Nasal surgery in children: a personal perspective.

Objective: To comment on the experience gained from completing 518 nasal procedures in 480 children over the 21-year period from 1986 to 2006 inclusively.

Design: Prospective, nonblinded, nonrandomized study.

Setting: Tertiary care pediatric academic otolaryngology-head and neck surgical practice.

Preoperative characteristics and postoperative outcomes following adenoidectomy in children.

Objectives: (1) To describe various preoperative and diagnostic findings of children undergoing adenoidectomy and (2) to evaluate quality of life outcomes following adenoidectomy in children.

Methods: This was a prospective observational study. Patients who were candidates for adenoidectomy at The Hospital for Sick Children were evaluated with respect to preoperative symptoms, flexible nasal endoscopy (FNE) findings, and nasal airflow (NAF) studies.

Saliva control issues in the neurologically challenged. A 30 year experience in team management.

Objective: The objective of this paper is to report the experience of a multidisciplinary team (otolaryngologist, speech-language pathologists, pediatric dentist, and social worker) functioning at a pediatric rehabilitation center have had in the management of 1487 neurologically challenged individuals with saliva control issues assessed from 1976 to the end of 2004.

Method: The role of each team member is outlined. Management decisions have consisted of no treatment, utilization of oral-motor training program, elimination of contributing situational factors, utilization of medication, surgery and Botox injections of the major salivary glands.

Observations on the early results of treatment of recurrent respiratory papillomatosis using cidofovir.

Objective: To document the response of two patients with severe recurrent laryngeal papillomatosis following treatment with intralesional cidofovir in conjunction with carbon-dioxide laser evaporation.

Setting: Tertiary referral centre.

Methods: Retrospective review of treatment of two patients followed up over a 12-month period.

A study of anthropometric measures before and after external septoplasty in children: a preliminary study.

Objective: To test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions.

Design: Paired study.

Setting: Tertiary care center.

Management of drooling in individuals with neurodisability: a surgical experience.

From 1975 to 1 January 1999, 1103 neurologically involved patients (mean age 13.2 years; 686 males, 417 females) referred with problematic drooling, or sialorrhea, were assessed at a pediatric rehabilitation center by a team consisting of an otolaryngologist, speech pathologist, and a dentist. The initial standard treatment for persistent sialorrhea (in the compliant or aware patient) is oral-motor training.

Nasal obstruction in children with craniofacial malformations.

The etiology, patient evaluation and management of nasal obstruction in children with craniofacial malformations is broadly discussed. Specific reference is made to the experience by the senior author (WSC) with respect to nasal surgery in 29 of these patients during the 12 years from 1987 to January 1st, 1998.

Nasal growth after external septoplasty in children.

Objective: To assess the impact of external septoplasty surgery on nasal growth in children.

Design: Twelve anthropometric measurements (9 linear and 3 angular) were obtained in patients who previously underwent external septoplasty surgery for severe nasal obstruction caused by septal deviation anterior to the nasal spine. Surgery consisted of excision, refashioning, and reinsertion of the quadrilateral cartilage.

Otoplasty. Clinical protocol and long-term results.

Objective: To evaluate the long-term results after otoplasty on prominent ears.

Design: Between 1988 and 1993, ear protrusion was measured preoperatively and postoperatively in pediatric patients undergoing otoplasty by means of a standard protocol based on the Frankfort horizontal line. Patients were asked to return for follow-up measurements a minimum of 1 year after surgery.

Congenital cystic adenomatoid malformation of the lung referred as 'airway foreign body'.

Congenital cystic adenomatoid malformation of the lung is an uncommon anomaly. Two patients with this condition were recently referred to the Otolaryngology Service at The Hospital for Sick Children, Toronto, Ontario, for bronchoscopic evaluation of the airway to rule out a foreign body. Although history did not disclose a clear episode of aspiration in either case, chest radiographs showed unilateral lobar hyperinflation with mediastinal shift, consistent with foreign body obstruction.

Laser aryepiglottoplasty for the treatment of neurasthenic laryngomalacia in cerebral palsy.

Patients with cerebral palsy usually suffer from lack of coordination in the neuromuscular mechanism in their upper airway and digestive tract. Difficulty in swallowing and aspiration are common problems in these patients, and stridorous breathing sometimes develops as a secondary symptom. Laryngoscopic examination revealed that redundant tissue in the aryepiglottic fold area was the cause of stridor and upper airway obstruction in four patients with cerebral palsy.

Congenital nasal pyriform aperture stenosis as a presenting feature of holoprosencephaly.

Congenital nasal pyriform apertures stenosis (CNPAS), a recently recognized uncommon cause of nasal airway obstruction, can be a life-threatening circumstance in the neonate. This study's experience with six cases confirmed the suggestion that CNPAS represents a manifestation of holoprosencephaly. Management of this condition depends firstly on the overall prognosis of the patient and secondly the severity of obstruction.

Sinusitis in patients with cystic fibrosis.

The management of sinus disease in children with cystic fibrosis is reviewed, based on a literature review and clinical experience in The Hospital for Sick Children, Toronto. Diagnostic and treatment approaches are discussed, with emphasis given to indications for surgical therapies. Great importance is given to the preservation of normal nasal anatomy whenever possible to minimize the possibility of iatrogenic injuries occurring, especially when revision surgery is required.

Electrocautery-induced ignition of tonsillar packing.

A recent case of ignition of a bismuth-subgallate pack during routine tonsillectomy prompted this investigation of local oxygen levels. Similar conditions were reproduced in the laboratory to determine their influence on the flammability of materials commonly used to aid in haemostasis. Cotton tonsil packs soaked in saline, adrenalin, or adrenalin and bismuth were compared.

External septorhinoplasty in children: patient selection and surgical technique.

The external or open septorhinoplasty is used in children as young as 6 years of age. The primary indication for this procedure is the presence of nasal septal pathology anterior to the anterior nasal spine causing significant nasal airway obstruction. Meticulous attention to technique, especially the construction of a "new" septum, is essential for a successful outcome.

External septorhinoplasty in children: Outcome and effect on growth of septal excision and reimplantation.

Outcome and effect on nasal growth of external septorhinoplasty was evaluated in 32 children. All had septal disease anterior to the nasal spine. In all cases, the cartilaginous septum was totally excised, refashioned, and then reinserted.

Evaluation and management of the drooling patient.

Drooling, or sialorrhea, may appear to be a most mundane problem but in fact can be a condition with a wide spectrum of etiologies. Unhappily, drooling also may lead to several unfortunate medical and psychosocial outcomes for the affected patient. The senior author (WSC) has had a 13 year interest in the treatment of drooling patients.

Tracheitis: outcome of 1,700 cases presenting to the emergency department during two years.

A retrospective analysis was completed of the charts of the 1,727 patients with the diagnosis of croup seen during two years (1985 and 1986) in the Emergency Department of The Hospital for Sick Children in Toronto. Cough (91.4%) was the most common presenting symptom.