Congenital Oral and Pharyngeal Masses: Diagnosis, Management, and Prognosis

Abstract

Objective: Understand the complex management and prognosis of patients with congenital oral and pharyngeal masses that cause cleft palate. To understand the multifaceted role of the pediatric otolaryngologist in the care of these patients. Method: Retrospective study of all patients with oral or pharyngeal masses and cleft palate or velopharyngeal insufficiency treated in one year at a tertiary care institution. Charts were reviewed for age; gender; comorbidities; birth history; location and pathology of the mass; surgical treatment; and follow-up care. Results: There were 5 patients, 21-months to 24-years-old, 3 of whom had other congenital anomalies. Three patients had large oral masses (2 hamartomas and 1 teratoma). Two patients had pharyngeal masses (teratomas). Four patients had cleft palate, all repaired by 1 year, 2 with later pharyngeal flaps. One patient with an intact but short palate underwent a pharyngeal flap at 6 year. One patient with a large oral mass had significant airway compromise at birth. Two patients underwent tracheotomy, and one was decannulated at 18 months. Additional surgeries were performed in all patients, including tympanostomy (2 patients), tonsillectomy (2 patients), maxillary and mandibular advancement (1 patient), and gastrostomy (1 patient). Conclusion: Congenital oral or pharyngeal masses may cause cleft palate. Otolaryngologists are involved in care from initial airway management and excision to reconstruction and rehabilitation of speech and swallow. After excision, most patients will have a stable airway and tolerate an oral diet. Additional surgeries are often performed for associated comorbidities.