A three-dimensional (3D) printed paediatric trachea for airway management training.

There is a deficit of commercially available paediatric airway models for anaesthesia airway management training, particularly for infant front-of-neck access and customised airway planning. Acknowledging this, we created a three-dimensional printed prototype for an affordable, high-fidelity training device, incorporating realistic tactile feedback, reproducibility and potential for modification for specific patient pathologies. Our model, created on a Stratasys Polyjet J750™ (Rehovot, Israel) printer, is a novel and useful educational tool in paediatric airway management, and we are pleased to share access to this resource with readers. Our work adds credence to three-dimensional printing as an accessible, reproducible and pluripotent technology in clinical anaesthesia.

Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic.

OBJECTIVES: Recent studies have shown an association between ankyloglossia (tongue tie) and upper-lip ties to breastfeeding difficulties. Treatment is commonly multidisciplinary involving lactation consultants and surgical management with tongue tie and upper lip tie release. There is currently limited data looking at posterior ankyloglossia and upper lip ties. METHODS: Consecutive patients seen at an ENT outpatient clinic for ankyloglossia and upper-lip ties from May 2014-August 2015 were assessed for an outpatient frenotomy. Breastfeeding outcomes were assessed following the procedure. RESULTS: 43 babies were seen and 34 patients had a procedure carried out. Babies ranged from 2 to 20 weeks old with the median age being 6.6 weeks. The most common presenting complaint was latching issues (85%) with mothers' painful nipples being the second (65%). 21 patients (62%) had a tongue tie release, 10 (29%) had both a tongue tie and upper lip tie divided, whereas 3 (9%) had an upper-lip tie alone divided. 29 (85%) of the patients who had a procedure carried out had an immediate improvement in breastfeeding, while 28 (82%) had a continued improvement at 2 weeks follow up. CONCLUSIONS: Frenotomy for posterior ankyloglossia and upper lip ties is a simple procedure that can be carried out in an outpatient setting with apparent immediate benefit. Otolaryngologists are likely to have an increasing role to play in the evaluation and management of ankyloglossia and upper lip ties in babies with breastfeeding difficulties.

Juvenile recurrent respiratory papillomatosis: 10-year audit and Australian prevalence estimates.

OBJECTIVES/HYPOTHESIS: To estimate the prevalence of juvenile onset recurrent respiratory papillomatosis (RRP) in Australia, describe its epidemiological profile, and assess the positive predictive value of International Classification of Disease, 10th revision (ICD-10) code D14.1 (benign neoplasm of larynx) in children for hospitalization due to RRP. STUDY DESIGN: Retrospective case series. METHODS: Retrospective case review undertaken at the three tertiary pediatric hospitals in New South Wales (Australia's largest state), by reviewing medical records of patients aged 0 to 16 years admitted during 2000-2009 containing the ICD-10 Australian modification code D14.1 or other possible disease (D14.2-4, D14.3, D14.4) and RRP-related procedure codes. For RRP diagnoses, we recorded treatment dates, length of stay, extent of disease, and surgical and adjuvant treatments. The positive predictive value (PPV) of code D14.1 and median number of hospitalizations per year were applied to national hospital separations data from 2000/2001 to 2012/2013 to estimate disease prevalence. RESULTS: We identified 30 cases of RRP using code D14.1, which had a PPV of 98.1%, with no further cases identified using other codes. Fifty-seven percent of cases were female, median age of onset was 36 months, and median treatment duration was 36 months (mean = 40 months, range = 1-118). There was one patient death. Between 2000 and 2013, the estimated national prevalence rate was 0.81 per 100,000 aged < 15 years, peaking at age 5 to 9 years (1.1 per 100,000). CONCLUSIONS: RRP prevalence can be monitored after human papillomavirus vaccination programs using routine hospital data. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:2827-2832, 2016.

Is day stay adenotonsillectomy safe in children with mild to moderate obstructive sleep apnoea? A retrospective review of 100 patients.

OBJECTIVE: This study explored the perioperative course of 100 children with polysomnogram (PSG) proven mild to moderate OSA to evaluate if day stay adenotonsillectomy is safe. METHODS: A retrospective chart review of patients who had undergone tonsillectomy with or without adenoidectomy following an overnight PSG at The Children's Hospital at Westmead Sleep Laboratory. 263 records were reviewed. Patients with apnoea hypopnea index (AHI) ≥ 1 and <15/h and/or a final sleep study report of mild to moderate OSA were included. Exclusion criteria were age <3 years, weight <10 kg, or any significant co-morbidities or other surgery that would preclude day stay surgery. Demographic, PSG and post-operative data was analyzed. RESULTS: No major respiratory complications occurred. No patient required an unplanned medical review for respiratory concerns, or admission to a high care facility. Eleven children left recovery with oxygen prescribed. One child had a desaturation to 88% in recovery, and one child had laryngospasm. The nine other children required oxygen to maintain saturation >90%. Supplemental oxygen was prescribed to 7 patients on the ward. Of these, three patients received supplemental oxygen beyond 6h. The other 97 patients had an uncomplicated post-operative course and would have been suitable for day-stay surgery. Increasing severity of OSA grade on pre-operative PSG was significantly associated with post-operative supplemental oxygen use (p=0.003; Cochrane-Armitage test for trend). CONCLUSIONS: Children who are otherwise well with mild to moderate OSA have a sufficiently low risk of respiratory complications following adenotonsillectomy to permit day-stay surgery in the setting of appropriate facilities with careful post-operative monitoring for the first 6h to identify a small sub-group who require overnight observations.