Tracheotomy in Children with Juvenile-Onset Recurrent Respiratory Papillomatosis: The Children's Hospital of Pittsburgh Experience

Despite the risk of airway obstruction, tracheotomy has been viewed with trepidation in the management of recurrent respiratory papillomatosis (RRP). The literature suggests that the injury associated with the tracheotomy site may initiate the progression of disease to the distal airway. Alternatively, patients who require tracheotomy for RRP may be predisposed to distal spread because of more aggressive disease. In an effort to clarify this issue, we reviewed the Children's Hospital of Pittsburgh experience with 35 patients with RRP between 1984 and 1994; 13 patients received tracheotomies. Tracheotomy patients presented at a younger age with more widespread disease, often involving the distal airway prior to tracheotomy. Although distal spread occurred in 50% of patients, it was generally limited to the tracheotomy site. Overall, outcome in the tracheotomy group was satisfactory. Complications related to the tracheotomy were rare. We conclude that tracheotomy is an appropriate option for significant airway compromise in patients with RRP.

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Prenatal Detection of Neuroblastoma: A Ten-Year Experience From the Dana-Farber Cancer Institute and Children's Hospital

PEDIATRICS ◽

10.1542/peds.92.3.358 ◽

1993 ◽

Vol 92 (3) ◽

pp. 358-364

Author(s):

Peter T.C. Ho ◽

Judy A. Estroff ◽

Harry Kozakewich ◽

Robert C. Shamberger ◽

Craig W. Lillehei ◽

...

Keyword(s):

Surgical Resection ◽

Abdominal Mass ◽

Tertiary Care ◽

Prognostic Indicators ◽

Adrenal Tumors ◽

Prenatal Ultrasonography ◽

Urinary Catecholamines ◽

Children's Hospital ◽

Children’S Hospital ◽

Progression Of Disease

Objectives. To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography. Design. Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992. Setting. Large, urban, tertiary care children's hospital in Boston, Massachusetts. Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were identified. Results. Nine patients had adrenal tumors; two had thoracic paraspinal tumors. Typical diagnostic evidence for neuroblastoma including a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favorable prognostic indicators including low stage of disease (10/11), favorable biological markers including cellular DNA content (5/5) and N-myc oncogene copy number (5/5), and histopathology suggestive for neuroblastoma in situ (7/11). All patients were treated by surgical resection. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen at a mean follow-up of 37 months (range 3 to 120 months). Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography generally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicated unless substantial progression of disease occurs.

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Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery

Ear Nose & Throat Journal ◽

10.1177/01455613211049845 ◽

2021 ◽

pp. 014556132110498

Author(s):

Xiaoli Qu ◽

Yang Xiao ◽

Lijing Ma ◽

Jun Wang

Keyword(s):

Vocal Cord ◽

Disease Severity ◽

Recurrent Respiratory Papillomatosis ◽

Age At Diagnosis ◽

Juvenile Onset ◽

Vocal Cords ◽

Younger Age ◽

False Vocal ◽

The Impact ◽

First Time

Objectives The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. Methods Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. Results Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. Conclusions Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.

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Challenges in Managing Sars-Cov-2 Positive Child with Juvenile Onset Recurrent Respiratory Papillomatosis: A Case Report with Review of Literature

Tribhuvan University Journal ◽

10.3126/tuj.v34i0.31538 ◽

2020 ◽

pp. 51-58

Author(s):

Heempali Das Dutta ◽

Bibhu Pradhan

Keyword(s):

Airway Obstruction ◽

Surgical Intervention ◽

Severe Form ◽

Recurrent Respiratory Papillomatosis ◽

Juvenile Onset ◽

Aerosol Generation ◽

Laryngeal Surgery ◽

Urgent Surgery ◽

Acute Airway Obstruction ◽

Challenging Situation

Juvenile-Onset Recurrent Respiratory Papillomatosis (JORRP) is a viral infection caused by Human papilloma virus 6, 11 which presents as hoarseness, shortness of breath and in severe form may present with acute airway obstruction because of papillomatous growth obstructing the larynx. Urgent surgical intervention may be needed to secure the airway. In the present situation of Coronavirus disease-2019 (COVID-19) pandemic, the case of JORRP with COVID-19 positive state is a challenging situation because any laryngeal or airway surgery is associated with high amount of aerosol generation. Air borne transmission is one of the major routes of transmission for SARS-Cov-2 virus which may result in spread of COVID-19 among to the health care provider. In this situation, it is better to avoid delay laryngeal surgery if the patient is not in acute airway obstruction requiring urgent surgical intervention. Otherwise, if the urgent surgery has to be done, then it should be done properly by following institutional guidelines to avoid the spread of the disease and to be done with all precautionary biosafety measures like use of personal protective equipment (PPE), N95 mask and proper donning and doffing.

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The Season and Diabetes

PEDIATRICS ◽

10.1542/peds.61.2.325a ◽

1978 ◽

Vol 61 (2) ◽

pp. 325-325

Author(s):

Francene Fleegler ◽

Kenneth D. Rogers ◽

Allan Drash ◽

Luther B. Travis ◽

Arlan L. Rosenbloom

Keyword(s):

Diabetic Patients ◽

Juvenile Onset ◽

Children's Hospital ◽

Onset Diabetes ◽

Children’S Hospital ◽

Insulin Dependent ◽

Juvenile Onset Diabetes ◽

Insulin Dependent Diabetic ◽

Diabetes Register

MacMillan and co-workers reported the ages and month of detection of all new insulin-dependent diabetic patients (N = 120) admitted to Children's Hospital, Louisville, Kentucky, from 1960 through 1975 (Pediatrics 59:113, January 1977). They reported possible differences in month of onset for children 6 years old or older and those under 6 years. A similar observation was made by Bloom et al. in the British diabetes register study for children under age 5 years.1 We recorded age and month of diagnosis of new cases of juvenile-onset diabetes in Pittsburgh (N = 673), Gainesville, Florida (N = 127), and Texas (N = 741).

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Synchronous Airway Lesions in Infancy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948709600119 ◽

1987 ◽

Vol 96 (1) ◽

pp. 77-80 ◽

Cited By ~ 77

Author(s):

Carlos Gonzalez ◽

James S. Reilly ◽

Charles D. Bluestone

Keyword(s):

Retrospective Study ◽

Respiratory Tract ◽

Airway Obstruction ◽

Lower Respiratory Tract ◽

Young Infant ◽

Careful Examination ◽

Concurrent Disorders ◽

Children's Hospital ◽

Children’S Hospital

Stridor in the young infant is evaluated by careful laryngoscopy. When a lesion of the larynx is diagnosed, the necessity and risk of bronchoscopy are challenged. To assess the need for careful examination of both the upper and lower respiratory tract, a 2-year retrospective study was performed at the Children's Hospital of Pittsburgh. Of 103 infants who underwent diagnostic laryngoscopy and bronchoscopy for airway obstruction, stridor, or both, 18 (17.5%) had two or more synchronous airway lesions detected. Laryngoscopy alone, without further workup of the entire respiratory tract (ie, bronchoscopy, radiographic studies) may fail to detect concurrent disorders in infants with airway obstruction.

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Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd18.2.76 ◽

2008 ◽

Vol 18 (2) ◽

pp. 76-86 ◽

Cited By ~ 2

Author(s):

Lauren Hofmann ◽

Joseph Bolton ◽

Susan Ferry

Keyword(s):

Tracheostomy Tube ◽

Pediatric Population ◽

Interdisciplinary Approach ◽

Extended Period ◽

Speech Development ◽

Tube Placement ◽

Background Information ◽

Speaking Valve ◽

Children's Hospital ◽

Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

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