RESUMO
OBJECTIVE: Assess the postoperative use of dexmedetomidine (Precedex) in pediatric patients following airway reconstruction. STUDY DESIGN: Historical cohort study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: A retrospective review of 24 children undergoing laryngotracheal reconstruction (LTR) or laryngeal cleft repair (LCR) was conducted. Twelve children were treated with standard sedation protocols where dexmedetomidine was administered in lieu of propofol (Diprivan); 12 age-, gender-, and procedure-matched controls were selected. Subjects were divided into groups based on duration of postoperative intubation for cross-comparison; group 1 was intubated <24 hours, group 2 was intubated 2 to 6 days, and group 3 was intubated 7 days or longer. Baseline heart rate and blood pressure measurements were compared to hourly measurements for the first 6 hours following initiation of dexmedetomidine or mechanical ventilation in the control group. Number of supportive respiratory interventions, adverse events, self-extubations, premature termination of dexmedetomidine, amount of muscle relaxants, agents to treat withdrawal, and length of stay were evaluated. RESULTS: Ten patients undergoing LTR and 2 patients undergoing LCR receiving dexmedetomidine were compared to 10 LTR and 2 LCR control patients. Overall, dexmedetomidine was well tolerated and without significant adverse effects, particularly in cases of short-term intubation or as a bridge to extubation. CONCLUSION: In cases requiring short-term intubation following airway reconstruction, dexmedetomidine may offer a safe alternative to propofol by providing readily reversible sedation during the periextubation period. Further studies are needed to determine the safety, efficacy, dosing, and potential complications of longer term dexmedetomidine administration in pediatric airway reconstruction.
Assuntos
Anestesia/métodos , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Laringe/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Cuidados Pós-Operatórios/métodos , Pré-Escolar , Anormalidades Congênitas , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Laringe/anormalidades , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To develop a protocol linking cine magnetic resonance (MR) imaging to simultaneously acquired audio recordings of specific phonatory tasks to evaluate velopharyngeal insufficiency (VPI) in children. DESIGN: Institutional review board-approved development and application of a novel dynamic cine MR imaging protocol linked to simultaneously recorded audio. SETTING: A tertiary care multidisciplinary pediatric airway center. PARTICIPANTS: Three healthy adult volunteers and 5 pediatric volunteers (age range, 9.3-18.9 years; mean age, 12.4 years) from the multidisciplinary pediatric airway center with VPI who previously had undergone nasopharyngoscopy, videofluoroscopy, or both. INTERVENTIONS: Cine MR imaging with simultaneously acquired audio files was performed in 3 adult volunteers to optimize the protocol and then in 5 pediatric volunteers meeting the inclusion criteria. MAIN OUTCOME MEASURES: High-resolution cine MR images with clear intelligible audio recordings of specific phonatory tasks. RESULTS: Using 3 healthy adult volunteers, a cine MR imaging VPI protocol was developed that links simultaneously acquired cine MR images to audio recordings of specific validated phonatory tasks. Five school-aged children with VPI from our multidisciplinary pediatric airway center were then enrolled and underwent cine MR imaging using this protocol. The cine MR images and audio recordings acquired were of sufficient diagnostic quality to evaluate VPI closure patterns in school-aged children with VPI. CONCLUSION: Cine MR imaging linked to audio is a quick, safe, and well-tolerated dynamic diagnostic imaging tool that may eventually have the potential to guide more precisely the selection and application of surgical techniques for VPI.
Assuntos
Processamento de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética , Fonação/fisiologia , Gravação em Fita/métodos , Insuficiência Velofaríngea/diagnóstico , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Palato Mole/fisiologia , Valores de Referência , Insuficiência Velofaríngea/fisiopatologiaRESUMO
A lateral dermoid cyst is a rare lesion of the floor of mouth, with only 12 cases reported in the literature. We describe the case of a 60-year-old man with a slowly enlarging mass in the submandibular region. Magnetic resonance imaging demonstrated a lesion containing multiple uniformly rounded foci, creating a "sack-of-marbles" appearance. Needle aspirations showed atypical findings, and the mass was excised. Histopathology revealed a cyst containing a keratinizing stratified squamous epithelial lining with apocrine and eccrine glands. These findings were diagnostic of a dermoid cyst, which should be considered in the differential diagnosis of any midline or lateral cervical lesion.
Assuntos
Cisto Dermoide/diagnóstico , Imageamento por Ressonância Magnética , Soalho Bucal , Neoplasias Bucais/diagnóstico , Idoso de 80 Anos ou mais , Biópsia por Agulha , Meios de Contraste , Cisto Dermoide/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Bucais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: We report a case of Rosai-Dorfman disease (RDD) presenting as an oropharyngeal mass, and we provide a detailed discussion of this rare clinical entity. METHODS: An initial biopsy, described as being consistent with lymphoma, was reviewed at a second outside institution and was thought to be reactive lymphoid hyperplasia. The patient then presented to our institution for a second opinion. Direct laryngoscopy revealed a firm 1- to 2-cm lesion involving the left soft palate and superior tonsillar pillar. RESULTS: The diagnosis of RDD was confirmed with immunohistochemical staining on both cytology and histology. The patient elected conservative management and has remained asymptomatic for over 15 months. CONCLUSION: The diagnosis of RDD may be challenging in cases presenting initially with extranodal disease. Close follow-up and repeat biopsies may be necessary. Identification of Rosai-Dorfman cells with emperipolesis and confirmation with appropriate immunohistochemical staining on both cytology and histology is diagnostic of RDD. Conservative treatment is appropriate in select cases.
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Histiocitose Sinusal/patologia , Linfonodos/patologia , Orofaringe/patologia , Prednisona/uso terapêutico , Biópsia por Agulha , Feminino , Seguimentos , Histiocitose Sinusal/diagnóstico , Histiocitose Sinusal/tratamento farmacológico , Humanos , Imuno-Histoquímica , Laringoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoAssuntos
Linfoma Difuso de Grandes Células B/patologia , Neoplasias Otorrinolaringológicas/patologia , Biópsia , Medula Óssea/patologia , Diagnóstico Diferencial , Secções Congeladas , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Otorrinolaringológicas/diagnóstico , Tomografia por Emissão de Pósitrons , Prognóstico , Tomografia Computadorizada por Raios XAssuntos
Sarcoma de Células Dendríticas Foliculares/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Criança , Terapia Combinada , Sarcoma de Células Dendríticas Foliculares/patologia , Sarcoma de Células Dendríticas Foliculares/terapia , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Terapia de SalvaçãoRESUMO
BACKGROUND: A devastating sequela of facial paralysis is the inability to close the eye. The resulting loss of corneal protection can lead to exposure keratitis, corneal ulceration, and potentially permanent vision loss. Methods to address lagophthalmos historically have included tarsorrhaphy, lid weighting, levator palpebrae superioris lengthening, chemodenervation to yield protective ptosis, and the placement of magnetic eyelid springs. The gold eyelid weight, introduced nearly 50 years ago, continues to enjoy immense popularity, despite high complication rates and nearly uniform visibility under the skin. The authors hypothesized that a commercially available, thin platinum weight would combat the visibility of the thicker gold weights and herein compare complication rates and visibility rates with literature-reported data for gold weights. METHODS: Beginning in 2004, 100 consecutive patients presenting to the authors' Facial Nerve Center with paralytic lagophthalmos requiring intervention were treated with thin-profile platinum eyelid weights. Ninety-six percent of cases were performed under local anesthesia in the office setting. RESULTS: Median follow-up was 22 months. In 102 weights placed, there have been six complications (5.9 percent): three extrusions, two capsule formations, and one case of astigmatism. All of the extrusions involved irradiated patients with parotid malignancies. CONCLUSIONS: The authors report the first large series of thin-profile platinum eyelid weight implantations for the treatment of lagophthalmos. This implant significantly reduces both capsule formation phenomena and extrusion compared with gold weights and should be considered as alternative to the more conventional gold implants.
Assuntos
Doenças Palpebrais/epidemiologia , Doenças Palpebrais/fisiopatologia , Doenças Palpebrais/cirurgia , Paralisia , Platina/uso terapêutico , Próteses e Implantes , Neoplasias Encefálicas/epidemiologia , Nervo Facial/patologia , Paralisia Facial/epidemiologia , Seguimentos , Humanos , Neuroma Acústico/epidemiologia , Paralisia/epidemiologia , Paralisia/fisiopatologia , Paralisia/cirurgia , Neoplasias Parotídeas/epidemiologia , Neoplasias do Sistema Nervoso Periférico/epidemiologia , Neoplasias do Sistema Nervoso Periférico/patologia , PrevalênciaRESUMO
A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Doenças do Nervo Óptico/etiologia , Doenças Orbitárias/etiologia , Doenças dos Seios Paranasais/etiologia , Administração Intranasal , Cegueira/diagnóstico , Cegueira/etiologia , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Doença Crônica , Cocaína/efeitos adversos , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Feminino , Fibrose/patologia , Humanos , Pessoa de Meia-Idade , Cavidade Nasal/patologia , Doenças do Nervo Óptico/diagnóstico , Órbita/patologia , Doenças Orbitárias/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: We performed a systematic review of 97 patients in whom an entirely endoscopic modified Lothrop procedure (EMLP) was performed. We studied the safety, efficacy, need for revision surgery, and rate of complication following an EMLP. STUDY DESIGN: The study design was a retrospective chart analysis. METHODS: We performed a retrospective chart review and patient survey of 97 patients who underwent an EMLP at our institution from January 1999 to March 2006. Main outcomes measured were the need for revision surgery including an osteoplastic flap (OPF), improvement in patients' symptoms, and rate of cerebrospinal fluid (CSF) leak. RESULTS: The most common indication for the procedure was chronic frontal sinusitis and/or formation of mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. CSF leak rate was 1% (1/97) and was managed successfully at the time of surgery without any long-term sequelae. Twenty-two (23%) patients required revision surgery. Three (3%) patients required revision with an OPF. Some degree of symptomatic clinical improvement was reported by 98% (95/97) of patients. CONCLUSION: EMLP is a safe and effective surgical alternative to OPF for patients with recalcitrant frontal sinus disease. Major complications are rare. A large percentage of patients may require revision surgery.