IMPORTANCE Numerous techniques are used for septal perforation repair, yet success rates remain variable. Few studies have evaluated the effectiveness of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair.OBJECTIVE To investigate and describe the use of interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft for septal perforation repair and the expansion of this technique to patients with more challenging comorbidities, including granulomatosis with polyangiitis. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical record review was performed of patients who underwent septal perforation repair using interposition grafts of polydioxanone plates combined with a temporoparietal fascia graft from

Introduction: Infantile hemangiomas (IHs) are the most common tumor of the parotid gland in children; however, there is no standard protocol for the treatment of IH. The generally accepted practice is to begin the patient on β-blocker therapy if there are no contraindications. Objective: The purpose of this study is to better understand the challenges and successes of management of pediatric patients with parotid IH. Methods: This retrospective study analyzed 15 patients diagnosed with parotid IH from 2009 to 2016 who were cared for at a tertiary care center. Demographic information, lesion characteristics, and treatment course were obtained through patient chart review. Results: Fifteen pediatric patients with parotid IH were evaluated. The female:male ratio was 4:1; the average age of diagnosis was 8.75 months. Most lesions were greater than 3 cm in their widest dimension (73.3%), and 13 patients underwent imaging to further clarify the parotid mass in their clinical workup. Fourteen patients began treatment with propranolol; 10 patients saw complete resolution of their IH (66.7%) and 3 had a partial response to β-blocker therapy (20%). After discontinuation of propranolol, 2 patients had regrowth 2 to 3 months later after regression and were restarted on therapy. The average duration of treatment was 9.9 ± 8.45 months. The known adverse effects of propranolol—hypoglycemia, hypotension, bradycardia, and bronchospasm—were not observed in any patient. Conclusion: In the treatment of parotid IH, propranolol is the generally accepted first-line therapy, as compared to corticosteroid or interferon α injections of years past. Parotid hemangiomas, however, have a lower response rate to propranolol and a similar recurrence rate compared to IH at other sites. The treatment duration necessary tends to be longer. Future studies will aim at identifying and evaluating potential predictors of outcomes to help inform the management of parotid hemangiomas.

Objectives: To describe prenatal diagnosis and perinatal management of patients with head and neck lymphatic malformations (LMs) at a tertiary fetal diagnostic and vascular anomalies center. To identify prenatal characteristics correlating with the need for airway intervention at birth. To describe postnatal clinical course in patients with prenatally diagnosed head and neck LMs. Methods: A retrospective review of all patients with head and neck LMs diagnosed in utero at a tertiary prenatal diagnostic center from 1996 to 2020 was performed. Prenatal records of pregnant patients and postnatal records of patients were reviewed. Univariate and multivariate logistic regression analyses were conducted to identify correlates of need for extrauterine intrapartum treatment (EXIT) delivery and correlates of clinical outcomes. Results: Over the study period, 26 fetuses were diagnosed with LM of the head and neck, 15 of which survived the perinatal period. Outcomes in these survivors are reported including birth modality, DeSerres’ stage, duration and modality of treatment, complications, hospitalizations, and functional outcomes including need for tracheostomy and gastrostomy tube. The majority of patients (n = 8) were born via the EXIT modality. Almost half (n = 7) were DeSerres’ stage V. Prenatal imaging findings of neck vessel compression (p = 0.023) and tracheal deviation (p = 0.006) correlated with EXIT delivery. The most common treatment modalities were sclerotherapy (n = 14), surgery (n = 7), and sirolimus (n = 8). Conclusions: This study identified prenatal anatomic findings of tracheal deviation and neck vessel compression as factors associated with EXIT delivery. None of the patients in our series required tracheostomy during the EXIT procedure, although 20% eventually underwent tracheostomy. The majority of infants with prenatally diagnosed head and LMs required multimodality treatment with some combination of sclerotherapy, surgery, and medical management, as well as multidisciplinary care from our vascular anomalies team throughout the first years of life and beyond.

Objective This study was aimed to evaluate the impact of a multidisciplinary perioperative pathway on length of stay (LOS) and postoperative outcomes after vestibular schwannoma surgery. Setting This study was conducted in a tertiary skull base center. Main Outcome Measures The impact of the pathway on intensive care unit (ICU) LOS was evaluated as the primary outcome measure of the study. Overall resource LOS, postoperative complications, and readmission rates were also evaluated as secondary outcome measures. Methods Present study is a retrospective review. Results A universally adopted perioperative pathway was developed to include standardization of preoperative education and expectations, intraoperative anesthetic delivery, postoperative nursing education, postoperative rehabilitation, and utilization of stepdown and surgical floor units after ICU stay. Outcomes were measured for 95 consecutive adult patients who underwent surgical resection for vestibular schwannoma (40 cases before implementation of the perioperative pathway and 55 cases after implementation). There were no significant differences in the two groups with regard to tumor size, operative time, or medical comorbidities. The mean ICU LOS decreased from 2.1 in the preimplementation group to 1.6 days in the postimplementation group (p = 0.02). There were no significant differences in overall resource LOS postoperative complications or readmission rates between groups. Conclusion Multidisciplinary, perioperative neurotologic pathways can be effective in lowering ICU LOS in patients undergoing vestibular schwannoma surgery without compromising quality of care. Further research is needed to continue to sustain and continuously improve these and other measures, while continuing to provide high-quality care to this patient population.

ObjectivePersistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy.Study DesignA retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management.SettingUniversity of California, San Francisco Pediatric Otolaryngology Department.ResultsAmong the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management.ConclusionThe majority of pediatric PACL is benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow‐up with neck ultrasound can be used to safely monitor patients.

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