METHODS: Expert recommendations on the diagnosis, management, surgical and post-operative considerations for TGDC were established through a multi-iterative Delphi-consensus survey of pediatric otolaryngologists.
RESULTS: The survey participants included 33 pediatric otolaryngologists from 18 different countries. The consensus recommendations are as follows: 1) ultrasound is the preferred diagnostic imaging modality, with cross-sectional imaging considered in the setting of an uncertain or complicated clinical presentation; 2) an open trans-cervical approach with removal of the central hyoid bone; 3) intra- and post-operative administration of antibiotics in the setting of active TGDC infection; 4) post-operative admission in patients with comorbidities or if a drain is employed.
CONCLUSION: Consensus was achieved for several diagnostic and surgical considerations in the management of children with TGDC. As there remains variability in opinion on other aspects of management, clinicians may need to provide a nuanced approach in the context of individual patient factors and institutional circumstances.
MATERIALS AND METHODS: Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature.
RESULTS: Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions.
CONCLUSION: The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management.