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Pediatric nasal surgery prior to puberty is not only safe, but may prevent facial deformity in certain patients.

Ganglioneuromas rarely occur in the retropharynx with only three cases reported in the current literature. The most common symptom associated with retropharyngeal ganglioneuromas is dysphagia. We report a retropharyngeal ganglioneuroma with an unusual clinical presentation of neck stiffness and pain. A 42-year-old woman presented with incapacitating neck pain, neck stiffness, right upper extremity weakness, as well as dysphagia. Neurological workup was normal. Imaging revealed a hyperdense, ill-defined, diffuse right retropharyngeal mass suggestive of a possible nerve sheath tumor with no communication with the cervical spine. Surgical removal was uneventful and associated with a postoperative Horner's syndrome. In follow-up, dysphagia and neck symptoms improved. Retropharyngeal ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive therapy but may be associated with an iatrogenic Horner's syndrome for which the patients should be counseled prior to operative intervention. Neck pain is an atypical symptom that needs to be worked up to rule out a communication with the spinal column prior to surgical removal. Patients must be counseled that atypical symptoms may not completely resolve with surgical treatment. KEYWORDS: Retropharyngeal, ganglioneuroma, neck pain, dysphagiaGanglioneuromas are benign tumors that originate from primordial neural crest cells which migrate from the mantle layer of the developing spinal cord to the sympathetic ganglia, adrenal medulla, and other sites. These tumors are well-circumscribed and consist of ganglion cells and Schwann cells with few neuroblasts. Ganglioneuroblastomas are malignant variations of these tumors that are characterized by decreased differentiation within ganglion cells in the presence of Schwann cells and are also associated with neuroblasts. Ganglioneuromas occur most commonly in children over 10 years of age.The most frequent sites of presentation include the posterior mediastinum and the retroperitoneum. In general, the neck is a rare site of presentation. 1 In a series of 88 patients with ganglioneuromas, only two occurred in the cervical region. 2 The retropharyngeal area of the neck is an extremely rare site of presentation with only three reported cases in the literature. [3][4][5][6][7] The most common symptom of presentation was dysphagia. We are reporting a retropharyngeal ganglioneuroma presenting with an unusual symptom complex that consisted primarily of neck stiffness, neck pain, and dysphagia.

Retropharyngeal ganglioneuromas can occur in a wide age range of patients. Surgical excision via a cervical approach offers definitive therapy but maybe associated with an iatrogenic Horner's syndrome for which the patients should be counseled prior to operative intervention. Neck pain is an atypical symptom that needs to be worked up to rule out a communication with the spinal column prior to surgical removal. Patients must be counseled that atypical symptoms may not completely resolve with surgical treatment.

Objective:To evaluate our preliminary experience with interventional sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP).Materials and Methods:Three consecutive pediatric patients with JRP who underwent interventional sialendoscopy were identified. Interventional sialendoscopy consisted of serial dilation of the Stenson's duct, endoscopy of the ductal system and saline irrigation followed by instillation of triamcinolone acetate. Clinical, demographic, procedure-related data and complications were documented. End points of the study were technical success, defined as completion of the procedure, subjective improvement in symptoms as indicated by the patients or their parents and assessment of safety in terms of complications.Results:Three male patients with a mean age of 9 years (range 6–11 years) underwent interventional sialendoscopy for JRP. Endoscopic findings included a blanched stenotic duct with intraductal debris in those who were symptomatic. Technical success was 100%. The mean number of episodes of JRP in the year prior to presenting to our service among the three patients was 5 (range 4–6 per year). There were no new episodes of JRP reported at the last follow-up. There were no major complications.Conclusion:Our preliminary experience concurs with the current literature and suggests that interventional sialendoscopy is effective for the management of JRP and can be considered for patients who fail conservative medical management.