LARYNGOMALASIA DIAGNOSIS AND TREATMENT IS DISCUSSED

This presentation will explore the comprehensive clinical management of hemangiomas within the scope of otorhinolaryngology, based on extensive experience from a regional reference center in malatya, türkiye. Hemangiomas, the most common benign vascular tumors in infancy, pose both diagnostic and therapeutic challenges, particularly when located in critical areas such as the periorbital region, larynx, lips, or subglottic space.

the lecture will cover distinguishing true hemangiomas from vascular malformations and other mimicking lesions such as pyogenic granulomas and teratomas. Special attention will be paid to the natural course of hemangiomas — proliferation, involution, and sequelae phases — with emphasis on early intervention to prevent cosmetic and functional complications.

the presentation will detail the evolving role of propranolol in infantile hemangiomas since its serendipitous discovery as a first-line therapy in 2009. Clinical protocols, safety monitoring, and outcome measures will be discussed, alongside surgical options for propranolol-resistant cases such as ulcerated, rapidly growing, or airway-threatening hemangiomas. Illustrative pediatric and adults case reports will highlight multidisciplinary decision-making in high-risk scenarios.

through these clinical examples, participants will gain insight into real-world applications of current guidelines, practical risk-benefit assessments, and tailored treatment strategies.

Thyroglossal duct cysts are among the most common congenital head and neck neck lumps with branchial cysts. Resection of the cysts and its tract with hyoid body (sistrunk) is the main surgical treatment.

4- The case i want to forget about.

Course description

This course is designed for otolaryngologists in the multidisciplinary management of pediatric sialorrhea. The curriculum provides a comprehensive overview of the pathophysiology, clinical assessment, and treatment modalities available for this challenging condition, with a particular emphasis on the novel integration of staggered botulinum toxin-a injections into the parotid and submandibular glands prior to four-duct ligation.

this approach has been shown to optimize surgical outcomes by reducing glandular secretion preoperatively, thereby minimizing patients' discomfort and postoperative complications such as gland swelling and sialadenitis. Through detailed anatomical review, evidence-based discussions, and operative video demonstrations, participants will gain the skills necessary to safely and effectively perform these interventions.

outcome objectives

upon completion of this course, participants will be able to:

1. describe the underlying pathophysiology and clinical manifestations of pediatric sialorrhea and its impact on functional swallowing and psychosocial well-being.

2. identify appropriate candidates for botulinum toxin-a injections and four-duct ligation based on clinical evaluation and diagnostic criteria.

3. explain the pharmacological mechanism of botulinum toxin-a and the clinical rationale for its staggered administration prior to surgical intervention.

4. critically evaluate surgical treatment options regard to their indications, contraindications, and complication profiles.

5. recognize potential perioperative and postoperative complications and apply strategies to prevent and manage these effectively.

6. formulate multidisciplinary management plans incorporating surgical, medical, and rehabilitative therapies tailored to individual patient needs to improve outcomes and quality of life.

background

sialorrhea in the pediatric population is most commonly associated with neurological impairments such as cerebral palsy, neuromuscular disorders, and developmental delays. The pathogenesis involves disrupted coordination of the oral phase of swallowing, leading to excessive saliva pooling and drooling. Excessive drooling or sialorrhea, often resulting from impaired oral phase swallowing coordination, significantly impacts patient health and quality of life through physical complications such as skin irritation, aspiration pneumonia, and social stigmatization.

conservative management strategies include oral motor and behavioral therapies, but their efficacy is often limited in severe or refractory cases. Pharmacological interventions, particularly botulinum toxin injections, provide transient reduction of salivary secretion but may require repeated administration. Surgical interventions aim to provide more durable solutions by altering salivary flow pathways or reducing glandular output.

four-duct ligation has been demonstrated as an effective surgical option. Nevertheless, it carries risks such as postoperative glandular swelling and sialadenitis, which can complicate recovery. The protocol of administering staggered botulinum toxin-a injections into the parotid and submandibular glands prior to surgery serves to transiently decrease gland function, reduce secretion, and prepare the tissues for duct ligation, thereby minimizing complications.

references

1. özturan o, çalım ÖF. Approach to the patient with sialorrhea and treatment management. Praxis of ORL. 2018;6(1):39-47.

2. calim OF, hassouna HNH, yildirim YS, dogan r, ozturan o. Pediatric sialorrhea: submandibular duct rerouting and intraparotid botulinum toxin a injection with literature review. Ann otol rhinol laryngol. 2019 feb;128(2):104-112.

3. calim OF, polat e, ozturan o. Staggered botulinum toxin-a injections into parotid and submandibular glands prior to four-duct ligation for pediatric sialorrhea. Eur arch otorhinolaryngol. 2025 apr;282(4):2043-2051. Doi: 10.1007/s00405-024-09022-z.