The objective of this study was to review experience, outcome, and satisfaction after a laryngotracheal separation (LTS) procedure in pediatric patients. Chart reviews and phone questionnaires were used. Factors reviewed included hospitalizations and infections prior to and after LTS, morbidity, and impact on quality of life. Twenty-one pediatric patients ranging in age from 8 to 172 months underwent LTS. Follow-up time ranged from 1 to 49 months. Complications were minor. Eighty-eight percent of patients had fewer hospitalizations or were discharged for the first time after LTS. Number of pneumonias and suctioning frequency decreased, mobility increased in patients with prior tracheostomies, and care requirements decreased in 95% of patients. Parents reported satisfaction and improved quality of life. LTS is a low-risk, successful procedure which increases quality of life and decreases morbidity in pediatric patients with irreversible upper airway dysfunction.
Objective: k humanitarian mission to Kiev Ukraine to assess the possibility of creating a comprehensive treatment center to help manage the epidemic of children with thyroid cancer from the Chernobyl explosion (April 26, 1986). Meetings with health officials and humanitarian organization heads allowed the examination of 22 children with advanced thyroid cancers requiring further treatment not available in Ukraine.Methods: A travel grant allowed a head and neck surgeon and an otolaryngology chief resident fluent in Ukrainian to spend 2 weeks at a screening clinic and perform examinations and flexible fiber-optic endoscopy on 22 children with airway complications from their treated thyroid cancers. In addition, arrangements were made for observations at the national otolaryngology research institute to become familiar with the local medical environment.Results: Twenty-two patients ranging in age from 10 to 17 years of age were examined. All patients had been treated by total thyroidectomy, and in most cases modified or radical neck dissection. Ninety percent of patients had neck disease at the time of diagnosis, and 50% were found to have pulmonary metastases. On flexible fiber-optic laryngoscopy, 21 of the 22 patients were found clinically to have various combinations of superior and recurrent laryngeal nerve paralysis. Ten children had incapacitating dyspnea and were homebound.Conclusions: Ten years after the Chernobyl nuclear explosion, epidemiologic studies predict up to 4000 cases of thyroid cancer in children exposed to the radioactive fallout. The National Otolaryngology Institute in Kiev has acknowledged its desire for assistance for the primary and secondary treatment of the young Chernobyl victims with aggressive thyroid cancers. This represents a unique opportunity for head and neck surgeons from the United States to offer humanitarian assistance to the victims of the worst nuclear disaster to date.
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