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Ingestions

Foreign Bodies in the Esophagus Seema Khan The majority (80%) of accidental foreign-body ingestions occur in children, most of whom are 5 yr of age or younger. Older children and adolescents with developmental delays and those with psychiatric disorders are also at increased risk. The presentation of a foreign body lodged in the esophagus constitutes an emergency and is associated with significant morbidity and mortality because of the…

Eosinophilic Esophagitis, Pill Esophagitis, and Infective Esophagitis

Eosinophilic Esophagitis Eosinophilic esophagitis (EoE) is a chronic esophageal disorder characterized by esophageal dysfunction and infiltration of the esophageal epithelium by ≥15 eosinophils per high-power field. The diagnostic criteria has recently been updated as a result of the consensus conference on Appraisal of Guidelines for Research and Evaluation (AGREE). The diagnosis of EoE should be considered in the clinical presentation of esophageal dysfunction, associated with esophageal…

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder in children of all ages. Gastroesophageal reflux (GER) signifies the retrograde movement of gastric contents across the lower esophageal sphincter (LES) into the esophagus, which occurs physiologically every day in all infants, older children, and adults. Physiologic GER is exemplified by the effortless regurgitation of normal infants. The phenomenon becomes pathologic GERD in infants and children…

Congenital Anomalies

Esophageal Atresia and Tracheoesophageal Fistula Seema Khan Sravan Kumar Reddy Matta Keywords VACTERL polyhydramnios Esophageal atresia (EA) is the most common congenital anomaly of the esophagus, with a prevalence of 1.7 per 10,000 live births. Of these, >90% have an associated tracheoesophageal fistula (TEF). In the most common form of EA, the upper esophagus ends in a blind pouch and the TEF is connected to the distal esophagus…

Embryology, Anatomy, and Function of the Esophagus

The esophagus is a hollow muscular tube, separated from the pharynx above and the stomach below by two tonically closed sphincters. Its primary function is to convey ingested material from the mouth to the stomach. Largely lacking digestive glands and enzymes, and exposed only briefly to nutrients, it has no active role in digestion. Embryology The esophagus develops from the postpharyngeal foregut and can be distinguished…

Diseases of the Salivary Glands and Jaws

With the exception of mumps (see Chapter 275 ), diseases of the salivary glands are rare in children. Bilateral enlargement of the submaxillary glands can occur in HIV/AIDS, cystic fibrosis, Epstein-Barr virus infection, malnutrition, and transiently during acute asthmatic attacks. Chronic vomiting can be accompanied by enlargement of the parotid glands. Benign salivary gland hypertrophy has been associated with endocrinopathies: thyroid disease, diabetes, and Cushing syndrome.…

Common Lesions of the Oral Soft Tissues

Oropharyngeal Candidiasis Oropharyngeal infection with Candida albicans (thrush, moniliasis) (see Chapter 261.1 ) is common in neonates from contact with the organism in the birth canal or contact with the breast during breastfeeding. The lesions of oropharyngeal candidiasis (OPC) appear as white plaques covering all or part of the oropharyngeal mucosa. These plaques are removable from the underlying surface, which is characteristically inflamed and has pinpoint…

Dental Trauma

Traumatic oral injuries may be categorized into 3 groups: injuries to teeth, injuries to soft tissue (contusions, abrasions, lacerations, punctures, avulsions, and burns), and injuries to jaw (mandibular and/or maxillary fractures). Injuries to Teeth Approximately 10% of children between 18 mo and 18 yr of age sustain significant tooth trauma. Oral injuries are second most common, covering 18% of all somatic injuries in the age group 0-6 yr. Among…

Periodontal Diseases

The periodontium includes the gingiva, alveolar bone, cementum, and periodontal ligament (see Fig. 338.5 ). Gingivitis Poor oral hygiene results in the accumulation of dental plaque at the tooth-gingival interface that activates an inflammatory response, expressed as localized or generalized reddening and swelling of the gingiva. More than half of American school children experience gingivitis. In severe cases, the gingiva spontaneously bleeds and there is oral…

Dental Caries

Etiology The development of dental caries depends on interrelationships among the tooth surface, dietary carbohydrates, and specific oral bacteria. Organic acids produced by bacterial fermentation of dietary carbohydrates reduce the pH of dental plaque adjacent to the tooth to a point where demineralization occurs. The initial demineralization appears as an opaque white spot lesion on the enamel, and with progressive loss of tooth mineral, cavitation of…

Cleft Lip and Palate

Clefts of the lip and palate are distinct entities which are closely related embryologically, functionally, and genetically. It is thought that cleft of the lip appears because of hypoplasia of the mesenchymal layer, resulting in a failure of the medial nasal and maxillary processes to join. Cleft of the palate results from failure of palatal shelves to approximate or fuse. Incidence and Epidemiology The incidence of…

Malocclusion

The oral cavity is essentially a masticatory instrument. The purpose of the anterior teeth is to bite off large portions of food. The posterior teeth reduce foodstuff to a soft, moist bolus. The cheeks and tongue force the food onto the areas of tooth contact. Establishing a proper relationship between the mandibular and maxillary teeth is important for both physiologic and cosmetic reasons. Variations in Growth…