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Kenth J, Maughan E, Butler CR, Gabrie J, Rouhani M, Silver B, Ogunbiyi OK, Wilkinson S, Nandi R, Walker R, Muthialu N, Jones S, Hewitt R, Bruce IA. Novel approach for tracheal resection in Morquio a syndrome with end-stage critical airway obstruction: a UK case series. Orphanet J Rare Dis 2024; 19:274. [PMID: 39039523 PMCID: PMC11264958 DOI: 10.1186/s13023-024-03253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 06/16/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Mucopolysaccharidosis (MPS) type IVA is a rare lysosomal storage disorder caused by aberrations of the N-acetyl-galactosamine-6-sulfatase (GALNS) enzyme. MPS IVA is associated with a wide gamut of respiratory and airway disorders that manifest in a continuum of severity. In individuals exhibiting severe phenotypic expression, terminal stages of the disease frequently culminate in life-threatening, critical airway obstruction. These manifestations of end-stage disease are engendered by an insidious progression of multi-level airway pathologies, comprising of tracheomalacia, stenosis, tortuosity and 'buckling'. Historically, the management of end-stage airway disease has predominantly leaned towards palliative modalities. However, contemporary literature has posited that the potential benefits of tracheal resection with aortopexy, performed under cardiopulmonary bypass (CPB), may offer a promising therapeutic option. In this context, we report on outcomes from patients undergoing a novel approach to tracheal resection that is combined with manubrial resection, leading to improved airway calibre, obviating the requisition for CPB. RESULTS In this study, seven patients with severe MPS IVA exhibited clinical symptoms and radiological evidence indicative of advanced airway obstruction. All patients had a tracheal resection with a partial upper manubriectomy via transcervical approach, which did not require CPB. The surgical cohort consisted of 5 females and 2 males, the median age was 16 years (range 11-19) and the median height was 105.6cm (range 96.4-113.4). Postoperatively, significant improvements were seen in forced expiratory volume in 1 second (FEV1), with a mean increase of 0.68 litres (95% CI: 0.45-0.91; SD: 0.20). Notably, other spirometry variables also showed meaningful improvements, providing evidence of positive treatment effects. Furthermore, there were no major long-term complications, and the procedure resulted in a significant enhancement in patient-reported domains using PedsQL (version 4.0). CONCLUSIONS This study represents the largest case series to date, on tracheal resection in patients with severe MPS IVA. Our findings demonstrate the effectiveness of the transcervical approach with partial manubriectomy for improving respiratory function and quality of life for individuals with advanced airway obstruction. Tracheal resection presents a promising treatment modality for severe cases of MPS IVA. Successful outcomes rely on meticulous multidisciplinary assessment, judicious decision-making, and appropriate timing of tracheal surgery. Further research and long-term follow-up studies are warranted to validate the long-term efficacy and safety of this approach.
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Affiliation(s)
- Johnny Kenth
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Divisions of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Elizabeth Maughan
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, UK
| | - Colin R Butler
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, UK
| | - Jasleen Gabrie
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Maral Rouhani
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Benjamin Silver
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Olumide K Ogunbiyi
- Great Ormond Street Hospital for Children, NHS Foundation Trust Research Histopathology Service, London, UK
| | - Stuart Wilkinson
- Department of Paediatric Respiratory Medicine, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Reema Nandi
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Robert Walker
- Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nagarajan Muthialu
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, UK
| | - Simon Jones
- Divisions of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- The Willink Metabolic Unit, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Hewitt
- National Paediatric Tracheal Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Iain A Bruce
- Divisions of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Wu Y, Wang G, Dai J, Li H, Li Y, Wu C, Wei G. Slide Tracheoplasty for Congenital Tracheal Stenosis Repair: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:1532-1541. [PMID: 34287919 DOI: 10.1002/lary.29771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Congenital tracheal stenosis (CTS) is a rare but life-threatening condition in children. At present, slide tracheoplasty has been advocated as the preferred technique for most cases of CTS. However, the morbidity and mortality subsequent to slide tracheoplasty need further elaboration. Therefore, a meta-analysis was performed on the outcomes of slide tracheoplasty in children with CTS. STUDY DESIGN Systematic review and meta-analysis. METHODS Electronic databases, including PubMed, Embase, and Cochrane Library CENTRAL, were systematically searched for the period from January 1990 to March 2021 for literature that reported clinical outcomes of slide tracheoplasty for children with CTS. Meta-regression and subgroup analyses were performed to determine the risk factors for in-hospital mortality and airway reinterventions. RESULTS A total of 25 studies involving 577 patients were included. For children with CTS, in-hospital and overall mortality after slide tracheoplasty was 6.1% (95% CI = 4.2%-8.0%) and 9.7% (95% CI = 7.3%-12.1%), respectively. The incidence of airway reinterventions was 23.0% (95% CI = 15.6%-30.5%). The length of postoperative ventilation and hospital stay was 6.8 days (95% CI = 5.1-8.4 days) and 19.2 days (95% CI = 15.8-22.7 days), respectively. Postoperative complications occurred in 46.6% (95% CI = 35.8%-57.4%) of all patients. Meta-regression analysis showed that a higher proportion of the recently published studies reported significantly better in-hospital survival (coefficient -0.011, P = .021). CONCLUSIONS In conclusion, in-hospital mortality after slide tracheoplasty is 6.1%, and the incidence of airway reinterventions is 23.0%. In-hospital mortality after slide tracheoplasty has decreased chronologically. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guanghui Wei
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Smith MM, Kou YF, Schweiger C, Lehenbauer DG, de Alarcon A, Rutter MJ. Congenital Absence of Tracheal or Bronchial Rings. Otolaryngol Head Neck Surg 2020; 164:422-426. [PMID: 32838669 DOI: 10.1177/0194599820950725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Congenital airway stenosis secondary to absent tracheal or bronchial rings is a rare congenital anomaly that is difficult to manage both clinically and surgically. This typically manifests as severe segmental tracheomalacia, and only isolated cases with short-term follow-up have been previously described. We aim to describe a series of children with absent tracheal or bronchial rings who underwent surgical management and had long-term follow-up. STUDY DESIGN Case series with chart review. SETTING Tertiary care pediatric hospital. METHODS Patients with absent tracheal or bronchial rings from 2002 to 2016. Electronic and paper medical records were queried to obtain demographics, age at diagnosis and surgery, pre- and postoperative symptoms, location of absent rings, procedure performed, length of follow-up, and adjunctive procedures performed. RESULTS Nine subjects were identified who underwent slide tracheoplasty for correction of congenital absent tracheal or bronchial rings. Age at diagnosis ranged from 10 days to 5 years of age (median, 4 weeks). Age at surgery ranged from 3 weeks to 5 years of age (median, 5 weeks). Six out of 9 subjects were extubated on postoperative day 1. Only 1 subject required additional intervention, which included balloon dilation, tracheobronchial stenting, and aortopexy to alleviate the obstruction. Mean follow-up time was 5.89 years. CONCLUSIONS This is the largest series of children with absent tracheal rings who underwent slide tracheoplasty with long-term follow-up presented to date. Slide tracheoplasty is an effective surgical intervention for the treatment of absent tracheal or bronchial rings in infants and young children.
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Affiliation(s)
- Matthew M Smith
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yann-Fuu Kou
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claudia Schweiger
- Department of Otolaryngology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - David G Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Sidell DR, Hart CK, Tabangin ME, Bryant R, Rutter MJ, Manning PB, Meinzen-Derr J, Balakrishnan K, Yang C, de Alarcon A. Revision thoracic slide tracheoplasty: Outcomes following unsuccessful tracheal reconstruction. Laryngoscope 2018; 128:2181-2186. [DOI: 10.1002/lary.27145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/04/2018] [Accepted: 01/25/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Douglas R. Sidell
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Stanford California
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Meredith E. Tabangin
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Roosevelt Bryant
- Division of Cardiothoracic Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Michael J. Rutter
- Department of Otolaryngology-Head and Neck Surgery; Stanford University; Stanford California
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
| | - Peter B. Manning
- Division of Cardiothoracic Surgery, Section of Pediatric Cardiothoracic Surgery; Washington University School of Medicine/St. Louis Children's Hospital; St. Louis Missouri
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology; Mayo Clinic College of Medicine; Rochester Minnesota
| | - Christina Yang
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center; Bronx New York U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio
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Zhang H, Wang S, Lu Z, Zhu L, Du X, Wang H, Xu Z. Slide tracheoplasty in 81 children: Improved outcomes with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96:e8013. [PMID: 28930836 PMCID: PMC5617703 DOI: 10.1097/md.0000000000008013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the surgical outcome of slide tracheoplasty.Eighty-one patients who underwent slide tracheoplasty were retrospectively reviewed. Before and after operation, all patients were examined by computed tomography (CT) and bronchoscopy regularly.There were 8 deaths and the mortality was 9.9%. They all died of respiratory failure associated with the formation of granulation tissue in the airway postoperatively. The mortality was 15.8% from 2009 to 2012 and decreased to 8.1% from 2013 to 2016. The mortality of patients aged 10 to 24 months was 5.7%, which was significantly lower than those younger than 10 months and those older than 24 months. After surgery, 11 patients had granulation tissue growing at anastomosis edges and 8 of them died eventually. Twenty patients had mucosa varus at the site of anastomosis which mainly happened in the early time. Between different time periods and different age groups, there was significant difference in the incidence of granulation tissue and mucosa varus (P < .01). Clinical symptoms of tracheal stenosis disappeared and the results of CT were satisfactory after operation.Slide tracheoplasty is an effective surgical method for congenital tracheal stenosis associated with congenital heart disease. With the continuous improvement of surgical technique, the mortality has been reduced and the incidence of granulation tissue and mucosa varus also has been reduced. The period of 10 to 24 months of age is the optimal cure time.
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Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis. Case Rep Anesthesiol 2016; 2016:6871565. [PMID: 26989518 PMCID: PMC4775790 DOI: 10.1155/2016/6871565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/28/2016] [Indexed: 12/15/2022] Open
Abstract
A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.
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Abelardo E, Muthialu N. Ultrashort-segment tracheal stenosis at juxtacarinal location: is it congenital absence of just the single cartilage or part of a spectrum of anomalous growth? Ann Thorac Surg 2014; 98:1106-9. [PMID: 25193201 DOI: 10.1016/j.athoracsur.2013.10.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/29/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022]
Abstract
Isolated absence of cartilage rings in the absence of a tracheoesophageal fistula is extremely rare and usually seen in the upper third of the trachea. A juxtacarinal segment is unique embryologically, with the distal tracheal cartilage being trifold in shape. Absence of this cartilage is rare and possibly implies specific developmental changes in airway. We report 3 such patients treated by excision of the affected segment and a direct anastomosis, with good result.
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Affiliation(s)
- Edgardo Abelardo
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
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Butler CR, Speggiorin S, Rijnberg FM, Roebuck DJ, Muthialu N, Hewitt RJ, Elliott MJ. Outcomes of slide tracheoplasty in 101 children: A 17-year single-center experience. J Thorac Cardiovasc Surg 2014; 147:1783-9. [DOI: 10.1016/j.jtcvs.2014.02.069] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
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Amendola RL, Reinhardt JM, Zimmerman MB, Sato Y, Diggelmann HR, Kacmarynski DSF. Development of a preliminary pediatric tracheal growth model from magnetic resonance images. Laryngoscope 2014; 124:1947-51. [DOI: 10.1002/lary.24547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/06/2013] [Accepted: 11/27/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Richard L. Amendola
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa; Iowa City Iowa U.S.A
| | - Joseph M. Reinhardt
- Department of Biomedical Engineering; University of Iowa; Iowa City Iowa U.S.A
| | | | - Yutaka Sato
- Division of Pediatric Radiology; Department of Radiology; University of Iowa; Iowa City Iowa U.S.A
| | - Henry R. Diggelmann
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa; Iowa City Iowa U.S.A
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Fandiño M, Kozak FK, Verchere C, Campbell A. Modified slide tracheoplasty in a newborn with bronchial and carinal stenosis. Int J Pediatr Otorhinolaryngol 2013; 77:2075-80. [PMID: 24139586 DOI: 10.1016/j.ijporl.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
Congenital tracheal stenosis (CTS) is a life-threatening condition that is associated with significant morbidity and mortality particularly when symptomatic presentation occurs in the newborn period. The most challenging form of CTS is long segment congenital tracheal stenosis (LSCTS) with compromise of the carina and main stem bronchi. We report the case of a newborn with severe distal tracheal stenosis with carinal and main stem bronchial involvement who was managed successfully with a modified slide and autologous rib graft tracheoplasty. The patient was discharged from hospital without ventilator support or oxygen requirement at 2 months of age. The details of this case and the description of the surgical procedure are presented and the related literature is reviewed.
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Affiliation(s)
- Marcela Fandiño
- Department of Surgery, Division of Pediatric Otolaryngology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Coticchia JM, Cohen D, Sachdeva L. Grand challenges in pediatric otolaryngology. Front Pediatr 2013; 1:10. [PMID: 24400256 PMCID: PMC3860887 DOI: 10.3389/fped.2013.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/01/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- James M Coticchia
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - David Cohen
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - Livjot Sachdeva
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
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