Complications in Pediatric Otolaryngology

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ISBN: 9780824724375 | 0824724372
Cover: Hardcover
Copyright: 6/9/2005

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The first text on the subject to focus specifically on the pediatric population, this comprehensive reference collects best practices in the prevention, recognition, diagnosis, and management of complications affecting the head and neck, ear, nose, and throat--addressing medical, surgical, and disease-related conditions, as well as situations in critical care treatment and transport.

SECTION I Personal Responsibility

Risk Management

(10)

Daniel L. Wohl

Linda Harvey

Introduction

(1)

Avoidance

(2)

Is It Better to Be Lucky than Good?

(1)

Judgment

(1)

Contract with Society

(1)

Knowledge

(1)

Can I Do the Job?

(1)

Technological and Pharmacological Advances

(1)

Managed Care Policies

(1)

Communication Skills

(1)

Recognition

(1)

If Something Can Go Wrong, It Probably Will

(1)

General and Specific Pediatric Complications

(1)

Think First and Act Second

(1)

How Much Experience Is Enough?

(1)

Stay Comfortable with a Moving Target

(1)

Management

(4)

Definitions of Complications

(1)

Management Principles of Surgical or Medical Complications

(1)

Management Principles of Social Issues

(1)

Family Communication

(1)

Communication with Superiors, Colleagues, and Partners

(1)

Postcomplication Follow-Up

(1)

Management Principle of Legal Issues

(1)

Informed Consent

(1)

I've Been Sued!

(1)

Definitions of Legal Language

(2)

What Is Public Information?

(1)

Conclusion

(1)

Why Bad Things Happen to Good Doctors

(1)

References

(2)

Continuing Education

(10)

Michael G. Stewart

Richard M. Rosenfeld

Melissa G. Kress

Introduction

(8)

What Is Continuing Medical Education and Why Is It Important?

(1)

Stages of Self-Assessment

(1)

Accreditation and Certification

(1)

Reading and Evaluating the Literature

(2)

Clinical vs. Statistical Significance

(1)

Classification of Articles

(1)

Searching the Literature

(2)

Evidence-Based Medicine

(1)

Practice Guidelines and Consensus Panels

(1)

Conclusion

(1)

Suggested Self-Study Guidelines

(1)

References

(1)

Managing the Stress of Surgical Complications

(8)

Benjamin F. Asher

Ronald M. Epstein

The ``Stress Response''

(1)

Impact of the Stress Response on the Surgeon

(1)

Developing Strategies for Managing Stress in a Surgical Practice

(3)

Mindfulness

(1)

Stress Reduction Techniques

(1)

Conclusion

(1)

General Principles

(1)

Resources for Stress Reduction

(1)

References

(3)

SECTION II The Hospital Experience

Perioperative Care: Family-Centered Surgical Care

(10)

Linda Miller Calandra

Lora Lee Sparacino

Gary D. Josephson

Introduction

(1)

Patient Management Preoperatively

(1)

Preoperative Parent Management Issues

(1)

Managed Care Difficulties

(1)

Day of Surgery Issues

(2)

Home Management

(1)

Planning Ahead

(1)

Handling Emergencies

(1)

Empowering Parents to Handle Their Recovering Child

(1)

Infants

(1)

Toddlers

(1)

Preschoolers

(1)

School-Aged Children

(1)

Older Children

(1)

Conclusions

(1)

Suggested Reading

(1)

Issues in Anesthesia

(38)

Andrew Woods

Steven V. Collins

Introduction

(2)

Size Matters

(1)

Enter Modern Anesthetic Technology

(1)

Infants Feel Pain, Too

(1)

Enter Modern Technology

(1)

Children Are Different

(1)

Neonatal, Infant, and Child Hemodynamic Physiology

(2)

Fetal Circulation

(1)

Newborn Circulation

(1)

Newborn and Infant Blood Volume and Blood Pressure

(1)

Hemoglobin Concentration

(1)

Red Blood Cell Volume: Surgical Concerns

(1)

Airway Size and Physics

(1)

Laminar and Turbulent Airflow

(1)

Endotracheal Tubes and Airflow

(1)

Bronchoscope and Telescope Compatibility

(1)

``Silent'' Airway Obstruction during Bronchoscopy

(1)

The Nature of Anesthetic Complications

(27)

Emotional Complications

(1)

Preoperative Issues

(4)

Induction of General Anesthesia

(1)

Emergence

(1)

Postoperative Nausea and Vomiting

(1)

Physical Complications

(1)

Monitoring Devices

(1)

Anesthetic Technique in Shared Airway Cases

(1)

Apneic Oxygenation and Intermittent Ventilation

(1)

Insufflation with Spontaneous Ventilation

(1)

Jet Ventilation

(2)

Equipment in the Airway

(1)

Whose Airway Is It, Anyway?

(1)

Intubation and Endotracheal Tubes

(2)

Mechanics of Intubation

(1)

Laryngeal Devices

(1)

Use of Airway Exchange Devices

(1)

Inadequate Ventilation and Perfusion

(1)

Airway Obstruction

(1)

Impaired Alveolar Function

(1)

Endobronchial Intubation

(1)

Deadspace Ventilation

(1)

Decreased Cardiac Output

(1)

Pulmonary Embolus

(1)

Major Intraoperative Blood Loss

(1)

Re-Emergence of Fetal Blood Flow and Cardiovascular Shunting

(1)

Inhalational Anesthetics

(1)

Solubility and Partial Pressures

(1)

Anesthetic Concentration

(1)

Cardiac Output and Minute Ventilation

(1)

Ventricular Ectopy

(1)

Halothane-Associated Hepatitis

(1)

Choice of Inhalation Agent

(1)

Intravenous Anesthesia

(1)

Propofol

(1)

Opioids: Agonists and Antagonists

(1)

Preemptive Analgesia

(1)

Balanced Anesthesia

(1)

Fluid and Blood Product Replacement

(1)

Early Postoperative Bleeding

(1)

Body Temperature

(1)

Hypothermia

(1)

Hyperthermia

(1)

Malignant Hyperthermia

(1)

Positioning and Pressure Injuries

(1)

Web and Text Resources

(1)

Conclusions

(1)

References

(4)

Emergency Airway Management and Critical Care Issues for the Child with a Difficult Airway

(26)

Thomas A. Nakagawa

David W. Tellez

Introduction

(1)

Emergency Management and Stabilization of the Difficult Airway

(8)

Airway and Airway-Related Anatomy and Physiology

(1)

Developmental Anatomic Differences

(1)

Respiratory Physiology Differences

(1)

Other Physiologic Differences

(1)

Psychological Differences

(1)

Patient Assessment

(1)

Recognition

(1)

Physical Examination

(1)

Intubation

(1)

Indications

(1)

Intubation Complications

(1)

Instrumentation and Equipment Preparation

(1)

Patient Preparation

(1)

Technique

(1)

Support of the Child with an Artificial Airway

(1)

The Complicated Intubation

(1)

General Considerations

(1)

Rapid Sequence Intubation

(1)

Rapid Paralysis

(1)

Aspiration

(1)

The Emergency Surgical Airway

(1)

Critical Care Issues

(9)

Mechanical Ventilation

(1)

General Considerations

(1)

Ventilator Features

(1)

Mechanical Ventilation Complications

(1)

Endotracheal Tube Complications

(1)

Laryngeal Trauma

(1)

Subglottic and Tracheal Trauma

(1)

Pulmonary Parenchymal Trauma

(1)

Secondary Organ System Complications

(1)

Fluid Overload

(1)

Atelectasis

(1)

Nososcomial Infections

(1)

Pharmacotherapeutic Support

(1)

Neuromuscular Paralysis

(1)

Prolonged muscle weakness

(1)

Other Risks of Paralysis

(1)

Sedation

(1)

Pain

(1)

ICU Psychosis

(1)

Drug Tolerance, Dependence, and Withdrawal

(1)

Vascular Access

(1)

Fluids and Nutrition

(1)

Fluid Maintenance

(1)

Enteral Alimentation

(1)

Weaning from Mechanical Ventilation

(1)

General Considerations

(1)

Criteria

(1)

Preparation for Extubation

(1)

Weaning with a Tracheostomy Tube

(1)

Care of the Child Following Extubation

(1)

General Considerations

(1)

Adjunctive Intervention

(1)

Transport of the Pediatric Patient with a Critical Airway

(1)

Background

(1)

Planning and Preparation

(1)

Transport Complications

(1)

Conclusions

(1)

References

100

(5)

Pediatric Otolaryngology Imaging

105

(34)

Michelle S. Whiteman

Bernadette Koch

Available Imaging Tools

106

(2)

Sedation vs. General Anesthesia

108

(1)

Sinonasal Imaging

109

(5)

Sinusitis

110

(3)

Sinonasal Polyps

113

(1)

Sinonasal Neoplasms

114

(1)

Congenital Nasal Masses

114

(1)

Imaging of the Neck and Pharynx

114

(6)

Croup vs. Epiglottitis

114

(1)

Complete Tracheal Rings

115

(1)

Inflammatory Masses

115

(1)

Aberrant Internal Carotid Artery

116

(1)

Thyroglossal Duct Cyst

116

(2)

Branchial Apparatus Anomalies

118

(1)

Fibromatosis Colli

119

(1)

Hemangiomas and Vascular Malformations

119

(1)

Neoplasms

119

(1)

Imaging the Pediatric Temporal Bone

120

(11)

Congenital/Developmental Abnormalities

121

(1)

The External Ear

121

(1)

The Middle Ear

121

(1)

The Inner Ear

122

(1)

Perilymphatic Fistula

122

(1)

Imaging of Cochlear Implant Candidates

123

(1)

Vascular Anomalies

123

(1)

Inflammatory Disease

123

(3)

Cholesteatoma

126

(1)

Bell's Palsy

127

(1)

Postoperative Imaging

127

(1)

Trauma

127

(1)

Mass Lesions of the Temporal Bone

128

(2)

IAC and CPA Masses

130

(1)

Glomus Tumors

131

(1)

Fibrous Dysplasia

131

(1)

Conclusion

131

(1)

References

131

(8)

SECTION III Cognitive Impairment

Hearing Loss

139

(14)

Kenneth M. Grundfast

Mary Jo Schuh

Nancy Sculerati

Introduction

140

(1)

Conductive Hearing Loss

140

(1)

Failure to Identify a Syndrome Associated with Conductive Hearing Loss

140

(1)

Failure to Close Air/Bone Gap with Ossiculoplasty

140

(1)

Ossiculoplasty Resulting in an Anacustic Ear

141

(1)

Mixed Hearing Loss

141

(1)

Not Realizing That a Sensorineural Component Exists

141

(1)

Causing Perilymph Gusher When Operating on a Child with a Congenital Hereditary Disorder

142

(1)

Ossiculoplasty Resulting in an Anacustic Ear

142

(1)

Profound Congenital Sensorineural Hearing Loss

142

(2)

Failure to Detect at an Early Age

142

(1)

Failure to Identify Syndrome Associated with Hearing Loss

143

(1)

Insensitivity in Presenting Options for Child's Methods for Communicating and Educational Setting

143

(1)

Delay in Beginning Appropriate Helpful Intervention

144

(1)

Progressive Sensorineural Hearing Loss

144

(1)

Failure to Find a Treatable Underlying Cause

144

(1)

Misleading Parents by Offering to Perform a Surgical Procedure with Little Likelihood of Preventing Further Hearing Loss

144

(1)

Essential Considerations of Pediatric Diagnostic Audiology

145

(1)

Delay in Diagnosis or Missing a Hearing Loss

145

(1)

Behavioral Audiometric Testing

145

(1)

Audiogram Is the Only ``True'' Hearing Test

145

(1)

No Child Is Too Young or Difficult to Test

146

(1)

Objective Hearing Measures

146

(5)

Hearing Tools, Not Hearing Tests

146

(1)

Technically Poor Measures Lead to Misinterpretation and Inaccurate Diagnoses

147

(1)

Otoacoustic Emissions Measure Outer Hair Cell Function, Not Hearing

147

(1)

ABR Is Not the Definitive Answer

148

(1)

Cross-Check Principle

149

(2)

References

151

(2)

Language Development

153

(14)

Suzanne Hasenstab

Ralph F. Wetmore

Tara Eggleston

Introduction

154

(1)

Communication Development and Language Code Acquisition

154

(1)

Language Code Forms

154

(1)

Language Code Development

154

(1)

Metalinguistic Competency

154

(1)

Educational Obstacles

155

(1)

Stages of Communication Development and Spoken Language Acquisition

155

(3)

Terminology

155

(1)

Preverbal Communication: The First Year

156

(1)

Birth through 4 Months

156

(1)

5 Months through 1 Year

156

(1)

Verbal Communication: The Second and Third Year

156

(1)

Single-Word Utterances

156

(1)

Two-Word Utterances

156

(1)

Language Expression and Refinement: Preschool and Elementary School Years

157

(1)

Multiword Utterances

157

(1)

Communication Disorders

158

(1)

Early Developmental

158

(1)

Late Developmental

158

(1)

Associated Medical Conditions

159

(1)

Articulation Disorders

159

(1)

Voice Disorders

160

(3)

Age-Related Voice Changes

160

(1)

Etiology

161

(1)

Congenital Disorders

161

(1)

Acquired Disorders

161

(1)

Evaluation

162

(1)

Management

163

(1)

Conclusion

163

(1)

A Final Word

163

(1)

Selected Reading

164

(1)

References

164

(3)

Coagulopathy

167

(12)

Joanna A. Davis

Jeanne Lusher

Introduction

167

(1)

Hemostasis

168

(1)

Preoperative Evaluation

168

(1)

Platelet Disorders

168

(3)

Platelets

168

(1)

Platelet Function Assays

169

(2)

Coagulopathies

171

(1)

Protime and Partial Thromboplastin Time

171

(1)

Medical History

171

(5)

von Willebrand's Disease (vWD)

172

(1)

Treatment of von Willebrand's Disease

173

(1)

Adjunctive Treatment

174

(1)

F XI Deficiency

174

(1)

F VIII and F IX Deficiencies

174

(1)

Low-Level ``Carriers'' of Hemophilia

174

(1)

Acquired Disorders of Hemostasis

175

(1)

Bleeding Associated with Vitamin K Deficiency

175

(1)

Hepatocellular Disease

175

(1)

End Stage Renal Disease

175

(1)

Nephrotic Syndrome

176

(1)

Conclusion

176

(1)

Acknowledgments

176

(1)

References

176

(3)

Allergy and Immunology

179

(20)

Dale Schrum

Louis M. Mendelson

Introduction

179

(1)

Immunodeficiency

180

(2)

IgA with IgG Subclass Deficiency

180

(1)

Bruton's Disease (X-Linked Agammaglobulinemia)

180

(1)

Common Variable Immunodeficiency

181

(1)

Other Immune Deficiency Categories

181

(1)

Clinical Evaluation

182

(1)

Asthma

182

(2)

Allergic Rhinitis

184

(2)

Presentation and Symptoms

184

(1)

Seasonal Allergic Rhinitis

184

(1)

Perennial Allergic Rhinitis

185

(1)

Differential Diagnosis

185

(1)

Physical Examination and Laboratory Evaluation

186

(4)

Management

187

(1)

Avoidance Measures

187

(1)

Pharmacotherapy

188

(2)

Drug Allergy

190

(3)

Anaphylaxis

193

(1)

References

194

(5)

Caring for Children with Syndromic Features

199

(8)

Joann N. Bodurtha

Walter E. Nance

David N. Madgy

Introduction

199

(1)

Background

200

(1)

Key Points to Improve Recognition and Care

200

(1)

Variations in Physical Examination of the Head and Neck

200

(1)

Family History

200

(1)

Minor or Subtle Anomalies

201

(1)

Measurement Tables

201

(1)

Specific Examination Features

201

(1)

New Developments in Syndrome Identification

202

(2)

22q11.2

202

(1)

Craniosynostosis

203

(1)

Connexin

203

(1)

Waardenburg

203

(1)

Cleft Lip and Palate

204

(1)

Superficial Siderosis

204

(1)

Measures to Improve Family-Centered Care

204

(1)

Resources

205

(1)

References

205

(2)

Caring for Children with Cancer

207

(12)

Paul A. Pitel

Cynthia A. Gauger

Introduction

207

(1)

Overview of Pediatric Oncology

208

(1)

Head and Neck Malignancies

208

(1)

Clinical Presentation

208

(2)

Lymphadenopathy

208

(1)

Other Masses

209

(1)

Tissue Sampling

210

(1)

Evaluation

211

(1)

Treatment

212

(1)

Complications

212

(2)

Acute Side Effects

212

(1)

Myelosuppression

212

(1)

Epistaxis

212

(1)

Nausea and Vomiting

213

(1)

Other Toxicities

213

(1)

Specific Drug Toxicities

213

(1)

Infections

213

(1)

Long-Term Effects

214

(1)

Family Issues

214

(1)

Conclusions

215

(1)

References

215

(4)

SECTION IV Head and Neck

Obstructive Sleep Apnea Syndrome

219

(12)

David E. Tunkel

Laura M. Sterni

Introduction

219

(1)

Classification of Childhood Obstructive Sleep Disorders

220

(1)

Symptoms of Childhood OSAS

220

(1)

Diagnosis of Childhood OSAS

220

(2)

Complications and Consequences of Childhood OSAS

222

(1)

Growth

222

(1)

Cardiopulmonary

223

(1)

Behavioral/Learning

223

(1)

Treatment of Childhood OSAS

223

(1)

Complications of Surgery for OSAS

223

(3)

Identification of the High-Risk Child

224

(1)

Perioperative Precautions

224

(1)

Uvulopalatopharyngoplasty

225

(1)

Nonsurgical Treatment of OSAS

226

(1)

Conclusions

227

(1)

References

227

(4)

Tonsillectomy and Adenoidectomy

231

(24)

Michael J. Cunningham

Charles M. Myers III

Introduction

232

(1)

Hemorrhage

232

(2)

Intraoperative Hemorrhage

232

(1)

Postoperative Hemorrhage

233

(1)

Airway Obstruction and Inpatient/Outpatient Relevance

234

(1)

Hematologic Preoperative Evaluation

234

(1)

Special Hematologic Circumstances

235

(2)

von Willebrand's Disease

235

(1)

Hemophilia and Christmas Disease

236

(1)

Jehovah's Witnesses

236

(1)

Ketorolac Administration

237

(1)

Emesis and Poor Fluid Intake

237

(1)

Risk Populations

238

(2)

Down Syndrome

238

(1)

Children with Neuromuscular Disease

239

(1)

Mucopolysaccharidoses

239

(1)

Sickle Cell Disease

239

(1)

Intraoperative Complications

240

(1)

Short-Term Postoperative Complications

241

(3)

Postobstructive Pulmonary Edema

241

(1)

Fever

241

(1)

Throat Pain

242

(2)

Otalgia

244

(1)

Long-Term Postoperative Complications

244

(3)

Velopharyngeal Insufficiency

244

(2)

Nasopharyngeal and Oropharyngeal Stenosis

246

(1)

Eagle Stylohyoid Syndrome

246

(1)

Atlantoaxial Subluxation (Grisel Syndrome)

247

(1)

Unusual Complications

247

(1)

Conclusion

248

(1)

References

248

(7)

Head and Neck Infections

255

(18)

Earl H. Harley

Samir Midani

Introduction

256

(2)

Bacterial Milieu

256

(1)

Antibiotic Treatment Considerations

256

(1)

Antibiotic Resistance

257

(1)

Cervical Infections

258

(1)

General Considerations

258

(1)

Fascial Spaces

258

(1)

Lymphatics of the Head and Neck

259

(1)

Imaging Studies

259

(1)

Complications

259

(2)

General Considerations

259

(1)

Airway Control

260

(1)

Mediastinitis

261

(1)

Vascular Complications

261

(1)

Neural Complications

261

(1)

Cervical Adenitis

261

(3)

Bacterial Disease

262

(1)

Granulomatous Disease

262

(1)

Viral Disease

263

(1)

Epstein--Barr Virus

263

(1)

Cytomegalovirus

263

(1)

Other Viral Infections

263

(1)

Other

264

(1)

Deep Space Abscesses

264

(3)

Peritonsillar Abscess

264

(1)

Retropharyngeal Abscess

265

(1)

Parapharyngeal Abscess

266

(1)

Salivary Gland Infections

267

(1)

Epiglottitis and Croup

267

(2)

Epiglottitis (Supraglottitis)

267

(1)

Croup (Laryngotracheobronchitis)

268

(1)

Facial Skin Infections

269

(1)

Other Infections

269

(1)

Botulism

269

(1)

Anthrax

269

(1)

Smallpox

269

(1)

Conclusion

269

(1)

Managed Care Influences

269

(1)

References

270

(3)

Managing Head and Neck Lesions

273

(20)

Laurence J. DiNardo

Scott R. Schoem

James E. Arnold

Introduction

274

(1)

The Nature of Complications in Head and Neck Surgery

274

(1)

General Considerations

274

(1)

Airway Management and Anesthesia

274

(1)

Communication with Other Subspecialists

275

(1)

Communication with Parents and Family

275

(1)

Embryonic Lesions

275

(9)

Preauricular Sinus Tracts and Acrochordons

276

(1)

Management

276

(1)

Branchial Cleft Anomalies

277

(1)

Evaluation and General Considerations

277

(1)

Management

277

(2)

Thyroglossal Duct Anomalies

279

(1)

Evaluation and General Considerations

279

(1)

Management

279

(1)

Angiomas

280

(1)

Hemangiomas

280

(1)

Lymphatic Malformations (Lymphangiomas)

281

(1)

Arteriovenous Malformations

282

(1)

Management

282

(1)

Teratomas

282

(1)

Management

282

(1)

Sternocleidomastoid Muscle Tumor of Infancy

282

(1)

Management

283

(1)

Other Neck Masses

283

(1)

Nasal Dermoids and Encephaloceles

283

(1)

Management

283

(1)

Nonembryonic Congenital/Noncongenital Masses

284

(5)

Salivary Gland Tumors

284

(1)

Evaluation and General Considerations

284

(1)

Facial Nerve Preservation

284

(1)

Hematoma

285

(1)

Frey's Syndrome (Gustatory Sweating)

285

(1)

Salivary Sialocele and Fistula

285

(1)

Thyroid Gland Tumors

285

(1)

Evaluation and General Considerations

285

(1)

Recurrent Laryngeal Nerve Preservation

285

(1)

Parathyroid Gland Preservation

286

(1)

Hematoma

286

(1)

Extent of Thyroidectomy

286

(1)

Postoperative Considerations

287

(1)

Rhabdomyosarcoma

287

(1)

Fibromatosis

287

(1)

Nasopharyngeal Angiofibroma

287

(1)

Langerhans' Cell Histiocytosis

288

(1)

Rare Tumors: Diagnostic and Treatment Pitfalls

289

(1)

Antenatal Diagnosis of Congenital Masses

289

(1)

References

290

(3)

Pediatric Swallowing Disorders

293

(18)

Jacqueline E. Jones

Chandra M. Ivey

William F. McGuirt, Jr.

Introduction

293

(1)

Anatomy and Developmental Physiology

294

(1)

Evaluation

295

(1)

The Neonate

296

(2)

Choanal Stenosis and Atresia

296

(1)

Craniofacial Anomalies

297

(1)

Cleft Lip and Palate

297

(1)

Laryngeal Abnormalities

297

(1)

The Infant

298

(4)

Genetic Syndromes

299

(1)

Cranial Nerve Deficits

299

(1)

Neurogenic Dysphagia

299

(1)

Gastroesophageal Reflux

300

(1)

Anatomic Anomalies of the Great Vessels

301

(1)

Tumors of the Head and Neck

301

(1)

The Older Child

302

(4)

Foreign Bodies

302

(1)

Trauma

303

(1)

Caustic Ingestion

303

(1)

Infectious Etiologies

304

(1)

Adenotonsillar Hyperplasia

305

(1)

Myopathies

305

(1)

Functional Disorders

306

(1)

Treatment

306

(1)

Conclusions

306

(1)

References

307

(4)

Gastroesophageal Reflux

311

(16)

William F. McGuirt, Jr.

Andrew J. Hotaling

Introduction

311

(1)

Classification of Reflux

312

(1)

Manifestations

313

(2)

Chronic Cough or Asthma

313

(1)

Hoarseness

313

(1)

Laryngomalacia

313

(1)

Subglottic Stenosis

314

(1)

Apnea/Sudden Infant Death Syndrome/Apparent Life-Threatening Event

314

(1)

Other Considerations

314

(1)

Diagnosis

315

(3)

Barium Esophagram and Radionucleotide Reflux Scan

315

(1)

Esophagogastroduodenoscopy with Biopsy

316

(1)

pH Monitoring Study

316

(1)

Need for the Pharyngeal Sensor

316

(1)

Definition of Reflux Event

317

(1)

What Is Normal Acid Exposure in the Pharynx?

317

(1)

pH-Metry Variability

318

(1)

Therapy

318

(1)

Conclusions

319

(1)

References

319

(8)

SECTION V General

Lasers in Otolaryngology

327

(12)

John P. Bent III

James S. Reilly

Introduction

327

(1)

Laser Properties and Delivery Systems

328

(2)

Safety Considerations

330

(1)

Patient Safety

330

(1)

Equipment Safety

331

(1)

Personnel Safety

331

(1)

Aerodigestive Procedures

331

(2)

Oxygen Concentration

331

(1)

Anesthetic Technique

332

(1)

Instrumentation

333

(1)

Otologic Procedures

333

(1)

Ossicles and Oval Window

333

(1)

Tympanic Membrane

333

(1)

External Auditory Canal

334

(1)

Management of Complications

334

(2)

Tracheotomy Tube Considerations

334

(1)

Fiberoptic Cable

334

(1)

Nonlaryngeal Head and Neck Procedures

334

(1)

Laryngeal Procedures

335

(1)

Airway Fires

335

(1)

Thermal Injury

335

(1)

Excessive Tissue Ablation

335

(1)

Pneumothorax

336

(1)

Continuing Education

336

(1)

Conclusions

337

(1)

References

337

(2)

Foreign Bodies in Otolaryngology (Nontracheobronchial)

339

(10)

Jay N. Dolitsky

Amelia F. Drake

Introduction

339

(1)

Esophageal Foreign Bodies

340

(2)

Presentation

340

(1)

Management

340

(1)

Complications

341

(1)

Foreign Bodies of the Ear

342

(2)

Presentation

342

(1)

Management

343

(1)

Complications

343

(1)

Foreign Bodies of the Nose

344

(1)

Presentation

344

(1)

Management

344

(1)

Complications

345

(1)

Conclusions

345

(1)

References

346

(3)

SECTION VI Airway and Endoscopy

Extubation Problems in Infants and Children

349

(16)

Ellen S. Deutsch

George H. Zalzal

Awareness

350

(1)

Extubation Risk Factors

350

(2)

Anatomy and Development

350

(1)

Pulmonary Physiology

351

(1)

Mechanics and Physical Properties

351

(1)

Duration of Intubation and the Physical Characteristics of the Tube

351

(1)

Traumatic Intubation, Repeated Intubation, and Tube Movement

351

(1)

Cuff Injuries

351

(1)

Prolonged Positioning

352

(1)

Endotracheal Tube Composition

352

(1)

Nasogastric Tubes

352

(1)

Co-Morbid Conditions

352

(1)

Extraesophageal Gastric Reflux

352

(1)

Underlying Anatomic or Metabolic Conditions

352

(1)

Mechanism of Injury

352

(1)

Extubation

353

(2)

Preparation

353

(1)

Periextubation Examination

354

(1)

Postextubation Assessment

354

(1)

Management of Postextubation Pathology

355

(6)

General Principles

355

(1)

Specific Lesions

355

(1)

Glottic or Subglottic Edema

355

(1)

Ulceration

355

(1)

Granulation Tissue

355

(1)

Granulomas

355

(2)

Laryngeal Webs

357

(1)

Interarytenoid Synechia

357

(1)

Vocal Fold Paralysis

358

(1)

Artenoid Dislocation or Subluxation/Cricoarytenoid Fixation or Ankylosis

358

(1)

Posterior Glottic Stenosis

359

(1)

Acquired Subglottic Stenosis

359

(1)

Subglottic Cysts

359

(1)

Tracheal Stenosis

359

(2)

Incidental Injuries

361

(1)

Surgical Intervention

361

(1)

General Considerations

361

(1)

Cricoid Split

361

(1)

Conclusion

362

(1)

References

362

(3)

Aerodigestive Endoscopy

365

(28)

Eric A. Mair

Jon Robitschek

Joseph Haddad, Jr.

Introduction

366

(1)

Guiding Principles

367

(2)

Background

367

(1)

How Old Is the Patient?

367

(1)

Infants

367

(1)

Children

367

(1)

Where Is the Proper Locale?

367

(1)

Office or Out-Patient Clinic

368

(1)

Intensive Care Unit

368

(1)

Operating Room

368

(1)

What Are the Clinical Objectives?

368

(1)

Diagnosis

368

(1)

Therapeutic Intervention

368

(1)

Early Recognition and Timely Intervention

369

(1)

Basic Anesthesia Principles

369

(1)

Things to Watch for

369

(1)

Laryngoscopy

370

(5)

Flexible Laryngoscopy

370

(1)

Indications

370

(1)

Anatomic Hurdles

370

(2)

Complications

372

(1)

Direct Laryngoscopy

372

(1)

Indications

372

(1)

Anesthesia and Ventilation

372

(1)

Patient Positioning

373

(1)

Choice of Laryngoscope

374

(1)

Anatomic Hurdles

374

(1)

Complications

375

(1)

Bronchoscopy

375

(10)

Rigid Bronchoscopy

376

(1)

Indications

376

(1)

Anesthesia and Ventilation

376

(1)

Anatomical Hurdles

377

(1)

Complications

378

(1)

Flexible Fiberoptic Bronchoscopy

379

(1)

Indications

379

(1)

Anesthesia and Ventilation

379

(1)

Anatomical Hurdles

380

(1)

Complications

381

(1)

Bronchoalveolar Lavage

381

(1)

Esophagoscopy

382

(1)

Indications

382

(1)

Anatomical Hurdles

382

(1)

General Considerations

382

(1)

Narrowing Points

382

(1)

Anatomical Variances

382

(1)

Rigid Esophagoscopy

382

(1)

Indications

382

(1)

Anesthesia and Ventilation

382

(1)

Esophagoscope Advancement

382

(1)

Flexible Fiberoptic Esophagoscopy

383

(1)

Indications

383

(1)

Anesthesia and Ventilation

383

(1)

Esophagoscope Advancement

384

(1)

Complications

384

(1)

Esophageal Perforation

384

(1)

Specific Pathology

385

(6)

Foreign Body in the Airway

385

(1)

General Considerations

385

(1)

Predictive Factors for Complications

386

(1)

Instrumentation

386

(1)

Anesthesia and Ventilation

386

(1)

Complications

387

(1)

Alternative Approaches

387

(1)

Foreign Body in the Esophagus

388

(1)

General Considerations

388

(1)

Critical Management Issues

388

(1)

Management

388

(1)

Technique Pearls

389

(1)

Complications

390

(1)

Specific Esophageal Pathology

390

(1)

Conclusions

391

(1)

References

391

(2)

Pediatric Tracheotomy

393

(12)

Ian N. Jacobs

George H. Zalzal

Introduction

393

(1)

Indications

394

(1)

Procedure and Technique

394

(1)

Tracheotomy Tube Types

395

(1)

Routine Tracheotomy Care

396

(1)

Tracheotomy Tube Changes

397

(1)

Complications

397

(4)

Immediate (Perioperative) Complications

398

(1)

Operative Hemorrhage

398

(1)

Pneumothorax

398

(1)

Accidental Decannulation

398

(1)

False Passage

398

(1)

Early Complications

399

(1)

Local Infection/Skin Breakdown

399

(1)

Late Complications

399

(1)

Tracheal Granulation Tissue

399

(1)

Suprastomal Collapse (Tracheomalacia)

399

(1)

Tracheal or Subglottic Stenosis

400

(1)

Tracheal-Cutaneous Fistula

400

(1)

Innominate Artery Erosion

400

(1)

Dysphagia

401

(1)

Speech and Language Delays

401

(1)

Decannulation

401

(1)

General Considerations

401

(1)

Decannulation Methods

402

(1)

Alternative Modes of Ventilation (Noninvasive Ventilation)

402

(1)

Summary

402

(1)

References

402

(3)

Laryngotracheal Reconstruction

405

(12)

Gregory F. Hulka

Daniel L. Wohl

Introduction

405

(1)

Avoidance of Complications

406

(2)

Preparation and Planning

406

(1)

Preoperative Assessment

406

(1)

Preoperative Medical and Surgical History

406

(1)

Endoscopic Diagnosis

407

(1)

Technique

408

(2)

Single-Stage vs. Two-Stage Procedures

408

(1)

Cricotracheal Resection vs. Grafting

408

(1)

Grafting Material

409

(1)

Type of Stent

409

(1)

Use of Mitomycin

409

(1)

Neuromuscular Blockade and Prolonged Sedation

409

(1)

Recognition and Management of Complications

410

(2)

Intraoperative Complications

410

(1)

Immediate Postoperative Complications

410

(1)

Extended Postoperative Complications

411

(1)

Long-Term Complications

411

(1)

Revision Laryngotracheal Reconstruction

412

(1)

Continuing Education Issues

412

(1)

Conclusions

412

(1)

References

412

(5)

SECTION VII Rhinology

Rhinosinusitis

417

(8)

Ellis M. Arjmand

Rodney P. Lusk

Introduction

417

(1)

Background

418

(1)

Obtaining an Accurate Diagnosis

418

(1)

Bacteriology

418

(1)

Medical Complications

419

(1)

Complications of Acute Sinusitis

420

(2)

Orbital Complications

420

(1)

Regional and Intracranial Complications

421

(1)

Complications of Chronic Sinusitis

422

(1)

Conclusions

422

(1)

Bibliography

422

(1)

References

422

(3)

Pediatric Endoscopic Sinonasal Surgery

425

(18)

Gary D. Josephson

Jordan S. Josephson

Charles W. Gross

Introduction

426

(1)

History

427

(1)

History of Endoscopic Sinus Surgery

427

(1)

Complications

427

(10)

Minor Complications

428

(1)

Periorbital Hematoma

428

(1)

Subcutaneous Orbital Emphysema

428

(1)

Periorbital Cellulitis (Preseptal)

428

(1)

Orbital Abscess

429

(1)

Epiphora

429

(1)

Synechiae

429

(1)

Natural Ostia Closure

430

(1)

Diplopia

430

(1)

Facial Growth

430

(1)

Major Complications

430

(1)

Hemorrhage

430

(1)

Cerebral Spinal Fluid Leak

431

(1)

Intraoperative Identification

431

(1)

Postoperative Identification

432

(1)

Blindness and Visual Disturbance

432

(3)

Surgical Therapies

435

(1)

Lateral Canthotomy and Cantholysis

435

(1)

Medial Orbital Decompression and Optic Nerve Decompression

435

(1)

Pneumocephalus

436

(1)

Meningitis and Brain Abscess

436

(1)

Image-Guided System

436

(1)

Choanal Atresia Repair

437

(1)

Restenosis

437

(1)

Palatal Fistula

437

(1)

Septoplasty

437

(1)

Conclusions

438

(1)

References

438

(5)

SECTION VIII Otology

Otitis Media

443

(34)

David H. Darrow

Craig S. Derkay

Introduction

444

(1)

Otitis Media -- a Brief Review

444

(4)

Background, Definition, Incidence, and Etiology

444

(1)

Bacteriology and Antibiotic Resistance

445

(1)

Diagnostic Variability

446

(1)

Medical Management

446

(1)

Surgical Management

447

(1)

Developmental Complications

448

(1)

Social and Economic Complications

448

(1)

Complications of Myringotomy and Ventilation Tube Placement

449

(2)

Technique

449

(1)

Anesthesia

449

(1)

Otorrhea

449

(1)

Duration and Extrusion

450

(1)

Impact of Managed Care

451

(1)

Intratympanic Complications

451

(2)

Tympanic Membrane Atrophy, Retraction Pockets, and Adhesive Otitis Media

451

(1)

Acute Perforation

452

(1)

Acquired Cholesteatoma

452

(1)

Tympanosclerosis

452

(1)

Progression and Extension of Otitis Media

453

(4)

Factors in the Spread of Otitic Infection

453

(1)

Species and Virulence of the Organism

454

(1)

Host Conditions

454

(1)

Prior Therapy

454

(1)

Pathways in the Spread of Otitic Infection

454

(1)

Direct Extension as a Result of Disease

454

(1)

Direct Extension through Anatomic Pathways

454

(1)

Direct Extension through Traumatic Defects

455

(1)

Thrombophlebitis

455

(1)

Classification

455

(1)

Symptoms and Signs of Impending Complication

455

(1)

Initial Management

456

(1)

General Considerations

456

(1)

Diagnostic Imaging

456

(1)

Antimicrobial Therapy

456

(1)

Surgical Considerations

457

(1)

Complications of Otitis Media

457

(13)

Intratemporal Complications

457

(1)

Acute Mastoiditis

457

(1)

Subperiosteal Abscess

458

(1)

Facial Paralysis

459

(1)

Petrositis

460

(1)

Labyrinthitis

461

(2)

Intracranial Complications

463

(1)

Extradural Abscess

463

(1)

Lateral Sinus Thrombosis

464

(1)

Brain Abscess

465

(3)

Otitic Meningitis

468

(1)

Subdural Infection

469

(1)

Otitic Hydrocephalus

470

(1)

Conclusions

470

(1)

References

471

(6)

Otologic Surgery

477

(24)

Daniel L. Wohl

Walter M. Belenky

Introduction

478

(1)

Perioperative Planning

479

(3)

Clinical Objectives

479

(1)

Indications

479

(1)

General Considerations

479

(1)

Preoperative Considerations

480

(1)

Postoperative Considerations

480

(1)

Surgical Technique Considerations

481

(1)

Tympanoplasty

482

(4)

Tympanic Membrane Pathology

482

(2)

General Principles

484

(1)

Surgical Technique

484

(1)

Overlay vs. Underlay vs. ``Other''

484

(1)

Ossiculoplasty

485

(1)

Mastoidectomy

486

(5)

Temporal Bone Pathology

486

(1)

General Principles

487

(1)

Procedure Selection

487

(1)

Surgical Techniques

487

(1)

Canal Wall Up

487

(1)

Canal Wall Down

488

(1)

Modified Radical, Bondy Modified Radical, Radical Mastoidectomy, and Mastoid Obliteration

489

(1)

Revision Surgery

490

(1)

Surgical Considerations

490

(1)

Avoidance and Recognition of Surgical Complications in Otologic Surgery

491

(2)

Avoidance

491

(1)

General Principles

491

(1)

Recognition

492

(1)

Possible Complications of Tympanoplasty

492

(1)

Possible Complications of Mastoidectomy

492

(1)

Management of Surgical Complications in Otologic Surgery

493

(4)

Intraoperative Complications

493

(1)

Major Bleeding

493

(1)

Dural Tear

494

(1)

Facial Nerve Injury

494

(1)

Labyrinthine Fistula and Perilymph Leak

494

(1)

Ossicular Dislocation or Disruption

495

(1)

Postoperative Complications

495

(1)

Facial Nerve Injury

495

(1)

Sensorineural Hearing Loss, Vertigo, and Tinnitus

495

(1)

Conductive Hearing Loss

496

(1)

Canal Granulation Tissue

496

(1)

Acquired Canal Stenosis

496

(1)

Canal Dehiscence

496

(1)

Taste Changes

496

(1)

Neck Injury/Positioning

496

(1)

Other

497

(1)

Patient Compliance and Family Communication

497

(1)

Ergonomics and Operator Comfort

497

(1)

Conclusion

497

(1)

Reasonable Expectations

497

(1)

References

498

(3)

Cochlear Implantation

501

(12)

Adrien A. Eshraghi

Audie L. Woolley

Thomas J. Balkany

Judith M. Barnes

Introduction

502

(1)

Social and Educational Issues

502

(1)

The Deaf Community

502

(1)

Educational Approaches and Communication Mode

502

(1)

Surgical Indications

503

(2)

Selection Criteria (2002)

503

(1)

Audiologic Assessment

504

(1)

History and Physical Examination

504

(1)

Parental Expectations

505

(1)

Preoperative Planning

505

(1)

Computerized Tomography

505

(1)

Magnetic Resonance Imaging

505

(1)

Management of Middle Ear Effusion

505

(1)

Surgical Technique

506

(1)

Intraoperative Considerations

506

(3)

Cochlea Ossification

506

(1)

Congenital Inner Ear Malformations

507

(1)

Complications in Implanting the Anomalous Ear

507

(1)

Revision Surgery

508

(1)

Postoperative Complications

509

(2)

Flap Complications

509

(1)

Fascial Nerve Palsy

509

(1)

Infection

509

(1)

Infected Implant

510

(1)

Electrode Complications

510

(1)

Device Failure

510

(1)

Follow-Up Considerations

511

(1)

Surgical Follow-Up

511

(1)

Commitment to Rehabilitation

511

(1)

Conclusion

511

(1)

References

511

(2)

Microtia and Atretic Ear Surgery

513

(14)

Roland D. Eavey

Paul Lambert

General Introduction

514

(1)

Introduction to Microtia Reconstructive Surgery

514

(3)

Classical Rib Reconstruction

514

(3)

Related Issues

517

(1)

Conclusions to Mictrotia Surgery

517

(1)

Introduction to Atresia Surgery

517

(2)

Epidemiology and Classification

517

(1)

Patient Evaluation

518

(1)

Computed Tomography

519

(1)

Hearing Amplification

519

(1)

Unilateral Atresia

519

(1)

Bilateral Atresia

519

(1)

Surgical Management

519

(1)

General Considerations

519

(1)

Surgical Technique

520

(1)

Avoiding Complications

521

(1)

Facial Nerve

521

(1)

Canal Stenosis

521

(1)

Labyrinthine Injury

521

(1)

Treating Complications

521

(1)

Persistent/Recurrent Conductive Hearing Loss

521

(1)

Canal Stenosis

522

(1)

Conclusions

522

(1)

Acknowledgment

522

(1)

References

522

(5)

SECTION IX Facial Plastic and Reconstructive Surgery

Wound Healing

527

(12)

Ian N. Jacobs

David W. Low

Timothy M. Crombleholme

Introduction

527

(1)

Basic Science

528

(2)

Cellular Events

528

(1)

Role and Regulation of Growth Factors

528

(1)

Gene Therapy Research and Applications

529

(1)

Fetal Wound Healing and Clinical Applications

530

(1)

Clinical Wound Healing in the Infant and Child

530

(3)

Clinical Wound Repair

530

(1)

Extrinsic Factors Affecting Wound Healing

531

(1)

Pharmacologic Manipulations

531

(1)

Prophylactic Antibiotics

532

(1)

Surgical Aspects of Wound Care

533

(2)

Elective Incisions

533

(1)

Instrumentation

533

(1)

Wound Closure

534

(1)

Postoperative Care

534

(1)

Special Problems and Complications

535

(1)

Hypertrophic Scarring and Keloids

535

(1)

Hematomas

536

(1)

Healing by Secondary Intention

536

(1)

Conclusion

536

(1)

References

536

(3)

Cleft Lip and Palate

539

(14)

Charles M. Bower

Robert W. Seibert

Harlan R. Muntz

Introduction

539

(1)

Cleft Palate

539

(2)

Early Complications

540

(1)

Cleft Palate Repair

541

(3)

Perioperative Complications

542

(1)

Late Complications

543

(1)

Cleft Lip

544

(2)

Lip Adhesion

544

(1)

Complications

544

(1)

Definitive Unilateral Cleft Lip Repair/Cheiloplasty

545

(1)

Complications

545

(1)

Bilateral Cleft Lip Repair

545

(1)

Complications

546

(1)

The Alveolus

546

(1)

Complications

546

(1)

Velopharyngeal Insufficiency

546

(3)

Complications

547

(2)

Conclusion

549

(1)

References

550

(3)

Pediatric Maxillofacial Trauma

553

(14)

Harlan R. Muntz

Andrew Shapiro

Introduction

554

(1)

Initial Evaluation and Management

554

(1)

Secondary Survey: Diagnosis of Facial Injuries

555

(1)

Soft Tissue Injuries

555

(1)

Skin and Subcutaneous Tissue

555

(1)

Sites Requiring Special Attention

556

(1)

Fractures of the Facial Skeleton

556

(2)

Anatomic Features

557

(1)

Physiologic Features

557

(1)

Mandibulo-Maxillary Fixation in Children

557

(1)

Rigid Internal Fixation in Pediatric Fractures

557

(1)

Fractures of Specific Sites

558

(2)

Nasal Fractures

558

(1)

Mandible Fractures

558

(1)

Midfacial Fractures (Maxillary and Zygomatic)

558

(1)

Orbital Floor and Rim Fractures

559

(1)

Nasoethmoid Fractures

559

(1)

Frontal and Orbital Roof Fractures

559

(1)

Temporal Bone Fracture

560

(2)

Initial Evaluation

560

(1)

Anatomic Features

560

(1)

Physiologic Features

561

(1)

Facial Nerve Paralysis

561

(1)

Hearing Loss

561

(1)

Laryngeal Trauma

562

(2)

Anatomic Features

562

(1)

Physiologic Features

562

(1)

Initial Evaluation

562

(1)

Management

563

(1)

Hoarseness

563

(1)

Vocal Fold Paralysis

563

(1)

Laryngeal Stenosis

563

(1)

Conclusions

564

(1)

References

564

(3)

Pediatric Facial Plastic and Reconstructive Surgery

567

(20)

William C. Giles

W. Scott McDonald

Introduction

567

(1)

Otoplasty

568

(1)

Nasalplasty

569

(2)

Craniofacial Surgery

571

(2)

Craniofacial Disorders

573

(3)

References

576

(5)

SECTION X Epilogue

Epilogue: Beyond the Blame

581

(1)

Paul A. Gluck

Introduction

581

(1)

The Evolution of Patient Safety

582

(1)

System of Medical Care

582

(1)

Working at the ``Sharp'' End

582

(1)

Error Theory

583

(1)

Swiss Cheese Theory of Error

583

(1)

Making Health Care Safer

583

(2)

Reducing Medical Errors

583

(2)

Conclusions

585

(1)

References

585

(2)

Index

587

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Complications in Pediatric Otolaryngology

Summary

Table of Contents

Supplemental Materials