RESUMEN
Two-flap palatoplasty is commonly used to treat cleft palate defects, but only a few reports on outcomes have been published in the literature. We conducted a retrospective analysis of 257 cases of cleft palate treated with two-flap palatoplasty at a single center in Greece over a 13-year period. Our outcomes data included surgical complication rates, the results of speech assessments, midface development, and other parameters. We found a low rate of short- and long-term complications that required revision surgery, such as symptomatic fistula (5.4%) and velopharyngeal insufficiency (5.3%). Speech outcomes in relation to intelligibility, hypernasality, and nasal emissions were satisfactory in 70 to 86% of patients. Dental arch relationships, as estimated by the 5-Year-Olds Index, were judged to be either good or excellent in 62% of those evaluated. A considerable proportion of patients (45%) who had otitis media with effusion experienced a spontaneous resolution without the use of tympanostomy tubes 2 to 8 months after their operation. We conclude that two-flap palatoplasty is an effective procedure that warrants further attention. We describe the surgical technique in detail. Our technique includes a modified intravelar veloplasty that incorporates near-total muscle retropositioning.
Asunto(s)
Fisura del Paladar/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Colgajos Quirúrgicos , Adolescente , Niño , Preescolar , Humanos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the range of medical and surgical therapies for children with PFAPA syndrome. METHODS: A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS: The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/- adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P<0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P=0.83). CONCLUSIONS: The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/- adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms.
Asunto(s)
Fiebre/terapia , Linfadenitis/terapia , Faringitis/terapia , Estomatitis Aftosa/terapia , Adenoidectomía , Antibacterianos/uso terapéutico , Niño , Cimetidina/uso terapéutico , Glucocorticoides/uso terapéutico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Síndrome , TonsilectomíaRESUMEN
PURPOSE: This study aimed to evaluate (a) specific histologic findings in children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome who had tonsillectomy and (b) to assess any improvement of symptoms after tonsillectomy with or without adenoidectomy. MATERIALS AND METHODS: This project is a retrospective study performed at "Aghia Sophia" Children's Hospital (Athens, Greece), between May 2007 and July 2008. Nine children were recruited into this study. Patients with defined diagnostic criteria for PFAPA syndrome till 14 years of age undergoing tonsillectomy with or without adenoidectomy were included in the study. RESULTS: Nine children met our inclusion criteria in the PFAPA group, of which 5 were male (55.56%) and 4 were female (44.44%), with ages ranging between 2.5 and 5 years at the age of surgery (mean, 3.4 years). The length of follow-up ranged from 6 to 19 months. Eight (88.89%) of 9 patients had complete remission of symptoms immediately after surgery. The histologic and immunohistochemical examination showed features of chronic tonsillar inflammation. CONCLUSIONS: (a) No specific findings were observed in the tonsils of PFAPA patients; (b) we could not find any difference in tonsillar histology between PFAPA and chronic tonsillar inflammation; and (c) tonsillectomy is an effective treatment for PFAPA syndrome, improving patients and parental quality of life.
Asunto(s)
Fiebre/cirugía , Linfadenitis/cirugía , Faringitis/cirugía , Estomatitis Aftosa/cirugía , Tonsilectomía , Adenoidectomía , Niño , Preescolar , Femenino , Fiebre/patología , Humanos , Linfadenitis/patología , Masculino , Tonsila Palatina/patología , Periodicidad , Faringitis/patología , Estudios Retrospectivos , Estomatitis Aftosa/patología , Síndrome , Resultado del TratamientoRESUMEN
OBJECTIVE: Foreign bodies (FB) of the ear and nose are common findings in the pediatric population. The objective of this project is to present our experience of cases presented to our department and to correlate the insertion of the FB in relation to the child's handedness. METHODS: This project was carried out at the Department of Otorhinolaryngology Head and Neck Surgery of "Aghia Sophia" Children's Hospital (Athens, Greece), between December 2007 and August 2008. Data collected includes age and sex of the child, time elapsed between the insertion of the FB and its removal, type of FB, site of insertion, description of the child's handedness, conditions of removal and complications. RESULTS: 46 FB were removed from the nasal cavities. On the right nasal cavity, 29/31 (93.55%) children were right handed and 2/31 (6.45%) were left handed. On the left nasal cavity, 11/14 (78.57%) were right handed and 3/14 (21.43%) children were left handed. One right handed child had a FB in both nasal cavities. 44 FB were removed from the ear (external auditory canal: EAC), 30 (68.18%) from the right EAC and 14 (31.82%) from the left. On the right EAC, 28/30 (93.33%) children were right handed and 2/30 (6.67%) were left handed. Children with FB of the left EAC were 9/14 (64.29%) right handed and 5/14 (35.71%) left handed. CONCLUSIONS: Children insert FB into their nasal cavities randomly (P=0.308). As a result, there is no correlation with the child's handedness and right/left nasal cavities FB insertion. On the other hand, children do insert FB into their right/left EAC according whether they are right/left handed (P=0.014). Consequently, right handed children insert FB into their right EAC and left handed children into their left EAC.
Asunto(s)
Conducto Auditivo Externo , Cuerpos Extraños/clasificación , Lateralidad Funcional , Cavidad Nasal , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: We sought to determine the morbidity and the short and long-term effectiveness of tonsillotomy (partial tonsillectomy) performed with scissors compared with conventional cold knife (total) tonsillectomy. METHODS: We conducted a 2-year prospective non-randomized study at a tertiary children's hospital. One thousand and twenty-three children were recruited (243 in the tonsillotomy and 780 in the tonsillectomy group). Age, sex, weight, and time of operation, immediately post-operative complications and pain were recorded. Eighteen months after the operation data on weight, parents' satisfaction and recurrence of obstructed symptoms was obtained in 60 randomly selected children of each group. RESULTS: Post-operative complications rates were very low in both groups and their differences did not reach statistical significance. However, tonsillotomies were significantly better than tonsillectomies in relation to post-operative pain the 1st (P<0.001) and the 7th (P<0.001) post-operative day, and lasted an average of 2.5 min less. Concerning long-term effects, both methods resulted in an increase of patients' weight without the difference in weight increase be statistically significant. In addition, parents' satisfaction as well as oral malodour do not seem to differ significantly. Finally, although twice as many children in the tonsillotomy group had a recurrence of snoring compared to tonsillectomy group, only in about half of them was the problem regarded significant enough by their parents to require medical consultation or reoperation. At the end, an estimated 3.5% of the tonsillotomy group was offered a tonsillectomy in the long term. CONCLUSION: This trial shows that scissors tonsillotomy in combination with an adenoidectomy is a viable therapeutic option with less immediate post-operative morbidity than tonsillectomy in young children whose sleep disorder breathing is due to a combination of tonsilar and adenoid hypertrophy. However, parents should be informed of the possibility of regrowth and reoperation.