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2.
Int J Pediatr Otorhinolaryngol ; 131: 109886, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31968273

RESUMO

INTRODUCTION: Injection laryngoplasty (IL) is a brief, minimally invasive procedure involving injection of agents to augment the interarytenoid space. It was initially described as a diagnostic and temporizing measure for management of type one laryngeal clefts (LC1) and associated swallowing dysfunction (SwD), but more gradually it is being proposed as a definitive treatment modality. However, the morbidity of this treatment for LC1 remains under-investigated. This study sought to determine the morbidities associated with IL as a treatment modality for LC1 and associated SwD. METHOD: Single centre retrospective review of a prospective surgical database of one Pediatric Otolaryngologist at a tertiary care center. Participants included pediatric patients with an endoscopic diagnosis of LC1, treated with IL between 2000 and 2018-excluding those with concurrent upper airway anomalies. Patient charts were reviewed for demographic information, immediate post-op complications (within the first 14 days following IL), and subsequent management. RESULTS: Out of 85 consecutive, eligible patients, 12 were excluded (5 subglottic stenosis, 6 laryngomalacia, and one tracheomalacia). Of the 73 included patients, 42 were male and 31 females. The median age at IL was 29 months (range 1-132, interquartile range of 38 months). All IL procedures in this study utilized hyaluronic acid derivatives. From this series, 13 patients experienced post-operative complications. The complications encountered were respiratory distress (N = 5), croup-like cough (N = 6), and stridor (N = 6). These complications were either self-limiting (N=9), managed by systemic or inhaled steroids (N = 4), or admitted to hospital for monitoring (N=3). One case (augmented with dextranomer and hyaluronic acid) required intubation, repeat endoscopy, and drainage of seroma. CONCLUSION: IL was followed by respiratory morbidity in nearly two in ten of this series of consecutive patients. All the morbidities occurred in association with one injection product. Parents should be counselled appropriately about potential morbidities associated with this procedure.


Assuntos
Anormalidades Congênitas/cirurgia , Dextranos/administração & dosagem , Dextranos/efeitos adversos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/efeitos adversos , Laringoplastia/efeitos adversos , Laringe/anormalidades , Complicações Pós-Operatórias/epidemiologia , Criança , Pré-Escolar , Endoscopia , Feminino , Humanos , Lactente , Injeções , Laringoplastia/métodos , Laringe/cirurgia , Masculino , Estudos Retrospectivos
3.
Int J Pediatr Otorhinolaryngol ; 131: 109844, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901483

RESUMO

OBJECTIVE: Identify incidence and factors associated with respiratory complications after type 1 cleft repair. METHODS: Retrospective chart review of patients who underwent cleft repair over a 5-year period performed by a single surgeon. Primary endpoint was respiratory complications (oxygen desaturation <90%). Fisher's exact test was used to identify differences between repair types (endoscopic carbon dioxide laser-assisted repair and injection laryngoplasty). Logistic regression was used to identify predictors of respiratory events. RESULTS: Fifty-five patients were included. Thirty-four (62%) patients underwent endoscopic carbon dioxide laser-assisted repair and 21 (38%) underwent injection laryngoplasty. Average hospital stay for each group was 1.6 days (SD = 3.1) and 0.6 days (SD = 0.9), respectively. Desaturations occurred in three patients (9%) in the laser-assisted repair group and one patient (4%) in the injection group. All occurred within 3 h after surgery and resolved with supplemental oxygen, oral airway placement, and/or mask ventilation. Two affected patients had comorbid diagnosis of asthma (one had poor medication compliance), and one had a history of developmental delay and hypotonia. In the injection group, desaturations occurred in one patient with a history of tracheal stenosis and double aortic arch. No correlation existed between repair type and desaturation (p = 0.57). No variables were significant predictors of events. CONCLUSIONS: In this cohort, respiratory events after type 1 laryngeal cleft repair occurred early in the postoperative period, in children with cardiac and pulmonary comorbidities. This suggests postoperative admission may only be necessary for a select group of patients undergoing type 1 cleft repair. However, further research is needed to determine criteria for same-day discharge.


Assuntos
Anormalidades Congênitas/cirurgia , Laringoplastia/efeitos adversos , Laringoplastia/métodos , Laringe/anormalidades , Oxigênio/sangue , Complicações Pós-Operatórias/etiologia , Asma/complicações , Criança , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/complicações , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Injeções , Laringe/cirurgia , Lasers de Gás/uso terapêutico , Tempo de Internação , Masculino , Hipotonia Muscular/complicações , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Estudos Retrospectivos , Estenose Traqueal/complicações , Anel Vascular/complicações
4.
Int J Pediatr Otorhinolaryngol ; 128: 109731, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648159

RESUMO

INTRODUCTION: Interarytenoid injection augmentation (IIA) during initial diagnostic endoscopy for aspiration and dysphagia has been described as both a diagnostic and therapeutic technique in the evaluation of type 1 laryngeal cleft (LC-1). IIA is additionally hypothesized to be a temporizing measure that facilitates improvement of swallowing function and potentially obviates the need for future formal endoscopic suture repair of LC-1. However, long-term (>6 month) outcomes of IIA for LC-1 remain largely unknown. The objective of this study was to evaluate the effect of IIA on long-term swallowing outcomes and need for formal endoscopic suture repair in patients with LC-1. METHODS: This is a retrospective cohort study of patients age ≤24 months with pharyngeal phase dysphagia on preoperative videofluoroscopic swallow study (VFSS) who underwent IIA for LC-1 during diagnostic laryngoscopy and bronchoscopy at a single tertiary care academic subspecialty hospital from June 2017 to May 2018. Included patients underwent VFSS within 30 days of IIA and had documented SLP follow up at 6 months or more post-procedure. Exclusion criteria included prior cleft repair, gastrostomy tube dependence, additional procedures at the time of IIA, or lack of documented follow up. A total of 34 patients underwent LC-1 during study period with 24 included in final analyses. The primary outcome measure was improvement in safely swallowed consistency at 6 months or greater following injection. Secondary outcomes included need for formal suture LC-1 repair following IIA and comparison of 30-day and long-term swallowing function. RESULTS: Median [range] age at injection was 15.3 [10.3-19.1] months and 50% were female (n = 12). Improvement was noted in 12 (50%) patients within 30 days of IIA, with 11 of 12 demonstrating sustained improvement at long-term follow up (10.3 [9.3-14.0] months). Among all patients, 15 of 24 (63%) demonstrated improvement compared to preoperative baseline. Six of 24 (25%) required formal suture repair of LC-1. CONCLUSIONS: IIA is a safe procedure that may result in both immediate and long-term improvement in dysphagia in select patients with LC-1. Additional studies are required to determine impact of IIA on pulmonary complications and hospital utilization and as well as patient- and caregiver-related outcome measures.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Anormalidades Congênitas , Transtornos de Deglutição/terapia , Durapatita/administração & dosagem , Laringe/anormalidades , Adolescente , Cartilagem Aritenoide , Criança , Estudos de Coortes , Transtornos de Deglutição/etiologia , Feminino , Humanos , Injeções , Laringoscopia , Masculino , Estudos Retrospectivos , Adulto Jovem
5.
Laryngoscope ; 130(1): 252-256, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30734293

RESUMO

OBJECTIVE: To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair. METHODS: Twenty-one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate. RESULTS: Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%). Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases. According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases. Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases. CONCLUSION: Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:252-256, 2020.


Assuntos
Laringe/anormalidades , Laringe/fisiopatologia , Feminino , Humanos , Recém-Nascido , Laringe/patologia , Masculino , Prognóstico
6.
J Clin Ultrasound ; 48(4): 244-246, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31763688

RESUMO

Detailed assessment of the larynx is not easy because of its complex structures and the associated technical difficulties. We performed sonography in multiple planes to assess the laryngeal anatomy and movements of a fetus with laryngeal atresia. The distended trachea ended abruptly with an echogenic non-structured larynx which showed shallow rapid "flutter-like" movements and up and down but not adduction- abduction movements during swallowing. Shadowing from the chin could be reduced by scanning through fluid in the oral cavity or between the transverse processes of vertebrae in a coronal plane.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Doenças da Laringe/diagnóstico por imagem , Laringe/anormalidades , Ultrassonografia Pré-Natal , Adulto , Feminino , Feto , Idade Gestacional , Humanos , Laringe/diagnóstico por imagem , Gravidez , Traqueia , Ultrassonografia
7.
Plast Reconstr Surg ; 144(3): 704-709, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461034

RESUMO

BACKGROUND: Apert syndrome is frequently combined with respiratory insufficiency, because of the midfacial deformity which, in turn, is influenced by the malformation of the skull base. Respiratory impairment resulting from Apert syndrome is caused by multilevel limitations in airway space. Therefore, this study evaluated the segmented nasopharyngeal and laryngopharyngeal anatomy to clarify subcranial anatomy in children with Apert syndrome and its relevance to clinical management. METHODS: Twenty-seven patients (Apert syndrome, n = 10; control, n = 17) were included. All of the computed tomographic scans were obtained from the patients preoperatively, and no patient had confounding disease comorbidity. Computed tomographic scans were analyzed using Surgicase CMF. Craniometric data relating to the midface, airway, and subcranial structures were collected. Statistical significance was determined using t test analysis. RESULTS: Although all of the nasal measurements were consistent with those of the controls, the nasion-to-posterior nasal spine, sphenethmoid-to-posterior nasal spine, sella-to-posterior nasal spine, and basion-to-posterior nasal spine distances were decreased 20 (p < 0.001), 23 (p = 0.001), 29 (p < 0.001), and 22 percent (p < 0.001), respectively. The distance between bilateral gonions and condylions was decreased 17 (p = 0.017) and 18 percent (p = 0.004), respectively. The pharyngeal airway volume was reduced by 40 percent (p = 0.01). CONCLUSION: The airway compromise seen in patients with Apert syndrome is attributable more to the pharyngeal region than to the nasal cavity, with a gradually worsening trend from the anterior to the posterior airway, resulting in a significantly reduced volume in the hypopharynx.


Assuntos
Acrocefalossindactilia/patologia , Laringe/anormalidades , Nasofaringe/anormalidades , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
8.
Indian Pediatr ; 56(7): 563-565, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333210

RESUMO

OBJECTIVE: To describe the utility of flexible fiberoptic bronchoscopy for the diagnosis and management in the neonatal ICU. METHODS: A retrospective, medical chart review was conducted in neonates who underwent flexible fiberoptic bronchoscopy over a period of 7 years. Besides demographic data and diagnostic findings, the results of medical and/or surgical interventions done by treating neonatologist were recorded. RESULTS: 88 bronchoscopies were performed in 83 neonates, of which 37 were done through endotracheal tube. Indications included persistent need for mechanical ventilation (32), persistent atelectasis (21), and stridor (27). Most common airway anomalies diagnosed included tracheobronchomalacia (20), laryngomalacia (18), subglottic stenosis (7), choanal atresia (4), laryngeal cleft (4), and tracheoesophageal fistula (4). Surgical interventions were undertaken in 17 cases (9 tracheostomies and 2 cases of slide tracheoplasty). CONCLUSIONS: Flexible fiberoptic bronchoscopy can be beneficial for the diagnosis and management of neonates with persistent or undiagnosed respiratory problems.


Assuntos
Manuseio das Vias Aéreas/métodos , Broncoscopia , Doenças do Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/métodos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Doenças das Cartilagens/diagnóstico , Doenças das Cartilagens/epidemiologia , Atresia das Cóanas/diagnóstico , Atresia das Cóanas/epidemiologia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Laringoestenose/diagnóstico , Laringoestenose/epidemiologia , Laringe/anormalidades , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fístula Traqueoesofágica/diagnóstico
9.
Medicine (Baltimore) ; 98(28): e16364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305433

RESUMO

RATIONALE: Esophageal duplication cyst (EDC) is a rare developmental aberration originated from the embryonic foregut. It may remain asymptomatic but produce local mass effect on surrounding organs if rapid enlarges. EDC may sometimes accompany with other congenital malformations. Congenital pulmonary airway malformation (CPAM) is a congenital lung malformation with an unknown chance of developing symptoms. Here we report a rare case of esophageal duplication cyst with type 2 congenital pulmonary airway malformation (CPAM). PATIENT CONCERNS: A 16-month old boy with a prenatal diagnosis of type 2 CPAM presented progressive stridor and respiratory distress and was admitted to our hospital under the diagnosis of pneumonia. The patient responded poorly to antibiotics. A chest Xray (CXR) showed consolidation over the left upper lobe with trachea deviated to right side. A chest computed tomography (CT) revealed a cystic lesion sized 3.3 × 3.3 cm in the superior mediastinum. DIAGNOSES: Post-operative pathological report confirmed the diagnosis of esophageal duplication cyst. INTERVENTIONS: We pre-medicated the patient with steroids and inhaled bronchodilators for airway maintenance. Then the patient received tumor resection via median sternotomy. OUTCOMES: The patient recovered without complication and discharged smoothly 4 days after the surgery. LESSONS: EDC is a rare but potentially life-threatening disease owning to compression of large airways. Chest CT scan could detect the lesion non-invasively and should be considered in patients with persistent stridor, as well as CXR findings of the trachea deviated by a mass lesion in mediastinum, especially for those with CPAM.


Assuntos
Anormalidades Congênitas , Cisto Esofágico/complicações , Esôfago/anormalidades , Laringe/anormalidades , Pulmão/anormalidades , Sons Respiratórios , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico , Cisto Esofágico/terapia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Sons Respiratórios/diagnóstico
10.
Pediatr Pulmonol ; 54(11): 1837-1843, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31313533

RESUMO

Canadian Inuit infants suffer the highest rate of lower respiratory tract infections (LRTI's) in the world. The causes of this are incompletely understood. The primary objective of this study was to determine whether there exists an association between respiratory morbidity and oral aspiration in Inuit children. A retrospective chart review was conducted including children from Nunavut who underwent Video Fluoroscopic Swallowing Study between the years of 2001 to 2015. The primary outcome was hospitalization for LRTI. We hypothesized that infants found to have aspiration would experience a higher rate of admissions for LRTI than those with normal swallowing studies. One-hundred and twenty-seven patients were identified, of whom 94 were included. Fifty-six percent of patients had an abnormal swallowing study. Compared with patients with normal swallowing, the incidence rate of LRTI was higher in patients with aspiration (incidence rate ratio [IRR] = 1.51; 95% confidence interval [CI] = 1.23-1.87) and in patients with penetration (IRR = 1.40; 95% CI = 1.11-1.76). Fourteen percent of patients had confirmed laryngeal cleft; patients with confirmed presence of this also had a higher incidence rate of LRTI (IRR = 1.66; 95% CI = 1.32-2.07). The incidence of abnormal swallowing study showed an 11-fold variation across the five regions in Nunavut, with the highest prevalence in west Qikiqtani Region (Baffin Island). We conclude that swallowing dysfunction is not only prevalent amongst Canadian Inuit but clinically significant. This is the first study to demonstrate an association between swallowing dysfunction and respiratory morbidity in this population. Geographic distribution patterns and high rates of laryngeal cleft may point to a potential genetic etiology for what remains at this point, idiopathic swallowing dysfunction.


Assuntos
Anormalidades Congênitas/epidemiologia , Inuítes , Laringe/anormalidades , Aspiração Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Canadá/epidemiologia , Deglutição , Feminino , Hospitalização , Humanos , Incidência , Lactente , Masculino , Prevalência , Estudos Retrospectivos
11.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192393

RESUMO

The main, but not sole, indication for an Ex-utero Intrapartum Treatment (EXIT) delivery is an airway obstruction due to either laryngeal atresia or tumors in the head and neck region. Here we present our Institution's experience with eleven cases: three teratomas, four lymphatic malformations, two laryngeal atresias and two dermoid cysts. The EXIT procedure was used to secure the fetal airway while maintaining uteroplacental gas exchange and fetal hemodynamic stability through the umbilical circulation. Five fetuses required tracheostomy. Only one fetal death occurred due to extensive growth of a teratoma preventing us from establishing an airway. No other fetal or major maternal complication occurred. The EXIT procedure is a complex procedure and these rare cases should be referred to a center with a dedicated and experienced multidisciplinary team.


Assuntos
Obstrução das Vias Respiratórias , Histerotomia/métodos , Laparotomia/métodos , Adulto , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/cirurgia , Cesárea , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Universitários , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Laringe/anormalidades , Laringe/cirurgia , Anormalidades Linfáticas/cirurgia , Equipe de Assistência ao Paciente , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Região Sacrococcígea/patologia , Região Sacrococcígea/cirurgia , Suécia , Teratoma/congênito , Teratoma/cirurgia , Traqueotomia/métodos
12.
Int J Pediatr Otorhinolaryngol ; 121: 164-172, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30917301

RESUMO

INTRODUCTION: Congenital head and neck pathology may cause direct postnatal airway obstruction. Prenatal diagnosis facilitates safe delivery with pre- and perinatal airway assessment and management and Ex-Utero-Intrapartum-Treatment (EXIT) if necessary. Fetoscopic airway evaluation can optimize the selection of patients in need of an EXIT procedure. METHODS: Description of 11 consecutive fetuses, born with a potential airway obstruction between 1999 and 2011 and treated at the University Hospitals Leuven, with a long-term follow-up until 2018. An algorithm including fetoscopic airway evaluation is presented. RESULTS: In utero imaging revealed seven teratomas, one fourth branchial pouch cyst, one thymopharyngeal duct remnant, one lymphatic malformation and one laryngeal atresia. A multidisciplinary team could avoid EXIT in eight patients by ultrasonographic (n = 2) or fetoscopic (n = 6) documentation of accessible airways. Three patients needed an EXIT-to-airway-procedure. Neonatal surgery included tracheostomy during EXIT (n = 2) and resection of teratoma (n = 7) or branchiogenic pathology (n = 3). All patients do well at long-term (minimum 54 months) follow-up. CONCLUSIONS: Combining prenatal imaging and perinatal fetoscopy, EXIT-procedure and neonatal surgery yields an optimal long-term outcome in these complex patients. Fetoscopy can dramatically reduce the number of EXIT-procedures.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/cirurgia , Anormalidades Congênitas/diagnóstico por imagem , Fetoscopia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/etiologia , Algoritmos , Anormalidades Congênitas/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Recém-Nascido , Laringe/anormalidades , Anormalidades Linfáticas/complicações , Anormalidades Linfáticas/diagnóstico por imagem , Período Periparto , Gravidez , Teratoma/complicações , Teratoma/congênito , Teratoma/cirurgia , Fatores de Tempo , Traqueostomia , Ultrassonografia Pré-Natal
13.
Pediatr Surg Int ; 35(5): 565-568, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30783751

RESUMO

PURPOSE: A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO). METHODS: A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy. RESULTS: The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy. CONCLUSIONS: Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.


Assuntos
Anormalidades Congênitas/cirurgia , Esôfago/anormalidades , Esôfago/cirurgia , Oxigenação por Membrana Extracorpórea , Laringe/anormalidades , Traqueia/anormalidades , Traqueia/cirurgia , Anormalidades Múltiplas/cirurgia , Humanos , Recém-Nascido , Laringoscopia , Laringe/cirurgia , Masculino , Traqueostomia , Resultado do Tratamento
14.
Laryngoscope ; 129(11): 2588-2593, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30671968

RESUMO

OBJECTIVES: The clinical significance of the interarytenoid mucosal height (IAMH) in pediatric dysphagia, ranging from normal anatomy to a laryngeal cleft, is unknown. This study seeks to evaluate a cohort of patients who underwent evaluation of their IAMH during microdirect laryngoscopy (MDL) for associations between IAMH and dysphagia as diagnosed on preoperative videofluoroscopic swallow study (VFSS). METHODS: A retrospective case series of 1,351 patients who underwent MDL between 2011 and 2016 were reviewed for intraoperative evaluation of IAMH using our interarytenoid assessment protocol. After exclusions, 182 patients were divided into three groups: 1) thickened diet: VFSS with recommendation for thickened liquids (n = 82 of 182; 45.1%), 2) normal diet: VFSS with allowance of thin liquids (n = 19 of 182; 10.4%), and 3) control: no VFSS performed (n = 81 of 182; 44.5%). RESULTS: There was no difference in IAMH between groups (P = 0.35). Power analysis was able to achieve > 80% power to detect an effect size of ≥ 0.5 (1-5 mucosal height scale). The majority of patients in each group had an IAMH above the false vocal folds (thickened diet: 57.3%, normal diet: 57.9%, control: 64.2%). There were similar percentages of patients in each group with an IAMH at or below the true vocal folds (thickened diet: 4.9%, normal diet: 5.3%, control: 6.1%). CONCLUSION: There was no significant association between IAMH and preoperative thickened liquid recommendation in this cohort. This data fails to support the hypothesis that the IAMH is an independent etiological factor for pediatric pharyngeal dysphagia. Further studies comparing IAMH with outcomes after feeding therapy and surgery may better clarify this relationship between anatomy and physiology. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:2588-2593, 2019.


Assuntos
Cartilagem Cricoide/patologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/patologia , Mucosa Laríngea/patologia , Fotofluorografia/estatística & dados numéricos , Estatura , Criança , Pré-Escolar , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/patologia , Cartilagem Cricoide/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Feminino , Humanos , Mucosa Laríngea/diagnóstico por imagem , Laringoscopia/métodos , Laringe/anormalidades , Laringe/patologia , Masculino , Microcirurgia/métodos , Período Pré-Operatório , Estudos Retrospectivos , Gravação em Vídeo
16.
Int J Pediatr Otorhinolaryngol ; 118: 115-119, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30611096

RESUMO

OBJECTIVES: Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. METHODS: We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. RESULTS: Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). CONCLUSIONS: These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.


Assuntos
Anormalidades Congênitas/terapia , Transtornos de Deglutição/terapia , Laringoplastia/métodos , Laringe/anormalidades , Aspiração Respiratória/terapia , Pré-Escolar , Transtornos de Deglutição/etiologia , Feminino , Humanos , Lactente , Injeções , Masculino , Projetos Piloto , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Desmame
17.
Laryngoscope ; 129(7): 1696-1698, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30450589

RESUMO

A 12-month-old male underwent injection laryngoplasty for dysphagia associated with a deep interarytenoid notch. He subsequently developed a large postcricoid mucocele requiring revision surgery and marsupialization of the cyst just 2 weeks following the initial surgery. Laryngoscope, 129:1696-1698, 2019.


Assuntos
Anormalidades Congênitas/cirurgia , Laringe/anormalidades , Mucocele/cirurgia , Complicações Pós-Operatórias/cirurgia , Humanos , Lactente , Injeções/efeitos adversos , Laringoscopia , Laringe/cirurgia , Masculino , Reoperação
18.
J Voice ; 33(4): 561-563, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30224307

RESUMO

OBJECTIVES: Vocal nodules are frequent in children and tend to be reabsorbed after puberty, especially in boys. The aims of the present study were to analyze the progression of nodules in boys after puberty and to investigate the role of microweb in the persistence of these lesions. METHODS: Clinical and videolaryngoscopy evaluations were carried out in boys with vocal nodules treated between 2009 and 2016, followed up to the age of 17 years or until remission of symptoms and reabsorption of the nodules. Boys with vocal nodules who underwent regular vocal therapy are included in the study. The outcomes were remission of symptoms and of the nodular lesions. RESULTS: A total of 34 boys with vocal nodules were diagnosed, of which 21 completed follow-up. Mean age of the first evaluation was 9 years (5-11 years) and of end of treatment was 14 years (13-18 years). Mean number of videolaryngoscopy per child was five. After adolescence there was complete remission of symptoms and of the lesions in 15 children (71.4%), partial remission in four (19.0%), and no remission of symptoms and of the lesions in two cases. In these two, videolaryngoscopy identified the presence of microweb and nodules. CONCLUSIONS: Favorable reabsorption of the vocal nodules after adolescence was observed in the majority of the boys who underwent voice therapy; however, in two cases there was no remission of symptoms and of the lesions. The unfavorable course can be attributed to anterior laryngeal microwebs.


Assuntos
Anormalidades Congênitas/patologia , Doenças da Laringe/patologia , Laringe/anormalidades , Puberdade , Prega Vocal/patologia , Adolescente , Desenvolvimento do Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil , Pré-Escolar , Anormalidades Congênitas/fisiopatologia , Anormalidades Congênitas/terapia , Humanos , Doenças da Laringe/fisiopatologia , Doenças da Laringe/terapia , Laringe/patologia , Laringe/fisiopatologia , Masculino , Indução de Remissão , Maturidade Sexual , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/fisiopatologia , Qualidade da Voz , Treinamento da Voz
19.
Int J Pediatr Otorhinolaryngol ; 116: 159-163, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554689

RESUMO

INTRODUCTION: Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (IIA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS). METHODS: This was a retrospective cohort study of patients age ≤24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n = 1), gastrostomy tube dependence (n = 1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n = 1). Children without postoperative VFSS within 30 days of injection were excluded (n = 2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events. RESULTS: Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n = 10). The majority (13/15) of patients were full-term and 80% of patients (n = 12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n = 9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n = 6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation. CONCLUSION: IIA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.


Assuntos
Materiais Biocompatíveis/administração & dosagem , Anormalidades Congênitas/terapia , Transtornos de Deglutição/terapia , Deglutição/fisiologia , Durapatita/administração & dosagem , Laringe/anormalidades , Cartilagem Aritenoide , Broncoscopia/métodos , Pré-Escolar , Estudos de Coortes , Transtornos de Deglutição/etiologia , Feminino , Fluoroscopia/métodos , Humanos , Lactente , Laringoscopia/métodos , Laringe/efeitos dos fármacos , Laringe/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
20.
Int J Pediatr Otorhinolaryngol ; 118: 59-61, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30583194

RESUMO

OBJECTIVE: To report on the prevalence of voice disturbances in pediatric airway patients. METHODS: Consecutive patients seen in a specialized Center for Airway Disorders at a tertiary children's hospital from February 2017 to September 2017 were included. Patients' families were invited to complete a pediatric voice health handicap index (pVHI) questionnaire. Patients underwent evaluation including flexible laryngoscopy and/or direct laryngoscopy and bronchoscopy. RESULTS: 146 patients were included. Of these children, 73 patients (50.3%) presented with swallowing difficulty and 44 patients (30.3%) presented with respiratory complaints. Only 9 patients (6.2%) reported hoarseness initially. The median age at referral was 2.7 years of age (interquartile range: 1.4-4.3). The mean total pVHI score was 9.5 (± 12.9). Sixty-seven patients (45.9%) had abnormal pVHI findings of score > 4. Six patients (4.1%) had pVHI > 40. The mean pVHI score was 26.0 (± 21.1) among 12 patients with a history of tracheostomy, 12.0 (± 14.3) among 30 patients with laryngeal cleft, and 9.0 (± 9.9) among 19 patients with laryngomalacia. CONCLUSION: Voice disturbances are not uncommon in pediatric patients evaluated for airway disorders. Although patients may present with primary concerns for breathing or swallowing difficulties, many of these patients may need further work-up and treatment for dysphonia.


Assuntos
Transtornos de Deglutição/epidemiologia , Disfonia/epidemiologia , Rouquidão/epidemiologia , Broncoscopia , Pré-Escolar , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Lactente , Laringomalácia/epidemiologia , Laringoscopia , Laringe/anormalidades , Masculino , Prevalência , Sistema Respiratório , Índice de Gravidade de Doença , Inquéritos e Questionários , Traqueostomia/estatística & dados numéricos
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