BACKGROUND Castleman's disease (CD) is a reactive lymph node hyperplasia initially identified by Castleman in 1956. CD predominantly affects individuals 20-50 years of age, with low incidence in children. This case report describes 3 cases of CD treated in our hospital and reviews the relevant literature. The purpose of this case report was to enhance clinical understanding and treatment of CD in the head and neck in children. CASE REPORT To enhance clinical understanding and improve treatment of CD in the head and neck region in children, we present the cases of 3 patients who were admitted to the hospital, primarily presenting with a neck mass. Preoperatively, the patients collectively exhibited non-specific findings. Surgical interventions were performed with Cases 1 and 3 undergoing left functional (radical) neck lymph node dissection, in contrast to Case 2, in which bilateral functional (radical) neck lymph node dissection was executed. Pathological examination confirmed the diagnosis of CD in each of the 3 patients. Following surgery, a follow-up period ranging from 3 months to 1 year revealed that all patients had successfully recovered, with no recurrence. CONCLUSIONS Castleman disease is a rare disease in children and difficult clinical diagnosis. Some patients with unicentric Castleman disease (UCD) can be treated with surgery, and those with multicentric Castleman disease (MCD) need chemotherapy, but at present there is no widely accepted treatment plan.
Castleman Disease , Neck , Child , Female , Humans , Male , Castleman Disease/surgery , Castleman Disease/diagnosis , Neck Dissection , Child, Preschool
We describe a case of lymphatic malformation (LM) with snoring as the primary symptom. The patient, an 11-year-old boy, sought medical attention due to "snoring that had worsened over 3 years, accompanied by shortness of breath for 1 month." The preoperative examination showed that the apnea-hypopnea index during sleep was 33.4. The average overnight blood oxygen saturation was 95.3%, reaching a lowest level of 79.9%. Magnetic resonance imaging identified a space-occupying lesion in the postpharyngeal space, leading to significant compression and narrowing of the pharyngeal cavity. This suggested the possibility of a vascular malformation, with a higher proportion of vascular components. The patient underwent resection of the pharyngeal mass and temporary tracheostomy under general anesthesia, and intraoperative freeze and postoperative pathological diagnoses confirmed LM. Postoperative prognosis was favorable.
PURPOSE: This study aimed to conduct a meta-analysis and systematic review of drug-induced sleep endoscopy (DISE) in pediatric conventional obstructive sleep apnea-hypopnea syndrome (OSAHS) without previous upper airway surgery, or comorbidity, to evaluate the change in treatment strategies and to identify obstructive sites observed during DISE. This study aimed to explore the role of DISE in the management of pediatric conventional OSAHS. METHODS: A comprehensive search was conducted using both computerized and manual methods to retrieve relevant case studies on DISE-guided treatment of pediatric conventional OSAHS from databases including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WF, and VIP database. The search period extended from database inception to January 2023. Strict inclusion and exclusion criteria were applied to select relevant literature, and data extraction was performed accordingly. Meta-analysis was conducted using the Stata 16.0 software. RESULTS: A total of 761 patients from four studies were included in the meta-analysis. All pediatric patients had no history of upper airway surgery, craniofacial abnormalities, or syndromes other than OSAHS. The quality assessment revealed that the included studies were of low methodological quality and consisted of non-randomized case studies. Meta-analysis results indicated that in pediatric patients with OSAHS, the obstruction rates observed during DISE were as follows: nasopharyngeal (adenoid) obstruction 93%, soft palate obstruction 35%, oropharyngeal (tonsil) obstruction 76%, tongue base obstruction 32%, supraglottic obstruction 31%, and multi-level obstruction 60%. DISE led to a change in the conventional surgical approach in 45% (95% CI: 29-60%) of patients with OSAHS, providing individualized treatment plans. Postoperative symptoms and sleep-related parameters improved significantly compared to preoperative values, with DISE findings possibly enhancing surgical success rates and potentially avoiding unnecessary procedures. CONCLUSION: In some cases, DISE may potentially lead to alterations in conventional surgical approaches for children with OSAHS who had no history of upper airway surgery, craniofacial abnormalities, or other syndromes.. The results of our meta-analysis were in favor of DISE-directed approach for pediatric conventional OSAHS. However, further high-quality randomized controlled trials (RCTs) are warranted in future research to investigate the role of DISE in the management of pediatric OSAHS.
The Castleman Disease (CD), also recognized as giant lymph node hyperplasia or vascular follicular lymphoid hyperplasia, is an infrequent lymphoproliferative disorder with substantial clinical variability. Parapharyngeal location of this disease is very rare and in pediatric population it is even rarer. This article presents a case of Unicentric CD (hyaline vascular type) in an 8-year-old female, where the disease was localized within the parapharyngeal space. Clinical manifestations were limited to the presence of a local mass, with no other specific symptoms observed. Laboratory assessments revealed no significant abnormalities. She underwent surgery using a cervical-parotid approach and experienced a good postoperative recovery. Histopathological analysis confirmed the diagnosis. This case underscores the need for a comprehensive evaluation and consideration of uncommon etiologies in the assessment of parapharyngeal masses, even in pediatric patients.
BACKGROUND: Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned. METHODS: We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period. RESULTS: The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients. CONCLUSION: In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.
Purpose: China adjusted and optimized its prevention and control strategies in December 2022, and it entered a new era of the coronavirus epidemic. Here, we describe the general and otolaryngology-related symptoms of coronavirus disease 2019 (COVID-19) in children during the first pandemic in the post-epidemic era, focusing on the frequency and severity of smell and taste loss, as well as the recovery process and its influencing factors. Patients and methods: From 2 January to 7 January 2023, we conducted a cross-sectional online questionnaire survey through Questionnaire Stars in order to collect relevant information about COVID-19 in children in Shenzhen. Results: A total of 1,247 valid questionnaires were received, with an effective response rate of 78.72%. All of the diagnoses were confirmed by nucleic acid or antigen test for COVID-19. Among the subjects, the sex ratio of male to female was more inclined to male (1.35:1), and the age was 3-16 years, with an average of 10.13 ± 2.82 years old. The most common symptoms were cough (58.24%), stuffy nose (56.18%), headache (42.09%), fatigue (40.44%), and sore throat (31.63%). Approximately 6.43% of the children reported dysosmia, the mean time of the duration of dysosmia was 5.38 ± 2.92 days, and the mean score of the severity of the dysosmia as assessed by visual analogue scale (VAS) was 4.63 ± 2.29. Approximately 13.34% reported dysgeusia, the mean time of the duration of dysgeusia was 4.77 ± 3.98 days, and the mean score of the severity of the dysgeusia as assessed by VAS was 5.12 ± 2.29. Univariate and multivariate logistic regression analysis showed that the prevalence of taste and olfactory disorders increased with age, mainly in children with severe symptoms and older children. Conclusion: In the post-epidemic era, due to weakening of the pathogenicity of the subvariant of Omicron, overall condition of children with COVID-19 was mild, incidence of olfactory and taste disorders was low, recovery was faster, and prognosis was better. In our study, cough, runny nose, and sore throat were the most common symptoms, and the prevalence of taste and olfactory disorders increased with age, mainly in older children with severe symptoms.
OBJECTIVE: Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. METHODS: We performed a retrospective case-control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children's Hospital between January 2016 and December 2021. RESULTS: We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. CONCLUSION: The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.
Mucocutaneous Lymph Node Syndrome , Retropharyngeal Abscess , Child , Humans , Retropharyngeal Abscess/etiology , Retropharyngeal Abscess/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/complications , Retrospective Studies , Case-Control Studies , Radiography
OBJECTIVE: To evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants. METHODS: From January 2009 to December 2011, 32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital. According to the choice made by the parents, 16 children accepted CO2 laser supraglottoplasty (group 1), the others were treated conservatively (group 2). The beginning observation point T0 was defined as the age on the first medicine taking day or the age of surgery. T1, T3, T6 were defined as 1, 3, 6 months following T0. Clinical symptoms included stridor, dyspnea, aspiration, and respiratory infections. The body weight, PSG reports, laryngoscope findings, cure rates of the two groups were compared. RESULTS: The anatomical abnormalities were corrected surgically, and the symptoms ,such as stridor, dyspnea, and aspiration improved rapidly after the operation. The cure rates was higher in group 1 than in group 2 on T1, T3, T6 stage. There were statistically significant differences(χ(2) were 13.9, 28.1, 24.6 respectively; all P < 0.01). Children in group 1 gained weight better than in group 2. There was a statistically significant difference in Z scores median on T1, T3, T6 stage (z score were -0.848, -2.940, -4.110; P < 0.05, or P < 0.01 respectively). The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ± 0.106 to 0.901 ± 0.041). There was a statistically significant difference (t = -7.876, P = 0.001). Complications included adhesion (1 case) and temporary new-onset aspiration (1 case). CONCLUSIONS: The CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor, dyspnea and aspiration. It can reduce the frequency of respiratory infections, and contribute to weight gaining. The CO2 laser supraglottoplasty is effective, of high security and with rare complications.
Laryngomalacia/radiotherapy , Lasers, Gas/therapeutic use , Low-Level Light Therapy , Carbon Dioxide , Glottis , Humans , Infant , Infant, Newborn , Laryngoscopes , Retrospective Studies
OBJECTIVE: To evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes. METHODS: Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct. RESULTS: There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied. CONCLUSIONS: Poor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.
Adenoidectomy/adverse effects , Postoperative Hemorrhage/etiology , Adolescent , Child , Child, Preschool , Female , Hematocrit , Hemoglobins/analysis , Humans , Infant , Male , Retrospective Studies , Tonsillectomy/adverse effects
