INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and ... more INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and a rare cause of respiratory distress in neonates that may require early surgical intervention. The aim of this study is to report our experience in patients operated for CNPAS and present characteristics of this population. MATERIAL AND METHODS A retrospective, analytical cohort study was conducted of patients who underwent surgical treatment for CNPAS in the Hospital de Pediatría Garrahan from May 2008 to May 2018. RESULTS Nineteen patients underwent surgical treatment; 47.36% had some associated genetic syndrome. The surgical approach was sublabial. Follow-up was more than 45 days in 14 patients, 9 did not require additional treatment, and the remaining 5 required further surgical and/or medical treatment. Short-term post-surgical outcome was good in 85.7%. CONCLUSIONS Better post-surgical results were obtained in patients in whom endonasal stenting was not used and who did not present associated craniofacial malformations.
Resumen Introduccion La estenosis congenita de la apertura piriforme (ECAP) es una malformacion i... more Resumen Introduccion La estenosis congenita de la apertura piriforme (ECAP) es una malformacion infrecuente y una causa rara de distress respiratorio en neonatos que puede requerir de intervencion quirurgica temprana. El objetivo del estudio es reportar nuestra experiencia en pacientes operados por ECAP y las caracteristicas de la poblacion. Material y metodos Pacientes operados de ECAP desde mayo del 2008 hasta mayo del 2018 en el Hospital de Pediatria Garrahan. Estudio de cohorte analitico retrospectivo. Resultados Se intervinieron quirurgicamente 19 pacientes. El 47,36% presentaba algun sindrome genetico asociado. El abordaje quirurgico fue por via sublabial. Se logro el seguimiento por mas de 45 dias en 14 pacientes, 9 no requirieron tratamiento adicional, y los 5 restantes requirieron otro tratamiento quirurgico y/o medico. El exito global posquirurgico en primera instancia fue del 85,7%. Conclusiones Se obtuvieron mejores resultados posquirurgicos en los pacientes en que no se utilizaron tutores endonasales y que no presentaban malformaciones craneofaciales asociadas.
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The ai... more Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. 47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with...
Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of whi... more Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of which resulting from endotracheal intubation. The diagnosis is based on the patient's clinical, radiologic evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. It must be suspected in children with respiratory distress after extubation. The therapeutic approach depends on the severity of the subglottic stenosis and the patient's symptoms. We describe our experience with the subglottic stenosis etiologies, diagnosis, treatment and outcome of patients with this condition.
International Journal of Pediatric Otorhinolaryngology, 2020
OBJECTIVE to describe the frequency and predictive factors associated with laryngeal scarring cau... more OBJECTIVE to describe the frequency and predictive factors associated with laryngeal scarring caused by surgical treatment of recurrent respiratory papillomatosis (RRP) in children. INTRODUCTION RRP is an important cause of hoarseness and respiratory obstruction in children. The current standard of care for RRP is the systematic and repetitive surgical interventions. The repetitive surgeries may increase the risk of sequelae. A larger number of surgeries, the surgical technique used, and disease severity are related to an increased risk of scarring. MATERIAL AND METHODS A retrospective, descriptive review of the medical charts of patients with RRP younger than 18 years was conducted. Between 2014 and 2017, 79 patients were identified; five patients were excluded. Demographic and clinical data were recorded and analyzed. The patients were divided into two groups, one with and the other without surgical sequelae, for comparison to identify sequela-associated factors. RESULTS 75 patients, 40 (53.3%) male, were analyzed. Age at symptom onset ranged from 2 months to 13 years. Median age at the time of diagnosis was 42 months. Overall, 44% presented with disseminated disease. A median of nine (range, 1 to 86) surgeries were performed in each patient with a median of two (range, 0.6 to 10) of the average number of surgeries per year per patient. 29 patients (38.7%) had laryngeal sequelae. When comparing the patients with and without sequelae, statistically significant differences were found in the variables of dissemination during the course of the disease, overall number of surgeries and mean number of surgeries per year, history and number of previous surgeries at an outside institution, urgent surgeries, and CO2 laser use. Patients who underwent more than 10 surgeries or who had a history of previous surgeries at an outside institution had a higher frequency of laryngeal scarring in multivariate analysis. CONCLUSION Scarring secondary to surgical treatment for RRP is common. Surgery-related variables seem to be predisposing factors. A greater number of surgeries and surgeries performed at less specialized centers are strongly related to this complication. Future studies with a larger sample size are necessary to determine whether other factors are involved.
INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and ... more INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon malformation and a rare cause of respiratory distress in neonates that may require early surgical intervention. The aim of this study is to report our experience in patients operated for CNPAS and present characteristics of this population. MATERIAL AND METHODS A retrospective, analytical cohort study was conducted of patients who underwent surgical treatment for CNPAS in the Hospital de Pediatría Garrahan from May 2008 to May 2018. RESULTS Nineteen patients underwent surgical treatment; 47.36% had some associated genetic syndrome. The surgical approach was sublabial. Follow-up was more than 45 days in 14 patients, 9 did not require additional treatment, and the remaining 5 required further surgical and/or medical treatment. Short-term post-surgical outcome was good in 85.7%. CONCLUSIONS Better post-surgical results were obtained in patients in whom endonasal stenting was not used and who did not present associated craniofacial malformations.
Resumen Introduccion La estenosis congenita de la apertura piriforme (ECAP) es una malformacion i... more Resumen Introduccion La estenosis congenita de la apertura piriforme (ECAP) es una malformacion infrecuente y una causa rara de distress respiratorio en neonatos que puede requerir de intervencion quirurgica temprana. El objetivo del estudio es reportar nuestra experiencia en pacientes operados por ECAP y las caracteristicas de la poblacion. Material y metodos Pacientes operados de ECAP desde mayo del 2008 hasta mayo del 2018 en el Hospital de Pediatria Garrahan. Estudio de cohorte analitico retrospectivo. Resultados Se intervinieron quirurgicamente 19 pacientes. El 47,36% presentaba algun sindrome genetico asociado. El abordaje quirurgico fue por via sublabial. Se logro el seguimiento por mas de 45 dias en 14 pacientes, 9 no requirieron tratamiento adicional, y los 5 restantes requirieron otro tratamiento quirurgico y/o medico. El exito global posquirurgico en primera instancia fue del 85,7%. Conclusiones Se obtuvieron mejores resultados posquirurgicos en los pacientes en que no se utilizaron tutores endonasales y que no presentaban malformaciones craneofaciales asociadas.
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The ai... more Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. 47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with...
Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of whi... more Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of which resulting from endotracheal intubation. The diagnosis is based on the patient's clinical, radiologic evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. It must be suspected in children with respiratory distress after extubation. The therapeutic approach depends on the severity of the subglottic stenosis and the patient's symptoms. We describe our experience with the subglottic stenosis etiologies, diagnosis, treatment and outcome of patients with this condition.
International Journal of Pediatric Otorhinolaryngology, 2020
OBJECTIVE to describe the frequency and predictive factors associated with laryngeal scarring cau... more OBJECTIVE to describe the frequency and predictive factors associated with laryngeal scarring caused by surgical treatment of recurrent respiratory papillomatosis (RRP) in children. INTRODUCTION RRP is an important cause of hoarseness and respiratory obstruction in children. The current standard of care for RRP is the systematic and repetitive surgical interventions. The repetitive surgeries may increase the risk of sequelae. A larger number of surgeries, the surgical technique used, and disease severity are related to an increased risk of scarring. MATERIAL AND METHODS A retrospective, descriptive review of the medical charts of patients with RRP younger than 18 years was conducted. Between 2014 and 2017, 79 patients were identified; five patients were excluded. Demographic and clinical data were recorded and analyzed. The patients were divided into two groups, one with and the other without surgical sequelae, for comparison to identify sequela-associated factors. RESULTS 75 patients, 40 (53.3%) male, were analyzed. Age at symptom onset ranged from 2 months to 13 years. Median age at the time of diagnosis was 42 months. Overall, 44% presented with disseminated disease. A median of nine (range, 1 to 86) surgeries were performed in each patient with a median of two (range, 0.6 to 10) of the average number of surgeries per year per patient. 29 patients (38.7%) had laryngeal sequelae. When comparing the patients with and without sequelae, statistically significant differences were found in the variables of dissemination during the course of the disease, overall number of surgeries and mean number of surgeries per year, history and number of previous surgeries at an outside institution, urgent surgeries, and CO2 laser use. Patients who underwent more than 10 surgeries or who had a history of previous surgeries at an outside institution had a higher frequency of laryngeal scarring in multivariate analysis. CONCLUSION Scarring secondary to surgical treatment for RRP is common. Surgery-related variables seem to be predisposing factors. A greater number of surgeries and surgeries performed at less specialized centers are strongly related to this complication. Future studies with a larger sample size are necessary to determine whether other factors are involved.
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