of the effusions, 80 per cent of culture positive and 17 per cent of culture negative effusions. The NOW test proved to be rapid, simple, reliable and relatively inexpensive for the detection of pneumococcal antigen in the middle-ear effusions. This test may prove valuable for the management of children with acute otitis media who undergo tympanocentesis.