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Endoscopic sinus surgery has become an accepted method of treating chronic sinusitis in children. It has been shown to be a safe and well-tolerated procedure. The results of endoscopic sinus surgery from multiple institutions has shown approximately 85% efficacy, and there is now evidence that facial growth is not affected. Endoscopic sinus surgery is described in detail in this report.
Vocal fold medialization for unilateral vocal fold paralysis in appropriately selected children is possible. Indications include persistent dysphonia or aspiration. Techniques for medialization in adults are not uniformly transferable to pediatric cases. Successful surgical implementation requires knowledge of evolving laryngeal anatomy and ability to adapt an operation to the anatomy of the individual...
Medial subperiosteal orbital abscess is the most common suppurative complication of sinusitis. Small abscesses, especially in young children, may respond to therapy with intravenous antibiotics. Surgical drainage is indicated for large obscesses or for failure to respond to medical management. Traditionally, external ethmoidectomy approaches have been used to gain access to the medial orbital subperiosteal...
Hemangiomas are the most common tumors of infancy; they occur in up to 10% of Caucasian births and are only slightly less common in African Americans. Previous complacency in the treatment of hemangiomas is changing to a more proactive approach. We review our approach to hemangiomas of the head and neck with emphasis on the timing of surgery and the surgical approaches to correction of these often...
Significant postoperative pain and discomfort continues to be associated with a tonsillectomy procedure. Various instruments have been used over the years, but in an attempt to simplify the surgical procedure and minimize the postoperative morbidity, the ultrasonic (harmonic) scalpel uses high frequency piezoelectric technology to create intracellular pressure waves that lyse cellular connections...
Rigid external distraction is a very powerful technique for reconstruction of patients with both congenital and acquired severe caraniomaxillofacial disorders. Patients with extensive bone loss or dysgenesis in the facial skeleton traditionally challenged our standard reconstructive procedures. Distraction osteogenesis through rigid external distraction now allows positioning of displaced and hypoplastic...
Otitis media is one of the most common medical conditions treated by physicians in the United States, especially in children. Antibiotics have been a mainstay of treatment for this condition for decades. However, in recent years, with the evolution of antibiotic-resistant organisms and increased costs of prescription drugs, alternative therapies have been sought. Surgical techniques, most often tympanostomy...
The principles of diagnosis and management of airway foreign body aspiration has not changed since the days of Chevalier Jackson. History and physical examination continue to be the most important aspects in diagnosis and management. The development of optical endoscopic equipment and advances in anesthesia has made the treatment safer. This report will discuss the initial evaluation and methods in...
Treatment of subglottic hemangiomas lacks a standard treatment algorithm defining the role and proper place for the multiple medical and surgical therapeutic alternatives. Open excision of subglottic hemangiomas represents an emerging operative technique with the advantage of being a single-stage procedure with limited morbidity that, at the same time, avoids the potential complications of long-term...
The potential for severe distortion of the normal anatomy makes the repair of aural atresia technically difficult and risky. However, there is a good success rate and low rate of complications in selected patients. The ideal candidate for surgical repair has an isolated atresia with a well-developed atresia plate, a well-developed middle ear, ossicles, facial nerve, and mastoid, and no other severe...
Lymphatic malformations are usually congenital in origin and often arise in the head and neck region. The size of lymphatic malformations varies markedly and treatment is tailored ascending to the degree of function and cosmetic compromise. Current common treatment options include observation, sclerosant therapy, somnoplasty, laser reduction/excision, and surgical removal. The classification, clinical...
The recent use of powered microdebriders in laryngeal surgery has significantly altered the surgical management of supraglottic lesions. We have successfully used these microresectors to treat more than 40 pediatric patients with respiratory papillomas, vocal cord lesions, or vallecular disease. Before positioning the patient with the Lewy suspension system (Pilling, Fort Washington, PA), direct laryngoscopy...
Recurrent respiratory papillomatosis (RRP) remains a difficult and challenging disease to treat. Cidofovir, when administered intralesionally for severe RRP, has shown effective control in early trials. Appropriate patient selection and technique of administration will be reviewed.
Preauricular cysts and sinuses occur commonly in children; they are congenital anomalies resulting from faulty resorption of the first and second branchial arch hillocks. The diagnosis is straightforward in most instances. When surgery is indicated, complete excision is required to prevent recurrence. Identification of the entire lesion may be difficult because of previous infections, their tendency...
The purpose of this report is to present the application of distraction osteogenesis (DO) to the correction of mandibular deformities. DO is a technique used to lengthen bones after a cut is made within the bone and the segments are gradually separated, creating new bone between them. Elongation of the mandible improves the deficient bone structure as well as the surrounding soft tissues, including...
Although topical Mitomycin C has been used for more than 20 years, it is a relative newcomer to the field of otolaryngology. This intraoperative therapy is the first of its kind to offer surgeons the ability to modify the healing response at the molecular level. To understand mitomycin's use and applications, it is important to review both the evolution of this drug in our field and the rapidly changing...
Sialorrhea is a common and potentially debilitating problem that may arise in children with neurologic disorders, such as cerebral palsy. Excessive drooling may lead to serious quality of life problems in addition to serious life-threatening problems, ie, recurrent pneumonitis, secondary to aspiration of secretions. Numerous medical and surgical procedures have been proposed for the treatment of this...
Congenital abnormalities of the auricle span a spectrum of abnormalities from total anotia to slight asymmetries of an otherwise normal appearing ear. This article is dedicated to the management of the prominent, or protruding ear. A number of well-known surgical techniques have been described for the correction of the protruding ear. The ideal set of techniques must accomplish several goals. The...
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