Biomedical subjects
Adrian James
Publications and source records attributed to Adrian James.
A new classification system for congenital laryngeal cysts.
OBJECTIVES: A new classification system for congenital laryngeal cysts based on the extent of the cyst and on the embryologic tissue of origin is proposed. STUDY DESIGN: Retrospective chart review. METHODS: The charts of 20 patients with either congenital or acquired laryngeal cysts that were treated surgically between 1987 and 2002 at the Hospital for Sick Children, Toronto were retrospectively reviewed. Clinical presentation, radiologic findings, surgical management, histopathology, and outcome were recorded. A new classification system is proposed to better appreciate the origin of these cysts and to guide in their successful surgical management. RESULTS: Fourteen of the supraglottic and subglottic simple mucous retention cysts posed no diagnostic or therapeutic challenge and were treated successfully by a single endoscopic excision or marsupialization. The remaining six patients with congenital cysts in the study were deemed more complex, and all required open surgical procedures for cure. On the basis of the analysis of the data of these patients, a new classification of congenital laryngeal cysts is proposed. Type I cysts are confined to the larynx, the cyst wall composed of endodermal elements only, and can be managed endoscopically. Type II cysts extend beyond the confines of the larynx and require an external approach. The Type II cysts are further subclassified histologically on the basis of the embryologic tissue of origin: IIa, composed of endoderm only and IIb, containing endodermal and mesodermal elements (epithelium and cartilage) in the wall of the cyst. CONCLUSIONS: A new classification system for congenital laryngeal cysts is proposed on the basis of the extent of the cyst and the embryologic tissue of origin. This classification can help guide the surgeon with initial management and help us better understand the origin of these cysts.
Bilateral cholesteatomas: the hospital for sick children experience.
OBJECTIVE: The purpose of this article is to review the cases of bilateral cholesteatomas in a tertiary care pediatric otolaryngology department. We compare the presenting signs and symptoms and timing of ipsilateral and contralateral cholesteatomas and the initial audiometric findings. METHODS: Retrospective chart review. SETTING: Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON. RESULTS: Twenty-two patients with bilateral cholesteatomas were accrued. Nine patients had bilateral congenital cholesteatomas and presented at a substantially younger age than those with acquired disease (average of 5 years, 9 months vs 11 years). Sixteen of the 22 patients were initially diagnosed with bilateral cholesteatomas. The majority of the remaining patients had evidence on initial assessment of contralateral middle ear disease. A particular subset of patients with severe disease requiring numerous bilateral revision surgeries was also identified. These patients also underwent revision surgery after a substantially shorter follow-up period. CONCLUSIONS: Bilateral cholesteatomas in the pediatric population are extremely rare. Bilateral congenital cholesteatomas are more common in males, whereas bilateral acquired cholesteatomas are more common in females. The outcome is generally poor. A small subset with particularly aggressive disease requires many more bilateral revision surgeries at an earlier period when compared with the remainder of the group.