Rise of Subspecialties in Pediatric Otolaryngology Has Changed Practice

There was some debate regarding the timing of removing lesions. Some surgeons have the philosophy of waiting a short while so parents have a better understanding of the severity of the abnormality that needs repair-so they aren’t as shocked by any deformities that may be left after surgery, said Dr. Haddad.

However, Dr. Papsin added that the philosophy at his center is to get them as soon as the kid is stable. Earlier removal can lead to less scarring, he said.

Endoscopic Sinus Surgery

The final topic of discussion was endoscopic sinus surgery and whether there is still much of a role for it. The approach was advocated in the mid 1990s, then interest waned in later years as follow-up showed results that weren’t as good as anticipated. But, there are still problems for which it is a useful procedure.

One example discussed was the case of a 6-year-old boy with a visible polyp in his nostril. An endoscopic approach is good for this, but a CT scan should be performed ahead of time to verify details of the polyp and whether there is obstruction, said Dr. Haddad.

However, the effectiveness of endoscopic surgery verses other approaches still has some uncertainty because the evidence is weak, said Dr. Myer. We don’t have data- its more what you feel, he said. At this point, it’s better for doctors to use the approach they are most comfortable with.

Sometimes an endoscopic approach doesn’t solve the problem and there can be recurrence. A second procedure may require an open approach, and families should be made aware ahead of time that recurrence is a possibility, said Dr. Hartnick.

Panelists agreed that in a case where a child has a periorbital abscess, endoscopy would be the best first approach. If it didn’t solve the problem, then they would switch to an open incision.

©2006 The Triological Society