Procedure In Young Children Research Articles

Role of Intraoral Scanners in Pediatric Dentistry

Intraoral Scanners (IOS) are devices which are used for capturing direct optical impressions in dentistry. They are handheld devices used to directly create digital impression data of the oral cavity. Light source from the scanner is projected onto the scan objects, such as full dental arches, and then a 3D model processed by the scanning software will be displayed in real-time on a touch screen. Pediatric dental patients requiring dental prostheses is considered the most challenging for dental professionals owing to managing the children’s behavioural problems, gagging reflex, foreign body aspiration, and choking (breathing) concerns. The conventional impression-making procedures in young children are regarded as quite cumbersome and difficult due to several clinical factors in dentistry. Pediatric dentistry is evolving to minimise the disadvantages of traditional techniques by introducing advanced digital intraoral scanners in the field of pediatric dentistry. Thus this paper reviews the application of intraoral scanners in pediatric dentistry.

Caudal Block versus Wound Infiltration for Inguinal Procedures in Young Children: A Randomized Clinical Study.

Inguinal procedures in children are frequent and typically performed in an outpatient setting. We aimed to analyze whether there is a difference in postoperative pain scores and setup time (start of anesthesia management to incision time) when comparing caudal block (CB) with local wound infiltration. We enrolled pediatric outpatients scheduled for inguinal procedures. Patients were randomized to receive either preincision CBs or end-of-procedure local wound infiltration. Postoperative pain scores until 24 hours postoperatively and setup time were analyzed. Fifty-two patients were included in the study. Thirty patients received a CB, and 22 patients received local infiltration (LI). There was no significant difference in postoperative pain scores. Setup time was significantly higher in the CB group: median 22.5 minutes IQR (16-46 minutes) compared with 17 minutes in the LI group IQR (10-35 minutes), p-value of 0.0026. Both CB and LI result in good postoperative pain control after inguinal procedures in pediatric outpatients. Since LI is less time consuming and has lower risks for complications, we recommend this technique for inguinal procedures in pediatric outpatients. Our findings will need to be confirmed in larger cohorts, but we believe the evidence generated with this study has the potential to positively influence patient care, operating room efficiency, and costs.

Clinical interventions for caries management through minimal intervention procedures in young children: an updated evidence-based review.

This review aimed to summarize the preventive, non-restorative and restorative minimal intervention dentistry (MID) interventions for managing dental caries during the primary dentition stage, after selecting the highest quality evidence. A comprehensive literature search for relevant studies was performed in PubMed (MEDLINE), Embase, Cochrane Library and Google Scholar, published between 2007 and 2022. Only clinical randomized controlled trials, clinical guidelines with literature review, systematic reviews and meta-analyses conducted in the primary dentition were included. One hundred fifty-three MID-associated references were found, and 63 of them were considered for the present review. Of these, 24 were clinical randomized controlled trials, 21 were systematic reviews, 3 umbrella reviews and 11 practice guidelines with a literature review. The retrieved evidence was divided into (and discussed) three general caries management strategies: (i) carious lesion diagnosis and individual risk assessment; (ii) preventive measurements and non-cavitated lesions management; and (iii) cavitated lesions management. MID is an attractive alternative management that promotes prevention rather than intervention to achieve a long-lasting oral health in young children through easy and cost-benefit preventive, non-invasive, minimally invasive or conservative invasive restorative measures. This philosophy of management is suitable for treating young children, considered friendlier and less anxiety-provoking than traditional methods.

Modern Digital Pediatric Dentistry with the Advent of Intraoral Sensors, Computer-Aided Design/Computer-Aided Manufacturing, and Three-dimensional Printing Technologies: A Comprehensive Review

The conventional methods of fabrication of the dental prosthesis/appliances in pediatric dental patients pose many challenges such as prolonged and multiple appointments, discrepancy in the accuracy of the fit of prosthesis, and cumbersome dental laboratory procedures. The conventional impression-making procedures in young children are regarded as quite cumbersome and difficult due to several clinical factors in dentistry. In recent years, digital Intra-Oral Sensors (IOS), three-dimensional printing (3D-printing) technology and computer-aided design/computer-aided manufacturing (CAD-CAM) technology have been described in existing literature related to different aspects of pediatric dentistry. The aim of the current study was to review the literature related to recent innovative applications of IOS, CAD-CAM, and 3D-printing technology in modern pediatric dentistry. Pediatric dental procedures involving the modern digital technologies such as IOS, CAD-CAM, and 3D-printing in the applications for the digital impression procedure and the fabrication of various types of dental appliances have the good potential to deliver optimum oral-health care in children. Furthermore, it can help in motivating the children and also in instilling the positive attitude and behavior toward dentistry.

Success Rate of Augmented Trabeculectomy in Primary Congenital Glaucoma.

To evaluate the outcome of trabeculectomy augmented with mitomycin C in primary congenital glaucoma and to document the complications of the procedure in young children. This was a prospective study of children younger than 2 years with primary congenital glaucoma who were treated with primary trabeculectomy with mitomycin C. After surgery, patients were observed for a minimum of 1 year. Trabeculectomy success was defined as an intraocular pressure (IOP) of 21 mm Hg or less without (absolute success) or with (qualified success) topical antiglaucoma medications. Surgical success was assessed at 1, 6, and 12 months after the procedure. Seventy-four eyes of 42 children were included in the current study. The mean age was 11.7 ± 8.5 months. Of the 42 children, 57.2% were male and 42.8% were female. The mean IOP after surgery was significantly lower than the preoperative IOP (P < .0001). Absolute success was observed in 98.6%, 50%, and 27% of eyes at 1, 6, and 12 months, respectively. Qualified success was achieved in 1.4%, 36.5%, and 48.6% of eyes at 1, 6, and 12 months, respectively. Overall success of the procedure was 100% at 1 month but reduced to 86.5% at 6 months and 75.7% at 12 months. In 24.3% of eyes, IOP was not controlled even with adjunctive topical glaucoma medications and was considered a failure. Postoperative complications were shallow anterior chamber (10.8%), collapsed anterior chamber (1.3%), and choroidal detachment (12.0%). Complications were managed conservatively, and 6 eyes needed surgical intervention. Augmented trabeculectomy is a useful primary procedure in children with primary congenital glaucoma. Topical glaucoma medications supplement the success of the procedure. [J Pediatr Ophthalmol Strabismus. 2022;59(3):180-186.].

Performance and safety of the induced sputum procedure in young children in Malawi: a prospective study.

BackgroundCollecting sputum specimens is a challenge in infants and young children. We assessed the performance and safety of induced sputum (IS) collection in this population, embedded in a prospective study evaluating respiratory cryptosporidiosis in Malawian children with diarrheal disease.MethodsWe assessed the sputum quality and correlation with detection of Cryptosporidium spp. and evaluated safety and adverse events in 162 children.ResultsAmong 159 stool specimens tested, 34 (21%, 95% CI 15.0 to 28%) were positive for Cryptosporidium spp. There were 160 IS and 161 nasopharyngeal (NP) specimens collected. IS and NP specimen collection was performed for each patient. The majority of IS specimens (122/147; 83%) were clear in appearance and 132/147 (90%) were of good quality. Among the respiratory specimens tested, 10 (6.3%, 95% CI 2.5 to 10%) IS and 4 (3%, 95% CI 0 to 5%) NP were positive for Cryptosporidium spp. When stool cryptosporidium PCR was the gold standard, IS PCR sensitivity was higher (29%, 95% CI 22 to 37%) compared with NP PCR (12%, 95% CI 7 to 17%) for detection of Cryptosporidium spp. One (0.4%) adverse event occurred, consisting of a drop in oxygen saturations at the 30-min postprocedure evaluation. Consciousness level, median respiratory rate and oxygen saturations were unchanged, before or after IS.ConclusionsIS provides good quality specimens, is more sensitive than NP specimens for diagnosis of respiratory cryptosporidiosis, and collection can be performed safely in children hospitalized with diarrheal disease.

Are Mechanical Prostheses Valid Alternatives to the Ross Procedure in Young Children Under 6 Years Old?

Aortic valve replacement in young children is associated with technical difficulties and potential morbidity. In contrast to the versatile Ross operation, mechanical prostheses (MP) are uncommonly used. We examined transplant-free survival and cardiac reoperation among 124 young children (aged 1-6 years) who underwent the Ross operation (n= 84) or MP (n= 40) for congenital disease (1982-2003) using the Pediatric Cardiac Care Consortium database. We explored variables influencing outcomes. Children who received MP were operated in an earlier era and were more likely to have aortic regurgitation, conotruncal abnormalities, prior aortic valve surgery, and to need Konno annular enlargement. Although no significant differences were found in hospital mortality (1.2% vs 5.0%, P= .24) or 15-year transplant-free survival (94.1% vs 87.5%, P= .16) between Ross and MP recipients, survival diverged with later follow-up (91.3% vs 68.9%, respectively, at 25 years; P= .01). On multivariable regression analysis the association of MP use and transplant-free survival changed over time (hazard ratios, 0.8 [95% confidence interval, 0.1-4.4; P= .78] vs 6.0 [95% confidence interval, 0.6-63.1; P= .13], respectively) before and after 17 years. Cumulative incidence of cardiac reoperation at 10 years was 37.7% and 53.6% after the Ross procedure and MP, respectively (P= .05). The most common reoperation after the Ross procedure was conduit replacement and pacemaker ± automated internal cardiac defibrillator and after MP was pacemaker ± automated internal cardiac defibrillator and redo aortic valve replacement. Over the study period there was a trend for increased Ross utilization. Interestingly MP use was associated with comparable operative mortality and survival up to 17 years, albeit with higher need for redo aortic valve replacement. On longer follow-up survival diverged with increased attrition in the MP group, likely because of late valve- and reoperation-related complications.

Recurrence of pectus excavatum in long-term follow-up after the Nuss procedure in young children based on the radiographic Haller index

Background/PurposeTo show the changes of the thorax after bar removal in young children with pectus excavatum in long-term postoperative follow-up. MethodsA total of 173 patients who underwent Nuss procedure under the age of 10 years from January 2005 to December 2013 and underwent bar removal were retrospectively reviewed. Then, Patients who were followed-up for more than 5 years after bar removal were selected and assessed. All patients were evaluated with the Haller index (HI) by chest computed tomography before the Nuss procedure. Follow-up after bar removal was done by two-view radiography. Radiographic HI (rHI) change was evaluated from before bar removal, to immediately after bar removal, and 3 years and 5 years after bar removal. ResultsForty-two patients (35 boys, 7 girls) were followed-up for more than 5 years after bar removal. The average age at the Nuss procedure was 6.1 ± 1.3 years, and the average HI was 5.07 ± 1.54. The average age at bar removal was 8.5 ± 1.2 years. The average rHI was 2.47 ± 0.33 before bar removal, 2.75 ± 0.50 immediately after bar removal, 3.24 ± 0.64 at 3 years after bar removal, and 3.46 ± 0.91 at 5 years after bar removal. The rHI value increased significantly between all periods. ConclusionsThe Nuss procedure for young children may have the risk of recurrence during growth after bar removal. Level of EvidenceLevel IV.

Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial

AimThe aim of this study was to examine the effect of a water-friendly Projector-Based Hybrid Virtual Reality (VR) dome environment combined with standard pharmacological treatment on pain in young children undergoing burn wound care in hydrotherapy. MethodsThis study was a prospective, within-subject crossover trial of 38 children aged 6 months to 7 years old (mean age=1.8 years old). Each hydrotherapy procedure was divided into two equivalent wound care segments (No hybrid VR during one segment vs. Hybrid VR during the other segment, treatment order was randomized). Pain was measured using the 0–10 FLACC (Face, Legs, Activity, Cry Consolability scale) and the 0–10 NRS-obs (Numerical Rating Scale-obs). ResultsProjector-Based Hybrid VR significantly reduced procedural pain levels measured by the FLACC (p=0.026) and significantly increased patients' comfort levels (p=0.002). Patients' pain levels rated by the nurses using the NRS-obs were non-significant between both groups (p=0.135). No side effects were reported. ConclusionProjector-Based Hybrid VR helped in reducing the pain related to hydrotherapy procedures in young children with burn wound injuries. This is the first study using virtual reality distraction with young children, and our findings are especially important because a large percentage of pediatric burn patients are very young. Additional research and development are recommended. Trial registrationClinicalTrials.gov, NCT02986464, registered on June 12, 2016.

Surgical treatment of inguinal hernia in neonates and infants: Early surgery or elective surgery?

PURPOSE: The surgical technique for inguinal hernia repair is well established. However, the safety of this procedure in young children still remains under debate because of risks of general anesthesia in young children. We assessed the indications for inguinal hernia repair in neonates and infants. PATIENTS AND METHODS: Between 2007 and 2017, laparoscopic hernia repair was performed in 408 patients at our institution. We reviewed the data from their medical records, including their sex, age at surgery, and incidence of asymptomatic patent processus vaginalis (PPV) during the surgery. RESULTS: The incidence of asymptomatic contralateral PPV in the female neonates/infants in whom the original hernia was on the left side was 75% and higher as compared to the frequency in other subpopulations. The incidence of bilateral inguinal hernia repair in female neonates/infants was 68.8% and higher as compared to that in other subpopulations. CONCLUSION: The incidence of an asymptomatic contralateral PPV and of a bilateral inguinal hernia repair was higher in female neonates/infants as compared to the corresponding frequencies in other subpopulations. In some infants of this group, the PPV on the contralateral side could potentially close as the children grew older. Therefore, girls with inguinal hernia under 1 year of age should be treated by elective surgery after they become at least 1 year old.

Lidocaine and phenylephrine versus saline placebo nasal spray for the pain and distress of nasogastric tube insertion in young children and infants: a randomised, double-blind, controlled trial

Nasogastric tube insertion is a common but distressing procedure in young children. We aimed to compare the efficacy of topical local anaesthetic and vasoconstrictor nasal spray with placebo for distress related to nasogastric tube insertion. We did a prospective, randomised, controlled, double-blind, superiority trial in a single tertiary paediatric emergency department in Australia. Eligible participants were children aged 6 months to 5 years who were planned to have a nasogastric tube inserted as part of their emergency department treatment. Patients were assigned using computer-generated block randomisation to receive lidocaine and phenylephrine nasal spray (10 mg lidocaine and 1 mg phenylephrine for children weighing 6-12 kg; 20 mg lidocaine and 2 mg phenylephrine for children weighing >12 kg), or 0·9% sodium chloride placebo nasal spray, before nasogastric insertion. Guardians, observers, and proceduralists were all masked to the intervention. The primary outcome was procedure-related distress, measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale during the final attempt at nasogastric tube insertion. All patients were included in the primary analysis (intention-to-treat). FLACC scores were compared using the Wilcoxon rank-sum test, and categorical outcomes were compared using χ2 or Fisher's exact tests as appropriate. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000092695. Between July 30, 2014, and Aug 17, 2017, 107 children in a convenience sample were randomly assigned to receive lidocaine and phenylephrine nasal spray (n=54) or placebo (n=53). Seven children did not receive study medication (six no longer required nasogastric tube insertion and one withdrew consent). 50 children received each intervention; all were included in the analysis. There was no difference in median FLACC score at time of nasogastric tube insertion (9 [IQR 7-10] for lidocaine and phenylephrine vs 9 [IQR 8-10] for placebo; median difference between groups -1, 95% CI -2·7 to 0·7, p=0·21). Adverse effects of the spray or nasogastric tube insertion (most commonly vomiting and gagging) occurred in 14 (28%) of those who received lidocaine and phenylephrine and 21 (42%) of those who received placebo. Lidocaine and phenylephrine nasal spray does not reduce procedure-related distress associated with nasogastric tube insertion in young children compared with placebo. Further research addressing distress associated with nasogastric tube insertion in young children is needed. Monash Health Senior Medical Staff Association, Australasian College for Emergency Medicine, Emergency Medicine Research Foundation.

Incidence of tolerance in children undergoing repeated administration of propofol for proton radiation therapy: a retrospective study

BackgroundPropofol is an excellent hypnotic drug for use in repeated radiation procedures in young children. To date, tolerance to propofol generally does not develop in pediatric patients undergoing radiation therapy. However, several studies have suggested that there may be potential for development of tolerance to propofol. The aim of this study was to evaluate the development of a tolerance to propofol used for repeated deep sedation in children undergoing proton radiation therapy (PRT).MethodsAll children undergoing PRT at our institution between December 2015 and January 2018 were eligible for inclusion in this study. Sedation was induced by a bolus dose of propofol (2.0 mg.kg− 1) followed by a continuous infusion of 250 μg.kg− 1.min− 1 via an infusion pump to achieve deep sedation. Sedation was maintained with the propofol infusion of 200 μg.kg− 1.min− 1, which was adjusted in 25 μg.kg− 1.min− 1 increments up or down as necessary to ensure deep sedation. The primary outcome was mean doses of propofol over time.ResultsFifty-eight children were analyzed. The mean (SD) age was 4.5 (2.1) years. The mean (SD) number of treatment sessions was 19 (7). Fifteen patients (26%) developed tolerance to propofol. However, there were no significant differences between the children who developed tolerance and the children who did not develop tolerance in mean propofol dose and awakening time over time (p = 0.887 and P = 0.652, respectively). Age, the number of PRT, and attending anesthesiologists was not significantly associated with the incidence of tolerance to propofol.ConclusionRepeated prolonged deep sedation for PRT elicited multiple times over several weeks in young children using propofol did not develop tolerance in 74% of patients. Although the incidence of 26% tolerance to propofol may still be present, the increase in propofol dose was minimal. Therefore, the use of repeated propofol for children was safe.

Can laparoscopy be part of a paediatric surgery outreach service?

INTRODUCTION The aim of this study was to assess the outreach laparoscopic service delivered by four paediatric surgeons to a district general hospital (DGH). METHODS A retrospective review was carried out of all laparoscopic procedures performed in a single DGH between January 2004 and November 2014 by the four paediatric surgeons providing the outreach service. All operations were identified from the electronic theatre system and archived correspondence. Demographic and clinical details were obtained from contemporaneous records. RESULTS Over the 11-year study period, 1,339 operations were performed as part of the outreach paediatric surgery service, with 128 patients (9.6%) undergoing laparoscopy. The indications for laparoscopic surgery were impalpable unilateral or bilateral undescended testes (UDT) (n=79, 62%) or request for insertion of a feeding gastrostomy (n=49, 38%). All but six UDT cases (96%) were performed as day surgery and the median length of stay for gastrostomy patients was 3 days (interquartile range: 2-3 days). There were three UDT cases with surgical complications and one had complications related to the anaesthesia. One gastrostomy case required transfer to our tertiary centre for management of postoperative urinary retention and urethral injury. CONCLUSIONS Elective laparoscopic procedures in young children can be provided safely as components of an outreach paediatric surgery service in a DGH setting as part of an increasing volume of operations performed by specialist paediatric surgeons. This enables children to have a high quality service as close to their home as possible.

A Hearing Screening Program for Children in Primary Schools in Tajikistan: A Telemedicine Model.

BackgroundAccording to the guidelines of the European Scientific Consensus on Hearing (European Federation of Audiology Societies ‘EFAS’ Congress, June 2011, Warsaw, Poland), the detection and treatment of communication disorders in early school-age children is of the highest importance. This objective was adopted by the Polish president of the EFAS Council from the second half of 2011; as a result, pilot programs on children’s hearing screening were initiated in various European countries. This paper reports data from a pilot program in Dushanbe, Tajikistan.Material/MethodsWe randomly selected 143 children from 2 primary schools. Each child was assessed by pure tone audiometry and 2 questionnaires (dedicated to parents and children). The study allowed the validation of: (i) hearing screening procedures in young children, and (ii) data collection via a telemedicine model.ResultsHearing impairments were identified in 34 cases (23.7%) with a 50% ratio between unilateral and bilateral losses. We found a higher incidence of hearing impairment in children than that reported in previous Polish studies.ConclusionsThe data from the present study suggest that it is possible to use a telemedicine model to assess the hearing status of children and to provide a long-distance expert assistance. The latter is very important for rural areas without specialized medical services.

Technical refinement of Stenström otoplasty procedure

Surgical correction of prominent ears is a common aesthetic procedure in young children. Stenström technique is widely performed in France. We present some technical refinements that may be associated to this technique in order to allow for a simple correction of the majority of deformations. The first step of the Stenström technique is the treatment of the unfolded antihelix if necessary. Our first modification consists in introducing the rasp by an anterior approach, hidden under the upper plication of the helix, allowing for a better control. A second modification consists in a resection of the concha by a posterior approach in case of conchal hypertrophy. A third modification is the burying of the concha by suture to the mastoid periosteum after posterior auricular muscle resection in case of obtuse conchoscaphal angle. These refinements can be performed either separately or in combination according to the deformities to be corrected. The technical refinements presented may correct almost all the ear deformities. The suture-less technique allows for a natural aspect of the antihelix plication.

The knowledge of pregnant women regarding appropriate oral hygiene practices of young children – a questionnaire survey

Abstract Maintaining appropriate oral cavity hygiene in a young child is closely related to the health awareness and health-promoting behaviours of their parents/guardians, and especially that of the child’s mother. The aim of the study was to evaluate the knowledge of pregnant women regarding best practice oral hygiene procedures in young children. The survey involved 327 pregnant women aged 16-49 years, and the tool utilized was an anonymous questionnaire survey. The questionnaire included seven one-choice questions concerning basic information on proper oral hygiene procedures as should be practiced by young children. The statistical analysis was performed using Statistica PROGRAM 10 (StatSoft). The results of the survey reveal 60.55% of all surveyed had correct knowledge with regard to appropriate cleaning practices for the toothless oral cavity of an infant, that concerning the beginning of tooth brushing - 70.03%, tooth cleaning after night feeding - 39.76%, the duration of tooth brushing (at least 3-4 minutes) - 43.12%. What is more, the result of the survey demonstrate that slightly more than a half of the surveyed mothers (53.82%) would encourage their children to brush their teeth on their own from the first year of age, while 18.35% believe that children should be assisted in tooth brushing at least to their eighth year of age, and 59.63% would use fluoride toothpaste to brush their child’s teeth before he or she is one year old. Of the participants in this survey, pregnant women with university education, those living in large cities, or who are older, and those who had had previous pregnancies, show greater knowledge regarding suitable oral hygiene practices among young children. Our results reveal that extensive application of modern information technologies can be a means of preventing early childhood caries by facilitating the transmission of knowledge on proper nutrition and oral hygiene practices among young children.

Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years.

Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years.

Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT=computed tomography; EP=electrophysiology; FDA= U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9–e51)

Management of Pediatric Mandible Fractures

Objectives: The use of conservative measures, mandibulomaxillary fixation (MMF), and closed reduction in children with mandible fractures has been advised due to developing dentition. Open reduction and internal fixation (ORIF) of mandible fractures with non-resorbable plates has been the preferred procedure in young children at our institution. This study evaluates the outcomes of ORIF in the management of pediatric mandible fractures. Methods: A six year retrospective chart review of children, ages 18 years and younger, treated at a tertiary pediatric hospital for mandible fractures. Demographics, fracture site, mode of treatment, and complications were evaluated. Results: A total of 303 records of children evaluated for facial fractures were reviewed. Complete records of 62 patients who suffered from a mandible fracture were identified (M = 48, F = 14, mean age = 15 years (range 2-18)). The most common fracture sites were angle (37%) and parasymphyseal (35%). Assault (53%) was the most common cause. Three patients were treated conservatively, and 1 was placed in MMF only. Fifty-eight patients (93.8%) underwent ORIF, 6 of which were placed in MMF concurrently. Average follow-up was 141 days (14-800). Complications included plate removal in 11 patients (18.9%; 6 for extruded hardware), malocclusion in 8 patients (12.9%), and infection in 1 patient. Conclusions: Management of mandibular fractures in the pediatric population can be both challenging and controversial. Many authors advocate the use of MMF whenever possible secondary to the known potential complications of ORIF. This study suggests that conservative management or ORIF of selected displaced fractures, avoiding the need for MMF, has favorable outcomes.

Rib Reconstruction of the Absent Mandibular Condyle in Children

To describe pediatric costochondral graft reconstruction of the absent mandibular condyle and to report the short-term and long-term outcomes and complications associated with performing this procedure in young children. Case series with a retrospective chart review. Pediatric otolaryngology clinic and tertiary children's hospital in a metropolitan area. All children treated for an absent mandibular condyle with a costochondral graft at Children's Hospitals and Clinics of Minnesota were identified from 2002 through 2011, and a retrospective chart review was performed. Ten patients aged 3 to 11 years were identified. The most common diagnosis, in 8 of 10 patients, was oculo-auriculo-vertebral syndrome. Three of the patients had a tracheostomy, of which 1 was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 of 10 patients. Five patients have required no further surgeries to date, with a mean follow-up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case, and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years, whereas resorption occurred after an average of 2.5 years. Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short-term results show particular improvement in function and mandibular alignment. The mean follow-up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population.