Intratemporal facial nerve neurofibroma causing facial paralysis in an infant: Case report and review of the literature.

This article describes the first recorded case of intratemporal neurofibroma in an infant. A literature review of all other existing cases of intratemporal neurofibroma is performed, finding that the majority of cases involve multiple segments and can be found in the mastoid segment most often. Most common symptoms described included facial paralysis, otalgia, and conductive hearing loss, respectively.

Management of Dog-Related Penetrating Laryngotracheal Trauma in a Pediatric Patient.

Dog-bite-related laryngotracheal injuries are rare but can be life-threatening. We present a case of penetrating laryngotracheal trauma in a six-year-old male and the management, considerations, and outcomes. The patient suffered extensive laryngotracheal trauma, including near complete tracheal transection, complete thyroid cartilage fracture, crush injury to the cricoid, and multiple tracheal perforations after a dog attack. We review initial management, subsequent airway interventions, multi-disciplinary approach, and airway outcomes. We present one of the few reports describing extensive dog-related penetrating laryngotracheal trauma in a pediatric patient, with successful airway management.

A Unique Apparatus to Treat Dehiscence Following Bilateral Cleft Lip Repair: A Case Report.

We report a case of a 6-month-old male that presented with wound dehiscence, in part due to mechanical tongue trauma, following bilateral cleft lip repair. A silastic sheeting dressing with retention sutures was uniquely fashioned to decrease wound tension and protect the surgical site from patient interference. This solution may potentially be used in similar circumstances.

Neurologic variant laryngomalacia associated with Chiari malformation and cervicomedullary compression: case reports.

Two infants presented with intermittent stridor and evidence of laryngomalacia on flexible laryngoscopy. The first was a 10-month-old girl who had undergone 3 supraglottoplasty surgeries at an outside institution, without long-term resolution of symptoms. She was found during our evaluation to have a Chiari malformation. Laryngomalacia symptoms resolved after suboccipital decompression and C1 laminectomy, and the patient remained symptom-free at 6-month follow-up. The second infant was a 24-day-old boy with velocardiofacial syndrome who was found to have posterior cervicomedullary junction compression at the level of C1. He underwent C1 laminectomy for decompression of the brain stem, which resulted in immediate resolution of symptoms, and he remained symptom-free at 12-month follow-up. Neurologic abnormalities have been reported in up to 50% of infants with laryngomalacia. As such, brain stem dysfunction should be considered among the causes of laryngomalacia during evaluation, especially in patients with failure of supraglottoplasty. Both of these infants had resolution of symptoms after their neurosurgical procedures.

Prognostic factors in the management of pediatric subglottic stenosis.

OBJECTIVE: We report outcomes of endoscopic interventions in the management of pediatric subglottic stenosis (SGS), and factors that lead to open airway reconstruction. METHODS: A retrospective cohort review of all pediatric patients with SGS, treated by a single surgeon, at a tertiary academic medical center from 2012 to 2020 was conducted. Variables recorded included patient demographics, initial grade of stenosis, gestational age, length of intubation, comorbidities as well as total number of interventions. RESULTS: A total of 47 patients were included in the study, of which 51% (n = 24) were female. Laryngotracheal reconstruction (LTR) was performed in 49% (n = 23) of patients. Decannulation was achieved in 25 of 32 tracheostomized patients. Fifteen patients did not have tracheostomy. There was a significant difference in gestational age (28.7 ± 5.36 vs 33.2 ± 6.13), initial grade of stenosis (2.3 ± 0.82 vs 1.6 ± 0.88), and total number of interventions (5.7 ± 2.8 vs 2.3 ± 1.5) when stratifying patients proceeding to LTR versus not (p < 0.05). There was no significant difference, however, in the length of intubation between the two groups. Of the comorbidities recorded, none were found to have a significant impact on the outcome. CONCLUSION: Subglottic stenosis is a challenging condition to treat, often requiring multiple interventions including LTR. We propose a set of risk factors that may assist in the treatment of SGS patients with certain comorbidities to minimize interventions and maximize outcomes.

Transoral approach to type 1 laryngeal cleft repair: A novel, non-endoscopic technique.

Endoscopic type 1 laryngeal cleft repair under spontaneous ventilation can be difficult in patients with poor pulmonary reserve. Intubation makes visualization of the interarytenoid area challenging during an endoscopic repair. As an alternative technique, we utilized a transoral, non-endoscopic approach with a McIvor mouth gag in two such patients. This provided adequate visualization and a larger working field with readily available instrumentation. The ability to intubate the patient obviated the need to intermittently place an endotracheal tube and allowed for uninterrupted working time. This technique does require favorable patient anatomy for adequate exposure, but is worth considering in certain patients.

Papillary thyroid carcinoma presenting as acute suppurative thyroiditis: A case report and review of the literature.

Acute suppurative thyroiditis is a rare, potentially life-threatening condition. We report the case of a 17-year-old male who initially presented with a thyroid abscess. Due to persistent symptoms and lack of evidence for underlying predisposing factors, he was followed closely and subsequently diagnosed with papillary thyroid cancer. He was successfully managed with surgery. His clinical course, radiological evaluation, and pathology reports are presented here along with a review of the literature. This case of papillary thyroid cancer highlights the need for close follow-up of patients presenting with a thyroid abscess, when other predisposing risk factors are not evident.

Dynamic facial reanimation with orthodromic temporalis tendon transfer in children.

IMPORTANCE: To our knowledge, orthodromic temporalis tendon transfer (OTTT) for dynamic facial reanimation has not been described for use in children. OBSERVATIONS: Three pediatric patients with permanent facial paralysis underwent OTTT using our modified technique between August 30, 2010, and January 23, 2012. Outcomes were assessed by the surgeons, patients, and patient families, with the longest follow-up period being 13 months after surgery. Two patients were 4 years old at the time of surgery, and the third patient was 17 years old. All underwent upper eyelid gold weight placement and OTTT. The hospital length of stay was 1 to 2 nights. By the first postoperative visit, all patients exhibited improved symmetry at rest, creation of a melolabial crease, and voluntary movement of the oral commissure and smile production without physical therapy. CONCLUSIONS AND RELEVANCE: The OTTT for dynamic facial reanimation in children seems to be safe and effective. To our knowledge, this is the first report of the use of this procedure in pediatric patients. This procedure has an advantage over free muscle transfer procedures in achieving immediate dynamic reanimation in a single-stage surgical procedure, without significant additional donor site morbidity. This is an important procedure in our armamentarium for treating pediatric facial paralysis.

Airway management in an infant with alobar holoprosencephaly and cebocephaly associated with maternal diabetes mellitus.

We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents' goal was to bring their child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers' goals of care.

Cochlear implantation in children 12 months of age and younger.

OBJECTIVE: To investigate surgical, anesthetic, and device-related complications as well as auditory and speech-language development outcomes associated with cochlear implantation (CI) in children 12 months of age and younger. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic referral center. PATIENTS: All children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation at 12 months of age or younger and an audiometric control group implanted between 13 and 24 months of age. MAIN OUTCOME MEASURES: Anesthetic and surgical course; major and minor surgical, anesthetic and device-related complications; postoperative disposition; postoperative auditory receptive and expressive language development. RESULTS: Twenty-six patients (41 ears) met criteria. The median duration of follow-up was 58 months. No major surgical or anesthetic complications occurred. One patient (4%) experienced device failure, which required revision surgery and implant exchange. Two other patients (8%) had individual electrode anomalies that were treated with map exclusion. At the last recorded follow-up, 73% of patients were performing at or above the level of normal-hearing age-matched peers. Patients that were implanted at 12 months of age or younger reached age-appropriate speech and language skills by 24 months of age compared with 40 months for the older pediatric control group. CONCLUSION: The current study demonstrates that CI provides substantial benefit among infant recipients. Furthermore, when performed by an experienced cochlear implant and pediatric anesthesia team, the surgical and anesthetic risks are similar to that expected with both older pediatric and adult patients.

Identification of congenital auricular deformities during newborn hearing screening allows for non-surgical correction: a Mayo Clinic pilot study.

OBJECTIVE: To introduce a Mayo Clinic pilot study in which newborn hearing screeners are trained to identify congenital auricular deformities, allowing for non-surgical correction with a simple splint initiated in the immediate neonatal period. METHODS: Newborn hearing screeners received education on evaluation of congenital auricular deformities. Ten infants with 19 affected ears amenable to treatment with a simple splint were enrolled between June 15 and December 10, 2009. Splinting was initiated prior to the infant's discharge from the hospital. RESULTS: Congenital auricular deformities amenable to correction with splinting included cup ear, Stahl's ear, and prominent ear. All ears were assessed by physical examination and photographic documentation prior to splinting and at follow-up visits. All exhibited improvement from the original deformity after 1-4 weeks of splinting. There were no instances of skin irritation or breakdown. CONCLUSION: Splinting therapy of congenital auricular deformities is very effective when initiated within the first 3 days of life while cartilage is quite malleable. Newborn hearing screening is performed within 24-48 h of birth and is an ideal opportunity to identify auricular deformities. This pilot study shows that early identification of auricular deformities by properly educated newborn hearing screeners is feasible, allowing for successful initiation of splinting therapy.

Current trends in otoplasty.

PURPOSE OF REVIEW: We present basic concepts and current trends in otoplasty, through a review of the recent literature. RECENT FINDINGS: Over 200 otoplasty techniques have been described, yet most technical advances are minor modifications of techniques described 40-50 years ago. These techniques can be categorized as cartilage-cutting or cartilage-sparing techniques. Many approaches described today seem to combine elements of both. Recent retrospective analyses of several popular techniques show each to be effective and reliable, with low morbidity. Several technical updates and advances have also been described within the last few years. SUMMARY: Otoplasty technique is constantly being modified and refined, with its basis in historically reliable techniques. The use of a graduated approach, combining elements of various techniques, is a common trend in otoplasty today.