Airway management of three cases of congenital cervical teratoma

• Published in: Pediatric anesthesia Vol. 16; no. 7; pp. 794 - 798
• Main Authors: HULLETT, BRUCE J., SHINE, NEVILLE P., CHAMBERS, NEIL A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2006; Blackwell
• Subjects: Adult; airway obstruction; Airway Obstruction - congenital; Airway Obstruction - etiology; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; cervical teratoma; Cesarean Section; congenital neck mass; Female; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - congenital; Head and Neck Neoplasms - surgery; Humans; Infant, Newborn; Medical sciences; neonatal; Pregnancy; Prenatal Diagnosis; Respiration, Artificial; Teratoma - complications; Teratoma - congenital; Teratoma - surgery; Tomography, X-Ray Computed; Human; Teratoma; Congenital; Respiratory disease; cervical teratoma; neonatal; congenital neck mass; airway obstruction; Clinical management; Newborn; Tumor; Anesthesia; Airways obstruction; Neck
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2006.01859.x

Summary Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size they may attain can potentiate life‐threatening upper airway obstruction. All cases require the specialist airway skills of the pediatric anesthetist. This may be planned, in the case of antenatally diagnosed lesions, when the pediatric anesthetist is part of a multidisciplinary team involved in an EX utero Intrapartum Treatment (EXIT) or Operation On Placental Support (OOPS) procedure, or when a neonate is undergoing elective excision in the early neonatal period as definitive treatment. Alternatively the anesthetist may be called upon urgently to secure a compromised airway immediately postpartum when no antenatal diagnosis has been made. Furthermore, after elective surgical excision, airway compromise is possible, which may again require anesthetic intervention. The aim of this study is to report the authors’ experience in managing the airway in three cases of congenital cervical teratoma in the study institution over the last 24 months. These cases highlight the possible airway scenarios that may confront the anesthetist in the immediate postpartum, elective surgery and postoperative stages and the variety of techniques that may be employed in order to overcome the potential difficulties encountered.