Children: Surgical Problems

PLAGIOCEPHALY (FLAT HEAD SYNDROME)

• Asymmetry of skull affects 1 in 5 infants

• Congenital or acquired by sleeping in one position, usually on back

• Skull X-ray performed if any doubt

• Treat by changing sleeping sides; prone position while awake

HYDROCEPHALUS

If significant, early referral for diversion of ventricular fluid.

EAR, NOSE, FACE AND ORAL CAVITY

Prominent bat/shell ears

• Optimal time for surgical correction is after 5–6 yrs

• Possible to correct by moulding ear with tape within first 6 mths

Facial deformity

Refer as soon as it is detected.

External angular dermoid

Lies in outer aspect of eyebrow. Progressively enlarges. Best excised.

Cleft lip and cleft palate

Be careful of the ‘hidden’ submucus cleft—bifid uvula and deep groove in midline of palate. Ideal age for repair of cleft lip is <3 mths and the palate 6–12 mths before the child begins to speak.

Nasal disorders

• Rhinoplasty is best deferred to late adolescence

• Choanal atresia can lead to asphyxia if bilateral and the thin membrane can be perforated with a urethral sound as an emergency procedure

Tongue tie

Consider with breastfeeding problems and an inability to protrude the tongue beyond the lips. Often a strong family history. Surgery to release the ‘tie’ is usu. recommended in first 4 months or later at 2–6 yrs.

Pre-auricular sinus

If infected, discharges pus from tiny opening at level of meatus in front of the upper crus of the helix. Refer for surgical excision but it can be left if unproblematic.

Branchial sinus/cyst/fistula

Located inferior to the external auditory meatus or anterior to the sternomastoid muscle. Refer for excision.

EYES

Strabismus (squint)

126

Blocked nasolacrimal duct

239—40

NECK LUMPS

80% of neck lumps are benign. Benign lumps usu. occur in anterior triangle while malignant lumps are commonly in posterior triangle.

Sternomastoid tumour/congenital muscular torticollis

Features in infants:

• hard painless lump or thickening (2–3 cm) in muscle

• tight and shortened sternomastoid

• apparent at 20–30 days of age

• torticollis—head away from but tilted towards the tumour

Most resolve spont. within 1 yr. Refer to physiotherapy early. Gently massage lump and stretch neck away from the tumour. Rarely surgery—best <12 mths. Acute-onset torticollis requires referal for prompt investigation.

Thyroglossal cyst

This most common midline ...