Objective: To study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis Methods: Retrospective chart review at a tertiary care pediatric hospital Main outcomes: Demographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures Results: Twenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n =10), epidural abscess (n =10), meningitis (n = 5), intraparenchymal abscess (n = 5), and cavernous sinus thrombosis (n = 2). Neurologic symptoms included headache (n = 12), hemiparesis (n = 5) and aphasia (n = 3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. Discussion: Early ESS may be associated with less need for neurosurgical procedures.

A sinonasal mucocele can develop after the obstruction of a sinus ostium, which can occur secondary to trauma, infection, a neoplasm, or an iatrogenic cause. These mucoceles typically arise in the frontal and ethmoid sinuses. Sinonasal mucoceles are epithelium-lined cysts that can gradually expand to fill a paranasal sinus. They can present with ophthalmologic, rhinologic, and neurologic symptoms. There are reports in the literature of sinonasal mucocele development after radiation for nasopharyngeal carcinoma. However, these cases are rare; when they do occur, they tend to arise in the sphenoid sinus. We describe the case of a 21-year-old man who had undergone external-beam radiotherapy for a right maxillary sinus rhabdomyosarcoma at the age of 4 years and who subsequently developed bilateral maxillary sinus mucoceles and multiple other known complications of radiation therapy. To the best of our knowledge, this is the first case of postirradiation bilateral maxillary sinus mucoceles to be reported in the literature.

Airway obstruction in children has a wide differential diagnosis that includes laryngomalacia, infectious processes, paralysis, extrinsic compression, and other rare anatomic anomalies. Isolated laryngeal lymphatic malformations are rare developments that can manifest with clinically significant airway obstruction. To the best of our knowledge, there have been fewer than 20 reported cases. These laryngeal mucosal lesions are best managed with radiofrequency ablation or laser ablation. We present a case of a 2-year-old child who presented with airway obstruction, initially diagnosed with laryngomalacia, who was subsequently diagnosed and treated for an isolated epiglottic lymphatic malformation.

ABSTRACTThyroid surgery in the pediatric population is performed for a variety of benign and malignant conditions, including thyroid nodules, hyperthyroidism, goiter, and thyroid cancer. Thyroid nodules, though uncommon in children, are more likely to be malignant than in adults and require careful evaluation with history, imaging, thyroid function tests and often ultrasoundguided biopsy to determine which nodules will require further interventions. The treatment of thyroid malignancy is primarily surgical, though the extent of surgery is an area of active debate. Moreover, thyroid surgery in children may have a higher rate of complications, and a number proposals have been suggested to mitigate these risks. The guidelines developed by the 2015 American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer are a helpful tool in directing the medical and surgical management of these complex patients, and provide a method for stratification of patient risk for recurrent disease. Children with thyroid disease are recommended to be cared for using a multidisciplinary approach and by providers and facilities experienced in management of pediatric patients. Surgery should be performed by surgeons experienced in pediatric cervical procedures. The objective of this review is to describe the range of thyroid disease affecting pediatric patients, examine current diagnostic algorithms, and discuss common treatment approaches, including the role for both surgery and adjunctive therapies.How to cite this articleWindsor AM, Kiell EP, Berg EE, Kazahaya K. Surgery of the Thyroid in Children: Current Trends in Practice. Int J Head Neck Surg 2016;7(2):57-63.

An abnormal fetal cystic left neck mass was found on ultrasonography at 18 weeks gestation in a young woman. Fetal magnetic resonance imaging (MRI) demonstrated a large cystic anterior neck mass (Figure, A, sagittal view, and Figure, B, axial view, on T2-weighted half-Fourier acquired single turbo spin-echo [HASTE] MRI). The tracheoesophageal displacement index (TEDI) was found to be 24 mm. The neonate did well at the cesarean delivery (scheduled owing to the mother’s previous cesarean delivery) and had initial Apgar scores of 7 (1 minute) and 9 (5 minutes). Subsequently, the infant was intubated owing to increased difficulty with milky oral secretions and respiratory distress. Examination of the infant revealed a 5-cm, soft, fluctuant, and mobile neck mass that caused the head to deviate to the right with no cutaneous involvement. On day 2 of life, the mass had an air-fluid level and was markedly hyperintense on axial T2-weighted MRI with fat saturation (Figure, C). It appeared to be predominantly in the retropharyngeal space, anterior to the left carotid artery, and extended to abut themedial aspect of the right carotid sheath.Onday8of life, direct laryngoscopydemonstratedbulging in the left lateralpharyngealand retropharyngealwalls.Whentheneckmasswascompressed,air and fluid escaped froma communicating sinus lateral to the arytenoids in the left pyriform sinus (Figure, D). The mass was excised. A tract was isolated and ligated at the pyriform sinus, deep to the left thyroid lobe. The thyroid lobe was uninvolved. The patient was extubated on day 9 of life and had no problems breathing. What is your diagnosis? 80 mm 80 mm A B