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Floor of mouth masses in children: proposal of a new algorithm
Theresa W Schwanke1, Karin P Q Oomen, Max M April
1Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, 428 East 72nd Street, Suite 100, New York, NY 10021, USA.
Insights
This study reviewed pediatric floor of mouth (FOM) masses, finding transoral removal effective with low recurrence and infection rates. Surgical approach depended on mass location, with complex cases potentially needing further procedures.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Head and Neck Surgery
Background:
- Floor of mouth masses in children are uncommon.
- Limited literature exists on pediatric floor of mouth mass management.
Purpose of the Study:
- To summarize a single institution's experience with pediatric floor of mouth masses.
- To describe surgical approaches and outcomes for these lesions.
Main Methods:
- Retrospective chart review of pediatric patients with floor of mouth masses (2007-2012).
- Analysis of clinical presentation, surgical management, and outcomes.
Main Results:
- Thirteen cases included: dermoid cysts, ranulas, lymphatic malformations, etc.
- Transoral management for most masses; transcervical for those with submental components.
- No recurrences or postoperative infections reported; one patient required an additional procedure.
Conclusions:
- Pediatric floor of mouth mass types align with existing literature.
- Transoral and transcervical approaches yield favorable outcomes.
- Complex masses may necessitate staged surgical interventions.
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.
