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1.
J Craniofac Surg ; 32(7): 2326-2329, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34705382

INTRODUCTION: Neonates with severe Pierre Robin sequence (PRS) can be treated by mandibular distraction osteogenesis (MDO), tongue-lip adhesion, or tracheostomy; however, there is an active debate regarding the indications of MDO in this patient population. Published algorithms identify tracheomalacia, bronchomalacia, laryngomalacia, hypotonic syndromes, and central sleep apnea as contraindications for MDO and indications for tracheostomy, but these comorbidities may exist along a spectrum of severity. The authors propose that appropriately selected neonates with PRS who concurrently express 1 or more of these traditional contraindications may be successfully treated with MDO. METHODS: The authors performed a 5-year retrospective chart review of all neonates who underwent MDO for treatment of severe PRS. All patients expressed a comorbidity previously identified as an indication for tracheostomy. Pre- and postoperative characteristics were recorded. Apnea/hypopnea index (AHI) before and after MDO were compared using 2-tailed repeated measures t-test. RESULTS: The authors identified 12 patients with severe PRS and conditions associated with contraindications to MDO: 9 (75.0%) patients had laryngomalacia, 6 (50.0%) patients had tracheomalacia, 2 (16.6%) patients had bronchomalacia, 1 (8.3%) patient had central sleep apnea, and 3 (25.0%) patients had hypotonia. Five (41.7%) patients underwent concurrent gastrostomy tube placement due to feeding insufficiency. Average birthweight was 3.0 kg. Average pre-op AHI was 34.8. Average post-op AHI was 7.3. All patients successfully underwent MDO with avoidance of tracheostomy. CONCLUSIONS: By employing an interdisciplinary evaluation of patient candidacy, MDO can safely and effectively treat upper airway obstruction and avoid tracheostomy in higher-risk neonatal patients with traditional indications for tracheostomy.


Airway Obstruction , Osteogenesis, Distraction , Pierre Robin Syndrome , Airway Obstruction/surgery , Humans , Infant , Infant, Newborn , Mandible/surgery , Pierre Robin Syndrome/complications , Pierre Robin Syndrome/surgery , Retrospective Studies , Treatment Outcome
2.
BMJ Case Rep ; 14(8)2021 Aug 05.
Article En | MEDLINE | ID: mdl-34353829

We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of Candida albicans requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.


Airway Obstruction , Candidiasis , Larynx , Adult , Airway Obstruction/etiology , Airway Obstruction/surgery , Candidiasis/complications , Candidiasis/diagnosis , Candidiasis/drug therapy , Female , Humans , Intubation, Intratracheal , Laryngoscopy , Larynx/diagnostic imaging , Tracheostomy
3.
J Craniofac Surg ; 32(4): 1459-1463, 2021 Jun.
Article En | MEDLINE | ID: mdl-34403227

Background: Effective airway management is critical to Pierre Robin Sequence treatment. The goal of this study is to assess the three-dimensional changes in airway size and shape in 117 newborns with isolated Pierre Robin sequence who underwent mandibular distraction osteogenesis. Methods: During the study period (11/29/2016 to 11/26/2019), 117 newborns affected by isolated Pierre Robin sequence met the inclusion criteria for the present study. All 117 included patients underwent linear distraction. Demographic variables were recorded and analyzed. Cone-beam computed tomography were performed before and after mandibular distraction osteogenesis. A systemic quantitative three-dimensional analysis of size and shape of upper airway was performed. Results: The mean age was 71 day (range 12 to 213). The mean weight was 3.9 kg (range 2.3-6.8). A total of 53 patients are female and 64 are male. When the distraction device was removed, the upper and lower jaws were symmetrically aligned. Pre- and post-distraction comparison clearly showed osteogenesis. For the size of the upper airway, airway volume, anteroposterior dimension of the retroglossal airway, lateral dimension of retroglossal airway, minimum retropalatal area, minimum retroglossal area, average cross-sectional area and minimum cross-sectional area increased significantly after mandibular distraction osteogenesis (P < 0.001). However, the airway length did not change significantly (P > 0.05). For the shape of the upper airway, the lateral/anteroposterior ratio in the retroglossal region and the ratio of the retropalatal airway diameter to the retroglossal airway diameter significantly decreased after mandibular distraction osteogenesis (P < 0.001). The airway uniformity significantly increased after mandibular distraction osteogenesis (P < 0.001). Conclusion: Mandibular distraction osteogenesis for isolated Pierre Robin sequence improved size and shape of the upper airway, further confirming mandibular osteogenesis distraction as an effective surgical modality to address the airway obstruction in newborns affected by isolated Pierre Robin sequence. Cone-beam computed tomography scanning and analysis can serve as a safe and effective examination modality for upper airway applications of PRS newborns.


Airway Obstruction , Osteogenesis, Distraction , Pierre Robin Syndrome , Aged , Airway Obstruction/diagnostic imaging , Airway Obstruction/surgery , Female , Humans , Infant , Infant, Newborn , Male , Mandible/diagnostic imaging , Mandible/surgery , Pierre Robin Syndrome/diagnostic imaging , Pierre Robin Syndrome/surgery , Retrospective Studies , Treatment Outcome
4.
Int J Pediatr Otorhinolaryngol ; 149: 110841, 2021 Oct.
Article En | MEDLINE | ID: mdl-34303126

OBJECTIVES: The effectiveness of adenotonsillectomy for obstructive sleep disorder breathing (OSDB) in children under age 2 years is unclear. The present study aimed to identify the perioperative symptoms and clinical outcomes of adenoidectomy and tonsillectomy in very young children. PATIENTS AND METHODS: The present, single-center, retrospective cohort study, conducted from January 2010 to April 2020, enrolled patients under age 2 years with moderate to severe upper airway obstruction who underwent an adenoidectomy or tonsillectomy. The patients were divided according to The Brodsky grading scale into group 1 (Grade 0 to 1 tonsils) or group 2 (Grade 2 or higher tonsils), who received only an adenoidectomy. Group 3 comprised patients with a concomitant adenoidectomy and tonsillectomy. Perioperative symptoms among the groups and the cumulative revision-free status and recurrence-free status rates in groups 1 and 2 were analyzed. RESULTS: Fifty-three patients were enrolled. The median standard deviation score (SDS) for height and weight was -0.79 and -0.31, respectively. No postoperative complications, such as bleeding, were observed. However, two patients underwent intubation preoperatively due to severe obstruction. Seven patients underwent revision surgery. The cumulative revision-free and recurrence-free rates at week 60 were 81% and 100% for Group 1 and 42% and 48.5% for Group 2, respectively. The cumulative revision-free rate and cumulative recurrence-free rate were significantly higher in Group 1 (P < 0.0001; HR: 47.9; 95% CI: 1.12-2050 and P < 0.007; HR: 4.62; 95% CI: 1.37-15.6, respectively). None of the patients in Group 3 had revision surgery or symptom recurrence. CONCLUSION: Simple adenoidectomy in children with large tonsils carries a high risk of revision surgery. However, given the high risk of severe obstruction in very young children with OSDB, timely surgery is recommended. LEVEL OF EVIDENCE: 3.


Airway Obstruction , Tonsillectomy , Adenoidectomy , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/surgery , Child , Child, Preschool , Humans , Palatine Tonsil , Retrospective Studies , Tonsillectomy/adverse effects
5.
BMJ Case Rep ; 14(7)2021 Jul 28.
Article En | MEDLINE | ID: mdl-34321261

A 17-year-old man was admitted to Accident & Emergency out of hours with unilateral tonsillar enlargement covering more than 75% of his oropharyngeal inlet. He appeared calm and stable on initial presentation, but in a short span of time rapidly deteriorated, leading to near complete airway obstruction necessitating an emergency awake cricothyroidotomy. Tracheostomy and tonsillectomy were done after this, he was ventilated postoperatively in intensive therapy unit and discharged home in a week. This is a rare clinical scenario in a patient presenting with palatine tonsillitis. A few subtle points in the history and examination alerted the team and prevented a risky inter hospital transfer for ear, nose and throat review. This is the first reported case in UK of palatine tonsillitis not due to infectious mononucleosis presenting with acute upper airway obstruction in a patient with no airway anomalies. It may also have been a varied presentation of COVID-19.


Airway Obstruction , COVID-19 , Tonsillectomy , Tonsillitis , Adolescent , Airway Obstruction/etiology , Airway Obstruction/surgery , Humans , Male , SARS-CoV-2 , Tonsillitis/complications , Tonsillitis/surgery
6.
Pediatr Pulmonol ; 56(9): 3047-3050, 2021 09.
Article En | MEDLINE | ID: mdl-34185970

We report an unusual case of a 14-month-old ex-28 week, ventilator-dependent male with a history of bronchopulmonary dysplasia and tracheostomy at 2 months of age. Lost to follow-up, at age 9 months, he presented to the emergency department with worsening respiratory distress. The patient was taken to the operating room at which time direct visualization of the airway demonstrated a mass filling the entire glottic inlet without supraglottic or pharyngeal mucosal attachments. The solid, nonvascular, mass appeared to be emanating from a suprastomal site. Excision proved to relieve the airway obstruction and postoperatively the patient has thrived.


Airway Obstruction , Tracheostomy , Airway Obstruction/etiology , Airway Obstruction/surgery , Child , Humans , Infant , Infant, Newborn , Male
7.
J Anesth ; 35(4): 595-598, 2021 08.
Article En | MEDLINE | ID: mdl-34075478

Recent technological developments in three-dimensional (3D) printing have created new opportunities for applications in clinical medicine. 3D printing has been adopted for teaching and planning complicated surgeries, including maxillofacial, orthopedic reconstructions, and airway manipulation for one-lung ventilation or airway stenting. We present here the first use of such technology to print a model from in utero imaging for intrapartum treatment planning. A 32-week fetus presented with congenital high airway obstruction syndrome (CHAOS) due to a large cervical lymphatic malformation. An ex utero intrapartum treatment (EXIT) procedure was planned to allow delivery of a viable infant. We printed a 3D model of the fetal airway by printing separate elements: mandible, tongue, mass, larynx, and trachea from the fetal MRI. The elements were stuck together maintaining correct anatomical relationships. Airway planning was then performed in consultation with a pediatric ear nose and throat (ENT) surgeon. 3D modeling in utero presents many challenges: the resolution of the 3D model generated from a fetal MRI is less crisp than from CT images, fetal position may be variable and not in a defined anatomical plane, movement artifact occurs. Nevertheless, pre-procedure simulations with the aid of 3D modeling promoted team cooperation and well-prepared management of the fetus during EXIT.


Airway Obstruction , Larynx , Airway Obstruction/diagnostic imaging , Airway Obstruction/surgery , Child , Fetus/diagnostic imaging , Humans , Magnetic Resonance Imaging , Trachea
8.
Semin Pediatr Surg ; 30(3): 151066, 2021 Jun.
Article En | MEDLINE | ID: mdl-34172204

Ex-utero intrapartum treatment (EXIT) is a delivery strategy developed to manage a variety of prenatally diagnosed conditions in the transition to newborn life. This procedure allows control and provides time for intervention in otherwise life-threatening malformations, such as congenital upper airway obstructions. EXIT-to-airway has changed the outcome of fetuses with these anomalies. The main purpose of this intervention is to improve the safety of establishing a reliable airway at birth. Maximal but controlled uterine relaxation to maintain feto-maternal perfusion and thus gas exchange, while keeping the fetal and maternal well-being are the paradigms of any type of EXIT. The most important aspect of fetal airway management is to consolidate a highly trained, well-coordinated, multidisciplinary team that is prepared for every contingency. A comprehensive prenatal assessment, including ultrasound, fetal echocardiogram, fetal MRI, and genetic testing is imperative for patient selection. Extensive preoperative planning, ad-hoc team meetings, and surgical simulations for challenging cases are critical strategies to achieve the best outcomes. This article outlines the prenatal work-up, decision making, technical aspects, and principles for a successful EXIT-to-airway procedure.


Airway Obstruction , Airway Management , Airway Obstruction/surgery , Female , Fetus , Humans , Infant, Newborn , Magnetic Resonance Imaging , Pregnancy
9.
Semin Pediatr Surg ; 30(3): 151063, 2021 Jun.
Article En | MEDLINE | ID: mdl-34172216

Tracheobronchomalacia (TBM) is the most common tracheobronchial obstruction. Most cases are mild to moderate; therefore, they do not need surgical treatment. Severe tracheomalacia, however, represents a diagnostic and therapeutic challenge since they are very heterogeneous. In the armamentarium of resources for the treatment of dynamic airway collapse, splints and stents are two underused strategies and yet, they may represent the best alternative in selected cases. Lately, computed tomography 3D reconstruction of the airway has been used for the design of virtual models that can be 3D-printed for the creation of novel devices to address training, simulation, and biotechnological implants for refractory and severe airway malformations. This manuscript examines the role of resorbable stents, splints, and the 3D reconstruction and printing of the pediatric airway in tracheobronchomalacia.


Airway Obstruction , Tracheobronchomalacia , Airway Obstruction/diagnostic imaging , Airway Obstruction/surgery , Child , Humans , Imaging, Three-Dimensional , Printing, Three-Dimensional , Splints , Stents , Tracheobronchomalacia/surgery
10.
J Craniofac Surg ; 32(7): 2335-2340, 2021 Oct 01.
Article En | MEDLINE | ID: mdl-34074926

INTRODUCTION: Mandibular distraction osteogenesis (MDO) effectively treats upper airway obstruction (UAO) in young patients with Robin sequence (RS). The most commonly used MDO devices have internal and external components that require manual activation. Although complications associated with MDO in infants with RS have been well documented, hardware/device malfunction has not been precisely described. The present study reports the authors' recent experiences with such problems, in an effort to shed light on these complications and identify potential steps to mitigate future related issues. DESIGN: The authors reviewed a prospectively gathered database to identify all young children under the age of 3 years who underwent MDO using buried internal devices for UAO associated with grade 3 RS from March 2007 to September 2019. We specifically focused on complications attributable to the hardware itself. RESULTS: Nineteen patients with 40 devices met inclusion criteria. The median age at MDO was 2.3 months (interquartile range 1.4-6.3 months). Intraoperative activation of all devices under direct vision resulted in satisfactory distraction. Four devices (10.5%) developed postoperative complications directly related to the device, including break down of component parts (N = 3) and failure to maintain distraction distance (N = 1). Two patients required surgical replacement of one device each, whereas the remaining complications occurred during the consolidation phase and did not require intervention. CONCLUSIONS: This report documents a series of device/hardware malfunction in infants and young children undergoing MDO for severe UAO associated with RS. Despite rigorous testing and development, these devices may fail, resulting in patient morbidity.


Airway Obstruction , Osteogenesis, Distraction , Pierre Robin Syndrome , Airway Obstruction/etiology , Airway Obstruction/surgery , Child , Child, Preschool , Humans , Infant , Mandible , Pierre Robin Syndrome/surgery , Retrospective Studies , Treatment Outcome
11.
Med J Malaysia ; 76(3): 441-445, 2021 05.
Article En | MEDLINE | ID: mdl-34031351

Hunter Syndrome is a genetic disease characterized by deficiency of Iduronate-2-Sulfatase enzyme activity, resulting in accumulation of glycoaminoglycans in various organs including the central airways. We report a case of severe tracheomalacia and airway stenosis at Hospital Sultanah Aminah, Johor Bahru, Malaysia requiring mechanical ventilation in a middle aged gentleman who was previously undiagnosed of mucopolysaccharidosis. The patient underwent emergency tracheostomy for failed intubation, when he presented with shortness of breath and acute respiratory failure. A contrast-enhanced computed tomography of the neck and thorax revealed that the trachea distal to the tracheostomy tube had collapsed with narrowed right and left main bronchus. These findings were confirmed via direct visualization of the airway through a flexible bronchoscopy. Eventually, a tracheal stenting were performed to maintain the airway patency and assist in weaning off from mechanical ventilation. Further investigations to identify the aetiology of the central airway stenosis revealed elevated urinary glycoaminoglycans and the absence of iduronate-2-Sulfatase activity tested on dried blood spots, thus confirming the diagnosis of Hunter Syndrome. Managing mucopolysacharidosis with central airway obstruction requires multidisciplinary team effort in handling the difficult airway, anaesthesiology risk, potential comorbidities and providing genetic counselling.


Airway Obstruction , Mucopolysaccharidosis II , Tracheomalacia , Airway Obstruction/etiology , Airway Obstruction/surgery , Bronchoscopy , Constriction, Pathologic , Humans , Male , Middle Aged , Mucopolysaccharidosis II/complications , Mucopolysaccharidosis II/diagnosis , Tracheomalacia/diagnostic imaging , Tracheomalacia/etiology , Tracheostomy
12.
BMJ Case Rep ; 14(5)2021 May 19.
Article En | MEDLINE | ID: mdl-34011665

We describe a rare case of hypopharyngeal liposarcoma with an atypical presentation. The patient presented with a 3-month history of intermittent, transient acute airway obstruction. In between episodes, he was asymptomatic. A pedunculated tumour originating in the postcricoid region was seen to be suspended into the oesophagus and intermittently regurgitated into the larynx to cause airway obstruction. The lesion was endoscopically removed and examined histologically to confirm the diagnosis. On-going management of rare lesions such as this should be through multidisciplinary team meetings at a tertiary sarcoma centre.


Airway Obstruction , Larynx , Liposarcoma , Airway Obstruction/diagnostic imaging , Airway Obstruction/etiology , Airway Obstruction/surgery , Esophagus , Humans , Hypopharynx/diagnostic imaging , Liposarcoma/complications , Liposarcoma/diagnostic imaging , Liposarcoma/surgery , Male
13.
J Cardiothorac Surg ; 16(1): 144, 2021 May 26.
Article En | MEDLINE | ID: mdl-34039398

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is a rare tumor with malignant potential. We presented a case of a young adult who was diagnosed with IMT and treated with loop electrocautery therapy to relieve airway obstruction, followed by lobectomy to complete resection. Recent studies have supported the use of such interventional resection methods. CASE PRESENTATION: A non-smoking 30-year-old woman presented with a 1-month history of progressive dyspnea and productive cough. The Chest X-ray showed a homogenous opacity invading the entire left hemithorax, and the mediastinum content was attracted to the left side. In an effort to avoid pneumonectomy and afford rapid palliation of dyspnea, loop electrocautery was selected as the most appropriate therapy. The left upper lobectomy by thoracoscopy was performed instead of left upper lobe sleeve resection in order to better prevent the recurrence of lung atelectasis. After 6 years of follow-up, no evidence of recurrence has been found till now. CONCLUSION: Interventional bronchoscopy coupled with surgical resection serves not only as a palliative management to bronchial obstruction but also a way to avoid pneumonectomy.


Airway Obstruction/surgery , Plasma Cell Granuloma, Pulmonary/surgery , Adult , Airway Obstruction/etiology , Bronchoscopy , Cough/etiology , Dyspnea/etiology , Female , Humans , Lung Neoplasms/surgery , Plasma Cell Granuloma, Pulmonary/complications , Pneumonectomy , Pulmonary Atelectasis/etiology , Thoracoscopy
14.
J Craniofac Surg ; 32(6): e578-e582, 2021 Sep 01.
Article En | MEDLINE | ID: mdl-34054095

ABSTRACT: Obstructive respiratory stress and feeding difficulties in infants with Robin sequence (RS) may result in poor weight gain or loss. Following failure of conservative treatment, surgical options include mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA). Whilst both techniques have demonstrated to improve airway patency and feeding behavior, an advantage of either in restoring weight growth remains unknown. This study aimed to improve procedural selection by examining weight gain following MDO and TLA. A retrospective chart review was performed for 17 RS patients that had undergone MDO and 25 that had received TLA. The mean body weight in both groups was below the 50th population percentile at birth and fell further in the period before surgery. A mixed model analysis demonstrated that postoperative weight gain depended on the progression of time and preoperative weight. Conversely, biological sex, congenital comorbidities, method of feeding, the respective cleft team, and the type of surgery did not significantly influence the evolution of postoperative body weight. In conclusion, both MDO and TLA were able to restore weight growth in infants affected by RS, though a clear superiority of either technique could not be established.


Airway Obstruction , Osteogenesis, Distraction , Pierre Robin Syndrome , Airway Obstruction/surgery , Humans , Infant , Infant, Newborn , Mandible/surgery , Pierre Robin Syndrome/surgery , Retrospective Studies , Tongue/surgery , Treatment Outcome , Weight Gain
15.
Clin Plast Surg ; 48(3): 363-373, 2021 Jul.
Article En | MEDLINE | ID: mdl-34051891

Pierre Robin sequence is defined by the clinical triad: mandibular hypoplasia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) is a standard treatment of Robin sequence associated with severe airway obstruction and is the only intervention that directly corrects the underlying anatomic pathologic condition. Compared with tongue-lip adhesion, MDO has demonstrated more success in treating airway obstruction in infants with Pierre Robin sequence, including patients with syndromic diagnoses and concomitant anomalies. This article provides a current, comprehensive review of neonatal mandibular distraction and offers treatment guidelines based on a combined surgical experience of more than 400 patients.


Mandible/surgery , Orthognathic Surgical Procedures/methods , Osteogenesis, Distraction/methods , Pierre Robin Syndrome/surgery , Airway Obstruction/surgery , Humans , Infant, Newborn , Osteogenesis, Distraction/adverse effects , Osteogenesis, Distraction/instrumentation , Postoperative Complications , Treatment Outcome
16.
Clin Plast Surg ; 48(3): 445-454, 2021 Jul.
Article En | MEDLINE | ID: mdl-34051897

Anatomic studies have identified that patients with Treacher Collins syndrome and some cases of bilateral craniofacial microsomia are characterized by multilevel airway obstruction as a result of hypoplasia and clockwise rotation of the maxillomandibular complex. Patients often remain tracheostomy-dependent despite multiple airway surgeries. Counterclockwise craniofacial distraction osteogenesis aims to correct the facial skeletal deformity and expand the upper airway volume by rotating the subcranial complex en bloc around the nasofrontal junction. Early results have demonstrated significant increases in the nasopharyngeal and oropharyngeal airway volumes with successful decannulation in a majority of patients who have undergone this operation.


Goldenhar Syndrome/surgery , Mandibulofacial Dysostosis/surgery , Osteogenesis, Distraction/methods , Airway Obstruction/etiology , Airway Obstruction/surgery , Facial Bones/abnormalities , Facial Bones/surgery , Female , Humans , Male , Mandible/surgery , Tracheostomy
17.
Clin Plast Surg ; 48(3): 473-485, 2021 Jul.
Article En | MEDLINE | ID: mdl-34051899

The Le Fort III advancement was first described in 1950 and has since become a key technique in the armamentarium of craniofacial surgeons. The application of distraction osteogenesis to the craniofacial skeleton has allowed for large movements to be performed safely in young patients. This technique is valuable for correcting exorbitism, airway obstruction owing to midface retrusion, and class III malocclusion. It can be performed with either an external distractor or internal distractors. Although serious complications have been reported, these occur rarely when performed by experienced providers.


Craniosynostoses/surgery , Osteogenesis, Distraction/methods , Osteotomy, Le Fort/methods , Airway Obstruction/etiology , Airway Obstruction/surgery , Female , Humans , Male , Orthognathic Surgical Procedures/methods , Osteotomy, Le Fort/adverse effects , Osteotomy, Le Fort/instrumentation , Preoperative Care
18.
ORL J Otorhinolaryngol Relat Spec ; 83(4): 295-298, 2021.
Article En | MEDLINE | ID: mdl-33951656

Adult laryngeal haemangioma is normally seen in the supraglottic or glottic region. Transglottic haemangioma is unusual, and treatment with primary endolaryngeal surgical excision may lead to undesirable bleeding and poor voice outcomes. A 25-year-old female presented with hoarseness and progressive upper airway obstruction symptoms. Videoendoscopy showed haemangioma involving all unilateral subunits of the larynx obstructing half of the subglottis. The transglottic haemangioma was treated with endolaryngeal ethanol injection with prior tracheostomy under local anaesthesia. Endolaryngeal laser surgery was performed later on to remove small residual haemangioma and granuloma. The haemangioma resolved; however, the ethanol injection to the paraglottic space results in vocal fold immobility but with favourable position and good muscle tone and bulk. The patient was successfully decannulated. Post-intervention subjective and objective voice assessments showed normal parameters except slight impairment of voice handicap index-10 with a total score of 12. Adult transglottic haemangioma can cause upper airway obstruction and requires intervention. Excision of the lesion endoscopically without sacrificing voice is achievable.


Airway Obstruction , Hemangioma , Larynx , Adult , Airway Obstruction/etiology , Airway Obstruction/surgery , Female , Hemangioma/complications , Hemangioma/surgery , Hoarseness , Humans , Vocal Cords
19.
ScientificWorldJournal ; 2021: 5591251, 2021.
Article En | MEDLINE | ID: mdl-33981185

OSA pediatric subjects suffer from episodes of upper airway obstruction that can be partial or complete, with atypical sleep patterns and blood-gas level alteration. If poor treated and/or diagnosed, it can cause cardiovascular disease, learning difficulties, behavioural issues, and retardation of growth. In the literature, there are conflicting evidence about OSA assessment and treatment in pediatric age, so the aim of this paper is to highlight the multidisciplinary approach in the management of sleep disorders, stressing the role of the pediatric dentist in both diagnosing and treating the OSAS in children, according to the current evidence of the treatment options effectiveness of the syndrome itself. Conclusions. Scientific evidence shows that OSAS management requires a multidisciplinary approach in order to make an early diagnosis and a correct treatment plan. The orthodontic treatment approach includes orthopedic maxillary expansion and mandibular advancement using intraoral appliances. Hence, the orthodontist and the pediatric dentist play an important role not only in early diagnosis but also in the treatment of pediatric OSAS.


Airway Obstruction/diagnosis , Cardiovascular Diseases/diagnosis , Growth Disorders/diagnosis , Mandibular Advancement/methods , Orthodontics, Corrective/methods , Sleep Apnea, Obstructive/diagnosis , Airway Obstruction/complications , Airway Obstruction/pathology , Airway Obstruction/surgery , Cardiovascular Diseases/etiology , Cardiovascular Diseases/pathology , Cardiovascular Diseases/prevention & control , Child , Dentists , Early Diagnosis , Growth Disorders/etiology , Growth Disorders/pathology , Growth Disorders/prevention & control , Humans , Orthodontists , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/pathology , Sleep Apnea, Obstructive/surgery
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