Kimsey Rodriguez - Academia.edu (original) (raw)

Papers by Kimsey Rodriguez

The Journal of the Louisiana State Medical Society, Jul 23, 2003

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society, 2003

Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft l... more Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft lip and palate. While its precise etiology is not yet known, it is likely caused by a disruption in the development of the first two branchial arches early in embryologic development. The resulting phenotype is one of varying degrees of unilateral hypoplasia of the mandible, ear deformity, and macrostomia. Early diagnosis of hemifacial microsomia is important not only to plan for surgical reconstruction of affected features, but also to lead the physician in further evaluation for associated abnormalities or disabilities. This article will introduce the reader to the most common variants seen in hemifacial microsomia, discuss the possible etiologies of the anomalies, and will highlight the importance of evaluating these patients early in life for such potentially disabling but correctable problems such as hearing loss, feeding disabilities, and neurological deformities.

JAMA otolaryngology-- head & neck surgery, Jan 15, 2018

The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryn... more The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Pediatric Otolaryngology Committee recommended that children younger than 3 years be admitted following tonsillectomy. Recommendations for hospital observation were not included as a key action statement in the 2011 AAO-HNS Clinical Practice Guidelines for Tonsillectomy in Children. To examine the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery. This was a multicenter case series study with medical record review of 2139 consecutive children ages 3 to 6 years who underwent tonsillectomy at 1 tertiary care academic center and 5 acute care centers in New Orleans, Louisiana, between 2005 and 2015. Children with moderate to severe developmental delay, bleeding disorders, and other major medical comorbidities were excluded. Complications examined included respiratory distress, dehydration ...

Clinical Pediatrics, 2017

Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origi... more Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.

Clinical pediatrics, 2017

A previously healthy 5-week-old female was admitted for sepsis secondary to methicillin-resistant... more A previously healthy 5-week-old female was admitted for sepsis secondary to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. After several days of hospitalization, she experienced acute decompensation in mental status despite having received targeted antibiotic therapy. Imaging revealed left peritonsillar/parapharyngeal space abscess, left venous thrombophlebitis of the internal jugular vein, and septic emboli of the lungs and brain consistent with Lemierre syndrome. Bedside needle aspiration of the parapharyngeal abscess confirmed MRSA involvement. Unfortunately, the patient continued to deteriorate over the next several days and life support was withdrawn on hospital day 16. We present the youngest reported case of Lemierre syndrome and review the literature.

International Journal of Pediatric Otorhinolaryngology, 2017

Objective: To examine the efficacy of polysomnography in determining the severity of laryngomalac... more Objective: To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients. Methods: Prospective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score. Results: 25 pediatric patients (n ¼ 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p ¼ 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p ¼ 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p ¼ 0.81, r ¼ 0.08, CI: À0.5197 to 0.6235). Conclusion: In our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.

The Laryngoscope, Jan 26, 2015

The human cochlea is most commonly considered to have two and a half turns. Although the causes o... more The human cochlea is most commonly considered to have two and a half turns. Although the causes of cochlear hypoplasia are well described, cochlear hyperplasia is a rarer entity that is poorly understood. We describe rare anatomic cochlear malformations identified in a 4-month-old male originally referred for evaluation after a failed newborn hearing screening. The full diagnostic evaluation, imaging findings, treatment, and follow-up are described in detail. Cochleae with three turns are an uncommon malformation that is not included in current classifications schemes and may represent a distinct type of anomaly not caused by developmental arrest. Laryngoscope, 2015.

The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society

Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft l... more Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft lip and palate. While its precise etiology is not yet known, it is likely caused by a disruption in the development of the first two branchial arches early in embryologic development. The resulting phenotype is one of varying degrees of unilateral hypoplasia of the mandible, ear deformity, and macrostomia. Early diagnosis of hemifacial microsomia is important not only to plan for surgical reconstruction of affected features, but also to lead the physician in further evaluation for associated abnormalities or disabilities. This article will introduce the reader to the most common variants seen in hemifacial microsomia, discuss the possible etiologies of the anomalies, and will highlight the importance of evaluating these patients early in life for such potentially disabling but correctable problems such as hearing loss, feeding disabilities, and neurological deformities.

The Ochsner journal, 2014

The Ochsner journal, 2013

The most common lysosomal storage disorder, Gaucher disease, represents a collection of 3 clinica... more The most common lysosomal storage disorder, Gaucher disease, represents a collection of 3 clinical syndromes associated with disrupted glucocerebroside catabolism. Despite the common occurrence of dyspnea in advanced Gaucher, dyspnea is rarely reported as a presenting symptom of the disease. A 10-month-old male was referred to the Otolaryngology Clinic for evaluation of progressive dyspnea. Physical examination was significant for cervical adenopathy, inspiratory stridor, and developmental delay. A complete evaluation for failure to thrive and lymphadenopathy was performed, with subsequent lymph node biopsy and enzyme assay confirming the presence of Gaucher disease. A high level of suspicion is required to make an early diagnosis of Gaucher disease, but it should be considered in patients presenting with failure to thrive, generalized lymphadenopathy, and respiratory or neurologic findings. Initiation of early treatment is paramount for the prevention of irreversible disease.

The Ochsner journal, 2008

To compile information regarding obstructive subglottic lesions in children, including anatomy, p... more To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan. Review of the literature. Although they are infrequent, obstructive subglottic lesions pose significant challenges to treating physicians, from airway management and injury prevention to decannulation and voice rehabilitation. Most patients with these lesions require multidisciplinary care and long-term treatment and can nearly always be treated successfully.

The Annals of otology, rhinology, and laryngology, 2007

Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the i... more Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal...

Objective: To evaluate the presentation, imaging characteristics and treatment outcome of pleomor... more Objective: To evaluate the presentation, imaging characteristics and treatment outcome of pleomorphic adenoma of the parotid in the pediatric population. Design: Retrospective study with institutional review board approval. Setting: Tertiary care pediatric medical center. Methods: An extensive review of medical records with regard to presentation, imaging, histopathology, complication, recurrence and prognosis on patients 18 years or younger presenting from 1983 to 2005. Results: Eleven patients (six females, five males) were identified. The most common presentation was an asymptomatic mass. Preoperative imaging was done on nine patients: MRI (N = 6), CT (N = 3), ultrasound (N = 2), and sialogram (N = 1). Initial treatments included: superficial parotidectomy (N = 5), total parotidectomy (N = 3), excisional biopsy followed by superficial parotidectomy (N = 2), and excisional biopsy (N = 1). There were two recurrences (18%); one presenting 7 months following excisional biopsy who underwent superficial parotidectomy and one occurred 3 years following total parotidectomy requiring revision parotidectomy and radiation. Other complications included: transient facial nerve paresis (N = 5; 45%) and permanent weakness (N = 1; 9%). The patients were followed an average of 18 months.

International journal of pediatric otorhinolaryngology, 2014

Rosai Dorfman disease (RD), also known as sinus histiocytosis with massive lymphadenopathy (SHML)... more Rosai Dorfman disease (RD), also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a benign histiocytic proliferative condition of unsubstantiated etiology that most often presents as bilateral painless cervical lymphadenopathy. Head and neck manifestations of RD are diverse but most commonly present as massive cervical lymphadenopathy. Interestingly, a retropharyngeal fluid collection has never been described as a sequelae of RD. Our objective is to present a novel case of a 9-year old female with RD that suffered from recurrent retropharyngeal phlegmon and to discuss diagnostic and treatment recommendations for this disease process.

The Ochsner journal, 2014

Cystic fibrosis (CF) is an autosomal recessive genetic disease that affects approximately 30,000 ... more Cystic fibrosis (CF) is an autosomal recessive genetic disease that affects approximately 30,000 people in the United States. Mucus in CF patients can be exceptionally viscous, leading to progressive cycles of inflammation and infection. The most widely accepted staging system used to score sinus computed tomography (CT) scans is the Lund-Mackay Score (LMS). To determine if a significant correlation exists between LMS and the need for revision sinus surgery in a patient population with CF, we performed a retrospective review of 32 patients with CF who were referred to the Tulane Otolaryngology Clinic from 2005 to 2011 and received a CT scan of the paranasal sinuses. CT scans were graded in a blinded manner by the institution's neuroradiologist using the LMS system. We found no statistically significant difference in the raw or scaled LMSs between patients receiving revision surgery (n=9) and patients receiving a single surgery (n=23). CT scans are vital for preoperative planning...

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society

Juvenile ossifying fibroma is a rare, benign tumor that may present in the sinonasal area but has... more Juvenile ossifying fibroma is a rare, benign tumor that may present in the sinonasal area but has never been described arising from the middle turbinate. The lesion's locally aggressive behavior and close proximity to orbit and anterior skull base create a significant challenge for the patient and practitioner. This is a case presentation of a 7-year-old female with an invasive recurrent juvenile ossifying fibroma arising from the middle turbinate.

International Journal of Pediatric Otorhinolaryngology, 2014

To identify factors associated with efficient operating room work flow on high volume pediatric o... more To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction. Methods: Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction. Results: 223 cases were performed over 20 operative days. The average turnover time was significantly longer in ''major'' surgeries (p = 0.03), cases with multispecialty involvement (p = 0.01), cases requiring intubation (p < 0.001), and in cases where a fellowship trained pediatric anesthesiologist (p = 0.01) or CRNA was present (p < 0.001). When comparing ''fast'' (<25 min average turnover) operative days vs. ''slow'' (>25 min average turnover) days, presence of a non-fellowship trained anesthesiologist (p < 0.001), and the presence of an anesthesiology resident (p = 0.03) were significantly associated with ''fast'' days, while the presence of a CRNA was associated with ''slow'' days (p < 0.001). A significantly greater proportion of patients required intubation on ''slow'' turnover days vs. ''fast'' days (p = 0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p = 0.047) and on days with turnover times of 25 min or less (p < 0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover. Conclusions: High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.

The Laryngoscope, 2009

To describe partial adenoidectomy using a powered microdebrider and review the experience with th... more To describe partial adenoidectomy using a powered microdebrider and review the experience with the procedure. Study Design: Prospective study and review. Methods: To perform a powerassisted partial adenoidectomy, the surgeon directs the window in the microdebrider blade tip toward the tissue, which is drawn in by suction; the rotating blade then shaves the tissue. Studies have compared this adenoidectomy technique with curette procedures. Results: In a comparative prospective study, we found that operating time and time required for hemostasis were significantly shorter (P ‫؍‬ .001) with power-assisted partial adenoidectomy than with curettage. There was no significant difference between the two procedures in blood loss or complication rate. These results were similar to those of previous studies. Overall, we have performed more than 1000 power-assisted partial adenoidectomies. No longterm complications have occurred, blood loss remains low, and surgeons are satisfied with the technique because of its speed, improved visibility during resection, and precision. Conclusion: We and other authors have found power-assisted partial adenoidectomy to provide a faster, more precise operation than curette techniques, with benefits for both patient and surgeon.

Otolaryngology–Head and Neck Surgery, 2008

Objective Laryngopharyngeal reflux (LPR) is the disorder caused by the regurgitation of gastric c... more Objective Laryngopharyngeal reflux (LPR) is the disorder caused by the regurgitation of gastric contents into the laryngopharynx. Many persons diagnosed with LPR who fail medical therapy regurgitate contents from the proximal esophagus into the laryngopharynx (esophagopharyngeal reflux or EPR) on cinefluoroscopy. Study Design Retrospective review. Subjects and Methods The charts of consecutive adult patients with findings of EPR on cinefluoroscopy were reviewed. Results Twenty patients met the diagnostic criteria for EPR (mean age, 50 years of age; 60% female). Most common symptoms were cough (40%), dysphagia (35%), dysphonia (25%), and chronic throat clearing (25%). Eighty-five percent had a prior diagnosis of acid reflux disease (LPR or GER) and were unsuccessfully treated with proton pump inhibitors and/or anti-reflux surgery; 15% had fluoroscopic oropharyngeal abnormalities; all patients had fluoroscopic esophageal abnormalities. Conclusion EPR is characterized by regurgitation ...

Otolaryngology - Head and Neck Surgery, 2004

Salivary secretions play a critical role in maintaining oral health via innate host defense mecha... more Salivary secretions play a critical role in maintaining oral health via innate host defense mechanisms and secretion of secretory IgA. One of the antimicrobial peptides, LL-37 is the only cathelicidin protein so far identified in human beings. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. The purpose of this study was to examine the expression of cathelicidin in human salivary glands and to investigate up-regulation of cathelicidin in inflammatory conditions. Methods: Reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, 10 from normal and 10 from chronic sialadenitis. Results: Cathelicidin mRNA transcripts were detected in the normal salivary gland and chronic sialadenitis. The level of cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. Conclusion: The results indicate that cathelicidin might play an important role in the innate host defense of human salivary glands. Significance: In the present study, we showed the localizing expression of the human cathelicidin in salivary glands and up-regulation in the inflammatory conditions. This finding suggested the physiologic importance of cathelicidin in the defense of retrograde infection. Other functions for this broadly expressed peptide and possible expression of cathelicidin in saliva need to be evaluated.

The Journal of the Louisiana State Medical Society, Jul 23, 2003

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society, 2003

Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft l... more Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft lip and palate. While its precise etiology is not yet known, it is likely caused by a disruption in the development of the first two branchial arches early in embryologic development. The resulting phenotype is one of varying degrees of unilateral hypoplasia of the mandible, ear deformity, and macrostomia. Early diagnosis of hemifacial microsomia is important not only to plan for surgical reconstruction of affected features, but also to lead the physician in further evaluation for associated abnormalities or disabilities. This article will introduce the reader to the most common variants seen in hemifacial microsomia, discuss the possible etiologies of the anomalies, and will highlight the importance of evaluating these patients early in life for such potentially disabling but correctable problems such as hearing loss, feeding disabilities, and neurological deformities.

JAMA otolaryngology-- head & neck surgery, Jan 15, 2018

The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryn... more The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Pediatric Otolaryngology Committee recommended that children younger than 3 years be admitted following tonsillectomy. Recommendations for hospital observation were not included as a key action statement in the 2011 AAO-HNS Clinical Practice Guidelines for Tonsillectomy in Children. To examine the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery. This was a multicenter case series study with medical record review of 2139 consecutive children ages 3 to 6 years who underwent tonsillectomy at 1 tertiary care academic center and 5 acute care centers in New Orleans, Louisiana, between 2005 and 2015. Children with moderate to severe developmental delay, bleeding disorders, and other major medical comorbidities were excluded. Complications examined included respiratory distress, dehydration ...

Clinical Pediatrics, 2017

Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origi... more Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.

Clinical pediatrics, 2017

A previously healthy 5-week-old female was admitted for sepsis secondary to methicillin-resistant... more A previously healthy 5-week-old female was admitted for sepsis secondary to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. After several days of hospitalization, she experienced acute decompensation in mental status despite having received targeted antibiotic therapy. Imaging revealed left peritonsillar/parapharyngeal space abscess, left venous thrombophlebitis of the internal jugular vein, and septic emboli of the lungs and brain consistent with Lemierre syndrome. Bedside needle aspiration of the parapharyngeal abscess confirmed MRSA involvement. Unfortunately, the patient continued to deteriorate over the next several days and life support was withdrawn on hospital day 16. We present the youngest reported case of Lemierre syndrome and review the literature.

International Journal of Pediatric Otorhinolaryngology, 2017

Objective: To examine the efficacy of polysomnography in determining the severity of laryngomalac... more Objective: To examine the efficacy of polysomnography in determining the severity of laryngomalacia in pediatric patients. Methods: Prospective cohort study. Pediatric patients referred to our pediatric otolaryngology department with a polysomnogram already performed for a presumptive diagnosis of laryngomalacia were enrolled in the study. Patients with concurrent airway lesions or neuromuscular disorders were excluded. Patients underwent history, physical exam, and flexible fiberoptic laryngoscopy. These results were used to calculate a total laryngomalacia severity score. Results: 25 pediatric patients (n ¼ 25) with an average age of 3.9 months at time of initial evaluation met criteria for enrollment in our study. 100% of patients had obstructive sleep apnea by definition. 80% of these patients underwent supraglottoplasty. The average AHI of those who underwent surgery (57.26) was not significantly different in those who underwent surgery vs. those that did not (55.43) (p ¼ 0.41). In comparison, the average laryngomalacia severity score based from history, physical exam and flexible laryngoscopy was significantly greater in the patients that required supraglottoplasty (11.16) vs. those who did not (5.33) (p ¼ 0.03). In addition a higher laryngomalacia severity score was not correlated with a higher AHI (p ¼ 0.81, r ¼ 0.08, CI: À0.5197 to 0.6235). Conclusion: In our cohort, polysomnography was not useful in determining the severity of laryngomalacia, did not correlate with the clinical evaluation, and alone was not predictive of the patients that would require surgical intervention. History, physical exam, and endoscopic findings remain reliable predictors of disease severity and need for operative intervention.

The Laryngoscope, Jan 26, 2015

The human cochlea is most commonly considered to have two and a half turns. Although the causes o... more The human cochlea is most commonly considered to have two and a half turns. Although the causes of cochlear hypoplasia are well described, cochlear hyperplasia is a rarer entity that is poorly understood. We describe rare anatomic cochlear malformations identified in a 4-month-old male originally referred for evaluation after a failed newborn hearing screening. The full diagnostic evaluation, imaging findings, treatment, and follow-up are described in detail. Cochleae with three turns are an uncommon malformation that is not included in current classifications schemes and may represent a distinct type of anomaly not caused by developmental arrest. Laryngoscope, 2015.

The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society

Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft l... more Hemifacial microsomia is the second most common congenital facial anomaly, second only to cleft lip and palate. While its precise etiology is not yet known, it is likely caused by a disruption in the development of the first two branchial arches early in embryologic development. The resulting phenotype is one of varying degrees of unilateral hypoplasia of the mandible, ear deformity, and macrostomia. Early diagnosis of hemifacial microsomia is important not only to plan for surgical reconstruction of affected features, but also to lead the physician in further evaluation for associated abnormalities or disabilities. This article will introduce the reader to the most common variants seen in hemifacial microsomia, discuss the possible etiologies of the anomalies, and will highlight the importance of evaluating these patients early in life for such potentially disabling but correctable problems such as hearing loss, feeding disabilities, and neurological deformities.

The Ochsner journal, 2014

The Ochsner journal, 2013

The most common lysosomal storage disorder, Gaucher disease, represents a collection of 3 clinica... more The most common lysosomal storage disorder, Gaucher disease, represents a collection of 3 clinical syndromes associated with disrupted glucocerebroside catabolism. Despite the common occurrence of dyspnea in advanced Gaucher, dyspnea is rarely reported as a presenting symptom of the disease. A 10-month-old male was referred to the Otolaryngology Clinic for evaluation of progressive dyspnea. Physical examination was significant for cervical adenopathy, inspiratory stridor, and developmental delay. A complete evaluation for failure to thrive and lymphadenopathy was performed, with subsequent lymph node biopsy and enzyme assay confirming the presence of Gaucher disease. A high level of suspicion is required to make an early diagnosis of Gaucher disease, but it should be considered in patients presenting with failure to thrive, generalized lymphadenopathy, and respiratory or neurologic findings. Initiation of early treatment is paramount for the prevention of irreversible disease.

The Ochsner journal, 2008

To compile information regarding obstructive subglottic lesions in children, including anatomy, p... more To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan. Review of the literature. Although they are infrequent, obstructive subglottic lesions pose significant challenges to treating physicians, from airway management and injury prevention to decannulation and voice rehabilitation. Most patients with these lesions require multidisciplinary care and long-term treatment and can nearly always be treated successfully.

The Annals of otology, rhinology, and laryngology, 2007

Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the i... more Fiberoptic endoscopic evaluation of swallowing with sensory testing has been used to assess the integrity of laryngopharyngeal sensory and motor components. The pharyngeal squeeze is a maneuver used during fiberoptic endoscopic evaluation of swallowing with sensory testing to assess pharyngeal motor function. Although the pharyngeal squeeze manuever has been used in numerous scientific publications, its reliability has not been critically evaluated. Therefore, we sought to evaluate the reliability of the pharyngeal squeeze maneuver. Forty individuals who were undergoing fiberoptic laryngoscopy for various reasons were instructed to perform the pharyngeal squeeze maneuver. Three different clinicians reviewed the videotape on 4 separate occasions. The clinicians were first asked to rate each side of the pharynx as normal, diminished, or absent. They were then instructed to simply rate the maneuver as normal or abnormal. The interobserver and intraobserver reliability of the pharyngeal...

Objective: To evaluate the presentation, imaging characteristics and treatment outcome of pleomor... more Objective: To evaluate the presentation, imaging characteristics and treatment outcome of pleomorphic adenoma of the parotid in the pediatric population. Design: Retrospective study with institutional review board approval. Setting: Tertiary care pediatric medical center. Methods: An extensive review of medical records with regard to presentation, imaging, histopathology, complication, recurrence and prognosis on patients 18 years or younger presenting from 1983 to 2005. Results: Eleven patients (six females, five males) were identified. The most common presentation was an asymptomatic mass. Preoperative imaging was done on nine patients: MRI (N = 6), CT (N = 3), ultrasound (N = 2), and sialogram (N = 1). Initial treatments included: superficial parotidectomy (N = 5), total parotidectomy (N = 3), excisional biopsy followed by superficial parotidectomy (N = 2), and excisional biopsy (N = 1). There were two recurrences (18%); one presenting 7 months following excisional biopsy who underwent superficial parotidectomy and one occurred 3 years following total parotidectomy requiring revision parotidectomy and radiation. Other complications included: transient facial nerve paresis (N = 5; 45%) and permanent weakness (N = 1; 9%). The patients were followed an average of 18 months.

International journal of pediatric otorhinolaryngology, 2014

Rosai Dorfman disease (RD), also known as sinus histiocytosis with massive lymphadenopathy (SHML)... more Rosai Dorfman disease (RD), also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a benign histiocytic proliferative condition of unsubstantiated etiology that most often presents as bilateral painless cervical lymphadenopathy. Head and neck manifestations of RD are diverse but most commonly present as massive cervical lymphadenopathy. Interestingly, a retropharyngeal fluid collection has never been described as a sequelae of RD. Our objective is to present a novel case of a 9-year old female with RD that suffered from recurrent retropharyngeal phlegmon and to discuss diagnostic and treatment recommendations for this disease process.

The Ochsner journal, 2014

Cystic fibrosis (CF) is an autosomal recessive genetic disease that affects approximately 30,000 ... more Cystic fibrosis (CF) is an autosomal recessive genetic disease that affects approximately 30,000 people in the United States. Mucus in CF patients can be exceptionally viscous, leading to progressive cycles of inflammation and infection. The most widely accepted staging system used to score sinus computed tomography (CT) scans is the Lund-Mackay Score (LMS). To determine if a significant correlation exists between LMS and the need for revision sinus surgery in a patient population with CF, we performed a retrospective review of 32 patients with CF who were referred to the Tulane Otolaryngology Clinic from 2005 to 2011 and received a CT scan of the paranasal sinuses. CT scans were graded in a blinded manner by the institution's neuroradiologist using the LMS system. We found no statistically significant difference in the raw or scaled LMSs between patients receiving revision surgery (n=9) and patients receiving a single surgery (n=23). CT scans are vital for preoperative planning...

The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society

Juvenile ossifying fibroma is a rare, benign tumor that may present in the sinonasal area but has... more Juvenile ossifying fibroma is a rare, benign tumor that may present in the sinonasal area but has never been described arising from the middle turbinate. The lesion's locally aggressive behavior and close proximity to orbit and anterior skull base create a significant challenge for the patient and practitioner. This is a case presentation of a 7-year-old female with an invasive recurrent juvenile ossifying fibroma arising from the middle turbinate.

International Journal of Pediatric Otorhinolaryngology, 2014

To identify factors associated with efficient operating room work flow on high volume pediatric o... more To identify factors associated with efficient operating room work flow on high volume pediatric otolaryngology days and the effects on provider and perceived parent satisfaction. Methods: Retrospective review was performed of a sample of 20 days with greater than 10 cases per day performed by a pediatric otolaryngologist operating in 2 rooms. Turnover time and complications were the main outcome measures. Providers from otolaryngology and anesthesia that participated in these days were surveyed regarding efficiency, safety, and satisfaction. Results: 223 cases were performed over 20 operative days. The average turnover time was significantly longer in ''major'' surgeries (p = 0.03), cases with multispecialty involvement (p = 0.01), cases requiring intubation (p < 0.001), and in cases where a fellowship trained pediatric anesthesiologist (p = 0.01) or CRNA was present (p < 0.001). When comparing ''fast'' (<25 min average turnover) operative days vs. ''slow'' (>25 min average turnover) days, presence of a non-fellowship trained anesthesiologist (p < 0.001), and the presence of an anesthesiology resident (p = 0.03) were significantly associated with ''fast'' days, while the presence of a CRNA was associated with ''slow'' days (p < 0.001). A significantly greater proportion of patients required intubation on ''slow'' turnover days vs. ''fast'' days (p = 0.13). Only one complication was observed (0.4%). 48 providers were surveyed with a 63% response rate. Reported satisfaction amongst providers was significantly greater on days with at least 10 cases (p = 0.047) and on days with turnover times of 25 min or less (p < 0.001). Pre-operative nursing evaluation/preparation of the patient, inter-provider communication and delays in room cleaning/setup were identified most often as causative factors responsible for delays in turnover. Conclusions: High-operative volume operating days are common in pediatric otolaryngology and can be safely performed in an efficient manner. Appropriate scheduling and high-level communication between providers is needed to ensure success on these days. Identified areas of potential inefficiency can be a starting point for work flow optimization practices.

The Laryngoscope, 2009

To describe partial adenoidectomy using a powered microdebrider and review the experience with th... more To describe partial adenoidectomy using a powered microdebrider and review the experience with the procedure. Study Design: Prospective study and review. Methods: To perform a powerassisted partial adenoidectomy, the surgeon directs the window in the microdebrider blade tip toward the tissue, which is drawn in by suction; the rotating blade then shaves the tissue. Studies have compared this adenoidectomy technique with curette procedures. Results: In a comparative prospective study, we found that operating time and time required for hemostasis were significantly shorter (P ‫؍‬ .001) with power-assisted partial adenoidectomy than with curettage. There was no significant difference between the two procedures in blood loss or complication rate. These results were similar to those of previous studies. Overall, we have performed more than 1000 power-assisted partial adenoidectomies. No longterm complications have occurred, blood loss remains low, and surgeons are satisfied with the technique because of its speed, improved visibility during resection, and precision. Conclusion: We and other authors have found power-assisted partial adenoidectomy to provide a faster, more precise operation than curette techniques, with benefits for both patient and surgeon.

Otolaryngology–Head and Neck Surgery, 2008

Objective Laryngopharyngeal reflux (LPR) is the disorder caused by the regurgitation of gastric c... more Objective Laryngopharyngeal reflux (LPR) is the disorder caused by the regurgitation of gastric contents into the laryngopharynx. Many persons diagnosed with LPR who fail medical therapy regurgitate contents from the proximal esophagus into the laryngopharynx (esophagopharyngeal reflux or EPR) on cinefluoroscopy. Study Design Retrospective review. Subjects and Methods The charts of consecutive adult patients with findings of EPR on cinefluoroscopy were reviewed. Results Twenty patients met the diagnostic criteria for EPR (mean age, 50 years of age; 60% female). Most common symptoms were cough (40%), dysphagia (35%), dysphonia (25%), and chronic throat clearing (25%). Eighty-five percent had a prior diagnosis of acid reflux disease (LPR or GER) and were unsuccessfully treated with proton pump inhibitors and/or anti-reflux surgery; 15% had fluoroscopic oropharyngeal abnormalities; all patients had fluoroscopic esophageal abnormalities. Conclusion EPR is characterized by regurgitation ...

Otolaryngology - Head and Neck Surgery, 2004

Salivary secretions play a critical role in maintaining oral health via innate host defense mecha... more Salivary secretions play a critical role in maintaining oral health via innate host defense mechanisms and secretion of secretory IgA. One of the antimicrobial peptides, LL-37 is the only cathelicidin protein so far identified in human beings. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. The purpose of this study was to examine the expression of cathelicidin in human salivary glands and to investigate up-regulation of cathelicidin in inflammatory conditions. Methods: Reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, 10 from normal and 10 from chronic sialadenitis. Results: Cathelicidin mRNA transcripts were detected in the normal salivary gland and chronic sialadenitis. The level of cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. Conclusion: The results indicate that cathelicidin might play an important role in the innate host defense of human salivary glands. Significance: In the present study, we showed the localizing expression of the human cathelicidin in salivary glands and up-regulation in the inflammatory conditions. This finding suggested the physiologic importance of cathelicidin in the defense of retrograde infection. Other functions for this broadly expressed peptide and possible expression of cathelicidin in saliva need to be evaluated.