An infant with a giant cystic lymphangioma of the neck underwent tracheotomy and conservative resections after repetitive intracystic injections of OK-432. Surgery dramatically improved both respiration and swallowing, and OK-432 injections were effective as preliminary chemotherapy. Vocalization was partly impaired by the use of a tracheostomy cannula. However, this had little effect on speech development, which enabled common communication at a primary school from the age of six to ten. The course of upper airway management was good, but unfortunately, the patient died of streptococcal toxic shock syndrome (STSS) caused by group A streptococcal infection at the age of eleven.
Introduction: Neonates and Infants with congenital cysts at the tongue base frequently show upper airway obstruction. We report five cases of cysts at the tongue base. Subjects: Five children (three males and two females) who visited our department for a cyst at the tongue base in the period from April 2000 to August 2004. Results: Their chief complaints were stridor, dyspnea, and vomiting. Three children showed their respective symptoms at one month after birth, one at two months and one at three years. We performed laryngoscopic surgery to open the cystic wall in all cases. In two cases, the histopathology of the resected specimen confirmed the diagnosis of a thyroglossal duct cyst. No recurrence has been observed. Conclusion: Laryngoscopy, lateral neck X-ray film, CT, MRI and ultrasonography were especially useful for the diagnosis of this case.
A piriform sinus fistula is not usually present during the newborn period. We report a case of piriform sinus fistula causing a life-threatening respiratory obstruction in the period immediately after birth. Radiographs and computed tomography (CT) showed an air-containing retropharyngeal cyst. Cystostomy was carried out because the upper respiratory obstruction had worsened. We diagnosed a piriform sinus fistula using a laryngeal fiberscope and coloring matter. Moreover, threedimensional CT was contributory to the diagnosis. Finally, total resection of the cyst was conducted and the patient left our hospital without any obvious complications.
We investigated sixty-two children with stridor who visited us from July,2002 through June,2004. The diseases causing stridor were aryngomalacia with the highest rate of 40%, followed by vocal cord palsy (23%), and stricture below the vocal cords (13%). Congenital disease causing stridor accounted for 79% and acquired disease for 21% of cases. Some 95% of children aged less than one year were affected with congenital disorders such as laryngomalacia. The older the patient, the more frequently he/she appeared to be affected with acquired diseases such as inflammation, tonsillar hypertrophy, and foreign body aspiration.
We often experience respiratory tract injury resulting from the inhalation of hot air and toxins. However, it is rare to encounter patients whose upper airway is compromised after the aspiration of caustic substances or hot beverages. We report two cases of laryngeal edema after accidental ingestion of caustic substances and hot milk. Both cases were saved by emergency airway intervention. Case 1 was a two-year-old boy who ingested caustic substances accidentally. He had a markedly enlarged epiglottis on arrival at the ER. Case 2 was a two-year-old boy who had swallowed near-boiling milk. Nine hours later, his epiglottis had become swollen.
We report two infant patients with endotracheal granulation. In Case 1 (6 month-old-boy), granulation developed after tracheotomy in the tracheal wall where the proximal top of the canula was situated. A specifically produced canula was useful for controlling the safety of respiration. Case 2 (5 month-old-boy) was orally intubated because of RDS immediately after birth. Bacterial tracheitis was caused by MRSA infection. There was severe granulation from the subglottic area to the 4th tracheal ring at least. Though he has survived to 8 years of age, tracheomalacia can be observed under the area of the tracheotomy pore.
Forty-three patients under 15 years of age underwent tracheotomy in the 15-year period from 1989 to 2004. Forty-one cases received intratracheal intubation before the tracheostomy. Thirty-six casesr eceivedv ertical skin incisions. A seriousc annulaa ccident occurred in 4 cases. I t wasp ossible to close the tracheostoma in 12 of 29 surviving cases, but not in 15 cases. Two remaining cases required a small tracheal fistula. Eight cases died from the primary disease or the complication. Nonclosed cases require control of the tracheostomy aperture on an average of 7 times per year, and it is thought that accidental prevention is important.
We report three representative infants with severe sensori-neural hearing loss who underwent auditory steady-state response (ASSR) and conditioned orientation reflex audiometry (COR). The differences in thresholds between ASSR and COR were only 5 to 15 dB. The results of our experiments showed that ASSR was useful for cases with high frequency hearing loss and differences in thresholds between the right and left ears. Though ASSR is a time-consuming procedure, its frequencyspecific hearing assessment is useful for determining the hearing aid volume and confirming whether or not a cochlear implantation should be performed.
A child is not a small adult. The characteristic feature of pediatric diagnostic imaging has growth and development. And pediatric head and neck pathologies depend on the age. The pathologic processes of the pediatric head and neck can be classified as congenital, inflammatory, benign and malignant tumors, and traumatic lesions. Diagnostic imaging of head and neck lesions includes plain radiography, ultrasound, CT, MRI, and nuclear medicine. CT and MRI are useful in the evaluation of anatomies. Recently, CT and MRI is increased for pediatric patients. On the other hand, it is important to familiar with the radiographic change of normal growth and development, in order to diagnosis head and neck lesions. Diagnostic imaging is considered to be played efficiency and to be in offering the information which is useful to medical examination. In this presentation, we review the imaging of normal development and the imaging features of pediatric head and neck pathologies.
We proposed a concept model for the pathogenesis of obstructive sleep apnea syndrome (OSAS) in children. This concept model consists of three circles: adenotonsillar hypertrophy, obese and complex high risk. Each patient's severity and treatment efficacy depend on the combination area to which the patient belongs in this concept model. Overnight polysomnography (PSG) is recognized as the gold standard, but is not easy to perform in every institution for all OSAS-suspected children. PSG is recommended especially for children with problem behaviors suggestive of attention-deficit/hyperactivity disorder, mild-moderate OSAS for determining surgical indications, postoperative snoring children, and children with high-risk complications for the detection of central apnea hypopnea or central hypoventilation syndrome.