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Diagnostic algorithm for evaluating bilateral congenital cervical rests
Otolaryngology Head and Neck Surgery P208
August 1995
Scientific Posters
166
Evaluation of Chronic Xerostomia in Patients Treated for Pediatric Nasopharyngeal Carcinoma SETH P. LINKER,MD, K. THOMAS ROBBINS, MD, THOMAS MURRY, PHD, CAROL GREENWALD, MD, KENNETH HOPKINS, DDS, MS, and DEO K. SRIVASTAVA, PHD, Memphis, Tenn.
The prevalence and severity of chronic xerostomia in children receiving head and neck irradiation is considered to be less than in their adult counterparts. However, supporting evidence for this is lacking in the literature, so we objectively measured salivary function in subjects treated for pediatric nasopharyngeal carcinoma. The Carlson-Crittendon Cup technique was used to measure salivary flow in three groups that were (1) subjects treated for pediatric nasopharyngeal carcinoma (NPC); (2) a control group with an unrelated cancer (acute lymphocytic leukemia); and (3) a control group of healthy adolescents. A standardized xerostomia questionnaire and a complete head and neck examination were also administered. On the basis of physical examination criteria, 53% of group 1 had evidence of xerostomia compared with none of the patients in groups 2 and 3. Stimulated left and right parotid saliva ftow rates were significantly different among the three groups, with group 1 having the lowest rate (/7 = 0.0001). There was no significant difference between the flow rate in group 2 and group 3. Subjective complaints of greatest magnitude included dry mouth, thick saliva, stickiness in the mouth, difficulty swallowing liquids, difficulty sleeping, decreased appetite, and voice changes. Contrary to common belief, the data indicate that patients treated for pediatric nasopharyngeal carcinoma experience chronic xerostomia. Long-term follow-up is important for minimizing adverse sequelae from chronic xerostomia in young patients undergoing treatment for head and neck malignancies. 167
Diagnostic Algorithm for Evaluating Bilateral Congenital Cervical Rests ROGER S. ZUNDEL, MD, and DIANE G. HEATLEY,MD, Madison, Wis.
Bilateral congenital cartilagenous cervical rests or wattles are an unusual occurrence that requires thorough evaluation to exclude heritable syndromes. We present an algorithm for the evaluation of bilateral wattles in the infant. The term wattle describes the fleshy appendage on the throat of goats. This term has also been applied to describe springy skincovered nodules that can occur as one manifestation of abnormal branchial apparatus development. Several syndromes, such as hemifacial microsomia, branchio-oto-renal syndrome (BOR), and branchio-oto dysplasia (BO) have been described, which include cartilaginous rests of the neck. Wattles have also been reported to occur as an isolated nongenetic defect. BO and BOR are related autosomal-dominant disorders. They are both characterized by hearing loss, pre-
auricular pits, branchial cleft anomalies, and lacrimal stenosis. In BOR, renal anomalies and Potter facies are also present. Expression of both syndromes may vary even within the same family. Hearing loss in BO and BOR is usually conductive but may be mixed or sensorineural. Branchial cleft anomalies seen in BO and BOR are generally second arch malformations. These most commonly are cysts, sinuses, or fistulae, but cartilaginous rests are also rarely seen. The renal anomalies seen in BOR range from asymptomatic unilateral renal hypoplasia to bilateral renal agenesis. Oligohydramnios leads to the constellation of abnormal facial features known as Potter facies including telecanthus, epicanthal folds, flattening of the nose, and enlargement and decreased chondrification of the ears. Because carriers of the gene for BOR may have a potentially lethal renal malformation, it is important to distinguish this from other otobranchial syndromes. Renal ultrasound and serum creatinine are appropriate screening tests to rule out BOR. In addition to physical examination of the ear, audiometric evaluation either through behavioral testing or auditory brainstem response are recommended in an child or adult with bilateral branchial arch anomalies. Complete surgical excision of the branchial anomalies is appropriate. 168
Cholesteatoma in Children MARK NICHOLS, MD, JEFFREYKUHN, MD, HERBERT SILVERSTEIN, MD, SETH ROSENBERG, MD, and MICHAEL HOFFER, MD, Houston, Tex., and Sarasota, Fla.
Cholesteatoma is an aggressive disease in children. A retrospective review of 47 consecutive cases of cholesteatoma in children was performed. A wide canaloplasty with an intact canal wall tympanomastoidectomy was the procedure of choice. Forty-nine ears had one procedure, 28 ears had two procedures, and seven ears had three procedures. The rate of recurrent cholesteatoma at surgery was seven and 14% for the second and third procedures respectively. In 23 patients who underwent a planned second-look procedure, there was residual cholesteatoma in 57% of the cases, primarily in the mesotympanum (39%). Closure of the air-bone gap was to within 20 dB in 51% of the patients, w e conclude that aggressive surgical treatment of pediatric cholesteatoma with second-look surgery is warranted by the high rate of residual and recurrent cholesteatoma in this series. 169
The Incidence of Postoperative Vocal Fold Paralysis in Infants Less Than or Equal to One Year of Age Undergoing Ligation of Patent Ductus Arleriosus ROSS I. S. ZBAR, MD, ACHIH H. CHEN, and RICHARD J. H. SMITH, MD, Iowa City, Iowa
Six cases of left-sided, iatrogenic vocal fold paralysis (VFP) were diagnosed in 68 infants less than or equal to 1 year of age who underwent surgical closure of a patent duc-
August 1995
Scientific Posters
166
Evaluation of Chronic Xerostomia in Patients Treated for Pediatric Nasopharyngeal Carcinoma SETH P. LINKER,MD, K. THOMAS ROBBINS, MD, THOMAS MURRY, PHD, CAROL GREENWALD, MD, KENNETH HOPKINS, DDS, MS, and DEO K. SRIVASTAVA, PHD, Memphis, Tenn.
The prevalence and severity of chronic xerostomia in children receiving head and neck irradiation is considered to be less than in their adult counterparts. However, supporting evidence for this is lacking in the literature, so we objectively measured salivary function in subjects treated for pediatric nasopharyngeal carcinoma. The Carlson-Crittendon Cup technique was used to measure salivary flow in three groups that were (1) subjects treated for pediatric nasopharyngeal carcinoma (NPC); (2) a control group with an unrelated cancer (acute lymphocytic leukemia); and (3) a control group of healthy adolescents. A standardized xerostomia questionnaire and a complete head and neck examination were also administered. On the basis of physical examination criteria, 53% of group 1 had evidence of xerostomia compared with none of the patients in groups 2 and 3. Stimulated left and right parotid saliva ftow rates were significantly different among the three groups, with group 1 having the lowest rate (/7 = 0.0001). There was no significant difference between the flow rate in group 2 and group 3. Subjective complaints of greatest magnitude included dry mouth, thick saliva, stickiness in the mouth, difficulty swallowing liquids, difficulty sleeping, decreased appetite, and voice changes. Contrary to common belief, the data indicate that patients treated for pediatric nasopharyngeal carcinoma experience chronic xerostomia. Long-term follow-up is important for minimizing adverse sequelae from chronic xerostomia in young patients undergoing treatment for head and neck malignancies. 167
Diagnostic Algorithm for Evaluating Bilateral Congenital Cervical Rests ROGER S. ZUNDEL, MD, and DIANE G. HEATLEY,MD, Madison, Wis.
Bilateral congenital cartilagenous cervical rests or wattles are an unusual occurrence that requires thorough evaluation to exclude heritable syndromes. We present an algorithm for the evaluation of bilateral wattles in the infant. The term wattle describes the fleshy appendage on the throat of goats. This term has also been applied to describe springy skincovered nodules that can occur as one manifestation of abnormal branchial apparatus development. Several syndromes, such as hemifacial microsomia, branchio-oto-renal syndrome (BOR), and branchio-oto dysplasia (BO) have been described, which include cartilaginous rests of the neck. Wattles have also been reported to occur as an isolated nongenetic defect. BO and BOR are related autosomal-dominant disorders. They are both characterized by hearing loss, pre-
auricular pits, branchial cleft anomalies, and lacrimal stenosis. In BOR, renal anomalies and Potter facies are also present. Expression of both syndromes may vary even within the same family. Hearing loss in BO and BOR is usually conductive but may be mixed or sensorineural. Branchial cleft anomalies seen in BO and BOR are generally second arch malformations. These most commonly are cysts, sinuses, or fistulae, but cartilaginous rests are also rarely seen. The renal anomalies seen in BOR range from asymptomatic unilateral renal hypoplasia to bilateral renal agenesis. Oligohydramnios leads to the constellation of abnormal facial features known as Potter facies including telecanthus, epicanthal folds, flattening of the nose, and enlargement and decreased chondrification of the ears. Because carriers of the gene for BOR may have a potentially lethal renal malformation, it is important to distinguish this from other otobranchial syndromes. Renal ultrasound and serum creatinine are appropriate screening tests to rule out BOR. In addition to physical examination of the ear, audiometric evaluation either through behavioral testing or auditory brainstem response are recommended in an child or adult with bilateral branchial arch anomalies. Complete surgical excision of the branchial anomalies is appropriate. 168
Cholesteatoma in Children MARK NICHOLS, MD, JEFFREYKUHN, MD, HERBERT SILVERSTEIN, MD, SETH ROSENBERG, MD, and MICHAEL HOFFER, MD, Houston, Tex., and Sarasota, Fla.
Cholesteatoma is an aggressive disease in children. A retrospective review of 47 consecutive cases of cholesteatoma in children was performed. A wide canaloplasty with an intact canal wall tympanomastoidectomy was the procedure of choice. Forty-nine ears had one procedure, 28 ears had two procedures, and seven ears had three procedures. The rate of recurrent cholesteatoma at surgery was seven and 14% for the second and third procedures respectively. In 23 patients who underwent a planned second-look procedure, there was residual cholesteatoma in 57% of the cases, primarily in the mesotympanum (39%). Closure of the air-bone gap was to within 20 dB in 51% of the patients, w e conclude that aggressive surgical treatment of pediatric cholesteatoma with second-look surgery is warranted by the high rate of residual and recurrent cholesteatoma in this series. 169
The Incidence of Postoperative Vocal Fold Paralysis in Infants Less Than or Equal to One Year of Age Undergoing Ligation of Patent Ductus Arleriosus ROSS I. S. ZBAR, MD, ACHIH H. CHEN, and RICHARD J. H. SMITH, MD, Iowa City, Iowa
Six cases of left-sided, iatrogenic vocal fold paralysis (VFP) were diagnosed in 68 infants less than or equal to 1 year of age who underwent surgical closure of a patent duc-