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09:40: Airway Interventions in Children with Pierre Robin Sequence
9:30 AM to 10:30 AM SCIENTIFIC SESSION WCC 207AB
䡲
Scientific Session Orals: Pediatric Otolaryngology Moderators: Sukgi S Choi, MD; Amelia F Drake, MD
09:32 Preoperative Management of Complete Tracheal Rings Alessandro de Alarcon, MD (presenter); Gresham Thomas Richter, MD; Peter Bruce Manning, MD; Michael J Rutter, MD, FRACS OBJECTIVES: Describe the preoperative management and evaluation of patients with complete tracheal rings. Describe the most common preoperative management pitfalls and errors leading to morbidity and mortality. METHODS: Design: Retrospective database and chart review. Setting: Tertiary care referral center. Patients: 47 patients were evaluated for complete tracheal rings at a tertiary care children’s hospital between 2000 and 2006. Initial evaluation was often performed at outside institutions. Demographic data, operative records, transfer notes, discharge summaries, complications, morbidities, and mortalities were obtained from charts and reviewed. Preoperative management complications were categorized as mild, moderate, and severe based on resulting long-term morbidity. RESULTS: Demographics: 42 patients with complete tracheal rings, 3 sleeve trachea, 2 with tracheal hypoplasia; 36% (17/ 47) patients had complications associated with preoperative management and evaluation–10 mild complications, 4 moderate complications and 3 severe. Inappropriate endotracheal tube placement with tracheal injury, failure to evaluate for complete rings in patients with a PA sling, and tracheostomy were the most common causes of morbidity. Severe complications included anoxic brain injury, death, and DIC. CONCLUSIONS: Complete tracheal rings is a rare cause of airway obstruction. Advances in surgical therapy with slide tracheoplasty have revolutionized care of these patients. The preoperative management and evaluation of these patients has become a major determinant of morbidity and mortality in these patients. Appropriate management and evaluation can prevent the most common causes that lead to significant morbidity and occasionally mortality in these patients.
09:40 Airway Interventions in Children with Pierre Robin Sequence Abby C Meyer, MD (presenter); Michael Lidsky; Timothy Lander, MD; James D Sidman, MD
P63 OBJECTIVES: 1. Describe the interventions required for successful airway management in children with Pierre Robin Sequence. 2. Compare airway interventions used in isolated Pierre Robin Sequence with those used in syndromic Pierre Robin Sequence. METHODS: The records of both a cleft and craniofacial clinic and a pediatric otolaryngology clinic were searched and all children carrying the diagnosis of Pierre Robin Sequence (PRS) were identified. Data concerning airway interventions, feeding interventions, and co-morbid conditions were extracted. RESULTS: Seventy-four cases of PRS were identified. Thirtyeight of 74 children (51.4%) required airway intervention other than prone positioning. Fourteen of these 38 were managed nonsurgically with nasopharyngeal airway and/or short-term endotracheal intubation, while the remaining 24 required surgical intervention. Eighteen of the 24 underwent distraction osteogenesis of the mandible, 1 underwent tracheostomy, and 5 underwent tracheostomy followed by eventual distraction. Of the 74 cases of PRS, 53 (71.6%) were considered isolated PRS. Twenty-six of these 53 children (49.1%) required airway intervention with 10 of the 26 being successfully managed nonsurgically and the remaining 16 undergoing surgical intervention. Of the 21 children with either syndromic PRS or PRS with significant neurologic-related co-morbidities, 12 (57.1%) required airway intervention. Four of the 12 were managed successfully with nonsurgical intervention while the other 8 children required surgical intervention. CONCLUSIONS: In this series, over 50% of children with PRS required an airway intervention of some type. These interventions consisted of nonsurgical interventions such as nasopharyngeal airway placement and endotracheal intubation and surgical interventions such as distraction osteogenesis of the mandible and tracheostomy.
09:48 Quantum Resonance Tonsillectomy in Children Riccardo D’Eredita, MD (presenter) OBJECTIVES: Quantum molecular resonance (QMR) coagulation is an innovative technology that uses molecular resonance to cut and coagulate precisely, cleanly and hemostatically at low tissue temperature levels. This technology offers a new possibility for tonsillectomy. The histologic morphology of excised tonsils and postoperative tonsillectomy pain between two commonly used surgical modalities was compared: the cold dissection (CD) and electrocautery (EC), and a new surgical device, the QMR. METHODS: Prospective, three-group (CD, EC, and QMR) randomized, blinded study in a tertiary-care pediatric institution. One hundred and twelve children for whom tonsillectomy was indicated were randomly as-
MONDAY
Scientific Sessions—Monday
䡲
Scientific Session Orals: Pediatric Otolaryngology Moderators: Sukgi S Choi, MD; Amelia F Drake, MD
09:32 Preoperative Management of Complete Tracheal Rings Alessandro de Alarcon, MD (presenter); Gresham Thomas Richter, MD; Peter Bruce Manning, MD; Michael J Rutter, MD, FRACS OBJECTIVES: Describe the preoperative management and evaluation of patients with complete tracheal rings. Describe the most common preoperative management pitfalls and errors leading to morbidity and mortality. METHODS: Design: Retrospective database and chart review. Setting: Tertiary care referral center. Patients: 47 patients were evaluated for complete tracheal rings at a tertiary care children’s hospital between 2000 and 2006. Initial evaluation was often performed at outside institutions. Demographic data, operative records, transfer notes, discharge summaries, complications, morbidities, and mortalities were obtained from charts and reviewed. Preoperative management complications were categorized as mild, moderate, and severe based on resulting long-term morbidity. RESULTS: Demographics: 42 patients with complete tracheal rings, 3 sleeve trachea, 2 with tracheal hypoplasia; 36% (17/ 47) patients had complications associated with preoperative management and evaluation–10 mild complications, 4 moderate complications and 3 severe. Inappropriate endotracheal tube placement with tracheal injury, failure to evaluate for complete rings in patients with a PA sling, and tracheostomy were the most common causes of morbidity. Severe complications included anoxic brain injury, death, and DIC. CONCLUSIONS: Complete tracheal rings is a rare cause of airway obstruction. Advances in surgical therapy with slide tracheoplasty have revolutionized care of these patients. The preoperative management and evaluation of these patients has become a major determinant of morbidity and mortality in these patients. Appropriate management and evaluation can prevent the most common causes that lead to significant morbidity and occasionally mortality in these patients.
09:40 Airway Interventions in Children with Pierre Robin Sequence Abby C Meyer, MD (presenter); Michael Lidsky; Timothy Lander, MD; James D Sidman, MD
P63 OBJECTIVES: 1. Describe the interventions required for successful airway management in children with Pierre Robin Sequence. 2. Compare airway interventions used in isolated Pierre Robin Sequence with those used in syndromic Pierre Robin Sequence. METHODS: The records of both a cleft and craniofacial clinic and a pediatric otolaryngology clinic were searched and all children carrying the diagnosis of Pierre Robin Sequence (PRS) were identified. Data concerning airway interventions, feeding interventions, and co-morbid conditions were extracted. RESULTS: Seventy-four cases of PRS were identified. Thirtyeight of 74 children (51.4%) required airway intervention other than prone positioning. Fourteen of these 38 were managed nonsurgically with nasopharyngeal airway and/or short-term endotracheal intubation, while the remaining 24 required surgical intervention. Eighteen of the 24 underwent distraction osteogenesis of the mandible, 1 underwent tracheostomy, and 5 underwent tracheostomy followed by eventual distraction. Of the 74 cases of PRS, 53 (71.6%) were considered isolated PRS. Twenty-six of these 53 children (49.1%) required airway intervention with 10 of the 26 being successfully managed nonsurgically and the remaining 16 undergoing surgical intervention. Of the 21 children with either syndromic PRS or PRS with significant neurologic-related co-morbidities, 12 (57.1%) required airway intervention. Four of the 12 were managed successfully with nonsurgical intervention while the other 8 children required surgical intervention. CONCLUSIONS: In this series, over 50% of children with PRS required an airway intervention of some type. These interventions consisted of nonsurgical interventions such as nasopharyngeal airway placement and endotracheal intubation and surgical interventions such as distraction osteogenesis of the mandible and tracheostomy.
09:48 Quantum Resonance Tonsillectomy in Children Riccardo D’Eredita, MD (presenter) OBJECTIVES: Quantum molecular resonance (QMR) coagulation is an innovative technology that uses molecular resonance to cut and coagulate precisely, cleanly and hemostatically at low tissue temperature levels. This technology offers a new possibility for tonsillectomy. The histologic morphology of excised tonsils and postoperative tonsillectomy pain between two commonly used surgical modalities was compared: the cold dissection (CD) and electrocautery (EC), and a new surgical device, the QMR. METHODS: Prospective, three-group (CD, EC, and QMR) randomized, blinded study in a tertiary-care pediatric institution. One hundred and twelve children for whom tonsillectomy was indicated were randomly as-
MONDAY
Scientific Sessions—Monday