Complications in Pediatric Otolaryngology

Front cover......Page 1
In Memoriam......Page 6
Research......Page 9
Disciplinary Actions......Page 10
American Society of Pediatric Otolaryngology Code of Ethics......Page 11
Foreword......Page 12
Preface......Page 14
Contributors......Page 16
Contents......Page 22
Personal Responsibility......Page 26
Risk Management......Page 28
Contract with Society......Page 29
Managed Care Policies......Page 30
How Much Experience Is Enough?......Page 31
Management Principles of Surgical or Medical Complications......Page 32
Postcomplication Follow-Up......Page 33
Definitions of Legal Language......Page 34
References......Page 36
What Is Continuing Medical Education and Why Is It Important?......Page 38
Accreditation and Certification......Page 39
Reading and Evaluating the Literature......Page 40
Classification of Articles......Page 42
Searching the Literature......Page 43
Evidence-Based Medicine......Page 45
Suggested Self-Study Guidelines......Page 46
References......Page 47
The “Stress Response”......Page 48
Developing Strategies for Managing Stress in a Surgical Practice......Page 49
Mindfulness......Page 50
Stress Reduction Techniques......Page 51
Resources for Stress Reduction......Page 52
References......Page 53
The Hospital Experience......Page 54
Introduction......Page 56
Patient Management Preoperatively......Page 57
Preoperative Parent Management Issues......Page 58
Day of Surgery Issues......Page 59
Planning Ahead......Page 61
Handling Emergencies......Page 62
Preschoolers......Page 63
Conclusions......Page 64
Suggested Reading......Page 65
Issues in Anesthesia......Page 66
Enter Modern Anesthetic Technology......Page 67
Children Are Different......Page 68
Newborn Circulation......Page 69
Red Blood Cell Volume: Surgical Concerns......Page 70
Bronchoscope and Telescope Compatibility......Page 71
Preoperative Issues......Page 72
Induction of General Anesthesia......Page 76
Postoperative Nausea and Vomiting......Page 77
Monitoring Devices......Page 78
Apneic Oxygenation and Intermittent Ventilation......Page 79
Jet Ventilation......Page 80
Intubation and Endotracheal Tubes......Page 82
Mechanics of Intubation......Page 84
Use of Airway Exchange Devices......Page 85
Inadequate Ventilation and Perfusion......Page 86
Airway Obstruction......Page 87
Deadspace Ventilation......Page 88
Decreased Cardiac Output......Page 89
Pulmonary Embolus......Page 90
Inhalational Anesthetics......Page 91
Cardiac Output and Minute Ventilation......Page 92
Intravenous Anesthesia......Page 93
Opioids: Agonists and Antagonists......Page 94
Balanced Anesthesia......Page 95
Fluid and Blood Product Replacement......Page 96
Hyperthermia......Page 97
Positioning and Pressure Injuries......Page 98
Web and Text Resources......Page 99
References......Page 100
Emergency Airway Management and Critical Care Issues for the Child with a Difficult Airway......Page 104
Introduction......Page 105
Respiratory Physiology Differences......Page 106
Physical Examination......Page 107
Instrumentation and Equipment Preparation......Page 108
Technique......Page 109
Support of the Child with an Artificial Airway......Page 110
General Considerations......Page 111
Rapid Paralysis......Page 112
The Emergency Surgical Airway......Page 113
Ventilator Features......Page 114
Pulmonary Parenchymal Trauma......Page 115
Nososcomial Infections......Page 116
Sedation......Page 117
Drug Tolerance, Dependence, and Withdrawal......Page 118
Fluid Maintenance......Page 119
Criteria......Page 120
Weaning with a Tracheostomy Tube......Page 121
Adjunctive Intervention......Page 122
Planning and Preparation......Page 123
Conclusions......Page 124
References......Page 125
Pediatric Otolaryngology Imaging......Page 130
Available Imaging Tools......Page 131
Sedation vs. General Anesthesia......Page 133
Sinonasal Imaging......Page 134
Sinusitis......Page 135
Sinonasal Polyps......Page 138
Croup vs. Epiglottitis......Page 139
Inflammatory Masses......Page 140
Thyroglossal Duct Cyst......Page 141
Branchial Apparatus Anomalies......Page 143
Neoplasms......Page 144
Imaging the Pediatric Temporal Bone......Page 145
The Middle Ear......Page 146
Perilymphatic Fistula......Page 147
Inflammatory Disease......Page 148
Cholesteatoma......Page 151
Trauma......Page 152
Mass Lesions of the Temporal Bone......Page 153
IAC and CPA Masses......Page 155
References......Page 156
Cognitive Impairment......Page 162
Hearing Loss......Page 164
Failure to Close Air/Bone Gap with Ossiculoplasty......Page 165
Not Realizing That a Sensorineural Component Exists......Page 166
Failure to Detect at an Early Age......Page 167
Insensitivity in Presenting Options for Child’s Methods for Communicating and Educational Setting......Page 168
Misleading Parents by Offering to Perform a Surgical Procedure with Little Likelihood of Preventing Further Hearing Loss......Page 169
Audiogram Is the Only “True” Hearing Test......Page 170
Hearing Tools, Not Hearing Tests......Page 171
Otoacoustic Emissions Measure Outer Hair Cell Function, Not Hearing......Page 172
ABR Is Not the Definitive Answer......Page 173
Cross-Check Principle......Page 174
References......Page 176
Language Development......Page 178
Metalinguistic Competency......Page 179
Terminology......Page 180
Two-Word Utterances......Page 181
Multiword Utterances......Page 182
Late Developmental......Page 183
Articulation Disorders......Page 184
Age-Related Voice Changes......Page 185
Acquired Disorders......Page 186
Evaluation......Page 187
A Final Word......Page 188
References......Page 189
Introduction......Page 192
Platelets......Page 193
Platelet Function Assays......Page 194
Medical History......Page 196
von Willebrand’s Disease (vWD)......Page 197
Treatment of von Willebrand’s Disease......Page 198
Low-Level “Carriers” of Hemophilia......Page 199
End Stage Renal Disease......Page 200
References......Page 201
Introduction......Page 204
Bruton’s Disease (X-Linked Agammaglobulinemia)......Page 205
Other Immune Deficiency Categories......Page 206
Asthma......Page 207
Seasonal Allergic Rhinitis......Page 209
Differential Diagnosis......Page 210
Physical Examination and Laboratory Evaluation......Page 211
Avoidance Measures......Page 212
Pharmacotherapy......Page 213
Drug Allergy......Page 215
Anaphylaxis......Page 218
References......Page 219
Introduction......Page 224
Family History......Page 225
Specific Examination Features......Page 226
22q11.2......Page 227
Waardenburg......Page 228
Measures to Improve Family-Centered Care......Page 229
References......Page 230
Introduction......Page 232
Lymphadenopathy......Page 233
Other Masses......Page 234
Tissue Sampling......Page 235
Evaluation......Page 236
Epistaxis......Page 237
Infections......Page 238
Family Issues......Page 239
References......Page 240
Head and Neck......Page 242
Introduction......Page 244
Diagnosis of Childhood OSAS......Page 245
Growth......Page 247
Complications of Surgery for OSAS......Page 248
Perioperative Precautions......Page 249
Uvulopalatopharyngoplasty......Page 250
Nonsurgical Treatment of OSAS......Page 251
References......Page 252
Tonsillectomy and Adenoidectomy......Page 256
Intraoperative Hemorrhage......Page 257
Postoperative Hemorrhage......Page 258
Hematologic Preoperative Evaluation......Page 259
von Willebrand’s Disease......Page 260
Jehovah’s Witnesses......Page 261
Emesis and Poor Fluid Intake......Page 262
Down Syndrome......Page 263
Sickle Cell Disease......Page 264
Intraoperative Complications......Page 265
Fever......Page 266
Throat Pain......Page 267
Velopharyngeal Insufficiency......Page 269
Eagle Stylohyoid Syndrome......Page 271
Unusual Complications......Page 272
References......Page 273
Head and Neck Infections......Page 280
Antibiotic Treatment Considerations......Page 281
Antibiotic Resistance......Page 282
Fascial Spaces......Page 283
General Considerations......Page 284
Airway Control......Page 285
Cervical Adenitis......Page 286
Granulomatous Disease......Page 287
Other Viral Infections......Page 288
Peritonsillar Abscess......Page 289
Retropharyngeal Abscess......Page 290
Parapharyngeal Abscess......Page 291
Epiglottitis (Supraglottitis)......Page 292
Croup (Laryngotracheobronchitis)......Page 293
Managed Care Influences......Page 294
References......Page 295
Managing Head and Neck Lesions......Page 298
Airway Management and Anesthesia......Page 299
Embryonic Lesions......Page 300
Management......Page 301
Management......Page 302
Management......Page 304
Hemangiomas......Page 305
Lymphatic Malformations (Lymphangiomas)......Page 306
Sternocleidomastoid Muscle Tumor of Infancy......Page 307
Management......Page 308
Facial Nerve Preservation......Page 309
Recurrent Laryngeal Nerve Preservation......Page 310
Extent of Thyroidectomy......Page 311
Nasopharyngeal Angiofibroma......Page 312
Langerhans’ Cell Histiocytosis......Page 313
Antenatal Diagnosis of Congenital Masses......Page 314
References......Page 315
Introduction......Page 318
Anatomy and Developmental Physiology......Page 319
Evaluation......Page 320
Choanal Stenosis and Atresia......Page 321
Laryngeal Abnormalities......Page 322
The Infant......Page 323
Neurogenic Dysphagia......Page 324
Gastroesophageal Reflux......Page 325
Tumors of the Head and Neck......Page 326
Foreign Bodies......Page 327
Caustic Ingestion......Page 328
Infectious Etiologies......Page 329
Myopathies......Page 330
Conclusions......Page 331
References......Page 332
Introduction......Page 336
Classification of Reflux......Page 337
Laryngomalacia......Page 338
Other Considerations......Page 339
Barium Esophagram and Radionucleotide Reflux Scan......Page 340
Need for the Pharyngeal Sensor......Page 341
What Is Normal Acid Exposure in the Pharynx?......Page 342
Therapy......Page 343
References......Page 344
General......Page 350
Introduction......Page 352
Laser Properties and Delivery Systems......Page 353
Patient Safety......Page 355
Oxygen Concentration......Page 356
Anesthetic Technique......Page 357
Tympanic Membrane......Page 358
Nonlaryngeal Head and Neck Procedures......Page 359
Excessive Tissue Ablation......Page 360
Continuing Education......Page 361
References......Page 362
Introduction......Page 364
Management......Page 365
Complications......Page 366
Presentation......Page 367
Complications......Page 368
Management......Page 369
Conclusions......Page 370
References......Page 371
Airway and Endoscopy......Page 372
Extubation Problems in Infants and Children......Page 374
Anatomy and Development......Page 375
Cuff Injuries......Page 376
Mechanism of Injury......Page 377
Preparation......Page 378
Postextubation Assessment......Page 379
Granulomas......Page 380
Interarytenoid Synechia......Page 382
Artenoid Dislocation or Subluxation/Cricoarytenoid Fixation or Ankylosis......Page 383
Tracheal Stenosis......Page 384
Cricoid Split......Page 386
References......Page 387
Aerodigestive Endoscopy......Page 390
Introduction......Page 391
Where Is the Proper Locale?......Page 392
Therapeutic Intervention......Page 393
Things to Watch for......Page 394
Anatomic Hurdles......Page 395
Anesthesia and Ventilation......Page 397
Patient Positioning......Page 398
Anatomic Hurdles......Page 399
Bronchoscopy......Page 400
Anesthesia and Ventilation......Page 401
Anatomical Hurdles......Page 402
Complications......Page 403
Anesthesia and Ventilation......Page 404
Anatomical Hurdles......Page 405
Bronchoalveolar Lavage......Page 406
Esophagoscope Advancement......Page 407
Anesthesia and Ventilation......Page 408
Esophageal Perforation......Page 409
General Considerations......Page 410
Anesthesia and Ventilation......Page 411
Alternative Approaches......Page 412
Management......Page 413
Technique Pearls......Page 414
Specific Esophageal Pathology......Page 415
References......Page 416
Introduction......Page 418
Procedure and Technique......Page 419
Tracheotomy Tube Types......Page 420
Routine Tracheotomy Care......Page 421
Complications......Page 422
False Passage......Page 423
Suprastomal Collapse (Tracheomalacia)......Page 424
Dysphagia......Page 425
General Considerations......Page 426
References......Page 427
Introduction......Page 430
Preoperative Medical and Surgical History......Page 431
Endoscopic Diagnosis......Page 432
Cricotracheal Resection vs. Grafting......Page 433
Neuromuscular Blockade and Prolonged Sedation......Page 434
Immediate Postoperative Complications......Page 435
Long-Term Complications......Page 436
References......Page 437
Rhinology......Page 440
Introduction......Page 442
Bacteriology......Page 443
Medical Complications......Page 444
Orbital Complications......Page 445
Regional and Intracranial Complications......Page 446
References......Page 447
Pediatric Endoscopic Sinonasal Surgery......Page 450
Introduction......Page 451
Complications......Page 452
Periorbital Cellulitis (Preseptal)......Page 453
Synechiae......Page 454
Hemorrhage......Page 455
Intraoperative Identification......Page 456
Blindness and Visual Disturbance......Page 457
Medial Orbital Decompression and Optic Nerve Decompression......Page 460
Image-Guided System......Page 461
Septoplasty......Page 462
References......Page 463
Otology......Page 466
Otitis Media......Page 468
Background, Definition, Incidence, and Etiology......Page 469
Bacteriology and Antibiotic Resistance......Page 470
Medical Management......Page 471
Surgical Management......Page 472
Social and Economic Complications......Page 473
Otorrhea......Page 474
Duration and Extrusion......Page 475
Tympanic Membrane Atrophy, Retraction Pockets, and Adhesive Otitis Media......Page 476
Tympanosclerosis......Page 477
Factors in the Spread of Otitic Infection......Page 478
Direct Extension through Anatomic Pathways......Page 479
Symptoms and Signs of Impending Complication......Page 480
Antimicrobial Therapy......Page 481
Acute Mastoiditis......Page 482
Subperiosteal Abscess......Page 483
Facial Paralysis......Page 484
Petrositis......Page 485
Labyrinthitis......Page 486
Extradural Abscess......Page 488
Lateral Sinus Thrombosis......Page 489
Brain Abscess......Page 490
Otitic Meningitis......Page 493
Subdural Infection......Page 494
Conclusions......Page 495
References......Page 496
Otologic Surgery......Page 502
Introduction......Page 503
General Considerations......Page 504
Postoperative Considerations......Page 505
Surgical Technique Considerations......Page 506
Tympanic Membrane Pathology......Page 507
Overlay vs. Underlay vs. “Other”......Page 509
Ossiculoplasty......Page 510
Temporal Bone Pathology......Page 511
Canal Wall Up......Page 512
Canal Wall Down......Page 513
Modified Radical, Bondy Modified Radical, Radical Mastoidectomy, and Mastoid Obliteration......Page 514
Surgical Considerations......Page 515
General Principles......Page 516
Possible Complications of Mastoidectomy......Page 517
Major Bleeding......Page 518
Labyrinthine Fistula and Perilymph Leak......Page 519
Sensorineural Hearing Loss, Vertigo, and Tinnitus......Page 520
Neck Injury/Positioning......Page 521
Reasonable Expectations......Page 522
References......Page 523
Cochlear Implantation......Page 526
Educational Approaches and Communication Mode......Page 527
Selection Criteria (2002)......Page 528
History and Physical Examination......Page 529
Management of Middle Ear Effusion......Page 530
Cochlea Ossification......Page 531
Complications in Implanting the Anomalous Ear......Page 532
Revision Surgery......Page 533
Infection......Page 534
Device Failure......Page 535
References......Page 536
Microtia and Atretic Ear Surgery......Page 538
Classical Rib Reconstruction......Page 539
Epidemiology and Classification......Page 542
Patient Evaluation......Page 543
General Considerations......Page 544
Surgical Technique......Page 545
Persistent/Recurrent Conductive Hearing Loss......Page 546
References......Page 547
Facial Plastic and Reconstructive Surgery......Page 550
Introduction......Page 552
Role and Regulation of Growth Factors......Page 553
Gene Therapy Research and Applications......Page 554
Clinical Wound Repair......Page 555
Pharmacologic Manipulations......Page 556
Prophylactic Antibiotics......Page 557
Instrumentation......Page 558
Postoperative Care......Page 559
Hypertrophic Scarring and Keloids......Page 560
References......Page 561
Cleft Palate......Page 564
Early Complications......Page 565
Cleft Palate Repair......Page 566
Perioperative Complications......Page 567
Late Complications......Page 568
Complications......Page 569
Bilateral Cleft Lip Repair......Page 570
Velopharyngeal Insufficiency......Page 571
Complications......Page 572
Conclusion......Page 574
References......Page 575
Pediatric Maxillofacial Trauma......Page 578
Initial Evaluation and Management......Page 579
Skin and Subcutaneous Tissue......Page 580
Fractures of the Facial Skeleton......Page 581
Rigid Internal Fixation in Pediatric Fractures......Page 582
Midfacial Fractures (Maxillary and Zygomatic)......Page 583
Frontal and Orbital Roof Fractures......Page 584
Anatomic Features......Page 585
Hearing Loss......Page 586
Initial Evaluation......Page 587
Laryngeal Stenosis......Page 588
References......Page 589
Introduction......Page 592
Otoplasty......Page 593
Nasalplasty......Page 594
Craniofacial Surgery......Page 596
Craniofacial Disorders......Page 598
References......Page 601
Epilogue......Page 604
Introduction......Page 606
Working at the “Sharp” End......Page 607
Reducing Medical Errors......Page 608
References......Page 610
Index......Page 612