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Dorra C, Nadia R, Selima J, Maya C, Achraf C, Chiraz M. A rare etiology of infantile dyspnea: Oropharyngeal teratoma. Int J Surg Case Rep 2024; 122:110062. [PMID: 39121721 PMCID: PMC11363839 DOI: 10.1016/j.ijscr.2024.110062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/14/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Oropharyngeal teratoma is a rare congenital tumor that grows slowly and can be suspected prenatally. It entails the obstruction of upper airway and upper digestive tract. Clinical examination is always completed by imaging particularly the MRI. CASE PRESENTATION We present a case of an eight- month -old infant who presented an oropharyngeal mass which caused intermittent dyspnea and feeding difficulties. DISCUSSION The treatment is only surgical and histopathological examination confirms the diagnosis. CONCLUSION Early diagnosis is key to successful management of oropharyngeal teratomas.
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Affiliation(s)
- Chiboub Dorra
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Jouini Selima
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia.
| | - Cherif Maya
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Chedly Achraf
- Cytopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Mbarek Chiraz
- ENT Department, Habib Thameur Hospital, Tunis, Tunisia
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Fetal Oropharyngeal Teratoma: A Case Report. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Narayan R, Ahmad MS, Kumar A. Fetal Oropharyngeal Teratoma: Prenatal Diagnosis and Imaging Characteristics. Cureus 2020; 12:e11329. [PMID: 33304667 PMCID: PMC7719477 DOI: 10.7759/cureus.11329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fetal oropharyngeal teratoma (OPT) is an extremely rare disorder. This generally originates from the upper jaws that are connected to the hard palate. Pregnant women with fetal OPT usually present with oropharyngeal mass and polyhydramnios. Ultrasound can help in the pre-natal diagnosis of this condition, although magnetic resonance imaging (MRI) is useful for further characterization of the lesion. Because of severe obstruction to airways, OPTs are associated with high morbidity and mortality rates during peripartum period. We present here a case of fetal OPT with imaging characteristics with respect to the antenatal diagnosis.
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Affiliation(s)
- Ruchika Narayan
- Radiodiagnosis/Gastroenterology, Narayan Medical College and Hospital, Sasaram, IND
| | - Md Shamim Ahmad
- Radiodiagnosis, Narayan Medical College and Hospital, Sasaram, IND
| | - Amit Kumar
- Radiodiagnosis, Narayan Medical College and Hospital, Sasaram, IND
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Novoa RH, Quintana W, Castillo-Urquiaga W, Ventura W. EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature. J Pediatr Surg 2020; 55:1188-1195. [PMID: 32151401 DOI: 10.1016/j.jpedsurg.2020.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 11/24/2019] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To provide a comprehensive overview of the perinatal and maternal outcomes of fetuses undergoing EXIT surgery for the management of fetal airway obstruction secondary to cervical or oral tumors. METHODS A comprehensive search from inception to September 2018 was conducted on databases including MEDLINE, EMBASE, Cochrane Library and LILACS. All studies that reported an EXIT surgery in singleton were considered eligible. A descriptive analysis was performed. RESULTS Out of the 250 full-text study reports, 120 articles reporting 235 cases of EXIT surgery were included. EXIT surgery was performed at 35.1 weeks of gestation on average. The most frequent diagnosis was teratoma (46.4%, n = 109/235). There were 13 adverse maternal events, and the most frequent one was postpartum hemorrhage (4.7%, n = 11/235). No maternal death was reported. Fetal and neonatal death occurred in 17% (40/235) of the cases. There were 29 adverse fetal events (12.2%), and the most frequent one was the failure of intubation or tracheostomy (3.4%, n = 8/235). CONCLUSION EXIT surgery could be considered for the management of an oral or cervical tumor that's highly suspicious of blocking the fetal airway. This systematic review reports that EXIT surgery poses substantial risks of maternal and fetal adverse events, including neonatal death. LEVEL OF EVIDENCE IV case series with no comparison group.
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Affiliation(s)
- Rommy H Novoa
- Resident trainee in Ob/Gyn Department of Obstetrics and Gynecology, InstitutoNacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Willy Quintana
- Resident trainee in Ob/Gyn Department of Obstetrics and Gynecology, InstitutoNacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Walter Ventura
- Fetal Medicine Unit, Instituto Nacional Materno Perinatal, Lima, Peru; Fetal Medicine Unit, Clinica Delgado, Grupo AUNA, Lima, Peru.
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Tranvinh E, Yeom KW, Iv M. Imaging Neck Masses in the Neonate and Young Infant. Semin Ultrasound CT MR 2015; 36:120-37. [DOI: 10.1053/j.sult.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bhatnagar A, Verma VK, Purohit V. Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty. Natl J Maxillofac Surg 2013; 4:114-6. [PMID: 24163567 PMCID: PMC3800373 DOI: 10.4103/0975-5950.117817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.
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Affiliation(s)
- Ankur Bhatnagar
- Department of Plastic Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lulla C, Hegde A, Thakur P. Antenatal 3-dimensional sonographic diagnosis of fetal oropharyngeal teratoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:305-307. [PMID: 18386813 DOI: 10.1002/jcu.20438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a case of a large fetal oropharyngeal teratoma in a 19-week fetus evaluated with 3-dimensional (3D) sonography. The 3D sonographic surface and maximum mode rendering of the tumor allowed detailed visualization of the mass lesion and thus enabled active patient participation in the management of the pregnancy.
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Affiliation(s)
- Chander Lulla
- The Ria Clinic, B44 Gita, Pandita Ramabai Road, Gamdevi, Mumbai, Maharashtra, India 400007
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8
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Abstract
Fetal surgery has emerged from the realm of medical curiosity into an exciting, multidisciplinary specialty now capable of improving patient outcomes for a wide variety of diseases. Recent advances allow prenatal providers to both accurately diagnose and treat many fetal anomalies while maintaining maternal safety. As the initial postnatal health care providers to the majority of these newborns, neonatologists need to be familiar with some of the more recent state-of-the-art procedures currently being used. In this review, the authors discuss the prenatal evaluation process and various operative approaches (ie, open hysterotomy, fetoscopy, and percutaneous) to conduct fetal surgery. They then analyze the effectiveness of some of the more established and experimental prenatal therapies that are being performed for a number of fetal anomalies, including twin-twin transfusion syndrome, thoracic malformations, airway obstruction, congenital diaphragmatic hernia, myelomeningocele, and aortic valve stenosis.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Abstract
Ultrasonography is the screening method of choice for the evaluation of the fetus. It is safe, inexpensive, and easily performed. However, it is operator dependent, and evaluation may be limited because of fetal position, maternal obesity, overlying bone, and/or oligohydramnios. Magnetic resonance imaging is an alternative modality that uses no ionizing radiation, has excellent tissue contrast and a large field of view, is not limited by obesity or overlying bone, and can image the fetus in multiple planes, no matter the fetal lie. Faster scanning techniques allow studies to be performed without sedation in the second and third trimester with minimal motion artifact.
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Affiliation(s)
- Dorothy Bulas
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010, USA.
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Araujo Júnior E, Guimarães Filho HA, Saito M, Pires AB, Pontes ALS, Nardozza LMM, Moron AF. Prenatal diagnosis of a large fetal cervical teratoma by three-dimensional ultrasonography: a case report. Arch Gynecol Obstet 2006; 275:141-4. [PMID: 16770588 DOI: 10.1007/s00404-006-0180-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
CONTEXT The cervical teratomas are rare, benign tumors, they are formed by the three embryonic layers, and they represent only 6% of teratomas. The prognosis depends mainly on the size and location of the lesion, on the tumor growth rate, and on the level of tracheal compression. Prenatal diagnosis is usually reached with the aid of a two-dimensional ultrasonography (2DUS) after the 15th week of gestation, which shows a large heterogeneous mass in the cervical region, plus a polyhydramnios, on the Doppler mode which also shows the vascularization of the tumor. CASE REPORT We report a case of cervical teratoma diagnosed on the 31st week of gestation with the aid of a 2DUS and color Doppler mode. We focus on the main findings obtained with the three-dimensional ultrasonography in surface mode, and we highlight the importance of this methodology for the indirect evaluation of the neonatal prognosis.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Sao Paulo's Federal University (Unifesp/EPM), Napoleão de Barros Street, 871 Vila Clementino, 04024-002 São Paulo, Brazil.
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Kdous M, Hachicha R, Risk E, Sauvanet E. Tératome fœtal du rhinopharynx : diagnostic anténatal et pronostic. À propos d'un cas. ACTA ACUST UNITED AC 2006; 34:403-6. [PMID: 16650795 DOI: 10.1016/j.gyobfe.2005.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 06/24/2005] [Indexed: 11/18/2022]
Abstract
Fetal teratomas are commonly found in the sacrococcygeal area. More rarely, these tumors may be found in cervicofacial forms. Rhinopharyngeal teratoma represent an extremely rare congenital tumor, often resulting in intracranial extension, obstruction of the respiratory or the digestive pathways and rapid asphyxia following birth. We report a case of rhinopharyngeal teratoma identified in a foetus at 18 weeks of gestation. The diagnosis was made by antenatal ultrasound and IRM. Tumor invaded the cavum and the right infratemporal region with no intracranial extension. The pregnancy was interrupted at 27 weeks of gestation. Authors discuss the difficulties to establish antenatal diagnosis by ultrasound, and those to decide what treatment to carry out.
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Affiliation(s)
- M Kdous
- Service de Gynécologie-Obstétrique, Hôpital Notre-Dame-du-Bon-Secours, 68, Rue des Plantes, 75674 Paris cedex 14, France.
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Eschertzhuber S, Keller C, Mitterschiffthaler G, Jochberger S, Kühbacher G. Verifying Correct Endotracheal Intubation by Measurement of End-Tidal Carbon Dioxide During an Ex Utero Intrapartum Treatment Procedure. Anesth Analg 2005; 101:658-660. [PMID: 16115970 DOI: 10.1213/01.ane.0000175206.91231.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ex utero intrapartum treatment (EXIT) procedure provides time to secure the airway of the fetus while utero-placental circulation supplies the fetus with oxygen. We report the anesthetic management of a fetus with a large neck mass during an EXIT procedure in which the confirmation of correct endotracheal intubation was hampered by parts of the mass, blood, and other fluids. The use of a standard end-tidal carbon dioxide probe provided a reliable signal and proved the endotracheal position of the tube while utero-placental circulation was still intact.
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Affiliation(s)
- Stephan Eschertzhuber
- Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:93-8. [PMID: 15706703 DOI: 10.1002/pd.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Fetal tumors are a diverse group of neoplasms, which are unique in their histologic characteristics, anatomic distribution, and pathophysiology. The biologic behavior of tumors in the fetus may differ dramatically compared with that of the same tumor detected later in life. Teratomas are the dominant histologic type and constitute the majority of both extracranial and intracranial neoplasms. Although often histologically mature, they may prove lethal because of their location and metabolic demands on the fetus. Large solid tumors may lead to cardiovascular compromise and hydrops fetalis. Extracranial teratomas are most commonly located in the sacrococcygeal area, followed by the head and neck, chest, and retroperitoneum. Fetuses with intracranial tumors have a poor prognosis regardless of histologic type. There are, however, two notable exceptions: lipomas and choroid plexus papillomas, both of which have a more favorable outcome. Neuroblastoma is the most common fetal malignancy. It may be either solid or cystic and is more often located on the right side. It typically has favorable biologic markers and stage at presentation. The prognosis for prenatally diagnosed cases is excellent. Other fetal neoplasms include soft-tissue tumors (both benign and malignant), leukemia, mesenchymal hamartoma of the kidney, and liver tumors (hemangioendothelioma, mesenchymal hamartoma, and hepatoblastoma).
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th and Alaska Ave NW, Washington, DC 20306-6000, USA.
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