Fetal MRI assessment of head & neck vascular malformation in predicting outcome of EXIT-to-airway procedure

• Published in: Case reports in perinatal medicine Vol. 10; no. 1
• Main Authors: Baseri Huddin, Azzam, Abu Hassan, Hasyma, Mohd Jamil, Amilia Afzan, Mohd Nor, Khadijah, Velayudham, Vairavan@Ramesh
• Format: Journal Article
• Language: English
• Published: Berlin De Gruyter 01.01.2021; Walter de Gruyter GmbH
• Subjects: Airway management; Case reports; Cesarean section; Emphysema; EXIT procedure; fetal airway obstruction; fetal MRI; Fetuses; Health sciences; Intubation; Larynx; Otolaryngology; Sepsis; Ultrasonic imaging; vascular malformation
• ISSN: 2192-8932; 2192-8959
• DOI: 10.1515/crpm-2020-0063

The objective of this clinical case report is to highlight the MRI features and staging system which may guide clinicians in determining further management.Three different cases with fetal head and neck vascular malformation diagnosed during prenatal screening were presented. MRI demonstrates large cystic neck masses which may compromise fetal airway during delivery. Thus, this required multidisciplinary team management among obstetricians, otolaryngologists, pediatricians, anesthesiologists, and radiologists. A decision for complex birth delivery through the cesarean section aided with EXIT-to-airway procedure was made. Each of these procedures demonstrates the different challenges and outcomes of the neonates which correlated with the characterization and staging based on prenatal MRI.EXIT-to-airway procedure in head and neck malformation may be beneficial in transiting complicated and potentially catastrophic delivery situations to a more controlled environment. However, it also needs to align with prenatal MRI evaluation, which provides a more objective assessment guide for the clinicians.