Eighty pediatric patients with head and neck tumors treated at our department over the 10-year period from 1987 to 1996, were reviewed. The subjects included 33 males and 47 females. The age at the first visit to our department ranged from 2 days to 15 years 3 months, with a mean of 3 years. The most common head and neck tumor in children was hemangioma (31 cases), followed by lymphangioma (17), malignant tumor (8), hamartoma (6), pleomorphic adenoma (3), laryngeal papilloma (3), tongue papilloma (3) and fibromatosis (2). We also had one case each of calcifying epithelioma, angiofibroma, histiocytosis X, glioma, neurilemmoma, osteoma and teratoma. The 8malignant tumors consisted of 4 rhabdomyosarcomas,2 metastatic neuroblastomas,1 metastatic congenital leukemia lesion and 1 mucoepidermoid carcinoma of the larynx. Among the children with hemangiomas, one fourth showed subglottic space involvement. Two thirds of the lymphangiomas were located in the neck region and half of the hamartomas were located in the midline of the tongue. The symptom onset for these tumors ranged from 0 days to 13 years 4 months, and nearly half of the cases had manifestations at birth. It is noteworthy that none of the patients with subglottic hemangiomas had symptoms at birth despite the congenital nature of their disorders, which did not become evident until 1-2 months of age.
A baby girl was born with inspiratory stridor and difficulty of breathing. The diagnosis of laryngeal lymphangioma mainly in the epiglottis, bilateral neck and the base of the tongue was made. She has been treated repeatedly by CO2 laser, tracheotomy and partial removal of the lymphangioma. She has survived 12 years and has grown well with proper nutritional support. At present, however, she is under observation because the lymphangioma is slowly growing and laryngoplasty is planned for the future.
A One year and 5 months-old boy with cystic lymphangioma of the neck underwent local injection of OK-432 at another hospital, and consulted our clinic one month later with the chief complaint of dyspnea due to rapid growth of the neck mass after the local injection therapy. In spite of the repeated puncture of the somewhat bloody contents measuring 60-80 ml daily, dyspnea increased, resulting in the wed for respiratory management. The CT and MRI findings before the OK-432 chemotherapy revealed a large multilocular cystic tumor occupying the right side of the neck extending to the parapharyngeal space and further to the contralateral retropharyngeal space. After the tracheostomy, extensive total extirpation was carried out by the cervical and transpalatal approaches. Advanced postinflammatory adhesion due to the OK-432 local injection rendered the separation of the cystic wall from the surrounding tissues very difficult. Both the accessory and phrenic nerves included in the tumor were sacrificed. The postoperative course was uneventful and there is no evidence of recurrence of the disease seven months postoperatively.
Four cases are presented who, after prolonged indwelling cannulation followed by tracheostomy, developed severe tracheal granulation. It is very difficult with forceps to remove tracheal granulation. An operation was performed by endoscopic KTP laser to vaporise the granulation until a lumen was established down to the tracheostomy site under general anesthesia. After KTP laser surgery we sedated the patient to avoid bronchospasm and used an artificial respirator for 4 to 12 days in the ICU. A KTP laser is indicated when the granulation is too hard to cut by forceps and granulation exist in a very narrow trachea of a child.
A case of intractable juvenile laryngo-tracheal papillomatosis is reported. A 1-year-old girl with hoarseness was referred to our hospital in May,1995. After tracheostomy, she was treated by local injection of interferon (IFN) combined with laser surgery. Recurrent growth of tracheal papillomas was rapid and widespread, and surgical removal was needed to maintain an airway. Surgical treatment was repeated 45 times in 1 year and 7 months. Even with additional systemic administration of IFN therapy, it was hard to control the papilloma. Human papillomavirus (HPV) type 6 was detected in this case. We have presented this case to seek other opinions on more effective therapy.