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1.
Laryngoscope ; 2024 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-39140255

RESUMEN

OBJECTIVE: To characterize incidence of mandibular anomalies (MAs) and compare gestational age, airway interventions, and complications among individuals with MA phenotypes (isolated retrognathia, isolated micrognathia, syndromic micrognathia, micrognathia plus cleft palate/cleft lip and palate, agnathia/micrognathia plus cervical auricle/otocephaly, and agnathia/micrognathia plus microstomia) and unaffected individuals. METHODS: The Healthcare Cost and Utilization Project Kids' Inpatient Database was used to collect data over a 20-year period beginning in 2000. Interventions were classified as perinatal when performed on day of life (DOL) 0 or 1 and subsequent when performed during the birth hospitalization after DOL 1. Hypoxic complications included cardiac arrest, birth asphyxia, hypoxic-ischemic encephalopathy, anoxic brain damage, intraventricular hemorrhage or cerebral infarction. Descriptive statistics are reported, and the Rao-Scott chi-square test compared groups. RESULTS: MAs affected 119 per 100,000 birth visits. Preterm delivery was more frequent for all MA phenotypes. Individuals with MA phenotypes are more likely to require medical attention (airway intervention on DOL 0 or 1 OR no airway intervention received but patient sustained hypoxic complication/mortality): 16.2%-70.7% vs. 3.8%, p < 0.01. Despite receipt of airway interventions at a higher rate, collectively individuals with MAs who received an airway intervention on DOL 0 or 1 have a mildly elevated risk of hypoxic complication or mortality (32.4% vs. 26.4%, p < 0.01). CONCLUSIONS: Preterm birth is more common, however, does not account for the elevated rate of airway intervention. Individuals with MAs require higher rates of medical attention, and current airway management paradigms are insufficient to prevent complications and mortality. LEVEL OF EVIDENCE: III Laryngoscope, 2024.

2.
Int J Pediatr Otorhinolaryngol ; 175: 111767, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37931498

RESUMEN

INTRODUCTION: Fetal goiter is a rare congenital disorder that can present with life-threatening neonatal airway obstruction. Lifesaving and function-preserving airway management strategies are available, but routine delivery affords a limited window for intervention. Accordingly, fetal goiter is reported among the most common indications for ex-utero intrapartum treatment (EXIT). While EXIT prolongs the window for airway intervention to benefit the neonate, it elevates the risk to the pregnant person and requires extensive resources; therefore, data to guide ideal treatment selection are essential. This study aims to compare perinatal airway interventions between individuals with a birth hospitalization discharge diagnosis (BHDD) of goiter and the general population. MATERIALS AND METHODS: Individuals with and without BHDD of goiter were identified in the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database from 2000 to 2019. The frequency of airway interventions on day of life (DOL) 0 or 1 were compared using the Rao-Scott chi-square test. Additionally, gestational age, type of intervention, complications, mortality, birth weight, and length of stay were examined for the goiter cohort. RESULTS: Two-hundred eighty-seven weighted cases of goiter were identified in the study period. The population was 61 % male, 55 % White, and median birthweight was 3.3 kg. The median length of stay was 4.3 days, and average total charges were $42,332. Airway intervention on DOL 0 or 1 was performed in 16.9 % of individuals with goiter compared to 1.6 % in neonates without goiter (p < 0.001). Interventions in the goiter cohort included endotracheal intubation in 16 % of cases, laryngoscopy/bronchoscopy in 1-5% of cases, and tracheostomy in <1 % of cases. Fewer than 1 % of individuals undergoing intubation additionally had mass decompression/resection on DOL 0 or 1. No neonates received extracorporeal membrane oxygenation cannulation or cardiopulmonary resuscitation. Hypoxic encephalopathy occurred in <1 % of cases, among which endotracheal intubation was the only airway intervention performed. There were no mortalities among neonates with goiter. CONCLUSION: Individuals with BHDD of goiter receive significantly higher rates of perinatal airway intervention. In most cases, endoscopic interventions alone were sufficient to avoid hypoxic neurological complications. These findings contribute to data to aid in clinical counseling and empower patients to make informed decisions according to their values and treatment goals.


Asunto(s)
Obstrucción de las Vías Aéreas , Enfermedades Fetales , Bocio , Embarazo , Recién Nacido , Femenino , Humanos , Masculino , Pacientes Internos , Enfermedades Fetales/cirugía , Manejo de la Vía Aérea , Obstrucción de las Vías Aéreas/terapia , Obstrucción de las Vías Aéreas/cirugía , Costos de la Atención en Salud , Bocio/terapia , Bocio/complicaciones
3.
Int J Pediatr Otorhinolaryngol ; 175: 111749, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37839292

RESUMEN

Cervical and craniocervical instability are associated with catastrophic procedural outcomes. We discuss three individuals who required otolaryngologic surgical intervention: two with symptomatic spinal instability and one in whom spinal stability was unable to be assessed. Two cases were managed with procedural positioning precautions and evoked potential monitoring, and the other with procedural positioning precautions alone. Methods of monitoring and triggers for repositioning are discussed. This series is intended to discuss the approach and potential added value of evoked potential monitoring for risk mitigation in pediatric patients with concern for cervical spine instability.


Asunto(s)
Potenciales Evocados Somatosensoriales , Monitorización Neurofisiológica Intraoperatoria , Humanos , Niño , Potenciales Evocados Somatosensoriales/fisiología , Potenciales Evocados Motores/fisiología , Cuello/cirugía , Procedimientos Neuroquirúrgicos , Vértebras Cervicales/cirugía
4.
Ann Otol Rhinol Laryngol ; 130(3): 311-313, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32772542

RESUMEN

INTRODUCTION: Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature. METHODS: Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed. RESULTS: Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported. CONCLUSION: Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.


Asunto(s)
Epiglotis/anomalías , Epiglotis/lesiones , Intubación Intratraqueal/efectos adversos , Laringoscopía , Epiglotis/fisiopatología , Epiglotis/cirugía , Femenino , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Músculos Laríngeos/cirugía , Aspiración Respiratoria/fisiopatología
5.
Laryngoscope ; 131(7): 1647-1651, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33300625

RESUMEN

OBJECTIVES/HYPOTHESIS: The anatomy of children with severe Pierre Robin sequence can present a challenge for direct laryngoscopy and intubation. Advanced techniques including flexible fiberoptic laryngoscopic intubation have been described but require highly specialized skill and equipment. Rigid video laryngoscopy is more accessible but has not been described in this population. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review was completed at a tertiary care center of all children between January 2016 and March 2020 with Pierre Robin sequence who underwent a mandibular distraction osteogenesis procedure. Intubation events were collected, and a descriptive analysis was performed. A univariate logistic regression model was applied to direct laryngoscopy and flexible fiberoptic laryngoscopy with rigid video laryngoscopy as a reference. RESULTS: Twenty-five patients were identified with a total of 56 endotracheal events. All patients were successfully intubated. Direct laryngoscopy was successful at first intubation attempt in 47.3% (9/19) of events. Six direct laryngoscopy events required switching to another device. Rigid video laryngoscopy was successful at first intubation attempt in 80.5% (29/36) of events. Two cases required switching to another device. Flexible fiberoptic laryngoscopy was found successful at first intubation attempt in 88.9% (8/9) of events. Direct laryngoscopy was 4 times more likely to fail first intubation attempt when compared to rigid video laryngoscopy (P < .05). There was no significant difference between rigid video laryngoscopy and flexible fiberoptic laryngoscopy for intubation. CONCLUSIONS: For children with Pierre Robin sequence rigid video laryngoscopy should be considered as a first attempt intubation device both in the operating room and for emergent situations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1647-1651, 2021.


Asunto(s)
Obstrucción de las Vías Aéreas/cirugía , Intubación Intratraqueal/métodos , Laringoscopía/métodos , Síndrome de Pierre Robin/complicaciones , Adolescente , Obstrucción de las Vías Aéreas/etiología , Niño , Preescolar , Falla de Equipo , Femenino , Humanos , Lactante , Recién Nacido , Intubación Intratraqueal/instrumentación , Laringoscopios , Laringoscopía/instrumentación , Masculino , Mandíbula/anomalías , Mandíbula/cirugía , Osteogénesis por Distracción , Síndrome de Pierre Robin/diagnóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
7.
Int J Pediatr Otorhinolaryngol ; 138: 110281, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32891939

RESUMEN

OBJECTIVE: To make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. METHODS: Recommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. "Consensus" was defined by >80% respondent affirmative responses, "agreement" by 51-80% affirmative responses, and "no agreement" by 50% or less affirmative responses. RESULTS: Recommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. CONCLUSIONS: Thorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.


Asunto(s)
Obstrucción de las Vías Aéreas , Otolaringología , Manejo de la Vía Aérea , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/terapia , Niño , Consenso , Femenino , Humanos , Placenta , Embarazo
9.
Otol Neurotol ; 40(10): e1037-e1044, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31592820

RESUMEN

HYPOTHESIS: Anatomic study of the external auditory canal's (EAC) anterior bulge, scutum, and ossicular chain will generate knowledge applicable to safe ear surgery and instrument design. BACKGROUND: The EAC contains two structures that obscure view of the middle ear: the anterior bulge and the scutum. The dimensions of these structures and their relationships to the ossicular chain have not been previously described. METHODS: Cadaveric temporal bones underwent computed tomography scanning, and three-dimensional reconstructions were created. Dimensions and angles of the EAC, its anterior bulge and scutum were measured. Distances to ossicular landmarks and the facial nerve were examined. RESULTS: The anterior EAC had a swan-neck shape. The thinnest portion was located medially and correlated with the canal thickness at the anterior bulge. However the thickness of the anterior bulge was not correlated with its angulation. The scutum averaged 3.8 mm long with a base thickness of 2.3 mm and a mean tip angle of 33 degrees. The short process of the incus was significantly closer to the scutum than other ossicular landmarks. CONCLUSION: Prominent anterior canal bulges are formed by posterior temporomandibular joints, not thicker bone. The scutum has asymmetric distances to various portions of the ossicles with the incus short process sometimes as close as 0.2 mm, placing it at risk of injury.


Asunto(s)
Conducto Auditivo Externo/anatomía & histología , Oído Medio/anatomía & histología , Hueso Temporal/anatomía & histología , Humanos , Procedimientos Quirúrgicos Otológicos
10.
Otolaryngol Head Neck Surg ; 156(3): 549-553, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28140829

RESUMEN

Objective To define the presence and relationship of the petrosquamous stalactite (PsS)-a condensation of the trabecular Korner's septum into a bony plate of the petrosquamous suture-to surrounding structures and understand its surgical implications. Study Design Series of cadaver dissections. Setting University of Missouri Alumni Temporal Bone and Microvascular Laboratory. Subjects and Methods Anatomic dissections were conducted on 15 consecutive formalin-preserved and frozen adult human temporal bones. A calibrated Dino-Lite Premier Digital Microscope was used to photograph dissections of each bone. Measurements were conducted with DinoCapture 2.0 software, with measurement agreement between 2 authors. Results The PsS was present in all specimens. A conserved vascular structure courses within the structure, and the superior malleolar ligament inserts on it. The mean ± SEM distances from the PsS to the tegmen tympani and incus buttress were 2 ± 0.24 mm and 4.23 ± 0.14 mm, respectively. The shortest distance from the PsS to the posterior body of the incus was 1.25 ± 0.13 mm, while the greatest distance from the posterior prominence of the PsS to the posterior body of the incus was 4.58 ± 0.25 mm. Conclusion The PsS is a consistently identifiable structure that may facilitate identification of the tegmen tympani and guide the otologic surgeon from the mastoid antrum to the incus. It is important to recognize the contribution of the PsS to the division of the epitympanic space when cholesteatoma involves the region, to avoid leaving a nidus for future disease.


Asunto(s)
Apófisis Mastoides/anatomía & histología , Hueso Temporal/anatomía & histología , Cadáver , Humanos
13.
Nutr Clin Pract ; 31(1): 121-4, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26487513

RESUMEN

Nasoenteric tubes provide short-term nutrition support to patients unable to take an adequate oral diet. Bridling systems may be used to secure tubes to guard against displacement. We present the first case of an avulsed magnet from a bridling system to raise awareness of this potential complication. The primary methods of securing a nasogastric tube are reviewed, and comparative assessment of the 3 main systems is presented. Diagnosis and management of nasal foreign bodies relevant to this case are reviewed and prevention/safety considerations discussed.


Asunto(s)
Nutrición Enteral/instrumentación , Cuerpos Extraños/etiología , Intubación Gastrointestinal/instrumentación , Imanes/efectos adversos , Nariz , Nutrición Enteral/métodos , Femenino , Humanos , Intubación Gastrointestinal/métodos , Persona de Mediana Edad
14.
Biochem J ; 443(2): 339-53, 2012 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-22452816

RESUMEN

The current literature fully supports HPV (human papillomavirus)-associated OPSCC (oropharyngeal squamous cell carcinoma) as a unique clinical entity. It affects an unambiguous patient population with defined risk factors, has a genetic expression pattern more similar to cervical squamous cell carcinoma than non-HPV-associated HNSCC (head and neck squamous cell carcinoma), and may warrant divergent clinical management compared with HNSCC associated with traditional risk factors. However, a detailed understanding of the molecular mechanisms driving these differences and the ability to exploit this knowledge to improve clinical management of OPSCC has not yet come to fruition. The present review summarizes the aetiology of HPV-positive (HPV+) OPSCC and provides a detailed overview of HPV virology and molecular pathogenesis relevant to infection of oropharyngeal tissues. Methods of detection and differential gene expression analyses are also summarized. Future research into mechanisms that mediate tropism of HPV to oropharyngeal tissues, improved detection strategies and the pathophysiological significance of altered gene and microRNA expression profiles is warranted.


Asunto(s)
Carcinoma de Células Escamosas/virología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/complicaciones , Animales , Carcinoma de Células Escamosas/genética , Regulación Neoplásica de la Expresión Génica , Regulación Viral de la Expresión Génica , Humanos , Neoplasias Orofaríngeas/genética , Infecciones por Papillomavirus/genética
16.
Mo Med ; 107(6): 416-20, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-21319692

RESUMEN

In April 2010, the Missouri State Medical Association (MSMA) sponsored the Second Annual Medical Student Lobby Day to increase student understanding of the relationship between state politics and medicine, further MSMA policy positions, remove barriers to political action, and improve future Lobby Day events. A detailed description is provided, which could be used as a reproducible model for creating similar events in other states. Participant surveys were administered and outcome data was collected and analyzed.


Asunto(s)
Maniobras Políticas , Sociedades Médicas , Gobierno Estatal , Estudiantes de Medicina , Humanos , Missouri
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