Head and neck pilomatricoma in the pediatric age group: a retrospective study and literature review

OBJECTIVE: To discuss the clinical course and management of pilomatricoma involving the head and neck in the pediatric age group and to review the literature. METHODS: Retrospective analysis of the author's case files between the years of 1996 and 2000, revealed seven cases of head and neck pilomatricoma involving children. A literature review was employed to compare this study to others. RESULTS: In all cases, the presenting sign was a superficially located rock-hard mass in the head and neck. The mean duration the mass was present at the initial otolaryngologic evaluation was 11 months. There was a total of seven patients of which five (71%) were female while two (29%) were male. Each patient presented with a single pilomatricoma. Five (71%) occurred in the neck while two (29%) occurred in the face. All were treated with surgical excision. There were no recurrences. CONCLUSION: Pilomatricoma is a rare, benign, skin neoplasm that is superficially located and most commonly occurs in the head and neck, thus otolaryngologists should be aware of its clinical presentation. Although malignant transformation has been described, it is exceedingly rare. Diagnosis is usually suspected based on palpation of a superficial, rock-hard mass and confirmed by histopathologic examination. Since this neoplasm doesn't spontaneously regress, surgical excision is both curative and the treatment of choice. Recurrence is rare.     

Sleep nasendoscopy: a 10-year retrospective audit study

Sleep nasendoscopy was conceived at the Royal National Throat, Nose and Ear Hospital, UK in 1991, and has remained fully implemented in patient selection for targeted treatment of the spectrum of sleep-disordered breathing. The senior authors (B.T.K. and P.B.) have been performing sleep nasendoscopy together for over 10 years, and we look back at their decade’s experience. A retrospective audit study based on case notes was performed over a 10-year period (1995–2005) in a tertiary-referral practice setting. Case notes were retrieved on all patients who had undergone sleep nasendoscopy during the study period, and agreed data were extracted and analyzed. A total of 2,485 sleep nasendoscopies were performed in patients with a mean age of 44.1 years, a 4:1 male preponderance, and a mean body mass index of 27.3 kg m⁻². Sleep nasendoscopy grading correlated well with apnoea–hypopnoea index and mean oxygen desaturation. Such grading helped us define and discuss treatment options with patients. After a median follow-up period of 518 days, 72% of patients reported feeling better; 26% of patients reported no change; and only 2% of patients reported feeling worse after treatment. Sleep nasendoscopy has proved to be a useful adjunctive method to identify the anatomical site of snoring, not to mention upper airway collapse, and remains integral to our tertiary-referral practice. It has allowed us quality assessment of the dynamic anatomy of sleep-disordered breathing that most closely and cost-effectively simulates the natural situation of patients. And for targeted treatment, such assessment has been fundamental.     

Intranasal sphenoethmoidectomy: 10-year experience and literature review

We believe that complete intranasal sphenoethmoidectomy is the procedure of choice for massive nasal polyposis and polypoid sinusitis. The anatomy is complex, visualization with conventional matters is limited, and the potential complications can be severe. Nevertheless, with thorough underlying knowledge of the anatomy and proper training consisting of cadaver dissection and supervised surgery, a safe, effective technique can be mastered. Two hundred and thirty sphenoethmoidectomies done in 87 patients over the past 10 years are reviewed. The initial recurrence rate was 25%. There was a 3% incidence of serious complications. These results are comparable to those in the literature. While recognizing the potential complications of this difficult procedure, we believe that it can be performed safely and effectively by properly trained surgeons and that an effort should be made to extend proper instruction to otolaryngology residents.     

Ludwig's angina in the pediatric population: report of a case and review of the literature

Ludwig's angina is a rapidly progressing cellulitis involving the submandibular neck space. It is characterized by brawny induration of the submental region and floor of mouth, bearing the potential for rapid airway obstruction. Airway management, antibiotics, and judicious surgical intervention are the mainstays of successful therapy. We present a case of Ludwig's angina in a 5-year-old child and offer a meta-analysis of pediatric cases of Ludwig's angina described in the literature over the past 30 years. The presentation, etiology, management, and potential complications of this disorder in the pediatric population are discussed.     

Diagnosis and treatment of branchial cleft anomalies in UKMMC: a 10-year retrospective study

Branchial cleft anomalies result from abnormal persistence of branchial apparatus, which is located at the lateral part of the neck. These occur due to failure of obliteration of the branchial apparatus during embryonic development. Differential diagnoses of lateral neck mass are salivary gland or neurogenic neoplasms, paragangliomas, adenopathies, cystic hygroma or cystic metastasis from squamous cell carcinoma or thyroid papillary carcinoma. Clinically, a branchial cyst is smooth, round, fluctuant and non-tender, and usually occurs over the upper part of the neck, anterior to the sternocleidomastoid muscle. Sometimes, it may present as infected cyst (or abscess), a sinus or fistula. Surgical excision is the definitive treatment for branchial anomalies. The objective of the work was to study the demographic data, clinical presentation, definite diagnostic workup and treatment of patients diagnosed with branchial anomalies. This is a retrospective study of 26 patients who were diagnosed with branchial anomalies (branchial cyst and fistula), of which only 12 patients had data available between July 1999 and June 2009 at the Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre. Twelve cases of branchial anomalies were seen, in which 10 patients had second branchial cyst anomalies, 1 had third branchial fistula and 1 had bilateral branchial lesion. There were seven females and five males. The age of the patients varied over a wide range (4–44 years), but the majority of the patients were in their second and third decade of life. All branchial anomalies occurred at the classical site; eight patients had left-sided neck lesion. Correct clinical diagnosis was made only in five patients (41.6 %). All patients underwent surgical excision with no reported recurrence. Branchial anomalies are frequently forgotten in the differential diagnosis of lateral neck swelling. Diagnosis is usually delayed, leading to improper treatment. The diagnosis of patients who present with lateral neck cystic swelling with or without episodes of recurrent neck abscess should be considered with a high suspicion for branchial anomalies. FNA cytology is a good investigative tool in reaching toward a diagnosis of branchial lesion, with the concurrent assistance of radiological modalities. Surgical excision is the gold standard treatment of lesions of branchial anomalies.     

A retrospective study of nasopharyngeal carcinoma presenting over a 10-year period

67 cases of nasopharyngeal tumours presenting at the Royal National Throat, Nose and Ear Hospital over a 10-year period were examined, of which 47 were poorly differentiated carcinomas. The population under review could be subdivided into three separate groups on the basis of geographical origin: Northern European, Southern European and Middle Eastern. The proportion of poorly differentiated carcinomas in each geographical area was calculated and was found to differ significantly between the Northern European and Middle Eastern groups.     

The origin of bronchial foreign bodies: a retrospective study and literature review

Nasal foreign bodies are managed as an emergency for the risk of aspiration, yet it is not clear what proportion of bronchial foreign bodies actually originate in the nose. The aim of this study was to identify the origin of bronchial foreign bodies and estimate the risk of a nasal foreign body becoming impacted in the bronchial tree. We present a retrospective study of suspected bronchial foreign body cases at Addenbrooke’s Hospital in Cambridge, UK, who underwent a bronchoscopy between 2002 and 2007. We further compare our experience with a literature review on bronchial and nasal foreign bodies to highlight important differences between these distinct clinical problems. Our experience shows that all cases of proven foreign body at bronchoscopy had ingested the foreign body orally. We could find only one case of a nasal foreign body in the literature that had been ingested during its removal, but no cases specifically entering the tracheo-bronchial tree. We therefore conclude that bronchial foreign bodies have their origin almost invariably in the mouth and the risk of a nasal foreign body entering the bronchial tree is negligible (<0.06%).     

Primary hyperparathyroidism in the pediatric population. Report of a case and review of the literature

Parathyroid adenomas presenting as primary hyperparathyroidism are uncommon in children. We report a case in a 14 years-old male diagnosed as such illness who was studied by imaging tests (scintigraphy and IRM) that detected the responsible upper-left adenoma. He was operated without complications, with good postoperative evolution and normal calcium levels. Finally review the literature of this clinical entity in the pediatric population.     

Mastoiditis in adults: a 19-year retrospective study

The objective of our study was to review retrospectively the clinical, radiological and therapeutic findings in 62 adults with acute mastoiditis treated at the ENT Department of Ferrara from 1992 to 2010. 62 adult cases fulfilled the following inclusion criteria: otoscopical evidence of co-existent or recent otitis media; postauricular swelling, erythema or tenderness; protrusion of the auricle; fever and/or significant radiological findings of mastoiditis. Conservative treatment comprehended antibiotic ± ventilation tube. Surgical procedures comprehended mastoidectomy or mastoido-tympanoplasty. The incidence of adult’s mastoiditis in our district (0.99 cases/year/100.000 inhabitants) has maintained quite stable during the considered 19-year period. The typical clinical presentation was observed in 48 % of cases. Complications were meningitis (15 cases), meningo-encephalitis (1), meningitis associated with lateral sinus thrombosis (1), facial nerve paralysis (11), and labyrinthitis (8). In all cases except one, the facial palsy recovered completely and no mortality was observed due to these complications. Complete cure was obtained with conservative treatment in 69 % of uncomplicated cases and in 24 % of patients with intracranial complications. Mastoiditis in adults may present as the acute classical form, as well as latent forms which often have prolonged and insidious development followed by a rapid clinical deterioration. Clinical features are frequently atypical, while incidence of meningitis and other complications is still high particularly in the most elderly. Thus, great care is required from clinicians to make an early diagnosis in order to promote adequate treatment.     

Post-tonsillectomy haemorrhage: a 7-year retrospective study

Amongst fears about iatrogenic transmission of new variant Creutzfeldt-Jakob disease (vCJD), last year the Department of Health of the U.K. advised that all adenotonsillectomies be performed using disposable instruments. Following implementation of these guidelines, many consultants reported an increase in post-tonsillectomy haemorrhage in association with the use of disposable instruments. We have undertaken a retrospective study of tonsillectomy and have confirmed a significant increase in the incidence of return to the theatre for arrest of postoperative haemorrhage (5.32% vs. 2.18%) during the period when disposable instruments were used.     

Subglottic cysts in children: a 10-year review

Subglottic cysts are associated with prematurity and periods of early neonatal intubation and are a rare cause of infant stridor. In this study we analyse our experience of this rare but important problem. We discuss the aetiology, diagnosis and management of subglottic cysts. We carried out a retrospective review of all cases of subglottic cysts presenting to the otorhinolaryngology department at the Leeds teaching hospitals trust during the period between 1995 and 2005. In total seven patients were identified. A retrospective review of the case notes of all patients proven to have subglottic cysts at direct laryngoscopy and bronchoscopy was undertaken. Seven patients were identified, four males and three females. Five were born premature (24-31 weeks). All were intubated with average intubation period of 20.6 days. Six of our patients' underwent endoscopic marsupialisation using cup forceps and one with a contact diode laser. Two patients had recurrence of the cyst and had a repeat of endoscopic marsupialisation. This study highlights the associated risk of neonatal intubation with the risk of formation of subglottic cysts, and the need for early diagnosis and appropriate treatment to avoid unnecessary morbidity.     

Endolaryngeal jet ventilation: a 10-year review

Jet ventilation for microsurgery of the larynx has been in common use at our institution since 1978. There were 942 cases performed, with ages ranging from 7 days to 90 years. A specially modified laryngoscope with multiple ports into which a 14- or 16-gauge ventilation needle can be advanced just distal to the vocal cords simplifies this form of anesthesia and ventilation. Jet ventilation has been advocated in place of conventional ventilation methods during carbon dioxide laser surgery because it eliminates the potential fire hazard of the endotracheal tube and allows superior visibility of the vocal cords. Despite these advantages, it is still not in common use. We will review the airway mechanics and special anesthesia considerations that make jet ventilation a safe and time-proven technique.     

Trends in turbinate surgery literature: a 35-year review

A MEDLINE search was used to identify articles involving all forms of turbinate surgery over a 35-year period. Five hundred and sixty-one papers were identified. Of these, 283 specifically detailed turbinate surgery. These demonstrated a marked increase in the number of papers detailing endoscopic and laser turbinate surgery in the last 5 years. No randomised controlled studies were identified describing inferior turbinate surgery for nasal obstruction or middle turbinate surgery for any cause. The evidence supporting the efficacy of these procedures remains debatable. Research in this field appears to be driven by technological advancement rather than by establishment of patient benefit. Properly conducted randomised controlled trials are required to establish whether there is a long-term patient benefit from these commonly performed operations.     

Chronic esophageal foreign bodies in pediatric patients: a retrospective review

OBJECTIVE: Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. METHODS: We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week. RESULTS: Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series. CONCLUSIONS: Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.     

Surgery for pediatric vocal cord paralysis: a retrospective review

To determine the outcome of surgical procedures for bilateral vocal cord paralysis in children, we performed a retrospective review of children under 18 years of age with bilateral vocal cord paralysis and a previous tracheotomy who underwent a primary procedure at a single tertiary care institution with an aim of decannulation. The primary outcome measure was the operation-specific decannulation rate (OSDR). The overall decannulation rates, as well as morbidity rates, were also recorded. Fifty-two children met the inclusion criteria (mean age at time of primary surgery, 6.2 years; SD, 5 years). Vocal cord lateralization procedures combined with a partial arytenoidectomy achieved the highest OSDR (17/24 or 71%). This OSDR was statistically higher than the OSDRs for CO2 laser cordotomy or arytenoidectomy procedures (OSDR, 5/17 or 29%, p = .008), for isolated arytenoidopexy procedures (OSDR, 1/4 or 25%, p = .000004), or for posterior costal cartilage graft procedures (OSDR, 3/5 or 60%, p = .0004). Neither of the 2 children who underwent isolated arytenoidectomy achieved primary decannulation. The incidence of aspiration following posterior cartilage graft procedures was 15% (2/15). Subanalysis by age failed to reveal differences in OSDR. We conclude that vocal cord lateralization procedures with partial arytenoidectomy afford the highest OSDR among primary procedures for pediatric vocal cord paralysis. The CO2 laser procedures, while having limited success as a primary procedure, are effective for revision.