Floor of mouth masses in children: Proposal of a new algorithm

• Published in: International journal of pediatric otorhinolaryngology 2013-09, Vol.77 (9), p.1489-1494
• Main Authors: Schwanke, Theresa W, Oomen, Karin P.Q, April, Max M, Ward, Robert F, Modi, Vikash K
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adolescent; Algorithms; Child; Child, Preschool; Cohort Studies; Dermoid cyst; Dermoid Cyst - diagnosis; Dermoid Cyst - epidemiology; Dermoid Cyst - surgery; Female; Floor of mouth; Humans; Incidence; Infant; Infant, Newborn; Lymphatic malformation; Lymphatic System - abnormalities; Lymphatic System - pathology; Magnetic Resonance Imaging - methods; Male; Mouth Diseases - epidemiology; Mouth Diseases - pathology; Mouth Diseases - surgery; Mouth Floor - pathology; Mouth Floor - surgery; Mouth Neoplasms - epidemiology; Mouth Neoplasms - pathology; Mouth Neoplasms - surgery; New York City; Otolaryngology; Pediatrics; Prognosis; Ranula; Ranula - diagnosis; Ranula - epidemiology; Ranula - surgery; Registries; Retrospective Studies; Risk Assessment; Salivary Gland Diseases - epidemiology; Salivary Gland Diseases - pathology; Salivary Gland Diseases - surgery; Salivary Glands - pathology; Salivary Glands - surgery; Sublingual Gland - pathology; Sublingual Gland - surgery; Treatment Outcome
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2013.06.016

Abstract Objective Many surgical techniques have been described to manage floor of mouth masses, but few studies have described the approach to these masses in children. This case series summarizes a single institution's experience with pediatric floor of mouth masses. Methods We performed a retrospective chart review of all children who presented at our tertiary care facility with FOM masses between 2007 and 2012. Charts were reviewed for clinical presentation, preoperative, intraoperative and postoperative management. Results Thirteen cases were retrieved: 6 dermoid cysts, 4 ranulas, 1 lymphatic malformation, 1 imperforate submandibular duct, and 1 enlarged salivary gland. In 10 of 13 patients, clinical diagnosis was consistent with postoperative diagnosis. Imaging was consistent with postoperative diagnosis in 8 of 9 cases. Ten of 13 masses were managed transorally; 7 were excised, 2 were marsupialized and 1 was managed with submandibular duct dilation. Three masses with a larger submental component, 2 dermoids and 1 ranula, were removed transcervically. Most patients undergoing transoral excision underwent nasotracheal intubation; patients who underwent marsupialization underwent orotracheal intubation. There were no recurrences, complications or postoperative infections. An additional surgical procedure was necessary in one patient. Conclusion Our cohort displays a common distribution of lesion types when compared to the literature. Low recurrence and infection rates are observed when oral masses are removed transorally, and masses with a larger cervical component are removed transcervically. More complex masses may warrant additional surgical procedures.