Flashcards in Pediatrics Deck (37):
What is the sequence of sinus development
Maxillary - birth
Ethmoid - birth
Sphenoid - 5yo
Frontal - 10yo
What drains into the osteomeatal complex?
What three structures bound the osteomeatal complex, and therefore can occlude it via mucosal hypertrophy or anatomic enlargement
At which age does the pinna reach almost full adult size?
4-5 yo, full at 9
What allows establishment of a nasopharyngeal airway in infants?
The more superior cervical postition of the larynx and overlap of the epiglottis and velum (palate)
At what level is the pediatric larynx located at rest and with swallowing?
Peds: at rest - 3rd-4th vertebrae, swallowing - 1st-2nd
Chonal atresia is a potential manifestation of which syndrome, whose presence may make other intervention necessary prior to repair of atresia?
Coloboma, Heart defects, Atresia of the choanae, Retardation, Genital abnormalities, Ear abnormalities
What should be ruled out in the setting of pyriform aperature stenosis?
Holoprosencephaly (central mega-incisor syndrome): get CNS imaging
What are the three main types of congenital nasal masses that typically present with s/s nasal obstruction?
Location of lymphatic vascular malformations often defines if the lesion is macrocystic or microcystic. Where are each more commonly found?
Macrocystic: Infrahyoid and extrinsic to the laryngotracheal airway
Microcystic: Suprahyoid and involved with the laryngotracheal airway
What study is important in a child with bilateral VF paralysis?
MRI to r/o posterior fossa abnormalities
What is the major source of saliva production at rest? During mealtime?
Rest: submandibular gland
Meals: parotid gland
During normal nasal development (weeks 4-12), what provides communication between the prenasal space and the anterior neuropore?
What are the two thickenings of the frontonasal prominence which burrow to form nasal pits, flanked by the medial and lateral nasal prominences
What is the name of the primitive oral cavity
What is the mandibular arch subdivided into?
Mandibular and maxillary processes
Oral-nasal patterning of the palate and oral cavity/tongue devlopment is under the control of what gene?
Sonic hedgehog (Shh)
What 4 regions fuse to form the tongue?
Lateral lingual swellings: 1st arch, oral tongue, ant 2/3
Midline lingual swelling: 1st arch, oral tongue, ant 2/3
Hypobranchial eminence: 2nd-4th arch, oropharyngeal, post 1/3
What is the V shaped sulcus that seperates the anterior 2/3 from the posterior 1/3 of the tongue? What lies at the center?
Foramen cecum (origin of the mesodermally derived thyroid)
What is a mass of normal tissue in an abnormal location that is classified based on the predominant epithelial lining?
Where do most oral choristomas occur?
Near the ventral reflection of the tongue onto the FOM
What is the mechanism by which vallecular cysts cause stridor and respiratory distress?
Mass forces the epiglottis into the laryngeal inlet
Is congenital or acquired subglottic stenosis more common?
Congential is 1/10 as common as aquired SGS
What is the initial therapy for subglottic hemangiomas?
Propranolol (others include steroid injection, systemic steroids, laser ablation, and open resection with LTR)
Laryngeal cleft can occur in isolation, or in association with one of the following syndromes (3)
Pallister-Hall: hypothalamic hamartoma, polydactyly, bifid epiglottis
Opitz-G: midline abnormalities- optic hypertelorism, LTE defects, and hypopspadias
Classification system for laryngeal clefts
Benjamin Ingles Classification
Type I: deep interarytenoid notch
Type II: extends into but not through cricoid
Type III: through cricoid into cervical trachea
Type IV: into thoracic trachea/bronchi
What percent of patients with TEF have esophagial atresia?
What is the most common of the 5 types of TEF?
Esophagial atresia with distal TEF
What is the only type of TEF that may remain occult and present with aspiration pneumonias?
What imaging should be performed in the setting of tracheal stenosis?
CTA with 3D recon
What is cyclical cyanosis indicative of?
Complete nasal obstruction--cyanosis that resolves with crying
What is piriform aperature stenosis associated with?
Single upper central incisor
Findings of micrognathia and glossoptosis in a neonate with airway obstruction is pathognomotic for:
What worsens the stridor causes by laryngomalacia
Infants with persistent 'croup' sx should be suspected of having
**physical exam will reveal a cutaneous hemangioma of the H&N in 50% of cases
What is the tx of choice for complete tracheal rings?