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Transoral robotic surgery (TORS) in children is in its infancy, and indications have been primarily limited to lingual tonsillar hypertrophy and superficial mucosal lesions. However, the relatively avascular channel of the midline posterior tongue, vallecula, and posterior hyoid space provides a safe plane of dissection for deep lesions of the tongue and access to structures in the anterior neck. As robotic surgeons gain experience, application of this technology will continue to grow. The method is retrospective case series. We present seven patients who had either a primary (n = 3) or recurrent (n = 4) lingual thyroglossal duct cyst (TGDC) and underwent TORS excision. Four of the seven patients also underwent transoral resection of the central portion of the hyoid bone, while three had central hyoid resection during prior surgery. Two minor complications occurred with no evidence of lesion recurrence after mean follow-up of 19.7 mo. The midline avascular channel of the tongue allows for relatively bloodless surgical access to pathologies of the midline base of tongue and anterior neck. Lingual thyroglossal duct cysts can safely be removed via a TORS approach with evidence of limited recurrence. Robotic technology can provide safe and effective surgical alternatives for children with a variety of pathologies, and we aim to promote the widespread adoption of TORS in pediatric head and neck surgery by sharing our knowledge and clinical experience. Further study and publication are needed to establish safety and efficacy. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Otolaryngologists are frequently consulted for the evaluation and treatment of pediatric epistaxis. There is a lack of consensus as to the optimal approach to this problem. This study evaluated an approach used to evaluate and treat patients referred on an outpatient basis. Study Design: Retrospective study. Methods: Charts from 90 patients referred for the treatment of epistaxis were reviewed. Results: Anemia was identified in 22% of patients. An abnormal coagulation study was identified in 7.8% of patients. Computed tomography (CT) imaging of the sinuses was obtained in nearly 90% of patients and revealed no suspicious masses. Opacification of the sinuses consistent with sinusitis was commonly seen. The majority of cases were resolved by the first follow-up visit with a topical nasal emollient. Conclusions: The outpatient evaluation of epistaxis should include a screen for anemia and coagulopathy. Routine CT imaging of the sinuses is unhelpful and is not recommended. The majority of cases are easily treated with rehydration of the nasal mucosa. Consideration should be given to rhinosinusitis as a co-existing factor in patients with epistaxis. [ABSTRACT FROM AUTHOR]

A previously undescribed deficiency of the posterior cricoid at the midline, wherein the mucosa overlying this deficiency is intact, is described. Clinically this presents as a variety of subglottic stenoses wherein the narrowing is primarily in the transverse subglottic diameter; the symptoms are, therefore, those of airway obstruction not laryngeal incompetence. It is suggested that this deformity has been previously overlooked by laryngologists and pathologists by virtue of a postmortem routine in which the larynx is routinely split in the posterior midline. Demonstration in these cases was by serial horizontal section of the intact, unsplit, whole larynx. [ABSTRACT FROM AUTHOR]

There is always concern for a malignancy or other serious disease when a child presents with a chief complaint of a neck mass. However, a neck mass in child is commonly inflammatory or congenital rather than neoplastic. A complete history and physical exam will often provide enough information to guide management and reassure the concerned parents. In some cases, laboratory tests, radiologic studies or a surgical procedure may be necessary to determine a specific diagnosis and treatment plan. An organized and systematic approach is recommended and detailed in this review. [ABSTRACT FROM AUTHOR]