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A case of familial sternocleidomastoid tumor of infancy
P212
Otolaryngology Head and Neck Surgery August 1995
Scientific Posters
18 kg boy during a 30-hour interval is reported. During his hospitalization for suppurative cervical adenitis, both Tytenot elixir and Tylenol with codeine elixir was inadvertently administered to the patient. The overdosage was suspected after diaphoresis and emesis developed and was confirmed by elevated transaminase enzyme levels and a prolonged prothrombin time, both indicators of hepatotoxicity. The patient recovered uneventfully after therapy with Nacetylcysteine. Despite the numerous publications addressing the diagnosis and management of acute acetaminophen overdose, there is a paucity of literature regarding subacute and chronic overdoses. The true incidence is unknown but is speculated to be vastly underrecognized and underreported based on the frequency of calls to poison control centers. Although most patients will recover without sequelae, some patients proceed to hepatotoxicity and death. A review of the pharmacology and toxicity of acetaminophen is discussed. The subtle, nonspecific symptoms of early acetaminophen overdosage are described. The treatment for subacute or chronic acetaminophen toxicity is controversial. On the basis of the recommendations of the Rocky Mount Poison Control Center, a nationally recognized referral source and research center for acetaminophen overdosage, a management protocol is described. With the popularity of acetaminophen for mild analgesic and antipyretic effect in pediatric patients, ototaryngologists must recognize the potentially lethal hepatotoxic potential of multiple-dose acetaminophen ingestion. 181 A Case of Familial Sternocleidomastoid Tumor of Infancy MICHAEL A. TAVILL, MD, and RALPH F. WETMORE, MD, Philadelphia, Pa,
Sternocleidomastoid tumor of infancy (STOI) is a benign, firm, fibrous swelling that predominately involves the middle or inferior portion of the sternocleidomastoid muscle. Patients may present sinmltaneously with or progress to the development of congenital muscular torticollis during childhood. This pseudotumor predominantly affects infants in their first few weeks of life, with the vast majority showing complete regression over the ensuing few months. Multiple postulates have been presented as to the etiology of this growth; however, the exact cause remains unknown. Two siblings, both requiring a vacuum extraction during delivery, presented at 4 weeks of age to The Children's Hospital of Philadelphia with STOI. Familial cases of congenital muscular torticollis have been noted, along with the possible genetic or peripartum factors that could play a role in its development. We reviewed these same mechanisms that could also predispose to familial STOL Currently, magnetic resonance imaging is the diagnostic modality of choice. Fortunately, the majority of patients with STOI respond to conservative measures with aggressive physical therapy, thus avoiding operative intervention.
182 Obstructing Laryngeal Granuloma Following Brief Endotracheal Intubation in Neonates STEVEN M. KELLY,MD, MAX M. APRIL, MD, FAAP, FACS, and DAVID E. TUNKEL, MD, FAAP, FACS, Baltimore, Md., and Stony Brook, N.Y.
Laryngeal granuloma formation is an unusual complication of endotracheal intubation, especially in young children. Two neonates were evaluated for new onset stridor and life-threatening upper airway obstruction that developed 2 days after birth. Each infant had been endotracheally intubated for a brief period (<5 minutes) to facilitate meconium suctioning in the delivery suite. Obstructive true vocal cord granulomas were seen at microlaryngoscopy, and surgical excision provided relief of obstruction. The pathogenesis and treatment of postintubation laryngeal granulomas will be discussed. Intubation for suctioning of aspirated meconium is a common procedure in the delivery suite. Laryngeal granuloma should be considered in the differential diagnosis of stridor and airway obstruction in the newborn infant when there is a history of even a brief period of irltubation. 183 Castleman's Disease: A Rare Presentation of a Pediatric Neck Mass ERIK D. SCHOENBERG, MD, DON S. RESPLER,MD, and ASHISH K. BHATTACHARYA, MD, West Orange, Newark, and Montclair, N.J.
Casfleman's disease, also known as benign angiofollicular lymph node hyperplasia, is a rare entity characterized by localized lymphatic enlargement that generally involves the mediastinal and pulmonary lymph nodes. However, in 15% to 20% of cases, Castlernan's disease may present as a neck mass. Several other diseases have very similar microscopic features, which makes the diagnosis more difficult. In addition, there is a particular concern about the malignant potential of certain variants of Castleman's disease. In all cases, surgical excision is required for diagnosis and therapy. We present the case of a 12-year-old girl who underwent excision of a gradually enlarging right neck mass associated with intermittent fever and headaches. The lesion was confirmed to be benign angiofollicular lymph node hyperplasia, or Castleman's disease. Discussion will include radiologic, histologic, and clinical features of Castleman's disease and its association and similarities with other diseases. It is particularly important for the surgeon to be aware of the potential for malignancy and thus the need to follow-up patients postoperatively.
Otolaryngology Head and Neck Surgery August 1995
Scientific Posters
18 kg boy during a 30-hour interval is reported. During his hospitalization for suppurative cervical adenitis, both Tytenot elixir and Tylenol with codeine elixir was inadvertently administered to the patient. The overdosage was suspected after diaphoresis and emesis developed and was confirmed by elevated transaminase enzyme levels and a prolonged prothrombin time, both indicators of hepatotoxicity. The patient recovered uneventfully after therapy with Nacetylcysteine. Despite the numerous publications addressing the diagnosis and management of acute acetaminophen overdose, there is a paucity of literature regarding subacute and chronic overdoses. The true incidence is unknown but is speculated to be vastly underrecognized and underreported based on the frequency of calls to poison control centers. Although most patients will recover without sequelae, some patients proceed to hepatotoxicity and death. A review of the pharmacology and toxicity of acetaminophen is discussed. The subtle, nonspecific symptoms of early acetaminophen overdosage are described. The treatment for subacute or chronic acetaminophen toxicity is controversial. On the basis of the recommendations of the Rocky Mount Poison Control Center, a nationally recognized referral source and research center for acetaminophen overdosage, a management protocol is described. With the popularity of acetaminophen for mild analgesic and antipyretic effect in pediatric patients, ototaryngologists must recognize the potentially lethal hepatotoxic potential of multiple-dose acetaminophen ingestion. 181 A Case of Familial Sternocleidomastoid Tumor of Infancy MICHAEL A. TAVILL, MD, and RALPH F. WETMORE, MD, Philadelphia, Pa,
Sternocleidomastoid tumor of infancy (STOI) is a benign, firm, fibrous swelling that predominately involves the middle or inferior portion of the sternocleidomastoid muscle. Patients may present sinmltaneously with or progress to the development of congenital muscular torticollis during childhood. This pseudotumor predominantly affects infants in their first few weeks of life, with the vast majority showing complete regression over the ensuing few months. Multiple postulates have been presented as to the etiology of this growth; however, the exact cause remains unknown. Two siblings, both requiring a vacuum extraction during delivery, presented at 4 weeks of age to The Children's Hospital of Philadelphia with STOI. Familial cases of congenital muscular torticollis have been noted, along with the possible genetic or peripartum factors that could play a role in its development. We reviewed these same mechanisms that could also predispose to familial STOL Currently, magnetic resonance imaging is the diagnostic modality of choice. Fortunately, the majority of patients with STOI respond to conservative measures with aggressive physical therapy, thus avoiding operative intervention.
182 Obstructing Laryngeal Granuloma Following Brief Endotracheal Intubation in Neonates STEVEN M. KELLY,MD, MAX M. APRIL, MD, FAAP, FACS, and DAVID E. TUNKEL, MD, FAAP, FACS, Baltimore, Md., and Stony Brook, N.Y.
Laryngeal granuloma formation is an unusual complication of endotracheal intubation, especially in young children. Two neonates were evaluated for new onset stridor and life-threatening upper airway obstruction that developed 2 days after birth. Each infant had been endotracheally intubated for a brief period (<5 minutes) to facilitate meconium suctioning in the delivery suite. Obstructive true vocal cord granulomas were seen at microlaryngoscopy, and surgical excision provided relief of obstruction. The pathogenesis and treatment of postintubation laryngeal granulomas will be discussed. Intubation for suctioning of aspirated meconium is a common procedure in the delivery suite. Laryngeal granuloma should be considered in the differential diagnosis of stridor and airway obstruction in the newborn infant when there is a history of even a brief period of irltubation. 183 Castleman's Disease: A Rare Presentation of a Pediatric Neck Mass ERIK D. SCHOENBERG, MD, DON S. RESPLER,MD, and ASHISH K. BHATTACHARYA, MD, West Orange, Newark, and Montclair, N.J.
Casfleman's disease, also known as benign angiofollicular lymph node hyperplasia, is a rare entity characterized by localized lymphatic enlargement that generally involves the mediastinal and pulmonary lymph nodes. However, in 15% to 20% of cases, Castlernan's disease may present as a neck mass. Several other diseases have very similar microscopic features, which makes the diagnosis more difficult. In addition, there is a particular concern about the malignant potential of certain variants of Castleman's disease. In all cases, surgical excision is required for diagnosis and therapy. We present the case of a 12-year-old girl who underwent excision of a gradually enlarging right neck mass associated with intermittent fever and headaches. The lesion was confirmed to be benign angiofollicular lymph node hyperplasia, or Castleman's disease. Discussion will include radiologic, histologic, and clinical features of Castleman's disease and its association and similarities with other diseases. It is particularly important for the surgeon to be aware of the potential for malignancy and thus the need to follow-up patients postoperatively.