Biomedical subjects

Shyan Vijayasekaran

Publications and source records attributed to Shyan Vijayasekaran.

5 recordsLinked to original sources

PubMed2006

Salivary gland surgery for chronic pulmonary aspiration in children.

INTRODUCTION: Chronic aspiration in the neurologically impaired child has a considerable morbidity and occasional morbidity. Hospitalization, physician visits and health costs associated with the sequelae of aspiration are considerable. AIM: To assess the efficacy of salivary gland surgery to treat chronic aspiration in children. SETTING: Tertiary pediatric center. STUDY DESIGN: A 6 year retrospective chart review of all patients undergoing salivary gland surgery to treat chronic aspiration. OUTCOME PARAMETERS: (1) Rate of lower respiratory tract infection (LRTI); (2) baseline oxygen saturation pre- and post-surgery. RESULTS: Sixty-two patients aged 7-279 months (mean 68 months) underwent four duct ligation or bilateral submandibular gland excision with unilateral or bilateral parotid duct ligation. The mean rate was 1.2/year pre-operatively and 0.7/year post-operatively (p=0.6). There was, however, a significant improvement in the baseline post-operative oxygen saturation (mean 94.3%) when compared to the pre-operative baseline oxygen saturation (mean 92.8%, p=0.003). Analysis of the cerebral palsy subgroup was performed (n=13). In this group there was no difference between mean pre- and post-operative LRTI rate (p=0.5) nor change in baseline oxygen saturation (p=0.83). Children under 3 years of age showed a reduction in the LRTI rate (mean of 2.1 versus 0.7 episodes per year, p=0.04) and an improvement in the post-operative baseline oxygen saturation (p=0.001) following surgery. CONCLUSIONS: Unlike a previous publication from this institution, when evaluating the population sample as a whole, there was no significant improvement in the rate of LRTI following salivary gland surgery, however, there was an improvement in baseline oxygen saturation, possibly reflecting an improvement in lung function. There was an improvement in neither outcome parameter in children with cerebral palsy and improvements in both outcome measures in children under the age of 3.

Adolescent↗

PubMed2006

Deficient tracheal rings.

Deficient cartilaginous rings are an extremely rare intrinsic tracheal defect. To our knowledge, only two cases have previously been reported in the literature. We describe our experience with three patients presenting with this unusual defect causing severe tracheomalacia who were successfully managed with slide-tracheoplasty. With respect to correction of the stenotic tracheal segment, our clinical outcomes were excellent. Dissimilarities in medical history suggest that the origin of deficient tracheal rings can be either congenital or acquired.

Child, Preschool↗

PubMed2006

Management of choanal atresia in CHARGE association patients: a retrospective review.

RATIONALE: To examine the management and outcomes of choanal atresia in children with CHARGE association compared with non-CHARGE children. METHODS: This is a retrospective chart review at a tertiary care children's hospital examining the management and outcomes of choanal atresia repair in children with CHARGE from 1990-2005. At least two CHARGE features were used to define these children. Children with CHARGE association were compared with non-CHARGE children regarding type of atresia, method of repair, post-operative management, re-stenosis rate and revision surgery. RESULTS: Fifty-seven children (36 female, 21 male) with complete records were identified with 24% diagnosed with CHARGE association. The median age of primary repair was 0.75 months for CHARGE and 15 months for non-CHARGE children (p=0.047). Unilateral atresia was diagnosed in 36% of CHARGE children and 81% of non-CHARGE children. Bilateral atresia was diagnosed in 64% of CHARGE and 19% of non-CHARGE children (p=0.006). The median duration of stent placement was slightly longer in the CHARGE group with no difference in the median number of post-operative dilations. Of those with CHARGE, 36% required revision surgery compared to 44% of the non-CHARGE subjects (p=0.58). Of those undergoing primary transnasal repairs, 40% of the CHARGE and 37% of the non-CHARGE patients failed. 50% of CHARGE patients with primary transnasal repair for bilateral atresia failed. Only 25% of transpalatal CHARGE repairs failed, while 75% of transpalatal repairs failed in the non-CHARGE group. The median follow-up was 24.6 months for CHARGE and 24.9 months for non-CHARGE patients. CONCLUSIONS: Children with CHARGE and unilateral choanal atresia can be managed successfully with a transnasal approach. However, our data, as well as prior published reports, suggests that CHARGE patients with bilateral atresia should have primary transpalatal repairs due to the high failure rate with the transnasal approach in this population.

Case-Control Studies↗

PubMed2006

Changes in the cricoarytenoid joint induced by intubation in neonates.

OBJECTIVE: To characterize the histopathologic characteristics of the cricoarytenoid joint (CAJ) as a means to understand the mechanisms of vocal cord fixation in children after prolonged intubation. DESIGN: Histologic analysis of laryngeal specimens obtained from infants who had died secondary to various causes and who had been intubated from 1 to 30 days. MAIN OUTCOME MEASURE: Histopathologic characteristics of CAJ. RESULTS: Laryngeal specimens from infants who had been intubated for prolonged periods of time demonstrated evidence of hemorrhage, infection, inflammation, and fibrosis within the CAJ. Furthermore, a statistical correlation was found between the length of intubation and the presence of these histologic abnormalities. CONCLUSIONS: To our knowledge, this is the first study to demonstrate histologic changes in the CAJ in laryngeal specimens of children who have been intubated for prolonged periods of time. Such histological changes in the CAJ could explain the mechanism of vocal cord immobility in children after intubation.

Arytenoid Cartilage↗

PubMed2006

Open excision of subglottic hemangiomas to avoid tracheostomy.

OBJECTIVE: To assess the efficacy of open excision as an alternative to tracheostomy in the management of subglottic hemangioma. DESIGN: A retrospective review of patients undergoing open surgical excision of subglottic hemangiomas over a 10-year period. SETTING: A tertiary pediatric center. PATIENTS: The study included 22 children ranging in age from 2 to 42 months (median age, 5 months) who underwent open excision of subglottic hemangioma over a 10-year period. RESULTS: Twenty-one patients were treated with single-stage procedures, with postoperative endotracheal intubation for an average of 5 days. One patient who had a preexisting tracheostomy was treated with a 2-stage procedure and underwent decannulation 2 months after excision. Seven other patients were tracheostomy dependent at the time of excision and underwent decannulation at the time of the procedure. Cartilage grafts were inserted in 10 patients. There were no problems with subglottic stenosis. Twenty-one patients reported good voice and no airway symptoms after a mean follow-up period of 42 months. Five patients had significant postoperative problems. Three patients required further endoscopic procedures for removal of granulation tissue, and 1 patient, who remains minimally symptomatic, developed an anterior glottic web. One patient required a 6-month course of steroids after surgery to treat residual glottic hemangioma. CONCLUSIONS: Open surgical excision of subglottic hemangiomas can be performed as a single procedure, avoiding a tracheostomy, when modern surgical techniques developed for laryngotracheal reconstruction are incorporated. This approach can avoid repeated endoscopic procedures, prolonged treatment with corticosteroids, and years spent with a tracheostomy waiting for spontaneous involution of the hemangioma.

Child, Preschool↗