[Pediatric radiology in oto-rhino-laryngology]. / Pädiatrische Radiologie in der Hals-Nasen-Ohren-Heilkunde.

ABSTRACT

Head and neck diseases in children and adolescents pose special diagnostic and differential diagnostic challenges to ENT surgeons as well as to radiologists. Both disciplines have to adapt the latest radiological and interventional technologies to the needs of the paediatric patient in order to enable a minimally invasive but successful diagnostic procedure. High quality sonography by an experienced examiner often is the only imaging technique that is required in children and adolescents. Radiographs are rarely indicated in paediatric head and neck diseases. MRI, compared to computed tomography, has the advantage of the lack of radiation exposure. Additionally, because of current advances in high resolution techniques to delineate very small details or in visualization of different tissue characteristics it has become an integral part of the pre-and post-operative imaging. However, children should not be denied an adequate diagnostic procedure even if it includes a sedation, an intervention or an exposure to radiation. The responsible use of the diagnostic options under consideration of the therapeutic consequences is essential. It is most likely to be successful in a close interdisciplinary cooperation of paediatric ENT specialists and radiologists as well as paediatric anaesthesiologists in selected cases. Although benign diseases predominate in children and adolescents, the possibility of a malignancy has to be considered in case of atypical clinical and radiological findings. In many of these young patients the outcome and the probability of survival are directly connected to the initial diagnostic and therapeutic strategies, which should therefore be in accordance with the current guidelines in oncological therapy studies. Our collection of clinical cases consists of representative examples of useful diagnostic approaches in common and age specific diagnoses as well as in rare diseases and malformations. It shows the significance of a special knowledge in embryology and normal postnatal development for the differentiation of normal variants from pathological findings. Only in considering the results of imaging studies in their clinical context, we may succeed in detecting a syndrome behind a single malformation or in adequately caring for a patient with a chronic disease such as cystic fibrosis.