Surgical treatment of cervicofacial nontuberculous mycobacterial adenitis in children

Fifteen children with nontuberculous mycobacterial adenitis of the head and neck underwent surgical treatment between July 1991 and July 1994. Fineneedle aspiration for biopsy and culture allowed early diagnosis in nine children. Positive cultures grew Mycobacterium auium-intracellulare complex in 12 children and M. chelonei in one child. Total excision was performed in 10 cases with combinations of lymphadenectomy and salivary gland excision. Curettage was used to successfully treat five children. One patient required local flap coverage for primary wound repair. Two patients required more than one surgical procedure. Our approach to early diagnosis and surgical treatment of cervicofacial nontuberculous mycobacterial adenitis is presented.     

Surgical excision as primary treatment modality for extensive cervicofacial lymphatic malformations in children

Objective

There has been much recent focus on sclerotherapy treatment of lymphatic malformations with OK432. Surgical treatment however can have a number of advantages, including complete curative excision. The aim of this study was to evaluate the results of surgical excision as the primary (first) treatment for this condition. This group includes a number of children with very extensive disease as well as some with smaller lesions.

Methods

Prospectively collected database with additional information from medical records of children with cervicofacial lymphangiomas treated over 10 years at a tertiary paediatric referral centre. For this study only children who underwent surgical excision as the primary treatment modality were included.

Results

Total of 118 children with lymphatic malformations were treated under the care of the senior author over a 10 year period. Of these 53 patients, who underwent surgical excision as the primary treatment modality for cervicofacial lymphatic malformations were included in this study. Forty-one patients who underwent sclerotherapy as the initial treatment were excluded. Also excluded were 6 patients who underwent thoracic surgery and 18 who were treated conservatively. The majority of the patients (41, 77.3%) underwent only a single surgical procedure (36 - surgical excision, 5 - laser excision). At the first follow up after the primary surgery, the result was complete resolution of symptoms in 29 patients, near complete resolution in 13 patients (together 79.3%) and partial response in 11 (19.7%) patients. Twenty-three patients with disease localised only to the neck, all (100%) had a complete or near complete resolution of the disease after the primary surgery. Complete/near complete response was achieved in 98% cases with macrocystic disease, regardless of the location. Minor complications occurred in 11.3% patients. No permanent nerve weaknesses occurred.

Conclusion

Cervicofacial lymphatic malformations in children should be managed in a multidisciplinary setting. Surgery remains a very important treatment modality. The majority of patients (80%) in this study had complete or near complete resolution with one surgical procedure. Isolated neck lesions have the best outcomes (100% resolution in this study). Patients with macrocystic disease, achieved complete or near complete resolution in 97% of cases, regardless of the location. Some children with extensive disease will need multiple treatments. Surgical excision as the primary treatment modality in selected cases is safe and reliable technique and has good aesthetic and functional outcomes in experienced hands.     

Surgical excision of cervicofacial giant macrocystic lymphatic malformations in infants and children

Objectives

Various modalities have been used to treat lymphatic malformations, such as steroids, the injection of sclerosing agents, aspiration, and surgery. Giant macrocystic lymphangiomas involving the cervicofacial region in infants and children constitute a major therapeutic challenge.

Methods

This was a retrospective review of 47 pediatric patients with giant macrocystic lymphatic malformations of the cervicofacial region that underwent surgical resections. There were 27 males and 20 females; 25 were newborns, 9 were infants, 8 were of preschool age, and 5 were school age. Of the patients, 72.4% was presented before 3 years of age. The neck was involved in 48.9% of the patients, followed by the parotid region and parapharynx (34.0%), lingual base and oral floor (12.8%), and face and cheek (4.3%). The lesions ranged from 4 × 3 to 15 × 10 cm in size. All cases showed symptoms of space-occupying lesions preoperatively.

Results

Hemorrhage within the lessons was the most common preoperative symptom, and dysphasia and airway obstruction are serious preoperative symptoms. Nine (19.1%) minor surgical complications occurred. The mean follow-up was 9.6 months; five patients had recurrent lesions, while surgical radicality was achieved in 89.4% of the cases. A significantly higher rate of residual or recurrent lesions was noted in the newborn group, as compared with the other age groups (P = 0.04; χ² test).

Conclusions

Surgical dissection of giant macrocystic lymphatic malformations involving the cervicofacial region in infants and children is safe and gives satisfactory esthetic and functional results, including lesions in the newborn.     

Long-term outcome of surgical excision for treatment of cervicofacial granulomatous lymphadenitis in children

European Archives of Oto-Rhino-Laryngology - Granulomatous inflammation is a common cause of subacute cervicofacial lymphadenitis in children. Nontuberculous mycobacterial (NTM) infections and...     

Surgical treatment of cholesteatoma in children

We retrospectively reviewed patients surgically treated for cholesteatoma to determine the impact of surgical procedures on preoperative hearing status and whether there was preservation, improvement, or deterioration. We reviewed 173 patients treated over a 15-year period. One hundred eighteen (68%) patients had acquired cholesteatoma and 55 (32%) patients had congenital cholesteatoma. One hundred (58%) patients had extensive disease on presentation that required canal wall-down mastoidectomy. Patients with attic cholesteatoma underwent canal wall-up mastoidectomy, and those with cholesteatoma localized to the middle-ear space were adequately treated with tympanotomy. Hearing was preserved in 101 cases (59%), improved in 30 (17%), became worse in 23 (13%), and could not be accurately assessed in 19 (11%) due to lack of documentation. A second surgical procedure for recidivistic (recurrent or residual) disease was required in 53 (30%). Ipsilateral facial paralysis was noted in 3 (1.7%) patients immediately after recovery from anaesthesia, and 1 (0.5%) patient had a sensorineural hearing loss. This study confirmed the aggressiveness of cholesteatoma in children and demonstrated the need for careful preoperative evaluation, meticulous surgical technique, and prudent postoperative follow-up.     

Surgical treatment of hypopharyngeal stenosis in children

Five cases are presented of severe scarring, in the hypopharynx in children, which did not respond to conservative measures. These patients were treated by excision of the scar tissue and reconstitution of the area by Z-plasty, local mucosal flaps, regional chest flaps and colon transfer depending upon the severity of the problem. All had rehabilitation undertaken of the structural integrity of deglutive, respiratory, and vocal mechanisms. It is recommended that in this type of problem early rehabilitation is warranted rather than subjecting the child to prolonged gastrostomy and tracheotomy into puberty. When extended, the morbidity has a physical and psychological affect on these children.     

Surgical treatment of sleep-related breathing disorders in children

The surgical treatment of sleep-related breathing disorders in children depends on the cause of the upper airway obstruction, which can be located in the nasal fossae, pharynx (the most frequent adenotonsillar hyperplasia), or larynx (laryngomalacia, cysts…), or can be multilevel, as in syndromic diseases. Adenotonsillectomy is the most frequently performed and effective (70-80%) procedure. The aim of this technique is to normalize nocturnal respiratory parameters and daytime symptoms, as well as to revert, or at least to halt, cardiovascular complications, neurocognitive disturbances, growth delay and enuresis, which can develop if treatment is not provided or is delayed. However, despite its effectiveness, adenotonsillectomy more frequently leads to complications in children with sleep apnea-hypopnea syndrome (SAHS) than in those undergoing this procedure for other reasons. Moreover, 20-30% of children with SAHS who undergo adenotonsillectomy will show residual SAHS, and this percentage can increase to 70% in patients with severe SAHS, Down syndrome, craniofacial anomalies, neuromuscular disturbances, and morbid obesity. Consequently, both clinical and polysomnographic follow-up are recommended after adenotonsillectomy, especially in the latter risk group. Finally, other obstructive disorders of the upper airway must also be treated, although less frequently due to their lower incidence. These disorders include choanal atresia or stenosis, laryngomalacia, and hypoplasia of the midface or mandible. Tracheotomy will sometimes be required.     

小儿喉尖锐湿疣43例临床分析

目的：探讨小儿喉尖锐湿疣的治疗方法。方法：对43例小儿喉尖锐湿疣进行手术治疗，26例在表面麻醉下行直接喉镜喉肿瘤切除术，17例在全身麻醉下行气管插管、支撑喉镜喉尖锐湿疣切除术，其中13例同时行疣组织上臂内侧皮下埋植术、干扰素声带黏膜下注射。结果：随访35例，痊愈26例，好转7例，死亡2例；其中，气管切开7例，拔管困难3例。结论：本病病变范围大，复发率高，应用支撑喉镜行喉肿瘤摘除术，疣组织上臂内侧皮下埋植术及干扰素辅助治疗，可更精确切除肿瘤和减少复发，避免气管切开术后拔管困难。     

Surgical treatment of laryngotracheal stenosis in infants and children

Summary Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi, Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris 26–29 September 1988     

Surgical treatment of acute recurrent throat infections in children

Objective

The purpose of this study was to define the contribute of surgery and watchful waiting in the treatment of feverish episodes and other clinical manifestations related to acute recurrent throat infections in children.

Methods

An observational, retrospective and multi-centric study was carried out on 407 subjects, aged 2-11, with a minimum two-year follow-up. Chi square test and Fisher's test were used for the statistical analysis.

Results

Watchful waiting prevented, similarly to surgery, recurrences of feverish episodes, but did not favourably impact on other clinical manifestations (respiratory obstruction, otitis media, group A beta hemolyticus streptococcus positive laboratory findings) as compared to surgery (p < 0.001).

Conclusions

The higher effectiveness of surgical treatment, as compared to watchful waiting, was documented in the study patients, considering all the clinical manifestations related to acute recurrent throat infections.     

Surgical treatment of laryngotracheal stenosis in infants and children

Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi. Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.     

Surgery for cervicofacial nontuberculous mycobacterial adenitis in children: an update.

OBJECTIVE: To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) adenitis. DESIGN: Retrospective case series. SETTING: Tertiary university-based pediatric referral center. PATIENTS: Patients younger than 18 years diagnosed as having cervicofacial NTM adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation. INTERVENTIONS: Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment. MAIN OUTCOME MEASURES: Number of procedures per patient, complications, resolution of mass. RESULTS: A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM adenitis. CONCLUSIONS: Cervicofacial NTM adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM adenitis.     

Surgical treatment of nasal septum fractures in children with acute trauma

Statistics are provided on the prevalence, age-related aspects and results of conventional treatment of nasal septum fractures (NSF) in 15% of children treated in hospitals. An original approach to surgical treatment of NSF is proposed. It consists in open endonasal reposition of the osteochondrous base of the nasal septum with removal of small fragments, sparing resection of the quadrangular cartilage along the fracture line with perforation of the cartilage for reliable fixation by targeted formation of the scars. Possibility of one-stage correction of NSF and nasal bones fractures, advantages of the method are outlined. The novel surgical treatment was tried in eleven 9-14-year old patients with NSF. Long-term cosmetic and functional treatment results (follow-up for 12-18 months) are positive, postoperative complications were absent.     

Cervical cystic lymphangioma in children

INTRODUCTION: Cervical cystic lymphangioma are rare and benign, but the prognosis can be serious in terms of its development and management. OBJECTIVES: To describe the epidemiological, clinical and therapeutic characteristics. MATERIALS AND METHODS: A retrospective study of eight cases. RESULTS: The mean age was 7 years, with a slight female predominance. Ultrasound scanning was sufficient to establish the diagnosis. CT scan or MRI scan was used if parapharyngeal or a mediastinal extension was suspected. All patients in this series underwent surgical excision. There were no postoperative complications or recurrence at one year post-surgery. DISCUSSION: These lesions present as soft compressible cervical swellings of variable size. Radiological imaging (CT, MRI) aid diagnosis and demonstrate extent, however final diagnosis is made by histopathological examination. The treatment of choice is surgical excision. Another option is the use of sclerosing agents. These are used by some surgeons as a first line treatment and also for surgical recurrence.     

儿童阻塞性睡眠呼吸暂停低通气综合征240例的手术治疗

目的探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hy-popnea syndrome,OSAHS)的适应证、手术方法和疗效。方法回顾性总结了2 4 0例确诊为OSAHS需手术治疗病例,其中腺样体加扁桃体切除214例,单纯腺样体切除11例,单纯扁桃体切除15例。结果所有患者术后随访半年以上,175例(72.91%)痊愈,50例(20.83%)好转,15例(6.25%)无效。其中11例乳牙松动,3例乳牙脱落,8例术后24 h体温超过38℃;给予对症支持治疗后病情愈合。结论手术切除肥大的扁桃体和腺样体是治疗儿童OSAHS的主要治疗方法,但应根据不同的阻塞因素选择不同的手术方式。     

儿童头颈部淋巴管畸形的外科治疗

目的 探讨儿童头颈部淋巴管畸形的外科治疗方法和疗效.方法 回顾性总结北京大学第一医院自1998年1月至2008年12月住院治疗的11例儿童短径大于4 cm的头颈部淋巴管畸形.11例儿童头颈部淋巴管畸形均行增强CT或MRI扫描检查,治疗均采用外科手术治疗,其中行肿物及腮腺浅叶切除4例,肿物及腮腺全切除2例,颈清扫术式切除肿物2例,颈清扫术式联合开胸术切除肿物1例,颌下肿物切除术2例.术中采用假包膜外剥离法及顺行解剖面神经主干法,肿物与面神经粘连紧密的2例行肿物剔除术.其中6例行外周面神经解剖,2例行面神经下颌缘支解剖.结果 11例儿童头颈部肿物均彻底切除,无器官功能异常,无明显外形变化,治愈率为100%.3例在行面神经下颌缘支解剖和肿物切除时牵拉下颌缘支出现轻度面瘫(下颌缘支力弱),1例颈部广泛肿物行颈清扫术后出现Homer综合征,均在神经营养治疗后术后1～3个月内恢复.1例1岁患儿行颈清扫术式联合开胸术切除肿物的术中输血150 ml.所有病例随访6～121个月,随访中位数32个月,未见肿物复发.结论 采用面神经解剖及(或)颈部解剖、肿物假包膜外剥离法等手术可以根治儿童头颈部大型淋巴管畸形,是保留功能、防止畸形的有效方法.