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Deep Neck Infections of Congenital Causes

2011, … --Head and Neck Surgery

Objectives. To review cases of deep neck infections with underlying congenital etiology with special emphasis on their clinical presentations and the computed tomographic findings and to discuss the various therapeutic modalities employed for such lesions.

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