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Abstract
OBJECTIVE Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. DESIGN Case study. PATIENT A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. INTERVENTION The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. RESULTS During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. CONCLUSIONS The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.
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Affiliation(s)
- R T Younis
- Otolaryngology Consultants of Memphis, LeBonheur Children's Medical Center, TN 39105, USA
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2
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Younis RT, Hesse SV, Anand VK. Evaluation of the utility and cost-effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 2001; 111:2166-9. [PMID: 11802018 DOI: 10.1097/00005537-200112000-00017] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the use and necessity of obtaining histopathology on patients undergoing tonsillectomy, and to provide indications and guidelines for requesting histopathology on tonsillectomy patients. STUDY DESIGN At the University of Mississippi Medical Center, we have been routinely obtaining histopathologic diagnoses on every patient undergoing tonsillectomy or tonsillectomy and adenoidectomy. Specimens are separated into left and right tonsils and adenoids. This study was designed at our tertiary care academic center to evaluate the necessity for obtaining histopathologic diagnosis on each of these patients. METHODS A retrospective review of histopathologic reports on all patients in both pediatric and adult age groups undergoing tonsillectomy or tonsillectomy and adenoidectomy between January 1994 and December 1999 was performed. RESULTS A total of 2438 reports were reviewed. There were 2099 in the pediatric age group and 339 were adults. None of the children had an unusual histopathology finding other than lymphoid hyperplasia. Of the 339 adults, 34 had squamous cell carcinoma and 6 had lymphoma; however, these findings were suspected preoperatively by history and clinical manifestations. CONCLUSIONS The general practice guidelines mandate obtaining histopathologic diagnoses on most of the tissues received. Based on our review, histopathology of tonsillectomy and/or adenoidectomy may not be necessary, especially in children. In this era of cutting excess costs of health care dollars, waving histopathology in these cases may have major implications without compromising delivery of quality care.
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MESH Headings
- Adenoidectomy/economics
- Adenoids/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy/economics
- Carcinoma, Squamous Cell/economics
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Child
- Child, Preschool
- Cost-Benefit Analysis
- Female
- Humans
- Hyperplasia
- Infant
- Lymphoma, Large B-Cell, Diffuse/economics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Male
- Middle Aged
- Palatine Tonsil/pathology
- Practice Guidelines as Topic
- Tonsillectomy/economics
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Affiliation(s)
- R T Younis
- Division of Otolaryngology, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
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3
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Abstract
OBJECTIVES Meningitis is the most common intracranial complication of sinusitis. We review the incidence, current management, outcomes, and complications of this serious infection. Our study also examines the evolving roles of endoscopic sinus surgery and other new therapeutic and diagnostic modalities in our armamentarium. STUDY DESIGN A retrospective chart review was performed at a tertiary academic medical center of all patients diagnosed with sinusitis with complications between January 1985 and December 1999. METHODS The patients were divided into two main groups: intracranial versus orbital complications. Meningitis was the most common intracranial complication. Data on patients with sinusitis and meningitis were collected and analyzed. RESULTS Intracranial complications were present in 39 of 82 patients whereas orbital complications were noted in 43 patients. Twenty-one of the 39 intracranial complications were meningitis. The most common computed tomography finding in adults (54%) was sphenoid sinusitis. All patients with AIDS (6 of 21) had unique cryptococcus meningitis. In patients without AIDS, the most common organism was Streptococcus pneumoniae (10 of 21). The most common sequela was seizure disorder (4 of 21). Endoscopic sinus surgery was performed on 7 of 21 patients. One patient with AIDS who had sinusitis and meningitis died. CONCLUSIONS Meningitis as a complication of sinusitis may still pose a serious threat. Although outcomes are encouraging, sequelae such as seizure disorders and hearing loss are common complications. The introduction of high-resolution computed tomography scans and magnetic resonance imaging and the availability of wide-spectrum antibiotics have improved our management significantly.
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Affiliation(s)
- R T Younis
- Division of Otolaryngology, Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, U.S.A.
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4
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Mitchell RB, Pereira KD, Younis RT, Lazar RH. The management of asymptomatic firearm injuries in children. J R Coll Surg Edinb 1997; 42:418-9. [PMID: 9448401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Paediatric firearm injuries in the UK are uncommon. We present two children with BB-gun pellets in the parapharyngeal space who were managed conservatively and remained asymptomatic 6 months after the gunshot injury. The management of asymptomatic firearm injuries in children is discussed and a literature review included.
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Affiliation(s)
- R B Mitchell
- Le Bonheur Childrens Medical Center, Memphis, Tennessee, USA
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5
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Abstract
Functional endoscopic sinus surgery (FESS) has become the surgical procedure of choice for the treatment of chronic sinusitis that is refractory to medical treatment. It has become routine to perform endoscopy in children under general anesthesia 2 to 3 weeks after FESS to facilitate examination and cleaning of the operative site. We compared the clinical outcome of 50 children who underwent FESS without a second-look endoscopy with 50 children who underwent a routine second look. Patients with systemic disease (cystic fibrosis, immotile ciliary syndrome, immunoglobulin deficiency) or undergoing a revision procedure were excluded from the study. The results show that the postoperative improvement in nasal obstruction, nasal drainage, and chronic cough was the same for both groups. We conclude that in the vast majority of children without systemic disease and not undergoing a revision procedure, a second endoscopic procedure may not offer any apparent advantage.
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Affiliation(s)
- R B Mitchell
- Otolaryngology Consultants of Memphis, Le Bonheur Children's Medical Center, Tennessee 38105, U.S.A
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6
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Abstract
OBJECTIVE To highlight the incidence of subglottic stenosis (SGS) as a complication of surgery for congenital heart disease and the role of single-stage laryngotracheoplasty in treating this complication. DESIGN Retrospective case series. SETTING University-based referral center specializing in surgery for congenital heart disease and complex airway problem management. INTERVENTION Laryngotracheal reconstruction (LTR). MAIN OUTCOME MEASURE Successful airway expansion. RESULTS At last follow-up, 87.5% (7 of 8) of patients remain free of obstructive airway symptoms. CONCLUSION SGS can complicate surgery for congenital heart disease in children. Single-stage LTR is an effective treatment modality for this problem.
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Affiliation(s)
- K D Pereira
- Otolaryngology Consultants of Memphis, Tenn., USA
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7
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Friedman NR, Mitchell RB, Pereira KD, Younis RT, Lazar RH. Peritonsillar abscess in early childhood. Presentation and management. Arch Otolaryngol Head Neck Surg 1997; 123:630-2. [PMID: 9193226 DOI: 10.1001/archotol.1997.01900060072013] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To highlight the modes of presentation and management of a peritonsillar abscess in children younger than 5 years. DESIGN Retrospective case series. SETTING Tertiary referral pediatric otolaryngology practice. PATIENTS Seven children younger than 5 years. RESULTS The mean age of the children studied was 27 months (age range, 7-41 months). Five (71%) of the 7 patients underwent computed tomographic scanning to confirm the diagnosis. Pus was cultured at surgery in every case. The most common organism detected was Streptococcus viridans. The average hospital stay was 72 hours (range, 22 hours to 12 days). After diagnosis of an abscess, all patients underwent an electrocautery tonsillectomy and had an uneventful recovery. CONCLUSIONS Children younger than 5 years who present with poor oral intake, high fever, drooling, and trismus should be suspected of having a peritonsillar abscess. A computed tomographic scan of the neck is usually required to confirm a suspected diagnosis. Prompt diagnosis and treatment will lead to a considerable decrease in morbidity. Immediate tonsillectomy is a safe and effective means of abscess drainage.
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Affiliation(s)
- N R Friedman
- Le Bonheur Children's Medical Center, Memphis, Tenn, USA
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8
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Abstract
Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children, and although a variety of stents have been described, the practice of prolonged stenting continues to diminish. We describe 21 pediatric patients with moderate-to-severe subglottic or tracheal stenosis who had laryngotracheal reconstructions with anterior rib cartilage grafts without stenting or intubation. The patients were between 6 months and 7 years of age at the time of surgery. All patients were extubated in the operating room after the procedure was terminated. One patient required reintubation in the intensive care unit for 48 hours after surgery, and another patient required a tracheotomy. Wound infection occurred in one patient. Most patients were discharged to their homes 3 to 5 days after surgery. We report the indications, technique, results, and complications of laryngotracheal reconstruction using a rib graft without stenting.
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Affiliation(s)
- R T Younis
- Department of Pediatric Otolaryngology, Yale University Medical Center, New Haven, Connecticut, USA
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9
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Abstract
Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children, and although a variety of stents have been described, the practice of prolonged stenting continues to diminish. We describe 21 pediatric patients with moderate-to-severe subglottic or tracheal stenosis who had laryngotracheal reconstructions with anterior rib cartilage grafts without stenting or intubation. The patients were between 6 months and 7 years of age at the time of surgery. All patients were extubated in the operating room after the procedure was terminated. One patient required reintubation in the intensive care unit for 48 hours after surgery, and another patient required a tracheotomy. Wound infection occurred in one patient. Most patients were discharged to their homes 3 to 5 days after surgery. We report the indications, technique, results, and complications of laryngotracheal reconstruction using a rib graft without stenting.
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Affiliation(s)
- R T Younis
- Department of Pediatric Otolaryngology, Yale University Medical Center, New Haven, Connecticut, USA
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10
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Abstract
A medial subperiosteal abscess (SPA) of the orbit is the most common serious complication of sinusitis in children. The distinction between SPA and the more benign pre-septal disease is difficult to make especially in a young child in whom an ophthalmological evaluation is often difficult. Computerised tomography (CT) is the investigation of choice in making this distinction. Subperiosteal inflammatory disease of the orbit is initially treated with intravenous antibiotic therapy with surgery reserved for those patients who do not respond to medical treatment and in whom a medial SPA is confirmed by CT. Conventionally, the abscess is drained via an external incision and an ethmoidectomy is performed at the same time. More recently, successful drainage of SPA's has been accomplished endoscopically via a intranasal approach with less morbidity and superior cosmesis. We present a 5 year experience of 24 patients with CT scans suggestive of medial SPA who underwent endoscopic exploration of the medial subperiosteal orbital space. We discuss the current management of medial subperiosteal disease of the orbit in children and include a review of the literature. Also included is a clinical staging system which aids the management of orbital complications of sinusitis.
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Affiliation(s)
- K D Pereira
- Otolaryngology Consultants of Memphis, Le Bonheur Childrens Medical Center, Tennessee 38105, USA
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11
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Ruan L, Mitchell RB, Pereira KD, Younis RT, Lazar RH. Campomelic syndrome--laryngotracheomalacia treated with single-stage laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 1996; 37:277-81. [PMID: 8905462 DOI: 10.1016/0165-5876(96)01413-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The campomelic syndrome is a rare osteochondrodysplasia which frequently leads to early death from pulmonary insufficiency. We describe a patient with anatomic compromise of the upper airway due to diffuse laryngotracheomalacia and a moderate subglottic stenosis, treated successfully with single-stage laryngotracheal reconstruction using a rib graft. To our knowledge this has not been previously described. A review of the current literature is included.
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Affiliation(s)
- L Ruan
- Otolaryngology Consultants of Memphis, TN 38105, USA
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12
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Mitchell RB, Pereira KD, Younis RT, Lazar RH. Bilateral fat graft myringoplasty in children. Ear Nose Throat J 1996; 75:652, 655-6. [PMID: 8942085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The results after simultaneous bilateral fat graft myringoplasties in children have not been previously reported in the literature. We report on 28 children who underwent bilateral fat graft myringoplasties as outpatient procedures under general anesthesia. The success rate was 91% at final follow-up, with only 16% of children requiring insertion of pressure-equalizing (PE) tubes following surgery. No complications were documented. We concluded that bilateral fat graft myringoplasties are safe to perform, with an excellent success rate, and are suitable as outpatient procedures.
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Affiliation(s)
- R B Mitchell
- LeBonheur Childrens Medical Center, Memphis, Tennessee 38105, USA
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13
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Abstract
Functional endonasal sinus surgery (FESS) is widely used in the treatment of chronic sinusitis in adults and children. Although success rates of 80% to 93% have been reported, no criteria for success or improvement have been suggested. Standardized measures are needed to assess the outcome of FESS and to compare the results obtained by different surgical teams and for various patient groups. After reviewing the charts of 500 pediatric patients who underwent FESS between July 1987 and June 1992, the authors of this study formalized criteria for assessing the outcome of surgery.
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Affiliation(s)
- R T Younis
- Pediatric Otolaryngology Fellowship Training Program, LeBonheur Children's Medical Center, Memphis, Tenn. 38105, USA
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14
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Abstract
Toxic shock syndrome (TSS) is an uncommon, severe, multisystem illness that may follow any surgical procedure. It usually occurs in the immediate postoperative period and is manifested by the sudden onset of a high fever and a variety of other signs and symptoms. The reported incidence of TSS after nasal surgery is 16 cases per 100,000 patients. We report five unusual cases of delayed TSS that occurred after functional endonasal sinus surgery in which no packing was used. Toxic shock syndrome developed in three children and two adults 5 days to 5 weeks postoperatively. All patients were treated successfully with no sequelae. The pathophysiologic features, clinical manifestations, and treatment of TSS are described in detail.
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Affiliation(s)
- R T Younis
- Yale University Medical Center, New Haven, Conn, USA
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15
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Abstract
OBJECTIVE Choanal atresia, consisting of a unilateral or bilateral bony or membranous septum between the nose and the pharynx, occurs in approximately one of 7000 live births. Conventional treatment has consisted of watchful observation and elective surgical repair or immediate intervention using a variety of surgical techniques. We attempted transnasal repair using a telescope to remedy the obstruction. PATIENTS Over an 18-month period, six female and four male patients, who were between 3 weeks and 14 years of age at the time of surgery, underwent transnasal repair of unilateral or bilateral choanal atresia with the aid of a rod-lens telescope. All 10 patients had nasal stents made from endotracheal tubes that were fixed with sublabial and transseptal sutures. RESULTS Seven patients remain free of symptoms 18 to 24 months after surgery. Three patients required revision surgery. Two of the revision cases recovered completely, with no restenosis 12 months after the second surgery. There were no postoperative complications. CONCLUSION Transnasal repair of choanal atresia using a rod-lens telescope appears to be an effective procedure with low morbidity.
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Affiliation(s)
- R H Lazar
- LeBonheur Children's Medical Center, Memphis, Tenn, USA
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16
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Willner A, Lazar RH, Younis RT, Beckford NS. Sinusitis in children: current management. Ear Nose Throat J 1994; 73:485-91. [PMID: 8082603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- A Willner
- LeBonheur Children's Medical Center, Memphis, TN 39105
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17
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Abstract
Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic and recurrent sinusitis in adults and children. Retrospective analysis of the charts of 513 adult and 260 pediatric patients who underwent FESS after failing to respond to optimal medical treatment revealed an improvement rate of approximately 80% for both age groups. Although high response rates and low complication rates were found for both groups, there were significant differences in indications, preoperative evaluation, operative technique, and methods of postoperative follow-up for children.
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Affiliation(s)
- R H Lazar
- Department of Otolaryngology, Le Bonheur Children's Medical Center, Memphis, TN
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18
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Lazar RH, Younis RT, Kluka EA, Joyner RE, Storgion S. Granular cell tumor of the larynx: report of two pediatric cases. Ear Nose Throat J 1992; 71:440-3. [PMID: 1425384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Granular cell tumors are uncommon neoplasms of the head and neck that usually involve the tongue. The larynx is an atypical site of involvement in adults and a rare site in children. We report two cases of subglottic granular cell tumors, one in a 10-year-old boy and the other in a 6-year-old girl. Although both were initially misdiagnosed as having asthma, radiologic, laryngoscopic, and histologic evaluation of the obstructions eventually furnished the correct diagnosis. The patients were successfully treated by surgical excision of their subglottic masses. The history, presentation, pathologic findings, management, and prognosis of this rare pediatric laryngeal tumor are explored.
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Affiliation(s)
- R H Lazar
- Otolaryngology Consultants of Memphis, TN 38120
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19
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Lazar RH, Younis RT, Parvey LS. Comparison of plain radiographs, coronal CT, and intraoperative findings in children with chronic sinusitis. Otolaryngol Head Neck Surg 1992; 107:29-34. [PMID: 1528599 DOI: 10.1177/019459989210700105] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Evaluating the extent of chronic sinusitis in children is critical in management of the disease and determination of the need for surgery. High-resolution computed tomography can demonstrate disease that is not shown on routine x-ray films. It can also delineate pathologic variations and demonstrate inaccessible anatomic structures. We compared plain radiographs, CT scans, and intraoperative findings for 300 pediatric patients with chronic or recurrent sinusitis. Despite an imperfect record in demonstration of sinus disease in all of our patients, computed tomography was unquestionably better than plain radiography in diagnosis of chronic sinusitis and evaluation of the need for surgery. Despite its superior performance, CT should not be used exclusively to diagnose disease or propose surgery. These determinations must be made on the basis of a combination of the patient's symptoms, physical examination findings, and CT results.
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Affiliation(s)
- R H Lazar
- Department of Pediatric Otolaryngology, Le Bonheur Children's Medical Center, Memphis, TN
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20
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Lazar RH, Younis RT, Long TE, Gross CW. Revision functional endonasal sinus surgery. Ear Nose Throat J 1992; 71:131-3. [PMID: 1572271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Revision functional endonasal sinus surgery (FESS) is recommended for patients whose symptoms of chronic or recurrent sinusitis persist despite primary FESS, long-term maximal medical therapy, and no sign of other abnormalities as demonstrated by computed tomography. After analyzing the charts of 673 patients who underwent primary FESS, we reviewed the 63 cases of revision surgery performed between 1986 and 1989. This retrospective analysis presents the management and outcome of 16 children (less than 16 years) and 47 adults who had revision FESS. The overall success rate of revision FESS was 78%, with no major complications, reflecting the improved management of sinus disease offered by this procedure.
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Affiliation(s)
- R H Lazar
- Le Bonheur Children's Medical Center, Memphis, Tennessee
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21
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Abstract
Functional endonasal sinus surgery (FESS) is an effective treatment for chronic or recurrent sinusitis in children, most of whom have failed more conservative medical treatment. The endoscopes used in FESS allow direct visualization of the diseased tissue and restoration of physiologic mucociliary clearance, enabling the sinus mucosa to return to its normal condition after the procedure. For a period of 3 to 36 months, we followed the recovery of 210 children who underwent FESS between 1986 and 1989. The age range of the children at the time of the procedure was 14 months to 16 years. Eighty percent of these patients had improvement of their sinusitis. There were no major complications. Eight percent of the 210 children needed revision surgery. Pediatric FESS is a two-stage operation requiring follow-up nasal cleaning under general anesthesia. The most common findings during the second-stage endoscopy were adhesions and granulation formation.
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Affiliation(s)
- R H Lazar
- Department of Pediatric Otolaryngology, Le Bonheur Children's Medical Center, Memphis, Tennessee 38103
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22
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Younis RT, Lazar RH, Long TE. Ventilation tubes and prophylactic antibiotic eardrops. Otolaryngol Head Neck Surg 1992; 106:193-5. [PMID: 1738553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Insertion of ventilation tubes has successfully remedied chronic otitis media with effusion in millions of children, but the procedure has been complicated by secondary infections and otorrhea in as many as 34% of the cases. Because infection at the time of surgery was suspected as the primary cause of these postoperative complications, short-term prophylaxis with antibiotic eardrops was proposed for averting secondary infections. To evaluate this hypothesis, we conducted a 6-month prospective study in which 200 children had bilateral tube insertions. Antibiotic eardrops were administered to patients' right ears intraoperatively and for 3 days after surgery; left ears received no eardrops and served as controls. The prophylactic strategy did not significantly decrease the incidence of postoperative otorrhea in treated right ears compared with controls.
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Affiliation(s)
- R T Younis
- Department of Otolaryngology, Head and Neck Surgery, Le Bonheur Children's Medical Center, Memphis, TN
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23
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Abstract
The paranasal sinuses are common sites of infection in children. The diagnosis of sinusitis may be challenging because the sinus cavities are small and variably contoured, the clinical manifestations are often nonspecific, and the radiologic findings may be equivocal. Because many local and systemic factors contribute to sinusitis in children, the therapeutic regimens vary. In addition to conventional medical approaches, new surgical procedures and improved anesthetic techniques have made functional endonasal sinus surgery an excellent management tool for selected patients with chronic or recurrent disease.
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Affiliation(s)
- R H Lazar
- Fellowship Training Program, Le Bonheur Children's Medical Center, Memphis, TN
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24
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Abstract
Schwann's cell tumors are common neoplasms arising from the neural sheath of autonomic, cranial, or peripheral nerves. We describe a case of destructive malignant schwannoma of the right ethmoid and sphenoid sinuses. The tumor was successfully treated by surgical excision, external radiotherapy, and radon seed implants. The patient remains symptom free 3 years after therapy ended, emphasizing the previously unrecognized benefits of radiotherapy for these types of tumors. The value of endoscopy in diagnosing and following schwannomas of the nasal and paranasal sinuses is highlighted in our review of the clinicopathologic features and radiologic findings of this tumor.
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Affiliation(s)
- R T Younis
- LeBonheur Children's Medical Center, Memphis, Tenn
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25
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Abstract
Toxic shock syndrome (TSS) is a serious multisystem disease that was first described in 1978 by Todd. It occurs most often in menstruating women using superabsorbent tampons. The exact pathogenesis is not well understood, but it is felt to be due to the effects of an enterotoxin produced by certain strains of Staphylococcus aureus. The reported incidence of TSS following nasal surgery is 16/100,000. We report a case of TSS following endonasal sinus surgery in which minimal packing was used. The nasal surgeon should be aware of this rare and possibly fatal entity, as TSS may occur following any nasal/sinus surgery, even where packing is minimal and of short duration and when the patient is receiving antibiotic therapy.
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Affiliation(s)
- R T Younis
- Department of Pediatric Otolaryngology, LeBonheur Children's Medical Center, Memphis, Tennessee
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26
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Abstract
Bronchogenic cyst of the mediastinum, a cause of stridor in the neonate, is one of a group of congenital lesions of the mediastinum that results from abnormal budding of the ventral segment of the primitive foregut. A review of our treatment of 15 patients over 10 years at Le Bonheur Children's Medical Center is highlighted by a case report of a newborn with stridor and severe respiratory distress caused by a mediastinal bronchogenic cyst. We assess the literature on these rare but life-threatening lesions, and discuss the embryology, diagnostic work-up, and treatment, emphasizing the roles of different radiologic modalities in evaluating patients.
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Affiliation(s)
- R H Lazar
- Department of Pediatric Otolaryngology, Le Bonheur Children's Medical Center, Memphis, TN
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27
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Gurucharri MJ, Lazar RH, Younis RT. Current management and treatment of complications of sinusitis in children. Ear Nose Throat J 1991; 70:107-12. [PMID: 2044473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This paper has been a brief review of complications present in pediatric sinus disease. Complications of sinus disease are rare in the community setting, so that the clinician must be alert to the possibilities of serious disease accompanying sinus infection.
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Affiliation(s)
- M J Gurucharri
- Ear, Nose and Throat Associates of Manattee, Bradenton, FL 34209
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28
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Lew KM, Younis RT, Lazar RH. The current management of sialorrhea. Ear Nose Throat J 1991; 70:99-105. [PMID: 2044481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- K M Lew
- LeBonheur Children's Medical Center, Memphis, TN
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Younis RT, Lazar RH. The approach to acute and chronic sinusitis in children. Ear Nose Throat J 1991; 70:35-9. [PMID: 2065617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- R T Younis
- LeBonheur Children's Medical Center, Memphis, Tennessee
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