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Use of Imaging to Evaluate Course of the Carotid Artery in Surgery for Velopharyngeal Insufficiency.
[22q11.2 deletion syndrome]
This
study
aimed
to
describe
syndromes
where
preoperative
imaging
may
be
essential
in
determining
the
course
of
the
carotid
arteries
before
velopharyngeal
insufficiency
(
VPI
)
surgery
and
therefore
affect
surgical
planning
.
Records
of
children
who
underwent
surgery
for
VPI
between
May
1
,
2012
,
and
October
30
,
2013
,
at
a
tertiary
care
pediatric
otolaryngology
center
were
reviewed
.
Data
collected
included
age
at
operation
,
preoperative
and
postoperative
nasometry
values
,
presence
of
underlying
genetic
disorders
,
and
imaging
findings
.
Twenty
-
five
patients
underwent
33
surgeries
for
VPI
,
with
1
posterior
pharyngeal
wall
augmentation
,
6
Furlow
palatoplasties
,
11
sphincter
pharyngoplasties
,
and
15
pharyngeal
flaps
.
Medialized
carotid
vasculature
was
identified
in
5
of
25
patients
(
20
%
)
.
Seven
syndromic
patients
were
identified
,
with
3
patients
having
22
q
11
.
2
deletion
syndrome
.
All
patients
(
100
%
)
with
22
q
11
.
2
deletion
syndrome
had
medialized
carotid
arteries
.
Of
the
4
additional
syndromic
children
,
2
(
50
%
)
had
medial
internal
carotid
arteries
,
with
1
patient
diagnosed
with
neurofibromatosis
1
and
another
with
Prader-
Willi
syndrome
.
Both
patients
underwent
Furlow
palatoplasty
.
Whereas
22
q
11
.
2
deletion
syndrome
is
recognized
as
an
entity
where
a
medial
carotid
is
often
present
,
other
syndromic
children
may
also
demonstrate
vascular
variability
.
Although
a
larger
study
is
needed
to
confirm
an
increased
prevalence
in
these
patients
,
clinicians
may
need
a
higher
degree
of
suspicion
while
performing
the
physical
examination
.
If
examination
findings
are
suggestive
or
the
disease
process
may
lend
itself
to
this
abnormality
,
vascular
imaging
can
be
considered
as
part
of
presurgical
planning
to
help
guide
surgical
technique
and
prevent
complications
.
Diseases
Validation
Diseases presenting
"2"
symptom
22q11.2 deletion syndrome
cushing syndrome
epidermolysis bullosa simplex
erythropoietic protoporphyria
krabbe disease
monosomy 21
pendred syndrome
thoracic outlet syndrome
trochlear dysplasia
werner syndrome
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