[Ectopic thyroid gland: clinical features and diagnostics in children].

BACKGROUND: The frequency of ectopia of thyroid gland among all types of dysgenesis varies from 30 to 70%, its most common localization is the root of the tongue. Otorhinolaryngologists, oncologists, pediatricians can take lingual ectopia for hypertrophy of the lingual tonsil or fibroma of the tongue root, which leads to unreasonable surgical treatment. Thyroid scintigraphy plays a key role in the diagnosis of ectopia. AIM: To assess the etiological structure of congenital hypothyroidism (CH) and demonstrate the clinical course in patients with ectopic thyroid tissue in the root of the tongue. MATERIALS AND METHODS: A group of patients with CH was examined. All patients underwent neck ultrasound and radionuclide imaging. The examination was carried out against the background of the abolition of hormone replacement therapy for 14 days or before its initiation. Patients with ectopia in the root of the tongue underwent videofibrolaryngoscopy. Some patients underwent a genetic study with using genes panel of a panel of candidate genes responsible for the development of CH using the NGS method. The molecular genetic study was conducted to some patients, next-generation sequencing with the genes panel. RESULTS: The study included 73 patients with primary CH aged from 2 weeks to 17.3 years: 69 children were diagnosed based on the results of neonatal screening, 4 children with thyroid ectopia were first examined older than 6 years. The median age of patients at the time of the examination was 6.9 years [4.8; 10.0]. By data of ultrasound aplasia was diagnosed in 47.9% of patients, one child had hemiagenesis and ectopic thyroid tissue of various localization was detected in 26.0% of  children. In 24.7% of children thyroid tissue was found in a typical location. Scintigraphy confirmed thyroid aplasia in 65.7% of children. Examination revealed various variants of ectopically located thyroid tissue in 31 children (42.4%): thyroid ectopia in the root of the tongue in 25 children (80.6%), ectopia in the sublingual region in 5 children (16.2%), double ectopia was detected in 1 child. The median level of TSH in newborns with ectopic thyroid gland was 124 IU/ml and was significantly lower than in children with aplasia - 219 IU/ml, p<0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia - 37.12 ng/ml versus 0.82 ng/ml, p><0.05. CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH - ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment. ><0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia - 37.12 ng/ml versus 0.82 ng/ml, p< 0.05. CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH - ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment.

[Clinical case of a hairy polyp in a 6 month old baby]. / Volosatyi polip u rebenka 6 mesyatsev (klinicheskoe nablyudenie).

Hairy polyp is a rare congenital anomaly, pharynx mass, that causes respiratory and swallowing disorders, and sometimes threatens child's life. A 6 mounths old girl with this pathology was examined and surgically treated at the Department of Otorhinolaryngology, Pediatric Faculty, N.I. Pirogov Russian National Research Medical University. Epipharingoscopy and computed tomography (CT scan) were used during diagnosis. The surgery was performed under endotracheal anesthesia using ERBE VIO electrosurgical complex.

[New ways of solving the problem of restenosis in the surgical treatment of congenital choanal atresia in children]. / Novye puti resheniia problemy restenozirovaniia pri khirurgicheskom lechenii vrozhdennoi atrezii khoan u detei.

This article presents the literature data and our own findings on the surgical treatment and options for solving the problem of restenosis in congenital atresia of the choanae (CAC) in children. PURPOSE: In order to solve the issues of prevention of the fibrosis in the postoperative period in patients with CAC, the prospects of using the carboxymethyl cellulose gel-sodium salt (CGSS) were assessed. PATIENTS AND METHODS: This medicine was used in patients, who were: primarily operated, after a period of wearing a protector (n=17); primarily operated without using a protector, at the final stage of the operation and in the early postoperative period (n=15); reoperated because of the restenosis, also at the final stage of the operation and in the early postoperative period (n=12). RESULTS: We present our results of application of the carboxymethyl cellulose gel-sodium salt for the prevention of scar adhesions in this condition: endoscopy of the nasal cavity and choanal region in all 44 patients with follow-up observation (from 1 year to 5 years) showed no signs of restenosis. CONCLUSION: The use of sodium carboxymethyl cellulose sodium salt in the intra- and postoperative period may be one of the ways of solving the problem of restenosis after surgery in children with CAC along with the use of endoscopic techniques for performing choanotomy.

[Causes of restenosis in the surgical treatment of congenital choanal atresia in children]. / Prichiny restenozirovaniya pri khirurgicheskom lechenii vrozhdennoi atrezii khoan u detei.

This article presents the literature data and our own findings on the surgical treatment congenital atresia of the choanae (CAC) in children. AIM: To find the causes of restenosis after a choanotomy in children with CAC. PATIENTS AND METHODS: We analyzed the results of surgical treatment of 144 children with the use of an endoscopic transnasal technique (n=94) and without using endoscopy (n=67). In patients with signs of restenosis, endoscopic revision of the choanal opening, computed tomography results clarifying the anatomy of the abnormal zone, anamnestic data, and the presence of concomitant pathology were assessed. RESULTS: The primary causes of the recurrence of the CAC are the concomitant anatomical features of the structure of the choanal zone, insufficient period of protector insertion in the postoperative period, and surgical intervention without visual control. CONCLUSION: Endoscopic transnasal choanotomy with intraoperative rhino- and epipharingoscopic imaging, which is performed taking the individual characteristics of the anatomy of the anomalous zone into account, is the most optimal surgical procedure in pediatric patients. In combination with the use of a protector with a distal extended zone, high efficiency and rarity of restenosis are achieved.