http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:9529 Lingual dermoid cysts are squamous epithelial-lined cavities with variable numbers of skin adnexae in the capsule and are rare entities in the head and neck. We discuss the presentation, possible aetiologies and the surgical management of these lesions and report on the ninth lingual dermoid cyst as an illustrative example, the first to be excised by laser. An extensive literature search was undertaken. We present the case of a 4-month-old di-zygotic twin girl with a firm midline anterior tongue dermoid cyst. Its extent was defined by magnetic resonance imaging. The cyst was excised using the CO2 laser via an extended median sagittal glossotomy approach. Lingual dermoid cysts most commonly present in early childhood or adolescence and are located in the anterior two thirds of the tongue. Eight lingual dermoid cysts have been reported, all of which were surgically excised, using varying techniques, and no recurrences have been reported. Our patient recovered well and was extubated immediately post-operatively. However, feeding was delayed for 48 h post-operatively due to pain, requiring opiate analgesia. The tongue healed completely with only a small indent in the tip. Treatment of these lesions consists of complete surgical excision. We propose that the midline sagittal glossotomy incision using the CO2 laser offers surgical precision, superior haemostasis and wound healing and minimal post-operative oedema. The involvement of the sensitive tongue tip in this approach may be its one drawback, however this may be compensated for with appropriate post-operative analgesia. 2011-11-29T04:30:07.418Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:8105 Objective: To determine the prevalence of tonsillar actinomycosis in pediatric tonsillectomies performed for sleep disordered breathing (SDB) compared with recurrent infective tonsillitis. Methods: All tonsillectomy specimens performed in a pediatric otolaryngology practice over a 10-year period were sent to the same pathology laboratory for histological analysis for the prevalence of Actinomyces. A database of 1213 children was generated and analyzed to determine any significant differences in Actinomyces carriage between children with a primary diagnosis of sleep disordered breathing, compared with recurrent tonsillitis. Statistical analysis was performed using a 2 way contingency table, and significance analyzed via chi-squared and Fisher's exact test. Results: Four hundred and sixty five children aged less than 16 underwent tonsillectomy for recurrent tonsillitis and 748 for SDB. Actinomyces were identified in 68 of the group with recurrent tonsillitis (14.6%) and in 153 of the group with SDB (20.5%). This difference was statistically significant with p = 0.009 on two-tail Fisher's exact test. Conclusion: There was a statistically significant higher rate of Actinomyces colonization in children undergoing tonsillectomies for SDB compared to recurrent tonsillitis. 2011-07-06T02:10:23.043Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7439 Objective: Recent reports have suggested a significant incidence of sensorineural hearing loss (SNHL) in children with Turner syndrome. This study reviewed a cohort of Australian children to clarify the incidence and pattern of conductive and sensorineural hearing loss. Methods: Retrospective cohort study of 23 individuals with Turner syndrome was identified – mean age 10 years 4 months. A retrospective review was undertaken and otologic status assigned. Results: Middle ear disease affected 91% of patients. Two children (9%) demonstrated sensorineural hearing loss attributable to Turner syndrome. Average age of onset was 15 years – one demonstrated a classic U-shaped mid-frequency loss, the other a bilateral down-sloping sensorineuralloss. Conclusions: In this Turner syndrome cohort, 91% of subjects suffered middle ear disease, whilst the incidence of SNHL was 9%. It is recommended that individuals with Turner syndrome should be screened for onset and progression of hearing loss. 2011-03-21T04:40:03.790Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:645 Five cases of antenatally diagnosed fetal airway obstruction have been cared for at the John Hunter Children's Hospital, Newcastle, Australia. A multi-disciplinary team manages them during the perinatal period. We present our technique at the time of delivery, which aims to afford us the greatest flexibility in managing both the mother, her child's airway, and the underlying lesion. We begin with an ex utero intrapartum technique (EXIT) and favor routine rigid bronchoscopy to secure the neonate's airway without preliminary attempts at endotracheal intubation. (c) 2005 Elsevier Ireland Ltd. All rights reserved. 2010-04-27T05:38:05.562Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5514 Article Outline: A 6-month-old term infant was referred with a history of snuffly breathing and obstructive sleep-disturbed breathing unless she was postured upright. From birth she had had daily right-sided rhinorrhea, which was mostly grayish and of egg-white consistency. It had not responded to antibiotics or intranasal steroids. Feeding was slow but weight gain was normal. Perinatal history was unremarkable, with cigarette smoking 4 per week the only potential teratogen identified. Clinical examination showed a left unilateral middle ear effusion, a left preauricular sinus, a bifid tip of uvula, and ankyloglossia. Flexible transnasal endoscopy demonstrated a pale skin-covered finger-like projection, arising from the left lateral nasopharyngeal wall in close proximity to the Eustachian tube, crossing to the contralateral side. CT showed patent bony choanae bilaterally with a 9 × 7-mm soft tissue density superior to the soft palate. MRI (T2 weighting and T1 fat saturation, pre- and postcontrast) showed a 7-mm-diameter lesion projecting 12.5 mm into the pharynx. It was separate to the left internal carotid artery, with slight contrast enhancement. The absence of a wide range of signal intensities and the ordered structure suggested teratoma unlikely. There appeared to be a cord-like extension with concentric ring structure immediately adjacent to the Eustachian tube, to the skull base postero-inferior to the Eustachian tube. Under general anesthesia a combined transnasal and retropalatal endoscopic approach was commenced. The attachment of the lesion to the mucosa of the anterior aspect of the Eustachian tube was needle-point diathermy-divided under vision and then with steady traction using non-thru-cut forceps the lesion was avulsed from its origin in the postero-inferior aspect of the lower third of the Eustachian tube, and delivered transorally. After removal the size of the left Eustachian tube orifice was seen to be 4 to 5 times that of the right (Fig 1 - Dilated Eustachian tube orifice after removal of hairy polyp). The operative procedure was uncomplicated. The left unilateral mucoid effusion was aspirated. Histopathology demonstrated a 15 × 7 × 7-mm polypoid lesion covered by epidermis with associated adnexae (hair follicles, sebaceous glands, and eccrine glands) overlying a core of fibroadipose tissue with minor salivary glands and skeletal muscle. This was characterized as a “hairy polyp of the Eustachian tube.” At general anesthetic for division of the ankyloglossia 5 months postexcision there was no recurrence of either the lesion or the middle ear effusion, and the orifice of the Eustachian tube had shrunk so as to be only a little larger than the contralateral side. Discussion: “Hairy polyp of the nasopharynx” is a clinico-pathological descriptive term. The clinical description derives from macroscopically visible fine hairs arising from the pale external covering of skin (Fig 2 - Hairy polyp of the Eustachian tube). At flexible or rigid transnasal or retropalatal endoscopy they typically appear as a sausage-like lesion projecting medially across the nasopharynx. Up to 2004, 114 cases of hairy polyp of the nasopharynx had been described, most arising from the lateral pharyngeal wall. Origin specifically from the Eustachian tube was thought to be excessively rare but it is quite possible that increasing use of nasal endoscopes before and after removal will show that origin from within the lower end of the Eustachian tube is more common than previously thought. It is presumably this origin that resulted in dilation of the developing cartilaginous Eustachian tube; and removal of the hairy polyp allowed remodeling towards a normal size. They most commonly present early in the first year, with a female preponderance up to 6:1. Presentation with nasal signs and symptoms occurs when nasopharyngeal and nasal obstruction predominate, and occurs with otologic signs and symptoms when Eustachian tube obstruction coexists. When larger, the lesions may be visible below the soft palate or acting as a ball-valve may obstruct the larynx causing positional cyanosis; indeed, fatal obstruction has been reported. Several theories of embryologic origin exist. Hairy polyps arising from the Eustachian tube may originate in the fourth postconceptual week from entrapped cells between the first pouch endoderm and first cleft ectoderm. Because they resemble the pinna, they have been postulated to be accessory auricles arising “internally” from the first branchial anlarge. Less likely would seem to be persistence of the bucconasal or buccopharyngeal membranes, or uncontrolled development from entrapped pluripotential cells. 2010-04-27T04:42:59.227Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5085 Laryngeal paraganglioma is a rare neuroendocrine neoplasm of neural origin. Most commonly it arises in the supraglottis, in either the false cords or aryepiglottic folds. Generally these neoplasms cause symptoms as they enlarge and cause obstruction. We present a case of this unusual condition with no obstructive symptoms, despite the large size of the tumor. 2010-04-27T04:35:45.035Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5489 Objective: To determine success rates after adenotonsillectomy for obstructive sleep apnea (OSA); postoperative polysomnogram (PSG) results were compared with preoperative results in children younger than 5 years. Methods: Thirty-four children with a preoperative respiratory disturbance index (RDI) greater than 5 in rapid eye movement (REM) sleep underwent both preoperative and postoperative PSG with at least five of seven parameters recorded. Results: Preoperatively, mean total RDI was 15.5, mean REM RDI was 39.6, and 25 (74%) had severe OSA (REM RDI > 20). Postoperatively, mean total RDI improved to 3 (P < 0.001), mean REM RDI to 7.4 (P < 0.001), and 4 remained severe. Overall 22 (65%) showed REM RDI in the normal range (<5), including all with a preoperative REM RDI less than 30. Conclusion: On PSG criteria, most children with OSA significantly improved after adenotonsillectomy, but a number had persisting abnormalities. Postoperative PSG should be considered to identify unresolved OSA. 2010-04-27T04:34:21.286Z ]]>