Subglottic stenosis and socio-economic deprivation: a 6-year review of the Scottish National Service for Paediatric Complex Airway Reconstruction.

OBJECTIVE: Subglottic stenosis is the third most common cause of stridor in children, and severe cases may need surgical reconstruction. Babies born to parents in high-deprivation areas are at increased risk of prematurity and low birth weight. This may require intensive care admission with prolonged intubation, hence, putting them at increased risk of subglottic stenosis. We aimed to review cases of subglottic stenosis requiring surgical intervention in the Scottish population and its association with socio-economic deprivation. METHODS: We collected retrospective data on all children who underwent open reconstructive surgery for subglottic stenosis between January 2005 and January 2011 at the Royal Hospital for Sick Children, Yorkhill, which provides the national complex airway reconstruction service for Scotland. The Scottish Index of Multiple Deprivation (SIMD) was used to categorise deprivation based on the child's home postal code. Incidence figures were calculated based on the total number of births in each deprivation category over the time period. RESULTS: There were a total of 53 cases of subglottic stenosis undergoing surgery in Scotland over the last 6 years, of which 31 were acquired and 22 were congenital. The most common procedure performed was laryngotracheal reconstruction with cartilage grafts (46 cases). No association was found between deprivation and the incidence of acquired or congenital subglottic stenosis. CONCLUSION: Our data is the first attempt to review the incidence of subglottic stenosis in the Scottish population and its association with deprivation. Perhaps surprisingly, we found no association.

Development of a screening service for neonatal ear deformity using neonatal hearing screeners and an information leaflet.

OBJECTIVES: Early splinting of neonatal ear deformities has been proven to be successful but the opportunity to splint is frequently missed due to lack of awareness amongst healthcare personnel. We aimed to develop a regional screening service using neonatal hearing screeners and an information leaflet to allow for the early detection and treatment of such children. METHODS: We created an information leaflet that was distributed by hearing screeners to all parents in Greater Glasgow at the time of the child's neonatal hearing assessment, with a contact number allowing parents to self refer. All neonates referred were seen at a dedicated clinic within a week and suitability for splints determined. We aimed to assess acceptability of the service, splinting result as rated by parents and otolaryngologist and also costs involved. RESULTS: Over a 15 month period, 13,403 leaflets were distributed. 88 babies were referred (0.7%) and 54 were found suitable for splinting. 78% of parents rated the efficacy of splints as either excellent or very good and 96% said they would recommend the service to a friend. Median age at first review was 4 days. We found a weak but statistically significant correlation between age at first review and the surgeon rated outcome from splinting (Spearman's rho=-0.321, p=0.038), with those babies commencing treatment early generally having a better splinting result. We also found that age at first review correlated with duration of splinting required (Spearman's rho=0.357, p=0.008), with younger babies generally requiring shorter splinting times. Cost analysis revealed a saving of £482.76 per child when comparing splint treatment to potential later corrective ear surgery costs. CONCLUSIONS: Our screening service is both acceptable to parents and efficient in allowing for early correction of ear deformity in the majority of cases. By detecting treatable children early, we propose that the introduction of routine screening and splinting on a wider basis will avoid the psychological burden of ear deformity in childhood and also avoid the need for later corrective surgery.

Sutureless repair of the facial nerve using biodegradable glass fabric.

OBJECTIVES/HYPOTHESIS: To compare a sutureless method of facial nerve repair using a biodegradable glass fabric with the standard method of microsurgical suture. STUDY DESIGN: The facial nerve was transected in groups of six sheep and repaired by either entubulation with a biodegradable glass fabric or standard microsurgical epineurial suture repair. METHODS: Both methods of repair were compared with each other and with a normal control group using electrophysiological and morphometric analysis. RESULTS: Maximum conduction velocity, axon and fiber diameter, and myelin-sheath thickness were all reduced in the repaired nerves when compared with the normal nerves. There was no significant difference among any of the outcome variables between the repair groups. CONCLUSIONS: Repair of nerve injuries by entubulation has several theoretical advantages over standard suture repair: less trauma to nerve ends, no need for microsurgical skills, and delivery of neurotrophic growth factors. It is concluded that repair of the facial nerve by glass-wrap entubulation offers an alternative to standard suture repair without the demands of microsurgery on both time and surgical expertise.