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Paul A, Blouin MJ, Minard-Colin V, Galmiche L, Coulomb A, Corradini N, Boutroux H, Van den Abbeele T, Leboulanger N, Denoyelle F, Garabedian EN, Couloigner V, Orbach D. Desmoid-type fibromatosis of the head and neck in children: A changing situation. Int J Pediatr Otorhinolaryngol 2019; 123:33-37. [PMID: 31059930 DOI: 10.1016/j.ijporl.2019.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Desmoid-type fibromatosis (DF) is a rare benign lesion known for its local aggressiveness. The tumor management still remains under debate. Primary head and neck (HN), represents the second most prevalently affected sitein children with DF. This study aims to analyze the specificity of HN-DF in children, focusing on long-term effects of the tumor and therapies. METHODS This retrospective multicenter study analyzed children treated for a HN-DF between 1993 and 2013. All medical files were reviewed and their outcomes analyzed according to the initial therapies provided. RESULTS Sixteen children were selected. Mandibular and submandibular areas were the main locations (11 cases). Eight children underwent chemotherapy as first-line therapy with tumor control in 3 cases and 5 cases needing additional treatment. Six children underwent primary surgery: isolated in 3 cases and with additional treatment after tumor progression in 3 cases. A wait-and-see attitude was adopted for 2 children without any additional treatment in 1 case, and followed by additional chemotherapy in the other case. Total burden of treatment to control the disease was a biopsy (1 case), surgery (3 unique cases, 1 multiple case), surgery with chemotherapy (6 cases), and exclusive medical therapies (5 cases). Surgical postoperative sequelae were facial palsy (cases of parotid gland affection), XIth cranial nerve sacrifice or sensory impairment. CONCLUSION HN-DF is a local and extensive disease that is difficult to control with surgery alone. Sequelae are frequent due to the initial tumor location or therapies. Initial conservative strategies need to be discussed in a multidisciplinary way in order to try to control the disease with the minimal morbidity.
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Affiliation(s)
- Antoine Paul
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Marie-Julie Blouin
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | | | - Louise Galmiche
- Pathology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Université Sorbonne Paris Cité, 75015, Paris, France
| | - Aurore Coulomb
- Department of Pathology, Armand Trousseau Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Nadege Corradini
- Institut D'Hématologie et D'Oncologie Pédiatrique, Centre Leon Berard, Lyon, France
| | - Hélène Boutroux
- Hematology and Oncology Department, Armand Trousseau Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Thierry Van den Abbeele
- Pediatric Ear, Nose, and Throat Department, Robert Debré Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Nicolas Leboulanger
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Françoise Denoyelle
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Erea-Nöel Garabedian
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Vincent Couloigner
- Pediatric Otolaryngology Department, Necker-Enfants Malades Hospital, Public Assistance-Hospitals of Paris, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France.
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Lecler A, Lenoir M, Peron J, Denoyelle F, Garabedian EN, Pointe HDL, Nevoux J. Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early? Int J Pediatr Otorhinolaryngol 2015; 79:1268-74. [PMID: 26071017 DOI: 10.1016/j.ijporl.2015.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/16/2015] [Accepted: 05/19/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma. METHODS This was a prospective monocentric consecutive study conducted in a tertiary academic referral center. Children were referred for MR imaging (MRI) one year after surgery. A 1.5T MRI was utilized, using nonecho-planar DW images and delayed gadolinium-enhanced T1-weighted images. Accuracy of magnetic resonance imaging was assessed by two radiologists before surgery. Interobserver and intraobserver agreements were assessed using the κ test. Magnetic resonance imaging data were compared with surgery, which was considered as the gold standard. RESULTS Twenty-four consecutive unselected pediatric patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected. CONCLUSIONS MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying the realization of MRI during follow-up could increase sensitivity, thus avoiding misdiagnosis as well as unnecessary second look surgery.
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Affiliation(s)
- A Lecler
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France; Service de Neuroradiologie diagnostique, Fondation Rothschild, 25 rue Manin, 75019 Paris, France.
| | - M Lenoir
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France
| | - J Peron
- Centre anticancéreux Léon Bérard, Oncologie Médicale, 28 rue Laennec, 69008 Lyon, France
| | - F Denoyelle
- Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - E N Garabedian
- Service d'Oto-Rhino-Laryngologie pédiatrique, Hôpital Necker, Université Paris René Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - H Ducou le Pointe
- Service de Radiologie pédiatrique, Hôpital Trousseau, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, 26 avenue du docteur Arnold Netter, 75012 Paris, France
| | - J Nevoux
- Service d'Oto-Rhino-Laryngologie, INSERM U1185, Hôpital Bicêtre, Université Paris Sud, Assistance Publique Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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Celerier C, Blanchard M, Thierry B, Rouillon I, Garabedian EN, Loundon N. How I do it Cochlear implantation and magnet removal: a silicone mold to maintain the transmitter coil. Int J Pediatr Otorhinolaryngol 2014; 78:2000-2. [PMID: 25193584 DOI: 10.1016/j.ijporl.2014.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/13/2014] [Accepted: 08/15/2014] [Indexed: 11/15/2022]
Affiliation(s)
- C Celerier
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - M Blanchard
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - B Thierry
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - I Rouillon
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - E N Garabedian
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - N Loundon
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France.
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Wartelle S, Blanchard M, Thierry B, Parodi M, Rouillon I, Garabedian EN, Loundon N. Atypical failure after cochlear implantation in children. Int J Pediatr Otorhinolaryngol 2014; 78:1405-7. [PMID: 24974146 DOI: 10.1016/j.ijporl.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/11/2014] [Indexed: 11/19/2022]
Abstract
We report a case of intermittent dysfunction in a 10-years-old boy, implanted with MedEL(®) cochlear implant. Few weeks after the surgery the boy described short and intermittent episodes of implant dysfunction with rapid return to a normal function. No evidence for any electric or neural dysfunction was found. After few weeks, a clinical link was discovered to episodes of sneeze or nose blowing. Clinical and surgical implications are discussed.
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Affiliation(s)
- S Wartelle
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France.
| | - M Blanchard
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - B Thierry
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - M Parodi
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - I Rouillon
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - E N Garabedian
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
| | - N Loundon
- Service ORL Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France
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Marlin S, Ducou Le Pointe H, Le Merrer M, Portnoi MF, Chantot S, Jonard L, Mantel-Guiochon A, Siffroi JP, Garabedian EN, Denoyelle F. Fourth case of cerebral, ocular, dental, auricular, skeletal syndrome (CODAS), description of new features and molecular analysis. Am J Med Genet A 2010; 152A:1510-4. [PMID: 20503327 DOI: 10.1002/ajmg.a.33242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cerebral, ocular, dental, auricular, skeletal syndrome (CODAS, OMIM 600373) is a very rare congenital malformation syndrome. This clinical entity is highly distinctive and associates mental retardation, cataract, enamel abnormalities, malformations of the helix, epiphyseal and vertebral malformations, and characteristic dysmorphic features. Since 1991, only three affected children have been reported. The etiology and pattern of inheritance of CODAS syndrome still remain unknown. We describe a new sporadic case presenting with all the characteristic features of CODAS syndrome associated with previously unreported malformations of the heart, larynx, and liver. All investigations such as karyotype, metabolic screening and array CGH were normal.
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Affiliation(s)
- S Marlin
- Service de Génétique, Hôpital Trousseau, APHP, Paris, France.
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Leboulanger N, Coulomb L'hermine A, Teissier N, Rouillon I, Zribi S, Roger G, Garabedian EN. [Cervical Castleman disease in childhood: a report of two cases and a review of the literature]. Arch Pediatr 2010; 17:1178-82. [PMID: 20627489 DOI: 10.1016/j.arcped.2010.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 01/11/2010] [Accepted: 04/25/2010] [Indexed: 10/19/2022]
Abstract
Castleman disease (CD) is a benign lymphoproliferative disorder, rare in children. Head and neck localizations are found only in 14 % of the cases. Two forms have been described: a hyaline vascular type and a plasma cell type. It can also be monocentric or multicentric. Both young patients were affected with an isolated neck localization of Castleman disease. Preoperative diagnosis can be difficult with a thymoma or a lymphoma. CT and MRI can help in the diagnosis, which is confirmed by histopathological assessment. The pathological features and the therapeutic management of CD are discussed. While surgery is the treatment for localized lesions, steroids and chemotherapy are indicated in the multicentric type. Because of the risk of relapse and malignant transformation, long-term follow-up is mandatory.
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Affiliation(s)
- N Leboulanger
- UMPC Univ Paris 6, Inserm U-587, Service d'oto-rhino-laryngologie et de chirurgie cervicofaciale, hôpital d'Enfants-Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Abstract
OBJECTIVE To evaluate surgical aspects and results of cochlear implantation in inner ear malformations. STUDY DESIGN Retrospective cohort study. SETTING Ear, nose, and throat department of a tertiary referral hospital. PATIENTS Out of 260 implanted children, 18 (6.9%) had inner ear malformations: complex cochleovestibular malformation (n = 11), common cavity (n = 1), and enlarged vestibular aqueduct (EVA) (n = 6). Deafness was progressive in 12 cases (G1) and congenital in 6 cases (G2). Genetics lead to diagnosis in 12 of 13 cases: PSD mutation (n = 11), Waardenburg syndrome (n = 1), negative (1). Mean age at implant was 7.8 years. Mean follow-up period was 48 months. MAIN OUTCOME MEASURES Medical and surgical outcomes were reported. Closed (CSW) and open (OSW) set word perception and level of speech production were evaluated each year. The results were compared pre- and postoperatively and between the two groups. RESULTS Gusher at surgery was observed in 50% of cases, with a persistent leak in one case. No facial injury or infectious complications were observed. At 12 months, 83% of the population had achieved more than 75% recognition in CSW, versus 16% before implant (p = 0.001). After 2 years, 64% of patients had more than 50% recognition in OSW. Good oral language was seen in 76% at 2 years and 100% at 3 years, versus 55% before implant (respectively, p > 0.05 and p = 0.03). At 1 year after implant, 83% of the G1 and 20% of the G2 achieved more than 50% recognition in OSW (p = 0.02). After 24 months, 83% of G1 and 40% of G2 had more than 50% in OSW (p > 0.05). Before implant, 75% in G1 and 0% in G2 had good oral language (p = 0.01). At 1 year, 83% in G1 and 16% in G2 had good oral language (p = 0.02). At 2 years, 100% in G1 and 20% in G2 had good oral language (p = 0.02). One child in G1 had no improvement after implantation. CONCLUSIONS No major complication was seen. Perceptive and linguistic results were variable and depended on the type of the deafness. In progressive deafness, the perceptive and linguistic result are expected to be good. In congenital deafness, the results are more variable.
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Affiliation(s)
- N Loundon
- ENT Department, Armand Trousseau Children's Hospital, Paris, France.
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8
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Abstract
AIMS The purpose of the study was to define boundaries between endocochlear hearing loss and auditory neuropathy in children with congenital profound hearing loss and positive otoacoustic emissions. PATIENT A child presented with bilateral profound hearing loss, which was confirmed by the absence of evoked auditory potentials at 110 dB and with conserved otoacoustic emissions. The lack of any relevant medical history, a normal neurologic pediatric examination, and the improvement obtained with powerful hearing aids suggested an endocochlear cause. Genetic testing identified mutations in OTOF, responsible for the DFNB9 recessive form of hearing loss. RESULTS In recent years, cases of children with hearing loss associated with positive otoacoustic emissions have been labeled as "auditory neuropathy." Classically, this form of hearing loss is refractory to the use of hearing aids and cochlear implants. Mutations in OTOF lead to inner hair cells dysfunction, whereas the outer hair cells are initially functionally preserved. As this form of endocochlear hearing loss can be detected at a molecular level, genetic testing can be proposed for cases of nonsyndromic auditory neuropathy, as those children could benefit from cochlear implantation. CONCLUSION It is advisable to reserve the term "auditory neuropathy" for patients who present hearing loss and conserved otoacoustic emissions in the context of a neurologic syndrome or for children with suggestive perinatal history. In other cases, genetic testing for mutations in OTOF should be carried out.
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Affiliation(s)
- N Loundon
- Département d'otorhinolaryngologie et de chirurgie cervico-faciale, Hôpital d'Enfants Armand-Trousseau, Paris, France.
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Khariwala SS, Nicollas R, Triglia JM, Garabedian EN, Marianowski R, Van Den Abbeele T, April M, Ward R, Koltai PJ. Cervical presentations of thymic anomalies in children. Int J Pediatr Otorhinolaryngol 2004; 68:909-14. [PMID: 15183582 DOI: 10.1016/j.ijporl.2004.02.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2004] [Accepted: 02/10/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To better define the clinical manifestations, radiologic imaging and the surgical management of cervical thymic lesions in children. STUDY DESIGN Multi-center retrospective case review. METHODS The charts of all children with pathologically confirmed thymic lesions at six children's hospitals (1990-2002) were reviewed for demographics, physical findings, X-ray findings, operative outcomes and pathology. RESULTS There were a total of 15 children, 2 of whom had ectopic cervical thymus and 13 who had thymic cysts. They ranged in age from 1 month to 18 years. Thymic lesions were more common in males. Ectopic cervical thymus was best defined by MRI whereas thymic cyst had a more consistent appearance on CT. All children had successful surgical resection with no recorded complications or recurrences. CONCLUSIONS Cervical thymic lesions are rare. Ectopic cervical thymus tends to be found primarily in infants whereas thymic cysts occur in a wider age range. Radiologic imaging is important but is not histologically specific. Definitive diagnosis and cure requires complete surgical excision.
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Affiliation(s)
- S S Khariwala
- Department of Otolaryngology and Communicative Disorders- A71, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Garabedian EN, Loundon N, Mondain M, Piron JP, Roman S, Triglia JM. [Pediatric cochlear implants]. Ann Otolaryngol Chir Cervicofac 2003; 120:139-51. [PMID: 12843983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Indications for cochlear implants have been widened since 1995. Most implant candidates are children with severe congenital deafness. The cochlear implant must be inserted as early as possible for these children in order to optimize development of perception and language. A cochlear implant can also be discussed in certain particular cases for children with associated diseases, malformation of the inner ear, or severe deafness. The educational project must be realistic and take into account the future difficulties as well as an established set of criteria for successful language acquisition.
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Affiliation(s)
- E N Garabedian
- Service d'ORL pédiatrique et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris
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Affiliation(s)
- N Loundon
- Service d'ORL pédiatrique et de chirurgie cervico-faciale, hôpital d'Enfants Armand-Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France.
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Abstract
Episodic laryngeal dysfunction (ELD), also known as paradoxical vocal cord dysfunction or laryngeal dyskinesia, is characterized by abnormal closure of the vocal cords during inspiration (and sometimes at the very start of expiration). It can manifest in different ways depending on the patient's age. In the newborn, it is usually associated with stridor restricted to the inspiratory breath following crying, and the natural history is always one of rapid resolution. Occasionally, a more severe form presents with intense dyspnea and marked inspiratory stridor in a baby that usually has extensive gastroesophageal reflux which has not been treated adequately enough to improve the dyspnea or the associated vasovagal attacks. A tracheotomy may be necessary. It is rare for this disease to present between the ages of 2 and 8 years. Thereafter, it may present as a form of pseudo asthma resistant to bronchodilators and anti-inflammatory drugs. The dyspnea can be very severe and lead the family to seek hospital admission, at least during the initial episodes. There is a female preponderance. The key to making the diagnosis is the complete reversibility of the patient's symptoms when they are distracted. Exertion asthma can be mimicked by forms of ELD that occur only by effort (apart from the profile of the lung function tests). There may be significant gastroesophageal reflux. Medical intervention (hospitalization and tracheotomy) must be avoided, treatment being essentially behavioral. Finally, some cases of paradoxical adduction of the vocal cords have been described with the use of neuroleptics, brain stem compression, cortical lesions and, much more rarely, motoneuron disease. This diagnosis requires a high index of suspicion, particularly in patients with asthma whose presentation or clinical course with treatment is atypical.
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Affiliation(s)
- G Roger
- Service d'ORL pédiatrique, hôpital d'enfants Armand-Trousseau, 26, avenue A. Netter 75012 Paris, AP-HP, université Paris-VI, Paris, France.
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Loundon N, Busquet D, Roger G, Moatti L, Garabedian EN. Audiophonological results after cochlear implantation in 40 congenitally deaf patients: preliminary results. Int J Pediatr Otorhinolaryngol 2000; 56:9-21. [PMID: 11074111 DOI: 10.1016/s0165-5876(00)00386-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate the prognostic factors of audiophonological results in cochlear implant in congenitally deaf patients. Between 1991 and 1996. 40 congenitally deaf children underwent cochlear implantation in our department, at an average age of 7 years (median: 5 years). The results of speech therapy were evaluated with a mean follow-up of 2 years and were classified according to four criteria: perception of sound, speech perception, speech production and the level of oral language. For each criterion, a score was established ranging from zero to four. These scores were weighted according to age such that the results before and after implantation only reflected the changes related to the implantation. The prognostic factors for good results were: a good level of oral communication before implantation, residual hearing, progressive deafness and implantation at a young age. On the other hand, poor prognostic factors were: the presence of behavioral disorders and poor communication skills prior to implantation. Overall, the major prognostic factor for a good outcome appeared to be the preoperative level of oral language, even if this was rudimentary.
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Affiliation(s)
- N Loundon
- ENT Department, Hôpital d'Enfants Armand Trousseau, AP-HP. 26 Av. du Dr A. Netter, 75571 12., Paris Cedex, France.
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Hartl DM, Roger G, Denoyelle F, Nicollas R, Triglia JM, Garabedian EN. Extensive lymphangioma presenting with upper airway obstruction. Arch Otolaryngol Head Neck Surg 2000; 126:1378-82. [PMID: 11074837 DOI: 10.1001/archotol.126.11.1378] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. DESIGN Retrospective review of files from January 1983 to September 1998. SETTING Pediatric otolaryngology departments from 2 referral centers. PATIENTS Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. INTERVENTIONS Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. MAIN OUTCOME MEASURES Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. RESULTS The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. CONCLUSIONS Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.
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Affiliation(s)
- D M Hartl
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Hopital d'Enfants Armand Trousseau, 26 avenue du Dr Arnold Netter, 75571 Paris Cedex 12, France
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15
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Garabedian EN. [Effects of the environment on upper airway pathology in children]. Rev Med Suisse Romande 2000; 120:623-7. [PMID: 11028181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- E N Garabedian
- Service d'ORL pédiatrique et de chirurgie cervico-faciale, Hôpital d'Enfants Armand-Trousseau, Paris
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Garabedian EN. [Recurrent ORL infections in children]. Rev Med Suisse Romande 2000; 120:629-33. [PMID: 11028182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- E N Garabedian
- Service d'ORL pédiatrique et de chirurgie cervico-faciale, Hôpital d'Enfants Armand-Trousseau, Paris
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Affiliation(s)
- E N Garabedian
- Service d'ORL pédiatrique et de chirurgie cervicofaciale, Hôpital d'Enfants-Armand-Trousseau, université Paris VI, 26, France
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18
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Abstract
Infantile myofibromatosis (IM) is a proliferative disorder characterized by the development of single or multiple nodular lesions arising from cutaneous, subcutaneous, muscular, bone or visceral structures. This proliferation may occur at any anatomical site, but in 30% of the cases it involves the head and neck. We report here three cases of head and neck IM occurring in young children and presenting as solitary lesions. The clinical heterogeneity and the misleading histopathological appearances can make the diagnosis difficult. The treatment is surgical but the low rate of recurrence and the possibility of spontaneous tumoral regression may lead to conservative surgery or therapeutic abstention.
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Affiliation(s)
- N Loundon
- ENT Department, Hôpital d'Enfants Armand Trousseau, Paris, France.
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19
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Abstract
The authors report a series of eight cases of isolated tracheoesophageal fistula without esophageal atresia (or an H type fistula), treated in three pediatric ENT departments. This is a rare malformation whose diagnosis requires investigation for associated anomalies. The clinical signs are mainly respiratory but also digestive and the symptomatology can be severe. The diagnosis can be made with a barium swallow combined with cineradiography, but a tracheoesophageal endoscopy remains the investigation of choice. The treatment is surgical. In most cases, the fistula is accessible by a right or left cervicotomy, depending on the surgeon's practice, with a much lower postoperative morbidity as compared to a thoracotomy. The postoperative management was straightforward in most of our cases. We discuss the role of gastro-esophageal reflux with respect to postoperative morbidity as well as systematic treatment for reflux peri-operatively. The pros and cons of the various surgical approaches are also discussed.
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Affiliation(s)
- E Genty
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-faciale, CHU Bicêtre, Le Kremlin-Bicêtre, France
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20
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Roger G, Morisseau-Durand MP, Van Den Abbeele T, Nicollas R, Triglia JM, Narcy P, Abadie V, Manac'h Y, Garabedian EN. The CHARGE association: the role of tracheotomy. Arch Otolaryngol Head Neck Surg 1999; 125:33-8. [PMID: 9932584 DOI: 10.1001/archotol.125.1.33] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To evaluate the need for a tracheotomy and its timing during the evolution of an association of malformations, including coloboma, heart defects, choanal atresia, developmental and growth retardation, genitourinary malformation, and ear anomalies (CHARGE association). DESIGN Retrospective study from January 1988 through December 1997. SETTING Four academic tertiary care centers. PATIENTS AND METHODS Forty-five patients with CHARGE association having at least 3 cardinal malformations (growth retardation excluded) and review of the malformations and respiratory manifestations encountered. All the patients underwent endoscopic exploration on several occasions. We reviewed the nature and the timing of therapeutic interventions performed on the airway. RESULTS Two patients died (one patient of septicemia, the other of unknown causes). Abnormalities of blood gas levels and/or sleep were found in 30 patients (67%), were responsible for cardiorespiratory arrest in 9 (20%), and required admission to the intensive care unit in 21 (47%). Pharyngolaryngeal anomalies leading to dyspnea (discoordinate pharyngolaryngomalacia, glossoptosis, retrognathia, laryngeal paralysis, cleft, stenosis, and difficult intubation) were found in 26 patients (58%). Tracheobronchial anomalies (esophagotracheal fistula, esophageal atresia, and tracheomalacia) were present in 18 patients (40%). Resection of the aryepiglottic folds was attempted 3 times, but without success. Tracheotomy was necessary in 13 patients (29%) at a median age of 2.4 months (mean duration, 25 months). Among these infants, the posterior nasal choanae were patent in 10 patients at the time of tracheotomy. Gastroesophageal reflux was encountered in 36 patients (80%). Prolonged enteral feeding was necessary in 21 patients (47%), with gastrostomy in 16 (of whom 9 needed a tracheotomy). These feeding difficulties and airway problems were highly correlated. CONCLUSIONS We encountered multiple, complicated airway abnormalities. Resection of aryepiglottic folds was inadequate. Often, a tracheotomy could not be avoided in these patients, regardless of choanal patency. Tracheotomy needs to be performed early to avoid hypoxic events. In some selected patients, ventilation using bilevel positive airway pressure may be an alternative.
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Affiliation(s)
- G Roger
- Ear Nose and Throat Department, Hôpital d'Enfants Armand Trousseau, Paris, France.
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21
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Garabedian EN, Ducroz V, Roger G, Denoyelle F, Catala M. Nasal fossa malformations and paramedian facial cleft: new perspectives. J Craniofac Genet Dev Biol 1999; 19:12-9. [PMID: 10378143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Choanal atresia may be associated with other cranio-facial malformations, including various degrees of nasal fossa malformation, and may be a part of paramedian facial clefts (as described by Tessier et al. [1977]). We identified five such cases with combined clinical elements corresponding to Tessier's paramedian facial cleft, including eyelid coloboma, mild to severe choanal and nasal fossa anomalies, ethmoidal hypoplasia and anterior skull base malformation, sometimes with proboscis lateralis and half-nose hypoplasia. These observations incited us, first, to elaborate a conception which accounts for the likely embryological mechanisms involved; second, to propose a new classification based on anatomical and pathogenic embryological considerations; and last, to propose the use of transpalatal approach to restore choanal permeability, since endonasal laser therapy is particularly dangerous in such cases.
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Affiliation(s)
- E N Garabedian
- Department of Paediatric ENT and Cervicofacial Surgery, Armand Trousseau Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
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22
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Abstract
OBJECTIVES To assess the results of myringoplasty in children and to determine which factors independently influence the postoperative results. STUDY DESIGN Retrospective study of the anatomic and functional results of 231 consecutive myringoplasties performed in 188 children between 1988 and 1992. Multivariate analysis of poor prognostic factors by cross-sectional comparison 1 year after surgery. METHODS Myringoplasties were performed via an endaural approach with a fascia temporalis underlay graft. RESULTS In 216 of 231 ears (93.5%) the tympanic membrane was closed. A good anatomic outcome was considered to have been achieved in 188 ears (81.6%), although in 18 ears (7.8%) seromucous otitis media occurred, in 8 ears (3.5%) a progressive retraction pocket was encountered, and in 2 ears significant lateralization was present. One hundred thirty-nine (67.5%) of the 206 ears tested in the postoperative period had a postoperative air-bone gap of 10 dB or less. On average, mean bone conduction remained unaltered. The age of the patient and the size and the location of the perforation did not affect the outcome. Three prognostic factors for an abnormal postoperative tympanic membrane were found, with 95% confidence intervals: inflammatory changes in the middle ear mucosa (P < .05), contralateral tympanic perforation (P < .05), and contralateral cholesteatoma (P < .01). CONCLUSIONS Myringoplasty with underlay grafting of the fascia temporalis in children gives good anatomic and functional results. Inflammatory changes within the middle ear mucosa, contralateral tympanic perforation, and contralateral cholesteatoma independently influence the risk of an abnormal postoperative tympanic membrane. The presence of one of these factors preoperatively should lead to the consideration of alternative, more durable graft material, such as autologous cartilage.
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Affiliation(s)
- F Denoyelle
- Department of Pediatric Otolaryngology and Head and Neck Surgery, Hôpital d'Enfants Armand-Trousseau, Paris, France
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23
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Abstract
We report a very rare case of disseminated pharyngo-laryngeal histoplasmosis with systemic spread in a 10-year-old, immunocompetent child from Guyana. The main signs were a marked deterioration in his general condition, hepato-splenomegaly, multiple lymphadenopathy and ulcerated pharyngo-laryngeal lesions. The diagnosis was made from brushings of the ulcerative lesions, a lymph node biopsy and serological tests performed in the national reference center for histoplasmosis. The initial treatment was with amphotericin B, which was then replaced by oral itraconazole. We report here the main epidemiological, clinical and therapeutic characteristics.
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Affiliation(s)
- T Coiffier
- Department of Pediatric ENT and Cervico-Facial Surgery, Trousseau Children's Hospital, Paris, France.
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24
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Abstract
An understanding of the pathogenesis of second cancers may help in their prevention. We report on two children who were treated for acute lymphoblastic leukemia (ALL), with an exclusively cranial prophylactic irradiation (18 Gy) and who presented with a thyroid carcinoma (TC) 12 and 13 years later. From a thorough review of the literature of TC after ALL and of radiation-induced TC, a strong case can be made that these tumors are caused by late effects of scattered radiation. The risk is at its highest in small children. After cranial irradiation, patients require clinical monitoring of the thyroid and cervical area for nodules, continued indefinitely. We suggest that, in most cases, an alternative form of neuromeningeal prophylaxis should be offered in small children with ALL.
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Affiliation(s)
- Y Perel
- Department of Pediatrics, Children's Hospital, Groupe Hospitalier Pellegrin, Bordeaux, France.
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25
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Abstract
OBJECTIVES To assess the clinical outcome and risk of failure after oral vs. intravenous treatment in otitis media caused by penicillin-resistant pneumococci. To determine the possible correlations between pneumococcal minimal inhibitory concentration (MIC) to penicillin and clinical outcome. DESIGN Retrospective study of 156 cases collected between 1993 and 1995. Mean follow-up: 5 months. Setting. Two tertiary academic medical centers in Paris, France. PATIENTS AND METHODS Pneumococcus was isolated from 191 of 570 ear samples obtained from children with otitis media and shown to be penicillin-resistant in 156. Medical history, antibiotic therapy during the previous 3 months and day-care center attendance were reviewed. For the current episode microbiologic characteristics of the isolated strains, type of treatment, therapy efficacy and clinical outcome were analyzed. Patients were predominantly young (76.3% were <1 year old) and bacteriologic samples were taken mainly because of previous treatment failure. RESULTS Among 156 children with pneumococcal penicillin-resistant otitis media, 72.2% attended day-care centers, 71.8% had been previously treated with aminopenicillin and 52.5% with cephalosporins. Failure of previous empirical oral therapy was noted in 84% (one-third of these had been receiving amoxicillin-clavulanate). Patients treated intravenously had had a more protracted otitis but no greater number of previous episodes of acute otitis media than those receiving oral therapy. Acute mastoiditis occurred in 4 infants resulting in mastoidectomy. Oral treatment (mainly with high dose amoxicillin,120 to 150 mg/kg/day) and intravenous therapy (cephalosporin or glycopeptide) had been used in 59 and 41%, respectively. Mean duration of therapy was 10.7 days. Three failures (1.9%) and 10 recurrences (6.4%, average 28 days) occurred. No statistical difference was found between intravenous and oral therapy with respect to risk of recurrence. A high penicillin MIC value was correlated with previous antibiotic treatment but not with clinical outcome. CONCLUSIONS Oral therapy appears to be as effective as intravenous therapy for the treatment of penicillin-resistant pneumococcal otitis media. Intravenous treatment should not necessarily be dictated by the penicillin susceptibility value but should be considered in cases of failure to thrive, persistent otitis or other complications.
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Affiliation(s)
- G Roger
- Department of Pediatric ENT, Hôpital d'Enfants Armand Trousseau, Paris, France.
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26
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Garabedian EN, Ducroz V, Roger G, Denoyelle F. Posterior laryngeal clefts: preliminary report of a new surgical procedure using tibial periosteum as an interposition graft. Laryngoscope 1998; 108:899-902. [PMID: 9628507 DOI: 10.1097/00005537-199806000-00020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair. DESIGN Retrospective study in an academic tertiary care center. METHOD The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheal intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery. MAIN OUTCOME MEASURE Clinical and endoscopic follow-up was used for evaluation of results. RESULTS The three patients had successful laryngeal repair at a mean follow-up of 6 months (range, 4-14 mo). CONCLUSION The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow-up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.
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Affiliation(s)
- E N Garabedian
- University Paris VI, Trousseau Children's Hospital, France
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27
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Triglia JM, Nicollas R, Ducroz V, Koltai PJ, Garabedian EN. First branchial cleft anomalies: a study of 39 cases and a review of the literature. Arch Otolaryngol Head Neck Surg 1998; 124:291-5. [PMID: 9525513 DOI: 10.1001/archotol.124.3.291] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To identify the clinical and anatomical presentations and to discuss the guidelines for surgical management of anomalies of the first branchial cleft. DESIGN Retrospective study. SETTING Three tertiary care centers. PATIENTS Thirty-nine patients with first branchial cleft anomalies operated on between 1980 and 1996. INTERVENTION All patients were treated surgically. Complete removal of the lesion required superficial parotidectomy with facial nerve dissection in 36 cases. The relationship of the facial nerve and anomalies is discussed. RESULTS Anatomically, 3 types of first branchial cleft anomalies are identified: fistulas (n=11), sinuses (n=20), and cysts (n=8). Clinically, 3 types of presentation are noted: chronic purulent drainage from the ear (n=12), periauricular swelling in the parotid area (n=18), and abscess or persistent fistula in the neck located above a horizontal plane passing through the hyoid bone (n=21). A membranous attachment between the floor of the external auditory canal and the tympanic membrane was observed in 10% of cases. The facial nerve was located lateral to the anomaly in 39% of cases. CONCLUSIONS Before definitive surgery, many patients (n=17) underwent incision and drainage for infection owing to the difficulties in diagnosing this anomaly. Wide exposure is necessary in most cases, and a standard parotidectomy incision allows adequate exposure of the anomaly and preservation of the facial nerve. Complete removal without complications depends on a good understanding of regional embryogenesis, a knowledge of the circumstances surrounding discovery, an awareness of the different anatomical presentations, and a readiness to identify and protect the facial nerve during resection.
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Affiliation(s)
- J M Triglia
- Department of Pediatric Otorhinolaryngology, La Timone Hospital, Marseille, France
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28
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Denoyelle F, Roger G, Ducroz V, Escudier E, Fauroux B, Garabedian EN. Results of tympanoplasty in children with primary ciliary dyskinesia. Arch Otolaryngol Head Neck Surg 1998; 124:177-9. [PMID: 9485109 DOI: 10.1001/archotol.124.2.177] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the results of tympanoplasty in children with primary ciliary dyskinesia complicated by tympanic perforation or cholesteatoma with hearing loss and/or recurrent otorrhea. DESIGN Retrospective study. Postoperative follow-up of 26.3 months in the type 1 tympanoplasty group and 46 months in the child with cholesteatoma. SETTING Hospitalized care, referral center. PATIENTS Seven children with primary ciliary dyskinesia, complicated in 6 children by 9 tympanic perforations (3 bilateral perforations) and in 1 child by an attical cholesteatoma. RESULTS After 9 type 1 tympanoplasties, the grafts were intact in 9 ears, with no recurrence of otorrhea, but serous otitis media was present in 6 of the 9 ears. Auditory improvement was significant, with an average gain of 17-dB hearing level in speech frequencies. After a canal wall-down tympanoplasty with mastoidectomy for attic cholesteatoma in 1 ear, the cavity that was operated on showed no signs of otorrhea or residual cholesteatoma after a follow-up of 46 months. CONCLUSION In children with primary ciliary dyskinesia, tympanoplasty has a high probability of graft success and auditory improvement, despite the frequent recurrence of serous otitis media.
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Affiliation(s)
- F Denoyelle
- Department of Pediatric Otolaryngology, Armand-Trousseau Children's Hospital, Paris, France
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29
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Affiliation(s)
- G Roger
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris, France
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30
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Affiliation(s)
- E N Garabedian
- ENT and Head and Neck Surgery Department, Hôpital Armand Trousseau, Paris, France
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31
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Roger G, Garabedian EN. Relation between environment and recurring upper-airway infections in children. Pediatr Pulmonol Suppl 1998; 16:77-8. [PMID: 9443213 DOI: 10.1002/ppul.1950230845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Roger
- Department of Otolaryngology and of Cervicofacial Surgery, Hôpital d'Enfants Armand Trousseau, Paris, France
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32
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Roger G, Denoyelle F, Chauvin P, Schlegel-Stuhl N, Garabedian EN. Predictive risk factors of residual cholesteatoma in children: a study of 256 cases. Am J Otol 1997; 18:550-8. [PMID: 9303150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to determine which children are at risk of having residual cholesteatoma develop after initial surgery for either cholesteatoma or severe retraction pocket. This study aimed to identify the characteristics of each patient and assessing whether predictive factors exist to propose a well-guided therapeutic approach. DESIGN This was a retrospective study. Mean follow-up period (after the last eradication intervention) was 42 months. PATIENTS Two hundred thirty-one children (256 ears) with either cholesteatoma (n = 157) or severe retraction pockets (n = 99), both treated surgically, composed the patient group. METHODS STATISTICAL ANALYSIS univariate analysis of event-free survivals (using log-rank test and Kaplan-Meier estimate) and multivariate analysis (using Cox regression model) of clinical history, surgical observations, residuals occurrence (using Kaplan-Meier's statistical method) were used. RESULTS Posterior mesotympanum involvement, ossicular chain interruption after disease excision (and moreover combination of both), relative lack of experience of the surgeon, and presumed incomplete removal were identified as independent risk factors highly correlated with residuals' development (relative risks ranging from 2.02-4.84). Disease extension, type of process (cholesteatoma vs. retraction pocket), eventual surgical history, and surgical method initially used (closed or open) showed no such correlation. CONCLUSION The identification of any of these factors should instigate a mandatory second-look procedure regardless of other initial surgical findings and of technique used. The authors propose to advance this procedure from 12 to 9 months when all these factors are found in one child.
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Affiliation(s)
- G Roger
- Service d'ORL Pédiatrique et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris, France
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33
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Abstract
Thirty-six children with nasal dermoid sinus cysts were treated in the Department Pediatric Otolaryngology, Armand Trousseau's Children's Hospital (Paris, France) between 1974 and 1994. Ten of the patients presented with a midline cyst only, eight had nasal pits only, and 18 had combined cases. In six of the 36 patients, presurgical imagery indicated signs of intracranial extension of the tract, reaching the foramen caecum without intracranial mass. Three surgical techniques were used: an external rhinoplasty approach with medial crura section in 23 cases, a direct median approach in seven cases, and a paracanthal approach in six cases. Only two cases had meningeal adherences. Two superficial recurrences occurred within the 7-year follow-up period. Widening of the scar occurred in four children after verticomedian approach or nasal pit excision. The external rhinoplasty procedure with medial crura section results in a wide surgical approach, low recurrence rate, and good aesthetic results.
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Affiliation(s)
- F Denoyelle
- Department of Pediatric Otolaryngology and Head and Neck Surgery, Armand Trousseau's Children's Hospital, Paris, France
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34
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Abstract
In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheostomy was necessary in 13 children. Bi-level positive airway pressure (BiPAP) was used successfully in 2 children and tracheotomy was avoided. Treatment still needs to be better defined.
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Affiliation(s)
- P Froehlich
- Département d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital E. Herriot, Lyon, France
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35
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Ducroz V, Girschig H, Roger G, Grimfeld A, Garabedian EN. [Inferior turbinectomy in asthmatic children]. Ann Otolaryngol Chir Cervicofac 1997; 114:36-40. [PMID: 9239260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nineteen children with asthma underwent bilateral inferior turbinectomy from 1990 to 1995. Mean age was 11.5 years (range 8-17). All had obstructive allergic rhinitis and were resistant to long-term local corticosteroids. All operations were done under general anesthesia and endoscopic control. Mean hospital stay was 3 days. The postoperative period was uneventful and mean follow-up is 21 months (10-44). The patients described outcome as a clear improvement (n = 15), partial improvement (n = 3) and unilateral improvement (n = 1). The effect on asthma was more difficult to ascertain due to the number of cofactors. It can be noted however that asthma was not aggravated and that in 9 cases episodes decreased in frequency. Inferior turbinectomy provides considerable improvement in the comfort of patients with asthma, especially in terms of nasal ventilation.
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Affiliation(s)
- V Ducroz
- Service ORL et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris
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36
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Denoyelle F, Garabedian EN. [Tracheobronchial complications of assisted ventilation in children]. Rev Mal Respir 1996; 13:259-64. [PMID: 8765918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Assisted ventilation in children may cause acquired lesions of the trachea and bronchi. Symptoms may appear even during or after assisted ventilation. Tracheobronchoscopy is the best method for diagnosis of tracheobronchial abnormalities. Tracheobronchial granulomas and stenosis, and tracheobronchomalacia are the most common adverse effects of assisted ventilation via either endotracheal tube or tracheostomy. The frequency of tracheobronchial lesions is higher in case of assisted ventilation via tracheostomy, with a high incidence of stomal complications.
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Affiliation(s)
- F Denoyelle
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital d'enfants Armand-Trousseau, Paris
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37
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Abstract
OBJECTIVE To describe 9 cases of stridor attributed to the failure of the vocal cord to abduct during inspiration. DESIGN Case series. SETTING Pediatric otolaryngology referral center. PATIENTS Nine hospitalized infants, aged 1 to 13 months, presented over a 3-year period for exploration of inspiratory stridor that was attributed to a condition that we have termed laryngeal dyskinesia. RESULTS A consistent clinical presentation was noted in all cases. The laryngeal dyskinesia occurred during calm breathing, crying, or sleep and was associated with gastroesophageal reflux in 8 cases (diagnosed clinically and/or with pH monitoring). In addition, 3 infants suffered from fainting spells associated with vagal hypertonia that was confirmed by 24-hour Holter monitoring. True paralysis of the abductor muscles was ruled out in all infants because of the presence of normal glottic motion during calm breathing or induction of anesthesia. The stridor resolved between the ages of 4 and 13 months in 7 of the patients. Improvement was progressive and had no clear relationship to treatment for gastroesophageal reflux. CONCLUSION Laryngeal dyskinesia in infants seems to be a distinct clinical entity, frequently associated with gastroesophageal reflux.
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Affiliation(s)
- F Denoyelle
- Department of Pediatric Otolaryngology and Cervicofacial Surgery, Armand Trousseau's Children's Hospital, Paris, France
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38
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Moissenet D, Guet L, Valcin M, Garabedian EN, Geslin P, Garbarg-Chenon A, Vu-Thien H. [Molecular epidemiology of pneumococci with decreased susceptibility to penicillin isolated in a Parisian pediatric hospital]. Pathol Biol (Paris) 1996; 44:423-9. [PMID: 8758488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pneumococci with decreased susceptibility or resistant to penicillin (PRP) have been isolated with an increasing frequency in France. Among PRP, isolates of serotypes 23F and 9V were the most frequently recovered in our children's hospital. Penicillin-resistance is due to the appearance of altered penicillin binding proteins (PBPs) with reduced affinity for beta-lactam antibiotics. 3 PBPs have been well studied, 2b, 2x and 1a, and the sequences of their genes have been determined. Our molecular epidemiological study of 14 PRP 9V and 26 PRP 23F isolated mainly from otitis in 1993-94, consisted of determining chromosomic restriction patterns (Apa I) by pulsed-field gel electrophoresis, and restriction patterns (Hinf I) of PBP genes pbp 2b, pbp 2x and pbp 1a after PCR. All the PRP 9V exhibited the same pulsotype and identical patterns for each of the genes pbp 2b, pbp 2x and pbp 1a, suggesting a clonal origin. The origins of PRP 23F were more heterogenous: 5 clones could be defined, with one predominant clone composed of 20 isolates. Most of the PRP 23F shared identical profiles for the genes pbp 2b, pbp 2x and pbp 1a with the PRP 9V, suggesting a horizontal transfer of DNA. Molecular markers, which provide more informations than serotyping, were useful to clarify the complex epidemiology of PRP.
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Affiliation(s)
- D Moissenet
- Service de Microbiologie, Hôpital d'Enfants Armand-Trousseau, Paris, France
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39
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Garabedian EN, Ducroz V, Leperchey F, Roger G, Denoyelle F. [Malformations of the nasal fossa and paramedian facial clefts. New perspectives]. Ann Otolaryngol Chir Cervicofac 1996; 113:373-8. [PMID: 9207969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Since choanal atresia may be associated with other cranio-facial malformations, including various degrees of nasal fossa malformation, and be a part of paramedian facial clefts, (as described by Tessier), they can be integrated into the larger group of neurocristopathies. We identified four such cases with combined clinical elements corresponding to Tessier's paramedian facial cleft, including eyelid coloboma, mild to severe choanal and nasal fossa anomalies, ethmoidal hypoplasia and anterior skull base malformation, sometimes with proboscis lateralis. These various malformations are due to abnormality of the olfactive placode and the adjacent mesenchyme. These discoveries incited us to elaborate a conception first of all on the pertinent embryology involved, second, to propose a new classification based on anatomical and pathogenic embryological considerations. And finally, since endonasal laser therapy is particularly dangerous in such cases, to propose the use of transpalatal approach to restore choanal permeability. Pediatric ENT surgeons should pay special attention to any small stigmatism of facial cleft when dealing with children affected by choanal atresia.
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Affiliation(s)
- E N Garabedian
- Service ORL et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris
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Abstract
Between 1987 and 1993, 115 children were operated on for severe forms of laryngomalacia in two pediatric ear, nose, and throat (ENT) departments. The criteria used to determine the severity of the illness were selected following short hospitalization periods during which the children received both pediatric and ENT checkups. Based on clinical manifestations and/or the results of pH monitoring gastroesophageal reflux was found to be present in 68% of the children in the study. Detailed analysis and endoscopy were used to differentiate the symptoms that were related to laryngomalacia from those that were caused by other conditions, including mixed-breathing, swallowing, and sucking difficulties. Endoscopic resection of the aryepiglottic folds, with or without the use of a carbon dioxide laser, resulted in rapid improvement of both ventilation and swallowing. The success rate of this simple and effective procedure, which has no inherent morbidity, was 98% in an average follow-up period of 30 months. Only seven children required an additional similar procedure. The procedure failed in only two children, who needed to be tracheotomized. Given these excellent results, endoscopic resection can be considered an effective technique for the management of severe laryngomalacia.
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Affiliation(s)
- G Roger
- ENT and Head and Neck Surgery Department, Armand Trousseau Children's Hospital, Paris, France
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Silberman B, Garabedian EN, Denoyelle F, Moatti L, Roger G. Role of modern imaging technology in the implementation of pediatric cochlear implants. Ann Otol Rhinol Laryngol 1995; 104:42-6. [PMID: 7832541 DOI: 10.1177/000348949510400107] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Since 1989, 40 patients have received cochlear implants in our institution. Over the past 2 years, 17 children among these patients have undergone radiographic assessment combining magnetic resonance imaging (MRI) and high-resolution computed tomography (CT) scanning. Imaging is not essential, and is only used after assessment by a multidisciplinary team. However, the imaging results influence the choice of implant, and sometimes the side to be implanted. The first study is always CT, as it detects congenital abnormalities, and for children with a history of bacterial meningitis, it can detect signs of labyrinthine ossification that contraindicates or complicates cochlear implantation. These signs are not always visible with tomodensitometry, especially when fibrosis within the canal has not yet ossified. This examination also provides for postoperative confirmation of implant position in case of failure or complication. Over the past 3 years, MRI has been combined with tomodensitometry, especially with children having a history of meningitis. This examination provides a basis for evaluating the liquid nature of the labyrinth. A GE Signa 1.5-T unit was used by the authors, employing sequences of volumetric acquisition (steady state free precision with 1.5-mm image slices and an angle of 15 degrees to 35 degrees). Hence, modern imaging plays an important role when the decision to implant has already been made, particularly in the case of profoundly deaf children. We always use MRI in combination with a CT scanner in children with a history of meningitis.
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Affiliation(s)
- B Silberman
- Department of Pediatric Radiology, Trousseau Children's Hospital, Paris, France
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Abstract
Sarcoidosis is a multisystemic granulomatosis of unknown etiology which mainly affects young adults. It is characterized primarily by bilateral hilar adenopathies, a pulmonary infiltrate and cutaneous and ocular lesions. It rarely occurs in children under the age of 16. Localization in the upper respiratory tract (URT) is infrequent and sarcoidosis of the URT in children is exceptional, with only 13 cases reported in the literature. In the present report we describe the clinical, diagnostic explorations, histological and therapeutic aspects of 2 new cases in children.
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Affiliation(s)
- G Roger
- Department of ENT and Head and Neck Surgery, Hôpital d'Enfants Armand Trousseau, Paris, France
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Sarfati D, Bestry C, Moatti L, Garabedian EN. [Auditory evoked potentials by electric stimulation of the cochlea]. Ann Otolaryngol Chir Cervicofac 1994; 111:389-392. [PMID: 7645888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The recording of auditory brain stem potentials evoked by electrical stimulation of the cochlea is a part of our assessment protocol before pediatric cochlear implantation. It constitutes an objective and reproducible method to estimate the stimulability of the auditory system for candidates to cochlear implant. Ten children, aged from 3 to 12 years, with deep deafness of the 2nd and 3rd group with no response to ABR, undergone electric stimulation of the cochlea. All patients were anesthetized and paralyzed. Electric pulses are delivered by a cochlear stimulator, through a transtympanic needle electrode, placed in the promontory. We record responses on a Medelec "Saphire" computer. One of the main problem we try to solve is the stimulus artefact which occurs during the first ms. The other one is to be sure that the recorded responses are corresponding to the neural activity of the auditory nerve and the brainstem auditory pathway.
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Affiliation(s)
- D Sarfati
- Service ORL de Chirurgie Cervico-faciale et d'Audiophonologie Pédiatrique, Hôpital d'Enfants Armand Trousseau, Paris
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Roger G, Tashjian G, Roelly P, Rahmi H, Lacombe H, Garabedian EN. [Fixed retraction pockets and cholesteatoma in children. Authors' experience with 199 cases]. Ann Otolaryngol Chir Cervicofac 1994; 111:103-109. [PMID: 7825936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cholesteatoma is more destructive in the child than in the adult, but few studies have examined the outcome as a function of age. The authors evaluated retrospectively their experience in 199 cases of cholesteatomas or uncontrollable fixed retraction pouches in children under the age of 15. Mean follow-up was 2 and a half years and the anatomic and functional results are detailed. Reasons for performing first intention or second intention canal wall up or down procedures were analyzed as a function of age. Residual cholesteatomas were particularly frequent in whatever the initial surgical procedure. Cholesteatomas and retraction pouches in the child under 5 (n = 24) were particularly aggressive and destructive, often requiring a canal wall down operation. Residual cholesteatomas were also very frequent and involved both bony and functional element of the petrus. The clinical course of cholesteatoma in the young child appears to be very different, becoming less destructive as the child reaches adulthood.
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Affiliation(s)
- G Roger
- Service d'ORL Pédiatrique et de Chirurgie Cervico-Faciale, Hôpital d'enfants Armand-Trousseau, Paris
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Garabedian EN. [Cochlear implants in children. Indications in rehabilitation of total deafness]. Arch Fr Pediatr 1993; 50:5-7. [PMID: 8507140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Roelly P, Roger G, Bellity A, Garabedian EN. [Choanal atresia: management and surgical treatment. Study of 50 cases]. Ann Pediatr (Paris) 1992; 39:479-83. [PMID: 1456674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Diagnosis of choanal atresia should lead to multidisciplinary investigations to look for other malformations which may or may not be part of the CHARGE syndrome. These concomitant defects have an adverse effect on prognosis in patients with choanal atresia. They seem to be more common in patients with bilateral choanal atresia due to a bony septum. Local investigations include nasal fiberoptic endoscopy to obtain a direct view of the atresia and a CT scan study to determine the type of obstruction. In neonates, treatment rests on transnasal perforation of the septum followed by stenting for four to six weeks. However recurrence is common and requires subsequent use of another therapeutic procedure. In patients with failed transnasal perforation or unilateral choanal atresia discovered at a later age, surgery through the palatal route seems to be virtually radical and can be carried out from eight months of age. Recently developed CO2 laser therapy is, in the opinion in of the authors, an elegant and simple means for transnasal treatment of fibrotic restenosis which, in many cases, obviates the need for transpalatal surgery.
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Affiliation(s)
- P Roelly
- Service d'Otorhinolaryngologie, Hôpital d'Enfants Armand Trousseau, Paris
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Denoyelle F, Roger G, Garabedian EN. [Current therapeutic indications in laryngeal stenoses in children]. Ann Pediatr (Paris) 1992; 39:509-12. [PMID: 1456680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Among pediatric patients with laryngeal stenosis, acquired forms are now more common than congenital forms. External surgery is not always warranted except in complete or tight obstructions. After establishing the diagnosis by endoscopy, consequences on respiration and phonation should be assessed before deciding on the most appropriate treatment: abstention, medical therapy, endoscopic treatment, or surgical treatment by the cervical route. Surgical laryngoplasty techniques have changed radically over the last twenty years. The Cotton procedure is the most widely used. Another available method is the cricoid-split technique. These laryngoplasty procedures can be performed from birth and tracheostomy is now warranted only after failure of initial surgery.
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Affiliation(s)
- F Denoyelle
- Service d'Otorhinolaryngologie, Hôpital Trousseau, Paris
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Denoyelle F, Garabedian EN, Roger G, Belloc JB. [Severe aplasia of the ear: management and surgical indications]. Ann Pediatr (Paris) 1992; 39:505-8. [PMID: 1456679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Severe aplasia of the ear raises both a cosmetic and a functional problem. Surgery is often performed starting at four or five years of age but early management is essential. The need for a hearing aid should be evaluated at the age of six months. At birth, the infant should have investigations for concomitant malformations, which are common, and for etiologic factors. Functional surgery to create a canal, tympanic membrane, and chain of ossicles should be performed only in bilateral forms. Satisfactory cosmetic results can be achieved by cartilage autografting according to Brent's technique.
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Affiliation(s)
- F Denoyelle
- Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, Hôpital d'Enfants Armand Trousseau, Paris
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Garabedian EN, Moatti L, Roger G, Denoyelle F, Roelly P. [Cochlear implants in children]. Ann Pediatr (Paris) 1992; 39:467-72. [PMID: 1456672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The development of surgically implantable hearing aids that are placed directly in the cochlea where they send electrical impulses to the cochlear nerve is a major break-through for patients whose hearing loss is so severe as to make conventional electroacoustic hearing aids ineffectual. Initially used only in adults, this method has gradually been extended to pediatric patients. To benefit from a cochlear implant, the patient must fulfill a number of criteria which are specified in this article. Following preoperative investigations, the decision is taken during a meeting of all the care providers involved, i.e., the surgeon, ENT phoniatrist or audiophonologist, hearing aid specialist, special education provider, speech therapist, psychologist, and other members of the health care staff. Team work is thus essential both before and after the procedure. The implant selected can be intracochlear or extracochlear and single-channel (one electrode) or multi-channel (several electrodes). Each team selects the implantation technique and type of implant they use according to their preferences and specific criteria. The authors use a multi-channel intracochlear system except in the rare instances where complete ossification of the cochlea requires use of an intracochlear mono-channel system. They have inserted implants in 29 patients to date. The cochlear implant has unquestionably had a significant impact of the life of these patients.
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Roelly P, Roger G, Tashjian G, Garabedian EN. [Current therapeutic approach to cervicofacial lymphangiomas in children]. Ann Pediatr (Paris) 1992; 39:491-4. [PMID: 1456676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Twenty-four cases of cervicofacial lymphangioma treated between 1984 and 1991 are reported. The therapeutic approach is discussed. Because the therapeutic problem depends on whether or not the airways are involved, an endoscopic evaluation and a CT scan study should be included in the workup. In the five patients with limited lymphangiomas, complete surgical exeresis was feasible and yielded good results. Sclerosing injections are an alternative to surgery in this situation. In patients with pharyngeal or laryngeal infiltration or involvement of the mediastinum, the prognosis is extremely grim and surgery is still the mainstay of therapy despite the potential for recurrence due to the fact that only incomplete exeresis can be performed. Tracheostomy was required in two patients.
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Affiliation(s)
- P Roelly
- Service d'Otorhinolaryngologie, Hôpital d'Enfants Armand Trousseau, Paris
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