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P264

Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006

OBJECTIVES: Nowadays, facial paralysis is an uncommon complication of acute otitis media, representing an estimated incidence of 0.005%. However, without appropriate therapy the prognosis is poor. This fact justifies a precise therapeutic protocol to accelerate recovery. METHODS: A retrospective study of all acute otitis media that came in to an emergency unit during the last six years. Six children who presented acute otitis media and facial paralysis were reviewed. Pathophysiological mechanisms and different treatment methods are discussed. RESULTS: The patient ages range from 22 months to 15 years. Facial palsies were identified a few hours to four days from the onset of acute otitis media. Two cases debuted with pain and otorrhea. In the other four cases the tympanic membrane was reddish and swollen. All patients received oral or endovenous treatment (antibiotics and corticosteroides). Myringotomy and local culture was performed in all nonotorrheic patients, except in one whose endovenous treatment immediately improved his paralysis. All patients showed rapid improvement after treatment and recovered completely. CONCLUSIONS: Immediate medical and surgical treatment was crucial to avoid permanent facial paralysis. P156 Tongue-Lip Fusion in Pierre Robin Sequence Philomena M Behar, MD (presenter); Angelo Ang Monroy, MD; Christopher Heard, MD; Mark L Nagy, MD; Christopher Peter Poje, MD; Michael P Pizzuto, MD; Linda S Brodsky, MD Buffalo NY; Amherst NY OBJECTIVES: To review tongue-lip fusion in newborns with Pierre Robin Sequence (PRS) and airway obstruction. 1. Learn preoperative evaluation and patient selection. 2. Understand intraoperative airway management and postoperative expectations. METHODS: Retrospective chart review. Years: 1997 to 2005. Disease Studied: Airway obstruction and PRS. Subjects: Newborns with PRS with and without other congenital anomalies (CA). Setting: Tertiary Care Children’s Hospital. Intervention: Tongue-lip fusion. Outcome measure: Airway maintenance, oral feeding. RESULTS: Tongue-lip fusion was performed in 11 patients (isolated PRS ⫽ 7, PRS and CA ⫽ 3, and syndromic ⫽ 1). Preoperative sleep studies demonstrated obstructive apnea in 10/11 patients. Average age and weight at surgery were 30 days and 2.98 kg. All patients had poor oral intake and inadequate weight gain preoperatively. All required nasogastric supplementation (n⫽ 9) or nasogastric only feeding (n⫽ 2). Intraoperatively, nasotracheal intubation was accomplished with fiberoptic laryngoscopy (2 patients) and direct laryngoscopy (9 patients). All patients remained intubated and sedated postoperatively for up to one week. One patient failed extubation and required tracheostomy (syndromic patient). Four patients had wound dehiscence (possibly from early oral feeding) and 3/4 required revision surgery. At discharge, all 7 patients

with isolated PRS maintained their airway and fed orally. Seven of 10 patients underwent tongue-lip fusion release (average age⫽10 months) and had stable airways postoperatively. All patients with PRS and CA required prolonged use of gastrostomy tubes. CONCLUSIONS: Tongue-lip fusion is useful in relieving airway obstruction in PRS patients with and without CA. Those with CA may need prolonged supplemental nutrition via gastrostomy. P157 Treatment of Cutaneous Hemangiomas with Topical Imiquimod 5% Andrew J. Senchak, DO (presenter); Benjamin B Cable, MD; Glenn Todd Bessinger, MD Tripler AMC HI; Kailua HI; Honolulu HI OBJECTIVES: 1. To report the use of topical imiquimod as an apparently safe and effective therapy that results in rapid resolution of cutaneous hemangiomas of infancy. 2. To report the current literature on hemangiomas. METHODS: A case series of facial hemagiomas that were treated with topical imiquimod. Clinical and photographic data will be presented. RESULTS: Three separate pediatric patients sought treatment at the presenters’ facility for rapidly growing facial hemangiomas. These previously untreated lesions had been present since birth and were isolated cutaneous hemangiomas without deeper involvement. Each patient was treated with nightly application of topical imiquimod 5% cream, five nights per week. By approximately 3-4 months of treatment, the lesions had near-complete resolution without significant side effect. CONCLUSIONS: Hemangiomas of infancy are the most common benign tumors of childhood. Although HOI can occur anywhere on the body, they demonstrate a striking predilection for the head and neck. Although most hemangiomas will involute over several years, many parents will seek out treatment because of the potential for disfigurement and psychosocial effects. Traditional management options including systemic and intralesional corticosteroids, subcutaneous interferon alpha, laser ablation, and embolization all carry potential risks. A more recently described treatment is topical application of imiquimod (Aldara®, 3M Pharmaceuticals), a potent immunomodulator that induces production of cytokines, namely interferon alpha, interleukins, and tumor necrosis factor-alpha. Topical application seems to provide rapid clinical resolution of head and neck cutaneous hemangiomas without significant side effects. Imiquimod may therefore be an important tool for the otolaryngologist treating such lesions. P158 Vascular Compromise in Deep Neck Space Infections Benjamin Darrell Webb, MD (presenter); Kevin D Pereira, MD; Brian Shih-ning Wang, MD Houston TX