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V Forte

Publications and source records attributed to V Forte.

At least 19 recordsLinked to original sources
PubMed2005

Endoscopic treatment of congenital H-Type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue.

OBJECTIVE: Congenital H-Type tracheoesophageal fistulae (H-Type TEF) and recurrent fistulae after primary repair of esophageal atresia represent a difficult problem in diagnosis and management. The treatment traditionally involved an open technique via a cervical or thoracic route, approaches with high morbidity and mortality rates of up to 50%. Endoscopic closure of fistulae has been reported with various techniques such as tissue adhesives, electrocautery, sclerosants and laser. However, the published case series contain a small number of patients with usually short-term follow-up. The aim of this paper is to present the experience of a decade at Toronto's Hospital for Sick Children, using diathermy and histoacryl tissue adhesive and discuss the indications and limitations of this technique. METHODS: Since 1995, 192 patients have been managed in this institution with tracheoesophageal fistulae of which 10 patients have been treated endoscopically. The fistulae were both of H-Type and recurrent tracheoesophageal fistulae following surgery for esophageal atresia and fistula division. One fistula occurred following trauma. The procedure was undertaken under general anesthesia in the image guided therapy suite under fluoroscopic control. Flexible ball electrocautery and injection of histoacryl glue were used either on their own or in combination. RESULTS: Fistula closure was achieved in 9 out of 10 fistulae. Four patients had a second endoscopic procedure. No major respiratory or other complications were encountered in association with the procedure. Follow-up has been between 3 months and 9 years. CONCLUSION: We conclude, endoscopic treatment of tracheoesophageal fistulae with electrocautery and histoacryl glue has been a safe and successful technique of managing H-Type and recurrent tracheoesophageal fistulae. In this paper, we discuss the indications and the surgical steps of the procedure. We highlight that diathermy should be carefully controlled and applied preferably in the small non-patulous fistulae. A fistula that has not closed after two endoscopic attempts is not suitable for further endoscopic treatment and therefore an external approach should be recommended.

Child↗
PubMed2003

Unilateral agenesis of the parotid gland: an unusual entity.

Agenesis of the parotid gland is extremely rare with only few cases reported in the medical literature. This entity can be important to diagnose as occasionally the normal parotid gland can be mistaken for a tumor due to the facial asymmetry. In this article, we present the case of an isolated unilateral parotid gland agenesis in a young child. The entity is discussed along with important associated conditions that should be ruled out. These include amongst others first and second branchial arch anomalies, as well as the Levy-Hollister or lacrimo-auriculo-dentodigital syndrome.

Child, Preschool↗
PubMed2003

Role of endoscopic CO2 laser surgery in the treatment of congenital infantile subglottic hemangioma. Experience in the Department of Otolaryngology, "Sick Children Hospital", Toronto, Canada.

Subglottic hemangioma is a rare, histologically benign congenital neoplasm. The natural history is characterized by progressive obstruction of the airways during the proliferative stage, followed by gradual regression of the obstructive symptomatology in the involutional phase. After an asymptomatic neonatal period, the infant presents a characteristic biphasic stridor as the lesion progressively obstructs the subglottic space. In 80-90% of cases, these symptoms appear in the first six months of life. The involutional process generally begins at 12 months of age and continues until the subglottic hemangioma regresses completely. Due to high incidence of mortality in untreated cases, therapy should be undertaken immediately. Aim of therapy is to restore normal respiration, attempting to preserve the child's voice and alter the quality of life both of the infant and the family as little as possible. A retrospective study was carried out on all cases of infantile subglottic hemangioma treated in the Department of Otolaryngology, "Sick Children Hospital", Toronto, between 1980 and 2000. The therapeutic strategy adopted until breathing returned to normal comprised repeated endoscopic CO2 laser treatment of the lesion and perioperative administration of oral cortisone (1 mg/kg/day dexamethazone, subdivided in 3 doses) for 24-48 hours. CO2 laser was used each time the patient presented progressive worsening of obstructive respiratory symptoms. The interval between two laser treatments was > or = 6 weeks. Repeated endoscopic laser treatment, combined with other therapeutic modalities, enabled tracheotomy to be avoided in all but 4 (7.2%) cases.

Algorithms↗
PubMed2001

Thyroid ala cartilage reconstruction in neonatal subglottic stenosis as a replacement for the anterior cricoid split.

Cricoid split is the procedure of choice in neonatal subglottic stenosis in many paediatric institutions. However, the post-operative care of these patients is a concern given the potentially lethal complications which can occur, in particular, self-extubation. We have been using the thyroid ala cartilage (TAC) reconstruction, a proven technique, as an alternative treatment for this disorder to avoid these complications. The purpose of this study was to compare the results of the TAC reconstruction for this patient population with the results of the cricoid split procedure previously reviewed at our own institution. Between January 1995 and December 1999, 17 patients that underwent the TAC reconstruction for neonatal subglottic stenosis were retrospectively reviewed. Of the 17 patients, two patients required tracheotomy prior to discharge from hospital. Fifteen patients were discharged from hospital with a safe airway without tracheotomy. There were only two minor complications. Compared with the cricoid split study, the success rate with TAC reconstruction was higher (88 vs 83%) and the major complication rate was lower (0 vs 9%). Factors associated with failed procedures may include prematurity, low birth and surgical weight and presence of severe GER. Those that failed required much greater resources in terms of post-operative care and length of hospital stay. The TAC reconstruction has replaced cricoid split in treatment of neonates with subglottic stenosis at our institution.

Cricoid Cartilage↗
PubMed2001

Corrosive esophagitis in children: a 30-year review.

Caustic ingestion with resultant corrosive esophagitis in the pediatric population comprises a heterogeneous group in terms of offending agent, location of burn and the degree of damage. Consequently, the treatment of these injuries has also varied over the years and the optimal management remains controversial. Another area of concern that is seldom reported in the otolaryngology literature is the socioeconomic impact of such injuries both on the child and on the family. We report a 30-year retrospective review of aerodigestive tract caustic injuries at The Hospital for Sick Children. Eighty patients were identified with an age range from 1 month to 16 years. Early and late complications are reviewed including 23 patients (29%) that developed medical complications and 16 patients (20%) that developed severe esophageal strictures. Five of these children required repeat prograde dilatation, while 11 children required gastrostomy and stringing with subsequent retrograde dilatation. All the 11 children required esophageal replacement surgery. The economic and social consequences to the child and family were also noted with particular attention to hospital costs, parental absenteeism from work, and the need for job relocation. A partial cost analysis using a child with a severe injury is presented as an example. Psychological aspects such as attempted murder, jail terms and attempted suicides are also documented. We also present an analysis of those children requiring esophageal replacement surgery, and examine the possible role of esophageal stents in recalcitrant strictures.

Adolescent↗
PubMed2001

Thyroid alar cartilage laryngotracheal reconstruction for severe pediatric subglottic stenosis.

BACKGROUND/PURPOSE: Laryngotracheoplasty has become an accepted treatment alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been used successfully in single stage laryngotracheal reconstruction in children with subglottic stenosis. METHODS: This is a retrospective study of 6 children (mean age, 16.6 months) undergoing TAC graft laryngotracheoplasty between September 1995, and June 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS: Four children underwent successfully extubation 9 to 21 days (mean, 15.5 days) postoperatively. Two required tracheostomy, which was maintained because of severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with CO2 laser because of symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the 6 cases. Repeat laryngoscopy and bronchoscopy showed a patent subglottic airway. All of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS: (1) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; (2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity.

Child, Preschool↗
PubMed2001

The role of nasal endoscopy in repeat pediatric nasolacrimal duct probings.

PURPOSE: To determine whether pediatric nasal endoscopy improves treatment success in recurrent nasolacrimal duct obstruction. METHODS: A retrospective analysis was carried out on 2 nonrandomized cohorts of consecutively treated patients who had one failed nasolacrimal duct probing at the Hospital for Sick Children, University of Toronto. The first cohort of 24 consecutive patients (32 eyes), group A, was treated with Crawford silicone tube intubation by one ophthalmologist (R.C.P.). The second cohort of 23 consecutive patients (33 eyes), group B, was treated with repeat probing by a second ophthalmologist (A.V.L.) in conjunction with nasal endoscopy by one otolaryngologist (V.F.). Abnormalities found on endoscopy were treated accordingly, and no tubes were inserted. Follow-up, through phone interviews or office visits, was conducted to assess the patients' symptoms. RESULTS: Group A patients were older at both the first probing (P = .048) and the second procedure (P = .012). No significant difference in the failure rates was found, with treatment failing in 3 eyes (2 patients) in group A and in 5 eyes (4 patients) in group B (P = .479). Interestingly, 17 of the 32 tubes in group A were extruded in 1 month or less. Also, 28 of 33 eyes in group B had abnormalities on endoscopy-some, multiple. Twenty-two eyes underwent inferior turbinate infracture: 5 had redundant mucosa, which was removed, and 6 had abnormal openings of the inferior meatus. CONCLUSIONS: We were unable to show any benefit of nasal endoscopy over intubation of the nasolacrimal system with silicone tubes in the treatment of failed probings despite the identification and treatment of abnormalities. The study was limited by its low power to detect differences because of the small number of patients and the high success rate of the traditional treatments for congenital nasolacrimal duct obstruction.

Child↗
PubMed2000

Branchio-oculo-facial syndrome.

Branchio-oculo-facial (BOF) syndrome is a rare autosomal dominant disorder that has a distinct phenotype with characteristic craniofacial abnormalities. These consist of branchial anomalies, including supra-auricular sinuses, and aplastic cervical skin lesions, with possible ectopic dermal thymus, malformed auricles, stenotic external auditory canals, conductive hearing loss, ocular abnormalities (microphthalmia and lacrimal duct obstruction), and pseudocleft of the upper lip. Extracraniofacial malformations are uncommon. We describe two new cases of BOF and discuss the classical clinical presentation and differential diagnosis. Our two patients presented with facial nerve paralysis and were also were found to have inner ear dysplasias with associated sensorineural hearing loss which, to our knowledge, have not been described in the literature in association with this syndrome.

Branchio-Oto-Renal Syndrome↗
PubMed2000

Comparison of thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in an animal model.

OBJECTIVE: To evaluate and compare the use of autogenous thyroid cartilage with that of auricular and costal cartilage in laryngotracheoplasty (LTP). DESIGN: A blinded comparison of LTP techniques using anterior thyroid, auricular, or costal cartilage as graft material in a rabbit model. Histological and anatomical analyses were performed on the laryngeal specimens 1, 4, and 6 weeks after surgery. The following factors were analyzed in each specimen: graft viability, cartilage proliferation, perichondrial viability, degree of necrosis, inflammatory response, and degree of epithelialization. SUBJECTS: Fifty-seven New Zealand adult male rabbits, aged 6 months, were divided into 3 study groups (19 animals in each group) initially and equally into the 3 time periods. RESULTS: No episodes of respiratory compromise occurred in any of the animals in the 3 study groups. Gross inspection of the laryngotracheal complex in the thyroid cartilage group revealed no evidence of laryngeal structural compromise. There was no statistical difference between the 3 types of cartilage used for reconstruction for the variables of graft or perichondrial viability, degree of necrosis, or inflammatory response at 1, 4, or 6 weeks. Cartilage proliferation in the thyroid cartilage group was decreased compared with that in the other 2 groups at 1 week. The amount of proliferation increased in this group and was equal to the amount present in the other 2 groups 4 and 6 weeks after surgery. Complete epithelialization of the graft material was present in all 3 groups at 4 and 6 weeks after reconstruction. CONCLUSIONS: The use of autogenous thyroid cartilage for LTP compares favorably with that of other methods of reconstruction that use either auricular or costal cartilage in the rabbit model. This technique is a viable alternative for single-stage LTP and has the added advantage of using a single incision.

Animals↗
PubMed2000

Pediatric rhabdomyosarcoma of the head and neck: is there a place for surgical management?

OBJECTIVE: To review and evaluate the place of surgical treatment in the management of rhabdomyosarcoma of the head and neck in children. DESIGN: Retrospective analysis of patient charts from January 1, 1972, to December 31, 1998. SETTING: Tertiary pediatric referral center. PATIENTS: Twenty-nine consecutive children with nonorbital head and neck rhabdomyosarcoma. INTERVENTIONS: Surgery, chemotherapy, and radiotherapy. MAIN OUTCOME MEASURES: Disease-free survival and long-term morbidity from treatment. RESULTS: Twenty patients had parameningeal and 9 had nonparameningeal head and neck tumors. All were treated with chemotherapy. For 18 patients, diagnostic biopsies were performed and they received radiotherapy. Eleven patients underwent surgery as definitive therapy. Using the Intergroup Rhabdomyosarcoma Study (IRS) staging system, 5 of these 11 patients had complete resection of tumor (IRS group I) and avoided radiotherapy. The other 6 patients required radiation because of compromised, regional, or incomplete resection of tumor. One had undergone regional resection with nodal involvement, and 2 had compromised resections with microscopic residual disease (IRS group II). Three had incomplete resections with gross residual tumor (IRS group III). Only 1 patient who underwent surgery ultimately died from recurrence at 2.7 years after an incomplete resection. The other 10 patients were relapse free at a median follow-up of 3.7 years (range 0.8-21.0 years). Long-term surgical morbidity was seen in 36% (4/11) of the patients and included facial nerve paralysis, trismus, and cosmetic deformity. CONCLUSIONS: Children with localized disease of the head and neck are able to undergo complete surgical resection, with low long-term surgical morbidity. By undergoing complete surgical resection, these children are able to avoid radiotherapy and its long-term complications, with no compromise in survival.

Child, Preschool↗
PubMed2000

Advances in the management of major airway collapse: the use of airway stents.

The management of major airway collapse in the pediatric age group has evolved and continues to evolve over time. Tracheobronchomalacia, either primary or secondary, is still the most frequent cause of major airway collapse. This article reviews tracheobronchomalacia and discusses several treatment options; from traditional aortopexy to the more recent introduction of tracheobronchial stenting. Various types of stents are discussed and the authors' preferences are included.

Bronchi↗
PubMed2000

Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus.

OBJECTIVE: To report the dramatic resolution of unilateral mucus plugging and atelectasis in a mechanically ventilated child with refractory status asthmaticus after intratracheal recombinant human DNase (rhDNase) therapy. DESIGN: Case report. SETTING: Critical care unit. PATIENT: A 7-yr-old boy with status asthmaticus, severe respiratory failure and barotrauma unresponsive to conventional therapy. Fiberoptic bronchoscopy confirmed widespread mucus impaction of the subsegmental bronchi of the left lung without response to bronchoscopic lavage. INTERVENTIONS: Two 10-mg doses of intratracheal rhDNase were administered 8 hrs apart. MAIN RESULTS: The left-sided atelectasis resolved 3 hrs after the first dose of rhDNase. Improvements in gas exchange and tidal volumes were sustained and particularly noticeable after the second dose. The patient was successfully extubated 26 hrs after receiving the rhDNase treatment without any adverse effects. CONCLUSIONS: rhDNase should be considered as a potential therapy for refractory mucus plugging and atelectasis in intubated patients with status asthmaticus.

Bronchoalveolar Lavage↗
PubMed2000

Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children.

UNLABELLED: Metallic foreign body (FB) ingestion is a common occurrence in the general paediatric population. We have shown that the use of a commercially available metal detector is sensitive in localizing and confirming metallic FB objects in the digestive tract. METHOD: In a double-blinded randomized control trial, we used a commercially available metal detector to localize metal coins in the digestive tract in an animal model. Localization of the coins was confirmed using fluoroscopy. In 10 consecutive patients with metallic FB ingestion, detection and localization of the FB using the metal detector was compared with standard confirmatory radiographic imaging. RESULTS: Using a commercially available, hand-held metal detector, we were able to localize a metallic FB in the gastrointestinal tract with 100% sensitivity in both the animal model and in 10 paediatric patients.

Child↗
PubMed1999

Ewing's sarcoma of the head and neck in children.

OBJECTIVE: The purpose of this paper was to review our experience with Ewing's sarcoma of the head and neck in children. DESIGN: Retrospective chart review. SETTING: The Hospital for Sick Children, Toronto, Ont., Canada. METHODS: Between 1986 and 1996, 70 cases of Ewing's sarcoma were identified. The medical records, roentgenographic and pathology reports were reviewed retrospectively. The gender, age of presentation, location and clinical presentation of the tumor were noted in the cases involving the head and neck. The treatment and follow-up of these patients were recorded. RESULTS: Of the 70 cases of Ewing's, five involved the head and neck (7.1%). The age of presentation ranged from 7.5 to 14 years. An enlarging mass in the mandible was the mode of presentation in three of the five children. Two patients had metastases at initial presentation. All patients received combination treatment regimens with chemotherapy initially, followed by adjuvant surgery and/or radiation. Follow-up ranged from 2 to 11 years. Three of five patients died of metastatic disease. Two are alive and well with no evidence of disease. CONCLUSIONS: Ewing's sarcoma occurs infrequently in the head and neck in children. An enlarging mass in the mandible is the most frequent mode of presentation. This tumor is treated systemically with high dose chemotherapy and locally with surgical excision where possible. In lesions that are initially unresectable and/or show a poor response to chemotherapy, radiation is used for local control. A good prognosis can be expected if the disease has not metastasized.

Adolescent↗