Pub Date : 2024-12-01DOI: 10.1016/j.ijporl.2024.112141
Wenshan Xing , Jiao Zhang , Tun Liu , Yue Wang , Jin Qian , Bingqing Wang , Yongbiao Zhang ([email protected]) , Qingguo Zhang
<div><h3>Background</h3><div>Microtia is a prevalent congenital malformation, the precise etiology and pathogenesis of which remain elusive. Mutations in the non-coding region of the <em>HMX1</em> gene have been implicated in isolated cases of microtia, emerging as a significant focus of contemporary research. Several pathogenic copy number variations (CNVs) proximal to the <em>HMX1</em> gene have been documented in wild animal populations, whereas only a single large segmental duplication in this region has been identified in humans. However, the absence of a gene-edited animal model has impeded the investigation of the unclear gene function associated with <em>HMX1</em> mutations in human isolated microtia. In this study, we sought to precisely identify the pathogenic mutation by analyzing three pedigrees alongside population controls. Subsequently, our objective was to develop a CRISPR/Cas9 gene-edited mouse model to elucidate the functional implications of the identified mutation.</div></div><div><h3>Methods</h3><div>Genomic DNA was collected from 32 affected individuals across three pedigrees, as well as from 2000 control subjects. Comprehensive genomic analyses, including genome-wide linkage analysis, targeted capture, second-generation sequencing, and copy number analysis, were conducted to identify potential mutations associated with congenital auricle malformation. CRISPR/Cas9 gene-edited murine models were generated in response to the identified mutation. The auricular phenotypes of these gene-edited mice were systematically monitored. Small-animal Micro-CT scanning was employed to identify potential craniofacial or skeletal abnormalities. Furthermore, the expression of the <em>HMX1</em> gene in the PA2 region of mouse embryos was quantified using RT-qPCR.</div></div><div><h3>Results</h3><div>A co-segregated 600 base pair duplication located on chromosome 4 (chr4:8701900-8702500, hg19) was identified in affected individuals across three pedigrees, but was absent in healthy controls. Two types of CRISPR/Cas9 gene-edited mice were subsequently generated. The knock-in (KI) mouse model was engineered by inserting one copy of the duplicated sequence directly adjacent to the mutated site, whereas the knockout (KO) mouse model was created by excising the mutation sequence. The phenotypes of different group of CRISPR/Cas9 gene-edited mice demonstrated distinct auricular deformities. Furthermore, an increase in the copy number of the mutated sequence was associated with elevated expression levels of <em>HMX1</em> in the gene-edited mouse model.</div></div><div><h3>Conclusions</h3><div>In this study, we further narrowed down and identified a 600 base pair copy number variation (CNV) located at chr4:8701900-8702500 (hg19), which is implicated in human bilateral, isolated microtia. Utilizing CRISPR/Cas9 technology, we developed novel mouse models harboring the identified mutation. These models serve as a robust platform for the comprehensive invest
{"title":"An innovative CRISPR/Cas9 mouse model of human isolated microtia indicates the potential contribution of CNVs near HMX1 gene","authors":"Wenshan Xing , Jiao Zhang , Tun Liu , Yue Wang , Jin Qian , Bingqing Wang , Yongbiao Zhang ([email protected]) , Qingguo Zhang","doi":"10.1016/j.ijporl.2024.112141","DOIUrl":"10.1016/j.ijporl.2024.112141","url":null,"abstract":"<div><h3>Background</h3><div>Microtia is a prevalent congenital malformation, the precise etiology and pathogenesis of which remain elusive. Mutations in the non-coding region of the <em>HMX1</em> gene have been implicated in isolated cases of microtia, emerging as a significant focus of contemporary research. Several pathogenic copy number variations (CNVs) proximal to the <em>HMX1</em> gene have been documented in wild animal populations, whereas only a single large segmental duplication in this region has been identified in humans. However, the absence of a gene-edited animal model has impeded the investigation of the unclear gene function associated with <em>HMX1</em> mutations in human isolated microtia. In this study, we sought to precisely identify the pathogenic mutation by analyzing three pedigrees alongside population controls. Subsequently, our objective was to develop a CRISPR/Cas9 gene-edited mouse model to elucidate the functional implications of the identified mutation.</div></div><div><h3>Methods</h3><div>Genomic DNA was collected from 32 affected individuals across three pedigrees, as well as from 2000 control subjects. Comprehensive genomic analyses, including genome-wide linkage analysis, targeted capture, second-generation sequencing, and copy number analysis, were conducted to identify potential mutations associated with congenital auricle malformation. CRISPR/Cas9 gene-edited murine models were generated in response to the identified mutation. The auricular phenotypes of these gene-edited mice were systematically monitored. Small-animal Micro-CT scanning was employed to identify potential craniofacial or skeletal abnormalities. Furthermore, the expression of the <em>HMX1</em> gene in the PA2 region of mouse embryos was quantified using RT-qPCR.</div></div><div><h3>Results</h3><div>A co-segregated 600 base pair duplication located on chromosome 4 (chr4:8701900-8702500, hg19) was identified in affected individuals across three pedigrees, but was absent in healthy controls. Two types of CRISPR/Cas9 gene-edited mice were subsequently generated. The knock-in (KI) mouse model was engineered by inserting one copy of the duplicated sequence directly adjacent to the mutated site, whereas the knockout (KO) mouse model was created by excising the mutation sequence. The phenotypes of different group of CRISPR/Cas9 gene-edited mice demonstrated distinct auricular deformities. Furthermore, an increase in the copy number of the mutated sequence was associated with elevated expression levels of <em>HMX1</em> in the gene-edited mouse model.</div></div><div><h3>Conclusions</h3><div>In this study, we further narrowed down and identified a 600 base pair copy number variation (CNV) located at chr4:8701900-8702500 (hg19), which is implicated in human bilateral, isolated microtia. Utilizing CRISPR/Cas9 technology, we developed novel mouse models harboring the identified mutation. These models serve as a robust platform for the comprehensive invest","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112141"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-26DOI: 10.1016/j.ijporl.2024.112176
Elysia Grose , Jenny B. Xiao , Evan Fang , Brigitte Routhier-Chevrier , Jennifer M. Siu , Nikolaus E. Wolter
Objective
This review aims to elucidate the role of endoscopic sinus surgery (ESS) on the outcomes of pediatric patients with sinogenic intracranial infections.
Methods
MEDLINE, Embase, and the Cochrane library were searched for articles that described the outcomes in pediatric patients who had intracranial complications of acute rhinosinusitis (ARS) and underwent ESS with or without open neurosurgical approaches (ONA) or external sinus approaches (ESA). Primary outcomes of interest include mortality, revision surgery, length of stay and neurological sequelae. Random effects meta-analysis was performed.
Results
Forty-eight articles met the final eligibility criteria, totaling 710 pediatric patients and 905 intracranial complications. The most common complications were subdural empyema (n = 261, 29 %), epidural abscess (n = 213, 24 %), and Pott's Puffy tumor (PPT) (n = 95, 10 %). When comparing patients who underwent ESS (alone or combined with ONA) to those who underwent ONA only, there was a decreased risk of revision surgery (RR = 0.66, 95 % CI = 0.38–1.12 and RR = 0.63, 95 % CI = 0.36–1.09, respectively) and decreased risk of neurological sequelae (RR = 0.65, 95 % CI = 0.15–2.74 and RR = 0.50, 95 % CI = 0.20–1.26, respectively), however these differences were not statistically significant. When patients who underwent combined intervention were compared to ESS only, the risk of revision surgery (RR = 1.04, 95 % CI = 0.62–1.72) and neurological sequelae (RR = 0.99, 95 % CI = 0.37–2.64) were similar. Risk of mortality was minimal and similar across all interventions.
Conclusion
The current study including primarily small retrospective studies found no statistically significant differences between children who received ESS alone, ESS with ONA or ONA alone, on mortality, revision surgery, length of stay and neurological sequelae. Although ESS may be beneficial for managing certain pediatric sinogenic intracranial infections, its true effectiveness is difficult to determine due to the variability in the types of intracranial complications and the inconsistent extent of ESS procedures reported in the literature.
{"title":"The impact of endoscopic sinus surgery in pediatric patients with sinogenic intracranial infection: A systematic review and meta-analysis","authors":"Elysia Grose , Jenny B. Xiao , Evan Fang , Brigitte Routhier-Chevrier , Jennifer M. Siu , Nikolaus E. Wolter","doi":"10.1016/j.ijporl.2024.112176","DOIUrl":"10.1016/j.ijporl.2024.112176","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to elucidate the role of endoscopic sinus surgery (ESS) on the outcomes of pediatric patients with sinogenic intracranial infections.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and the Cochrane library were searched for articles that described the outcomes in pediatric patients who had intracranial complications of acute rhinosinusitis (ARS) and underwent ESS with or without open neurosurgical approaches (ONA) or external sinus approaches (ESA). Primary outcomes of interest include mortality, revision surgery, length of stay and neurological sequelae. Random effects meta-analysis was performed.</div></div><div><h3>Results</h3><div>Forty-eight articles met the final eligibility criteria, totaling 710 pediatric patients and 905 intracranial complications. The most common complications were subdural empyema (n = 261, 29 %), epidural abscess (n = 213, 24 %), and Pott's Puffy tumor (PPT) (n = 95, 10 %). When comparing patients who underwent ESS (alone or combined with ONA) to those who underwent ONA only, there was a decreased risk of revision surgery (RR = 0.66, 95 % CI = 0.38–1.12 and RR = 0.63, 95 % CI = 0.36–1.09, respectively) and decreased risk of neurological sequelae (RR = 0.65, 95 % CI = 0.15–2.74 and RR = 0.50, 95 % CI = 0.20–1.26, respectively), however these differences were not statistically significant. When patients who underwent combined intervention were compared to ESS only, the risk of revision surgery (RR = 1.04, 95 % CI = 0.62–1.72) and neurological sequelae (RR = 0.99, 95 % CI = 0.37–2.64) were similar. Risk of mortality was minimal and similar across all interventions.</div></div><div><h3>Conclusion</h3><div>The current study including primarily small retrospective studies found no statistically significant differences between children who received ESS alone, ESS with ONA or ONA alone, on mortality, revision surgery, length of stay and neurological sequelae. Although ESS may be beneficial for managing certain pediatric sinogenic intracranial infections, its true effectiveness is difficult to determine due to the variability in the types of intracranial complications and the inconsistent extent of ESS procedures reported in the literature.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112176"},"PeriodicalIF":1.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.ijporl.2024.112175
Drew C. Gottman , Michaele Francesco Corbisiero , Arman Saeedi , Samantha Bothwell , Ellie Svoboda , Andy Ai , Soham Roy
Background
Robotic-assisted surgery is increasingly used in pediatric otolaryngology, offering potential benefits like improved cosmetic outcomes. However, challenges such as longer operative times, higher costs, and a steep learning curve remain.
Objectives
This systematic review and meta-analysis assess whether robotic-assisted surgery offers advantages in operative time, complication rates, hospital stay, and cosmetic outcomes compared to traditional methods in pediatric patients.
Methods
A literature search identified 20 studies, with six focused on thyroidectomy. Data on operative time, complications, hospital stay, and cosmetic outcomes were extracted and analyzed.
Results
No significant differences in operative time or complications were found for robotic-assisted thyroidectomy, but it showed superior cosmetic outcomes and, in some cases, shorter hospital stays. Additional analyses suggested feasibility and functional benefits of other robotic procedures.
Conclusions
Robotic-assisted surgery in pediatric otolaryngology is as safe and efficient as traditional methods, with added cosmetic and functional benefits. Further large-scale trials are needed.
{"title":"Assessing robotic-assisted procedures in pediatric otolaryngology: A systematic review and meta-analysis","authors":"Drew C. Gottman , Michaele Francesco Corbisiero , Arman Saeedi , Samantha Bothwell , Ellie Svoboda , Andy Ai , Soham Roy","doi":"10.1016/j.ijporl.2024.112175","DOIUrl":"10.1016/j.ijporl.2024.112175","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assisted surgery is increasingly used in pediatric otolaryngology, offering potential benefits like improved cosmetic outcomes. However, challenges such as longer operative times, higher costs, and a steep learning curve remain.</div></div><div><h3>Objectives</h3><div>This systematic review and meta-analysis assess whether robotic-assisted surgery offers advantages in operative time, complication rates, hospital stay, and cosmetic outcomes compared to traditional methods in pediatric patients.</div></div><div><h3>Methods</h3><div>A literature search identified 20 studies, with six focused on thyroidectomy. Data on operative time, complications, hospital stay, and cosmetic outcomes were extracted and analyzed.</div></div><div><h3>Results</h3><div>No significant differences in operative time or complications were found for robotic-assisted thyroidectomy, but it showed superior cosmetic outcomes and, in some cases, shorter hospital stays. Additional analyses suggested feasibility and functional benefits of other robotic procedures.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted surgery in pediatric otolaryngology is as safe and efficient as traditional methods, with added cosmetic and functional benefits. Further large-scale trials are needed.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112175"},"PeriodicalIF":1.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.ijporl.2024.112169
Yi Zhang , Yan Li , Rui Zhang , Lin Zhong , Lina Chen
Objective
To summarize the clinical characteristics and risk factors of occult foreign body aspiration (FBA) in children, which can help with early diagnosis and timely intervention, potentially preventing further exacerbations.
Methods
We retrospectively analyzed the clinical data of the children with a final diagnosis of FBA by flexible bronchoscopy in our hospital from 2017 to 2023. The patients were divided into occult and typical groups, and two groups were compared. Multivariate binary logistic regression analysis was employed to identify risk factors associated with the occurrence of occult FBA.
Results
Among 1031 patients, the incidence of occult FBA was 4.3 % (44 cases). Compared to the typical group, children in the occult group had higher odds of ventilator management (P = .006) and longer postoperative hospitalization time (P < .001). Risk factors for predicting occult FBA were identified as age greater than 3 years old [OR: 6. 918; 95%CI (3.150–15.191)], fever [OR: 2.323; 95%CI (1.092–4.939)], inspiratory laryngeal stridor [OR: 6.514; 95%CI (1.863–22.781)], atelectasis [OR: 3.372; 95%CI (1.418–8.020)], and infiltration [OR: 2.749; 95%CI (1.195–6.323)].
Conclusions
Unlike typical FBA, the diagnosis of occult FBA is far more challenging, and occult foreign bodies are linked to a further exacerbation. This study identifies a few risk factors that have the potential to facilitate an early diagnosis of occult FBA in children. Further multicenter studies should be conducted to validate the findings.
{"title":"The characteristics of occult foreign body aspiration and predicting factors in children","authors":"Yi Zhang , Yan Li , Rui Zhang , Lin Zhong , Lina Chen","doi":"10.1016/j.ijporl.2024.112169","DOIUrl":"10.1016/j.ijporl.2024.112169","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize the clinical characteristics and risk factors of occult foreign body aspiration (FBA) in children, which can help with early diagnosis and timely intervention, potentially preventing further exacerbations.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the clinical data of the children with a final diagnosis of FBA by flexible bronchoscopy in our hospital from 2017 to 2023. The patients were divided into occult and typical groups, and two groups were compared. Multivariate binary logistic regression analysis was employed to identify risk factors associated with the occurrence of occult FBA.</div></div><div><h3>Results</h3><div>Among 1031 patients, the incidence of occult FBA was 4.3 % (44 cases). Compared to the typical group, children in the occult group had higher odds of ventilator management (P = .006) and longer postoperative hospitalization time (P < .001). Risk factors for predicting occult FBA were identified as age greater than 3 years old [OR: 6. 918; 95%CI (3.150–15.191)], fever [OR: 2.323; 95%CI (1.092–4.939)], inspiratory laryngeal stridor [OR: 6.514; 95%CI (1.863–22.781)], atelectasis [OR: 3.372; 95%CI (1.418–8.020)], and infiltration [OR: 2.749; 95%CI (1.195–6.323)].</div></div><div><h3>Conclusions</h3><div>Unlike typical FBA, the diagnosis of occult FBA is far more challenging, and occult foreign bodies are linked to a further exacerbation. This study identifies a few risk factors that have the potential to facilitate an early diagnosis of occult FBA in children. Further multicenter studies should be conducted to validate the findings.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112169"},"PeriodicalIF":1.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.ijporl.2024.112170
Soorya Todatry , Robert Newsom , James Wald , Manuela Fina
Introduction
This study aims to assess the utility of the European Academy of Otology & Neurotology – Japanese Otologic Society (EAONO-JOS) and Potsic staging systems in predicting recidivism in pediatric patients with congenital (CC), primary acquired (PA), and secondary acquired (SA) cholesteatoma.
Methods
This is a retrospective study on 31 ears from 30 pediatric patients (≤18 years old) treated from 2015 to 2023 for CC, PA, and SA cholesteatoma. Surgical ears were classified according to EAONO-JOS and Potsic staging system. Surgery included transcanal endoscopic ear surgery (TEES), canal-wall up (CWU) or canal-wall down (CWD) mastoidectomy. Primary outcomes included the rate of residual disease at second-look surgery and the rate of recurrence at clinical observation. In addition, stapes erosion, incus erosion, labyrinthine fistula, and extension of disease in the mastoid at primary surgery were investigated for predictivity for recidivism. Descriptive statistics, Kaplan-Meier estimators (KM), and Fisher's Exact tests were used for statistical analysis.
Results
Based on EAONO-JOS staging, the majority (87 %) of cholesteatoma were stage II (100 % for CC, 86.7 % for PA, and 60 % for SA). The rate of residual disease was 45 % for CC, 60 % for PA, and 40 % for SA cholesteatoma. The rate of recurrent disease among the entire cohort was 6.5 %. Univariate analysis on stapes or incus erosion or mastoid extension did not predict residual disease. Within the CC cohort, outcomes suggest a potential correlation between Potsic stage and the risk of residual disease. Insufficient variability in EAONO-JOS stages precluded statistical analysis of the system's ability to predict residual disease. Among the EAONO-JOS stage II cases, those presenting with all three variables (mastoid extension, incus erosion, and stapes erosion) at primary surgery had lower KM survivability (p = 0.010). The type of surgery was predictive of residual disease: CWU was associated with a lower KM survivability compared to TEES (p = .009). CWD was not predictive, given the insufficient sample size. Among all ears, 58 % were managed with TEES.
Conclusions
In this limited cohort of pediatric CC, PA, and SA cholesteatoma, the majority of cases were managed with TEES. Among EAONO-JOS stage II cases, the simultaneous presence of mastoid extension, incus erosion, and stapes erosion at primary surgery demonstrated statistically significant decreased residual-free survivability; TEES approach at primary surgery also has a statistically significant improved residual-free survivability compared to CWU approach.
简介：本研究旨在评估欧洲耳科与神经耳科学会-日本耳科学会（EAONO-JOS）和Potsic分期系统在预测先天性（CC）、原发性获得性（PA）和继发性获得性（SA）胆脂瘤儿科患者复发率方面的实用性：这是一项回顾性研究，研究对象是2015年至2023年期间接受CC、PA和SA胆脂瘤治疗的30名儿科患者（≤18岁）的31只耳朵。手术耳根据 EAONO-JOS 和 Potsic 分期系统进行分类。手术包括经耳道内窥镜耳科手术（TEES）、管壁向上（CWU）或管壁向下（CWD）乳突切除术。主要结果包括二诊手术的残留率和临床观察的复发率。此外，还调查了镫骨糜烂、切迹糜烂、迷宫瘘管和乳突内疾病在初次手术时的扩展情况，以预测复发率。统计分析采用了描述性统计、卡普兰-梅耶估计器（KM）和费雪精确检验：根据EAONO-JOS分期，大多数胆脂瘤（87%）为II期（CC为100%，PA为86.7%，SA为60%）。CC、PA 和 SA 胆脂瘤的残留率分别为 45%、60% 和 40%。整个队列中疾病复发率为 6.5%。对镫骨或切迹糜烂或乳突扩展的单变量分析不能预测残留疾病。在CC队列中，结果表明Potsic分期与残留疾病风险之间存在潜在的相关性。由于EAONO-JOS分期的变异性不足，因此无法对该系统预测残留疾病的能力进行统计分析。在 EAONO-JOS II 期病例中，初次手术时出现所有三个变量（乳突扩展、切迹糜烂和镫骨糜烂）的病例的 KM 存活率较低（P = 0.010）。手术类型可预测残留疾病：与 TEES 相比，CWU 与较低的 KM 存活率相关（p = 0.009）。由于样本量不足，CWD 并不具有预测性。在所有病例中，58%的病例接受了TEES治疗：结论：在这批有限的小儿CC、PA和SA胆脂瘤患者中，大多数病例都采用了TEES治疗。在EAONO-JOS II期病例中，初次手术时同时存在乳突扩展、切迹糜烂和镫骨糜烂的病例，其无残留存活率在统计学上显著下降；与CWU方法相比，初次手术时采用TEES方法也在统计学上显著提高了无残留存活率。
{"title":"Comparison of current staging systems for predicting pediatric cholesteatoma outcomes","authors":"Soorya Todatry , Robert Newsom , James Wald , Manuela Fina","doi":"10.1016/j.ijporl.2024.112170","DOIUrl":"10.1016/j.ijporl.2024.112170","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to assess the utility of the European Academy of Otology & Neurotology – Japanese Otologic Society (EAONO-JOS) and Potsic staging systems in predicting recidivism in pediatric patients with congenital (CC), primary acquired (PA), and secondary acquired (SA) cholesteatoma.</div></div><div><h3>Methods</h3><div>This is a retrospective study on 31 ears from 30 pediatric patients (≤18 years old) treated from 2015 to 2023 for CC, PA, and SA cholesteatoma. Surgical ears were classified according to EAONO-JOS and Potsic staging system. Surgery included transcanal endoscopic ear surgery (TEES), canal-wall up (CWU) or canal-wall down (CWD) mastoidectomy. Primary outcomes included the rate of residual disease at second-look surgery and the rate of recurrence at clinical observation. In addition, stapes erosion, incus erosion, labyrinthine fistula, and extension of disease in the mastoid at primary surgery were investigated for predictivity for recidivism. Descriptive statistics, Kaplan-Meier estimators (KM), and Fisher's Exact tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Based on EAONO-JOS staging, the majority (87 %) of cholesteatoma were stage II (100 % for CC, 86.7 % for PA, and 60 % for SA). The rate of residual disease was 45 % for CC, 60 % for PA, and 40 % for SA cholesteatoma. The rate of recurrent disease among the entire cohort was 6.5 %. Univariate analysis on stapes or incus erosion or mastoid extension did not predict residual disease. Within the CC cohort, outcomes suggest a potential correlation between Potsic stage and the risk of residual disease. Insufficient variability in EAONO-JOS stages precluded statistical analysis of the system's ability to predict residual disease. Among the EAONO-JOS stage II cases, those presenting with all three variables (mastoid extension, incus erosion, and stapes erosion) at primary surgery had lower KM survivability (p = 0.010). The type of surgery was predictive of residual disease: CWU was associated with a lower KM survivability compared to TEES (p = .009). CWD was not predictive, given the insufficient sample size. Among all ears, 58 % were managed with TEES.</div></div><div><h3>Conclusions</h3><div>In this limited cohort of pediatric CC, PA, and SA cholesteatoma, the majority of cases were managed with TEES. Among EAONO-JOS stage II cases, the simultaneous presence of mastoid extension, incus erosion, and stapes erosion at primary surgery demonstrated statistically significant decreased residual-free survivability; TEES approach at primary surgery also has a statistically significant improved residual-free survivability compared to CWU approach.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112170"},"PeriodicalIF":1.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.ijporl.2024.112171
Anuj Kumar Neupane, C.S. Vanaja
Objectives
Voice onset time (VOT) has been identified as a potential temporal cue for predicting children's performance in speech-in-noise tasks, yet the relationship between these two factors has never been explored among children using CI. Hence, the present study aimed to explore the performance of children using CI on temporal cue-based syllable categorization test and speech perception in noise and examine the relationship between the two.
Methods
Temporal cue-based syllable categorization test was developed with the manipulation of /ba/ sound in 10 steps continuum with VOT varied between −74 ms to 26 ms. The developed test and revised speech in noise for Marathi-speaking children (0 and 5 dB SNR) were administered to thirty children with unilateral cochlear implant and thirty children with normal hearing, aged between 5 to 7 years.
Results
The Mann-Whitney U test showed significant differences between groups in temporal cue-based categorization and speech in noise tests at 0 dB and 5 dB SNR. Kendall Tau B revealed a moderate correlation between implant age and scores on the temporal cue-based categorization and speech in noise tests at 0 dB SNR, with a strong correlation at 5 dB SNR. Additionally, there was a significant moderate relationship between temporal cue-based categorization and speech in noise test scores at both 0 dB and 5 dB SNR.
Conclusion
The present study highlights the importance of temporal cues in speech perception and the need for temporal processing for children using cochlear implants. It reinforces the evidence that speech perception skills improve with implant age.
研究目的发声时间（VOT）被认为是预测儿童在噪声语音任务中表现的潜在时间线索，但使用 CI 的儿童从未探讨过这两个因素之间的关系。因此，本研究旨在探讨使用 CI 的儿童在基于时间线索的音节分类测试和噪声中的语音感知方面的表现，并研究两者之间的关系：方法：本研究开发了基于时间线索的音节分类测试，将 /ba/ 音分为 10 个连续步骤，VOT 在 -74 毫秒到 26 毫秒之间变化。对 30 名单侧人工耳蜗植入的儿童和 30 名听力正常的 5 至 7 岁儿童进行了所开发的测试和马拉地语儿童的噪声修订语音（0 和 5 dB SNR）测试：Mann-Whitney U 检验显示，在 0 分贝和 5 分贝信噪比条件下，基于时间线索的分类和噪音中的语音测试在组间存在显著差异。Kendall Tau B显示，植入年龄与0 dB信噪比时基于时间线索的分类和噪音中的语音测试得分之间存在中等程度的相关性，而在5 dB信噪比时则存在较强的相关性。此外，在 0 dB 和 5 dB SNR 条件下，基于时间线索的分类与噪声中语音测试得分之间存在显著的中度关系：本研究强调了时间线索在语音感知中的重要性，以及使用人工耳蜗的儿童进行时间处理的必要性。本研究加强了语言感知能力随植入年龄增长而提高的证据。
{"title":"Temporal cue based categorization and speech perception in noise among pediatric cochlear implant users","authors":"Anuj Kumar Neupane, C.S. Vanaja","doi":"10.1016/j.ijporl.2024.112171","DOIUrl":"10.1016/j.ijporl.2024.112171","url":null,"abstract":"<div><h3>Objectives</h3><div>Voice onset time (VOT) has been identified as a potential temporal cue for predicting children's performance in speech-in-noise tasks, yet the relationship between these two factors has never been explored among children using CI. Hence, the present study aimed to explore the performance of children using CI on temporal cue-based syllable categorization test and speech perception in noise and examine the relationship between the two.</div></div><div><h3>Methods</h3><div>Temporal cue-based syllable categorization test was developed with the manipulation of /ba/ sound in 10 steps continuum with VOT varied between −74 ms to 26 ms. The developed test and revised speech in noise for Marathi-speaking children (0 and 5 dB SNR) were administered to thirty children with unilateral cochlear implant and thirty children with normal hearing, aged between 5 to 7 years.</div></div><div><h3>Results</h3><div>The Mann-Whitney U test showed significant differences between groups in temporal cue-based categorization and speech in noise tests at 0 dB and 5 dB SNR. Kendall Tau B revealed a moderate correlation between implant age and scores on the temporal cue-based categorization and speech in noise tests at 0 dB SNR, with a strong correlation at 5 dB SNR. Additionally, there was a significant moderate relationship between temporal cue-based categorization and speech in noise test scores at both 0 dB and 5 dB SNR.</div></div><div><h3>Conclusion</h3><div>The present study highlights the importance of temporal cues in speech perception and the need for temporal processing for children using cochlear implants. It reinforces the evidence that speech perception skills improve with implant age.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112171"},"PeriodicalIF":1.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.ijporl.2024.112167
Francesca Galluzzi , Werner Garavello
Objectives
Children with mucopolysaccharidosis (MPS) with difficult airways may require tracheostomy, and surgery can be challenging. This review aims to study the indications, surgical aspects, postoperative complications and outcomes of tracheostomy in MPS children.
Methods
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Pubmed and Embase were searched for studies on tracheostomy in children with MPS. The Joanna Briggs Institute was used for quality appraisal.
Results
A total of 9 studies were included. Three were retrospectives, one was prospective, and five were case series. Overall, 34 subjects who underwent a tracheostomy were included. The mean age was 11 years and the male/female ratio was 1.7. MPS II was the most common type included (16/34). The percentage of tracheotomized MPS children was 10 % (ranging from 3.5 % to 15.5 %). Indications for tracheostomy were: progressive or urgent airway obstruction unresponsive to conservative treatments, before a planned surgical procedure, and in case of failed intubation/extubation. Characteristics clinical features make surgery difficult and predispose complications such as tracheal granulations, wound infection, stomal narrowing, persistent of abundant secretions and tracheitis. Considering tracheostomy outcome, two patients underwent decannulation, but one of them required reinsertion tracheostomy after one year. The duration of follow-up was 8.4 and 9.98 years.
Conclusion
Tracheostomy is an effective means of ensuring airway patency in children with MPS and is considered essentially permanent. Management can be challenging due to typical clinical features and progression of MPS. A planned multidisciplinary approach may prevent complications.
{"title":"Tracheostomy in children with mucopolysaccharidosis: A systematic review","authors":"Francesca Galluzzi , Werner Garavello","doi":"10.1016/j.ijporl.2024.112167","DOIUrl":"10.1016/j.ijporl.2024.112167","url":null,"abstract":"<div><h3>Objectives</h3><div>Children with mucopolysaccharidosis (MPS) with difficult airways may require tracheostomy, and surgery can be challenging. This review aims to study the indications, surgical aspects, postoperative complications and outcomes of tracheostomy in MPS children.</div></div><div><h3>Methods</h3><div>A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Pubmed and Embase were searched for studies on tracheostomy in children with MPS. The Joanna Briggs Institute was used for quality appraisal.</div></div><div><h3>Results</h3><div>A total of 9 studies were included. Three were retrospectives<em>,</em> one was prospective, and five were case series. Overall, 34 subjects who underwent a tracheostomy were included. The mean age was 11 years and the male/female ratio was 1.7. MPS II was the most common type included (16/34). The percentage of tracheotomized MPS children was 10 % (ranging from 3.5 % to 15.5 %). Indications for tracheostomy were: progressive or urgent airway obstruction unresponsive to conservative treatments, before a planned surgical procedure, and in case of failed intubation/extubation. Characteristics clinical features make surgery difficult and predispose complications such as tracheal granulations, wound infection, stomal narrowing, persistent of abundant secretions and tracheitis. Considering tracheostomy outcome, two patients underwent decannulation, but one of them required reinsertion tracheostomy after one year. The duration of follow-up was 8.4 and 9.98 years.</div></div><div><h3>Conclusion</h3><div>Tracheostomy is an effective means of ensuring airway patency in children with MPS and is considered essentially permanent. Management can be challenging due to typical clinical features and progression of MPS. A planned multidisciplinary approach may prevent complications.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112167"},"PeriodicalIF":1.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.ijporl.2024.112168
Chenxi Luo, Wenbo Chen, Qi Li
Objective
The aim of this study was to evaluate the variations in sleep architecture and types of sleep disturbances in preschool and school-age children diagnosed with obstructive sleep apnea (OSA).
Methods
Children who underwent polysomnography (PSG) were enrolled and divided into two groups based on age: a preschool group and a school-age group. We analyzed differences in sleep architecture and types of sleep disturbances between these groups.
Results
Total sleep time was significantly higher in the preschool group compared to the school-age group (P < 0.05). The percentage of Stage N1 sleep (N1%) was also higher in the preschool group (p < 0.05). Conversely, the percentage of Stage N2 sleep (N2%) was lower in the preschool group (p < 0.05). Additionally, the average and minimum heart rates were higher in the preschool group, while the minimum oxygen saturation, including during non-rapid eye movement (NREM) and REM stages, was lower compared to the school-age group (P < 0.05). The prevalence of positional OSA (P-OSA) was lower, and the prevalence of REM OSA (R-OSA) was higher in the preschool group (P < 0.05).
Conclusion
The prevalence of P-OSA was lower, and R-OSA was higher in preschool children compared to school-age children. Furthermore, the types of sleep disturbances in preschool children with OSA showed significant differences from those in school-age children with OSA.
本研究旨在评估被诊断患有阻塞性睡眠呼吸暂停（OSA）的学龄前儿童和学龄期儿童的睡眠结构和睡眠障碍类型的变化。方法对接受多导睡眠图（PSG）检查的儿童进行登记，并根据年龄分为两组：学龄前组和学龄期组。结果学龄前组的总睡眠时间明显高于学龄组（P <0.05）。学龄前组的 N1 阶段睡眠百分比（N1%）也较高（P < 0.05）。相反，学龄前组的 N2 阶段睡眠百分比（N2%）较低（P < 0.05）。此外，与学龄组相比，学龄组的平均心率和最低心率更高，而最低血氧饱和度（包括非快速眼动（NREM）和快速眼动阶段）更低（P <0.05）。结论 与学龄儿童相比，学龄前儿童的体位性 OSA（P-OSA）患病率较低，而快速动眼期 OSA（R-OSA）患病率较高（P <0.05）。此外，学龄前儿童 OSA 患者的睡眠障碍类型与学龄儿童 OSA 患者的睡眠障碍类型存在显著差异。
{"title":"Differential sleep subtypes in children with OSA of different ages","authors":"Chenxi Luo, Wenbo Chen, Qi Li","doi":"10.1016/j.ijporl.2024.112168","DOIUrl":"10.1016/j.ijporl.2024.112168","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the variations in sleep architecture and types of sleep disturbances in preschool and school-age children diagnosed with obstructive sleep apnea (OSA).</div></div><div><h3>Methods</h3><div>Children who underwent polysomnography (PSG) were enrolled and divided into two groups based on age: a preschool group and a school-age group. We analyzed differences in sleep architecture and types of sleep disturbances between these groups.</div></div><div><h3>Results</h3><div>Total sleep time was significantly higher in the preschool group compared to the school-age group (P < 0.05). The percentage of Stage N1 sleep (N1%) was also higher in the preschool group (p < 0.05). Conversely, the percentage of Stage N2 sleep (N2%) was lower in the preschool group (p < 0.05). Additionally, the average and minimum heart rates were higher in the preschool group, while the minimum oxygen saturation, including during non-rapid eye movement (NREM) and REM stages, was lower compared to the school-age group (P < 0.05). The prevalence of positional OSA (P-OSA) was lower, and the prevalence of REM OSA (R-OSA) was higher in the preschool group (P < 0.05).</div></div><div><h3>Conclusion</h3><div>The prevalence of P-OSA was lower, and R-OSA was higher in preschool children compared to school-age children. Furthermore, the types of sleep disturbances in preschool children with OSA showed significant differences from those in school-age children with OSA.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112168"},"PeriodicalIF":1.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.ijporl.2024.112166
Arifeen Rahman, Christopher Low, Alice Huang, Kara Meister, Karthik Balakrishnan
Objective
To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.
Methods
A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.
Results
A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1–15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4–22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05–0.53, p < 0.01).
Conclusion
Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.
{"title":"Impact of demographics and social vulnerability on outcomes in pediatric medullary thyroid cancer","authors":"Arifeen Rahman, Christopher Low, Alice Huang, Kara Meister, Karthik Balakrishnan","doi":"10.1016/j.ijporl.2024.112166","DOIUrl":"10.1016/j.ijporl.2024.112166","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.</div></div><div><h3>Methods</h3><div>A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.</div></div><div><h3>Results</h3><div>A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1–15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4–22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05–0.53, p < 0.01).</div></div><div><h3>Conclusion</h3><div>Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112166"},"PeriodicalIF":1.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-12DOI: 10.1016/j.ijporl.2024.112163
Elizabeth O. Shay , Madhuri Kesani , Michael G. Moore , Avinash V. Mantravadi , Michael W. Sim , Jessica Yesensky , Janice L. Farlow , David Campbell , Diane W. Chen
Objectives
Microvascular free tissue transfer (MVFTT) for head and neck reconstruction is infrequently performed in pediatric patients. There is a paucity of data on perioperative airway management in pediatric MVFTT, such as the need for tracheostomy, which can pose higher morbidity to young patients due to potential long-term effects on the softer, more pliable laryngotracheal cartilage. Our objective was to report airway outcomes on pediatric patients undergoing MVFTT after segmental mandibulectomy with or without tracheostomy.
Methods
Retrospective chart review of pediatric patients who underwent MVFTT reconstruction after segmental mandibulectomy at a tertiary care center from 2014 to 2023. Demographic variables, surgical characteristics, and hospital clinical outcomes were recorded. Statistical analyses were performed with JMP Pro, Version 16.0.0 (2021) SAS Institute Inc., Cary, NC, 1989–2021.
Results
Ten patients (median age 11.5 years old, IQR: 9.0–13.3) underwent fibular free flap reconstruction. Mandibular pathologies included 3 ameloblastoma, 2 mesenchymal chondrosarcoma, 2 desmoplastic fibroma, 1 Ewing sarcoma, 1 chondroblastic osteosarcoma, and 1 desmoid tumor. Two patients received upfront tracheostomy at time of initial surgery for a subtotal mandibulectomy and a sub-hemimandibulectomy, respectively. Both patients were decannulated within 1 week after surgery and prior to discharge. The median ICU and hospital length of stay for patients who underwent tracheostomy was 3.5 days [IQR: 3.0–4.0] and 8.5 days [IQR: 8.0–9.0] respectively. Of the remaining 8 patients without tracheostomy, surgical defects were hemimandibulectomy and anterior subtotal mandibulectomy. Median intubation duration was 1.0 day [IQR: 1.0–2.5]. The median ICU and hospital length of stay for these patients were 3.0 days [IQR: 2.0–6.3] and 8.5 days [IQR: 7.3–13.0], respectively. No patient had to be reintubated for respiratory failure following extubation or had long-term airway complications during the follow-up period.
Conclusions
Fibular free flap reconstruction without tracheostomy can be feasible in pediatric patients with mandibular defects, which can potentially reduce hospital resources required for fresh tracheostomy care needs and avoid additional surgical morbidity. Further studies in larger populations and prospective approaches are warranted.
{"title":"Airway management in pediatric patients undergoing microvascular free tissue transfer reconstruction after mandibulectomy","authors":"Elizabeth O. Shay , Madhuri Kesani , Michael G. Moore , Avinash V. Mantravadi , Michael W. Sim , Jessica Yesensky , Janice L. Farlow , David Campbell , Diane W. Chen","doi":"10.1016/j.ijporl.2024.112163","DOIUrl":"10.1016/j.ijporl.2024.112163","url":null,"abstract":"<div><h3>Objectives</h3><div>Microvascular free tissue transfer (MVFTT) for head and neck reconstruction is infrequently performed in pediatric patients. There is a paucity of data on perioperative airway management in pediatric MVFTT, such as the need for tracheostomy, which can pose higher morbidity to young patients due to potential long-term effects on the softer, more pliable laryngotracheal cartilage. Our objective was to report airway outcomes on pediatric patients undergoing MVFTT after segmental mandibulectomy with or without tracheostomy.</div></div><div><h3>Methods</h3><div>Retrospective chart review of pediatric patients who underwent MVFTT reconstruction after segmental mandibulectomy at a tertiary care center from 2014 to 2023. Demographic variables, surgical characteristics, and hospital clinical outcomes were recorded. Statistical analyses were performed with JMP Pro, Version 16.0.0 (2021) SAS Institute Inc., Cary, NC, 1989–2021.</div></div><div><h3>Results</h3><div>Ten patients (median age 11.5 years old, IQR: 9.0–13.3) underwent fibular free flap reconstruction. Mandibular pathologies included 3 ameloblastoma, 2 mesenchymal chondrosarcoma, 2 desmoplastic fibroma, 1 Ewing sarcoma, 1 chondroblastic osteosarcoma, and 1 desmoid tumor. Two patients received upfront tracheostomy at time of initial surgery for a subtotal mandibulectomy and a sub-hemimandibulectomy, respectively. Both patients were decannulated within 1 week after surgery and prior to discharge. The median ICU and hospital length of stay for patients who underwent tracheostomy was 3.5 days [IQR: 3.0–4.0] and 8.5 days [IQR: 8.0–9.0] respectively. Of the remaining 8 patients without tracheostomy, surgical defects were hemimandibulectomy and anterior subtotal mandibulectomy. Median intubation duration was 1.0 day [IQR: 1.0–2.5]. The median ICU and hospital length of stay for these patients were 3.0 days [IQR: 2.0–6.3] and 8.5 days [IQR: 7.3–13.0], respectively. No patient had to be reintubated for respiratory failure following extubation or had long-term airway complications during the follow-up period.</div></div><div><h3>Conclusions</h3><div>Fibular free flap reconstruction without tracheostomy can be feasible in pediatric patients with mandibular defects, which can potentially reduce hospital resources required for fresh tracheostomy care needs and avoid additional surgical morbidity. Further studies in larger populations and prospective approaches are warranted.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"187 ","pages":"Article 112163"},"PeriodicalIF":1.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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