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Submandibular Gland Excision in Pediatric Patients
Christopher L Kalmar1, Vijay A Patel2, Zachary D Zapatero1
1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia.
Insights
Children undergoing submandibular gland excision for ptyalism (excessive salivation) face higher risks. This condition is linked to more complications, longer procedures, and increased respiratory issues compared to other reasons for the surgery.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Surgical Outcomes Research
Background:
- Submandibular gland excision in children is often necessitated by ptyalism (excessive salivation).
- These children frequently present with comorbidities, notably neurodevelopmental disorders and respiratory challenges.
- Understanding the perioperative profile is crucial for managing this specific pediatric surgical cohort.
Purpose of the Study:
- To analyze the perioperative outcomes of pediatric submandibular gland excision.
- To specifically investigate the profile of children undergoing this procedure for ptyalism.
- To compare outcomes between ptyalism and other indications for submandibular gland excision.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset (2012-2018).
- Subclassified indications for submandibular gland excision using ICD-9 and ICD-10 codes.
- Analyzed complications, readmissions, and reoperations using statistical methods.
Main Results:
- 304 pediatric patients underwent submandibular gland excision; ptyalism was the primary indication (56.9%).
- Ptyalism cases were associated with younger age, longer operative times, and significantly higher rates of adverse events, readmissions, and medical complications, including pneumonia.
- Children with ptyalism exhibited higher rates of respiratory comorbidities, such as chronic lung disease, oxygen dependence, and tracheostomy.
Conclusions:
- Pediatric submandibular gland excision for ptyalism identifies a distinct patient group.
- This cohort experiences a greater burden of preoperative risk factors and postoperative adverse events.
- Outcomes for excision due to neoplasms were not significantly different from baseline adverse event rates.
Introduction:
Children who require submandibular gland excision for ptyalism often have multiple associated comorbidities, including neurodevelopmental disorders and respiratory risk factors. The purpose of this study is to utilize a large multicenter database to elucidate the perioperative profile of submandibular gland excision in children, with particular focus on children who require submandibular gland excision for ptyalism.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for submandibular gland excision performed from 2012 through 2018. Indications were subclassified based on International Classification of Disease (ICD)-9 and ICD-10 codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics.
Results:
During the study interval, 304 pediatric patients underwent submandibular gland excision, which was mostly performed for ptyalism (56.9%), followed by inflammatory conditions (20.7%). Patients requiring submandibular gland excision for ptyalism were significantly younger (P < 0.001) and underwent significantly longer procedures (P < 0.001). Ptyalism was associated with significantly higher related adverse events (P = 0.010), related readmission (P = 0.013), and medical complications (P = 0.013), which included a significantly higher risk of pneumonia (P = 0.050). Children with ptyalism had significantly higher rates of overall respiratory comorbidities (P < 0.001), including chronic lung disease (P < 0.001), supplemental oxygen support (P < 0.001), tracheostomy (P < 0.001), and ventilator dependence (P < 0.001). Patients undergoing submandibular gland excision for benign (P all ≥ 0.082) and malignant (P all ≥ 0.565) neoplasms did not have significantly higher rates of any indexed postoperative adverse event.
Conclusions:
Children requiring submandibular gland excision for ptyalism represent a unique cohort than those requiring excision for other indications, with significantly higher burden of preoperative risk factors, intraoperative durations, and postoperative adverse events.
