Meningitis after adenoidectomy: an anatomic explanation

Magnetic Resonance Imaging Evaluation of Distance Between Adenoid Tissue and Internal Carotid Artery in Children With Adenoid Hypertrophy

OBJECTIVES

In the present study, we investigated the distance between adenoid tissue and internal carotid artery (ICA) in children with adenoid hypertrophy by magnetic resonance imaging.

METHODS

Cranial magnetic resonance images of 200 children with adenoid hypertrophy between the ages of 5 and 15 were included. In group 1 (5-9 years of age), there were 100 children, and in group 2 (10-15 years of age), there were 100 children. In both groups, adenoid thickness, adenoid/nasopharynx) ratio, and superior, middle, and inferior adenoid-ICA distances were measured.

RESULTS

Adenoid thickness is significantly higher in the 10-to-15 years age group than in the 5-to-9 years age group (P < 0.05). Adenoid-ICA distance got lower from the superior to the inferior part in both age groups and in both sexes: inferior < middle < superior adenoid-ICA distance. In the 5-to-9 years age group, the minimum adenoid-ICA distances were 2.40 mmsuperior, 0.90 mmmiddle, and 1.20 mminferior. In 10-to-15 years age group, the minimum adenoid-ICA distances were 2.50 mmsuperior, 1.00 mmmiddle, and 0.90 mminferior. As adenoid thickness increased, the inferior adenoid-ICA distance decreased bilaterally (P < 0.05). As the age got older, adenoid thickness increased, and the left superior and middle adenoid ICA distances and bilateral inferior adenoid-ICA distances decreased (P < 0.05).

CONCLUSION

The distance between adenoid and ICA decreased from superior to inferior. In 10- to 15-year-old children, the distance between adenoid and ICA was determined as lower than in the 5- to 9-year-old children. The minimum distances between adenoid and ICA were found to be between 0.9 and 2.5 mm in the 10-to-15 age group and between 0.9 and 2.4 mm in the 5-to-9 age group. It should be remembered that ICA can be very close to the adenoid tissue. In addition, because thermal injury can cause deeper damage to the tissue, bipolar cautery should be used with caution in this area and unipolar cautery should not be used.

Pupil-Involving Oculomotor Nerve Palsy Following Tonsillectomy and Adenoidectomy

Ocular complications of adenotonsillectomy are rare. The authors describe a 6-year-old boy who developed mydrasis and limitations of supraduction and infraduction after adenotonsillectomy. This was attributed to the hemorrhagic compression of the nerve in the cavernous sinus. This is the first report of pupil-involving oculomotor nerve palsy following adenotonsillectomy. [J Pediatr Ophthalmol Strabismus. 2019;56:e76-e78.].

Infection of the spheno-occipital synchondrosis: A morbid complication following adenoidectomy

Two 2-year-old males presented post-operatively following adenoidectomy with persistent fever and neck stiffness. After multiple office visits, both patients were admitted and found to have a widened spheno-occipital synchondrosis and other imaging findings indicative of skull base osteomyelitis. Treatment with antibiotics allowed for recovery with good long-term outcomes. Infection involving the spheno-occiptal synchondrosis is rare and its circuitous presentation of these two children no doubt led to delayed diagnosis.

Bacterial meningitis after radiofrequency diathermy for adenoid hypertrophy

A 6-year-old otherwise healthy girl who underwent radiofrequency diathermy for adenoid hypertrophy presented with fever on the same day and was diagnosed as having bacterial meningitis 2 days later. Culture of cerebrospinal fluid indicated that the pathogens were penicillin-sensitive Streptococcus pneumoniae and methicillin-sensitive Staphylococcus aureus. The serotype of the causative pneumococcus, 11A, was not covered by the 7-valent pneumococcal conjugate vaccine the patient had been inoculated with. Although not previously reported, radiofrequency diathermy for adenoid hypertrophy can be considered a risk factor for bacteremia and meningitis.

The risk of acquiring bacterial meningitis following surgery in Denmark, 1996-2009: a nationwide retrospective cohort study with emphasis on ear, nose and throat (ENT) and neurosurgery

SUMMARY

This paper estimates the risk of bacterial meningitis following surgery between 1996 and 2009 in Denmark. We conducted two retrospective nationwide cohort studies; first by linking notified bacterial meningitis cases to the National Patient Registry to see how many had undergone a surgical procedure; second, we scrutinized notified bacterial meningitis cases to see if the clinician suspected a surgical procedure to be the aetiology. We found that ear, nose and throat surgery had an 11-fold, and neurosurgery a sevenfold, increased risk compared to the reference group in the first 10 days following surgery. Streptococcus pneumoniae was the pathogen most often involved. Operation procedures involving penetration of dura mater was associated with increased risk for post-operative bacterial meningitis. In absolute numbers we found few bacterial meningitis cases after surgery; however, patients undergoing certain surgical procedures are at-risk and should be considered when national vaccination guidelines are revised.

Ropivacaine Peritonsillar Infiltration for Analgesia after Adenotonsillectomy in Children: A Randomized, Double-Blind, Placebo-Controlled Study

Objectives:

Our randomized, double-blind, placebo-controlled study evaluates the possible benefit of peritonsillar infiltration with 0.75% ropivacaine hydrochloride on the pain level after adenotonsillectomy in 3- to 7-year-old children.

Methods:

We randomly administered intraoperative peritonsillar infiltration with 0.2 mL/kg ropivacaine 0.75% (group R) or 0.2 mL/kg saline 0.9% (group F) to sixty 3- to 7-year-old children (ASA 1 or 2) who were undergoing adenotonsillectomy. Postoperative pain was assessed 6 and 24 hours after surgery by a 6-face Faces Pain Scale that allowed quantification of pain on a 100-mm horizontal line (0 = no pain). The number of rectal doses of acetaminophen-codeine required during the first postoperative day was recorded.

Results:

The pain scores did not differ between the groups, either 6 or 24 hours after surgery (group F, 43 ± 26, versus group R, 29 ± 23, and group F, 24 ± 23, versus group R, 30 ± 28, respectively). Acetaminophen-codeine doses were similarly required in the two groups.

Conclusions:

Peritonsillar infiltration with 0.75% ropivacaine does not provide any major postoperative analgesic effect in 3- to 7-year-old children after adenotonsillectomy. A possible clinically minor analgesia 6 hours after surgery is suggested.

Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed

OBJECTIVE

To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed.

DESIGN

Case report.

SETTING

A tertiary pediatric critical care unit.

PATIENT

A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure.

INTERVENTIONS

Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy.

CONCLUSION

In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered.

Bacteremia during adenoidectomy

OBJECTIVE

Although adenoidectomy is one of the most commonly performed surgical procedures in children, there is no satisfactory information about the risk of bacteremia during adenoidectomy and necessity of antibiotic use. The aim of this study was to determine the incidence of bacteremia during adenoidectomy and identify the organisms leading to bacteremia.

METHODS

Thirty two patients who had undergone adenoidectomy at ENT Clinic of Sutcu Imam University were included in the study. They had received no antimicrobial therapy for at least 20 days before surgery. Adenoidal surface and deep tissue cultures were taken and venous blood samples were obtained for cultures before and immediately after adenoidectomy in which adenoid was removed with a curette.

RESULTS

While none of the blood cultures taken preoperatively was positive for any organisms, the cultures obtained postoperatively were positive in only two of 32 patients included in the study.

CONCLUSION

The results of this study suggest that there is an extremely low incidence of bacteremia during adenoidectomy. As a result, it may be concluded that the use of prophylactic antibiotics to prevent bacteremia or its complications is unnecessary unless the patient has a predisposing factor for cardiac infection like prosthetic valve replacement.

Medial medullary injury during adenoidectomy

We report medullary injury during adenoidectomy in two children who received injections of local anesthetic agents into the operative bed. Initial manifestations included hemiparesis, nystagmus, and ataxia. Magnetic resonance imaging showed hemorrhagic, paramedian medullary lesions in both patients. The mechanism of injury is likely to be injection of fluid into the medulla.

Meningococcal septicemia post adenotonsillectomy in a child: case report

Hemorrhage, nausea and vomiting and poor oral intake remain the most commonly encountered complications after adenotonsillectomy in the pediatric population. Life-threatening infectious complications such as meningitis have rarely been reported. We report a case of meningococcal septicemia complicating adenotonsillectomy in a 3-year-old male child. Possible etiologies postulated include: septicemia following transient bacteremia, increased meningococcal carrier rate, transient immune deficiency, and mucosal damage promoting bacterial translocation. This case highlights the responsibility of the otolaryngologist to maintain medical review, especially when recovery following TA is slow.

Meningitis as a complication of tonsillectomy

Adenotonsillar surgery remains among the most commonly-performed pediatric surgical procedures. The complication rate of tonsillectomy is generally considered to be in a range of 1-5%. Bacterial meningitis following adenotonsillectomy is a rarely reported complication. Bacterial meningitis is a potentially fatal acute infectious disease caused by a variety of micro-organisms. Current case fatality rates associated with this entity can be as low as 2% in infants and children and as high as 30% in neonates. The successful management of meningitis depends on early clinical suspicion and diagnosis, with prompt medical treatment using high-dose, broad-spectrum antibiotics that adequately cross the blood-brain barrier. We present a case of meningitis complicating a tonsillectomy procedure, in a 7-year-old girl. The diagnosis and treatment of this rare complication is illustrated, and the possible etiology is discussed.