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Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) are inflammatory airway diseases that may impinge on ENT practice in one of two ways. Firstly, a child thought previously to be healthy may present to the ENT surgeon with features that are suggestive of one of these conditions. Such a child should be referred for a diagnostic work up to a specialist unit. Secondly, a child known to have one of these conditions may be referred for treatment, either of a known complication, or of an unrelated condition.

due to reactive lymphadenopathy associated with tonsillitis and other common upper-respiratory infections. These are usually self-limiting but may progress to cellulitis, suppuration and abscess formation. Chronic infections are less common but need to be considered if the swelling persists.

The term “developing country” essentially refers to a country with low levels of economic development generally accompanied by poor social and infrastructural development. The United Nations compares countries in terms of the Human Development Index, a relative measure of wealth. This is assessed by: (1) gross domestic product, (2) health (life expectancy at birth) and (3) education (literacy levels).

The tonsils and adenoids are part of the lymphoid tissues that circle the pharynx known as Waldeyer’s ring. This consists of the lymphoid tissue on the base of the tongue (lingual tonsil), two (palatine) tonsils, the adenoids (nasopharyngeal tonsil), and the lymphoid tissue on the posterior pharyngeal wall. (Fig. 14.1) Waldeyer’s ring grows throughout childhood until the age of 11 years and after that decreases spontaneously (Arens et al. 2002).

The defining feature of obstructive sleep apnoea (OSA) is that reduction (hypopnoea) or cessation (apnoea) of oronasal airflow occurs despite continuing thoracic and abdominal respiratory effort (Guilleminault et al. 2005). OSA is at one end of a spectrum of disorders ranging from mild and innocuous snoring to multiple sequential episodes of prolonged nocturnal apnoea. Both adults and children are affected.

Clefts of the lip and palate occur as a result of the failure of fusion of the maxillary and frontonasal processes during embryonic development. At around 5 weeks of gestation, the palate anterior to the incisive foramen fuses progressively through the anterior hard palate, alveolus and lip. The failure of this fusion process produces a cleft lip, which can be either unilateral or bilateral. At about 7 weeks of gestation, a fusion process moves caudally from the incisive foramen through the hard palate and the soft palate to the tip of the uvula. Failure of this fusion process produces a cleft palate. The part of the palate anterior to the incisive foramen that fuses first is often referred to as the primary palate for that reason, but occurs as part of a cleft lip, not a cleft palate. A midline cleft of the upper lip is a very unusual anomaly and is often associated with other midline developmental problems such as absence of the corpus callosum and holoprosencephaly (failure of the hemispheres to divide).

The salivary glands include:

1. The parotid glands.

2. The submandibular salivary glands.

3. The sublingual glands.

4. The minor salivary glands distributed throughout the oral and pharyngeal mucosa.

While all babies dribble until their oral and swallowing reflexes mature, it is not normal in the older child, who has usually gained control by the age of 4 years or so. Persistent and uncontrollable dribbling or drooling is socially unacceptable even in children, and is a source of embarrassment to the parents. It may lead to ostracism and social isolation, and as children get older and develop insight, they too will become distressed by it.

An understanding of human developmental anatomy is important in appreciating the congenital abnormalities that can occur within the head and neck region in children. Although some cysts, sinuses and fistulae are immediately apparent at presentation, others are not, and children may be examined on several occasions before a diagnosis is made. Appropriate medical and surgical treatment at an early stage will help to avoid recurrence. This chapter will outline the underlying developmental anatomy, and discuss the presentation, investigation and treatment of the lesions most commonly encountered by paediatric otolaryngologists and head and neck surgeons.

Recent advances in airway endoscopy have made it an essential tool in the management of several pathologies of the pharyngolarynx, oesophagus and trachea. It can be performed using a flexible fibroscope or a rigid endoscope, and may require back-up examinations – notably by x-ray.