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El-Sobki A, Ae Ibrahim R, Elzayat S, El-Deeb ME, Ashraf B, Hashish MI, Alsobky MEI, Salamah A. Evaluation of swallowing in children with higher grades glottic web. Eur Arch Otorhinolaryngol 2023; 280:4987-4994. [PMID: 37500784 PMCID: PMC10562259 DOI: 10.1007/s00405-023-08127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE to evaluate the swallowing function in children with higher grades of glottic web and to detect the impact of surgical division of the glottic web on the swallowing parameters. We also performed a voice analysis as a secondary objective in this study. METHODS This prospective case series study included 12 children with higher grades of the glottic web; grades 3 and 4. Evaluation of the swallowing function was done by clinical swallowing evaluation including symptoms and signs of swallowing dysfunction during feeding, such as vomiting, coughing, choking, or cyanosis, and bedside swallowing assessment using the 3-oz water swallow test. Instrumental evaluation of swallowing function was performed using flexible endoscopic evaluation of swallowing (FEES). The evaluation was performed both preoperatively and postoperatively. RESULTS The number of children suffering from swallowing difficulties significantly increased during the postoperative evaluation where 6 (50%) children demonstrated choking during feeding after the surgical division of the web in comparison to only 3 (25%) preoperatively. Also, coughing and choking during the 3-oz water swallow test significantly increased following the division of the web with P < 0.001. CONCLUSION Swallowing assessment is mandatory as children with higher grades of the glottic web, requiring reconstructive surgeries, are at risk of swallowing deficit which can be aggravated postoperatively. With improvement in the airway and surgery-specific outcomes, swallowing function is an important secondary outcome that has a significant impact on the lives of these kids and their families.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Reham Ae Ibrahim
- Phoniatrics Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Bassem Ashraf
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Abeer Salamah
- Pediatrics Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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2
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Hankey PB, Ghulmiyyah J, Yeh HW, Tracy M, Arganbright J. Airway anomalies in patients with 22q11.2 deletion syndrome: A scoping review. Int J Pediatr Otorhinolaryngol 2022; 163:111373. [PMID: 36335759 DOI: 10.1016/j.ijporl.2022.111373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/22/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE People with 22q11.2 deletion syndrome (22q11DS) can present with a wide variety of findings. Various airway anomalies have been described intermittently within this syndrome, but this feature has not been extensively investigated. Increased provider awareness of these findings may help guide clinical decision-making and improve overall patient outcomes. The objectives of this review are to identify the types of airway anomalies in 22q11DS and the prevalence of airway anomalies within symptomatic individuals. METHODS PubMed/MEDLINE, Cochrane Library, and EMBASE databases were searched in February 2022 for all available articles. Search terms included those that described 22q11DS or one of its synonymous conditions AND those that described airway anatomy and anomalies. The term airway anomaly was defined as any structural aberration in the conductive airway from the oral or nasal vestibule region to the mainstem bronchus. Studies were screened by two authors. A review of references was conducted. Eligible manuscripts underwent full-text review for quality appraisal and data extraction. RESULTS From a total of 909 unique manuscripts, 58 studies were selected, describing 328 people. The prevalence of airway anomaly diagnosis within symptomatic individuals ranged from 14% to 74%. Twenty-two unique airway anomalies were described. Laryngeal web was the most frequently described anomaly, followed by airway malacia and subglottic stenosis. Laryngeal web was 40% sensitive for suggesting a diagnosis of 22q11DS. Among affected individuals, as many as 46% had multiple concomitant airway anomalies. Aside from respiratory symptoms, other features that prompted airway evaluation included difficult intubation or failed extubation. CONCLUSION The findings within this review support the notion that a wide variety of airway anomalies may be seen in people with 22q11DS and that these findings have been discovered frequently in those with airway symptoms. Providers should maintain a low threshold to perform an airway examination in those with 22q11DS, especially when airway symptoms are present.
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Affiliation(s)
- Paul Bryan Hankey
- Kansas City University College of Osteopathic Medicine, 1750 Independence Ave, Kansas City, MO, 64106, USA; Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Jana Ghulmiyyah
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Hung-Wen Yeh
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Meghan Tracy
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Jill Arganbright
- Children's Mercy Hospital, Division of Otolaryngology, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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3
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Srikanthan A, Scott S, Desai V, Reichert L. Neonatal Airway Abnormalities. CHILDREN 2022; 9:children9070944. [PMID: 35883928 PMCID: PMC9322467 DOI: 10.3390/children9070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.
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Affiliation(s)
| | - Samantha Scott
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
| | - Vilok Desai
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
| | - Lara Reichert
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
- Correspondence:
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Airway Characteristics of Patients With 22q11 Deletion Undergoing Pulmonary Artery Reconstruction Surgery: Retrospective Cohort Study. Pediatr Crit Care Med 2022; 23:371-377. [PMID: 35213412 DOI: 10.1097/pcc.0000000000002921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We have previously shown that patients with a chromosome 22q11 microdeletion are at risk for prolonged respiratory failure after pulmonary artery reconstruction surgery compared with those with normal genotype. We sought to describe preexisting airway abnormalities in this patient population and examine relationships between airway abnormalities and outcomes. DESIGN Single-center retrospective chart review from Society of Thoracic Surgery and Pediatric Cardiac Critical Care Consortium databases and the electronic medical record. SETTING Lucile Packard Children's Hospital at Stanford from September 2017 to February 2019. PATIENTS All patients undergoing pulmonary artery reconstruction surgery were considered for inclusion. INTERVENTIONS We identified 127 patients meeting study inclusion criteria. Thirty-nine patients met specific criteria and underwent screening preoperative bronchoscopy including microdirect laryngoscopy and lower airway examination. Postoperative bronchoscopy was performed at the discretion of the intensive care team. MEASUREMENTS AND MAIN RESULTS Airway abnormalities were detected in 25/26 of children (96%) with a chromosome 22q11 deletion who underwent preoperative bronchoscopy. Upper and lower airway pathologies were found in 19/25 (73%) and 21/25 (81%) patients, respectively, and it was common for patients to have more than one abnormality. Presence of 22q11 deletion was associated with longer duration of mechanical ventilation (9.1 vs 4.3 d; p = 0.001), use of noninvasive positive pressure support (13 vs 6 d; p = 0.001), and longer hospital stays (30 vs 14 d; p = 0.002). These outcomes were worse when compared with patients with known airway abnormalities who did not have 22q11 deletion. CONCLUSIONS Preexisting upper and lower airway pathologies are common in patients with a chromosome 22q11 deletion who undergo pulmonary artery reconstruction surgery. Despite similar postoperative hemodynamics and outcomes as their counterparts without 22q11 deletion, 22q11 deletion is associated with more postoperative respiratory complications not entirely explained by preexisting airway abnormalities.
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5
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Abstract
Laryngeal webs and laryngotracheoesophageal clefts (LTECs) are rare malformations of the larynx. Both can have a wide range of symptoms. While webs typically affect voice and airway and LTECs typically affect swallowing and airway, this is not always the case. A high index of suspicion is required for timely and accurate diagnosis. A discussion of management and treatment options will be presented. Both endoscopic and open surgical techniques exist for both pathologies and will be reviewed.
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6
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Abstract
Congenital webs are rare and represent <5% of all congenital laryngeal anomalies. They are usually a partial laryngeal atresia rather than a true web, and present as a thick and fibrotic web with subglottic extension and associated subglottic stenosis. All patients with a congenital anterior glottic web should be evaluated for chromosome 22q11.2 deletion syndrome. Management strategies are mainly based on the severity of airway obstruction and the anatomical extension of the webs. Simple division of the web endoscopically may be adequate for rare thin webs, however, an open approach is usually warranted for thick glottic webs regardless of Cohen grades. Open repair can be either with keel placement or reconstruction of the anterior commissure.
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Affiliation(s)
- I-Chun Kuo
- Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Michael Rutter
- Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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7
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Fayoux P, Devisme L. Histoanatomical structures of laryngeal atresia: Functional considerations. Laryngoscope 2019; 130:252-256. [DOI: 10.1002/lary.27855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Pierre Fayoux
- Department of Pediatric Otolaryngology–Head Neck SurgeryJeanne de Flandre Hospital–CHU Lille Lille France
- CERIM EA2694Lille University Lille France
| | - Louise Devisme
- Department of Anatomy and Pathology–CHU Lille Lille France
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8
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Abstract
BACKGROUND A 22q11 chromosome deletion is common in patients with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals. We sought to determine whether 22q11 chromosome deletion is associated with increased postoperative morbidity after unifocalisation surgery. METHODS We included all patients with this diagnosis undergoing primary or revision unifocalisation ± ventricular septal defect closure at our institution from 2008 to 2016, and we excluded patients with unknown 22q11 status. Demographic and surgical data were collected. We compared outcomes between those with 22q11 chromosome deletion and those without using non-parametric analysis. RESULTS We included 180 patients, 41% of whom were documented to have a chromosome 22q11 deletion. Complete unifocalisation was performed in all patients, and intracardiac repair was performed with similar frequency regardless of 22q11 chromosome status. Duration of mechanical ventilation was longer in 22q11 deletion patients. This difference remained significant after adjustment for delayed sternal closure and/or intracardiac repair. Duration of ICU stay was longer in patients with 22q11 deletion, although no longer significant when adjusted for delayed sternal closure and intracardiac repair. Finally, length of hospital stay was longer in 22q11-deleted patients, but this difference was not significant on unadjusted or adjusted analysis. CONCLUSION Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals and 22q11 deletion are at risk for greater prolonged mechanical ventilation after unifocalisation surgery. Careful attention should be given to the co-morbidities of this population in the perioperative period to mitigate risks that may complicate the postoperative course.
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Abstract
This article reviews congenital anomalies involving the larynx and trachea, including congenital subglottic stenosis, laryngeal webs, laryngeal cleft, and tracheal stenosis. Presenting signs and symptoms, prevailing surgical repair techniques, and postoperative care are discussed.
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Affiliation(s)
- April M Landry
- Department of Otolaryngology Head and Neck Surgery, Emory University, 1600 Tullie Road NE, Atlanta, GA 30329, USA.
| | - Michael J Rutter
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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10
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LeRiger MM, Franzen MH, Sewell RK, Duncan-Wiebe GL. Laryngoscopy and Bronchoscopy in an Infant With a Congenital Laryngeal Web Complicated by Bilateral Pneumothoraces: A Case Report. A A Pract 2018; 11:162-164. [PMID: 29621014 DOI: 10.1213/xaa.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neonates with laryngeal webs pose unique challenges to the anesthesiologist. We present a 2-day-old neonate with aphonia and stridor who underwent microdirect laryngoscopy. Intraoperatively, a Cohen type 4 laryngeal web was diagnosed not immediately amenable to resection. Therefore, the decision was made for endotracheal intubation and subsequent tracheostomy. After endotracheal intubation, there was acute respiratory compromise and oxygen desaturation that improved moderately after urgent tracheostomy. A chest radiograph revealed a large pneumothorax. Our experience suggests that in the presence of high-grade laryngeal webs, the possibility of intraoperative development of pneumothorax should be considered if respiratory difficulties are encountered.
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Affiliation(s)
- Michelle M LeRiger
- From the Division of Pediatric Anesthesiology, Department of Anesthesiology, Omaha Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Marcellene H Franzen
- From the Division of Pediatric Anesthesiology, Department of Anesthesiology, Omaha Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Greta L Duncan-Wiebe
- From the Division of Pediatric Anesthesiology, Department of Anesthesiology, Omaha Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
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11
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Jones JW, Tracy M, Perryman M, Arganbright JM. Airway Anomalies in Patients With 22q11.2 Deletion Syndrome: A 5-Year Review. Ann Otol Rhinol Laryngol 2018; 127:384-389. [PMID: 29732908 DOI: 10.1177/0003489418771711] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To characterize the frequency of airway anomalies in patients with 22q11.2 deletion syndrome (22q11DS). METHODS Retrospective review of patients with 22q11DS who had undergone microlaryngoscopy/bronchoscopy (MLB) for aerodigestive symptoms at a tertiary care children's hospital from 2011 to 2016. RESULTS Thirty patients underwent an MLB due to the following indications: aspiration (11), stridor (10), chronic respiratory failure due to ventilator dependence (8), and difficult intubation (1). Median age at MLB was 6.5 months (range, 0.25-32 months). Forty airway anomalies were identified in 20 (66%) patients. Laryngomalacia (10), tracheomalacia (8), and bronchomalcia (8) were the most common intraoperative findings, followed by laryngeal cleft (5), anterior glottic web (5), subglottic stenosis (3), and subglottic cysts (1). Synchronous airway anomalies were common and identified in 11 (55%) of the patients who had identified anomalies on MLB. Nineteen of the 20 patients required operative intervention due to the anomalies identified. CONCLUSIONS Structural airway abnormalities are common in children with 22q11DS undergoing MLB, and synchronous anomalies can frequently exist. Providers caring for children with 22q11DS should be vigilant about airway evaluation when aerodigestive symptoms are present.
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Affiliation(s)
- Joel W Jones
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Meghan Tracy
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Mollie Perryman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Jill M Arganbright
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
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12
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Unolt M, Versacci P, Anaclerio S, Lambiase C, Calcagni G, Trezzi M, Carotti A, Crowley TB, Zackai EH, Goldmuntz E, Gaynor JW, Digilio MC, McDonald-McGinn DM, Marino B. Congenital heart diseases and cardiovascular abnormalities in 22q11.2 deletion syndrome: From well-established knowledge to new frontiers. Am J Med Genet A 2018; 176:2087-2098. [PMID: 29663641 DOI: 10.1002/ajmg.a.38662] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/11/2022]
Abstract
Congenital heart diseases (CHDs) and cardiovascular abnormalities are one of the pillars of clinical diagnosis of 22q11.2 deletion syndrome (22q11.2DS) and still represent the main cause of mortality in the affected children. In the past 30 years, much progress has been made in describing the anatomical patterns of CHD, in improving their diagnosis, medical treatment, and surgical procedures for these conditions, as well as in understanding the underlying genetic and developmental mechanisms. However, further studies are still needed to better determine the true prevalence of CHDs in 22q11.2DS, including data from prenatal studies and on the adult population, to further clarify the genetic mechanisms behind the high variability of phenotypic expression of 22q11.2DS, and to fully understand the mechanism responsible for the increased postoperative morbidity and for the premature death of these patients. Moreover, the increased life expectancy of persons with 22q11.2DS allowed the expansion of the adult population that poses new challenges for clinicians such as acquired cardiovascular problems and complexity related to multisystemic comorbidity. In this review, we provide a comprehensive review of the existing literature about 22q11.2DS in order to summarize the knowledge gained in the past years of clinical experience and research, as well as to identify the remaining gaps in comprehension of this syndrome and the possible future research directions.
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Affiliation(s)
- Marta Unolt
- Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Anaclerio
- Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Caterina Lambiase
- Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Matteo Trezzi
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Adriano Carotti
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Terrence Blaine Crowley
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Goldmuntz
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James William Gaynor
- The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Donna M McDonald-McGinn
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bruno Marino
- Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
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13
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Verheij E, Speleman L, Mink van der Molen AB, Thomeer HGXM. Congenital respiratory tract disorders in 22q11.2 deletion syndrome. Int J Pediatr Otorhinolaryngol 2018; 104:1-4. [PMID: 29287846 DOI: 10.1016/j.ijporl.2017.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Respiratory tract disorders have been reported in patients with 22q11.2 deletion syndrome, however infrequently. This study describes the respiratory tract disorders encountered in a cohort of 278 patients with 22q11.2 deletion syndrome. METHODS We conducted a retrospective, cross-sectional, study at a single tertiary referral center. We identified the patients with 22q11.2 deletion syndrome and with an upper and/or lower respiratory tract disorder at our otorhinolaryngologic department. The different disorders were described. RESULTS Out of 278 patients referred to the otorhinolaryngologic department, we identified 14 patients with a laryngeal and/or tracheal disorder. Nine patients had more than one congenital disorder in this anatomical area. Disorders included a choanal stenosis (n = 1), laryngeal web (n = 5), laryngeal cleft (n = 2), subglottic stenosis (n = 3), pharyngo-, laryngo-, tracheo- and/or bronchomalacia (n = 11) and tracheal stenosis (n = 1). CONCLUSION Different types of respiratory tract disorders can be present in patients with 22q11.2 deletion syndrome. Clinicians should be aware of this clinical association for timely and accurate diagnosis and treatment. In addition, the diagnosis 22q11.2 deletion syndrome should be considered in patients presenting with a congenital respiratory tract disorder.
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Affiliation(s)
- Emmy Verheij
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Lucienne Speleman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Henricus G X M Thomeer
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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14
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Saravanam PK, Manimaran V. Flexible Laryngoscopy in Management of Congenital Stridor. Indian J Otolaryngol Head Neck Surg 2017; 69:509-513. [PMID: 29238683 DOI: 10.1007/s12070-017-1217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
Abstract
The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive and requires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simple and less invasive procedure can be done under topical anaesthesia for evaluation of stridor. In this study, we have presented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor.
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Affiliation(s)
- Prasanna Kumar Saravanam
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Vinoth Manimaran
- Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
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15
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Cronjé L. Bardet–Biedl syndrome: expect the unexpected, suspect the unsuspected. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1379719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Larissa Cronjé
- Perioperative Research Group, Department of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, King Edward VIII Hospital, Durban, South Africa
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16
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Clive B, Corsten G, Penney LS, Van den Hof M, El-Naggar W. Severe laryngeal stenosis in newly born twins with 22q11.2 deletion syndrome: A case report. J Neonatal Perinatal Med 2017; 9:223-6. [PMID: 27197926 DOI: 10.3233/npm-16915068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chromosome 22q11.2 deletion syndrome is common and presents with a range of clinical features from cardiac malformations to hypocalcemia. Laryngeal anomalies are not a common feature of this syndrome. We describe newly born twins who presented with unexpected severe birth depression secondary to severe type IV glottic webs requiring extensive resuscitation and emergency tracheostomy. They were diagnosed postnatally to have deletion of 22q11.2. The successful resuscitation of these infants at birth was only possible because they were born in a tertiary care hospital. This report shows the critical nature of prenatal diagnosis of 22q11.2 deletion syndrome.
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Affiliation(s)
- B Clive
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - G Corsten
- Department of Pediatric Otolaryngology, Dalhousie University, Halifax, Canada
| | - L S Penney
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - M Van den Hof
- Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Canada
| | - W El-Naggar
- Department of Pediatrics, Dalhousie University, Halifax, Canada
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17
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Parelkar KA, Thorawade VP, Shah KA, Walli AK, Pareek AH. A Misdiagnosed Laryngeal Web: Treated with an Innovative Self-Made Keel. J Clin Diagn Res 2017; 11:MD04-MD06. [PMID: 28658820 DOI: 10.7860/jcdr/2017/27221.9908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
Laryngeal web is a rare congenital anomaly. Late presentation at the age of 10 years as in our case, with misleading diagnosis of asthma in a Cohen's type III glottic web is even rarer. In cases of congenital laryngeal web the aim is to provide a patent airway and to achieve a good voice quality. Regardless of the technique used; the primary concern is recurrence. Traditionally, the treatment of choice for laryngeal web was laryngofissure with placement of a keel however; endoscopic laser excision of the web with keel placement is now the preferred technique for thin anterior glottic webs. This endoscopic technique not only requires a Lichtenberger needle carrier but also the ready-made keel, which many of the government set-ups in our country cannot provide. For an alternative to this problem, we have described an innovative, minimally invasive technique for placement of a self-made silicone keel without any sophisticated instruments.
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Affiliation(s)
- Kartik Anil Parelkar
- Senior Resident, Department of Ear, Nose and Throat, JJ Hospital, Mumbai, Maharashtra, India
| | - Vandana P Thorawade
- Associate Professor, Department of Ear, Nose and Throat, Solapur Government Medical College and Hospital, Mumbai, Maharashtra, India
| | - Keya A Shah
- Senior Resident, Department of Ear, Nose and Throat, K.E.M Hospital, Mumbai, Maharashtra, India
| | - Ankur K Walli
- Resident, Department of Ear, Nose and Throat, JJ Hospital, Mumbai, Maharashtra, India
| | - Ankur H Pareek
- Senior Resident, Department of Ear, Nose and Throat, K.E.M Hospital, Mumbai, Maharashtra, India
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de Trey LA, Lambercy K, Monnier P, Sandu K. Management of severe congenital laryngeal webs - a 12 year review. Int J Pediatr Otorhinolaryngol 2016; 86:82-6. [PMID: 27260586 DOI: 10.1016/j.ijporl.2016.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate respiratory and voice outcomes after open surgery for severe congenital laryngeal web. METHODS Included were all patients treated for severe congenital glottic web (Cohen type 3 and 4) between 2002 and 2014. Demographic data, symptoms, endoscopic findings, type of operation, outcome and complications were analyzed. Open surgery was performed with division of the web and enlargement of the subglottis by a laryngotracheal reconstruction or an extended partial cricotracheal resection. RESULTS Fourteen patients were included. Information on the pre-operative voice was available in 11 patients. Aphonia was present in 6 patients (55%), dysphonia was severe in 1 (9%), moderate in 2 (18%) and mild in 2 (18%). Median age at operation was 19.3 months. As a first line treatment, laryngotracheal reconstruction was performed in 12 patients, and an extended partial cricotracheal resection in 2. Median follow-up was 9.5 months. All patients were successfully decannulated in a median time of 4 months after first surgery. Voice was improved in 10/11 (91%). Post-operatively, 3 patients (27%) had good voice. Dysphonia was severe in 2 (18%), moderate in 3 (27%) and mild in 3 patients (27%). CONCLUSION Open surgery for Cohen type 3 and 4 glottic web allowed establishing a patent airway with successful decannulation in all cases. Quality of voice was improved in 91%, however, voice results were variable. In our opinion a delicate operative technique described in the paper is important for optimal voice results.
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Affiliation(s)
- L A de Trey
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland; Department of Otorhinolaryngology, Children's University Hospital Zurich, Switzerland.
| | - K Lambercy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - P Monnier
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - K Sandu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital (CHUV), Lausanne, Switzerland
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Miyamoto RC, Cotton RT, Rope AF, Hopkin RJ, Cohen AP, Shott SR, Rutter MJ. Association of Anterior Glottic Webs with Velocardiofacial Syndrome (Chromosome 22q11.2 Deletion). Otolaryngol Head Neck Surg 2016; 130:415-7. [PMID: 15100636 DOI: 10.1016/j.otohns.2003.12.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE: An association between anterior glottic webs and velocardiofacial syndrome (chromosome 22q11.2 deletion) has previously been noted in a number of case reports. Our objective was to determine if the presence of such webs warrants a high index of suspicion for this chromosome deletion. STUDY DESIGN AND SETTING: This study was carried out in the Division of Pediatric Otolaryngology-Head and Neck Surgery at Cincinnati Children's Hospital Medical Center. Chromosome 22q11.2 deletion status was determined for all patients endoscopically diagnosed with anterior glottic webs between July 1998 and December 2000. Families of patients who tested positive for the deletion were referred to the Cincinnati Children's Division of Human Genetics for additional evaluation and counseling. RESULTS: Eleven of 17 patients (65%) with anterior glottic webs were positive for chromosome 22q11.2 deletion. Of these 11 patients, 5 showed subtle clinical manifestations of velocardiofacial syndrome and underwent genetic testing due only to the presence of a web. All 11 patients were diagnosed with velocardiofacial syndrome. CONCLUSION: We strongly recommend that all patients diagnosed with anterior glottic webs undergo fluorescence in situ hybridization evaluation for this chromosome deletion. (Otolaryngol Head Neck Surg 2004;130:415-7.)
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Affiliation(s)
- R Christopher Miyamoto
- Division of Pediatric of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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Abstract
Stridor is a variably pitched respiratory sound, caused by abnormal air passage during breathing and often is the most prominent sign of upper airway obstruction. It is usually heard on inspiration (typically resulting from supraglottic or glottic obstruction) but also can occur on expiration (originating from obstruction at or below glottic level and/or severe upper airway obstruction). Stridor due to congenital anomalies may exist from birth or may develop within days, weeks or months. Various congenital and acquired disorders prevail in neonates, infants, children, and adolescents, and have to be distinguished. History, age of the child and physical examination together often allow a presumptive diagnosis. Further investigations may be necessary to establish a definite diagnosis, and flexible airway endoscopy is the diagnostic procedure of choice in most circumstances ("stridor is visible").
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Affiliation(s)
- Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria.
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Abstract
CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes--for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.
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Windsor A, Clemmens C, Jacobs IN. Rare Upper Airway Anomalies. Paediatr Respir Rev 2016; 17:24-8. [PMID: 26277452 DOI: 10.1016/j.prrv.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022]
Abstract
A broad spectrum of congenital upper airway anomalies can occur as a result of errors during embryologic development. In this review, we will describe the clinical presentation, diagnosis, and management strategies for a few select, rare congenital malformations of this system. The diagnostic tools used in workup of these disorders range from prenatal tests to radiological imaging, swallowing evaluations, indirect or direct laryngoscopy, and rigid bronchoscopy. While these congenital defects can occur in isolation, they are often associated with disorders of other organ systems or may present as part of a syndrome. Therefore workup and treatment planning for patients with these disorders often involves a team of multiple specialists, including paediatricians, otolaryngologists, pulmonologists, speech pathologists, gastroenterologists, and geneticists.
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Affiliation(s)
- Alanna Windsor
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
| | - Clarice Clemmens
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
| | - Ian N Jacobs
- Division of Otolaryngology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; Department of Otorhinolaryngology-Head and Neck Surgery, Pereleman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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23
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Shah J, White KE, Dohar J. Vocal characteristics of congenital anterior glottic webs in children: A case report. Int J Pediatr Otorhinolaryngol 2015; 79:941-945. [PMID: 25912682 DOI: 10.1016/j.ijporl.2015.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/04/2015] [Accepted: 04/07/2015] [Indexed: 10/01/2022]
Abstract
This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature.
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Affiliation(s)
- Jay Shah
- Department of Otolaryngology, Case Western Reserve University, University Hospitals Case Medical Center, United States.
| | - Katherine E White
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, United States
| | - Joseph Dohar
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, United States
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Abstract
Introduction It is essential for clinicians to understand issues relevant to the airway management of infants and to be cognizant of the fact that infants with congenital laryngeal anomalies are at particular risk for an unstable airway. Objectives To familiarize clinicians with issues relevant to the airway management of infants and to present a succinct description of the diagnosis and management of an array of congenital laryngeal anomalies. Methods Revision article, in which the main aspects concerning airway management of infants will be analyzed. Conclusions It is critical for clinicians to understand issues relevant to the airway management of infants.
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Affiliation(s)
- Michael J Rutter
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
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Laryngeal abnormalities are frequent in the 22q11 deletion syndrome. Int J Pediatr Otorhinolaryngol 2012; 76:36-40. [PMID: 22019154 DOI: 10.1016/j.ijporl.2011.09.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/22/2011] [Accepted: 09/24/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The 22q11 microdeletion is a chromosomal disorder detected by fluorescence in situ hybridization (FISH). It has been known since the 80s, and is involved in many malformative syndromes (DiGeorge sequence, VCFS syndrome, etc.). Airway abnormalities are frequently localized in the larynx, as reported in the following series. METHODS A retrospective chart review of laryngeal abnormalities and 22q11 deletion in a tertiary referral center. RESULTS Five cases of laryngeal abnormalities associated to 22q11 deletion syndrome (DS) were found in a series of 35 cases. Abnormalities encountered were subglottic stenosis (3%), glottic web (9%), laryngeal paralysis (9%), vocal nodule (3%), laryngomalacia (3%) associated with bronchial malposition (3%). CONCLUSION Laryngeal abnormalities are relatively common (14% in this series) and important to recognize with the 22q11 deletion syndrome, especially if cardiac surgery is planed. Conversely, in case of laryngeal abnormalities associated to other malformation (like facial dysmorphia or cardiac malformation), the 22q11 deletion must be searched.
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Goudy S, Bauman N, Manaligod J, Smith RJH. Congenital laryngeal webs: surgical course and outcomes. Ann Otol Rhinol Laryngol 2010; 119:704-6. [PMID: 21049857 DOI: 10.1177/000348941011901010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We compare the success of different surgical options in the treatment of laryngeal webs. METHODS We performed a retrospective study spanning the years 1980 to 2005. RESULTS Eighteen patients were identified. The average age at diagnosis was 6 months (range, 1 day to 2.5 years). The presenting symptoms included weak cry, stridor, airway obstruction, and difficulty breathing. Associated cardiac defects consistent with the diagnosis of 22q-syndrome were present in 7 patients. Webs were classified as grade I (5 patients), grade II (2 patients), grade III (10 patients), or grade IV (1 patient) according to the Cohen classification. In 5 patients, only endoscopic lysis was required. The remaining 13 patients underwent open procedures; 9 patients in this group required tracheotomy. An average of 1.3 open airway procedures was necessary to achieve a decannulation rate of 89%. After operation, 34% of patients had residual webbing and 20% had a weak or aphonic voice. CONCLUSIONS Management of laryngeal webs is dependent on the severity of airway obstruction. Grade I and II webs can be treated endoscopically; more severe laryngeal webs usually require tracheotomy and open airway reconstruction.
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Affiliation(s)
- Steven Goudy
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
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27
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Abstract
Anterior laryngeal webs can be congenital or acquired and occur secondary to a surgical procedure, intubation, or infection. Clinical presentation can include vocal and respiratory symptoms. The first step in managing a laryngeal web is performing flexible laryngoscopy, followed by a direct laryngoscopy under general anesthesia. Treatment remains a challenge. Endoscopically, the web can be incised with cold instruments or by laser, mitomycin-C can be applied, and a silastic keel can be inserted in the anterior commissure. Externally, an anterior cricothyrotomy is necessary and a silastic keel can be placed; anterior cartilage graft can be inserted in case of a thick web. Regardless of the technique used, the primary concern is recurrence.
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Carotti A, Digilio MC, Piacentini G, Saffirio C, Di Donato RM, Marino B. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. ACTA ACUST UNITED AC 2008; 14:35-42. [PMID: 18636635 DOI: 10.1002/ddrr.6] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Specific types and subtypes of cardiac defects have been described in children with 22q11.2 deletion syndrome as well as in other genetic syndromes. The conotruncal heart defects occurring in patients with 22q11.2 deletion syndrome include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus, interrupted aortic arch, isolated anomalies of the aortic arch, and ventricular septal defect. These conotruncal heart defects are frequently associated in this syndrome with additional cardiovascular anomalies of the aortic arch, pulmonary arteries, infundibular septum, and semilunar valves complicating cardiac anatomy and surgical treatment. In this review we describe the surgical anatomy, the operative treatment, and the prognostic results of the cardiac defects associated with 22q11.2 deletion syndrome. According to the current literature, in patients with tetralogy of Fallot with/without pulmonary atresia and truncus arteriosus, in spite of the complex cardiac anatomy, the presence of 22q11.2 deletion syndrome does not worsen the surgical prognosis. On the contrary in children with pulmonary atresia with ventricular septal defect and probably in those with interrupted aortic arch the association with 22q11.2 deletion syndrome is probably a risk factor for the operative treatment. The complex cardiovascular anatomy in association with depressed immunological status, pulmonary vascular reactivity, neonatal hypocalcemia, bronchomalacia and broncospasm, laryngeal web, and tendency to airway bleeding must be considered at the time of diagnosis and surgical procedure. Specific diagnostic, surgical, and perioperative protocols should be applied in order to provide appropriate treatment and to reduce surgical mortality and morbidity.
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Affiliation(s)
- Adriano Carotti
- Pediatric Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Sharma R, Saxena KN, Panda A, Bhagwat A. Laryngeal web in an infant with ventricular septal defect: a case of misdiagnosed congestive heart failure. Paediatr Anaesth 2008; 18:986-7. [PMID: 18811839 DOI: 10.1111/j.1460-9592.2008.02673.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
In the year 1955, Sedlácková described a syndrome of congenitally shortened velum accompanied by hypernasal speech, facial dysmorphisms and further anomalies, as well as mental retardation. In the following years, she also reported on cardiac malformations and submucous clefts. In 1978, Shprintzen's group published a very similar pattern apart from overt clefts, coined it as velocardiofacial syndrome (VCFS) and explained it in 1992 by microdeletion 22q11.2. Between 1996 and 2001, Vrticka and colleagues demonstrated del 22q11.2 in 16 of 20 cases classified as Sedlácková syndrome. Thus, the common etiology and the identity of Sedlácková syndrome with Shprintzen syndrome were proven. Our findings of frequent cardiovascular malformations, of prevailing mental retardation and of several late-onset psychoses emphasize the necessity of genetic testing in all individuals suspected of VCFS. In del 22q11.2-proven cases, we recommend genetic counseling because of the risk of more severe expression of the VCFS symptoms in subsequent generations. Recently, several authors repeatedly stressed the importance of VCFS by pointing out the associated cardiac and laryngeal malformations and by warning against the risk of innate carotid medialization in velopharyngeal surgery, by evoking linked otological problems, by elucidating the accompanying immune and hormonal dysfunctions, by summarizing the voice and resonance disorders as well as by discussing the difficulties in rehabilitation due to mental, language and speech retardation in VCFS subjects. Because of its multiple impact, the clinical pattern of VCFS due to del 22q11.2 remains a persistent and important present-day diagnostic and therapeutic challenge.
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Affiliation(s)
- Karel Vrticka
- Department of Phoniatrics, Cantonal Hospital Lucerne, Lucerne, Switzerland.
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Abstract
Most patients with the clinical features of DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes share a common genetic cause, namely, a deletion of chromosome 22q11, and define the most common deletion syndrome known at this time. The clinical features of the 22q11 deletion syndrome are highly variable between individuals; some have subtle findings, whereas others are severely affected. The most common clinical features include specific types of congenital heart disease, hypocalcemia, immunodeficiency, facial dysmorphia, palate anomalies, velopharyngeal dysfunction, renal anomalies, and speech and feeding disorders as well as neurocognitive, behavioral, and psychiatric disorders. A significant number of patients with tetralogy of Fallot, truncus arteriosus, an interrupted aortic arch, isolated aortic arch anomalies, and perimembranous ventricular septal defects have a 22q11 deletion. Routine testing for a 22q11 deletion in this subset of patients should be considered to provide anticipatory medical intervention and appropriate family counseling.
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Affiliation(s)
- Elizabeth Goldmuntz
- Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Abramson Research Center 702A, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA.
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Khariwala SS, Lee WT, Koltai PJ. Laryngotracheal Consequences of Pediatric Cardiac Surgery. ACTA ACUST UNITED AC 2005; 131:336-9. [PMID: 15837903 DOI: 10.1001/archotol.131.4.336] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the incidence and character of clinically significant laryngotracheal anomalies in pediatric patients undergoing surgical repair of congenital cardiac defects at a tertiary care center. DESIGN Single-center retrospective review. PATIENTS The charts of pediatric patients who required surgical treatment for congenital heart disease over a 4-year period were reviewed. Forty-eight of 1957 patients were seen in inpatient consultation by the otolaryngology service. The parameters studied included cardiac diagnosis, reason for consultation, findings on examination, and follow-up. RESULTS There were 16 (33%) cases of subglottic stenosis, which were graded according to the Cotton-Myer classification system as follows: grade 1 (n=8); grade 2 (n=3); and grade 3 (n=5). Three of the 16 patients with subglottic stenosis required tracheotomy and 4 required laryngotracheal reconstruction. Nine (19%) of the 48 patients were diagnosed as having unilateral true vocal cord paralysis and 3 (6%) as having bilateral paralysis. With the exception of 1 patient, all patients with true vocal cord paralysis on the left side had undergone repair of the aortic arch. CONCLUSIONS Pediatric patients with congenital cardiac disease are predisposed to laryngeal anomalies owing to (1) frequent intubation, (2) prolonged ventilatory support, and (3) recurrent laryngeal nerve injury. In our patients, subglottic stenosis was the most common laryngeal abnormality. When recognized early, in the eschar phase, most of these cases can be managed with sequential endoscopic debridement, which is conceptually similar to debridement that is performed after functional endoscopic sinus surgery. Established stenosis requires more vigorous intervention, the invasive degree of which depends on the length and circumference of the narrowing. Unilateral vocal paralysis tends to be a self-limited problem, while an elegant solution to bilateral paralysis remains elusive.
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Affiliation(s)
- Samir S Khariwala
- Cleveland Clinic Foundation, Head and Neck Institute, Cleveland, OH, USA
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