Foreign body aspiration in children: our pediatric tertiary care experience.

PURPOSE: Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. METHODS: We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. RESULTS: 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3 years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5 days (± 2.9). Complications such as pneumothorax were seen in two cases. CONCLUSIONS: Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.

3D bioprinting in airway reconstructive surgery: A pilot study.

OBJECTIVES: Open surgery is a reliable choice for congenital subglottic stenosis, that represents the third most common congenital anomaly of the larynx. One of the procedures performed is anterior laryngotracheal reconstruction (LTR) with anterior rib graft. The objective of this preliminary study was to evaluate the potential of 3D printing technology for the realization of laryngo-tracheal scaffold in Polycaprolactone (PCL) implanted in vivo in ovine animal model. METHODS: A 3D computer model of a laryngeal graft and a tracheal graft was designed and printed with PCL through 3D additive manufacturing technology. The scaffolds were seeded with autologous mesenchymal stem cells and cultured in vitro for up to 14 days. Anterior graft LTR with 3D printed scaffolds was performed on 5 sheep. The animals underwent endoscopic examinations at the first, 3rd, 6th, and 12th weeks after surgery and before sacrifice. The integration of the material was evaluated by the pathologist. RESULTS: Two animals showed a favourable postoperative course and were sacrificed at 6 months postoperatively. In these cases, we observed endoscopically a complete integration of the cellularized PCL scaffold into the peri-implant tissues, and the pathologist found the growth of respiratory epithelium on the scaffold's inner surface. Other two animals showed a difficult post-operative recovery characterized by respiratory distress resulting in early sacrifice on postoperative days 31 and 33. In these animals we found a poor integration of the grafts into the tracheal structure, and a better integration of the laryngeal scaffold. The last animal developed a wound abscess and was sacrificed 80 days after surgery. We observed, in this case, a poor scaffold integration and an acute inflammatory reaction. CONCLUSIONS: From the preliminary data obtained we found that the excessive stiffness of the material, along with the anatomical features of the sheep, is a major limitation of this study. It will be necessary in the future to create a new biocompatible, more flexible and elastic graft, to achieve greater integration into surrounding tissues. Bioconstructed grafts could simplify surgery for the treatment of laryngo-tracheal stenosis, particularly in the treatment of long tracheal stenoses, which have, at the moment, very complex surgical options. LEVEL OF EVIDENCE: NA.

Pediatric Voice Handicap Index (pVHI): A Tool for Evaluating the Reliability and Validity of Voice Therapy in Children With Benign Vocal Fold Nodules.

OBJECTIVES: benign vocal fold lesions (BVFLs) represent the most common etiology of voice disorders in paediatric population, cause of dysphonia by preventing full vocal fold closure and modifying vibratory characteristics. Of those pathologies, vocal fold nodules represent almost 63% of the cases in children between 0-14 years. Management may include a combination of phonosurgery, voice therapy and pharmacological treatment, but almost 95% of otolaryngologists recommend voice therapy as primary treatment. The Pediatric Voice Handicap Index (pVHI) is nowadays widely used and accepted in the evaluation and monitoring of paediatric patients with dysphonia. The aim of our study was to demonstrate the reliability and validity of PVHI in the evaluation of the effects of voice therapy as treatment of vocal fold nodules in the paediatric population. PATIENTS AND METHOD: in this retrospective chart review twenty-seven (27) dysphonic patients with bilateral vocal fold nodules were treated with behavioral voice therapy approaches, and the PVHI surveys was administered to each patient parent's before and after therapy. The age of the patients ranged from 4 to 14 years (mean age 8.7 y-o); 17 (63%) were male and 10 (37%) females. RESULTS: according to our results, behavioral voice therapy effectively improved pVHI scores from pre- to post-treatment in paediatric patients with bilateral vocal fold nodules.

Changes in Breathing Patterns after Surgery in Severe Laryngomalacia.

BACKGROUND: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. OBJECTIVE: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. STUDY DESIGN: A series of retrospective cases at a tertiary referral children's hospital. METHODS: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children's Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3-6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. RESULTS: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child's age. CONCLUSIONS: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.

Inflammatory Myofibroblastic Tumor of the Upper Airways Harboring a New TRAF3-ALK Fusion Transcript.

Inflammatory myofibroblastic tumor (IMT) is a rare disease that mainly involves the lung and the abdomen with an intermediate clinical course but a recurrence rate between 15-30%. Radical surgery represents the gold standard of treatment, while chemotherapy and radiotherapy are considered for unresectable lesions. The identification of ALK translocations in IMT opened the option for the use of target therapies. Indeed, the ALK inhibitors have changed the treatment approach for aggressive lesions, improving the prognosis. Intraluminal upper-way IMT is extremely rare and represents a medical challenge. We reported an endotracheal IMT case presenting a previously unknown TRAF3-ALK fusion transcript.

Surgical Options for Pediatric Bilateral Vocal Cord Palsy: State of the Art.

Management of pediatric bilateral vocal cord palsy (BVCP) is a controversial and challenging topic. It may represent a severe obstructive condition usually associated with respiratory distress, and, in such condition, tracheostomy has been considered the gold standard for a long time. Many surgical options have been described and used to increase the glottic space in BVCP (1), with ongoing research of less invasive techniques. The challenge and current trend in our department and in many major pediatric centers is to avoid tracheotomy through an early treatment. Many techniques introduced in the last decade reduced the number of tracheotomies and increased the decannulation rate. Furthermore, we observed a recent increase in attention to preserve the quality of the voice with new techniques, such as endoscopic arytenoid abduction lateropexy which is in our opinion an important innovation to improve glottic space with satisfactory voice results. We present a review of the literature about the evolution of the treatment options for pediatric BVCP during the years.

Prognostic value of resection margins in supracricoid laryngectomy.

OBJECTIVES: The objective was to assess the prognostic value of surgical margin involvement in patients treated for squamous cell carcinoma of the larynx. STUDY DESIGN: Retrospective study. METHODS: A review was made of 253 patients treated with supracricoid laryngectomy between 1984 and 2001. A histopathological study on the surgical resection margins was performed in all cases. The incidence of local recurrence was correlated with the histological features of resection margins. RESULTS: Forty patients (15.8%) were identified as having positive margins: 29 had invasive carcinoma and 11 had dysplastic lesions. The remaining 213 patients (84.2%) had negative margins. Subsequent follow-up showed that 19 of 253 patients developed local recurrence and 3 patients developed regional recurrence. Nine of these patients had positive resection margins (six with invasive carcinoma and three with dysplastic lesions), and 10 had negative resection margins. Overall survival at 3 years was significantly higher for patients without recurrence than for patients with local or regional failure (89.9% vs. 45.5% [P <.05]). CONCLUSION: According to results of the study, patients with positive resection margins developed local recurrence more frequently than those with clear resection margins (P <.05).