Assessment of a Multifaceted Approach, Including Frequent PCR Testing, to Mitigation of COVID-19 Transmission at a Residential Historically Black University.

Importance: COVID-19 posed an unprecedented threat to residential colleges in the fall of 2020. While there were mathematical models of COVID-19 transmission, there were no established or tested protocols of COVID-19 testing or mitigation for school administrators to follow. Objective: To investigate the association of a multifaceted COVID-19 mitigation strategy using social, behavioral, and educational interventions and a program of frequent testing with prevalence of disease spread. Design, Setting, and Participants: This cohort study was conducted as a retrospective review of COVID-19 positivity from August 16, 2020, to April 30, 2021, at Delaware State University, a publicly funded historically Black university. Participants included all students, faculty, and staff members with a campus presence. Positivity rates after use of mitigation strategies and testing on campus were compared with those of the surrounding community. Data were analyzed from July through September 2021. Exposures: Mitigation strategies included education and outreach about social distancing, masking, and handwashing, and a COVID-19 testing plan consisted of twice-weekly polymerase chain reaction (PCR) screening using anterior nasal samples (fall and early spring semester) and then saliva-based samples (middle to late spring semester). Main Outcomes and Measures: Cumulative tests, infections, daily quarantine, and isolation residence hall occupancy were measured, and comparisons were made with statewide COVID-19 positivity rates. Results: The campus cohort included 2320 individuals (1575 resident students, 415 nonresident students, and 330 faculty or staff members). There were 1488 (64.1%) women and 832 (35.9%) men; mean (SD) age was 27.5 (12.9) years. During the fall semester, 36 500 COVID-19 PCR tests were performed. Weekly positivity rates ranged from 0 of 372 tests to 16 of 869 tests (1.8%) (mean [SD] positivity rate, 0.5% [0.5%]; 168 positive results and 36 312 negative results). During the same period, statewide positivity ranged from 589 of 25 120 tests (2.3%) to 5405 of 54 596 tests (9.9%) (mean [SD] positivity rate, 4.8% [2.6%]). In the spring semester, 39 045 PCR tests were performed. Weekly positivity rates ranged from 4 of 2028 tests (0.2%) to 36 of 900 tests (4.0%) (mean [SD] positivity rate, 0.8% [0.9%]; 267 positive results and 38 767 negative results). During the same period, statewide positivity ranged from 1336 of 37 254 tests (3.6%) to 3630 of 42 458 tests (8.5%) (mean [SD] positivity rate, 5.1% [1.3%]). Compared with statewide rates, campus positivity rates were mean (SD) 4.4 (2.6) percentage points lower during the fall semester (P < .001) and mean (SD) 5.6 (1.6) percentage points lower during the spring semester (P < .001). Total daily quarantine and isolation residence hall occupancy ranged from 0 to 43 students in the fall and 1 to 47 students during the spring. Conclusions and Relevance: This study found that the combination of campuswide mitigation policies and twice-weekly COVID-19 PCR screening was associated with a significant decrease in COVID-19 positivity at a residential historically Black university campus compared with the surrounding community. Given the socioeconomic demographics of many students at historically Black colleges and universities, keeping these resident campuses open is critical not only to ensure access to educational resources, but also to provide housing and food security.

Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach.

PURPOSE: To update the outcomes of an institutional clinical management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. METHODS AND MATERIALS: Between August 2003 and April 2014, 61 consecutive patients with ipsilateral node-positive squamous cell carcinoma of the tonsil without involvement of the base of the tongue or midline soft palate were treated at a community hospital-based cancer center with radiotherapy to the primary site and ipsilateral neck. Overall survival, disease-free survival and freedom from contralateral failure were calculated. RESULTS: Median follow up was 37.2months (range 4-121months). Freedom from contralateral nodal failure at 5years was 98% with one contralateral nodal failure noted. The patient underwent a salvage neck dissection and was treated with post-operative radiotherapy with no evidence of disease to date. 5-year overall survival (OS) was 92.4% and 5year disease-free survival (DFS) was 86.7%. CONCLUSIONS: This represents the single largest series reported from a community hospital-based cancer center in which lateralized tonsil cancers with N+ disease were treated with ipsilateral neck radiotherapy. In this carefully selected cohort of patients with well-lateralized tonsil cancers, the risk of contralateral nodal failure appears to be <5%, suggesting that prophylactic radiation of the contralateral neck may not be necessary. Future planned studies will focus on prospectively selecting subgroups of patients eligible for treatment de-intensification as survivorship issues in excellent prognosis HPV positive patients are increasingly becoming relevant.

Transoral robotic surgery: role in the management of upper aerodigestive tract tumors.

The toxicity associated with concomitant chemoradiation for the management of laryngeal and pharyngeal carcinoma has been well documented. Minimally invasive surgical techniques offer the potential to extirpate the malignancy as a single-modality therapy and provide essential information that may direct subsequent treatment. In selected patients, radiation doses may be reduced and systemic chemotherapy may be withheld after tumor extirpation. Transoral laser microsurgery has proven effective, although inability to manipulate and suture tissue by this modality limits ablation and reconstruction of extensive defects. Transoral robotic surgery is a relatively new technique that provides several unique advantages, which include a 3-dimensional magnified view, ability to see and work around curves or angles, and the availability of 2 or 3 robotic arms that can be used to reconstruct extensive defects using either local, regional, or free flaps. Preliminary data suggest that transoral robotic surgery may provide a technique for ablation and reconstruction of pharyngeal defects that may be superior to other transoral techniques. It may also provide a means for personalizing therapy for oropharyngeal and supraglottic carcinoma.

In vitro discrimination of tumor cell lines with an electronic nose.

OBJECTIVE: The electronic nose is a sensor of volatile molecules that is useful in the analysis of expired gases. Our hypothesis is that the electronic nose can distinguish between different types of upper aerodigestive tract tumor cells in vitro. STUDY DESIGN: Cells from both tumor and normal cell lines were suspended in saline, and a polymer composite electronic nose was used to evaluate the headspace gases. The data were subjected to principal components analysis, and Mahalanobis distances were calculated to demonstrate the ability of the electronic nose to distinguish among samples. RESULTS: The tumor cell lines, including adenocarcinoma, squamous cell carcinoma, and mesothelioma, were distinct from each other, and from the normal fibroblast and smooth muscle cells as seen on canonical discrimination plots. CONCLUSION: The electronic nose can distinguish between tumor cell lines in vitro and has the potential to be a useful screening test for cancer.

Transoral robotic surgery: supraglottic partial laryngectomy.

OBJECTIVES: We assessed the feasibility of performing transoral supraglottic partial laryngectomy with robotic instrumentation. METHODS: Transoral robotic surgery (TORS) was performed on 3 human patients with supraglottic carcinoma in a prospective human trial. The study was approved by our institutional review board and involved the da Vinci Surgical Robot (Intuitive Surgical, Inc, Sunnyvale, California). RESULTS: All procedures were completed robotically. The median overall operation time to perform the robotic procedure was 120 minutes (range, 1:32:48 to 2:58:18), including 18 minutes (range, 00:6:07 to 00:30:39) for exposure and robotic positioning. There were no intraoperative or postoperative complications or surgical mortality. CONCLUSIONS: The preliminary results of our series suggest that application of the da Vinci robotic surgical system for TORS to supraglottic partial laryngectomy is technically feasible and relatively safe. Furthermore, TORS provides excellent surgical exposure that allows complete tumor resection. Most importantly, TORS provides an alternative to open approaches and "conventional" transoral supraglottic partial laryngectomy.

Transoral robotic surgery (TORS) for base of tongue neoplasms.

OBJECTIVE: To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. STUDY DESIGN: Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. METHODS: Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. RESULTS: The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. CONCLUSIONS: TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.

Transseptal suture to secure middle meatal spacers.

Middle meatal spacers are used by many sinus surgeons to aid postoperative care. Aspiration of a spacer is a concern. We demonstrate a novel method of securing spacers with a transseptal suture to prevent aspiration. We fashion each spacer from a powder-free, nonlatex glove finger that is packed with a Merocel sponge. The open end of the finger is closed with 2-0 Prolene sutures. For a bilateral procedure, the needle is left attached to one of the spacers. A spacer is placed in each ethmoid cavity, the attached needle is passed through the anterior cartilaginous septum, and the suture is tied to the suture on the opposite spacer. For unilateral procedures, the suture on the single spacer is passed to the contralateral side and tied on itself. One week later, the transseptal suture is cut and the spacers are removed. We performed this procedure on 78 patients who had undergone total ethmoidectomy. None of the spacers migrated during the 1 week they were in place. One patient complained of pain during removal of a spacer. During follow-up of 2 to 10 months, we found no evidence of injury to the septum at the site of the transseptal suture. We conclude that the transseptal suture is a safe and cosmetically superior method of securing middle meatal spacers.

Transoral robotic surgery (TORS): glottic microsurgery in a canine model.

OBJECTIVES/HYPOTHESIS: We hypothesize that bimanual, three-dimensional robotic surgery will prove valuable for glottic microsurgical procedures. STUDY DESIGN: To test this hypothesis, we developed and optimized a canine model for glottic microsurgery using a commercially available surgical robot. Methods Using a da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), glottic microsurgery was performed with a hydrodissection technique in a canine model. The experiments were performed on two orotracheal intubated mongrel dogs under general anesthesia in the supine position on a standard operating room table. A videoscope and two, 360-degree rotating, 5- and 8-mm, wrested-end effector instruments were introduced transorally with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. The procedure was performed in duplicate and was documented with still and video photography. RESULTS: Glottic microsurgery was successfully performed using the da Vinci Surgical Robot, with both 5- and 8-mm instrumentation. The smaller, 5-mm instruments afforded greater visualization of the operative site and increased maneuverability, which resulted in reduced operative time. The robotic system provided excellent visualization as well as controlled and delicate microdissection at the vocal cord level. CONCLUSIONS: Robotic laryngeal microsurgery is technically feasible in the canine model and warrants consideration for evaluation in controlled human trials.

Assessment of intraoperative safety in transoral robotic surgery.

INTRODUCTION: Robotic technology has been safely integrated into thoracic and abdominopelvic surgery, and the early experience has been very promising with very rare complications related to robotic device failure. Recently, several reports have documented the technical feasibility of transoral robotic surgery (TORS) with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy, base-of-tongue resection, supraglottic laryngectomy, and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration, tooth injury, mucosal laceration, mandible fracture, cervical spine fracture, and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. METHODS: To test this hypothesis, we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. RESULTS: Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth, mandible, and cervical spine fracture could not be achieved. CONCLUSIONS: Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally, we discuss several strategies to increase patient safety in TORS.

Correlation of pneumonia score with electronic nose signature: A prospective study.

OBJECTIVES: Ventilator-associated pneumonia (VAP) is a frequent complication in patients in surgical intensive care units. Pneumonia scores, chest radiography, and bronchoscopy are all employed, but there is no gold standard test for the diagnosis of VAP. The electronic nose, a sensor of volatile molecules, is well suited to testing the breath of mechanically ventilated patients. Our objective was to determine the potential use of an electronic nose as a diagnostic adjunct in the detection of VAP. METHODS: We performed a prospective study of mechanically ventilated patients in a surgical intensive care unit. Clinical data, including temperature, white blood cell count, character and quantity of tracheal secretions, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, and chest radiographs, were collected, and a pneumonia score between 0 and 10 was calculated. Exhaled gas was sampled from the expiratory limb of the ventilator circuit. The gases were assayed with a commercially available electronic nose. Multidimensional data reduction analysis was used to analyze the results. RESULTS: Forty-four patients were studied. Fifteen patients had pneumonia scores of 7 or greater, and 29 patients had scores of 6 or less. With Fisher discriminant analysis and K-nearest neighbor analysis, the electronic nose was able to discriminate between the two groups. CONCLUSIONS: The electronic nose is a new technology that is inexpensive, noninvasive, and portable. We demonstrate its ability to predict pneumonia, based on a well-recognized scoring system. This technology promises to serve as a diagnostic adjunct in the management of VAP.

Maintenance of hemostasis in transoral robotic surgery.

BACKGROUND: The last decade has seen a tremendous growth in the field of robotic surgery with an increasing number of cardiac and urologic procedures performed each year. Several attributes of this technology may offer advantages to laryngeal and pharyngeal surgery in that it allows for exceptional visualization of the operative field, precise handling of soft tissues, and multiplanar transection of tissues. One potential limitation is the management of bleeding in transoral pharyngeal and laryngeal surgery, which is critical to prevent both intravascular volume loss and aspiration. OBJECTIVES: To demonstrate methods for management of bleeding in the surgical field during transoral robotic surgery (TORS). METHODS: We developed a canine robotic surgery model for the evaluation of the ability to control bleeding in laryngeal and pharyngeal procedures using the daVinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, Calif., USA). Both large- and small-vessel hemostasis was obtained with both robotically controlled monopolar and bipolar cautery and with robotically controlled small hemoclips. Additionally, manually controlled large hemoclips were applied by an assistant surgeon viewing on a video monitor for management of large arterial vessels. Suction was performed with both flexible suction catheters controlled by the robotic arms and with manually controlled conventional suction catheters. Data were collected with still and video photography. RESULTS: The lingual artery as well as small arteries and veins were easily controlled and there were no difficulties with maintenance of hemostasis. CONCLUSIONS: Effective hemostasis with control of both large and small vessels can be obtained using both surgical hemoclips and electrocautery during TORS in a canine model.

Transoral robotic surgery: supraglottic laryngectomy in a canine model.

OBJECTIVES/HYPOTHESIS: To develop a technique for computer enhanced robotic transoral supraglottic partial laryngectomy in the canine model. STUDY DESIGN: Surgical procedure on the larynx in a canine model with a commercially available surgical robot. METHODS: With use of the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), the supraglottic partial laryngectomy was performed on a mongrel dog that had been orotracheally intubated using general anesthesia. The videoscope and the 8 mm end-effectors of the robotic system were introduced through three ports, transorally. The surgical procedure was performed remotely from the robotic system console. The procedure was documented with still and video photography. RESULTS: Supraglottic partial laryngectomy was successfully performed using the da Vinci Surgical Robot, with 8 mm instrumentation. The robotic system allowed for celerity and accuracy secondary to findings specific to the surgical approach, including excellent hemostasis, superb visualization of the operative field with expeditious identification of laryngeal submucosal soft tissue and skeletal landmarks, and multiplanar transection of tissues. In addition, the use of the robotic system also was found to have technical advantages inherent in robotic surgery, including the use of "wristed" instrumentation, tremor abolition, motion scaling, and three-dimensional vision. CONCLUSIONS: The da Vinci Surgical Robot allowed for successful robotic transoral supraglottic partial laryngectomy in the canine model.

Robot-assisted pharyngeal and laryngeal microsurgery: results of robotic cadaver dissections.

OBJECTIVES/HYPOTHESIS: Robotic surgery has significant potential in pharyngeal and microlaryngeal surgery. We demonstrate the use of a surgical robot in pharyngeal and microlaryngeal surgery in a cadaver. STUDY DESIGN: Six experimental surgical dissections, modeled after commonly performed pharyngeal and microlaryngeal procedures, were performed in a cadaver with a commercially available surgical robot in an operating room suite to demonstrate proof of concept. METHODS: Using the daVinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA), surgical procedures were performed on an edentulous, female cadaver. The procedures included 1) bilateral true vocal cord stripping, 2) rotation of a mucosal flap from the epiglottis to the anterior commissure, 3) partial vocal cordectomy, 4) arytenoidectomy, 5) partial epiglottectomy and thyrohyoid dissection and 6) partial resection of the base of tongue with primary closure. All procedures were timed and documented with still and video photography. RESULTS: The daVinci Surgical Robot, with currently available instruments, enabled performance of several laryngeal and pharyngeal surgical procedures on a cadaver. Laryngeal and pharyngeal exposure was excellent, instruments movement was unimpeded, tissue handling was delicate and precise, and endolaryngeal suturing was relatively easily performed. The duration of the different robotic cadaver dissections was comparable to procedure duration using conventional techniques. CONCLUSIONS: Using the daVinci Surgical Robot, six different pharyngeal and microlaryngeal dissections were successfully performed in a cadaver. The recent development of surgical robotics has a potential role in pharyngeal and microlaryngeal surgery. Surgical robots offer the ability to manipulate instruments at their distal ends with increased freedom of movement, scaled movement, tremor buffering, and under stereoscopic three-dimensional visualization. Surgical robots may increase the precision with which we perform currently described procedures; additionally, surgical robots may advance the field of endoscopic laryngeal and pharyngeal surgery.

Robotic microlaryngeal surgery: a technical feasibility study using the daVinci surgical robot and an airway mannequin.

OBJECTIVES/HYPOTHESIS: The trend toward minimally invasive surgery has led to the development and mastery of endoscopic and laparoscopic surgical techniques. These minimally invasive approaches, which only two decades ago were either novel or experimental, are now mainstream. More recently, robot-assisted surgery has evolved as an adjunct to open and endoscopic techniques. Surgical robots are now approved by the United States Food and Drug Administration for a variety of thoracic and abdominal/pelvic surgical procedures. The purpose of this study is to demonstrate the technical feasibility of robot-assisted microlaryngeal surgery. STUDY DESIGN: Experimental surgical manipulation of the larynx in an airway mannequin with a surgical robot. METHODS: A variety of laryngoscopes and mouthgags, coupled with the daVinci Surgical Robot's (Intuitive Surgical, Sunnyvale, CA) 0-degree and 30-degree, two-dimensional and three-dimensional endoscopes, were utilized to optimize visualization of the larynx in an airway mannequin. Five millimeter and 8 mm microinstruments compatible with the daVinci robot were utilized to manipulate different elements of the larynx. Experiments were recorded with both still and video photography. RESULTS: The endoscope and robotic arms of the daVinci robot are well suited to airway surgery. CONCLUSIONS: Robot-assisted laryngeal surgery can be performed with currently available technology. The potential for fine manipulation of tissues, increased freedom of instrument movement, and endolaryngeal suturing may increase the precision of endoscopic laryngeal microsurgery and offers the potential to increase the variety of laryngeal procedures that can be performed endoscopically.

Tracheal anomalies in Pfeiffer syndrome.

OBJECTIVE: To determine the types and frequency of airway anomalies in patients with Pfeiffer syndrome. DESIGN: Retrospective case series. SETTING: Academic tertiary care pediatric hospital. PARTICIPANTS: Eleven patients with Pfeiffer syndrome, 6 of whom were severely affected, were identified. All were included in the study. MAIN OUTCOME MEASURES: Presence of tracheal anomalies, need for tracheotomy, and length of life. RESULTS: The 6 severely affected patients had mutations in genes that code for fibroblast growth factor receptor 2 (S351C [3 patients]; C342S [2 patients]; and W290C [1 patient]). Five of these patients were diagnosed during bronchoscopy or tracheotomy as having a congenital tracheal cartilaginous sleeve. In 1 patient, supportive care was withdrawn at 2 weeks of life, and the patient died. The remaining 5 patients required tracheotomy because of severe upper airway obstruction. Three of these patients died (at ages 9 months and 7 and 15 years). Two are still alive at ages 23 and 18 months. CONCLUSIONS: Patients with Pfeiffer syndrome manifest significant airway pathologic conditions. Upper airway obstruction is related to midface hypoplasia and secondary nasal obstruction. Tracheal anomalies have been infrequently reported.

Flexible bronchoscopic removal of a distal bronchial foreign body with cinefluoroscopic guidance.

A 15-year-old girl presented to the emergency department with cough and bloody sputum. A chest radiograph demonstrated a radiopaque foreign body (a tongue stud) in the right lower lobe. Rigid and flexible bronchoscopy failed to localize the foreign body. Under fluoroscopic guidance, the foreign body was identified in a right lower lobe distal bronchus; it could be visualized from a distance with a 3.5-mm flexible bronchoscope. An endobronchial biopsy forceps was passed through the suction port of the bronchoscope, but the view of the foreign body was obstructed by the biopsy forceps. The bronchoscope could not be advanced closer to the foreign body, because its diameter was greater than that of the bronchus. Under cinefluoroscopic guidance, the endobronchial biopsy forceps was then used to remove the foreign body. A chest radiograph obtained after removal was normal. The patient was discharged home the following day. Removal of distal bronchial foreign bodies can be challenging, because the bronchial diameter may preclude the advancement of the bronchoscope. Cinefluoroscopy is a relatively safe therapeutic adjunct that may avert the need for thoracotomy.

Diagnosis of pneumonia with an electronic nose: correlation of vapor signature with chest computed tomography scan findings.

OBJECTIVES/HYPOTHESIS: The electronic nose is a sensor of volatile molecules that is useful in the analysis of expired gases. The device is well suited to testing the breath of patients receiving mechanical ventilation and is a potential diagnostic adjunct that can aid in the detection of patients with ventilator-associated pneumonia. STUDY DESIGN: A prospective study. METHODS: We performed a prospective study of patients receiving mechanical ventilation in a surgical intensive care unit who underwent chest computed tomography (CT) scanning. A single attending radiologist reviewed the chest CT scans, and imaging features were recorded on a standardized form. Within 48 hours of chest CT scan, five sets of exhaled gas were sampled from the expiratory limb of the ventilator circuit. The gases were assayed with a commercially available electronic nose. Both linear and nonlinear analyses were performed to identify correlations between imaging features and the assayed gas signatures. RESULTS: Twenty-five patients were identified, 13 of whom were diagnosed with pneumonia by CT scan. Support vector machine analysis was performed in two separate analyses. In the first analysis, in which a training set was identical to a prediction set, the accuracy of prediction results was greater than 91.6%. In the second analysis, in which the training set and the prediction set were different, the accuracy of prediction results was at least 80%, with higher accuracy depending on the specific parameters and models being used. CONCLUSION: The electronic nose is a new technology that continues to show promise as a potential diagnostic adjunct in the diagnosis of pneumonia and other infectious diseases.

Pediatric submandibular triangle masses: a fifteen-year experience.

BACKGROUND: The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes. METHODS: We retrospectively reviewed the medical records of 105 patients aged 6 months to 21 years who underwent surgery in the submandibular triangle at a major pediatric tertiary care hospital from 1987 to 2001. RESULTS: One hundred five patients who underwent surgery in the submandibular triangle were included in the study. Twenty patients had neoplastic processes, six of which were of primary salivary origin (two mucoepidermoid carcinomas and four pleomorphic adenomas). Twenty-four patients underwent excision of inflamed or infected lymph nodes, and 23 patients underwent excision of inflamed or infected submandibular glands. Thirty-eight patients were included who underwent surgery for sialorrhea or to gain access for another surgical procedure. Complications included tumor recurrence, transient and permanent marginal mandibular nerve weakness, ranula, postoperative fluid collection, and cellulitis. Duration of follow-up ranged from no follow-up to 11 years. CONCLUSION: Surgical excision of submandibular triangle masses is uncommon. We present our experience with these lesions, with a discussion of diagnosis, surgical indications, and surgical complications.