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McMahon, Michael J. MD, MPH; Chescheir, Nancy C. MD; Kuller, Jeffrey A. MD; Wells, Steven R. MD; Wright, Lydia N. MD; Nakayama, Don K. MD
Obstetrics & Gynecology:
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Background: Teratomas of the head and neck are and occur almost exclusively in neonates. Prenatal diagnosis of these tumors allows for a carefully planned delivery that maintains an open airway and potentially imporves perinatal outcome. We report the perinatal management of a huge intrapharyngeal and intra-oral teratoma that had a broad connection to the base of the tongue.

Case: An anterior neck mass (5x5 cm) in an otherwise normal-appearing fetus was detected at 19 weeks' gestatin. The mass increased in size over the next 10 weeks to 8 X 6.8 X 4.3 cm. Marked fetal head deflexion ws noted along wiht concomitant hydramnios. The mother had spontaneous repture of membrances with preterm labor at 29 weeks' gestation. A 1860-g male neonate was delivered by classical cesarean delivery. A tracheostomy was performed in the delivery room for ventilation after the upper aiway could not be accessed by bronchoscopy. Histology examination after surgical excision confirmed a congenital teratoma with immature neuroectodemal tissue and alpha-fetoproteinbgeaing endodermal sinus tumor components with exclusively polyvesicular vitelline charcteristics. The origin of the pharynegel mass was the base of the tongue.

Conclusion: The prenatal diagnosis of a pharyngeal teratoma should prompt a careful delivery plan to optimize perinatal outcome.

(C) 1996 The American College of Obstetricians and Gynecologists