National trends in tongue reduction surgery for macroglossia in children

OBJECTIVES

To examine the frequency of partial glossectomy performed for the indication of macroglossia in children within the United States, assessing for differences in rates of intervention across various demographics. To identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay and cost of admission following tongue reduction surgery.

STUDY DESIGN

Retrospective cross-sectional study.

SETTING

The Kids' Inpatient Database 2003, 2006, 2009, and 2012.

SUBJECTS

Patients under age 5 diagnosed with macroglossia who underwent partial glossectomy.

METHODS

Demographics were analyzed and cross tabulations, linear regression modeling, and multivariate analysis were performed.

RESULTS

During the four-years studied, partial glossectomy was performed in 196 children under age 5 with macroglossia. A disproportionately higher rate of intervention was seen in white children (p = 0.001), patients undergoing surgery in the mid-west (p < 0.001) and patients in the highest socioeconomic quartile (p = 0.015). Most patients underwent glossectomy in their second year of life. The average length of stay in patients who underwent partial glossectomy for macroglossia was 9.59 days (Range 1-211 days, median 3.45 days) and the average cost was $56,602 (median $16,330).

CONCLUSION

Partial glossectomy for macroglossia is typically performed prior to age 2 in the United States. A higher rate of intervention is seen in white children, those who have surgery in the mid-west and affluent children even when controlling for confounding variables.

LEVEL OF EVIDENCE

III.

Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction

OBJECTIVES

To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents' and surgeons' ratings of post-reduction nasal symmetry.

METHODS

Case series and chart review within an urban, tertiary pediatric otolaryngology practice.

RESULTS

100 cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks-18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%) and alcohol-related (2%). Of these 100 cases, 22% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 21 of 22 post-reduction patients were assessed for nasal symmetry at the postoperative visit (7-10 days following surgery). The operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) satisfied in 81% of cases. Both parent and surgeon were satisfied with post-reduction symmetry 33% of the time.

CONCLUSION

The most common sources of traumatic nasal deformity in children and adolescents vary by age. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases, however a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only one-third of cases.

Neonatal Macroglossia: Demographics, Cost of Care, and Associated Comorbidities

Objectives:

(1) Examine the birth prevalence of macroglossia, assessing for differences across sex, race, socioeconomic status, and geographic location. (2) Identify comorbidities associated with isolated and syndromic forms of macroglossia and determine how such factors may influence length of stay (LOS) and cost of admission.

Methods:

Retrospective cross-sectional study using the 2006 and 2009 Kids’ Inpatient Databases (KID).

Results:

The national birth prevalence of macroglossia was 3.4 out of 10,000 births (n = 556) with a higher rate in females (3.9/10,000, P = .001) and blacks (4.5/10,000, P = .01). Patients were classified as isolated (n = 423, 76%) or syndromic (n = 133, 24%) based on associated diagnoses. Syndromic cases were more prevalent in the West ( P = .01). LOS and cost were increased in the syndromic group (26.2 days vs 4.8 days, P < .01; $30.1k vs $3.9k, P < .01), while LOS and cost for isolated macroglossia were similar to the general population. The rate of concurrent cardiac anomalies, cleft palate, and Down syndrome was increased in patients with macroglossia compared to unaffected newborns ( P < .01). Rates of respiratory distress, feeding problems, GERD, endotracheal intubation, and prolonged ventilator support were higher in the syndromic group ( P < .01). Newborns with isolated macroglossia suffered these conditions at the same rate as the general population.

Conclusions:

The birth prevalence of macroglossia varies by sex, race, and geographic location. Prolonged LOS and increased cost are associated with syndromic forms of macroglossia. Syndromic comorbidities rather than enlargement of the tongue in and of itself appear to be the chief contributors to increased LOS and cost in this population.

National Trends in Tongue Reduction Surgery for Macroglossia in Children

Objectives:

(1) Examine the frequency of partial glossectomy performed for the indication of macroglossia in the United States, assessing for any differences in rates of intervention across various demographics. (2) Identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay (LOS) and cost of admission following tongue reduction surgery.

Methods:

Retrospective cross-sectional study using the 2006 and 2009 KidsTM Inpatient Databases (KID). During the 2-year study period, partial glossectomy was performed in 80 children under 5 years with macroglossia.

Results:

A disproportionately higher rate of intervention was seen in whites ( P = .001) and patients in the highest socioeconomic quartile ( P = .007). Conversely, a lower rate of intervention was observed in black children ( P = .011). The average age at the time of partial glossectomy was 23 months (mode, 12 months). Patients were classified as isolated (n = 16, 20%) or syndromic macroglossia (n = 64, 80%) based on associated diagnoses. The average length of stay after partial glossectomy for macroglossia ranged from 5 to 11 days. Differences in LOS (mean, 9.5 days) and cost (mean, $9.8k) between isolated and syndromic macroglossia groups were not significant.

Conclusions:

Partial glossectomy for macroglossia is typically performed prior to age 2 years in the United States. Syndromic comorbidities do not seem to contribute to increased LOS or cost of admission. White children and affluent children appear to be undergoing partial glossectomy at a higher rate than their peers.

Predicting Surgical Intervention for Airway Obstruction in Micrognathic Infants

Objective

To determine which factors present in the neonatal period may predict subsequent need for surgical intervention in infants with micrognathia.

Study Design

Case series with chart review.

Setting

Two, urban, tertiary pediatric hospitals.

Subjects and Methods

The otolaryngology databases from 2 institutions were queried for the diagnosis of micrognathia over a 10-year period, and 123 infants were identified (101 with Pierre Robin sequence and 21 with micrognathia without cleft palate). The presence or absence of surgical airway intervention during the first year of life was noted, as were associated diagnoses. Univariate and multivariate analyses were performed to identify risk factors for requiring a definitive airway intervention.

Results

Forty-eight (39%) micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of either tracheostomy (12 patients), mandibular distraction osteogenesis (MDO; 33 patients) or prolonged intubation prior to death (3 patients). Factors associated with a need for intervention included a history of intubation or tracheotomy in the first 24 hours of life (odds ratio [OR], 8.22; confidence interval [CI], 3.14-21.53), a history of intrauterine growth restriction (OR, 4.10; CI, 1.00-16.70), prematurity (<37 weeks of gestational age; OR, 2.38; CI, 1.02-5.56), and neurologic impairment (OR, 3.83; CI, 1.33-11.07). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR, 0.20; CI, 0.05-0.71).

Conclusions

While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors that may predict which neonates with micrognathia are at increased risk for meriting early surgical intervention for respiratory and feeding problems.

Predicting Surgical Intervention in Micrognathic Infants

Objective: To determine which factors in the early neonatal period may predict subsequent need for surgical intervention in infants with micrognathia.

Method: A retrospective case series of 123 infants from 2 tertiary pediatric referral centers over a 10-year period.

Results: Forty-eight (39%) of micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of tracheostomy (n = 12), mandibular distraction osteogenesis (MDO) (n = 33), or prolonged intubation prior to withdrawal of care (n = 3). Factors associated with a need for definitive airway intervention included a history of intubation or tracheotomy in the first 24 hours of life (OR: 8.22; CI: 3.14-21.54), a history of intrauterine growth restriction (OR: 4.1; CI: 1.00-16.71), neurologic impairment (OR: 3.83; CI: 1.33-11.06), and prematurity (<37 weeks gestational age) (OR: 2.38; CI: 1.02-5.56). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR: 0.2; CI: 0.05-0.71).

Conclusion: While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors, which may predict which neonates with micrognathia are at increased risk for requiring early surgical intervention for respiratory and feeding problems.

Weight Changes Immediately following Tonsillectomy

Objective: To evaluate weight change in the pediatric population after tonsillectomy and identify associated risk factors for weight loss.

Method: A retrospective medical record review of all patients 12 years of age and younger who underwent tonsillectomy at a tertiary care center from January 2008 to November 2011 was conducted. Patient characteristics, preoperative and postoperative weight, indication for surgery, surgical technique, and perioperative complications were recorded.

Results: In total, 152 patients met inclusion criteria based on complete medical records and postoperative follow-up. Weight was recorded preoperatively (mean of 30 days prior to surgery) and between 2 and 6 weeks postoperatively (mean of 24 days) using the same clinic scale. There was a total of 95 (62.5%) patients with ages ranging from 0 to 5 years (group A) and patients with ages ranging from 57 (37.5%) 6 to 12 years (group B). Regression analysis estimated the mean and distribution for weight change in each age group. At 21 days postoperatively, groups A and B experienced percentage weight changes of 1.7% and −1.2%, respectively ( P < .03).

Conclusion: Immediately following tonsillectomy, pediatric patients experience varying degrees of weight loss. This depends primarily upon age but may be mitigated by other factors. Patients age 6 years and above have predicted weight loss in the immediate postoperative setting, while younger children maintain or surpass their preoperative weight by the 21-day interval.