Nasal chondromesenchymal hamartoma with no nasal symptoms.

The authors present a case of nasal chondromesenchymal hamartoma (NCMH) in an 8-year-old boy with a 4-month history of frontal headache and no symptoms of nasal obstruction, rhinorrhoea or postnasal drip. An ENT examination as well as ophthalmology assessment presented normal results. CT scan showed a lesion involving the sphenoid and ethmoid sinuses. The patient had an endoscopic resection of the lesion that was confirmed histologically to be a NCMH. Though NCMH is known to present usually in infants with obstructing nasal mass, an unusual presentation of a patient with throbbing headache without any nasal symptoms is reported here.

Transnasal endoscopic repair of choanal atresia in a tertiary care centre: a review of outcomes.

INTRODUCTION/AIM: Choanal atresia (CA) is an obliteration, in newborns, of the airway at the level of posterior nasal aperture resulting in absence of connection between the nasal cavity and the aerodigestive tract. It is rare, with incidence of 1 in 7000 live births. This review is aimed at assessing the factors influencing the outcome of transnasal endoscopic repair of CA in a tertiary referral children's hospital. MATERIAL/METHOD: A retrospective study was carried out between 2002 and 2009. 31 children; 14 boys and 17 girls, age range 1 day to 15 years, mean 23.4 months were included. Unilateral presentation was 19 (11 right, 8 left) and bilateral was 12. All patients had transnasal endoscopic repair under direct vision. Nasal stents were placed for varying duration (range 4-12 weeks) or nasopharyngeal airways (removed within 24h) were inserted at time of surgery. Patients were monitored for re-stenosis and revisions carried out as necessary, with a mean follow-up of 11.9 months. RESULTS: 54.7% (n=17) of patients had re-stenosis requiring revision surgery. Of these, 41.1% (n=7) had success after the 1st revision, 20% had success after the 2nd revision while 12.3% had success after the 3rd revision. One patient required more than four revisions. 80% of re-stenosis requiring revisions occurred in children who had surgery under 10 months of age and of these, approx. 42% were 1-week-old or younger. 57% of those who had stents for 4-6 weeks (n=15) had re-stenosis requiring revision while only 33.3% of those who either had no stents or had NP airways removed within 24h (n=16) had re-stenosis (P=0.019). The re-stenosis rate was comparable for those who had mitomycin (53%) versus those who did not (60%). CONCLUSION: Transnasal endoscopic repair of CA is effective and safe and provides the benefit of surgery under direct vision. Age 1 week or less was a predictive factor for re-stenosis. Intranasal stents was also associated with increased incidence of re-stenosis and the use of mitomycin C does not seem to have any significant effect on re-stenosis.

Endoscope-assisted tonsillotomy (partial intracapsular tonsillectomy): how we do it.

Objective. To describe our technique of performing tonsillotomy that increases visibility by providing a better view of the tonsils and related structures through the use of a 30-degree scope. Method. Patients had tonsillotomy with microdebrider with the aid of a 30-degree endoscope for both visualization and on-screen projection and magnification. Result. The endoscope-assisted technique provides a more detailed exposure of pharyngeal structures and their relationships with the tonsils. It is easier to clearly visualize the upper and lower poles. The magnification with the endoscope makes it easier to appreciate anatomic details and identify/deal selectively with minute bleeding points. Conclusion. The use of 30-degree endoscope in tonsillotomy provides better visualization of the upper and lower tonsil poles and may make the procedure easier for the surgeon and safer for the patient.

Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray.

Retropharyngeal abscesses (RPA) are uncommon but potentially lethal deep neck space infections, over 95% of which occur in children under six years of age. Without a high index of suspicion, early recognition and prompt intervention, catastrophic consequences can ensue, and mortality can be as high as 60% if jugular vein thrombosis or mediastinitis occurs. While older children may have specific complaints referable to the pharynx, infants and young children may present with vague symptoms. To date, a lot of emphasis continues to be placed on the importance of lateral soft tissue neck X-ray in the diagnosis and management of patients with suspected retropharyngeal abscesses; and lateral neck X-ray has been cited as the most useful radiological view of the laryngopharynx. While we recognise the role of lateral neck X-rays in retropharyngeal and other upper airway pathologies, we present three case series in which lateral neck X-rays were normal and diagnosis was made only after CT scanning. These three cases were unusual as the abscesses were located high in the naso-pharynx making them impossible to detect on the lateral soft tissue neck X-rays and this underscores the need for high index of suspicion and prompt CT or MRI scanning, in any child with symptoms or signs suggestive of a possible retropharyngeal abscess.