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International journal of pediatric otorhinolaryngology 02/2013; · 0.85 Impact Factor
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ABSTRACT: OBJECTIVES To evaluate whether a low rate of exposure to sinonasal computed tomographic (CT) scans can be achieved when strict criteria are applied for their use in children with cystic fibrosis (CF) and to emphasize the importance of limiting radiation exposure in the context of the current longer life expectancy in this group of patients. DESIGN Retrospective chart review. SETTING Tertiary care children's hospital. PATIENTS The study included 277 children who were regularly followed up in the CF clinic in the last 11 years (mean duration of follow up, 7.87 years), 33 of whom underwent sinonasal CT. MAIN OUTCOME MEASURES Indications used for scanning, health professional (ear, nose, and throat specialist or pulmonologist) ordering the test, eventual modifications of ongoing treatment according to CT results, and time lapse between CT scanning and surgery. RESULTS Of 277 children with CF, 33 (12%) underwent a total of 39 sinonasal CT scans during the follow-up period (0.018 scans per patient per year of follow-up). Twenty-nine of the CT scans (74% of all cases, 90% of CT scans ordered by the ear, nose, and throat surgeon) were performed in the preoperative context and demonstrated the extent of the polypoid disease whenever present (26 cases [90%]) and the cause of nasal obstruction (20 cases [69%]). The mean period between the scanning and the surgery was 57 days (range, 0.10-173 days). Computed tomographic scans that were not meant for preoperative planning were performed in 10 cases (26%). The indications were disease evaluation (10%), ruling out a mucocele (5%); pre-lung transplantation status (5%), ruling out an intraorbital complication (3%); and headache investigation (3%). The results of the scans did not modify the management of the disease in those patients. CONCLUSIONS With the use of stringent criteria, it is possible to achieve a low rate of exposure to sinonasal CT scans in the population of children with CF. The main indication should be the preoperative planning regarding anatomy, extent of disease, and sites of nasal obstruction. The use of CT scans for disease evaluation does not seem to appreciably modify the treatment course and could be avoided.
JAMA otolaryngology-- head & neck surgery. 01/2013; 139(1):54-58.
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ABSTRACT: OBJECTIVES To compare hyaluronic acid fat graft myringoplasty (HAFGM) with fat graft myringoplasty (FGM) on grade I tympanic membrane perforations (TMPs) (<25% of the tympanic membrane surface) and to assess 12-month postoperative hearing outcomes in a pediatric population. DESIGN Prospective study. SETTING Tertiary care pediatric center. PATIENTS Ninety-two children with a TMP were included in the study and were operated on using either the HAFGM (n = 50) or FGM (n = 42) technique. Age at surgery ranged from 4 to 17 years (mean age, 11.52 years). INTERVENTIONS Hyaluronic acid fat graft myringoplasty is a new technique for TMP repair in a pediatric population and is performed using local anesthesia at the outpatient office. MAIN OUTCOME MEASURES Postoperative status of the tympanic membrane, hearing improvement, and incidence of complications. RESULTS Successful closure of the tympanic membrane was achieved in 90% of the HAFGM group and in 57.1% of the FGM group (P = .004). The mean (SD) postoperative air-bone gap in the HAFGM (6.86 [8.52] dB) group was significantly lower than in the FGM (18.32 [13.44] dB) group (P < .002). The mean postoperative follow-up time was 31.5 and 34.7 months for HAFGM and FGM groups, respectively. No difference was observed between children 10 years or younger and children older than 10 years. In the 2 groups, no postoperative complications were observed. The location of the perforation was not found to be a factor indicative of failure. CONCLUSIONS The success rate of HAFGM is superior to that of FGM alone. Hyaluronic acid fat graft myringoplasty can be performed as an office-based procedure using local anesthesia and requires no hospitalization. Because of its substantial advantages, HAFGM could be considered as the first choice for the reconstruction of a dry TMP in the pediatric population.
Archives of otolaryngology--head & neck surgery 10/2012; 138(10):950-5. · 1.92 Impact Factor
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ABSTRACT: OBJECTIVES: BAHA implantation surgery in a pediatric population is usually done in two-stage surgeries. This study aims to evaluate the safety and possible superiority of the one-stage over the two-stage BAHA implantation and which one would be the best standard of care for our pediatric patients. METHODS: A retrospective chart review of 55 patients operated in our tertiary care institutions between 2005 and 2010 was conducted. The actual tendency in our institutions, applied at the time of the study, is to perform a one-stage surgery for all operated patients (pediatric and adult), except for patients undergoing translabyrinthine surgeries for cerebellopontine tumor excision. These patients indeed had a two-stage insertion. 26 patients underwent one-stage surgery (group I) while 29 patients had a two-stage (group II) BAHA insertion. A period of 4 months was allowed for osseointegration before BAHA processor fitting. As for the safety assessment of the one-stage surgery, we compared both groups regarding the incidence and severity (minor, moderate and major) of encountered complications, as well as the operating time and follow-up. The operating time of the two-stage surgery includes the time of the first and of the second stage. RESULTS: The mean age at surgery was 8.5 years old for the group I and 50 years old for the group II patients. There was no difference in the incidence of minor (p=0.12), moderate (p=0.41) nor severe (p=0.68) complications between groups I and II. Two cases of traumatic extrusion were noted in the group I. Furthermore, the one-stage BAHA implantation requests a significantly lower operating time (mean: 54 [32-100] min) than the two-stage surgery (mean: 79 [63-148] min) (p=0.012). All pediatric cases of BAHA insertion were performed in a one day surgery. The mean postoperative follow-up was 114 and 96 weeks for groups I and II respectively (p=0.058). CONCLUSIONS: One-stage BAHA insertion surgery in the pediatric population is a reliable, safe and efficient therapeutic option that allows a good result in a significantly lower operating time compared to the two-stage insertion and is achieved in a one day surgery. It could therefore be considered as a standard of care for pediatric patients.
International journal of pediatric otorhinolaryngology 09/2012; · 0.85 Impact Factor
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ABSTRACT: Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives.
We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy.
Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB.
Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.
International journal of pediatric otorhinolaryngology 12/2011; 76(2):194-201. · 0.85 Impact Factor
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ABSTRACT: To evaluate hyaluronic acid fat graft myringoplasty (HAFGM) for different tympanic membrane perforation (TMP) sizes and to compare its success rate with that of the underlay and overlay techniques.
Prospective study.
Tertiary care pediatric center.
Two hundred eight children aged 4 to 16 years (mean age, 11.84 years) with TMPs.
The HAFGM is a new technique for TMP repair in an outpatient pediatric population using local anesthesia. All the patients in groups 1 (underlay) and 2 (overlay) were operated on using general anesthesia, whereas group 3 (HAFGM) was operated on at the outpatient office using local anesthesia.
Postoperative status of the eardrum, hearing improvement, and incidence of complications.
Patients with TMP were divided into 3 groups: group 1 had 75 patients; group 2, 65; and group 3, 73. The global success rate was 87% in group 3, with no difference with the remaining 2 groups. Successful closure of different TMP sizes was the same for the 3 groups. Postoperatively, air-bone gap improvement was better for group 3. No bone conduction threshold worsening was noted. The mean duration of the operative procedure was 65, 74, and 18 minutes for groups 1, 2, and 3, respectively (P = .02). Mean postoperative follow-up was 20.7, 17.5, and 14.6 months for groups 1, 2, and 3, respectively. Identification of the anterior perforation rim is mandatory to perform HAFGM.
The HAFGM did not require hospitalization for pediatric patients. It had the advantage of being feasible in children using local anesthesia. Its success rate was comparable with that of conventional techniques.
Archives of otolaryngology--head & neck surgery 12/2011; 137(12):1203-9. · 1.92 Impact Factor
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ABSTRACT: To compare the efficiency of the subannular T-tube (SAT) vs that of the repetitive transtympanic Duravent tube (TTT) in children with recurrent or chronic otitis media (OM) with effusion or tympanic membrane retraction and to establish which population would be more likely to benefit from TTTs vs SATs.
Medical record review.
Tertiary care pediatric center.
Children receiving an SAT (234 in 160 patients) or at least 2 TTTs (216 in 111 patients) between January 1, 2002, and December 31, 2006, to allow at least 4 years of follow-up from that period until 2010.
Average tube duration and complication rates.
The tubes remained in place for a median of 35 months with SAT and 7 months with TTT (P < .001). Overall complication rates were lower with SAT (otorrhea, 21.4%; perforation, 7.7%; plugged tube, 13.7%; new acute OM, 13.7%; new serous OM, 5.1%; and cholesteatoma, 1.7%) than with TTT (otorrhea, 26.9%; perforation, 5.1%; blocked tube, 20.8%; new acute OM, 23.1%; new serous OM, 37.5%; and cholesteatoma, 0.46%). Differences were statistically significant for otorrhea, blocked tube, and new acute and serous OM (P < .001). With similar rates, TTTs and SATs were used more frequently in acute (P = .26) and serous (P = .32) OM, whereas SATs were placed more often in adhesive OM and retracted tympanic membrane (P < .001).
Insertion of an SAT is a safe and effective method for long-term middle ear ventilation in recurrent or refractory OM, adhesive OM, and retracted tympanic membrane. Associated with fewer complications, SATs offer an alternative to repeated use of the short-term TTTs without damaging the tympanic membrane.
Archives of otolaryngology--head & neck surgery 12/2011; 137(12):1210-6. · 1.92 Impact Factor
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ABSTRACT: To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas.
Multi-institutional retrospective study.
Two tertiary care referral pediatric centers.
Thirty-nine children with head and neck infantile hemangiomas were treated.
Review of clinical records.
Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of β-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping.
Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation.
Archives of otolaryngology--head & neck surgery 05/2011; 137(5):471-8. · 1.92 Impact Factor
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ABSTRACT: The BAHA (bone-anchored hearing aid) remains the most reliable method of auditory rehabilitation for patients with congenital aural atresia and improves hearing outcome and quality of life in these patients who are otherwise unable to benefit from traditional hearing aids. New techniques are being developed, such as fully implantable hearing devices, and will have to prove their efficacy and safety in this indication.
To evaluate the audiological results and patient satisfaction after rehabilitation of congenital aural atresia using the BAHA.
Sixteen patients suffering from bilateral congenital aural atresia were implanted with unilateral BAHA. Preoperative air- and bone-conduction thresholds and air-bone gap (ABG), preoperative sound reception threshold (SRT), postoperative aided thresholds, implantation complications, patient satisfaction, and the APHAB questionnaire were collected.
After a mean follow-up period of 6.5 years, 15 patients were still using their device. Each patient had an average improvement of 33 ± 7 dB. Closure of the ABG within 15 dB of the preoperative bone-conduction thresholds occurred in 10 patients. Adverse skin reactions appeared in 50% of patients over 6.5 years of follow-up. Eleven of the 12 patients used their BAHA for more than 8 h per day.
Acta oto-laryngologica 12/2010; 130(12):1343-51. · 0.98 Impact Factor
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Nicolas Leboulanger,
Pierre Fayoux,
Natacha Teissier,
Amanda Cox,
Thierry Van Den Abbeele,
Laure Carrabin,
Vincent Couloigner,
Richard Nicollas,
Jean-Michel Triglia,
Sonia Ayari, Patrick Froehlich,
Emmanuel Lescanne,
Rémy Marianowski,
Thierry Mom,
Michel Mondain,
Jean-Paul Marie,
Gilles Roger,
Eréa-Noël Garabédian,
Françoise Denoyelle
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ABSTRACT: Preliminary assessment of the efficacy of propranolol on subglottic hemangioma in children on a nation-wide scale.
Multicentric, retrospective study of clinical files of 14 children; pre- and post-treatment endoscopies.
Mean age at diagnosis was 2.3 (0.7-4) months. Mean percentage of airway obstruction was 68% (15-90) before propranolol introduction. Propranolol was started at 5.2 (0.7-16) months of age. This treatment was effective in all cases with a mean regression of the stenosis to 22% after 2 weeks and 12% after 4 weeks. Other medical treatments (steroids) could be stopped. In one patient, a side effect of propranolol motivated the switch to another β-blocker. In four patients, treatment was stopped after 5.2 (1-10) months with a relapse in 2 (50%) cases. One of these two patients developed a resistance to propranolol and required a surgical procedure by external approach.
This preliminary nation-wide survey confirms propranolol high effectiveness against airways' localization of infantile hemangiomas. Propranolol also allows alleviation or cut-off of previous medical treatments. However, recurrences are possible after early treatment interruption.
International journal of pediatric otorhinolaryngology 11/2010; 74(11):1254-7. · 0.85 Impact Factor
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ABSTRACT: To evaluate the efficiency of diffusion-weighted magnetic resonance imaging (MRI) and high-resolution computed tomographic (CT) scan coregistration in predicting and adequately locating primary or recurrent cholesteatoma in children.
Prospective study.
Tertiary care university hospital.
Ten patients aged 2 to 17 years (mean age, 8.5 years) with cholesteatoma of the middle ear, some of which were previously treated, were included for follow-up with systematic CT scanning and MRI between 2007 and 2008.
Computed tomographic scanning was performed on a Siemens Somaton 128 (0.5/0.2-mm slices reformatted in 0.5/0.3-mm images). Fine cuts were obtained parallel and perpendicular to the lateral semicircular canal in each ear (100 × 100-mm field of view). Magnetic resonance imaging was undertaken on a Siemens Avanto 1.5T unit, with a protocol adapted for young children. Diffusion-weighted imaging was acquired using a single-shot turbo spin-echo mode. To allow for diagnosis and localization of the cholesteatoma, CT and diffusion-weighted MRIs were fused for each case.
In 10 children, fusion technique allowed for correct diagnosis and precise localization (hypotympanum, epitympanum, mastoid recess, and attical space) as confirmed by subsequent standard surgery (positive predictive value, 100%). In 3 cases, the surgical approach was adequately determined from the fusion results. Lesion sizes on the CT-MRI fusion corresponded with perioperative findings.
Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases.
Archives of otolaryngology--head & neck surgery 09/2010; 136(9):878-83. · 1.92 Impact Factor
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ABSTRACT: To evaluate the outcome of our experience in the treatment of salivary gland disorders in children undergoing sialendoscopy and to assess the evolution of the technique.
Retrospective medical record review.
Tertiary care university hospital.
Thirty-eight children with salivary gland disorders undergoing diagnostic and interventional sialendoscopy between January 1, 2003, and November 30, 2008.
Diagnostic and interventional sialendoscopy using general anesthesia.
Demographic, clinical, and surgical variables, including age, sex, date of first symptoms, parotid or submandibular location of disease, preoperative ultrasonographic results, sialendoscopy technique, sialendoscopy observations, and complications.
Pediatric sialendoscopy was performed on the parotid gland in 23 patients (61%) and on the submandibular gland in 15 patients (39%). The most frequent indication for sialendoscopy was recurrent salivary gland swelling. Thirty-two of 38 procedures (84%) were performed endoscopically, whereas a combined intervention was necessary for 3 patients and a submandibular gland excision for another 3 patients. Sialendoscopy allowed the diagnosis of 12 patients with salivary duct lithiasis, 21 with salivary duct stenosis, and 2 with both submandibular lithiasis and stenosis, and findings from 3 sialendoscopies were normal. Preoperative ultrasonographic results were confirmed by sialendoscopy in only 7 patients. Of the 10 patients with lithiasis found using sialendoscopy, only 4 had been detected using preoperative ultrasonography.
Sialendoscopy is a pertinent technique for the diagnosis and treatment of salivary gland disorders in children. It also allows the most conservative treatment of sialolithiasis and juvenile recurrent parotitis.
Archives of otolaryngology--head & neck surgery 01/2010; 136(1):33-6. · 1.92 Impact Factor
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ABSTRACT: The database revealed severity factors relating to human papillomavirus (HPV) type and age at diagnosis. While not exhaustive, the database is easy to use and could serve for a European multicentre epidemiological study.
To propose a database as a starting point for a national registry and to estimate prognostic factors in recurrent respiratory papillomatosis (RRP).
This was a retrospective study carried out in a tertiary care teaching hospital. From January 2005 to July 2007, epidemiological, clinical and treatment information on patients undergoing endoscopy for RRP in the department was entered in a database. Data were collected on three forms: the first comprised information about disease history before assessment in the department, the second about the disease and its treatment in the department, and the third about evolution after treatment.
Data on 72 patients were entered into an RRP database between January 2005 and July 2007. In all, 82% had already been treated for RRP in a different centre; 24 had juvenile-onset (JORRP) and 48 adult-onset (AORRP) papillomatosis. Cidovir injections had been administered to 91% of the patients. Histology found nine cases of dysplasia, one of carcinoma in situ and one of invasive carcinoma. Subglottic and tracheal locations were significantly more frequent in JORRP than in AORRP, as were the maximum Derkay scores and annual numbers of endoscopies. Patients with type 11 HPV had significantly more endoscopies per year than those with type 6.
Acta oto-laryngologica 03/2009; 129(4):462-70. · 0.98 Impact Factor
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ABSTRACT: To assess the relevance of sialendoscopy as a diagnostic and interventional procedure in juvenile recurrent parotitis (JRP).
Prospective case series study.
Tertiary care teaching hospital.
Sialendoscopy was used to examine 10 children (age range, 1.8-13.0 years) with symptomatic JRP for recurrent swelling of the parotid glands between January 2003 and January 2005. Diagnostic sialendoscopy allowed classification of ductal lesions, and interventional sialendoscopy was used to treat the lesions. Initial data analyzed included the type of endoscope used as well as the size and form of the main duct of the parotid gland. Outcome variables were resolution of symptoms and endoscopic enlargement of the ductal tree.
Initial ultrasound evaluation of the diseased gland revealed a white Stensen duct without the natural proliferation of blood vessels in all 10 cases. This finding was associated with a true stenosis of the Stensen duct. Two cases of suspected stones according to ultrasonography were subsequently diagnosed as localized stenoses. The sialendoscope was used to dilate the duct with pressurized saline solution in all cases as well as to dilate the 2 cases of stenoses. There were no major complications. The average length of follow-up was 11 months (range, 2-24 months). Seventeen parotid glands were dilated in all 10 patients, with a success rate of 89%. One patient needed repeated sialendoscopies for recurrent symptoms. Two patients presented with a second episode of JRP contralateral to the side initially treated.
Diagnostic sialendoscopy is a new procedure that can be used in children for reliable evaluation of salivary ductal disorders, with low morbidity. Sialendoscopic dilation of the main parotid ducts appears to be a safe and effective method for treating JRP.
Archives of otolaryngology--head & neck surgery 07/2008; 134(7):715-9. · 1.92 Impact Factor
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ABSTRACT: Sialendoscopy is finding increasing application in the management of salivary-gland swellings as it provides a diagnostic method for the main salivary ducts coupled with a therapeutic tool. Many recent studies have emphasized the diagnostic and therapeutic advantages of this noninvasive technique. This review discusses both of these aspects of sialendoscopy and their development in the management of salivary-gland diseases.
Management of paediatric obstructive swelling has improved during the last 10 years. New semi-rigid sialendoscopes and complete miniaturized instrumentation allow diagnosis and treatment of obstructive paediatric salivary-gland swelling. Paediatric sialendoscopy has allowed us to recognize salivary stones and stenoses misdiagnosed by conventional radiography or ultrasound.
Pediatric sialendoscopy is now an improved diagnostic technique for obstructive salivary-gland swelling. It has a greater sensitivity than conventional radiology ultrasound and MRI. With further improvement in devices and technique, early sialendoscopy is possible in very young children, using a conservative approach. Sialendoscopic dilatation of Stensen's duct is possible and could be used for the treatment of juvenile recurrent parotitis. The initial results need to be confirmed in a larger series with a more long-term follow-up.
Current opinion in otolaryngology & head and neck surgery 03/2008; 16(1):60-3.
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ABSTRACT: To specify the characteristics of the thulium laser and to evaluate the advantages and possibilities of treatment with this laser in laryngotracheal diseases in children.
Fiber-based lasers have facilitated a new style of surgery. When performing therapeutic airways endoscopies there is the possibility of good control of lesions and adequate visualization of the surgical field using the telescope. Different types of laser may be used but the 2013-nm thulium laser shows promise as a laser that is efficient in soft tissues with the advantages of the other lasers without their problems. The thulium laser has been described in treating urinary tract abnormalities and recently airways diseases in adults, but there are no reports of other uses for this technique in the pediatric airway.
The thulium laser appears to be an interesting tool in the management of laryngotracheal diseases such as subglottic stenosis, tracheal granuloma and laryngomalacia. The use of this laser in laryngotracheal diseases in children will probably progress in the future.
Current opinion in otolaryngology & head and neck surgery 03/2008; 16(1):55-9.
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La Revue du praticien 01/2008; 57(20):2281-3.
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ABSTRACT: To assess the efficacy of sialendoscopy as a diagnostic and interventional procedure for salivary ductal pathologies of children.
Prospective case series study.
Tertiary care teaching hospitals.
Eight children were investigated under general anesthesia by sialendoscopy for recurring salivary gland swellings between 2003 to 2004 in two university centers.
Diagnostic sialendoscopy was used for classifying ductal lesions as sialolithiasis or stenosis. Interventional sialendoscopy was used to treat these disorders. Different variables were analyzed: type of endoscope used, intraoperative findings, type of device used for sialoliths fragmentation or extraction, total number of procedures, and size and number of sialoliths removed.
Five cases of parotid and three cases of submandibular gland recurring swellings were included in the present study. Diagnostic sialendoscopy was possible in all cases. Salivary stones were found in six patients and parotid ductal stenosis in the remaining two. Multiple stones were seen in two cases. Interventional sialendoscopy was also possible in all cases, allowing an intraductal retrieval of the stones in three cases, and a marsupialization of the duct in two cases. Two cases required laser fragmentation of the stone. No major complications occurred intraoperatively or during follow-up (mean 18 months).
Diagnostic sialendoscopy is a new technique allowing a reliable evaluation of salivary ductal disorders in children, with low morbidity. Interventional sialendoscopy allows early treatment of pediatric sialoliths and stenosis in most cases, avoiding classical open surgery.
The Laryngoscope 09/2007; 117(8):1364-7. · 1.75 Impact Factor
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ABSTRACT: To discuss management of postcricoid and upper esophageal hemangiomas in infants. Four children presenting with progressive feeding and/or respiratory disturbance underwent endoscopy including systematic esophagoscopy revealing the hemangioma of the postcricoid area and extending to the lumen of the upper esophagus. In the three children with severe disturbance, systemic steroids were insufficient and open surgical excision brought the hemangioma under control. No significant stenosis occurred despite prolonged progressive oral feeding up to 1 month after surgery. The fourth child whose disturbance was moderate, was managed by intralesional steroids. Various solutions have been proposed for the treatment, i.e. conservative approach or partial or complete destruction or excision, management of postcricoid hemangioma by intralesional steroids or by open surgical excision. Indications will require greater series.
International Journal of Pediatric Otorhinolaryngology 02/2007; 71(1):147-51. · 1.17 Impact Factor
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ABSTRACT: We assessed the intermediate-term and long-term efficacy of intralesional injection of cidofovir used with surgical excision in juvenile-onset recurrent respiratory papillomatosis.
The protocol was revised during the study, from endoscopy at 4-week intervals with intralesional injection of cidofovir at 5 mg/mL, to a 2-week interval and a 7.5-mg/mL dosage. Partial surgical excision of hypertrophic papillomas was performed before the initiation of injection. Further injections at 4-week (or 2-week) intervals were performed until complete remission.
Sixteen patients received a mean 8.9 injections. Complete remission was obtained in 12 patients (75%) after a mean 7.2 endoscopic treatments. Remission was stable at a mean 33.6 months' follow-up. Five of these 12 patients received 5.2 injections and remained disease-free at a mean 39.3 months' follow-up. Seven of the 12 had 1 relapse; they needed complementary treatment to become disease-free, and remained so thereafter over a mean 27.3 months' follow-up. The other 4 of the 16 patients (25%) continued to present active disease.
Active endoscopic treatment until complete remission led to a higher-than-expected complete remission rate on intermediate-term to long-term follow-up, with or without relapse. Transient relapse was associated with a long delay in initiating cidofovir treatment.
The Annals of otology, rhinology, and laryngology 10/2006; 115(9):667-72. · 1.05 Impact Factor
