Langerhans Cell Histiocytosis of the Head and Neck: Experience at a Rural Tertiary Referral Center.

OBJECTIVES: Retrospectively analyze head and neck Langerhans Cell Histiocytosis at a rural tertiary referral center and compare results with previously published data. METHODS: Electronic health record review was performed from 2003 to 2019. Patients with biopsy proven LCH with primary head and neck involvement were included. Demographics, presentation, imaging characteristics, treatment modality, delay in diagnosis (DD, ≥60 days), and outcomes were analyzed and reported. RESULTS: Twenty-four patients were included. The most common presenting symptoms were otorrhea (n = 6) and scalp pain or swelling (n = 6). All patients had bony involvement. The most common site was facial or skull lesions (n = 20). Most skull lesions (75%) demonstrated CNS risk. Six patients were treated with primary surgery, 15 with primary chemotherapy, and 3 with surgery plus adjuvant chemotherapy. Nine patients experienced relapse of disease with median time to documented relapse of 11.4 months; all were treated with salvage chemotherapy to achieve complete remission (median follow-up: 72 months). Patients most likely to relapse were those with multisystem disease (5/7, 71.4%), temporal bone lesions (4/7, 57.1%), and DD (7/12, 58.3%). Of the 9 total patients who experienced relapse, 78% had a delay in diagnosis. CONCLUSIONS: LCH is a complex disease process in which diagnosis can be delayed if not considered in the differential. Within the head and neck, the skull, including isolated temporal bone involvement, is the most common site of involvement. Treatment modality does not appear to have an influence on relapse rates. Relapse was more likely to occur in the first year after treatment and close monitoring is required.

Predicting pediatric tracheal airway size from anthropomorphic measurements.

OBJECTIVES: To determine the relationship between body mass index and tracheal airway size in children. METHODS: Retrospective case series. CT or MRI images of the neck of 171 pediatric patients obtained from 2000 to 2010 at a tertiary pediatric hospital were analyzed. Age, gender, height, weight, BMI and CDC weight classification for each patient were compared with axial CT measurements (AP diameter and width) and calculated cross-sectional airway area. Linear regression models were performed to identify factors predictive of airway size. RESULTS: Age ranged from 2 to 20 years. Weight was the most significant predictor of tracheal AP diameter (P = 0.029), with height also approaching statistical significance (P = 0.051). Tracheal width was best predicted by height (P = 0.09). Weight was the only statistically significant predictor of cross-sectional tracheal area (P = 0.002). Body mass index was not a statistically significant predictor of airway size in any dimension; however, there was an obvious trend towards decreasing tracheal width and cross-sectional area in patients with BMI of 25 or greater. CONCLUSION: In pediatric patients, estimation of endotracheal or tracheostomy tube size should take into account height, weight and BMI in addition to the patient's age. Patients with elevated BMI may have smaller tracheal sizes in various dimensions than normal or low-weight patients.