Clinical Pearls

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Clinical Pearls. Eric D. Baum, MD Connecticut Pediatric Otolaryngology. Madison · North Haven · Shelton · Yale-New Haven Children’s Hospital. Nasal Dermoid Sinus Cyst. Most common congenital midline nasal lesion Also consider glioma or encephalocele - PowerPoint PPT Presentation

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Clinical Pearls

Clinical PearlsEric D. Baum, MDConnecticut Pediatric Otolaryngology

Madison North Haven Shelton Yale-New Haven Childrens Hospital 1Nasal Dermoid Sinus Cyst Most common congenital midline nasal lesionAlso consider glioma or encephaloceleLook for other anomaliesOther midline defectsOther head and neck defectsMust be evaluated for intracranial extension

Quach KA, Horner KL, et al. Arch Pediatr Adolesc Med, 2010.DiagnosisMidline cyst or mass anywhere from glabella to root of columellaOften will have a pit which might drain sebaceous stuffif theres hair in the pit, pathognomonic

Re M, Tarchini P et al. Int J Ped ORL, 2012.Embryology and Workup

Cambiaghi S, Micheli S, et al. Ped Dermatol, 2007.

Must Completely ExciseMany surgical approachesDirect excision with vertical incisionOpen rhinoplastyIntracranial excision may be requiredClassic: bicoronal craniotomyMany smaller craniotomies possible

Locke R, Kubba H, Int J Ped ORL, 2011.Goyal P, GellmanRM, Arch Facial Plastic Surg, 2007.

Timing of Nasal Fracture EvaluationToo soon: edema often obscures examinationToo late: closed reduction no longer possibleThere is no data

Pediatric Nasal FractureYoung children less likely to fractureNot impossibleMay be easier to dislocate septumAdolescents mostly like adultsDistal (inferior) portion of nasal bonesFurther injury always possible

Initial EvaluationUsual overall assessmentOther injuriesIntracranialPhysical examDescribe nasal abnormalityRadiologic studies rarely helpfulMust rule out septal hematomaSeptal Hematoma - Urgent

AO Foundation Website, 2012Septal Hematoma - Exam, 2012Soma DB, Homme JH. Int J Ped ORL, 2011.

Secondary EvaluationThis is where timing is trickyBest to callPhotographs can be helpfulPre-injuryImmediate (or at least within a few hours)Most isolated nasal fractures amenable to closed reductionWithin 1-2 weeksNot 100% success rateLove RL. N Z Med J, 2010.

Auricular HematomaSame idea as septal hematomaShear forces on lateral auricleTeenage boysWrestlingBoxingMartial arts

Presentation & EvaluationRule out other injuriesPressure injury from side can rupture eardrumHistory is importantClassic sports very commonPlenty of repeat businessIf not athletic, why?Specific timing importantWithin a few hours, fluid may thicken and organizeVery early injuries: needle aspiration onlyUsually must open the areaGreywoode JD, Pribitkin EA, Krein H. Fac Plas Surg, 2010.If It Works, Great

Brickman K, Adams DZ, et al. Clin J Sport Med, 2012.Must Keep Fluid From ReaccumulatingKakarala K, Kieff DA, Laryngoscope, 2012.Roy S, Smith LP. Am J Otolaryngol, 2010.

Delay = Cauliflower Ear

Hard to Repair

Fujiwara M, Suzuki A, et al. J Plast Recon Aesth Surg, 2011.Cefdinir and Red Stool

Mookadam M, Eisenhart A. Ann Emerg Med, 2009.Cefdinir-Associated Red StoolBenign process caused by medication-iron complex10% incidence?Should be heme-negativeDo not need to stop or avoid medicationGraves R, Weaver SP. J Am B Fam Med, 2008.


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