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ABSTRACT: To characterize aneurysmal bone cysts (ABCs) of the head and neck as seen at a tertiary care center.
A case series.
A retrospective chart review of pediatric patients with aneurysmal bone cyst of the head and neck treated at the Hospital for Sick Children during the years 1994-2006 was carried out.
Nine patients with ABC were treated. The average age at diagnosis was 9.3 years (range: 5 months-15 years), six males and three females. Four cysts originated in the paranasal sinuses, two in the mandible, one in the zygoma, one in the mastoid and one in the parietal bone. Two cases were associated with a previous localized trauma (mandible, zygoma). 5/9 presented with pain, 4/9 presented as an asymptomatic mass, 2/9 were associated with proptosis and nasal obstruction, 2/9 with nasal obstruction and 1/9 presented with an aural polyp. Seven cysts were successfully excised while one (in the pterygomaxillary fossa) is being followed conservatively. In one case the ABC was found to be secondary to an extensive osteoblastoma and this child continuous to be problematic. Follow-up time ranged from 2 years and 6 months to 10 years.
ABC of the head and neck may vary in presentation and severity. Surgical removal is the treatment of choice at our institution and may provide a satisfying outcome. ABC may be secondary to an underlying bone pathology (e.g., osteoblastoma) which may make it refractory to treatment.
International Journal of Pediatric Otorhinolaryngology 08/2008; 72(7):977-83. · 1.17 Impact Factor
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ABSTRACT: To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.
A double-blind randomized controlled trial.
Patients were assigned into two groups and were injected with either epinephrine 1:100,000 and lidocaine 1% or saline alone during endoscopic nasal surgery under general anesthesia. Pledgets soaked in epinephrine 1:1,000 were used throughout the procedure in both groups. Hemodynamic measurements and catecholamine blood levels were obtained.
Ten patients were randomized to the epinephrine group and 12 to the saline group. We were able to measure epinephrine and norepinephrine levels following injection in all patients. Epinephrine levels were similar in both groups immediately after injection; however, 15 minutes following injection, epinephrine was significantly higher in saline-injected patients. Mean arterial pressure and heart rate were affected by epinephrine and norepinephrine levels immediately after injection but were never elevated over the normal range. Heart rate was higher (P < .05) in the saline injected group than in the epinephrine group throughout the measurement period. The surgeons believed that the surgical field was bloodier in saline-injected patients (P < .05) however objective estimation of blood loss showed no difference.
Injection of epinephrine/lidocaine mixture does not produce higher blood levels of epinephrine when compared to saline injection and did not induce any harmful side effects. We postulate that the combination with lidocaine 1% may reduce the patients' stress and thus prevent higher catecholamine levels.
The Laryngoscope 07/2008; 118(7):1275-81. · 1.75 Impact Factor
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ABSTRACT: (1) To describe various preoperative and diagnostic findings of children undergoing adenoidectomy and (2) to evaluate quality of life outcomes following adenoidectomy in children.
This was a prospective observational study. Patients who were candidates for adenoidectomy at The Hospital for Sick Children were evaluated with respect to preoperative symptoms, flexible nasal endoscopy (FNE) findings, and nasal airflow (NAF) studies. Following surgery, a quality of life questionnaire was administered to all available patients and an attempt was made to repeat the NAF study.
Fifty-seven patients were included in the study (31 females and 26 males). The average age of the patient at surgery was 10.1 years. Thirty patients (52.6%) had a significant NAF study, whereas FNE revealed an average nasopharyngeal obstruction of 73.2%. We did not find any correlation between preoperative symptoms, FNE findings, or NAF study results. The degree of symptom reduction was the only predictor of how satisfied a patient would be in the postoperative period (p<.05).
In our study of adenoidectomy patients, clinical signs and symptoms appear to be more predictable than the objective tests of NAF and FNE. As such, following these symptoms in the postoperative period is important in determining a patient's satisfaction following surgery.
The Journal of otolaryngology 03/2007; 36(1):17-25. · 0.50 Impact Factor
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ABSTRACT: Alcohol is the most prevalent human teratogen affected by early exposure of the fetus. Although not listed as a major part of the fetal alcohol spectrum disorder (FASD), different texts list hearing loss as a characteristic of the FASD, based on several small studies.
To characterize hearing in children with FASD, diagnosed in the Motherisk Program in Toronto.
Cross sectional cohort study.
Academic referral center.
Children 4-16 years of age that met criteria for FASD, with no other known risk factor for sensorineural hearing loss. A consecutive sample of 41 children (13 girls, mean age 8.9 +/-3 years) was collected. Intervention: Physical examination, audiometry and tympanometry. Outcome measures: External and middle ear pathology on physical examination, pure tone average (PTA), speech reception threshold (SRT), discrimination and tympanometry. Results were compared to reference values in the normal population. Hearing loss equal or greater than 16dB hearing-level in each frequency tested was considered to be clinically significant.
A total of 5 (11.2%) of children had hearing loss of at least 16dB hearing-level, mostly unilateral. SRT was within the normal range in 40 (98%) of children with FASD and discrimination was normal in all children. None had auricular or external canal dysmorphology. 14.7% of the children had frequent episodes of acute otitis media. Middle ear effusion was detected in 8 ears (9.8%).
The prevalence of mild sensorineural hearing loss in children diagnosed with FASD (16dB hearing-level or greater) was not higher than expected in this age group. However, because children with FASD are academically and behaviorally challenged, early detection of hearing loss and early intervention is warranted.
The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique 02/2007; 14(3):e307-12.
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ABSTRACT: Obstructive sleep apnea in children is most commonly treated with adenotonsillectomy; however, in cases of significant tongue base prolapse, this may prove inadequate. Surgical procedures used to increase the retroglossal airway have significant morbidities and low patient acceptability. We theorized that effective reduction of the tongue base can be achieved through partial denervation of the hypoglossal nerve, which is easily accessed in the submandibular space with minimal morbidity.
We performed a prospective, experimental study in which topographic innervation maps of porcine tongue were generated by stimulating the hypoglossal main trunk and peripheral branches. The effects of complete unilateral nerve sectioning on tongue base volume and linear dimensions were measured and compared to the contralateral control side. In the final stage, only the peripheral nerve that was determined as the main supply to the tongue base was sectioned, and the results were compared to those in the matched controls.
A medial branch of the hypoglossal nerve was consistently identified as the main motor supply to the tongue base. Complete denervation resulted in a measurable decrease in the volume of the tongue base as compared to that of controls. Partial neurolysis produced inconsistent changes in 2 subjects, with decreases in linear dimensions that were not proportional to the decrease in volume. Histologically, complete denervation was followed by a significantly greater replacement of muscle with fat and connective tissue as compared with partial neurolysis.
There were inconsistent changes in volume and linear dimensions of the tongue base following partial neurolysis of the hypoglossal nerve over the 3-month experimental period.
The Annals of otology, rhinology, and laryngology 12/2006; 115(11):857-63. · 1.05 Impact Factor
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ABSTRACT: Over-the-counter cold remedies are widely used for symptomatic relief of upper respiratory tract infections. The safety of these drugs is not well established in infants and their efficacy is questionable. Our aim was to study the attitude of family physicians and pediatricians toward the use of cold remedies in infants and children. A questionnaire was sent to 400 family physicians and 100 pediatricians randomly selected across Ontario. The overall response rate was 53.2%. Sixteen percent of family physicians recommended cold remedies for infants 0 to 6 months of age compared to 4% of the pediatricians (P = 0.01). For infants 6 to 12 months of age, the difference between pediatricians and family physicians persisted (14% and 38% of, respectively; P < 0.001). Despite that cold remedies are not proven to be effective and some safety issues are associated with their use in the pediatric age group, physicians still recommend them. Continuing medical education programs should address the issue.
Clinical Pediatrics 12/2006; 45(9):828-34. · 1.15 Impact Factor
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ABSTRACT: Significant numbers of therapeutic abortions are performed for radiation-exposed pregnant women because of concerns about the teratogenic risk. However, available data suggest that current diagnostic radiation procedures are not teratogenic.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 02/2006; 28(1):43-8.
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ABSTRACT: To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome.
A systematic review of all English language literature.
Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%).
Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.
The American Journal of Surgery 10/2005; 190(3):467-73. · 2.78 Impact Factor
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ABSTRACT: Significant facial soft tissue injury can result from trauma to the head and neck. The long-term sequelae of such injuries include vascular anomalies, which may present weeks or months following the initial injury. We report here a case of a post-traumatic facial artery aneurysm which developed in a pediatric patient three weeks following a penetrating facial injury during motor vehicle accident (MVA). Although post-traumatic aneurysm of the facial artery is rare, follow-up on head and neck trauma patients with respect to this type of complication is warranted.
International Journal of Pediatric Otorhinolaryngology 01/2005; 68(12):1539-43. · 1.17 Impact Factor
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Raanan Cohen-Kerem MD,
Vitaly Kisilevsky MD,
Thomas R. Einarson PhD,
Eran Kozer MD,
Gideon Koren MD,
FRCSC John A. Rutka MD, Raanan Cohen‐Kerem,
Vitaly Kisilevsky,
Thomas R. Einarson,
Eran Kozer,
Gideon Koren,
John A. Rutka
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ABSTRACT: Objectives: To systematically review the published experience on intratympanic gentamicin treatment for intractable Menière's disease.Study Design: Meta-analysis using a random effect model.Methods: A comprehensive literature search was performed for articles using intratympanic gentamicin as a sole treatment modality with reporting of results according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for Menière's disease. Two reviewers independently assessed trial quality and extracted data.Results: Fifteen trials with 627 patients met the inclusion criteria. All trials reported “before-after” outcome measures, using patients as their own controls. No double-blind or blinded prospective control trials were identified. Complete (class A) vertigo control was achieved in 74.7% (confidence interval [CI]95% 67.8–81.5%) of patients, and complete or substantial (class B) control was achieved in 92.7% (CI95% 89.5–96.0%). The success rate was not affected by gentamicin treatment regimen (fixed vs. titration). Hearing level and word recognition were not adversely affected, regardless of gentamicin treatment regimen. Analysis of functional level was not performed because of lack of data in the selected articles.Conclusions: Intratympanic gentamicin treatment for intractable Menière's disease appears to be effective in the relief of vertigo. Cochleotoxicity and ototoxicity is unlikely to be a major side effect. However, the level of evidence reflected from the eligible articles is insufficient, especially because of relatively poor study design. Therefore, it is prudent that patients eligible for this type of treatment should be selected carefully and titrated with low-dose gentamicin. Further investigation with this treatment modality with control subjects is warranted.
The Laryngoscope 11/2004; 114(12):2085 - 2091. · 1.75 Impact Factor
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ABSTRACT: Central mucoepidermoid carcinoma is an uncommonly encountered tumor. A rare case of this malignant tumor arising in the mandible of a 14-year-old adolescent is presented. Symptoms, signs, and management approach are discussed. A literature review of similar previously described cases is discussed as well.
International Journal of Pediatric Otorhinolaryngology 10/2004; 68(9):1203-7. · 1.17 Impact Factor
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ABSTRACT: Ethanol is the most common human teratogen, and heavy drinking during pregnancy can result in serious adverse outcomes to the fetus. The cellular mechanisms by which ethanol induces damage in utero are not well understood, while induction of oxidative stress is believed to be one putative mechanism. Our objective is to review the data of antioxidant effects in experimental models of fetal alcohol syndrome. Prior to the description of the available experimental data, we will briefly review the mechanisms leading to ethanol-induced oxidative stress. Ethanol-induced oxidative damage to the fetus could be attenuated by a variety of antioxidants as was documented in whole animal and tissue culture studies. Experiments, retrieved from the literature search, are described and criticized. Although experimental data are still limited, the application of a treatment strategy that includes antioxidants is justified since antioxidant treatment in human pregnancy for pre-eclampsia was demonstrated to be safe and effective. The available experimental evidence and the safety of vitamins C and E in pregnancy suggest that experimental use of antioxidants in alcohol-consuming mothers should be seriously considered to reduce fetal alcohol damage.
Neurotoxicology and Teratology 25(1):1-9. · 2.98 Impact Factor
