Retrospective review of grommet insertions for otitis media with effusion in children in Singapore

Otitis media with effusion is one of the most common childhood infections, and grommet insertions are done for chronic otitis media which have failed medical therapy. The aims of this study were 1) to determine the patient profile of children needing grommet insertion and 2) to determine if grommet insertion is safe and effective. A retrospective review of 105 children with myringotomy and grommet insertions for chronic otitis media with effusion between 2006 and 2008 was performed. Seventy two percent of patients were younger than 6 years old. Male to female ratio was 4:3. Twelve percent of patients were syndromic. In children with otitis media with effusion, hearing and academic performance improved after grommet insertion. Allergic rhinitis and cleft palate are risk factors for chronic middle ear effusion.     

患单侧特发性全层黄斑裂孔的马来西亚患者脉络膜厚度研究

目的：比较患单侧特发性全层黄斑裂孔(FTMH)眼、对侧眼以及正常对照组黄斑脉络膜厚度。

方法：横断面研究。选取30例单侧特发性全层黄斑裂孔马来西亚患者,以及年龄、性别、种族相匹配的正常对照组。用激光干涉法测量研究对象眼轴长度。利用谱域光学相干层析成像技术获取增强深度成像光学相干断层成像。在黄斑中心凹处,距中心凹1 mm和 2 mm鼻侧、颞侧、上方、下方测量脉络膜厚度。采用独立统计分析法、配对样本t-tests、chi-square tests和Pearson相关性检验进行数据分析。

结果：全层黄斑裂孔组平均中心凹脉络膜厚度为201.0±44.0 μm,对侧眼平均为225.3±51.4 μm,对照组为262.3±70.3 μm。相较于对照组,全层黄斑裂孔各部位脉络膜较薄(P<0.05)。对侧眼组除了鼻侧1 mm 和2 mm处,其余地方脉络膜厚度较对照组薄(P<0.05)。全层黄斑裂孔组脉络膜厚度低于对侧眼组,但两组间差异无统计学意义(P>0.05)。脉络膜厚度通常在中心凹处最高,在鼻侧最低。黄斑中心凹脉络膜厚度与年龄(r=-0.278, P=0.032)和眼轴长度(r=-0.328, P=0.011)呈负相关。

结论：单侧全层黄斑裂孔患眼与对侧眼和健康对照组相比,脉络膜厚度较低。     

Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an alternative approach to a challenging problem

Background

Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perforation to perform exteriorization or limited resection and primary anastomosis.

Methods

We included low-birth weight infants presenting with sudden clinical deterioration and pneumoperitoneum. Patients with gross abdominal wall signs were excluded on the probability that they had extensive disease. Diagnostic laparoscopy was performed using a 3.5-mm trocar and 1.9-mm telescope. A 1-cm incision was made over the site of perforation, and local surgical debridement was performed.

Results

There were 3 extremely low-birth weight patients (580, 700, and 780 g) and 1 larger infant (1.6 kg). In all cases, an isolated perforation was detected. None had widespread disease. The 3 smaller infants had exteriorization and enterostomies. The larger patient had resection and primary anastomosis. All patients recovered uneventfully.

Conclusion

Diagnostic laparoscopy can be safely performed in extremely low-birth weight infants. It allows precise identification of the site of perforation to perform a limited microlaparotomy at this site, significantly reducing the surgical trauma of extensive bowel handling. We report a novel method of managing this vexing problem.     

Analysis of complications following multidisciplinary functional intervention in paediatric craniomaxillofacial deformities

Paediatric craniomaxillofacial (CMF) surgery requires a multidisciplinary team approach to ensure the optimal and holistic management of children with craniofacial deformities. The aim of this retrospective study was to analyse the complications following functional interventions among 34 CMF deformity patients in a single multidisciplinary craniofacial centre. Electronic data including patient demographic characteristics and clinical entry were analysed. Inclusion criteria were all paediatric patients with CMF deformities who underwent various functional interventions. A total of 64 interventions (48 intermediate and 16 definitive) were conducted. Based on the Sharma classification of complications, 20.3% were type I, 4.7% were type II, 1.6% were type III, and 4.7% were type IV . Most complications were type I, which included local infection (3.1%) and premature opening of tarsorrhaphy (3.1%). More serious complications (types III and IV) included temporary visual loss (1.6%) and intraoperative haemorrhage (1.6%). Although a low complication rate was observed in intermediate interventions, a higher complication rate was observed in more complex definitive interventions such as monobloc distraction osteogenesis. Although most complications were manageable, effective prevention remains mandatory, as serious complications may lead to permanent damage and mortality. This analysis highlights the importance of a multidisciplinary team approach to optimize the outcomes in CMF patient management.     

Nasal eschar: a warning sign of potentially fatal invasive fungal sinusitis in immunocompromised children

Most invasive fungal sinusitis occurs in immunocompromised adult patients. We present the case study of a 12-year-old boy diagnosed with acute myeloblastic leukemia undergoing chemotherapy. He developed a progressive darkening discoloration over the dorsum of the nose that turned into an eschar. Nasal endoscopy revealed extensive necrotic tissue in the nasal cavity mucosa, inferior and middle turbinates, and septal cartilage that extended to the eschar of the skin over the nasal dorsum. Histopathology showed aspergillus invasive fungal rhinosinusitis.     

Quantification of secondary dentin formation using dental orthopantomographs in a contemporary Malaysian population

ABSTRACT

The Kvaal method is recommended for age estimation in adults and is based on the analysis of the pulp chamber. Importantly, however, subsequent research has empirically demonstrated that the accuracy of this method varies across global populations. The aim of the current study is, therefore, to examine the relationship between secondary dentin formation and chronological age to establish forensic age estimation standards for a Malaysian population. A total of 300 anonymized dental orthopantomographs of Malaysian individuals, aged between 16 to 69 years were analysed following the Kvaal method. Length and width measurements of the tooth and pulp chamber were acquired in six teeth. Kvaal’s dental ratios were calculated and subsequently used to formulate multiple linear regression models. Intra-observer error was found to be within acceptable standards for all measurements (TEM<1.0, rTEM<5%, R>0.75). A significant negative correlation between chronological age and the Kvaal dental ratios was demonstrated (0.14–0.42). The most accurate model was for maxillary central incisor (SEE ±10.46 years). This study reaffirms the reproducibility of Kvaal’s method in dental radiographs and demonstrates its applicability amongst Malaysians.     

Lateral sinus thrombosis

We describe four cases of lateral sinus thrombosis secondary to otitis media. They presented with low-grade fever, headache, nausea, vomiting and ear discharge. One patient had facial nerve palsy. CT scan was helpful in managing these patients. They were treated with antibiotics followed by surgery. Two patients had intracranial abscesses and were treated accordingly.