RESUMEN
OBJECTIVE: To compare and contrast coblation and microdebrider with touch-up electrocautery (ME) for adenoidectomy in children. METHODS: Patients <18 years old undergoing adenoidectomy without tonsillectomy were selected for this prospective, single-blinded, randomized controlled trial. Participants were enrolled into one of two groups based on birth date: coblation or ME. The surgeons completed a standard survey about intraoperative factors for each method. Recovery nurses filled out a standardized survey postoperatively. A third standardized survey was completed via a phone interview with the parent or patient caregiver on postoperative day 3 to assess procedure outcomes. The survey results were then compared using ANOVA statistical analysis. RESULTS: 50 patients were enrolled in the coblation group and 51 were enrolled in the ME group. There was no significant difference in mean age between the coblation (4.96 years) and ME groups (4.58 years) (p = 0.525). The mean time (in minutes) for coblation (5.50) was significantly lower than ME (9.47) when controlling for the confounder: surgical site exposure (p < 0.001). The surgical time was significantly influenced by the quality of exposure/visualization (p = 0.037). The coblator method had significantly less intraoperative blood loss compared to ME (p < 0.001). There was a statistically significant difference between coblation (1.53) and ME (2.05) for days of pain (p = 0.045) when controlling for the confounder adenoid size. CONCLUSION: In our study we found that coblation demonstrated significantly less intraoperative time and less blood loss, as well as a shorter duration of postoperative pain, when compared to ME for adenoidectomy.
Asunto(s)
Técnicas de Ablación/métodos , Adenoidectomía/métodos , Electrocoagulación/métodos , Técnicas de Ablación/efectos adversos , Tonsila Faríngea/cirugía , Niño , Preescolar , Electrocoagulación/efectos adversos , Femenino , Humanos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: While generally well tolerated for the treatment of severe laryngomalacia, bilateral supraglottoplasty has potential complications including supraglottic stenosis and aspiration. We report a more conservative staged supraglottoplasty in infants with severe laryngomalacia. METHODS: A retrospective review was performed of our patients who underwent staged supraglottoplasty from June 2007 to June 2012. Fifteen infants were identified and scored based on stridor, retractions, oxygen saturation, and feeding quality. Outcomes were compared with those reported in the literature for conventional bilateral supraglottoplasty. RESULTS: Seventy-three percent had significant improvement or resolution of stridor following the first stage of surgery and 100% in those undergoing a second stage. Twelve patients (80%) had mild to no retractions following one procedure and 100% had resolution after a second surgery. All 6 patients with recurrent preoperative desaturations had resolution after the first stage of surgery. Of the 11 infants who had preoperative moderate-severe feeding problems, 9 of them (82%) had resolution after one surgery and the remaining 2 had resolution after a second surgery. There were no complications in any of the patients. CONCLUSIONS: Staged supraglottoplasty appears to be an effective, low-risk method to treat severe laryngomalacia. A second procedure was only required in 40% of patients.
Asunto(s)
Laringomalacia , Laringoplastia , Epiglotis/patología , Epiglotis/cirugía , Métodos de Alimentación , Femenino , Glotis/patología , Glotis/cirugía , Humanos , Lactante , Laringomalacia/complicaciones , Laringomalacia/congénito , Laringomalacia/metabolismo , Laringomalacia/fisiopatología , Laringomalacia/cirugía , Laringoplastia/efectos adversos , Laringoplastia/métodos , Masculino , Consumo de Oxígeno , Periodo Posoperatorio , Ruidos Respiratorios/etiología , Ruidos Respiratorios/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Nontoxic adenomatous multinodular goiter (AMNG) in infants is a rare condition. We discuss an extremely rare case of a nontoxic AMNG in a 3-month-old female presenting with airway obstruction. Surgical resection of the mass was performed to reduce the burden on the airway and for diagnosis. The literature is reviewed, and the clinical characteristics, pathology, and surgical treatment are discussed.
Asunto(s)
Adenoma/complicaciones , Obstrucción de las Vías Aéreas/etiología , Bocio Nodular/complicaciones , Bocio Nodular/patología , Neoplasias de la Tiroides/complicaciones , Adenoma/diagnóstico , Adenoma/cirugía , Obstrucción de las Vías Aéreas/patología , Obstrucción de las Vías Aéreas/cirugía , Biopsia con Aguja , Femenino , Estudios de Seguimiento , Bocio Nodular/cirugía , Humanos , Inmunohistoquímica , Lactante , Laringoscopía/métodos , Enfermedades Raras , Medición de Riesgo , Índice de Severidad de la Enfermedad , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: To determine the complication rate and the patient satisfaction of titanium osseointegrated ear implants for congenital microtia and anotia. To discuss external ear prostheses as a treatment option for children with microtia. STUDY DESIGN: Retrospective chart review of patient records from a tertiary pediatric otolaryngology practice. METHODS: The charts were reviewed for all pediatric patients who had undergone titanium implants for attachment of auricular prostheses from 2000-2006. Data collected included demographic information, congenital syndrome, number and size of screws placed, occurrence of skin reactions, presence of other complications, and length of time patients wore the prosthetic ear. RESULTS: Eight patients, nine ears, were implanted. Median age was 7 years old. 6/8 had oculoauriculovertebral (OAV) syndrome, and 2 had isolated microtia. All titanium screws achieved complete osseointegration, and no implants have failed. 5/27 (18%) of the screws contacted dura, but no patients exhibited CSF leak, meningitis, or other central complications. 3/9 ears developed skin complications at the abutment sites, and 1/9 required revision soft tissue surgery. All the patients without current skin complications wear their prosthesis full time during waking hours. CONCLUSIONS: Titanium osseointegrated ear prosthesis is a safe and useful procedure for children with microtia. It should be presented as an option for these patients, with low complication rates and high acceptance rates by the patients.
Asunto(s)
Oído Externo/anomalías , Oído Externo/cirugía , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Prótesis e Implantes , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Oseointegración , Diseño de Prótesis , Implantación de Prótesis , Procedimientos de Cirugía Plástica/métodos , Reoperación , Titanio , Resultado del TratamientoRESUMEN
OBJECTIVE: Determine the rate of hoarseness in children with cleft palate (CP). Understand the relationship between velopharyngeal insufficiency (VPI) and hoarseness in children with CP. STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: Retrospective chart review of 185 patients with CP treated by a Children's Hospital Cleft Team and born between 1991 and 2001. RESULTS: Of total patients, 54.1 percent were male and 45.9 percent female. All types of CP were represented. The overall rate of hoarseness was 20.0 percent at age 3-4 and 18.4 percent at age 6-7. The presence of VPI did not correlate with the presence of hoarseness or dysphonia. VPI decreased when comparing age 3-4 (58.4%) with age 6-7 (30.2%, P < 0.001), but the hoarseness rates did not change, 20.8 percent at age 3-4 and 19.5 percent at age 6-7 (P = 0.56). CONCLUSION: Patients with CP are thought to have increased risk of voice disturbances due to compensatory articulation mechanisms used when a patient has VPI. However, this study of 185 patients with CP showed no relationship between VPI and hoarseness. The overall rate of hoarseness of this population with CP was within the reported range for the normal population of children. These findings suggest that the theory that VPI causes hoarseness due to compensatory speech mechanisms may be incorrect.