Swelling at the angle of the mandible: imaging of the pediatric parotid gland and periparotid region.

The pediatric parotid gland and periparotid region are subject to a variety of lesions and are most often evaluated with ultrasonography (US), contrast material-enhanced computed tomography (CT), and magnetic resonance (MR) imaging. US may be used to assess the size of the parotid gland, distinguish diffuse from focal disease, assess vascularity and adjacent vascular structures, distinguish cystic from solid lesions, and guide fine-needle aspiration. However, further evaluation with CT or MR imaging may be needed to better define the nature and extent of disease. CT is the imaging modality of choice for most pediatric parotid disease (including acute inflammation, abscess, calculi, and major salivary duct obstruction) and most solid masses and may obviate sedation. However, a mass associated with facial nerve symptoms should be evaluated with MR imaging because it is the only modality that can consistently demonstrate the facial nerve. Findings at US, CT, and MR imaging allow localization of parotid lesions and may suggest a specific cause. Clinical information, familiarity with normal parotid anatomy at various stages of its development, and knowledge of the imaging characteristics of parotid and periparotid lesions are essential for appropriate radiologic evaluation. This information can be used to guide therapy and plan a surgical approach.

Hypovolemic shock after air reduction of intussusception.

A 7-month-old white baby girl developed hypovolemic shock requiring resuscitation secondary to an air enema reduction of intussusception. The implications of this case for standardization of the management techniques in this setting are emphasized.

Growth of adolescents who were born at extremely low birth weight without major disability.

OBJECTIVE: To compare growth between adolescents who were born at extremely low birth weight (ELBW, /=2500 g). DESIGN/METHODS: Cross-sectional design. Fifty-three ELBW and 53 NBW adolescents without a major neurodevelopmental disability were matched by sex, race, age, and socioeconomic status. Anthropometrics (z scores), bone age, body composition (Lunar DPX-L densitometry), and sexual maturity were assessed. ELBW adolescents were classified as being born small for gestational age (SGA) or not (NSGA). RESULTS: Subjects were 58.5% female, 43.4% black, and 56.6% white. The mean birth weight for ELBW subjects was 849 g and 3355 g for NBW subjects. The mean age was 14.85 years. On average, ELBW adolescents were 4.8 cm shorter and 9.1 kg lighter than NBW adolescents. ELBW adolescents had lower mean z scores for height (P <.0001), weight (P <.0001), and head circumference (P <.0001) than NBW adolescents. ELBW/SGA subjects had lower mean z scores for height (P <.0001) and weight (P =.001) than NBW subjects. Head circumference z scores were lower for the ELBW/SGA group than the ELBW/NSGA group or the NBW group (P =. 003). Sexual maturity and relative body composition were similar between groups. Bone age, measured in SD units, was more advanced in the ELBW group (0.86 vs. 0.42, P =.039). CONCLUSIONS: ELBW adolescents who survive without a major neurodevelopmental disability attain lower growth measurements compared with NBW adolescents but have similar sexual maturation and relative body composition.

Pediatric laryngeal granular cell tumor.

A female African-American patient in middle childhood presented with findings of laryngeal disease with airway obstruction and had a laryngeal granular cell tumor. A clinical review of granular cell tumors is presented, emphasizing its propensity for subglottic involvement, its imaging features, and differential diagnosis.

Single central maxillary incisor with nasal pyriform aperture stenosis--CT diagnosis prior to tooth eruption.

Two children with nasal pyriform aperture stenosis had the diagnosis of single central maxillary incisor made with CT scanning prior to tooth eruption and the clinical appreciation of this finding. The surgical and clinical implications of this diagnosis will be presented.

MRI diagnosis of suspected atlanto-occipital dissociation in childhood.

OBJECTIVE: To demonstrate the utility of magnetic resonance (MR) imaging in the diagnosis of complete and partial ligamentous injuries in patients with suspected atlanto-occipital dissociation (AOD). MATERIALS AND METHODS: Five patients with suspected AOD had MR imaging performed within an average of 4 days after injury. MR scans were reviewed with specific analysis of craniocervical ligamentous structures. Charts were reviewed to obtain clinical information regarding presentation, treatment, hospital course, and outcome. RESULTS: Two patients demonstrated MR evidence of complete AOD. One had disruption of all visualized major ligamentous structures at the craniocervical junction with anterolisthesis and evidence of cord damage. The second had injuries to the tectorial membrane, superior band of the cruciform ligament, apical ligament, and interspinous ligament at C 1-2. The remaining three patients sustained incomplete severance of the ligamentous structures at the craniocervical junction. All patients demonstrated subtle radiographic findings suggestive of AOD, including soft tissue swelling at the craniocervical junction without fracture. The two patients with complete AOD died. The three patients with partial AOD were treated with stabilization. On follow-up, these three children were asymptomatic following their craniocervical injury. CONCLUSION: MR imaging of acute AOD provides accurate identification of the craniocervical ligaments injured, classification of full versus partial ligamentous disruption, and analysis of accompanying spinal cord injury. This information is important for early appropriate neurosurgical management and preservation of neurologic function in survivors.

Rhinolithiasis: an unusual pediatric nasal mass.

Rhinoliths are uncommon nasal masses in pediatric patients. The etiology, clinical presentation, CT findings, and differential diagnosis in one case of rhinolith are presented in this report. Understanding this benign entity will allow its distinction from tumors of the nasal cavity.

Retained wooden foreign body in a child's parotid gland: a case report.

Foreign bodies can present a diagnostic challenge to even the experienced surgeon. In one review of 200 surgical cases involving retained foreign bodies, one-third of the cases had been initially missed. Wooden foreign bodies in particular pose a challenge to the physician. In the review cited above, only 15% of wooden foreign bodies were well visualized on plain radiographs. Acutely, on computed tomography (CT) scans, wooden foreign bodies will usually mimic air. However, with time, the attenuation value of a wooden foreign body may increase as moisture is absorbed from the surrounding tissues. Once this occurs, the wooden foreign body may mimic fat, water or muscle. We present an interesting case of a wooden foreign body in the parotid gland in order to illustrate a common presentation of such a foreign body, to review current guidelines for their clinical and radiologic diagnosis, and to suggest strategies for the management of their unique complications.

Laparoscopic gastric antroplasty in children with delayed gastric emptying and gastroesophageal reflux.

BACKGROUND/PURPOSE: A significant number of children (50%) with gastroesophageal reflux (GER) have delayed gastric emptying (DGE). Although controversial, many pediatric surgeons use a gastric outlet procedure in conjunction with fundoplication for gastroesophageal reflux in these patients. This paper describes the technique and clinical outcome of 61 patients undergoing a laparoscopic gastric antroplasty at the time of the laparoscopic fundoplication. METHODS: The charts of 61 patients who underwent laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication between May 26, 1992 and October 17, 1996 were reviewed retrospectively. All patients had a documented DGE confirmed by a liquid isotope meal being retained in the stomach. After completion of the fundoplication, a laparoscopic antroplasty was performed by incising a 2 to 3.5-cm linear incision in the pylorus and distal gastric antrum. The seromuscular wall was divided to the level of the mucosa allowing the mucosa to bulge through the defect. The wound was closed transversely using interrupted 2-0 silk sutures. RESULTS: Four of the 61 patients underwent conversion to open antroplasty for technical reasons. The remaining 57 patients recovered uneventfully from the laparoscopic antroplasty with clinical resolution of both GER and DGE. Two of 57 patients had intermittent episodes of retching and were unable to tolerate large bolus feedings because of dumping. They were treated by dividing the feedings into two smaller portions. These symptoms cleared within 6 months. The remaining 55 patients have tolerated feedings well. Evaluation of the gastric emptying was performed randomly in selected patients with documented improvement of the emptying after antroplasty. An evisceration of omentum through the umbilical incision developed in one patient on the third postoperative day. CONCLUSIONS: Patients with delayed gastric emptying who need fundoplication can be treated with laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication. Laparoscopic antroplasty appears to be clinically efficacious in improving delayed gastric emptying.