Pediatric Otorhinolaryngology Japan

Original Articles

Study of the force generated by the curvature and deformation of pediatric tracheostomy cannula

Takuya Ohara, Atuko Maki, Yutomo Seino, Taku Yamashita

Article type: Original Article
2017 Volume 38 Issue 1 Pages 1-7
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.1

JOURNAL FREE ACCESS

Show abstractHide abstract

The prevention of complications is an important element of pediatric tracheostomy management, and tracheostomy cannula-related complications require particular caution. Appropriate cannula selection is vital for preventing such complications. To obtain data regarding appropriate cannula selection, we experimentally investigated the characteristics of various cannulas by measuring the force generated by the contact with the cannula tip. The force generated owing to curvature was the weakest for a silicon cannula with stainless steel coil followed by silicon and polyvinylchloride cannulae. When pressure was applied perpendicular to the direction of the cannula axis, the measured force was the weakest for the silicon cannula followed by the polyvinylchloride cannula and the silicon cannula with stainless steel coil. These results suggest that for cases in which the trachea and cannula positions are likely to deviate because of factors such as excessive extension into the cervical region, the use of a silicon cannula with stainless steel coil could prevent complications. Complications might also be prevented by the use of a cannula made from silicon for cases in which the force is applied perpendicular to the cannula axis (e.g., tracheomalacia).

View full abstract

Download PDF (1167K)

Case Reports

A pediatric case of Autonomously Functioning Thyroid Nodule

Aya Iwamoto, Kazuma Sugahara, Yoshinobu Hirose, Hirotaka Hara, Makoto ...

Article type: Case Report
2017 Volume 38 Issue 1 Pages 8-13
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.8

JOURNAL FREE ACCESS

Show abstractHide abstract

An autonomously functioning thyroid nodule (AFTN) is a thyroid nodule that secretes thyroid hormones without control by thyroid-stimulating hormone. AFTN is rare in Japan, particularly among children. Here we report a case of AFTN in a 14–year-old boy with symptoms of hyperthyroidism. He was referred to our hospital for further examination of a neck swelling and hyperthyroidism. Examination revealed two thyroid nodules. A small nodule in the right lobe of the thyroid, which showed weak accumulation of Na¹²³I on thyroid scintigraphy, and a second massive nodule in the left lobe which showed strong accumulation of Na¹²³I. First, we treated the hyperthyroidism with medication. Next, we opted for surgical resection of the left lobe including the larger nodule, because that was thought to be the main cause of his symptoms. After surgery, the features of hyperthyroidism resolved and the clinical course was favorable. However, the remaining nodule in the right lobe might continue to grow and become autonomous in the future. Thus, the patient will require long-term follow-up.

View full abstract

Download PDF (7491K)
A case report of tracheoinnominate artery fistula treated successfully by endovascular embolization–with partly coil defluxion after treatment

Nozomi Takahashi, Hiroaki Mitsuzawa, Kenichi Takano, Tetsuo Himi

Article type: Case Report
2017 Volume 38 Issue 1 Pages 14-20
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.14

JOURNAL FREE ACCESS

Show abstractHide abstract

Tracheoinnominate artery fistula (TIF) is a rare but lethal complication occurring after tracheostomy or laryngotracheal separation. Although successful surgical intervention for TIF has been reported, fatal mediastinitis and severe wound infection are common post-surgical complications. Therefore, endovascular repair of TIF has been proposed as an alternative, minimally invasive procedure. We report here a 14-year-old boy with a history of meningitis-associated encephalopathy who presented with TIF 5 months after undergoing laryngotracheal separation. Following temporary control of bleeding, embolization of the innominate artery was performed with a five-piece coil. Although embolization was successful, 2 years after treatment, a piece of the coil was found to have entered the right bronchus. It was possible to remove the piece of coil using a bronchofiberscope and pliers and the subsequent postoperative follow-up was uneventful with no evidence of further bleeding. Thus, innominate artery embolization offers a valid and less invasive treatment option for TIF than open surgery. Despite this, surgeons must still be aware of its potential complications.

View full abstract

Download PDF (1545K)
The prognosis for 110 cases of pediatric tracheotomy

Nobuaki Kanemura, Tomoaki Nakano, Tunemasa Aiba, Ayako Kinosita, Go Ue ...

Article type: Case Report
2017 Volume 38 Issue 1 Pages 21-25
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.21

JOURNAL FREE ACCESS

Show abstractHide abstract

This study retrospectively examined the prognosis for 110 cases of pediatric tracheotomy at our hospital for the past 10 years from 2005 to 2014. Most of them underwent tracheotomy at the age of less than one year old. The cases underwent the surgery at 0 year old mainly contain the cases of facial malformation and cardiac disease. On the other hand, neuromuscular disease has a tendency to increase in the cases at 1year old or older. This study recognized no significant difference in survival curve with the examination of vital prognosis by age. For the examination by purpose, this study found poor prognosis in the group of respiratory care purpose. Furthermore, for the examination by primary disease, this study found poor prognosis in the case of acute encephalopathy and cerebral tumor. As the examination results, since vital prognosis may be influenced by primary disease and a time of surgery would not be prognostic factor, it was suggested that conducting a surgery at an appropriate timing would be important.

View full abstract

Download PDF (356K)
Treatment of a severe sleep apnea case with Down syndrome and high obesity

Chieko Tsubomatsu, Kenichi Takano, Tomoko Shintani, Tetsuo Himi

Article type: Case Report
2017 Volume 38 Issue 1 Pages 26-31
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.26

JOURNAL FREE ACCESS

Show abstractHide abstract

Children with Down syndrome (DS) frequently have obstructive sleep apnea (OSA) caused by upper airway obstruction because of adenoid and tonsillar hypertrophy, midfacial and maxillary hypoplasia, glossoptosis due to hypotonia and relative macroglossia, lingual tonsil hypertrophy, and obesity. Here we describe the treatment of severe OSA in a patient with DS and high obesity. The patient was a 14-year-old girl with tonsillar hypertrophy, relative macroglossia, and lingual tonsil hypertrophy. She suffered from sleep apnea and used to snore and sleeping while sitting. She had severe OSA, with an apnea?hypopnea index (AHI) of 58.1 by polysomnography (PSG) and frequent arousals, although the respiratory event index was 17.3 according to home monitoring. Initially, she was administered continuous positive airway pressure, but her treatment adherence was poor. Therefore, we performed tonsillectomy and treated with nasal high flow therapy after surgery. According to postoperative PSG, AHI was 2.9, arousals decreased, and sleep stages normalized.

View full abstract

Download PDF (3417K)
Numb chin syndrome as an initial symptom of acute lymphocytic leukemia

Naomi Imaizumi, Sei Kobayashi, Yukiko Inoue, Taisuke Nakamura, Naruo S ...

Article type: Case Report
2017 Volume 38 Issue 1 Pages 32-36
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.32

JOURNAL FREE ACCESS

Show abstractHide abstract

We encountered a patient with acute lymphocytic leukemia initially presenting as numb chin syndrome, a condition in which monoplegia of the mental nerve causes numbness, hypesthesia, and loss of sensation from the lower lip to the chin. The patient was a 14-year-old boy with pain, numbness, and anesthesia from the right lip to the lower jaw. Pain, numbness, and anesthesia were confirmed to extend from the right lip to the third branch of the trigeminal nerve, and the right palatine tonsil was also swollen. The patient did not exhibit any hematological abnormalities such as anemia, cytopenia, or blast cells, and diagnostic imaging did not reveal any abnormalities other than a swollen right palatine tonsil. Based on the results of palatine tonsil biopsy and bone-marrow aspiration, mature B-cell leukemia was diagnosed. Malignant tumor is frequently identified as the underlying cause of numb chin syndrome, which tends to be regarded lightly due to the mild nature of the symptoms. However, numb chin syndrome is clinically significant as a frequent initial symptom of malignancy. For this reason, even in the absence of symptoms suggesting acute lymphocytic leukemia such as our case, malignant tumor should be suspected in patients presenting with numbness from the lip to the lower jaw, and the underlying cause of the numbness should be investigated.

View full abstract

Download PDF (1572K)
Mite subcutaneous immunotherapy to treat allergic rhinitis with concomitant bronchial asthma

Kayoko Kawashima, Risa Terada, Keiko Onishi, Akiyuki Yamato

Article type: Case Report
2017 Volume 38 Issue 1 Pages 37-42
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.37

JOURNAL FREE ACCESS

Show abstractHide abstract

Allergic rhinitis developing in childhood typically follows a protracted course and involves the prolonged use of medication. Allergen immunotherapy has been described as having the potential to modify the natural course of allergic rhinitis and bronchial asthma. We describe the case of a child for whom mite allergen subcutaneous immunotherapy was used to treat concomitant allergic rhinitis and bronchial asthma. After therapy, improvements were seen in rhinitis symptoms and degree of impairment of daily living. Coughing also improved and peak flow rate was not decreased even after reducing the dose of medication. Allergen immunotherapy has been reported not only to improve symptoms and reduce medication usage, but also to inhibit new sensitizations and asthma onset, and should therefore be considered as a treatment option in some pediatric patients. Sublingual immunotherapy is currently not indicated in Japan for children under 12 years old, and subcutaneous delivery is the only indicated route of administration. However, subcutaneous immunotherapy can be painful and is only offered by a limited number of medical institutions, constraining the number of children that can receive this therapy. Our hope is therefore that the indications for sublingual therapy will be expanded in the future to include pediatric patients.

View full abstract

Download PDF (630K)
Long-term observation of a patient who underwent cochlear implant at the age of 13

Kiyoko Sato, Tomoko Sugiuchi

Article type: Case Report
2017 Volume 38 Issue 1 Pages 43-49
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.43

JOURNAL FREE ACCESS

Show abstractHide abstract

We report a case with severe deafness that received a cochlear implant at the age of 13. The patient had not used a hearing aid in infancy due to an extended period of otitis media. Therefore, she hadn't used a hearing aid for an extended period, but she was using one preoperatively. She was operated on at 13 years old. As a result, it became possible to hear environment sounds, but she couldn't hear speech However, in the evaluation, the parents and patient said that communication had become smooth. To evaluate a cochlear implant, it is necessary to consider various aspects of the improvement in QOL in addition to the hearing of environment sounds and speech because many factors are related to the growth of hearing-impaired children. Therefore, general support is necessary during a long-term observation.

View full abstract

Download PDF (364K)
Two cases of pediatric malignancy identified as facial palsy

Hitomi Higuchi, Takashi Nakagawa

Article type: Case Report
2017 Volume 38 Issue 1 Pages 50-55
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.50

JOURNAL FREE ACCESS

Show abstractHide abstract

Facial palsy has many causes, and precise identification of the cause is necessary for effective treatment. The causes are often congenital and associated with otitis in infants, while the incidence of Ramsay Hunt syndrome is higher in school-age children. Some patients exhibit facial palsy that is associated with minimal trauma and no bone fracture or bleeding. Idiopathic palsy (Bell's palsy) is the most frequent cause of acquired peripheral facial palsy in patients of all ages. Computed tomography and magnetic resonance imaging examinations are not actively performed for diagnosis in pediatric patients because of the practical difficulties of these techniques in children. However, it may be necessary to actively perform such diagnostic imaging examinations for patients with peripheral facial palsy complicated by other symptoms considering the potential association of these symptoms with tumorous lesions.

View full abstract

Download PDF (4999K)
An infant case of foreign body in subglottis that required a tracheotomy

Kaho Momiyama, Takuya Ohara, Atsuko Maki, Taku Yamashita

Article type: Case Report
2017 Volume 38 Issue 1 Pages 56-60
Published: 2017
Released on J-STAGE: May 29, 2017

DOIhttps://doi.org/10.11374/shonijibi.38.56

JOURNAL FREE ACCESS

Show abstractHide abstract

We experienced a 14 month-old boy with a piece of woodchips in the subglottis. In this case, we did the tracheotomy to remove the foreign body because his respiratory condition was got worse during the examination. After tracheotomy, we extracted the foreign body with a rigid bronchoscope. Laryngeal foreign bodies are rare cases in the dairy medical treatment. But, that causes an emergency situation, such as suffocation. So we should be considerate the possibility that required emergency tracheotomy, in the laryngeal foreign body cases.

View full abstract

Download PDF (895K)

Register with J-STAGE for free!