Pediatric Otolaryngology and Facial Plastic/Reconstructive Surgery
Core concepts
Pediatric airway anatomy differs from adults: the larynx is higher and more anterior, the epiglottis is floppy, and the narrowest point is the subglottis (versus the glottis in adults). This explains why croup (subglottic edema) causes stridor. Know the classic pediatric infections: acute otitis media (bulging tympanic membrane), croup (barking cough, steeple sign), epiglottitis (drooling, tripod position, thumb sign), and retropharyngeal abscess (neck stiffness, fever). Understand that most acute otitis media in older children can be observed, while young infants or severe cases warrant antibiotics. For facial plastic surgery, know principles of wound closure, scar management, and reconstructive ladder from primary closure to flaps and grafts. Recognize that cleft lip/palate timing and multidisciplinary care matter.
Traps
A frequent trap is intubating or examining the throat in suspected epiglottitis before airway control-this can precipitate obstruction. Another is confusing croup with epiglottitis: croup has a barking cough and gradual onset; epiglottitis has drooling and rapid progression. Also remember that the subglottis is the narrowest pediatric airway segment.
Worked example
A child has a barking cough, low-grade fever, and a steeple sign on neck radiograph. This is croup. Rule of thumb: barking cough plus steeple sign equals croup; drooling plus tripod equals epiglottitis.