RESUMEN

Although the ectopic thyroid in adults is rarely symptomatic, biochemistry and imaging workup are essential. Treatment modality of choice is dependent on patient factors, institution factors and surgeon factors. The mainstay treatment involves hormone suppression treatment with exogenous thyroid hormone. If medical management is unsuccessful, surgical excision requires an experienced team including an anaesthetist and otolaryngologist. Anaesthetic considerations are important because intubation may be a potentially difficult procedure secondary to potential serious obstruction of the upper airway. We present a case report and narrative review of the literature regarding lingual thyroid workup and management.

RESUMEN

OBJECTIVE: To evaluate whether the addition of BCS (balloon catheter sinuplasty) would improve the treatment outcome in children with chronic rhinosinusitis (CRS) compared to FESS (functional endoscopic sinus surgery). STUDY DESIGN: Two-group, retrospective cohort with blinded chart review comparison. SETTING: Children's Hospital of Michigan, Detroit, MI. SUBJECTS AND METHODS: Chart review of 15 pediatric patients who underwent BCS with ethmoidectomy and 16 who underwent FESS from 2008 to 2011 for treatment of CRS in a tertiary care, university affiliated, pediatric institution. Pre-operative CT-scans as well as pre and post-operative sinus symptoms and medications were compared. Post-surgical outcome was examined using chi square analysis. RESULTS: Mean age of children at the time of the procedure was 9.3 (SD=4.19; range=3-17). Both groups had similar pre-surgical Lund-Mackay CT CRS scores (FESS: mean=9.33 and t=0.67; balloon: mean=10.58, t=0.68, and p=0.51). Analyses identified significant post-treatment reductions in overall symptoms and needed interventions in both treatment groups. Side-by-side post-operative comparison of patients who underwent balloon sinuplasty to FESS demonstrated statistically significant post-operative difference between the two groups in antibiotic requirement, sinus congestion and headaches. Though not statistically significant, 62.5% of FESS patients and 80.0% of BCS patients (χ(2)=1.15) reported improvement in their overall sinus symptoms post-operatively. CONCLUSION: Both BCS and FESS are suitable treatments for CRS in children. Both treatments significantly reduced CRS complaints post-operatively and had similar overall results. BCS patients required significantly fewer antibiotics post-operatively for CRS related disease when compared to FESS. Larger prospective studies with long-term data are needed to further evaluate.

Asunto(s)

Endoscopía/métodos , Hueso Etmoides/cirugía , Senos Etmoidales/cirugía , Sinusitis/cirugía , Adolescente , Cateterismo , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

There is lot of controversy over the utility of pre-operative radiology in management of attico-antral disease. This study was done to find correlation between pre-operative HRCT and intra-operative findings in patients with attico-antral disease. Study revealed varying degrees of sensitivity and sensitivity for different aspects of the disease. We conclude that though HRCT given good visualization of the key areas, high levels of false positive and false negative prevent the wholesome reliability on it.