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Clinical Pearls Eric D. Baum, MD Connecticut Pediatric Otolaryngology Madison · North Haven · Shelton · Yale-New Haven Children’s Hospital.

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Presentation on theme: "Clinical Pearls Eric D. Baum, MD Connecticut Pediatric Otolaryngology Madison · North Haven · Shelton · Yale-New Haven Children’s Hospital."— Presentation transcript:

1 Clinical Pearls Eric D. Baum, MD Connecticut Pediatric Otolaryngology Madison · North Haven · Shelton · Yale-New Haven Children’s Hospital

2 Nasal Dermoid Sinus Cyst Most common congenital midline nasal lesion Most common congenital midline nasal lesion –Also consider glioma or encephalocele Look for other anomaliesLook for other anomalies –Other midline defects –Other head and neck defects Must be evaluated for intracranial extensionMust be evaluated for intracranial extension Quach KA, Horner KL, et al. Arch Pediatr Adolesc Med, 2010.

3 Diagnosis Midline cyst or mass anywhere from glabella to root of columellaMidline cyst or mass anywhere from glabella to root of columella Often will have a pitOften will have a pit –which might drain sebaceous stuff –if there’s hair in the pit, pathognomonic Re M, Tarchini P et al. Int J Ped ORL, 2012.

4 Embryology and Workup Cambiaghi S, Micheli S, et al. Ped Dermatol, 2007.

5 Must Completely Excise Many surgical approachesMany surgical approaches –Direct excision with vertical incision –Open rhinoplasty Intracranial excision may be requiredIntracranial excision may be required –Classic: bicoronal craniotomy –Many smaller craniotomies possible Locke R, Kubba H, Int J Ped ORL, Goyal P, GellmanRM, Arch Facial Plastic Surg, 2007.

6 Timing of Nasal Fracture Evaluation Too soon: edema often obscures examinationToo soon: edema often obscures examination Too late: closed reduction no longer possibleToo late: closed reduction no longer possible There is no dataThere is no data

7 Pediatric Nasal Fracture Young children less likely to fractureYoung children less likely to fracture –Not impossible –May be easier to dislocate septum Adolescents mostly like adultsAdolescents mostly like adults –Distal (inferior) portion of nasal bones –Further injury always possible

8 Initial Evaluation Usual overall assessmentUsual overall assessment –Other injuries –Intracranial Physical examPhysical exam –Describe nasal abnormality –Radiologic studies rarely helpful –Must rule out septal hematoma

9 Septal Hematoma - Urgent AO Foundation Website, 2012

10 Septal Hematoma - Exam Soma DB, Homme JH. Int J Ped ORL, 2011.

11 Secondary Evaluation This is where timing is trickyThis is where timing is tricky –Best to call Photographs can be helpfulPhotographs can be helpful –Pre-injury –Immediate (or at least within a few hours) Most isolated nasal fractures amenable to closed reductionMost isolated nasal fractures amenable to closed reduction –Within 1-2 weeks –Not 100% success rate Love RL. N Z Med J, 2010.

12 Auricular Hematoma Same idea as septal hematomaSame idea as septal hematoma Shear forces on lateral auricleShear forces on lateral auricle Teenage boysTeenage boys –Wrestling –Boxing –Martial arts

13 Presentation & Evaluation Rule out other injuriesRule out other injuries –Pressure injury from side can rupture eardrum History is importantHistory is important –“Classic” sports very common –Plenty of repeat business –If not athletic, why? Specific timing importantSpecific timing important –Within a few hours, fluid may thicken and organize –Very early injuries: needle aspiration only –Usually must open the area Greywoode JD, Pribitkin EA, Krein H. Fac Plas Surg, 2010.

14 If It Works, Great Brickman K, Adams DZ, et al. Clin J Sport Med, 2012.

15 Must Keep Fluid From Reaccumulating Kakarala K, Kieff DA, Laryngoscope, Roy S, Smith LP. Am J Otolaryngol, 2010.

16 Delay = Cauliflower Ear

17 Hard to Repair Fujiwara M, Suzuki A, et al. J Plast Recon Aesth Surg, 2011.

18 Cefdinir and Red Stool Mookadam M, Eisenhart A. Ann Emerg Med, 2009.

19 Cefdinir-Associated Red Stool Benign process caused by medication-iron complexBenign process caused by medication-iron complex 10% incidence?10% incidence? Should be heme-negativeShould be heme-negative Do not need to stop or avoid medicationDo not need to stop or avoid medication Graves R, Weaver SP. J Am B Fam Med, 2008.


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