Increasing Incidence of Streptococcus anginosus Group Intracranial Infections Associated With Sinusitis, Otitis Media, and Mastoiditis in Children.

BACKGROUND: The Streptococcus anginosus group (SAG) pathogens have the potential to cause head and neck space infections, including intracranial abscesses. Several centers noted an increase in intracranial abscesses in children during the SARS-CoV-2 pandemic, prompting a Centers for Disease Control and Prevention health alert in May 2022. We examined the epidemiology of pediatric intracranial abscesses at a tertiary care center with a focus on SAG pre- and post-pandemic. METHODS: Cases of intracranial abscesses of any microbiologic etiology admitted from January 2011 to December 2022 were identified using International Classification of Diseases 10 codes. Subjects were cross-referenced with culture results from the microbiology laboratory at Texas Children's Hospital. Cases included were those associated with either otitis media, mastoiditis or sinusitis and medical records were reviewed. RESULTS: A total of 157 cases were identified and 59.9% (n = 94) were caused by SAG. The incidence of all sinogenic/otogenic intracranial infections (P = 0.002), and SAG-specific infections (P = 0.004), increased from 2011 to 2022. SAG infection was more often associated with multiple surgeries, and these subjects were more likely to require craniotomy or craniectomy. Among sinogenic abscesses, S. intermedius was the most common pathogen, while among otogenic cases, S. pyogenes predominated. From March 2020 to Dec 2022, 9/49 cases tested positive for SARS-CoV-2 (18.4%); characteristics of infection were not significantly different among cases with and without SARS-CoV-2. CONCLUSIONS: Over the last decade, intracranial complications of sinusitis/otitis have been increasing, specifically those caused by SAG; this trend, however, predated the SARS-CoV-2 pandemic. SAG was associated with a greater need for surgical intervention, specifically neurosurgery. Further work is necessary to determine the cause for these rising infections.

Complex Head and Neck Resection, Reconstruction, and Rehabilitation in Children.

Pediatric head and neck tumors are uncommon but the consequences of radical resection are extensive. These tumors, benign and malignant, are uniquely challenging because of their proximity to critical functional and neurovascular structures and intimately affect speech, swallowing, voice, breathing, hearing, and vision. In addition, the psychosocial and emotional trauma from the cosmetic and functional consequences can be enduring. Their relative rarity limits surgeon experience and requires a focused effort to develop individual and programmatic expertise. A practiced multidisciplinary team can facilitate smooth preoperative evaluations, efficient coordinated operative procedures, comprehensive rehabilitation, and recovery, as well as optimal oncologic outcomes.

Decannulation protocol for short term tracheostomy in pediatric head and neck tumor patients.

BACKGROUND: While the majority of pediatric tracheostomies are performed in the setting of chronic and complex medical comorbidities, perioperative tracheostomies following head and neck tumor ablation are generally short-term. Deliberate planning is required for decannulation in this setting and no published protocols currently exist. Our study outlines a management strategy for short-term tracheostomy in pediatric patients following head and neck surgery. METHODS: A retrospective study of pediatric head and neck tumor patients undergoing tracheostomy was performed at a quaternary children's hospital from February 1, 2016 to December 31, 2018. Charts were reviewed for demographics, surgical operation, relevant tracheostomy-related complications, and time to decannulation. RESULTS: Eleven patients with a mean age of 10.4 years (st.dev. 6.7, range: 0.5-23) underwent tracheostomy during their primary ablative/reconstructive surgery. Trans-tracheal pressure monitoring helped direct the need for tracheostomy downsizing and readiness for capping trials. All patients were decannulated before hospital discharge after a mean of 12.8 days (st.dev. 2.5, range: 9-18) and were discharged after a mean of 14.8 days (st.dev. 2.5, range: 11-20). CONCLUSION: Pediatric head and neck surgery patients can be quickly and safely decannulated with an instructive protocol and multidisciplinary care.

Thyroid surgery outcomes at a children's hospital: The value of a multidisciplinary team approach.

BACKGROUND: Our purpose is to describe the structure, function and outcomes of our multidisciplinary pediatric thyroid program and to evaluate our experience in comparison to other high-volume centers. METHODS: We reviewed all thyroid operations performed 10/2012 through 09/2019, and examined number of cases per year, patient demographics, procedures, final diagnoses and results. Primary outcomes were hypoparathyroidism and recurrent laryngeal nerve (RLN) injury at 12 months. Data were analyzed using descriptive statistics and univariate analyses. RESULTS: We performed 294 thyroid operations on 279 patients. Seventy-nine percent were female. Median age was 15 years (IQR: 12-17). Operations included total thyroidectomy (65%), lobectomy (30%) and completion thyroidectomy (5%). Most common diagnoses were Graves' disease (35%), malignancy (29%), and benign nodule (20%). We developed an evidence-based clinical pathway and conducted weekly multidisciplinary meetings. A clinical data specialist reviewed process and outcome measures routinely. Overall, 6 patients (2.0%) had hypoparathyroidism and 2 (0.7%) had unilateral RLN injury at 12 months. Two of the patients with clinical suspicion of permanent hypoparathyroidism were ultimately weaned off calcium. Both patients with RLN injury had extensive locally advanced malignant disease involving the nerve. CONCLUSIONS: Our multidisciplinary team achieved excellent long-term outcomes for pediatric thyroid surgery comparable to other high-volume pediatric and adult centers.

Needle tract seeding following percutaneous biopsy of pediatric head and neck sarcoma: A case report.

This case report demonstrates the possibility of sarcoma biopsy needle track seeding from FNA/Core Needle Biopsy during the workup of a pediatric head and neck mass. Though not currently widely practiced in head and neck tumors, surgeons may consider placing biopsy tracks in the area of planned resection for suspected head and neck malignancies as is more common in approaches to extremity sarcoma.

Diagnosis and management of pediatric epithelial salivary gland malignancy.

PURPOSE OF REVIEW: Salivary tumors are uncommon among children but are more likely to be malignant compared with adults. A lack of experience makes consensus in treatment elusive. Amidst recent publication of large institutional and national series, this review aims to discuss the epidemiology, diagnosis, investigation, and treatment for pediatric epithelial salivary malignancies. RECENT FINDINGS: Pediatric salivary malignancies are often low grade and carry a favorable prognosis. High-grade tumors portend an increased risk of recurrence and a decreased survival. Surgeons should strive for oncologic resection with clear margins and avoid enucleation and excisional biopsies. Overt nodal metastases require concurrent neck dissection, whereas elective neck dissections may be reserved for cases with high risk of occult disease, such as advanced stage and high-grade neoplasms. Adjuvant radiation should be considered in high-grade tumors. SUMMARY: The paucity of high-level evidence clouds treatment decisions and further encourages pediatric salivary malignancies to be treated in an experienced center with a multidisciplinary approach.

Combined application of virtual surgery and 3D printing technology in postoperative reconstruction of head and neck cancers.

BACKGROUND: The complex anatomy of the head and neck creates a formidable challenge for surgical reconstruction. However, good functional reconstruction plays a vital role in the quality of life of patients undergoing head and neck surgery. Precision medical treatment in the field of head and neck surgery can greatly improve the prognosis of patients with head and neck tumors. In order to achieve better shape and function, a variety of modern techniques have been introduced to improve the restoration and reconstruction of head and neck surgical defects. Digital surgical technology has great potential applications in the clinical treatment of head and neck cancer because of its advantages of personalization and accuracy. CASE PRESENTATION: Our department has identified the value of modern digital surgical techniques in the field of head and neck surgery and has explored its utility, including CAD/CAM technology and VR technology. We have achieved good results in the reconstruction of head and neck surgical resection defects. CONCLUSION: In this article, we share five typical cases from the department of head and neck surgery where the reconstruction was performed with the assistance of digital surgical technology.

Assessment and Management of Thyroid Disease in Children.

This article summarizes the current management of pediatric thyroid disease, with an emphasis on surgical management. Medical and surgical approaches to hyperthyroidism are reviewed as well as pathways for evaluation of nodules and malignancy. Differences between pediatric and adult thyroid management are highlighted.

Pediatric Craniomaxillofacial Oncologic Reconstruction.

Reconstruction of defects of the head and face in the pediatric population requires special consideration for future growth, and at times temporization in anticipation for skeletal maturity followed by subsequent reoperation at an appropriate age. Additional challenges include more limited donor sites, smaller anastomoses, and unpredictable postoperative compliance compared with their adult counterparts. Nonetheless, successful composite bony and soft tissue, and isolated soft tissue defects in children are safely reconstructed using existing local tissue and microsurgical techniques.

Tracheal paraganglioma presenting as stridor in a pediatric patient, case report and literature review.

OBJECTIVE: To review tracheal paragangliomas and describe the clinical presentation, radiologic findings, operative management, and histologic findings of a pediatric patient who presented with stridor refractory to traditional asthma therapy. METHODS: Chart review of an 8-year-old male who presented to a tertiary care pediatric hospital and literature review of tracheal paragangliomas. RESULTS: We present the case of an 8-year-old male who presented with new-onset of wheezing and dyspnea on exertion. He was given a new diagnosis of asthma and treated with bronchodilators that failed to improve his symptoms, which progressed over 3 months until he presented urgently with biphasic stridor. Bedside flexible laryngoscopy failed to reveal an etiology. Computed tomography (CT) imaging demonstrated 17 × 12 × 16 mm exophytic mass arising from the posterior membranous trachea with extension of the mass to the border of the thyroid gland and separate from the esophagus. Magnetic resonance imaging (MRI) angiography confirmed vascular supply from the right thyrocervical trunk and inferior thyroid artery. Rigid microlaryngoscopy revealed a friable vascular polypoid mass 2 cm distal to the vocal folds with 75% obstruction of the airway from which a small biopsy was taken. Pathology confirmed paraganglioma with neuroendocrine cells arranged in "zellballen" architecture and strong immunopositivity for chromogranin and synaptophysin in the neuroendocrine cells and S100 immunopositivity in the sustentacular cells. The patient underwent complete open resection of the tumor including three tracheal rings with primary anastomosis. Final pathology confirmed paraganglioma and negative margins. Genetic screening revealed a succinate dehydrogenase complex subunit C (SDHC) germline mutation, confirming hereditary paraganglioma/pheochromocytoma syndrome. He remains well at 3 month follow up without dyspnea or stridor. CONCLUSION: Tracheal paragangliomas are exceptionally rare, with 12 reported cases. This is the only pediatric case reported. In pediatric patients with persistent airway complaints, subglottic and tracheal masses and obstruction should be considered. Due to the vascularity and endotracheal component of tracheal paragangliomas, a detailed surgical plan should consider embolization, endotracheal laser photocoagulation and electrocautery, and open surgical resection. Additionally, pediatric patients benefit from a multidisciplinary approach including radiology, endocrinology, and genetic counseling.