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Introduction: Although injection laryngoplasty (IL) is a well-accepted treatment strategy in older children and adults with unilateral vocal fold immobility (UVFI), its efficacy and safety have not been well studied in neonates and young children., Objectives: The main objective of this study was to evaluate the clinical and radiographic effects of IL on aspiration & dysphagia in neonates and young children with UVFI., Methods: This was a retrospective chart review of infants and children who underwent IL at a tertiary children's hospital. The primary endpoints were improved aspiration and avoidance of gastrostomy tube placement. Additional endpoints included adverse airway and swallowing effects of IL., Results: Eight patients were included in this case series. A total of 10 injection laryngoplasties were performed. Average corrected age of patients undergoing IL was 1.22 years(range 0.5-3.6 y). Seven out of 8 patients had preoperative modified barium swallow (MBS). Five out of seven showed improvement in aspiration. Three out of six (50%) patients who did not have gastrostomy tube preoperatively, were able to avoid gastrostomy tube. No adverse effects were noted following IL. One patient with severe tracheomalacia ultimately required tracheostomy 5 months after IL., Conclusion: Injection laryngoplasty appears to be a safe and effective therapeutic option in neonates and young children with unilateral vocal cord immobility and associated aspiration. It may be an effective treatment to improve aspiration and avoid gastrostomy tube placement. Further investigation is warranted., Level of Evidence: 4., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Aspirated thumbtacks can pose unique challenges during removal due to their shape. In particular, the flanges of the thumbtack can readily become trapped by the bronchial mucosa during extrication. We describe our experience of three children from whom aspirated thumbtacks were removed using rigid bronchoscopy following balloon dilation of the airway to reduce bronchial mucosa entrapment., Methods: This is a retrospective review of three pediatric otolaryngology cases., Results: In all three cases, the thumbtack was successfully removed from various sites within the lower respiratory tract. There were no iatrogenic complications, in particular bronchial wall injury leading to pneumothorax., Conclusion: In cases of complicated airway foreign bodies, such as thumbtacks, airway dilation is a useful and safe maneuver that may help facilitate removal., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Aim of the Study: Sialorrhoea and chronic salivary aspiration are a major problem in many neurologically impaired children causing embarrassment, skin issues and recurrent lower respiratory tract infections (LRTI). The aim of this study was to assess the efficacy of salivary gland surgery in the treatment of chronic salivary aspiration in such children., Objectives: To compare admission rates for LRTI per annum before and after surgical intervention., Methods: Retrospective review of all patients who underwent salivary management surgery for chronic aspiration under Princess Margaret Hospital's (PMH) Otolaryngology department from 2006 until 2013., Results: Twelve patients were included in this review. Their ages ranged from 3 to 21 years (mean=11.4). Their genders were equally distributed. Two patients had underlying congenital disorders; one had an acquired brain injury, while the majority (n=9, 75%) had cerebral palsy secondary to a sustained perinatal injury. Most patients (n=11, 91.7%) had bilateral submandibular gland excision and parotid duct ligation as a primary procedure. One patient had a laryngotracheal separation. Two patients went on to have a second procedure. The mean follow up time was five years. Using Wilcoxon Signed-Rank test we showed that the median rate of admission per annum for LRTI pre-operatively was 1.0. This was reduced to 0.5 post-operatively, which was statistically significant (p≤0.05)., Conclusions: We hypothesize that the combination of bilateral submandibular gland excision and bilateral parotid duct ligation is effective in reducing admissions with aspiration pneumonia in neurologically impaired children, and therefore improves the quality of life in these patients., (Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.)

Objectives: The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria., Methods: In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy., Results: The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%., Conclusion: Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: Pediatric airway foreign body aspiration is a life-threatening clinical entity. The standard of care for managing this situation is endoscopic retrieval using rigid bronchoscopy. However in resource-limited settings rigid bronchoscopy may not be available. This retrospective case series describes the successful application of one treatment modality for pediatric airway foreign body., Methods: A retrospective review was performed for seven pediatric patients who were treated at Soddo Christian Hospital with a diagnosis of airway foreign body aspiration. All patients were treated in the operating room using general anesthesia, a combination of inhaled halothane and intravenous ketamine. Paralytics were not used in any patient and spontaneous breathing was maintained. Flexible fiberoptic bronchoscopy was initially performed on each patient to confirm the presence of a foreign body and identify the anatomic position with the airway. Using a standard technique, a tracheotomy was performed. If the foreign body was still noted to be distal to the tracheotomy, postural percussion was performed to dislodge the foreign body into the trachea. Once the foreign body was identified at the tracheotomy, it was removed., Results: All seven patients presented in respiratory distress and were emergently managed in the operating room. The average age was 2.8 years (6 months-8 years of age). The foreign bodies were successfully removed in all patients. There were no mortalities and all patients were successfully discharged from the hospital., Conclusions: Pediatric airway foreign body aspiration is a life-threatening clinical entity in any setting, but it presents unique challenges in resource-limited settings where rigid bronchoscopy is not available. This report presents one such treatment modality and utilizes a combination of flexible fiberoptic bronchoscopy and tracheotomy to treat such patients., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To present the case of a premature child with a furrow in the posterior vocal cord as a result of prolonged intubation, with symptoms of aspiration and poor voice, treated with a novel method of vocal cord reconstruction., Methods: The vocal cord was reconstructed endoscopically by freeing up the edge of cord remnant and suturing this to a flap of inter-arytenoid mucosa to create a new cord., Results: The resulting neo-cord was able to achieve full glottic closure with resolution of aspiration, and this was also accompanied by improvement in voice quality., Conclusion: The described vocal cord reconstruction method proved to be a useful treatment for aspiration and poor voice caused by a post-intubation vocal cord furrow., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Laryngotracheal separation (LTS) is an effective and reliable definitive treatment for intractable aspiration. A major advantage of this treatment for intractable aspiration is its' potential reversibility. Should the underlying disorder improve, a reversal of the procedure may be attempted. This has been successfully achieved in the adult population. To our knowledge, no previous cases have been reported of successful reversal of LTS in children., Methods: A retrospective review from 2003 to 2010 identified four cases of intractable aspiration treated with LTS in our department. Two of these patients displayed objective evidence of sufficient recovery of their underlying aspiration to consider reversal. Patient selection for reversal was dependent upon successful oral intake for 9 months along with videofluoroscopic evidence of normal or minimally impaired swallow., Results: Two children who were successfully treated for intractable aspiration with LTS demonstrated objective evidence of recovery sufficient to attempt reversal. Both children underwent successful surgical reversal of LTS using a cricotracheal resection with end-to-end anastamosis, similar to that used in treatment of subglottic stenosis. Both children can now tolerate oral diet and their speech and language development is in line with their overall developmental level., Conclusions: Laryngotracheal separation is an effective and reliable definitive treatment for intractable aspiration facilitating protection of the airway and allowing safe swallowing with unimpeded respiration, but with the major drawback of loss of phonation. To our knowledge, we document the first two cases of successful LTS reversal in children., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The objectives of this study were to discuss the clinical magnifications and therapies of tracheobronchial foreign body aspiration (FBA) in children causing life-threatening complications., Method: We retrospectively reviewed 38 cases of FBA with serious complications in children out of 749 cases of FBA in children that had been admitted to and treated in the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China, from June 1990 to December 2007. The complications included pneumothorax (14 cases); pneumomediastinum (6 cases); pulmonary abscess (7 cases); massive hemorrhage, tracheoesophageal fistula and exudative pleurisy, in 3 cases, respectively; and heart failure (2 cases). Each child's symptoms, including duration, physical findings, chest radiographs, including CT, and the nature of the foreign body causing the complications due to FBA were recorded., Results: Among the 38 cases of FBA, the FBs in 36 cases were removed by bronchoscopy, and in 2 cases the FBs were removed via thoracotomy. Except for 1 case that resulted in death, the other 37 children were completely cured and discharged to home from the hospital., Conclusions: For children with FBA who experience severe and life-threatening complications from FBA, our recommendation is that emergency measures should be available during FBs removal. With correct judgment and management of the complications of FBA, the mortality rate can be reduced.

Objective: To evaluate the outcome of surgical saliva reduction to decrease pulmonary aspiration in children with cerebral palsy and its repercussions in respiratory infection control., Methods: Twenty-nine children with neurological impairment and diagnosis of chronic pulmonary aspiration were submitted to bilateral submandibular gland excision and bilateral parotid duct ligation at the Association for the Welfare of Physically Handicapped Children, from December 2001 to December 2004. Postoperative frequency of lower respiratory tract infection, hospitalization rate due to pulmonary infection and airway secretion level after the surgery were compared to preoperative period., Results: Twenty-nine children with cerebral palsy aged 18 months to 9 years were submitted to submandibular glands excision and parotid ducts ligation. All children had gastrostomy and no oral intake. There were no major complications; two children had reopening of one parotid duct. Frequency of lower respiratory tract infections, rate of hospitalization for treatment of pulmonary infections and level of airway secretion were statistically reduced. Preoperative mean rate of lower respiratory tract infection was 6.9/year; in postoperative period, rate was 2.4/year (p<0.001). Pneumonia hospitalization mean rate was 63.4 days/year preoperatively and 17.5 days/year postoperatively (p<0.001). There was also a significant improvement in the need for suctioning of upper airway secretion (mean 11 times/day in preoperative period and 3.1 times/day in the postoperative period; p<0.001)., Conclusion: In children with cerebral palsy, surgical saliva reduction by submandibular glands excision and parotid ducts ligation is an effective and safe technique for frequency reduction of lower respiratory tract infection and level of airway secretion.

Objective: Foreign body aspiration (FBA) is a serious problem in children. While bronchoscopy should be performed in all patients with aspiration; patients without aspiration should be carefully excluded to avoid an unnecessary bronchoscopy. In this study we analyzed the details of our series, complication rates and compared the diagnostic findings between patients with an aspirated FB and those without. We also calculated the sensitivities, specificities, positive predictive values and negative predictive values of clinical history, symptoms, physical examination findings and radiological findings in patients with suspected FBA (sFBA). Finally, we evaluated the validity of our bronchoscopy indications in these patients., Methods: We reviewed the data of 207 patients who underwent rigid bronchoscopy for sFBA. We used clinical history, symptoms, physical examination and radiological findings as diagnostic findings. Complication rates in addition to these four diagnostic criteria constitute our indications for performing a rigid bronchoscopy., Results: After excluding 15 patients with radiopaque FB or previous fiberoptic bronchoscopy, 138 of 192 patients had an aspirated foreign body. The sensitivity and specificity of clinical history, symptoms, physical examination findings and radiological findings were 90.5% and 24.1%, 97.8% and 7.4%, 96.4% and 46.3, and 71.7% and 74.1% respectively. There was only one major complication which caused moderate neurological sequelae. There was no mortality and no thoracotomy or tracheotomy requirement in this group., Conclusions: While symptoms, physical examination findings and clinical history had high sensitivities, radiological findings had the highest specificity. Low specificities of clinical history, symptoms and physical examination findings were due to our expanded bronchoscopy indication, which aimed to include all patients with foreign body aspiration. Our low complication rate facilitated the expansion of bronchoscopy indications, even for patients with slight clinical suspicion.

A developmentally delayed 11-year-old male developed extensive spontaneous subcutaneous emphysema 6 weeks after a laryngotracheal separation. Computed tomography demonstrated a small amount of air at the distal end of the laryngeal stump and significant esophageal air. Aerophagia was diagnosed with air presumed diverted through the laryngeal stump due to cricopharyngeal hypertension. Cricopharyngeal botulinum toxin injection was coordinated with a minimal neck dissection to drain the subcutaneous emphysema. The subcutaneous emphysema gradually improved and the patient was discharged home. His subcutaneous emphysema has not returned after four total botulinum toxin injections every 3 months.

Objective: To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children., Methods: A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999., Results: A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program., Conclusions: The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.

Background: Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay., Objectives: To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis., Methods: We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed., Results: During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis., Conclusions: Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.

Objective: To review the demographics, pathophysiology and management of aspiration of sharp, metallic foreign bodies; to review prevention strategies., Design: Case series and review of the related literature (1932-2006)., Setting: Tertiary care pediatric hospital., Patients: All patients presenting to BC Children's Hospital with aspiration of sharp, metallic foreign bodies since 1998., Results: The seven patients ranged in age from 11 to 15 years (mean 13 years). The two boys had been playing with other boys at the time of aspiration. One aspirated a thumbtack and one aspirated a homemade blowdart (which traveled from his carina to his subglottis with coughing). Three of the five girls had been holding thumbtacks or a darting pin between their lips while putting up posters or sewing. The other two girls, who aspirated thumbtacks, refused to provide a history. One was treated successfully 6 days after the aspiration. The other girl withheld the history for over a year, presented with hemoptysis and eventually required thoractomy and right main bronchotomy to remove the tack. All of the other patients were diagnosed and successfully treated by rigid bronchoscopy within 24h. (Two patients initially had a failed attempt at foreign body removal by flexible bronchoscopy at another hospital.) This is the second largest series of aspiration of sharp, metallic foreign bodies since at least 1966. Adolescents are still aspirating sharp, metallic foreign bodies because of the same behaviors described by Jackson and Jackson in 1932. Education about choking hazards is needed for this age group., Conclusions: Aspiration of a sharp, metallic foreign body is a serious injury which is best treated by rigid bronchoscopy. These injuries potentially could be prevented through education.

Introduction: Chronic aspiration in the neurologically impaired child has a considerable morbidity and occasional morbidity. Hospitalization, physician visits and health costs associated with the sequelae of aspiration are considerable., Aim: To assess the efficacy of salivary gland surgery to treat chronic aspiration in children., Setting: Tertiary pediatric center., Study Design: A 6 year retrospective chart review of all patients undergoing salivary gland surgery to treat chronic aspiration., Outcome Parameters: (1) Rate of lower respiratory tract infection (LRTI); (2) baseline oxygen saturation pre- and post-surgery., Results: Sixty-two patients aged 7-279 months (mean 68 months) underwent four duct ligation or bilateral submandibular gland excision with unilateral or bilateral parotid duct ligation. The mean rate was 1.2/year pre-operatively and 0.7/year post-operatively (p=0.6). There was, however, a significant improvement in the baseline post-operative oxygen saturation (mean 94.3%) when compared to the pre-operative baseline oxygen saturation (mean 92.8%, p=0.003). Analysis of the cerebral palsy subgroup was performed (n=13). In this group there was no difference between mean pre- and post-operative LRTI rate (p=0.5) nor change in baseline oxygen saturation (p=0.83). Children under 3 years of age showed a reduction in the LRTI rate (mean of 2.1 versus 0.7 episodes per year, p=0.04) and an improvement in the post-operative baseline oxygen saturation (p=0.001) following surgery., Conclusions: Unlike a previous publication from this institution, when evaluating the population sample as a whole, there was no significant improvement in the rate of LRTI following salivary gland surgery, however, there was an improvement in baseline oxygen saturation, possibly reflecting an improvement in lung function. There was an improvement in neither outcome parameter in children with cerebral palsy and improvements in both outcome measures in children under the age of 3.