Unilateral choanal atresia in one monozygotic twin: a case report.

Unilateral atresia is an extremely uncommon congenital disorder in monozygotic twins. We present the first case in the literature of premature, monozygotic twins with no other congenital genetic defects other than only one twin with unilateral choanal atresia on the right side, being the other sibling completely normal. Diagnostic examinations performed to both twins consisted of nasal endoscopy, which revealed only one twin with unilateral choanal atresia; axial computed tomography scan; genetic analysis; chromosome analysis; abdominal ultrasound and echocardiography. In our cases the genetic-chromosomal analysis failed to support a possible cause of unilateral choanal atresia in one monozygotic twin, suggesting a multifactorial etiology.

Outpatient cold knife tonsillectomy in toddlers with sleep disordered breathing.

PROBLEM: Tonsillectomy performed as day surgery has become popular over the last fifteen years. However, there are conflicting opinions regarding the safety of this practice, especially in children of very young age. We sought to determine the safety of outpatient tonsillectomy in children aged three years old and younger. METHODOLOGY: A retrospective study of all tonsillectomies performed in a major pediatric hospital during a two-year period was conducted. Age, gender, indication for tonsillectomy, other procedures performed simultaneously, seniority of operating surgeon, and reasons for hospital admissions during the first post-operative week were recorded. Patients with inappropriate records for the analysis were excluded. A total of 1058 patients were studied. Tonsillectomized children were divided into two age groups: greater than 3 years old (n = 951) and 3 years old or younger (n = 107). RESULTS: Male gender, obstructed sleep disordered breathing as indication for surgery, seniority of the operating surgeon, and age of 3 years old or younger were not associated with post-operative complications. CONCLUSIONS: Outpatient tonsillectomy can be managed safely regardless of age, as long as specific factors, such as good recovery room supervision, exist.

Acute mastoiditis in a newborn with aural atresia.

Acute mastoiditis in the newborn is a very rare disease. Herein we report a case of a 28-day-old child with right aural atresia and ipsilateral mastoiditis requiring mastoidectomy. To our knowledge, this is the youngest case reported in the literature. Issues on diagnosis and management of mastoiditis in cases of aural atresia are further discussed. Based on our experience and on previous reported cases we conclude that mastoiditis is difficult to diagnose in a child with aural atresia. Moreover, mastoidectomy may be necessary, although identification of the facial nerve and consequent treatment of the atresia are usually too difficult to perform simultaneously.