Hyperbaric oxygen therapy for wound breakdown after oronasal fistula and cleft palate repair: four cases.

We offer the first report of hyperbaric oxygen (HBO2) therapy to treat early surgical wound breakdown after oronasal fistula and cleft palate repair in the pediatric population. We present four patients' experiences after undergoing HBO2 therapy. HBO2 was initiated as soon as an oronasal fistula was identified. Three of the children underwent 10 HBO2 treatments with the fourth undergoing 11 treatments. There were no adverse effects during treatment; none of the patients required decompressive myringotomy. Follow-up shows portions of the repair have been salvaged by initiating HBO2 at the first sign of fistula formation. In our case series, the fistulas all decreased in size over the course of treatment and demonstrated granulation tissue at the wound edges. Given the positive outcomes from our preliminary results, our results suggest concurrent usage of HBO2 therapy for wound breakdown after cleft palate repair is an effective treatment option.

Detection of high-risk human papillomavirus infection in tonsillar specimens using 2 commercially available assays.

THE OBJECTIVE OF THE STUDY IS TO DETERMINE THE PREVALENCE OF HIGH-RISK HUMAN PAPILLOMAVIRUS (HRHPV) INFECTION IN TONSILLAR SWABS AND TISSUE: Patients undergoing tonsillectomy for nonmalignant causes were enrolled. A flocked swab and fresh tissue were collected from the left and right tonsil of each patient. Specimens were tested for hrHPV DNA using the Roche cobas test and for the presence of E6/E7 messenger RNA using the Hologic Aptima hrHPV test. Of the 193 patients enrolled, 129 were in the pediatric group (ages 1-12years; median, 5years), and 64 were in the adult group (ages 13-55; median, 22years). All swab and tissue specimens were negative for hrHPV by both methods. Positive, negative, and internal controls performed as expected. We found a 0% rate of infection indicating that detectable hrHPV infection in tonsillar tissue appears to be uncommon in the children and adults in the population sampled.

Augmentation pharyngoplasty for treatment of velopharyngeal insufficiency in children: Results with injectable dextranomer and hyaluronic acid copolymer.

OBJECTIVES/HYPOTHESIS: To evaluate the effectiveness, durability, and safety of a tissue filler (dextranomer and hyaluronic acid copolymer) when injected submucosally in the nasopharynx to treat velopharyngeal insufficiency (VPI) in pediatric patients. STUDY DESIGN: Retrospective case series. METHODS: Charts were reviewed for all patients treated with injectable filler at a tertiary children's center for VPI from April 2010 through September 2013. Main outcome measures included perceptual speech assessments before and after the procedure, velopharyngeal gap size on nasendoscopy, and nasalance. Length of follow-up, length of surgery, hospital admission, and complications were also identified. RESULTS: After injection augmentation pharyngoplasty, 93% of patients had no or mild hypernasality, 83% had resolution of nasal grimace, and 96% had resolution of audible nasal emission. Complications were minor and included mucosal infection, neck pain, snoring, and obstructive sleep apnea. CONCLUSIONS: Use of injectable filler to augment the nasopharynx is an effective, minimally invasive therapy for small or moderate-sized velopharyngeal gaps, with shorter procedural times, easier recovery, and acceptable durability. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:S5-S13, 2016.

Pediatric malignant salivary gland tumors: 60 year follow up.

OBJECTIVE: To evaluate the presentation, treatments and outcomes in pediatric patients with salivary gland malignancies. STUDY DESIGN: Retrospective chart review (1950-2012), Prospective phone interview. METHODS: Patients ≤18 years old with a salivary gland malignancy treated at our institution were identified. Patients were also contacted by phone for a follow up survey. RESULTS: Fifty-six patients were identified. Tumor origin was 88% parotid (n = 49), 5% (n = 3) submandibular and 7% (n = 4) minor salivary glands. Time from onset of symptoms to diagnosis was over one year (mean = 14.4 years). Fifteen out of 52 patients with major gland malignancy had a locoregional recurrence and local recurrences were almost all after initial enucleation. Two of these patients died of disease (overall disease specific survival = 96%). Three out of 4 patients with minor gland malignancy had a local recurrence and two patients with high grade pathology developed metastases and died of their disease (overall survival = 50%). On long term follow up survey in 13 patients (25%), 100% reported normal facial movement and 54% described symptoms of Frey's syndrome, which is higher than other reported series in children. Recurrence was noted up to 45 years after initial treatment. CONCLUSIONS: The majority of malignant pediatric salivary gland tumors are low grade and have excellent survival, especially if found at an early stage. Minor salivary gland malignancies, particularly high grade, have a worse prognosis. Long term mild Frey's syndrome can be expected in approximately half of patients. We advocate a need for long term follow up and increased awareness among providers to diagnose these patients earlier.

Supraglottoplasty outcomes in children with Down syndrome.

OBJECTIVE: Children with Down syndrome have a higher incidence of upper airway obstruction and laryngomalacia. We sought to determine outcomes of supraglottoplasty in this patient population. METHODS: A retrospective chart review was performed from January 2000 through January 2014. Children (n = 18) at our institution with the diagnosis of Down syndrome who underwent supraglottoplasty were included. We reviewed patient characteristics, preoperative findings, and surgical outcomes (stridor, feeding problems, respiratory distress, weight, sleep apnea, and tracheostomy or feeding tube dependence). RESULTS: The average age at surgery was 7.7 months. Operative indications included feeding difficulties (n = 9), noisy breathing or respiratory distress (or both) (n = 16), and sleep-related symptoms (n = 7). Most patients (89%) were extubated successfully on postoperative day 1. There were 2 major complications (CPAP requirement and aspiration pneumonia) and no perioperative deaths. Fifty percent had improved weight (mean = 18 percentile points). Feedback was available from 88% of parents with 100% reporting improvement in respiratory symptoms and 93% reporting improved feeding. Eight patients (44%) subsequently required either adenoidectomy or adenotonsillectomy. Two patients later underwent tracheostomy, 2 subsequently needed a gastrostomy tube and 2 required revision supraglottoplasty. CONCLUSIONS: The majority of children with Down syndrome and laryngomalacia benefit from supraglottoplasty, with outcomes of improved breathing, feeding, and sleeping. However, approximately half may require additional airway procedures. This procedure is well tolerated and associated with a low risk of complications especially given their high rate of comorbidities.

Primary sarcomas of the salivary glands: case series and literature review.

BACKGROUND: Mesenchymal malignancies of salivary origin are rare and are histologically diverse. We reviewed our experience with these tumors, as well as the published literature, with an emphasis on treatment modalities and prognosis. METHODS: We identified 17 patients treated for malignant mesenchymal cell tumors at The University of Texas MD Anderson Cancer Center between 1990 and 2007. We compared our results to the literature from January 1990 to July 2010. RESULTS: Tumors were located primarily in the parotid gland and were primarily T1 tumors (<5 cm). All patients were treated with surgical resection, and 13 patients were given adjuvant therapy. Seven patients (41%) had recurrence, and 4 developed distant metastases. The overall 5-year and 10-year survival rates were 42% and 20%, respectively. CONCLUSIONS: Our case series and literature review show that sarcomas of the salivary glands have a high rate of recurrence and are associated with a poor prognosis.