JAMA Otolaryngology–Head & Neck Surgery: Pediatric Otolaryngology Topic Collection

Conservative Management of Iatrogenic Membranous Tracheal Wall Injury A Discussion of 2 Successful Pediatric Cases Tracheal Injuries in Pediatric Patients

Cunningham LC, Jatana KR, Grischkan JM. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Management of pediatric tracheal injuries is a controversial topic not well documented in the otolaryngology literature.

Objectives

To present our case outcomes in 2 pediatric patients with tracheal injury and to review the literature on surgical vs conservative management of tracheal injuries in the pediatric age group.

Design

Case series and literature review.

Setting

Tertiary referral pediatric hospital.

Main Outcome Measures

Morbidity and mortality outcomes.

Results

The 2 tracheal injuries in the case studies were successfully managed with intubation, antibiotics, and careful monitoring without morbidity related to the tracheal injury.

Conclusions and Relevance

A high level of clinical suspicion is necessary for the diagnosis of tracheal injuries. Both conservatively and surgically managed patients require serial chest and lateral neck plain radiographs to follow resolution of pneumomediastinum and pneumothorax. Both require surveillance of the airway with operative laryngoscopy and bronchoscopy, in addition to long-term follow-up. Surgical repair of trachea rupture, although resulting in shorter intubation, may require tracheotomy. Promising results have been reported in the literature for conservative management with a relatively small risk of airway stenosis without the complications associated with intrathoracic repair. Conservative management should be considered in the management of tracheal injuries in the pediatric population.

Three-Dimensional Direct Laryngoscopy and Bronchoscopy Enhanced Visualization of the Airway 3D Direct Laryngoscopy and Bronchoscopy

Reilly BK, Holliday MA, Rock AN, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

This is the first description of 3-dimensional (3D) pediatric airway endoscopy in the otolaryngology literature detailing the superior visualization with this technology. Ultimately, enhanced optics may further improve the treatment of airway pathology.

Objective

To report the first case series examining the use of 3D direct laryngoscopy and bronchoscopy (DLB) in the diagnosis and management of laryngotracheal pathology.

Design

Case series.

Setting

Tertiary care pediatric hospital.

Participants

Three patients underwent both telescopic 2-dimensional (2D) and 3D DLB for comparison purposes: a 12-year-old boy for visualization of complete tracheal rings, a 23-year-old man for dilation of tracheal stenosis, and a 4-month-old boy for resection of subglottic cysts.

Main Outcome Measures

Enhanced visualization of laryngotracheal pathology and facilitated endoscopic surgery.

Results

To our knowledge, this is the first case series in the otolaryngology literature examining the use of 3D DLB for the resection of subglottic cysts, dilation of tracheal stenosis, and visualization of complete tracheal rings. We believe that the 3D view offers qualitatively improved depth perception, accuracy of balloon placement, and appraisal of subglottic cyst resection margins.

Conclusions and Relevance

This emerging technology has vast potential for improving endoscopy, surgical precision in airway interventions, tissue preservation, and methods of teaching. More research is needed in this area regarding the benefits and advantages of 3D compared with 2D endoscopy.

Radiology Quiz Case 1

Gilbert JW, Kalra VB, Malhotra A. — Mon, 01 Apr 2013 00:00:00 GMT

A 7-year-old girl presented with recurrent episodes of painful swelling below the left ear and no history of fever, malaise, or other symptoms. All of her prior episodes were self-limited and of similar severity. She was asymptomatic between episodes. There was no other relevant medical or dental history. The patient was up to date on all vaccinations. The physical examination revealed tenderness to palpation below the left mastoid tip without appreciation of a focal mass. The remainder of the examination was unremarkable.

Radiology Quiz Case 1: Diagnosis

Mon, 01 Apr 2013 00:00:00 GMT

Diagnosis: Juvenile recurrent parotitis (JRP).

Radiology Quiz Case 2

Oakley GM, Wiggins RH, Error ME, et al. — Mon, 01 Apr 2013 00:00:00 GMT

A 14-year-old girl presented to the emergency department with an 8-day history of worsening headache and right-sided nasal obstruction. She complained of pain and pressure localized primarily over the right periorbital and temporal region. She reported mild puffiness in the region and associated nausea but denied blurry or double vision, fevers, chills, or epistaxis. Her medical history was significant for type 1 diabetes mellitus, attention-deficit/hyperactivity disorder, and migraine headaches, which are characterized by nonfocal pain lasting no more than 2 days.