Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be manag... more Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be managed with conservative and surgical interventions. Mandibular distraction osteogenesis has been used to relieve micrognathia associated with severe airway obstruction. We conducted a retrospective chart review to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis during a 2-year period. Our study group was made up of 16 infants-11 boys and 5 girls, aged 21 to 112 days (mean: 55.9). In addition to demographic data, we compiled data on their baseline characteristics, airway characteristics, pre- and perioperative findings, and postoperative airway outcomes. Although most patients experienced documented improvements in Cormack-Lehane laryngoscopy grades postoperatively, the severity of micrognathia and airway obstruction did not always correlate with the higher grades. As well, the degree of improvement on laryngoscopic findings was not always evide...
International journal of pediatric otorhinolaryngology, 1996
Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high ... more Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.
The Annals of otology, rhinology, and laryngology, 2011
The purpose of this study was to review the clinical presentation, diagnosis, and management of c... more The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children. A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported. Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical...
Current opinion in otolaryngology & head and neck surgery, 2006
Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of... more Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of these midline lesions, nasal dermoids are the most common. This review centers on diagnosis of nasal dermoids, the role of imaging in diagnosis and surgical planning and the various approaches to surgical management of these lesions. Multiplanar, high-resolution thin section magnetic resonance imaging allows for excellent soft tissue detail, particularly when intracranial extension is expected. Open rhinoplasty is favored by many authors for excision of dermoids. Transnasal endoscopic excision of nasal dermoids has been reported but is not recommended for dermoids extending into or beyond the falx cerebri. Imaging of the midface and brain is essential for accurate diagnosis, assessment for any intracranial extension and appropriate surgical planning. Any surgical approach for removal of nasal dermoid cysts should permit adequate access, allow repair of the skull base and cerebrospinal f...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2002
DISCUSSION Musicians who play wind instruments generate extremely high intraoral pressures that o... more DISCUSSION Musicians who play wind instruments generate extremely high intraoral pressures that often exceed 130 mm Hg. 1 The peak pressures with “P” and “B” sounds in normal speech rarely exceed 5 to 10 mm Hg. 1 The inability to maintain an effective seal ...
International journal of pediatric otorhinolaryngology, Jan 25, 1999
Lingual tumors are rare, primarily benign, lesions in the pediatric population. Congenital lesion... more Lingual tumors are rare, primarily benign, lesions in the pediatric population. Congenital lesions, such as hemangiomas, lymphatic malformations, dermoids, hamartomas and thyroglossal ducts cysts, are seen more commonly. Primary, non-congenital lingual neoplasms are less common in children. We present three patients with benign lingual neoplasms. Evaluation, management, pathology and follow-up are discussed.
International journal of pediatric otorhinolaryngology, Jan 5, 1999
Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has ... more Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was bas...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1998
There is some evidence to suggest that the incidence and complications of ACM may be increasing. ... more There is some evidence to suggest that the incidence and complications of ACM may be increasing. However, in the current era of widespread access to health care and broad-spectrum antibiotics, an intratemporal or intracranial complication from acute otitis media may not initially be suspected. The reported case is significant in that the patient was very young, had no underlying disease or immunocompromise, and did not have a known antecedent acute otitis media. With the emergence of resistant streptococcal species and prolonged survival in immunocompromised patients, the relative incidence of complications caused by acute otitis media will probably continue to rise, making it imperative that we raise our index of suspicion for previously rare infectious complications of relatively common diseases.
International journal of pediatric otorhinolaryngology, Jan 14, 1997
In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic... more In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheost...
Page 1. 1996;97;127-128 Pediatrics Randy C. Randel, Donald B. Kearns, Mark P. Nespeca, Colin A. S... more Page 1. 1996;97;127-128 Pediatrics Randy C. Randel, Donald B. Kearns, Mark P. Nespeca, Colin A. Scher and Mark H. Sawyer Virus Vocal Cord Paralysis as a Presentation of Intrauterine Infection With Varicella-Zoster http ...
Congenital cholesteatoma is a rare entity. Bilateral involvement is rarer still. We present the s... more Congenital cholesteatoma is a rare entity. Bilateral involvement is rarer still. We present the sixth case of bilateral congenital cholesteatoma and briefly review the theories regarding the origin of congenital cholesteatoma. The lesion in the left ear was seen on physical examination, however the lesion in the right ear was detected only on a computed tomography (CT) scan, which was obtained to assess the extent of the disease on the left side. Although usually asymptomatic, these cholesteatomas can enlarge and lead to complications. Management of congenital cholesteatoma by various surgical approaches is discussed.
International journal of pediatric otorhinolaryngology, 1987
Congenital anomalies of the tracheobronchial tree must be included in the differential diagnosis ... more Congenital anomalies of the tracheobronchial tree must be included in the differential diagnosis of children with symptoms of respiratory distress. Tracheal agenesis is a rare major congenital anomaly that has been uniformly fatal. Diagnosis requires a high index of suspicion utilizing roentgenographic and endoscopic examinations.
International journal of pediatric otorhinolaryngology, 1988
Laryngeal carcinoma in childhood is rare and most commonly classified as squamous cell carcinoma.... more Laryngeal carcinoma in childhood is rare and most commonly classified as squamous cell carcinoma. Although mucoepidermoid carcinoma of the larynx has been noted in adults, it has not previously been reported in a child. A 13-year-old boy presented to our department with an epiglottic mass which was determined histologically to be mucoepidermoid carcinoma. A total epiglottectomy was performed and one year postoperatively the child is without disease.
Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be manag... more Newborn upper airway obstruction secondary to micrognathia and Pierre Robin sequence can be managed with conservative and surgical interventions. Mandibular distraction osteogenesis has been used to relieve micrognathia associated with severe airway obstruction. We conducted a retrospective chart review to identify patients with Pierre Robin sequence who underwent mandibular distraction osteogenesis during a 2-year period. Our study group was made up of 16 infants-11 boys and 5 girls, aged 21 to 112 days (mean: 55.9). In addition to demographic data, we compiled data on their baseline characteristics, airway characteristics, pre- and perioperative findings, and postoperative airway outcomes. Although most patients experienced documented improvements in Cormack-Lehane laryngoscopy grades postoperatively, the severity of micrognathia and airway obstruction did not always correlate with the higher grades. As well, the degree of improvement on laryngoscopic findings was not always evide...
International journal of pediatric otorhinolaryngology, 1996
Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high ... more Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.
The Annals of otology, rhinology, and laryngology, 2011
The purpose of this study was to review the clinical presentation, diagnosis, and management of c... more The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children. A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported. Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical...
Current opinion in otolaryngology & head and neck surgery, 2006
Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of... more Midline congenital nasal lesions are rare, occurring in one out of every 20,000-40,000 births. Of these midline lesions, nasal dermoids are the most common. This review centers on diagnosis of nasal dermoids, the role of imaging in diagnosis and surgical planning and the various approaches to surgical management of these lesions. Multiplanar, high-resolution thin section magnetic resonance imaging allows for excellent soft tissue detail, particularly when intracranial extension is expected. Open rhinoplasty is favored by many authors for excision of dermoids. Transnasal endoscopic excision of nasal dermoids has been reported but is not recommended for dermoids extending into or beyond the falx cerebri. Imaging of the midface and brain is essential for accurate diagnosis, assessment for any intracranial extension and appropriate surgical planning. Any surgical approach for removal of nasal dermoid cysts should permit adequate access, allow repair of the skull base and cerebrospinal f...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2002
DISCUSSION Musicians who play wind instruments generate extremely high intraoral pressures that o... more DISCUSSION Musicians who play wind instruments generate extremely high intraoral pressures that often exceed 130 mm Hg. 1 The peak pressures with “P” and “B” sounds in normal speech rarely exceed 5 to 10 mm Hg. 1 The inability to maintain an effective seal ...
International journal of pediatric otorhinolaryngology, Jan 25, 1999
Lingual tumors are rare, primarily benign, lesions in the pediatric population. Congenital lesion... more Lingual tumors are rare, primarily benign, lesions in the pediatric population. Congenital lesions, such as hemangiomas, lymphatic malformations, dermoids, hamartomas and thyroglossal ducts cysts, are seen more commonly. Primary, non-congenital lingual neoplasms are less common in children. We present three patients with benign lingual neoplasms. Evaluation, management, pathology and follow-up are discussed.
International journal of pediatric otorhinolaryngology, Jan 5, 1999
Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has ... more Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was bas...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1998
There is some evidence to suggest that the incidence and complications of ACM may be increasing. ... more There is some evidence to suggest that the incidence and complications of ACM may be increasing. However, in the current era of widespread access to health care and broad-spectrum antibiotics, an intratemporal or intracranial complication from acute otitis media may not initially be suspected. The reported case is significant in that the patient was very young, had no underlying disease or immunocompromise, and did not have a known antecedent acute otitis media. With the emergence of resistant streptococcal species and prolonged survival in immunocompromised patients, the relative incidence of complications caused by acute otitis media will probably continue to rise, making it imperative that we raise our index of suspicion for previously rare infectious complications of relatively common diseases.
International journal of pediatric otorhinolaryngology, Jan 14, 1997
In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic... more In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheost...
Page 1. 1996;97;127-128 Pediatrics Randy C. Randel, Donald B. Kearns, Mark P. Nespeca, Colin A. S... more Page 1. 1996;97;127-128 Pediatrics Randy C. Randel, Donald B. Kearns, Mark P. Nespeca, Colin A. Scher and Mark H. Sawyer Virus Vocal Cord Paralysis as a Presentation of Intrauterine Infection With Varicella-Zoster http ...
Congenital cholesteatoma is a rare entity. Bilateral involvement is rarer still. We present the s... more Congenital cholesteatoma is a rare entity. Bilateral involvement is rarer still. We present the sixth case of bilateral congenital cholesteatoma and briefly review the theories regarding the origin of congenital cholesteatoma. The lesion in the left ear was seen on physical examination, however the lesion in the right ear was detected only on a computed tomography (CT) scan, which was obtained to assess the extent of the disease on the left side. Although usually asymptomatic, these cholesteatomas can enlarge and lead to complications. Management of congenital cholesteatoma by various surgical approaches is discussed.
International journal of pediatric otorhinolaryngology, 1987
Congenital anomalies of the tracheobronchial tree must be included in the differential diagnosis ... more Congenital anomalies of the tracheobronchial tree must be included in the differential diagnosis of children with symptoms of respiratory distress. Tracheal agenesis is a rare major congenital anomaly that has been uniformly fatal. Diagnosis requires a high index of suspicion utilizing roentgenographic and endoscopic examinations.
International journal of pediatric otorhinolaryngology, 1988
Laryngeal carcinoma in childhood is rare and most commonly classified as squamous cell carcinoma.... more Laryngeal carcinoma in childhood is rare and most commonly classified as squamous cell carcinoma. Although mucoepidermoid carcinoma of the larynx has been noted in adults, it has not previously been reported in a child. A 13-year-old boy presented to our department with an epiglottic mass which was determined histologically to be mucoepidermoid carcinoma. A total epiglottectomy was performed and one year postoperatively the child is without disease.
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Papers by Donald Kearns