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Biomedical subjects

R F Wetmore

Publications and source records attributed to R F Wetmore.

At least 19 recordsLinked to original sources
PubMed1995

Vocal cord injection in children with unilateral vocal cord paralysis.

Unilateral vocal cord paralysis (UVCP) in children is uncommon and rarely leads to serious sequelae. However, on rare occasions, it can present with severe aspiration and dysphonia. Several therapeutic techniques have been used in adults with UVCP, but the reported alternatives in children have been much more limited. Observation and speech therapy are the standard treatment. We describe three children with UVCP and severe aspiration who were treated with vocal cord injection. The treatment indications, clinical courses, and outcomes of the three cases are detailed. The injection of vocal cords in children is discussed, with an emphasis on those aspects unique to the management of UVCP in pediatric patients. Alternative surgical treatment modalities are also presented. Vocal cord injection is an effective and viable therapeutic option for the management of UVCP in certain pediatric patients with severe aspiration and dysphonia.

Bronchiolitis↗
PubMed1994

Congenital tracheal stenosis. The otolaryngologist's perspective.

Congenital tracheal stenosis is a rare congenital anomaly, with less than 70 reported cases in the literature. The presenting signs and symptoms of stridor, recurrent pneumonia, and respiratory distress are commonly seen in other conditions. The rarity of congenital tracheal stenosis and the diverse presentations make accurate early diagnosis difficult and frequently lead to inappropriate treatment. We treated three patients with congenital tracheal stenosis who presented with different sites of stenosis. Each patient displayed different symptoms and required individualized management. The treatment of congenital tracheal stenosis depends on identifying the site and extent of the stenosis. We reviewed the embryogenesis and treatment of this abnormality and developed a new classification system that will aid in the management of congenital tracheal stenosis.

Female↗
PubMed1993

Effects of acid on the larynx of the maturing rabbit and their possible significance to the sudden infant death syndrome.

Sudden infant death syndrome (SIDS) has been shown to result from a variety of causes. One group of neonates at high risk for SIDS includes those who develop apnea secondary to gastroesophageal reflux (GER). Reflux has been shown to produce apnea in infants, and aggressive treatment results in significant improvement in symptoms. Because it is a site of resistance in the airway, the larynx plays an important role in the development of apnea. Through its sensory innervation, the larynx also serves as the afferent limb for reflexes that regulate respiration. In order to investigate the relationship between obstructive apnea and central apnea induced by the instillation of acid on the larynx, simulating GER, a rabbit model was developed. Maturing rabbits at 15-day intervals up to 60 days of age were studied using saline and acid solutions. Acid solutions produced obstructive apnea in all age groups. With acid solutions, central apnea occurred in all age groups but had a peak incidence at 45 days. Gasping respirations were seen in all groups but were most common at 30 days of age. Although obstructive and central apnea occurred together as mixed apnea, both types of apnea were seen independently of each other. Acid instilled on the larynx of maturing rabbits resulted in significant obstructive, central, and mixed apnea. Gasping respirations and frequent swallowing were frequent associated symptoms. Acid-induced obstructive apnea in rabbits mirrors symptoms seen in human infants with GER. Central apnea in infants with GER is seen less commonly; however, central apnea as the result of laryngeal stimulation has been demonstrated repeatedly in several animal models. Central apnea, culminating in fatal asphyxia, has been described in several animal models. The larynx appears to play a pivotal role in the development of apnea in susceptible infants with GER.

Aging↗
PubMed1992

Ventilation tube removal. Indications for paper patch myringoplasty.

Paper patch myringoplasties are commonly performed in children at the time of ventilation tube removal, yet no series documenting their efficacy appears in the otolaryngology literature. Over an 18-month period at the Children's Hospital of Philadelphia (Pa), 163 ventilation tube removals were performed on 131 children aged 1 to 18 years. In 95 of these ears, a paper patch myringoplasty was performed after tube removal. No significant difference (87% vs 85%) in the overall healing rate at 6 months was shown between these two groups. An analysis of the variables potentially affecting outcome revealed that healing following simple tube removal was influenced by the frequency of tube placement and by tube size. Paper patch myringoplasty significantly improved outcome (93% vs 61%) in ears with more than three previous tube placements.

Adolescent↗
PubMed1992

Is outpatient tonsillectomy appropriate for young children?

The current literature suggests that outpatient tonsillectomy is a safe, cost-effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedure.

Age Factors↗
PubMed1992

Nasopharyngeal malignancies in children.

A retrospective analysis identified 29 children with nasopharyngeal malignancies who were evaluated at the Children's Hospital of Philadelphia from 1970 through 1989. Rhabdomyosarcoma (15) and carcinoma (9) were the most common tumor types, and there were distinct differences in the clinical presentations of these two malignancies. Patients with rhabdomyosarcoma were generally younger than those with carcinoma and enjoyed longer survival. Six (67%) of the children with carcinoma were black; all of the patients with rhabdomyosarcoma were white. Patients with carcinoma were also more likely to present with cervical metastases. The presentation, evaluation, and methods of treatment for pediatric nasopharyngeal malignancies are discussed.

Adolescent↗
PubMed1992

Importance of maintaining normal nasal function in the cleft palate patient.

The external nose is a structure that provides prominence to the face. The internal nose is a paired nasal cavity that extends from the face to the pharynx. Turbinates are major structures within the lateral walls of the nose. They perform the major functions of the nose that include respiration, humidification, temperature regulation, and filtration of the inspired air. Conditions that obstruct the nose interfere with its optimal function. These range from acute or chronic infection to enlarged tonsils and adenoid tissue to nasal septal deviation. Surgeons caring for patients with clefts must have familiarity with nasal anatomy and function and conditions that alter them. Correction of these conditions may require medical and/or surgical treatment.

Adenoids↗
PubMed1992

Practical aspects of managing the child with apnea.

Sleep apnea is a common problem in children and probably more common than currently realized. Apnea in children may be central, obstructive or mixed. Otolaryngologists are called upon to diagnose and treat obstructive apnea. The most common cause of obstructive apnea in children is adenotonsillar hyperplasia, and several conditions predispose children to sleep apnea. The most severe, and occasionally only, signs occur during sleep. The majority of children can be diagnosed by a careful history from parents or caretakers. However, sleep sonography, pulse oximetry and polysomnography may be needed to assist in diagnosis. The treatment of apnea in children may include medications, but the most common procedure employed to resolve obstructive apnea in children is adenotonsillectomy.

Adolescent↗
PubMed1991

Mandibular fractures in the pediatric patient.

Seventy-three patients were admitted to the Children's Hospital of Philadelphia (Pa) between January 1979 and June 1989 with a diagnosis of mandibular fracture. Data were obtained through a retrospective review of these cases. The cases were divided into three age groups that reflected the developing structure of the mandible and the maturation of the dentition. A trend toward a greater number of fractures and a predominance of males is shown with increasing age. Child abuse is a relatively frequent cause of fractures throughout all groups. Associated injuries are more common in young children, except in cases where abuse has been documented. The high osteogenic potential of the pediatric mandible allowed conservative management to be successful in 25% of younger patients and was responsible for a low complication rate overall.

Accidents, Traffic↗
PubMed1991

Nodular fasciitis of the head and neck in children. A deceptive lesion.

Nodular fasciitis represents a discrete, benign, presumably reactive proliferation of fibroblasts. However, its rapid rate of growth and a sarcomatous histologic appearance are often deceptive. Multiple pathologic reviews are frequently conducted in an attempt to distinguish nodular fasciitis from other lesions. Such confusion is especially problematic in the pediatric otolaryngic population in which nodular fasciitis is not commonly encountered and mesenchymal malignancies of the head and neck are of fundamental concern. Between 1976 and 1988, 12 cases of nodular fasciitis were diagnosed at the Children's Hospital of Philadelphia (Pa). Six children presented with head and neck lesions and ranged from 6 to 13 years of age. The clinical and histopathologic features of these cases are reviewed.

Adolescent↗
PubMed1991

Radial versus circumferential incision in myringotomy and tube placement.

Pressure equalization tubes are a well-recognized treatment for persistent otitis media with effusion and recurrent acute otitis media. Ideally, the tube should remain in place until the Eustachian tube function returns. Efforts to improve the functional life expectancy of tubes have concentrated on tube design with little attention directed at modification of the surgical technique. Some authors have noted that a radial incision offers theoretical advantages over a circumferential incision. A randomized study comparing radial and circumferential incisions in myringotomy with tube placement was conducted. Two hundred and twenty-eight patients had a circumferential incision performed in one ear and a radial incision in the opposite ear. On follow-up examinations the tube position and time to extrusion were noted. Using the sign test, there was no statistical difference in extrusion rates between the two groups. This study does not support the theoretical advantages espoused in the literature.

Acute Disease↗
PubMed1990

Rhabdomyosarcoma of the head and neck in children.

Rhabdomyosarcoma is the most common soft-tissue sarcoma in infants and children, with the head and neck being the most frequent site of involvement. Treatment for this neoplasm has undergone many changes, with a much improved prognosis using a combination of surgery, radiation therapy, and chemotherapy. This retrospective analysis presents the management and outcome of 60 children (aged 3 months to 18 years) with rhabdomyosarcoma of the head and neck evaluated at the Children's Hospital of Philadelphia (Pa) between 1970 and 1987. The overall death rate for all head and neck sites decreased from 50% in 1970 to 1979 to 23% in 1980 to 1987, reflecting the improved management protocol.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Vocal cord paralysis in children.

Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.

Child↗
PubMed1990

Sleep disorders and airway obstruction in children.

Obstructive sleep disorders in children are not rare. Many parents will provide sufficient history to establish the diagnosis. Although there may be many causes of obstructive disorders, the most common in children is adenotonsillar hyperplasia. Aggressive treatment will result in prompt resolution of symptoms.

Adenoids↗
PubMed1989

Laryngotracheoplasty in the management of subglottic stenosis.

Laryngotracheoplasty (LTP) has revolutionized the surgical management of subglottic stenosis in children. A 10-year review of patients at the Children's Hospital of Philadelphia yielded 27 patients who had undergone a LTP. LTP with an anterior cartilage graft was utilized in over 80% of procedures. Morbidity was minimal, and there were no deaths. In this series, 78% of patients have been successfully decannulated. LTP has reduced the time necessary for decannulation in children with chronic tracheostomies as a result of subglottic stenosis.

Adolescent↗
PubMed1989

Laryngeal diversion in the treatment of chronic aspiration in children.

Chronic aspiration in children can be life-threatening, especially in patients with underlying pulmonary disorders. Numerous surgical procedures have been described to treat chronic aspiration. In patients with severe chronic aspiration, laryngeal diversion is the most effective procedure for reducing soilage of the pulmonary tract. Over a 10-year period at the Children's Hospital of Philadelphia, 14 patients with life-threatening aspiration were managed with a laryngeal diversion. Surgical correction of aspiration resulted in stabilization or improvement of pulmonary function in these patients. The surgical management of chronic aspiration in the pediatric patient is discussed.

Adolescent↗
PubMed1989

Paranasal sinus mucocele in cystic fibrosis.

The relationship between cystic fibrosis, nasal polyposis and chronic sinusitis is clearly defined. Mucoceles of the paranasal sinuses, however, are a well-described complication of chronic sinusitis in adults; but they rarely occur in the pediatric age group. We report a three-year-old who presented with epiphora and fullness at the right medial canthus. Computed tomography confirmed a right ethmoid mucocele which was surgically drained, with resolution of symptoms. Approximately 12 other cases of mucoceles have been reported in the pediatric age group. Although many of these patients had recognized cystic fibrosis, some were previously undiagnosed. Only after presentation with a mucocele, did sweat testing reveal their underlying pathology. No pediatric patients in the literature were found with mucoceles and normal sweat tests. Paranasal sinus mucoceles may be diagnostic of cystic fibrosis and may be the presenting sign in some patients.

Child↗