ening or replacement. 16 (50%) requiring revision had a syndrome other than microtia/atresia. 9 required multiple revisions. Overall, there were 45 episodes of soft tissue
debridement. 8 (10.8%) reported non-use of their implants.
CONCLUSION: Osseointegrated implants require frequent
maintenance care from the surgeon. Depending on criteria,
reported complication rates are highly variable for these implants, and major complication rates in children are likely
higher than previously reported.
Comprehensive Airway Management of Head and
Neck Teratomas
Marci Neidich, MD (presenter); Jeremy Prager, MD;
Stacey Smith, MD; Ravindhra Elluru, MD, PhD
OBJECTIVE: 1) Determine the success of initial airway management in patients with airway obstruction due to congenital
head and neck teratomas. 2) Characterize late airway-related
complications in children with congenital head and neck teratomas.
METHOD: Retrospective review of consecutive patients with
congenital head and neck teratomas from 1988 to 2010 at an
academic center. Variables examined include initial airway
procurement methods and subsequent airway management.
Outcomes include short and long-term complications.
RESULTS: Fourteen cases were reviewed. In 12 patients,
initial airway management was accomplished on placental
support with either intubation (oral or retrograde) or tracheotomy. Two vaginal births required subsequent uncomplicated
oral intubation within 24 hours. Eight patients required tracheotomy (3 within the delivery suite, 2 during mass excision on
day of life 6 and 24 and the remaining greater than 1 month
after birth). Five deaths occurred, 4 due to complications of
their teratomas within several days of birth and 1 due to an
airway complication on day of life 32. Follow-up for surviving
patients ranged from 1 month to 18 years. Long-term airway
complications ranged from vocal cord paralysis to stenosis
requiring laryngotracheoplasty.
CONCLUSION: A multidisciplinary team and a standardized
approach in the operating suite have led to successful initial
airway procurement. Additionally, this study demonstrates the
need for continued airway management beyond delivery, as
evidenced by our experience with airway-related mortality.
Airway management warrants discussion and likely operative
evaluation after birth, perhaps at time of mass excision. Longterm airway complications mandate close follow-up, long after
the well-planned delivery.
Deep Neck Infections of Congenital Causes
Yasser Nour, MD, FRCSEd (presenter); Alaa Gaafar,
MD
OBJECTIVE: 1) Estimate the incidence and enumerate types
of congenital lesions that can cause deep neck infections. 2)
P113
Discuss the computed tomographic and clinical findings of
these entities. 3) Identify the appropriate method of treatment
of such lesions.
METHOD: We retrospectively reviewed our clinical, imaging
and operative records of deep neck infection cases presented to
our department in the last 10 years. Deep neck infection cases
due to congenital causes were included in the study.
RESULTS: Thirty-nine patients were diagnosed as deep neck
infections due to congenital causes out of 249 deep neck
infections admitted to our department in the last 10 years.
Patients were classified into two groups. In group I (29 patients), computed tomography revealed the presence of infected cystic swelling in the neck that was classified as; 2nd
branchial cyst (16 patients), 3rd & 4th branchial cysts (8
patients) and thyroglossal duct cyst (5 patients). Group II (10
patients) presented with recurrent attacks of deep neck infection with history of incision and drainage for several times.
Radiological and operative findings revealed the presence of
congenital piriform sinus (3rd and 4th branchial internal sinus).
CONCLUSION: Computed tomography is helpful in diagnosing infected congenital cysts and its types. Infected congenital cysts could be excised completely under umbrella of
antibiotics. Recurrence of deep neck infections should alert the
physician to the possibility of underlying congenital lesions.
Thorough complete clinical and radiological assessment is
mandatory to rule out the possibility of a congenital piriform
sinus.
Dexmedetomidine Use in Pediatric Airway
Reconstruction
Amanda Silver, MD (presenter); Natan Noviski;
Christopher Hartnick, MD, MS; Phoebe Yager, MD
OBJECTIVE: Assess the post-operative use of dexmedetomidine (Precedex) in pediatric patients undergoing airway reconstructive surgery.
METHOD: Following IRB approval, a retrospective chart
review was conducted. Twelve pediatric patients undergoing
laryngotracheal reconstruction (LTR) or laryngeal cleft repair
(LCR) were divided into three groups based on duration of
post-operative intubation. Group 1 was intubated ⬍24 hours,
Group 2 was intubated two to six days, and Group 3 was
intubated longer than seven days. Twelve age-, gender- and
procedure-matched controls were selected. Baseline heart rate
and blood pressure measurements were compared to hourly
measurements for the first six hours following initiation of
dexmedetomidine or mechanical ventilation in the control
group. Number and type of supportive respiratory interventions, number of self-extubations, administration of analgesic,
anxiolytic, and sedative agents during intubation and following
extubation, as well as length of stay were evaluated.
ORALS
Oral Presentations