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Biomedical subjects

S C Manning

Publications and source records attributed to S C Manning.

At least 55 records · Page 3Linked to original sources
PubMed1991

Branchial anomaly in a newborn presenting as stridor.

A male patient presented at day 3 of life with a small anterior neck mass and mild intermittent upper airway obstruction. Despite intravenous antibiotics, the patient rapidly progressed to impending airway obstruction requiring surgical intervention. The clinical, radiographic, and histologic findings of this extremely rare case of a third branchial anomaly will be presented. The embryologic basis for the connection to the aerodigestive tract and the access provided to gram negative enteric organisms in newborns will be discussed.

Branchioma↗
PubMed1991

Blindness resulting from orbital complications of sinusitis.

Loss of vision remains a potential complication of orbital infection. Appropriate evaluation and management of the patient with signs and symptoms of orbital inflammation may prevent progression to blindness. Evaluation of patients with orbital inflammation from sinusitis includes a comprehensive clinical examination and radiographic studies. Clinical examination should test for changes in visual acuity, pupillary reactivity, and extraocular motion. Computerized tomography (CT) has facilitated the diagnosis of orbital infections and aids in diagnosis. However, CT can be misleading in patients with acute orbital infections and should not be relied on to determine the need for surgical intervention. We reviewed the records of all patients admitted to Parkland Memorial Hospital from 1978 to 1988 with orbital complications resulting from sinusitis. Four of 159 patients in this group had permanent blindness. The presence of an abscess, which was ultimately found at surgical exploration, was not diagnosed by CT in any of these four patients. Clinical examination remains the most important indicator for surgical intervention in patients with orbital complications of sinusitis. We present our findings and give guidelines for surgical intervention in patients with orbital infections resulting from sinusitis.

Abscess↗
PubMed1991

Measles: an epidemic of upper airway obstruction.

Between October 1989 and August 1990, Dallas County experienced an 11-month epidemic of measles. Of 995 cases of pediatric measles diagnosed in the outpatient department of Children's Medical Center, 108 patients were admitted and 34 of these demonstrated significant upper airway obstruction at the time of admission. Airway problems ranged from mild inspiratory stridor with nasal flaring to frank obstruction and arrest in the emergency room, requiring intubation. Eight of the 34 airway patients were eventually diagnosed with bacterial tracheitis on the basis of endoscopic findings and culture results. The remaining patients had pictures more consistent with viral laryngotracheitis, but all patients were treated with broad-spectrum antibiotics to prevent possible progression to bacterial tracheitis. A total of nine patients overall required intubation for airway obstruction and all were successfully extubated. Large outbreaks of measles are becoming common again in populations of urban poor--largely unvaccinated children. The disease in these populations tends to occur at a younger age and may be more aggressive with more associated complications. Physicians must keep in mind the possibility of upper airway obstruction in a significant proportion of these patients. Early diagnosis on the basis of clinical signs and symptoms, endoscopy, and radiographs is the key to timely appropriate management.

Adolescent↗
PubMed1991

Catastrophic otologic injury from oral jet irrigation of the external auditory canal.

Jet irrigation is an accepted method for removal of cerumen from the external auditory canal. Even at a submaximal power setting, oral jet irrigators can generate enough force to rupture the tympanic membrane. Parameters for safe use of these irrigators have never been established. Three cases are reported in which, in addition to tympanic membrane rupture, oral jet irrigators caused ossicular disruption, round and oval window fistulae, and subluxation of the stapedial footplate. A prospective study performed on 25 fresh cadavers demonstrated a 6% incidence of tympanic membrane perforation when the power setting was one-third full power or greater. Recommendations are made for safe use of oral jet irrigators for removal of external auditory canal cerumen.

Aged↗
PubMed1990

Rhabdomyoma of the cricopharyngeus in an infant.

Rhabdomyoma is a rare benign tumor characterized histologically by striated skeletal muscle. Rhabdomyomas can be classified into adult and fetal variants. The majority of adult variants arise in the head and neck region and are derived from the skeletal muscles of the pharyngeal (branchial) arches. The majority of cases of fetal variant rhabdomyomas have been described in the postauricular region of young children and the vulvovaginal region in middle-aged women. We present a case of a 15-month-old infant with a circumferential rhabdomyoma of the cricopharyngeus muscle requiring excision of the esophageal inlet and reconstruction with a free microvascular jejunal interposition graft. This case represents the youngest reported case of adult variant rhabdomyoma. The clinical, radiographic, and histologic findings of this unusual case and a review of reported cases of rhabdomyoma in the pediatric population will be presented.

Cricoid Cartilage↗
PubMed1990

Otolaryngologic manifestations of child abuse.

The number of reported cases of child abuse has increased dramatically over the past several years. Maltreatment of children can take several forms including neglect, sexual abuse, physical assault and psychological trauma. Five cases of child abuse presenting initially to the Otolaryngology Service are outlined: bilateral auricular hematomas, recurrent tympanic membrane lacerations, a pharyngeal laceration with retropharyngeal abscess and medical neglect of a patient with a parotid malignancy and one with laryngeal papillomatosis. Characteristic presentations and risk factors in family background are discussed toward the goal of early recognition and appropriate intervention.

Carcinoma↗
PubMed1989

Surgical management of nasopharyngeal angiofibroma involving the cavernous sinus.

Involvement of the cavernous sinus by juvenile nasopharyngeal angiofibroma represents a therapeutic challenge. We present our experience over the past 5 years with the surgical management of six cases of juvenile nasopharyngeal angiofibroma involving this site. Three of six patients had involvement of the medial aspect of the cavernous sinus and tumor was removed using a midline extracranial approach. Of three remaining patients, two had invasion of the medial and inferior margin of the cavernous sinus and one represented a recurrent lesion. The tumor in these three cases was resected using a combined frontotemporal and lateral infratemporal fossa approach. An extracranial recurrence occurred in one patient, and the remaining five patients have had no evidence of recurrent disease 12 to 71 months following surgery. Morbidity has been limited to trismus, facial hypesthesia, and serous otitis media.

Adolescent↗
PubMed1989

Congenital nasal pyriform aperture stenosis.

Congenital nasal pyriform aperture stenosis is an unusual and previously undescribed cause of nasal airway obstruction in the newborn. The nasal pyriform aperture is narrowed due to bony overgrowth of the nasal process of the maxilla. This anomaly may produce signs and symptoms of nasal airway obstruction in newborns and infants similar to those seen in bilateral posterior choanal atresia. Computed tomography confirms the diagnosis and delineates the anomaly. A series of six patients with nasal pyriform aperture stenosis is presented. Four patients were treated with surgical enlargement of the nasal pyriform aperture via a sublabial approach. One patient was repaired via a transnasal approach, and one patient did not undergo surgical intervention. Follow-up reveals normal nasal airway and facial growth in all patients. Mildly symptomatic patients with congenital nasal pyriform aperture stenosis may be treated expectantly, while severely symptomatic patients benefit from repair via the sublabial approach.

Airway Obstruction↗
PubMed1989

Allergic aspergillosis: a newly recognized form of sinusitis in the pediatric population.

In 1983, Katzenstein, et al. first described a form of noninvasive sinusitis in adults, which was histologically identical to allergic bronchopulmonary aspergillosis, with mucin-containing eosinophils, Charcot-Leyden crystals, and fungal elements resembling Aspergillus species. The authors have treated six pediatric patients ages 8 to 16 who had findings typical of allergic Aspergillus sinusitis. All patients presented with nasal polyposis and progressive facial deformity. All patients had computed tomography findings of diffuse expansile sinus disease and four patients had evidence of bony erosion, raising the suspicion of malignancy. At surgery, all were found to have multiple sinuses densely packed with greenish-black inspissated mucin. Therapy consisted of wide surgical drainage with careful follow-up and nasal steroids.

Adolescent↗
PubMed1988

Cor pulmonale secondary to tonsillar and adenoidal hypertrophy: management considerations.

Eleven cases of cor pulmonale secondary to tonsil and adenoid hypertrophy and upper airway obstruction were reviewed. These patients presented with a spectrum disease ranging from mild, with only abnormal ECG or chest X-ray findings, to severe with hypercarbia, hypoxia, and right heart failure. One patient with severe disease suffered a postoperative respiratory arrest. We have successfully managed 4 patients with severe cor pulmonale with postoperative intubation and assisted ventilation. Hypoxia is the driving stimulus for respiration in patients with upper airway obstruction and hypercarbia. Relief of respiratory obstruction by tonsillectomy and adenoidectomy with postoperative oxygen administration may remove the hypoxic drive, resulting in respiratory arrest. Patients undergoing tonsillectomy and adenoidectomy for upper airway obstruction disease should be screened for cor pulmonale. Affected patients should be managed after surgery in an intensive care unit (ICU) environment with careful monitoring of the respiratory status. Patients with severe cor pulmonale can be successfully managed with planned postoperative intubation and mechanical ventilation to prevent respiratory arrest.

Adenoidectomy↗
PubMed1987

An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy.

Preoperative coagulation studies are commonly employed in order to try to identify the 2-4% of all patients undergoing tonsillectomy/adenoidectomy surgery who experience hemorrhagic complications. In an atmosphere of increasing cost consciousness, evaluation of the efficacy of screening tests is warranted. The records of 994 out of 1050 patients consecutively scheduled for tonsillectomy, adenoidectomy or T&A over a 2.5-year period were retrospectively reviewed in order to determine the usefulness of partial thromboplastin (PTT) and prothrombin time (PT) screening in predicting surgical and postsurgical bleeding. For patients with no history or clinical signs indicating possible bleeding disorder, preoperative PT and PTT failed to predict bleeding as an outcome. Also no patients were identified in this series to have previously undiagnosed coagulopathies on the basis of screening PT/PTT. The purpose of any screening test is to identify disease early enough for therapeutic intervention to be effective. Although preoperative PT/PTT will occasionally identify an unsuspected von Willebrand's or other coagulopathy, the prevalence of bleeding disorders in patients with negative history and examination is low enough that PT/PTT has essentially a zero predictive value for surgical bleeding. Screening PT/PTT should therefore be reserved for patients with known or suspected coagulopathies.

Adenoidectomy↗
PubMed1987

Prognostic value of eustachian tube function in pediatric tympanoplasty.

Poor eustachian tube function and prevalence of infectious ear disease are thought to be the reasons for less successful outcome associated with tympanoplasty in children. Since both of these factors are related to age, identification of those patients who may benefit by delaying the surgery has been a concern to otolaryngologists. In an effort to investigate the role of eustachian tube function on the outcome, we tested the tubal function in 63 ears (56 children) undergoing tympanoplasty for central perforations. In 49 ears (78%), the graft took; of these, 33 had good middle-ear function, 8 developed persistent or recurrent otitis media, and 8 had severe retraction or atelectasis. There was a significant association (p less than 0.01) between outcome and preoperative tubal function as determined by combining the active and passive function parameters. However, the prognostic value of tubal function testing was low; predictive values for success and lack of success being 68% and 56%, respectively. Other factors, such as graft placement (medial or lateral) contralateral ear status, and child's age, were not associated with outcome. Consistent with other studies, good eustachian tube function was shown to predict good outcome, but poor tubal function was not helpful in predicting poor outcome.

Adolescent↗
PubMed1982

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