Mitigating Infectious Complications of Injection Pharyngoplasty with Calcium Hydroxyapatite for Velopharyngeal Insufficiency: Retropharyngeal Abscess and Osteomyelitis.

Velopharyngeal insufficiency is a complex condition with various treatment options. In this case, a patient with a cleft palate who was treated for velopharyngeal insufficiency with calcium hydroxyapatite injection pharyngoplasty developed persistent cervical pain on postoperative day 6. CT imaging showed a hypodense structure in the right retropharyngeal tissue, and cultures tested positive for Streptococcus intermedius and Staphylococcus aureus. An MRI later revealed skull base osteomyelitis. The infection was controlled via surgical intervention and antibiotics. This case highlights potential severe complications from injection pharyngoplasty and it underscores the importance of early recognition and management of infectious complications.

Head and neck pleomorphic myxoid liposarcoma in a child with Li-Fraumeni syndrome.

INTRODUCTION: Pleomorphic myxoid liposarcoma is a rare and aggressive cancer seen in the pediatric population that has been previously associated with hereditable cancer disorders like Li Fraumeni syndrome. We present a case report and review of the relevant literature. CASE PRESENTATION: Pleomorphic myxoid liposarcoma presenting as a second primary tumor in a child with a strong family history for cancer led to diagnosis of Li-Fraumeni syndrome, which is associated with TP53 tumor suppressor gene inactivation. MANAGEMENT AND OUTCOME: The tumor was fully excised, but postoperative radiation was deferred to limit future radiation-induced tumorgenesis. DISCUSSION: Pleomorphic myxoid liposarcoma is rare but aggressive, and should prompt caregivers to test for potential hereditable cancer disorders. Li-Fraumeni syndrome is associated with early onset neoplasia and development of recurrent primary tumors. Its presence affects treatment decisions and methods of surveillance. Chemoradiation should be used judiciously in this population.

Evaluating tonsillectomy as a risk factor for childhood obesity.

OBJECTIVE: To investigate weight gain and any increased risk of obesity in children who have undergone tonsillectomy. DESIGN: Retrospective chart review. SETTING: Tertiary care pediatric hospital. PATIENTS: The study included 200 children aged 2 to 12 years who were undergoing tonsillectomy and 200 age- and sex-matched controls. All children had a preoperative body mass index (BMI) and a postoperative BMI recorded 6 to 18 months after surgery. MAIN OUTCOME MEASURES: The BMI percentile (BMI%) for age was analyzed between and within groups. A Wilcoxon matched-pairs test was used to analyze BMI% before and after tonsillectomy. A Mann-Whitney test was used to compare BMI% between the study and the control groups. An odds ratio (OR) was used to compare overweight (≥ 85%) and obese (≥ 95%) patients before and after surgery. A correlation analysis was used to examine the relationship between age and weight gain. RESULTS: The BMI% did not differ significantly between the study and the control groups before surgery (P = .14). The BMI% in the study group increased significantly after tonsillectomy (P < .001). Although older children had a higher BMI% than matched controls before surgery, they had a smaller change in BMI% than younger children after tonsillectomy (P = .004). The odds of a child being overweight (OR, 1.23; P = .36) or obese (OR, 1.44; P = .12) were not significantly different before or after tonsillectomy. CONCLUSION: Children, particularly younger ones, gained weight after tonsillectomy, but the odds of a child being overweight or obese after tonsillectomy were no different than they were before surgery.