High procedural completion rate was observed across patients, sites, and approaches. All patients should be considered for in-office biopsy, a more time- and cost-effective option leading to earlier treatment.

This study suggests that pain, a rapidly enlarging neck mass, and younger age are predictive factors of underlying malignancy, which should prompt one to consider an aggressive diagnostic and management approach.

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Paper gowns demonstrated less bacterial transmission in the laboratory and lower rates of contamination in the operating room. Disposable paper gowns are recommended for all surgical cases, especially those involving implants, because of the heightened risk of infection. Outer glove exchange just before handling implant materials is also recommended to minimize intraoperative contamination.

Objectives: 1) Analyze the impact of a new postoperative care protocol on complications, including skin breakdown. 2) Analyze the safety of performing the first tracheostomy tube change prior to postoperative day 5. Methods: Retrospective case series in an academic medical center. Patients: Pediatric patients undergoing tracheostomy from February 2010 to February 2013. Intervention: In 2012 a new protocol was instituted for pediatric tracheostomy care in the immediate postoperative period that included: 1) securing tracheostomy tubes with Velcro straps rather than twill ties, 2) placing a clean drain sponge around the tracheostomy tube daily, and 3) performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome Measures: 1) Rate of complications, including skin breakdown, related to the tracheostomy tube and securing straps. 2) Presence of a mature stoma allowing for a safe first tracheostomy tube change. Results: 37 patients in the pre-protocol group and 16 in the post-protocol group were analyzed. Rate of skin breakdown related to the tracheostomy tube or securing straps was significantly higher in the pre-protocol group (32.40% vs. 0%, P = 0.01). There was a trend towards a higher overall complication rate change in the pre-protocol group, but this was not statistically different (18.90% vs. 0%, P = 0.062). In the post-protocol group, all tube changes were safely performed on postoperative day three or four. Conclusions: This new care protocol for pediatric tracheostomies resulted in decreased rates of skin breakdown. In addition, pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively.