Biomedical subjects

J Paul Willging

Publications and source records attributed to J Paul Willging.

15 recordsLinked to original sources

PubMed2005

Lingual cyst lined by squamous epithelium.

Lingual choristomas or foregut duplication cysts are infrequently reported congenital anomalies that typically present in the perinatal period, and can cause respiratory or feeding problems. These cysts are lined by epithelial cells characteristic of the upper aerodigestive tract. We describe two children who presented shortly after birth with lingual cysts lined with squamous epithelium and foci of respiratory epithelium. Unlike previously reported lingual choristomas, these cysts did not contain gastrointestinal epithelium. In both these cases, the lingual cysts were successfully excised via a transoral approach. This article will discuss the histological findings in these two cases, the differential diagnosis and attempt to classify these lesions in the context of existing terminology.

Adult↗

PubMed2005

Internet use by parents of children undergoing outpatient otolaryngology procedures.

OBJECTIVES: (1) To determine the prevalence of Internet medical information searches by parents prior to their child's surgical procedure, and (2) to evaluate whether Internet-based health information influences parents' medical decisions on behalf of their children. DESIGN: A questionnaire designed to gather information regarding preoperative use of the Internet by parents of children who were scheduled to undergo outpatient otolaryngology procedures. Parents were asked to respond to questions regarding Internet searches for information specific to their child's diagnosis and anticipated surgical procedure. SETTING: Tertiary care pediatric hospital. RESULTS: Internet access was available to 83% of respondents. Of those parents with Internet access, 48% searched the Internet for information regarding their child's diagnosis and surgical procedure. Of those who searched the Internet, 93% said they found information that was both understandable and helpful. More important, 84% of parents using the Internet said the information influenced or somewhat influenced the medical decisions they made on behalf of their child. Only 43% of parents discussed the information they found on the Internet with their child's surgeon. CONCLUSIONS: Approximately 50% of the parents in our study with Internet access used it to find medical information prior to their child's surgery. Parents who used the Internet found the information helpful and influential, although physicians remain the most important source of information that guides a parent or patient in their medical decision making. Ideally, surgeons would direct parents or patients to a few trusted Internet sites and be prepared to discuss this information.

Adolescent↗

PubMed2005

Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing.

Fiberoptic endoscopic evaluation of swallowing (FEES) was developed as an adjunct to the videofluoroscopic swallowing study and clinical examination of swallowing function in the adult. The sensory testing aspect of fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) utilizes an air pulse stimulus of mechanoreceptors within the larynx. The study can be performed safely in children as young as premature infants and in adults. Adequate levels of cooperation can be obtained in nearly all children requiring FEESST. No cases of laryngospasm or respiratory compromise have been encountered. FEESST was initially applied to patients with dysphagia. It is now used in the study of the effects of gastroesophageal reflux on the larynx and swallowing function. The extent of pooled secretions in the hypopharynx can be used as a surrogate measure of laryngopharyngeal sensory testing. When patients managed by FEESST were compared with patients managed by videofluoroscopic swallow studies, there were no statistical differences in the rates of pneumonia or pneumonia-free interval. A learning curve is present for the operator, but with basic endoscopic skills, FEESST is a skill within the scope of practice of most pediatric endoscopists.

Child↗

PubMed2005

Airway reconstruction in pediatric burn patients.

OBJECTIVE: Reconstruction of the laryngotracheal airway in pediatric burn victims has been described anecdotally as less successful than reconstruction performed in other populations. To evaluate this clinical impression, outcomes of laryngotracheal reconstruction (LTR) in pediatric burn victims were compared with a randomly selected, matched control population of children receiving LTR. DESIGN: Retrospective case control study. SUBJECTS: The records of 34 pediatric burn victims undergoing LTR were reviewed. A control group of 48 children undergoing LTR for acquired stenosis was randomly selected from a population matched for age and grade of stenosis. RESULTS: Decannulation rate after 1st procedure, number of open airway procedures required, and length of time after 1st procedure until decannulation were not significantly different between the 2 groups. Two deaths (both tracheostomy tube related) occurred in the burn group; 1 occurred in the control group. Two patients in the burn group and 3 patients in the control group remain tracheostomy tube dependent at least 1 year after the initial reconstructive attempt. CONCLUSIONS: Long-term outcomes of LTR in burn patients are not significantly different from outcomes of LTR in the pediatric acquired airway stenosis population.

Burns↗

PubMed2005

Altered laryngeal sensation: a potential cause of apnea of infancy.

Delayed maturation of respiratory control of breathing and the laryngeal adductor reflex (LAR) are commonly implicated in infant apnea. A swallow response occurs to remove the stimulus from the pharynx to prevent aspiration once the glottis reopens. Induction of apnea by poorly cleared endogenous upper airway secretions has been postulated to be a potential cause of infant apnea. Our purpose was to determine whether alteration in the LAR, an indicator of laryngeal sensation, and the presence of secretions influenced the responsiveness of the LAR in infants with apnea. The LAR was induced in 20 infants with apnea (median gestational age, 36.5 weeks) by application of air pulses of controlled duration (50 ms) and intensity (2.5 to 10 mm Hg) to the aryepiglottic fold. Twenty infants evaluated for upper respiratory tract anomalies were used as a comparison group (median gestational age, 39 weeks). The infants with apnea required higher-intensity stimuli (p < .001) to induce the LAR (6.2 +/- 1.6 mm Hg) than did the comparison group (4.3 +/- 1.0 mm Hg) and demonstrated poorer clearance of secretions (p < .001). These findings were significant even when we adjusted for postconceptional age at the time of the test (p = .007). The findings of this study suggest that decreased laryngeal sensitivity results in poor endogenous secretion clearance and that it may induce a prolonged glottic closure event to prevent aspiration. This closure may play a role in infant apnea.

Air Movements↗

PubMed2004

Nonoperative management of complete tracheal rings.

BACKGROUND: Children with complete tracheal rings are often challenging to manage. Most children will present early with a severely compromised airway and will require tracheal reconstruction. OBJECTIVE: To show that a small number of minimally symptomatic patients with complete tracheal rings experience airway growth over time and do not require tracheoplasty. DESIGN: A retrospective medical chart review over a 10-year period. SETTING: A tertiary care pediatric hospital. PATIENTS: Children (N = 10) with a diagnosis of complete tracheal rings, confirmed on bronchoscopy, who were observed for a minimum of 1 year prior to determining the need for tracheoplasty. MAIN OUTCOME MEASURES: Patient symptoms, bronchoscopic findings, airway size, and the progression of these over time. Other congenital anomalies, the reason for initial diagnosis, and the need for tracheoplasty were documented. RESULTS: The 10 patients in our series fell into the following 3 categories: 5 patients were minimally symptomatic or asymptomatic, showed bronchoscopic evidence of progressive airway growth, and did not require tracheoplasty; 2 patients had worsening symptoms of exercise intolerance, showed minimal airway growth, and ultimately required tracheoplasty; and 3 patients are still being clinically observed and may eventually require tracheoplasty. Periods of observation have varied from 1 year to over 12 years. CONCLUSIONS: Not all patients with complete tracheal rings require tracheoplasty. Some have satisfactory airway growth and do not require airway reconstruction. A period of observation to monitor airway growth and clinical symptoms is safe and may spare some patients from undergoing unwarranted airway reconstruction.

Airway Obstruction↗

PubMed2004

Chronic esophageal foreign bodies in pediatric patients: a retrospective review.

OBJECTIVE: Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. METHODS: We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week. RESULTS: Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series. CONCLUSIONS: Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.

Adolescent↗

PubMed2004

Intrapartum management of severe fetal airway obstruction.

OBJECTIVE: To review our experience with the planned intrapartum management of fetuses with suspected severe airway obstruction. METHODS: Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications. RESULTS: All cases (N = 11) at our tertiary airway referral institution between 1995 and 2002 were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases. CONCLUSIONS: Although full cesarean delivery of the fetus significantly reduces fetal-placental circulation times, in comparison with the formal ex utero intrapartum treatment (EXIT) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.

Airway Obstruction↗

PubMed2003

A rare case of combined type I and II first branchial sinus.

The authors report a rare case of first branchial sinus with combined Work's type I and type II characteristics. Instead of a sinus opening in the neck, this sinus opened above the angle of the jaw in the face. The facial nerve was significantly more superficial to the tympanomastoid suture line than normal. Early diagnosis, ensuring complete resection, and avoidance of facial nerve injury are challenging issues discussed here.

Branchial Region↗

PubMed2003

Harmonic scalpel tonsillectomy in children: a randomized prospective study.

OBJECTIVE: In this randomized prospective study, we evaluated postoperative morbidity after use of the Harmonic Scalpel (HS), an ultrasonic dissector coagulator (Ethicon Endo-Surgery Inc, Cincinnati, OH), or conventional electrocautery (EC) during tonsillectomy. STUDY DESIGN AND SETTINGS: Pediatric subjects at 2 sites were randomized and underwent tonsillectomy. Intraoperative blood loss and operation duration were recorded. Postoperative parameters and complications were recorded. RESULTS: One hundred seventeen subjects completed the study. For the HS group, mean operative time was significantly longer (P < 0.001), but intraoperative blood loss was equivalent (P = 1.000). HS subjects slept soundly on postoperative days 1, 2, 3, and 14 (P = 0.041, 0.013, 0.022, and 0.038, respectively, compared with EC group). Mean postoperative pain scores trended lower for HS subjects on postoperative days 2, 3, and 4. CONCLUSION: The use of the HS in pediatric tonsillectomy showed no increase in intraoperative or postoperative blood loss compared with the use of EC, and HS provided possible clinical advantages over EC in patient comfort. SIGNIFICANCE: Tonsillectomy subjects in the HS group showed a statistically significant ability to sleep soundly, suggesting that the subjects experienced less pain. These data correlate with the observed decrease in pain scores.

Blood Loss, Surgical↗

PubMed2003

Velopharyngeal insufficiency.

PURPOSE OF REVIEW: Velopharyngeal insufficiency is a niche within our specialty, but patients with hypernasality present who have never been diagnosed previously. Otolaryngologists should be familiar with current trends in diagnosis and treatment of hypernasality. RECENT FINDINGS: Velopharyngeal insufficiency has been associated with genetic conditions and identifiable syndromes. Multiple surgical techniques are available for the treatment of this condition, the results of which vary widely in the literature. There is difficulty in interpreting the success of surgical outcomes on speech intelligibility and resonance because of the heterogeneity of the patient population and the subjective nature of assessing results. More studies are now available for the evaluation of associations of comorbid conditions and their impact on speech results. SUMMARY: Velopharyngeal insufficiency must be diagnosed properly. Syndromes and comorbid conditions must be identified. No single specialty can care appropriately for these patients. A team approach is the ideal method of evaluating and managing patients with velopharyngeal insufficiency. Specialists with a particular interest and training in the management of patients with clefts of the palate and velopharyngeal insufficiency must collaborate to obtain the maximal functional outcome for these patients.

Adenoidectomy↗

PubMed2003

Surgery for pediatric vocal cord paralysis: a retrospective review.

To determine the outcome of surgical procedures for bilateral vocal cord paralysis in children, we performed a retrospective review of children under 18 years of age with bilateral vocal cord paralysis and a previous tracheotomy who underwent a primary procedure at a single tertiary care institution with an aim of decannulation. The primary outcome measure was the operation-specific decannulation rate (OSDR). The overall decannulation rates, as well as morbidity rates, were also recorded. Fifty-two children met the inclusion criteria (mean age at time of primary surgery, 6.2 years; SD, 5 years). Vocal cord lateralization procedures combined with a partial arytenoidectomy achieved the highest OSDR (17/24 or 71%). This OSDR was statistically higher than the OSDRs for CO2 laser cordotomy or arytenoidectomy procedures (OSDR, 5/17 or 29%, p = .008), for isolated arytenoidopexy procedures (OSDR, 1/4 or 25%, p = .000004), or for posterior costal cartilage graft procedures (OSDR, 3/5 or 60%, p = .0004). Neither of the 2 children who underwent isolated arytenoidectomy achieved primary decannulation. The incidence of aspiration following posterior cartilage graft procedures was 15% (2/15). Subanalysis by age failed to reveal differences in OSDR. We conclude that vocal cord lateralization procedures with partial arytenoidectomy afford the highest OSDR among primary procedures for pediatric vocal cord paralysis. The CO2 laser procedures, while having limited success as a primary procedure, are effective for revision.

Adolescent↗

PubMed2002

Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea.

Obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease in adults. However, there are severe limitations in the extent to which the cardiovascular consequences of OSA are being studied in children. To investigate the echocardiographic changes in children with OSA, right and left ventricular (RV, LV) dimensions and LV mass index and geometry were measured in 28 children with OSA and 19 children with primary snoring (PS). The study showed that LV mass index and relative wall thickness were greater in the OSA group compared with those with PS (p = 0.012 and p < 0.0001, respectively). An apnea-hypopnea index of more than 10 per hour was significantly associated with RV dimension above the 95th percentile (odds ratios, 6.7; 95% confidence interval, 1.4-32) and LV mass index above the 95th percentile (odds ratios, 11.2; confidence interval, 1.9-64). Abnormality of LV geometry was present in 15% of children with PS compared with 39% of children with OSA. We conclude that OSA in children is associated with increased LV mass.

Adolescent↗

PubMed2002

Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm.

OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. PATIENTS: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.

Abnormalities, Multiple↗

PubMed2002

Harmonic scalpel for tonsillectomy.

OBJECTIVE: To describe the Harmonic scalpel and review recent studies comparing its use in tonsillectomy with standard dissection and electrocautery. STUDY DESIGN: Review. METHODS: The Harmonic scalpel uses ultrasonic technology to cut and coagulate tissues at lower temperatures than those associated with electrocautery and lasers. Studies of the use of this device have assessed its performance with respect to intraoperative blood loss, postoperative hemorrhage, and postoperative pain. RESULTS: Intraoperative blood loss and episodes of postoperative hemorrhages have been found to be minimal in patients in whom the Harmonic scalpel was used for tonsillectomy. The device also appears to be associated with a reduction in postoperative pain. CONCLUSION: Use of the Harmonic scalpel for tonsillectomy may have several advantages over standard methods.

Child↗