Case series: Internal jugular vein ectasia in pediatric patients.

Jugular vein ectasia is a dilation of the vein without tortuosity. This finding can easily be misdiagnosed or overlooked. Because of its rarity, many pediatricians, otolaryngologists, and pediatric surgeons are unfamiliar with this diagnosis and how to manage it. We report a series of 2 cases of internal jugular vein ectasia in pediatric patients and discuss its clinical findings, simple and noninvasive method of diagnosis, and treatment.

Pediatric epidermoid cysts masquerading as ranulas: A case series.

Pediatric neck masses represent a variety of differential diagnoses. A common pathology in pediatric cystic neck tumors include ranulas, mucus retention cysts due to salivary gland obstruction. Epidermoid cysts are lesions infrequently encountered in the pediatric population and may appear similarly to ranulas on computed tomography imaging. MRI more easily differentiates these masses, and should therefore be the preferred imaging modality. Due to their distinct intraoperative management, ranulas and epidermoid cysts should be distinguished preoperatively through proper workup.

Follow-up audiometry after bilateral myringotomy and tympanostomy tube insertion.

OBJECTIVE: There are no evidence-based guidelines regarding timing of postoperative audiometric follow-up for children undergoing tympanostomy tube insertion. Given the variability of follow-up among physicians, we attempt to guide the timing of postoperative audiograms using objective data. STUDY DESIGN: Retrospective chart review. METHODS: All pediatric patients undergoing primary bilateral myringotomy and tympanostomy tube insertion for otitis media with effusion who had audiometric data available at two follow-up times were identified from 2014. Patients were classified according to the type of audiometry performed and were further categorized into those who had tympanostomy tube insertion only and those who had concurrent adenotonsillectomies. RESULTS: 34 patients were included in the study. Among patients assessed by sound field audiometry, the mean sound field threshold value was 29.2dB preoperatively and improved to 21dB 2 weeks postoperatively and 17.9dB 6 to 10 weeks postoperatively. The difference between the two postoperative means was significant (p<0.0001). For patients evaluated by pure-tone audiometry, the mean preoperative air-bone gap was 20.1dB; this improved to 10dB at the first postoperative visit and 7.3dB at the second visit. The difference between the two means was significant (p<0.0001). For the subgroups in which adjunct adenotonsillectomy was performed, the greater improvement at the later follow-up was still statistically significant. CONCLUSIONS: Progressive hearing improvement was demonstrated from 2 weeks to 6 to 10 weeks postoperatively. We recommend testing no fewer than 6 weeks after tympanostomy tube insertion. Earlier audiometry underestimates the degree of hearing improvement.

Sclerosing mucoepidermoid carcinoma of the parotid gland: case report.

Mucoepidermoid carcinoma is the most common malignant salivary gland neoplasm. Its sclerosing morphologic variant, however, is an extremely rare entity. Only 7 cases have been reported in the literature, and only 2 of those reports have discussed this unusual malignancy in detail. This report describes a case involving a 57-year-old woman with an intermediate-grade sclerosing mucoepidermoid carcinoma of the parotid gland. She underwent superficial parotidectomy and radiation therapy with excellent results. Diagnosis and options for treatment are discussed, as well as a review of the literature, which demonstrates that this is an extremely rare malignancy with no strict protocol for treatment.

Harmonic scalpel tonsillectomy versus hot electrocautery and cold dissection: an objective comparison.

We conducted a large-scale retrospective study to compare the surgical efficacy, practical utility, safety, and costeffectiveness of ultrasonic harmonic scalpel tonsillectomy, hot electrocautery, and cold surgical dissection. We based our findings on the length of operating time, complication rates, the length of hospital stay for patients with complications, and relative costs. We then compared our findings with those published in earlier reports, none of which were based on a three-way comparison. Our study population was made up of 316 patients--175 males and 141 females aged 1 to 23 years (mean: 7.3)--who had undergone adenotonsillectomy or tonsillectomy alone at our tertiary care children's hospital between Sept. 1, 2000, and Aug. 31, 2001. The harmonic scalpel was used on 75 patients (23.7%), electrocautery on 109 patients (34.5%), and cold surgical dissection on 132 (41.8%). The mean length of operating time for adenotonsillectomy was 42.4 (n = 70), 43.0 (n = 103), and 49.2 (n = 95) minutes, respectively; the corresponding times for tonsillectomy alone were 23.6 (n = 5), 30.2 (n = 6), and 35.3 (n = 37) minutes. Overall complication rates were 2.7, 5.5, and 6.1%, respectively. Hospital stays for immediate (<24 hr) postoperative bleeding averaged 2.0, 1.0, and 0.7 days, respectively, and stays for dehydration averaged 1.0, 1.3, and 1.5 days. Mean per-patient institutional costs were 460.00 dollars, 310.75 dollars, and 300.00 dollars, respectively. We conclude that harmonic scalpel tonsillectomy is efficacious, practical, safe, and cost-effective, and we recommend that any institution involved with a significant number of pediatric tonsillectomies consider using it.

Airway management in mucopolysaccharide storage disorders.

Mucopolysaccharidoses (MPS), a group of disorders caused by a genetic disruption, create a special challenge for the otolaryngologist. With the rare types of MPS IV and MPS 1 S, a skilled practitioner is required to abate airway management complications. The erratic deposits of mucopolysaccharides throughout the trachea should be taken into account when decisions to stent the airway are made. Proper management requires to provide an airway that is custom-made to meet the patient's needs. This is a case-by-case presentation of 3 patients with MPS who presented to the Children's Hospital of Michigan with progressive respiratory embarrassment. Discussed are the various issues revolving around our ability to provide proper airway management, from intubation to tracheostomy tube placement.

Esophagoscopy for removal of foreign bodies in the pediatric population.

A retrospective chart review of children who had rigid esophagoscopy for potential foreign body ingestion from 1998 to 2001 was conducted at Children's Hospital of Michigan Detroit. All pediatric patients less than 11 years of age who presented with suspected foreign body ingestion in a hospital setting over a 4-year period were retrospectively studied. Patient characteristics noted included age, sex and clinical presentation. Pre-operative radiographic findings, esophagoscopy findings, clinical presentations and types of foreign bodies were recorded. A history compatible with foreign body ingestion dictates diagnostic endoscopy with or without radiographic confirmation, and an acceptable rate of performing esophagoscopy without finding a foreign body was found to be 6.2%.

Pulmonary involvement in a case of juvenile-onset recurrent respiratory papillomatosis.

Juvenile-onset recurrent respiratory papillomatosis is primarily a disease of children and adolescents. Although most patients experience spontaneous regression at a later age, some patients continue to be affected throughout their lives. We report the case of a 35-year-old woman with a 33-year history of juvenile-onset recurrent respiratory papillomatosis who developed pulmonary dissemination with malignant transformation. Malignant transformation is the most feared sequela of pulmonary dissemination, and it should be addressed aggressively. If treated promptly, the patient can enjoy prolonged survival. Computed tomography is superior to plain radiography for detecting and evaluating the extent of disease.