it is a xourse about congenital laryngeal disorders

FUTURE OF PEDIATRIC ENT (developments)

Pediatric trasheostomy indications to decannulation is discussed.

Description This round table is submitted by the European Pediatric Skullbase taskforce from ESPO. It will explore one of the most critical challenges in managing juvenile nasopharyngeal angiofibroma (JNA): residual disease. Despite advances in endoscopic resection and embolization, complete tumor removal remains complex, particularly in cases with skull base or intracranial extension. The session will focus on how optimal planning of the initial surgery—through imaging, staging, and multidisciplinary collaboration—can reduce residual risk. It will also examine the nuances of postoperative management: Should all residual tumors be reoperated? When is imaging surveillance appropriate? Are there non-surgical alternatives for indolent residual disease? Faculty will share decision-making algorithms, long-term outcomes, and illustrative cases to help define modern standards of care.

Outcome Objectives By the end of the session, participants will be able to:

1. Optimize the planning of initial JNA surgery to minimize residual disease.

2. Identify radiologic and intraoperative predictors of incomplete resection.

3. Differentiate between residual and recurrent disease using imaging and clinical criteria.

4. Evaluate the risks and benefits of reoperation versus surveillance.

5. Understand current and emerging alternatives to surgical reintervention for residual JNA.

Background Residual disease in JNA remains a source of clinical uncertainty, especially when the remnant is small, asymptomatic, or surgically risky. Incomplete resection may stem from intraoperative bleeding, complex tumor extensions, or the need to avoid critical neurovascular structures. Not all residual lesions behave aggressively; some remain stable for years. This symposium will provide a critical overview of strategies to reduce residual disease risk from the outset and explore evidence-based approaches to managing remnants. The discussion will help clinicians move beyond a binary “operate or not” framework toward a personalized, risk-adapted model of care.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Approximately one-third of RMS cases arise in the head and neck region, with parameningeal (PM) primaries accounting for half of these.

Head and neck rhabdomyosarcoma, particularly parameningeal RMS, presents a significant oncological challenge due to its proximity to critical neurovascular structures, its frequent locally advanced presentation, and its high risk of local failure. The parameningeal site is recognized as an unfavorable location in children with localized RMS, associated with a poorer prognosis (5-year overall survival [OS] ranging from 55% to 75%) compared to other head and neck RMS subtypes (5-year OS of 65% to 80% for non-PM RMS and 85% to 90% for orbital RMS), primarily due to the high incidence of local failure.

Surgery is a potential therapeutic option for the local treatment of RMS. However, PM RMS are typically considered unresectable and are managed with a combination of early radiotherapy (RT) and multidrug chemotherapy. Despite the use of large treatment fields and high-dose RT, achieving local control remains a significant challenge, with local failure being the most common pattern of recurrence.

Extensive surgery in the head and neck region was considered to be associated with considerable morbidity. However, advancements in minimally invasive, endoscopic, and reconstructive surgical techniques have significantly challenged this paradigm.

This presentation aims to explore the role of surgery in the management of both "resectable" and "unresectable" tumors in the treatment of head and neck RMS, particularly parameningeal RMS.