Periorbital cellulitis in the pediatric population: clinical features and management of 117 cases.

OBJECTIVE: Since the advent of the Haemophilus influenzae type B vaccine, no North American case series has described periorbital cellulitis extensively as the main focus in the otolaryngology literature has been the management of orbital abscesses. The aim of this study was to describe the epidemiology, underlying causes, clinical presentation, and medical management of periorbital cellulitis. STUDY DESIGN: Retrospective observational case series. SETTING: Montreal Children's Hospital, McGill University Health Centre, a tertiary pediatric referral center in Montreal, Quebec. SUBJECTS AND METHODS: The medical charts of all pediatric patients hospitalized from January 2000 to August 2006 with a discharge ICD-9 code indicating a diagnosis of periorbital cellulitis without abscess were reviewed. One hundred seventeen cases were identified. RESULTS: Periorbital cellulitis in the pediatric population affects mainly preschool-aged patients (mean age 4.1 ± 4.2 years [SD]) and is more frequent among males than females (1.3:1). The most common predisposing conditions are sinusitis (24.8%), trauma (23.1%), and ocular conditions (13.7%). All patients were successfully managed with intravenous antibiotics for a mean period of 3.4 ± 2.6 days and oral antibiotics for 8.1 ± 4.4 days and recovered fully without complications. CONCLUSION: Our results are consistent with the literature on the subject and show that timely identification of periorbital cellulitis cases and appropriate medical management result in resolution of the condition without complications.

Sternoclavicular joint osteomyelitis following head and neck surgery.

OBJECTIVES/HYPOTHESIS: To review all reported cases of sternoclavicular joint (SCJ) osteomyelitis following head and neck surgery. STUDY DESIGN: Retrospective case review. METHODS: PubMed search and one additional case from our institution. RESULTS: Twelve cases were reviewed, and the following recommendations are suggested: risk factors for SCJ osteomyelitis should be identified; early and prompt diagnosis of SCJ osteomyelitis is warranted; tracheostoma care and careful examination of the skin should not be neglected; meticulous screening for cancer recurrence is imperative; if SCJ infection is suspected, cancer recurrence must be ruled out with biopsies; and surgical debridement is considered the gold standard of treatment. Administration of newer-generation antibiotics is a reasonable choice when the infection is detected early, as is maintaining a low threshold for surgical treatment if disease persists or progresses. CONCLUSIONS: Osteomyelitis of the SCJ following head and neck surgery is uncommon and must be distinguished from malignancy with biopsies. Early diagnosis and treatment are imperative. Laryngoscope, 2010.

Residents' satisfaction with Canadian otolaryngology-head and neck surgery programs.

OBJECTIVE: To describe residents' satisfaction with Canadian Otolaryngology-Head and Neck Surgery programs. DESIGN: Electronic survey of 21 items scored on a 5-point Likert scale. SETTING: All Canadian Otolaryngology-Head and Neck Surgery residency programs were surveyed between February and April 2008. Responses were anonymous and on a voluntary basis. METHODS: All Canadian Otolaryngology-Head and Neck Surgery residents were surveyed between February and April 2008. Responses were anonymous and on a voluntary basis. Overall and selected item scores were compared between sexes with the t-test and between postgraduate year levels with analysis of variance. Linear regression model was used to identify factors that would predict burnout. MAIN OUTCOME MEASURES: Item scores and overall score. RESULTS: Ninety-two of 140 residents responded (66%), including 23 female residents. More than 80% of residents agreed or strongly agreed with the following statements: satisfied with surgical volume (90%), satisfied with the amount of active operative participation (82%), confident about their surgical skills (90%), satisfied with teaching from attending staff (84%), have role models for career (93%) and have a good working environment (89%). Weaker areas identified included feedback, research support, and balance in life. Self-perceived burnout prevalence was 33%, with statistically significant higher rates in English programs (p < .001). No difference in both overall and item score was identified between sexes. Ninety-one percent of residents would still choose Otolaryngology-Head and Neck Surgery as a specialty. CONCLUSION: Overall, Canadian Otolaryngology-Head and Neck Surgery residents are very satisfied despite the fact that one-third reported suffering from burnout.

Familial clustering of parotid gland lymphoepithelioma in North America.

OBJECTIVE: To describe genetic susceptibility in the first familial clustering of parotid gland lymphoepithelioma reported in North America. DESIGN: Retrospective study. SETTING: Tertiary care institution with outreach to northern Quebec. METHODS: Chart, family history, literature review, and c-kit assay. MAIN OUTCOME MEASURE: C-kit assay. RESULTS: Four family members of both sexes over two generations had lymphoepithelioma of the parotid gland, without involvement of the nasopharynx. Two c-kit assays were positive of the three cases that could be done. Association with Epstein-Barr virus has been demonstrated in the oncogenesis of lymphoepithelioma. CONCLUSION: Genetic susceptibility and common familial environmental factors play a role in the development of parotid gland lymphoepithelioma. A complete family history should be obtained in all cases of lymphoepithelioma of the parotid gland.

Nontuberculous mycobacteria in children: a changing pattern.

UNLABELLED: Nontuberculous mycobacteria (NTM) infections seem to be increasing in numbers and in severity in developed countries worldwide. OBJECTIVE: To document the severity and to assess whether an increase in cases has occurred over the years, we described the epidemiology, clinical presentation, investigations, and treatment of NTM adenitis seen at the Montreal Children's Hospital. METHODS: Cases were identified through revision of the microbiology laboratory database for positive NTM culture from any site and through retrieval by the medical records of charts of patients with a diagnosis of adenitis and a node biopsy or excision or a diagnostic code of NTM disease, between 1990 and 2004. These charts were reviewed retrospectively. RESULTS: Over the 15-year period, we identified 36 patients with a median age of 2.8 years with NTM adenitis. Of these cases, 22 (61%) occurred in the past 5 years. Only 3 children were born outside Canada. The majority (92%) presented with a cervicofacial mass, and 25% had constitutional symptoms or fever. There were 3 cases of mediastinal adenitis and 2 cases of cervical disease extending to the deep neck vessels, all of which occurred in the past 5 years. The purified protein derivative (PPD) test for tuberculosis was positive (> or = 10 mm) in 11 of 15 patients tested (73%), none of whom had ever had contact with tuberculosis. Thirty-three patients had surgery. Of the 26 patients who had excisional biopsy or functional neck dissection, 15% required a second surgery for persistence or recurrence compared with 100% of those who had incision and drainage or curettage. Cultures were positive in 72% of the 32 specimens sent, mainly for Mycobacterium avium complex. Very few complications were noted. CONCLUSION: The number of cases of NTM disease has almost doubled between 2000-2004 compared with between 1990-1999, with more invasive cases seen in the past 4 years. The significance of this important rise in numbers is still unclear. Resolution of NTM adenitis is higher with complete surgical excision of affected lymph nodes. Moreover, given the proportion of PPD > or = 10mm among those tested, a pan-Canadian study assessing the incidence of NTM disease compared with tuberculosis is required to determine if a change in the recommendations for PPD positivity is needed.