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SP359 – Postoperative management following sphincter pharyngoplasty
P208
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
0/5 had a fever, and 0/3 had an elevated white count. 0/5 had CT findings suggesting abscess. Three were Burkitt’s lymphoma; two were rhabdomyosarcoma. On initial presentation, none of these children met some of the more classic signs and symptoms of a peritonsillar infection, including sore throat, trismus, fever and elevated white blood cell count. CONCLUSIONS: When diagnosing a peritonsillar abscess in a child the possibility of alternative diagnoses, including malignancy, must be considered, especially when presenting with an atypical clinical picture. Imaging of those presenting with an atypical clinical picture should be considered. SP359 – Postoperative management following sphincter pharyngoplasty Lauren A Kilpatrick, MD (presenter); David R White, MD; Richard Kline; Kathryn Hufnagle; Michael Vanlue, PhD OBJECTIVES: 1) Evaluate the acute postoperative recovery of children undergoing sphincter pharyngoplasty. 2) Determine the necessity of overnight observation after sphincter pharyngoplasty. METHODS: Postoperative management of sphincter pharyngoplasty (SP) conventionally includes overnight observation to monitor for upper airway obstruction. To evaluate for postoperative airway-related outcomes, 36 patients who underwent SP between April 2003 and January 2009 were evaluated retrospectively. Mean patient age was 8.1 years (SD 4.3), and mean follow-up was 6.5 months (SD 10.7). Cleft palate (36.1%), velocardiofacial syndrome (22.2%), and post-adenoidectomy (16.7%) were the most common causes of VPI. All patients underwent overnight observation postoperatively. RESULTS: Mean hospital stay was 1.2 days (SD 0.5). Five patients remained inpatient 2-3 days due to fever (2 patients), bleeding ear after concurrent otoplasty (1 patient), minimal oropharyngeal bleeding with spontaneous resolution (1 patient), and medication allergy (1 patient). No patient had a documented apneic event or desaturation below 95%. Although no desaturations were documented, four patients received supplemental oxygen: three for less than 2 hours and one for 12 hours. All patients had adequate oral intake and pain control on oral medications prior to discharge; nine patients required 1-2 doses of intravenous narcotic medication on postoperative day zero. CONCLUSIONS: Upper airway obstruction requiring overnight observation following SP is uncommon. In otherwise healthy patients, performing SP in an outpatient setting, given appropriate recovery room evaluation for airway concerns, oral intake, and pain control, should be considered. SP362 – Post-operative quality of life in 18 children with laryngomal Annette Paula Zimmermann, MD (presenter); Jochen Werner, MD; Susanne Wiegand, MD; Andreas Sesterhenn, MD, PhD
OBJECTIVES: To assess quality of life after transoral CO2laser microsurgical division of ary-epiglottic folds and/or epiglottopexy in children suffering from laryngomalacia. METHODS: A retrospective analysis of 18 children who were treated between 1998 and 2009 was performed. All children suffering from severe inspiratory stridor in connection with laryngomalacia underwent flexible pharyngo-laryngo-tracheoscopy. In case of evidence of treatment requiring laryngomalacia transoral CO2-laser microsurgery in terms of division of the ary-epiglottic folds and/ or epiglottopexy was performed (n ⫽ 18). A standardized questionnaire on the basis of the Glasgow Benefit Inventory (GBI)was used. Questions were focusing on different aspects concerning the children’s and parents’ quality of life postinterventionally. RESULTS: The questionnaire (comprising 18 items) was answered by all parents. None of the 18 surgically treated children had post-operative deterioration of the respiratory situation. 16/18 of the children and parents showed post-operatively a clear improvement of quality of life with reduction of stridor and enhancement of feeding. CONCLUSIONS: The present results underline that transoral laser microsurgery and/or epiglottopexy in treatment requiring laryngomalacia is a highly effective therapy option, which may lead to a significant improvement of quality of life in the affected patients in the post-operative course. SP351 – Radiofrequency tonsillotomy Goran Harsten, MD, PhD (presenter) OBJECTIVES: Children with symptoms of tonsillar hypertrophy have previously been treated with tonsillectomy. However, instead of removing otherwise healthy tonsils entirely, radiofrequency energy can be used to reduce their size. This study was conducted in order to investigate the effects of pediatric tonsillotomy with radiofrequncy-technique. METHODS: We investigated the post-operative condition of 167 children (under 15 years of age) who had undergone radiofrequncy surgery in 2007 and 2008 due to symptoms of tonsillar hypertrophy (i.e. snoring, nocturnal sleep apnoea, dysphagia, or speech impairment), but had no history of recurrent tonsillitis. Data were obtained from clinical records and from questionnaires answered by the patients and their parents. RESULTS: The duration of the post-operative follow up was two to 26 months. A complete or definite improvement regarding their pre-operative symptoms of tonsillar hypertrophy was obtained in more than 90% of the children. This result was uninfluenced by the duration of follow up. No serious side effects were noted. CONCLUSIONS: Thus, radiofrequncy-tonsillotomy, which enables us to reduce the size of the tonsillar tissue instead of removing the tonsils entirely, seems to be an effective and safe method of treating children with symptoms of tonsillar hypertrophy.
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
0/5 had a fever, and 0/3 had an elevated white count. 0/5 had CT findings suggesting abscess. Three were Burkitt’s lymphoma; two were rhabdomyosarcoma. On initial presentation, none of these children met some of the more classic signs and symptoms of a peritonsillar infection, including sore throat, trismus, fever and elevated white blood cell count. CONCLUSIONS: When diagnosing a peritonsillar abscess in a child the possibility of alternative diagnoses, including malignancy, must be considered, especially when presenting with an atypical clinical picture. Imaging of those presenting with an atypical clinical picture should be considered. SP359 – Postoperative management following sphincter pharyngoplasty Lauren A Kilpatrick, MD (presenter); David R White, MD; Richard Kline; Kathryn Hufnagle; Michael Vanlue, PhD OBJECTIVES: 1) Evaluate the acute postoperative recovery of children undergoing sphincter pharyngoplasty. 2) Determine the necessity of overnight observation after sphincter pharyngoplasty. METHODS: Postoperative management of sphincter pharyngoplasty (SP) conventionally includes overnight observation to monitor for upper airway obstruction. To evaluate for postoperative airway-related outcomes, 36 patients who underwent SP between April 2003 and January 2009 were evaluated retrospectively. Mean patient age was 8.1 years (SD 4.3), and mean follow-up was 6.5 months (SD 10.7). Cleft palate (36.1%), velocardiofacial syndrome (22.2%), and post-adenoidectomy (16.7%) were the most common causes of VPI. All patients underwent overnight observation postoperatively. RESULTS: Mean hospital stay was 1.2 days (SD 0.5). Five patients remained inpatient 2-3 days due to fever (2 patients), bleeding ear after concurrent otoplasty (1 patient), minimal oropharyngeal bleeding with spontaneous resolution (1 patient), and medication allergy (1 patient). No patient had a documented apneic event or desaturation below 95%. Although no desaturations were documented, four patients received supplemental oxygen: three for less than 2 hours and one for 12 hours. All patients had adequate oral intake and pain control on oral medications prior to discharge; nine patients required 1-2 doses of intravenous narcotic medication on postoperative day zero. CONCLUSIONS: Upper airway obstruction requiring overnight observation following SP is uncommon. In otherwise healthy patients, performing SP in an outpatient setting, given appropriate recovery room evaluation for airway concerns, oral intake, and pain control, should be considered. SP362 – Post-operative quality of life in 18 children with laryngomal Annette Paula Zimmermann, MD (presenter); Jochen Werner, MD; Susanne Wiegand, MD; Andreas Sesterhenn, MD, PhD
OBJECTIVES: To assess quality of life after transoral CO2laser microsurgical division of ary-epiglottic folds and/or epiglottopexy in children suffering from laryngomalacia. METHODS: A retrospective analysis of 18 children who were treated between 1998 and 2009 was performed. All children suffering from severe inspiratory stridor in connection with laryngomalacia underwent flexible pharyngo-laryngo-tracheoscopy. In case of evidence of treatment requiring laryngomalacia transoral CO2-laser microsurgery in terms of division of the ary-epiglottic folds and/ or epiglottopexy was performed (n ⫽ 18). A standardized questionnaire on the basis of the Glasgow Benefit Inventory (GBI)was used. Questions were focusing on different aspects concerning the children’s and parents’ quality of life postinterventionally. RESULTS: The questionnaire (comprising 18 items) was answered by all parents. None of the 18 surgically treated children had post-operative deterioration of the respiratory situation. 16/18 of the children and parents showed post-operatively a clear improvement of quality of life with reduction of stridor and enhancement of feeding. CONCLUSIONS: The present results underline that transoral laser microsurgery and/or epiglottopexy in treatment requiring laryngomalacia is a highly effective therapy option, which may lead to a significant improvement of quality of life in the affected patients in the post-operative course. SP351 – Radiofrequency tonsillotomy Goran Harsten, MD, PhD (presenter) OBJECTIVES: Children with symptoms of tonsillar hypertrophy have previously been treated with tonsillectomy. However, instead of removing otherwise healthy tonsils entirely, radiofrequency energy can be used to reduce their size. This study was conducted in order to investigate the effects of pediatric tonsillotomy with radiofrequncy-technique. METHODS: We investigated the post-operative condition of 167 children (under 15 years of age) who had undergone radiofrequncy surgery in 2007 and 2008 due to symptoms of tonsillar hypertrophy (i.e. snoring, nocturnal sleep apnoea, dysphagia, or speech impairment), but had no history of recurrent tonsillitis. Data were obtained from clinical records and from questionnaires answered by the patients and their parents. RESULTS: The duration of the post-operative follow up was two to 26 months. A complete or definite improvement regarding their pre-operative symptoms of tonsillar hypertrophy was obtained in more than 90% of the children. This result was uninfluenced by the duration of follow up. No serious side effects were noted. CONCLUSIONS: Thus, radiofrequncy-tonsillotomy, which enables us to reduce the size of the tonsillar tissue instead of removing the tonsils entirely, seems to be an effective and safe method of treating children with symptoms of tonsillar hypertrophy.