Background We evaluated impact of radiation, reconstruction and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. Methods Retrospective review identified 145 TEP patients between 2003–2007. Results Ninety-nine patients (68%) had primary and 46 (32%) secondary TEP, with complications occurring in 65% and 61% respectively (p=0.96). Twenty-nine patients (20%) had major complications (18 primary; 11 secondary, p=0.42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow up, 82% primary and 85% secondary used TEP for primary communication (p=0.66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% v 50%, p=0.02). Conclusions Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing.

This represents the largest series to date on endoscopic management of the orbit in benign and malignant sinonasal tumors. A majority of these cases can be managed by a purely endoscopic approach with low complication and recurrence rates, although a subset still require adjunct open approaches for successful tumor extirpation.

Purpose. To describe clinical, radiologic, and histological features of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate. Methods. Chart of a 2-day-old female referred to a tertiary care pediatric hospital for assessment of intraoral mass was reviewed. Results. The child was born at 32 weeks and an intraoral mass was noted. The patient was transferred to tertiary care children's hospital on day 2 of life. The child had increased work of breathing at presentation and required continuous positive airway pressure. Physical examination revealed a pedunculated mass which was protruding into the oropharynx from the nasopharynx. MRI of the lesion documented a discrete bilobed mass which filled the posterior nasopharynx. The mass abutted the uvula and soft palate; however, the mass did not appear to be arising from the soft palate. Intraoperative exam showed a mass arising from the right palatopharyngeus muscle in the superior pole region of the tonsil. Histologic examination showed ectodermal and mesodermal derivatives confirming congenital hairy polyp. At 8-month followup, the surgical site was healed with no evidence of recurrent lesion. Conclusions. Congenital hairy polyp, though uncommon, should be considered in the differential diagnosis of oropharyngeal mass in neonates.

Objectives: The primary aim of the study was to evaluate intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors. Methods: Retrospective chart review and prospective imaging assessment was performed of 215 cases managed at a tertiary care referral center between July 2009 and December 2012. Results: A total of 41 patients met predetermined criteria for inclusion. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign pathologies, respectively. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) most commonly demonstrated lamina papyracea erosion (78.1%), followed by extension into the periorbita (43.9%), lacrimal system (24.4%), orbit (14.6%), and orbital apex (7.3%). Procedures performed to address orbital involvement included endoscopic resection of lamina papyracea (85.3%), dacryocystorhinostomy (DCR) (26.8%), optic nerve decompression (7.3%), and orbital exenteration (4.8%). Ophthalmologic involvement was required in 31.7% of cases; anterior orbitotomy (26.8%) and open DCR (17.1%) were the most common adjunct open procedures. Orbital complications most commonly included epiphora (7.3%) and diplopia (5.1%), with no cases of change in visual acuity or orbital hematoma. CT reliably predicted invasion of the lamina papyracea and lacrimal system ( P < .05), while MRI reliably predicted invasion of the periorbita ( P < .05). Irregular tumor margin along the periorbita on MRI was statistically significant ( P < .05) for ophthalmologic involvement. Conclusions: CT and MR imaging provide complementary information for assessment of tumor extension to the orbit. This typically requires endoscopic and adjunct open approaches for effective tumor extirpation and can be achieved safely with low rate of complications.