Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Department of Otolaryngology, William Beaumont Hospital, Royal Oak, MI, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110541. doi: 10.1016/j.ijporl.2020.110541. Epub 2020 Dec 1.
Determine the utility of preoperative imaging and the optimal course of management for congenital floor of mouth (FOM) cysts in infants.
A systematic review of the literature was performed conforming to PRISMA guidelines. Pubmed, Embase and Cochrane Library databases were queried to identify cases of infants with congenital floor of mouth masses. Patient demographics, presenting findings, imaging, management, complications, and outcomes were determined.
85 patients were evaluated. 98% of patients presented at 16 months of age or younger. The most common presenting symptom was submental mass or swelling, 31.3%. Among the patients that underwent imaging, the suspected diagnosis obtained from imaging findings was consistent with the final pathologic diagnosis 59% of the time reported and inaccurate 34% of the time. There were multiple definitive treatment modalities described in the literature review including surgical excision, 82.3%, marsupialization, 12.9%, chemical injection 2.3%, sclerotherapy 1.2%,% and radiation, 1.2%. Recurrence rate after initial definitive treatment was as follows, surgical excision, 8.8%, marsupialization, 80%, sclerotherapy, 100%, chemical injection, 50%, and radiation, 100%.
Preoperative imaging studies should not be relied upon alone to determine suspected pathology and subsequent management in pediatric patients with FOM masses. It may be beneficial for these patients to undergo primary surgical excision regardless of imaging studies or suspected pathology. Needle aspiration offers limited addition to pathologic diagnosis and should only be performed in the setting of acute symptomatic management. Surgical excision should be considered as definitive treatment modality in all patients with FOM masses, regardless of the suspected diagnosis of ranula. Further multi-institutional cohort studies could be invaluable to elucidate definitive treatment guidelines in this patient population.
确定先天性口底（FOM）囊肿在婴儿中的术前影像学检查的效用和最佳处理流程。
按照 PRISMA 指南进行系统文献回顾。检索 Pubmed、Embase 和 Cochrane Library 数据库，以确定患有先天性口底肿块的婴儿病例。确定患者的人口统计学资料、临床表现、影像学检查、处理方法、并发症和结局。
共评估了 85 例患者。98%的患者在 16 个月或更小时就诊。最常见的表现症状为颏下肿块或肿胀，占 31.3%。在接受影像学检查的患者中，影像学检查结果提示的可疑诊断与最终病理诊断相符的比例为 59%，报告不准确的比例为 34%。文献综述中描述了多种明确的治疗方式，包括手术切除 82.3%、袋形手术 12.9%、化学注射 2.3%、硬化疗法 1.2%和放射治疗 1.2%。初次明确治疗后的复发率如下：手术切除 8.8%、袋形手术 80%、硬化疗法 100%、化学注射 50%和放射治疗 100%。
在小儿口底肿块患者中，术前影像学检查不应单独用于确定疑似病理和后续处理。对于这些患者，无论影像学检查或疑似病理如何，进行初次手术切除可能是有益的。针吸术对病理诊断的帮助有限，仅应在急性症状管理的情况下进行。对于所有 FOM 肿块患者，均应考虑手术切除作为明确的治疗方式，而不考虑疑似的蛤蟆肿诊断。进一步的多机构队列研究可能对阐明该患者人群的明确治疗指南具有重要价值。
