Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study.

BACKGROUND: Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants. METHODS: Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra­low­dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years. RESULTS: The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.001), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases. CONCLUSIONS: The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.

Endoscopic Treatment of Isolated Sphenoid Sinus Disease in Children.

In this article, we explore the disease spectrum and clinical characteristics of and the diagnosis and endoscopic approach to treating isolated sphenoid sinus disease (ISSD) in children. To these ends, we review a case series of 19 patients (mean age: 8.1 ± 4.9 years, range: 1.1-15 years, median age: 6.7 years, 13 males, 6 females) who underwent surgical treatment at our hospital for ISSD during the 4 years between 2012 and 2016. The symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific and include atypical headache, nasal congestion, epistaxis, postnasal drip, snoring, and impaired vision. Headache is the presenting symptom in 42% of patients, but headaches occurred in no specific or typical location. Ten patients underwent preoperative endoscopic examination, and abnormalities in the sphenoethmoidal recess were found in 6 (60%) of these 10 patients. All 19 patients underwent ultra-low-dose paranasal sinus computed tomography (CT) imaging, and 9 patients with suspected tumors or sphenoid mucoceles were further examined by magnetic resonance imaging (MRI). The endoscopic transostial approach was performed in all 19 patients: 16 patients received excision of inflammatory sphenoid sinus disorders and benign tumors, including sphenoid sinusitis, sphenoid sinus mucocele, sphenoid sinus polyp, and ossifying fibroma; 3 patients with suspected tumors received biopsies to detect rhabdomyosarcoma, Langerhans cell histiocytosis, and juvenile xanthogranuloma. No intraoperative or immediate postoperative complications were observed. Children with opacified sphenoid sinus identified by radiographic imaging presented a variety of pathologies. The most common lesions were associated with inflammatory disease. Because the symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific, CT remains the standard for evaluating sphenoid sinus disease, and ultra-low-dose paranasal sinus CT imaging is recommended and can provide images of equal or better quality compared with those obtained by standard dose CT. In addition, MRI is an essential adjunct in the diagnosis and selection of treatment for suspected tumors of the sphenoid sinus. The endoscopic transostial approach was especially suitable for the management of pediatric benign isolated sphenoid sinus lesions.

Nasal nitric oxide in allergic rhinitis in children and its relationship to severity and treatment.

BACKGROUND: Nasal nitrous oxide (nNO) is increased in allergic rhinitis (AR), but not in asthma, and is a non-invasive marker for inflammation in the nasal passages. METHODS: Levels of nNO were measured and compared in healthy children and children with mild and moderate-to-severe AR. Levels of nNO before and after treatment with steroids and/or antihistamine were then compared in the 2 AR groups. Their relationship to quality of life and nasal symptom and reactivity to outdoor and outdoor allergens were examined. RESULTS: nNO levels were higher in mild AR than in healthy children and higher in moderate-to-severe AR than in mild AR. One month steroid and/or antihistamine treatment lowered nNO levels to control levels in mild AR and approximately halfway to control levels in moderate-to-severe AR. nNO levels had a weak correlation to quality of life questions and a fair correlation to nasal symptom scores before treatment. This correlation was weakened or lost after treatment, and no correlation was seen between nNO levels and responses to indoor or outdoor allergens. CONCLUSION: nNO levels in children with AR may be useful for assessing the response to treatment. Their relationship to quality of life, nasal symptoms, and sensitivity to specific allergens needs further study.

Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients.

BACKGROUND: Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children. Although it is mainly benign, some cases may be fatal. Due to the rare nature of this clinical entity, proper assessment and management have been poorly studied so far. Here, we characterized the presentation and management of this clinical entity and provided an evaluation system for the management. METHODS: We retrospectively reviewed children with PM secondary to FBA, who were treated in Beijing Children's Hospital from January 2010 to December 2015. All patients were stratified according to the degree of dyspnea on admission, and interventions were given accordingly. Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients. For patients in acute respiratory distress, emergent air evacuation and/or resuscitations were performed first. Admission data, interventions, and clinical outcomes were recorded. RESULTS: A total of 39 patients were included in this study. The clinical severity was divided into three grades (Grades I, II, and III) according to the degree of dyspnea. Thirty-one patients were in Grade I dyspnea, and they simply underwent bronchoscopic FBs removals. PM resolved spontaneously and all patients recovered uneventfully. Six patients were in Grade II dyspnea, and emergent drainage preceded rigid bronchoscopy. They all recovered uneventfully under close observation. Two exhausted patients were in Grade III dyspnea. They died from large PM and bilateral pneumothorax, respectively, despite of aggressive interventions in our hospital. CONCLUSIONS: PM secondary to FBA could be life-threatening in some patients. The degree of dyspnea should be evaluated immediately, and patients in different dyspnea should be treated accordingly. For patients in Grade I dyspnea, simple bronchoscopic FBs removals could promise a good outcome. For patients in Grade II dyspnea, emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.

[Treatment of infantile subglottic hemangioma with oral propranolol].

OBJECTIVE: To observe the efficacy of oral Propranolol in the treatment of infantile subglottic hemangioma. METHODS: Eleven children (6 females and 5 males) with a median age at onset of treatment being 4 months were included in this study. Propranolol was given after laryngoscopy and a CT scan with contrast of the trachea confirming the presence of a subglottic hemangioma. The starting dose of Propranolol was 0.5 mg/kg per day, given in 2 or 3 divided doses. Heart rate and blood glucose were monitored during the treatment. If no side effects occurred, the dose was increased to 1 mg/kg per day at the third day and to 2 mg/kg per day at the sixth day. Treatment was continued at home after 10 days of inpatient treatment and the children were reevaluated monthly. RESULTS: After 24 - 48 hours of treatment, all of the children had improvement in their airway obstruction which was confirmed by fibro-laryngoscopy. The diameter of the subglottic stenosis from the hemangioma decreased from 3.9 - 5.0 mm to 1.5 - 2.0 mm,and the color was also lighter than before. In 3 children with cutaneous hemangioma, there was also significant improvement in the cutaneous lesions after treatment, with the color becoming lighter. There were no significant ECG, blood pressure or blood biochemical changes during the treatment. Two of the children had hypoglycemia at the first dose, but improved after blood transfusion and changing their diet. In five children, the treatment was stopped after 6 to 11 months when the obstructive symptoms improved. None of the children in this group had any evidence of recurrence. In the 5 children who stopped treatment, the obstructing mass in the subglottis was less than 10% of the diameter. CONCLUSION: Oral propranolol is a safe and effective treatment for infantile subglottic hemangioma. It may be used as a first-line therapeutic modality.