BACKGROUND: The frequency of ectopia of thyroid gland among all types of dysgenesis varies from 30 to 70%, its most common localization is the root of the tongue. Otorhinolaryngologists, oncologists, pediatricians can take lingual ectopia for hypertrophy of the lingual tonsil or fibroma of the tongue root, which leads to unreasonable surgical treatment. Thyroid scintigraphy plays a key role in the diagnosis of ectopia.AIM: To assess the etiological structure of congenital hypothyroidism (CH) and demonstrate the clinical course in patients with ectopic thyroid tissue in the root of the tongue.MATERIALS AND METHODS: A group of patients with CH was examined. All patients underwent neck ultrasound and radionuclide imaging. The examination was carried out against the background of the abolition of hormone replacement therapy for 14 days or before its initiation. Patients with ectopia in the root of the tongue underwent videofibrolaryngoscopy. Some patients underwent a genetic study with using genes panel of a panel of candidate genes responsible for the development of CH using the NGS method. The molecular genetic study was conducted to some patients, next-generation sequencing with the genes panel.RESULTS: The study included 73 patients with primary CH aged from 2 weeks to 17.3 years: 69 children were diagnosed based on the results of neonatal screening, 4 children with thyroid ectopia were first examined older than 6 years. The median age of patients at the time of the examination was 6.9 years [4.8; 10.0]. By data of ultrasound aplasia was diagnosed in 47.9% of patients, one child had hemiagenesis and ectopic thyroid tissue of various localization was detected in 26.0% of children. In 24.7% of children thyroid tissue was found in a typical location. Scintigraphy confirmed thyroid aplasia in 65.7% of children. Examination revealed various variants of ectopically located thyroid tissue in 31 children (42.4%): thyroid ectopia in the root of the tongue in 25 children (80.6%), ectopia in the sublingual region in 5 children (16.2%), double ectopia was detected in 1 child. The median level of TSH in newborns with ectopic thyroid gland was 124 IU/ml and was significantly lower than in children with aplasia — 219 IU/ml, p<0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia — 37.12 ng/ml versus 0.82 ng/ml, p><0.05. CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH — ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment. ><0.05. On the other side the level of TG in children with ectopia was significantly higher than in children with aplasia — 37.12 ng/ml versus 0.82 ng/ml, p< 0.05.CONCLUSION: Combination of two methods is the best diagnostic approach to determine the etiology of CH — ultrasound and scintigraphy studies compensates deficiencies of each other. Our study demonstrates the importance of scintigraphy in children with CH and patients with the formation of the root of the tongue and the anterior surface of the neck in order to avoid unnecessary removal of the thyroid gland. In case of confirmation of thyroid ectopia in the root of the tongue and in the absence of symptoms of obstruction or bleeding, it is recommended to refer the patient to an endocrinologist for conservative treatment.
Background. Nasopharyngeal cysts are mostly congenital malformations. However, their clinical manifestation can also occur in adolescence, depending on their severity, size and location. Nasopharyngeal cysts are rare in the practice of an otolaryngologist, but can be found in nasal obstruction. The article presents the literature data on the theories of the origin, clinical manifestations, peculiarities of the diagnostics and surgical treatment of the nasopharyngeal cysts. Aim. To increase the efficiency of diagnostics and treatment of nasopharyngeal cysts in children on the basis of a differentiated approach to the manifestation of the disease symptoms. Materials and methods. 29 patients aged from 1 to 8 years (mean age 4.210.39 years) with nasopharyngeal cysts and cyst-like neoplasms were treated at the clinical sites of the Department of Otorhinolaryngology and Pediatric Department of Pirogov Russian National Research Medical University (Moscow) from 2009 to 2022. Results. On admission all 29 (100%) children complained of an increasing nasal obstruction, anterior and posterior purulent rhinorrhea, snoring, decreased hearing, and epiphora. 18 patients (62.1%) had a history of recurrent otitis media and were diagnosed with bilateral exudative otitis media on examination. Transnasal or transoroepipharyngeal endoscopic marsupialization and cyst coagulation with an electrosurgical complex were performed in 28 (96.5%) children. In 19 (65.5%) cases the operation was performed with a single-stage adenotomy and in 8 (27.6%) cases with tubal valvular plasty, partial destruction of the tubal tonsils. Conclusion. Improvement of diagnostics quality due to modern imaging technologies leads to detection of a greater number of accidental findings of nasopharyngeal cysts and requires systematization and detailed elaboration of the accumulated knowledge in the work of the pediatric otorhinolaryngologist.
Background: Thyroid cancer is the most common endocrine malignancy, accounting for 3.4% of all cancers diagnosed annually. The primary treatment for differentiated thyroid cancer (DTC) is surgery, which can often involve complications such as postoperative pareses or reversible laryngeal nerve paralysis (RLN). Currently, rehabilitation possibilities for patients with postoperative RLN pairs are relevant. In our study, we used neuromuscular electrostimulation with VocaStim, in combination with drug therapy, and evaluated the effectiveness of the rehabilitation. Aims: Determine the possibility of using neuromuscular electrophonopathic laryngeal stimulation (NMELS) in restoring laryngeal function after surgical treatment of differentiated thyroid cancer complicated by pareses/paralysis of RLN. Materials and methods: 76 patients with DTC who have undergone surgical treatment, complicated by paresis of RLN, served as material for the present work. Results: The study analyzed the results of treatment of 76 patients (Table. 1). The age of the patients ranged from 6 to 78 years (average age 47), the ratio of women to men was 59 to 17 (women 77.6 % and men 22.4 %). Unilateral laryngeal paresis in the postoperative period was present in 56 (73.68%) patients, bilateral lesion - 20 (26.32%). Dysphonia was found in all patients: dysphonia - 76 (100%), dysphagia - 28 (36.84), respiratory failure - 11 (14.47), 2 patients (2.63%) were tracheotomized in the postoperative period. All patients underwent neuro-phonic rehabilitation with mandatory assessment and video fixation of laryngeal function. As a result of neuromuscular electrophonopathic stimulation of the larynx, 69 out of 76 patients (90.79%) had improved larynx function. Conclusions: Thus, based on our own experience, the method of neuromuscular electrophonopedic stimulation of the larynx with VocaStim, can be used for restoring the functions of the larynx in patients with RLN paresis of varying severity, after surgical treatment for DTC/
The objective of the present study was to determine the size of the vocal folds in the children during the first several years of life. The study included 137 children at the age from the birth up to 3 years who were referred to our clinic for the pre-planned surgical intervention with the use of endotracheal intubation. The length and the width of the vocal folds from the muscle tubercle to the anterior commissure in abduction were measured using a probe specially designed and adapted for this purpose. In all the cases, the endoscope was positioned at the same distance from the vocal folds. The fold length (ab) and width (cd) were expressed in millimeters. These parameters were measured in the following age groups of the patients: from the birth to 1 month 29 days (group 1), from 12 mo to 23 mo 29 d (group 2), from 24 mo to 35 mo 29 d (group 3), and above 36 months (group 4). The length and the width of the vocal folds varied from 2.6 mm to 7.8 mm and from 1.3 mm to 3.2 mm respectively. The length of the vocal folds increased at a rate of 1.025 mm per year showing marked variations within each age group, from the maximum value of 1.79 mm during the second year of life to the minimum of 0.48 mm during the fourth year. The authors conclude that these data may be of use for the improvement of the quality of the surgical treatment and subsequent rehabilitation of the respiratory and voice-generating functions of the larynx.
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