External airway splint placement for severe pediatric tracheobronchomalacia.

Objective: To present external airway splinting with bioabsorbable airway supportive devices (ASD) for severe, life-threatening cases of pediatric tracheomalacia (TM) or tracheobronchomalacia (TBM).

Methods: A retrospective cohort was performed for 5 pediatric patients with severe TM or TBM who underwent ASD placement. Devices were designed and 3D-printed from a bioabsorbable material, polycaprolactone (PCL).

Clinical grade manufacture of 3D printed patient specific biodegradable devices for pediatric airway support.

Implantable patient-specific devices are the next frontier of personalized medicine, positioned to improve the quality of care across multiple clinical disciplines. Translation of patient-specific devices requires time- and cost-effective processes to design, verify and validate in adherence to FDA guidance for medical device manufacture. In this study, we present a generalized strategy for selective laser sintering (SLS) of patient-specific medical devices following the prescribed guidance for additive manufacturing of medical devices issued by the FDA in 2018.

Sustaining standardized opioid prescribing practices after pediatric tonsillectomy.

Introduction: Opioid prescribing patterns after pediatric tonsillectomy are highly variable, and opioids may not improve pain control compared to over-the-counter pain relievers. We evaluated whether a standardized, opioid-sparing analgesic protocol effectively reduced opioid prescriptions without compromising patient outcomes.

Methods: A quality improvement project was initiated in July 2019 to standardize analgesic prescribing after hospital-based tonsillectomy with/without adenoidectomy.

Congenital Central Hypoventilation Syndrome: Optimizing Care with a Multidisciplinary Approach.

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder affecting respiratory control and autonomic nervous system function caused by variants in the paired-like homeobox 2B () gene. Although most patients are diagnosed in the newborn period, an increasing number of patients are presenting later in childhood, adolescence, and adulthood. Despite hypoxemia and hypercapnia, patients do not manifest clinical features of respiratory distress during sleep and wakefulness.

The utility of handheld ultrasound as a point-of-care screening tool to assess vocal fold impairment following congenital heart surgery.

Introduction: Vocal fold motion impairment (VFMI) is a known potential complication of congenital heart surgery (CHS). Flexible nasolaryngoscopy (FNL) is the gold standard for evaluation of vocal fold movement but has risks, including epistaxis, desaturation, and changes in heart rate. Laryngeal ultrasound (LUS) has begun to emerge as a diagnostic tool and has been shown to have high accuracy in the evaluation of VFMI.

Tracheostomy decannulation to noninvasive positive pressure ventilation in congenital central hypoventilation syndrome.

Purpose: Noninvasive positive pressure ventilation (NPPV) may permit tracheostomy decannulation (TD) in patients with congenital central hypoventilation syndrome (CCHS) requiring nocturnal positive pressure ventilation via tracheostomy (PPV-T). There is limited evidence on optimal strategies for transitioning patients from PPV-T to NPPV. This study aimed to describe the clinical course and outcome of children with CCHS who underwent TD and transitioned from PPV-T to NPPV.

Multicenter Advanced Pediatric Otolaryngology Fellowship Prep Surgical Simulation Course with 3D Printed High-Fidelity Models.

Objective: To assess the effect of 3-dimensional (3D)-printed surgical simulators used in an advanced pediatric otolaryngology fellowship preparatory course on trainee education.

Study Design: Quasi-experimental pre/postsurvey.

Setting: Multicenter collaborative course conducted at a contract research organization prior to a national conference.

Passy muir valve tolerance in medically complex infants and children: Are there predictors for success?

Objective: The aim of this study was to investigate if there are predictors for success with Passy Muir Valve (PMV) placement for medically complex pediatric patients.

Methods: Retrospective chart review of 52 pediatric patients with a tracheostomy with or without ventilator dependence who received PMV assessments from October 2017 through October 2018 in intensive care units and acute care units within Children's Healthcare of Atlanta (Atlanta, GA). Univariate analysis and logistic regression modeling were used to identify factors associated with a successful PMV trial.

Posterior Tongue Tie, Base of Tongue Movement, and Pharyngeal Dysphagia: What is the Connection?

Ankyloglossia, or tongue tie, and its impact on the oral phase of feeding has been studied and debated for decades. However, the impact of posterior tongue ties on the pharyngeal phase of swallowing is not well documented in the literature. A videofluoroscopic swallow study (VFSS) allows for visualization of the oral, pharyngeal, and esophageal phases of the swallow.

Sensorineural hearing loss in children with sickle cell disease.

Introduction: Sensorineural hearing loss (SNHL) has been reported to occur at increased frequency in the pediatric sickle cell disease (SCD) population, likely secondary to ototoxic medication regimens and repeat sickling events that lead to end organ damage. Risk and protective factors of SNHL in this population are not fully characterized. The objective of this study was to describe audiology results in children with SCD and the prevalence and sequelae of SNHL.

Airway Anomalies.

This article reviews congenital anomalies involving the larynx and trachea, including congenital subglottic stenosis, laryngeal webs, laryngeal cleft, and tracheal stenosis. Presenting signs and symptoms, prevailing surgical repair techniques, and postoperative care are discussed.

Adenotonsillectomy in children with sickle cell disease and obstructive sleep apnea.

Introduction: Obstructive sleep apnea (OSA) is prevalent and may be more severe in children with Sickle Cell Disease (SCD) compared to the general pediatric population.

Objectives: The objective of this study was to describe the therapeutic effects and complications of tonsillectomy and adenoidectomy (T&A) for treatment of OSA in children with SCD.

Methods: A comprehensive database of pediatric SCD patients was reviewed to identify all patients who underwent T&A between 2010 and 2016.

Structural airway abnormalities contribute to dysphagia in children with esophageal atresia and tracheoesophageal fistula.

Background: Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF.

Segmental deficiency of cervical tracheal rings masquerading as complete tracheal rings: A case report and literature review.

Congenital deficiency of distal tracheal rings is a rare anomaly and has been previously reported in the literature. Here we report the first case deficient tracheal rings confined to the cervical trachea. Patient was transferred to our institution for management of what was initial thought to be complete tracheal rings.

Polysomnographic results of prone versus supine positioning in micrognathia.

Background: Children with micrognathia commonly present with upper airway symptoms and are at risk for developing obstructive sleep apnea (OSA). Prone positioning is widely used as first-line management for micrognathic children with obstructive symptoms. The aim of the present study was to document the effect of positioning on oxygenation and upper airway obstruction as measured by polysomnography (PSG).

Open staple diverticulectomy for a large recurrent Zenker's diverticulum: still a valid procedure.

Objectives: We demonstrate indications for external mechanical stapler diverticulectomy in the modern era of endoscopic treatment. We review treatment of a large diverticulum and discuss considerations that should be made in deciding on the type of surgical treatment.

Methods: The index case was in a 75-year-old man who had undergone open cricopharyngeal myotomy with diverticulopexy 35 years earlier.

Lipohyperplasia of the parathyroid glands.

Parathyroid lipohyperplasia is an extremely rare cause of hyperparathyroidism. According to a MEDLINE search, there have been only 9 previously reported cases of parathyroid lipohyperplasia in the English-language literature. We report a new case of parathyroid lipohyperplasia, with a brief discussion of this rare disease process.

Intraoral metal contact allergy as a possible risk factor for oral squamous cell carcinoma.

Objectives: Intraoral exposure to dental restorations can cause contact allergy that may induce carcinogenesis. We investigated the relationship of intraoral metal contact allergy to epithelial carcinogenesis.

Methods: The prevalence of positive patch test reactions to dental restoration metals in 65 prospectively enrolled patients with newly or previously diagnosed oral squamous cell carcinoma (SCC) was compared to that in 48 control patients.

Laryngomalacia: disease presentation, spectrum, and management.

Laryngomalacia is the most common cause of stridor in newborns, affecting 45-75% of all infants with congenital stridor. The spectrum of disease presentation, progression, and outcomes is varied. Identifying symptoms and patient factors that influence disease severity helps predict outcomes.

Closely opposed apurinic/apyrimidinic sites are converted to double strand breaks in Escherichia coli even in the absence of exonuclease III, endonuclease IV, nucleotide excision repair and AP lyase cleavage.

Multiply damaged sites (MDSs) consist of two or more damages within 20 base pairs (bps) and are introduced into DNA by ionizing radiation. Using a plasmid assay, we previously demonstrated that repair in Escherichia coli generated a double strand break (DSB) from two closely opposed uracils when uracil DNA glycosylase initiated repair. To identify the enzymes that converted the resulting apurinic/apyrimidinic (AP) sites to DSBs, repair was examined in bacteria deficient in AP site cleavage.

The mutation frequency of 8-oxo-7,8-dihydroguanine (8-oxodG) situated in a multiply damaged site: comparison of a single and two closely opposed 8-oxodG in Escherichia coli.

A multiply damaged site (MDS) is defined as > or =2 lesions within a distance of 10-15 base pairs (bp). MDS generated by ionizing radiation contain oxidative base damage, and in vitro studies have indicated that if the base damage is <3bp apart, repair of one lesion is inhibited until repair of the lesion in the opposite strand is completed. Inhibition of repair could result in an increase in the mutation frequency of the base damage.