An unusual cause of inspiratory stridor in the newborn: congenital pharyngeal teratoma – a case report

Abstract

BackgroundNeonatal inspiratory stridor is an important examination finding that requires immediate and adequate evaluation of the underlying etiology. Depending on the severity of the airway obstruction and the presence or absence of associated symptoms such as respiratory distress and feeding problems, early initiation of a complete diagnostic workup can be crucial. The most common cause of neonatal inspiratory stridor is laryngomalacia, however, several differential diagnoses need to be investigated. More rare causes include oral or laryngeal masses. Teratomas of the head and neck region are one of the most unusual causes of respiratory distress during the neonatal period. We present a case of a mature teratoma in the oropharynx presenting with airway obstruction in a newborn infant.Case presentationA four-day-old female Caucasian infant was admitted to the neonatal intensive care unit of our hospital because of inspiratory stridor and profound desaturations while feeding. Diagnostic workup by ultrasound, magnetic resonance imaging and flexible endoscopy revealed a pediculated lesion in the pharyngeal region causing intermittent complete airway obstruction. The mass was surgically removed by transoral laser resection on the seventh day of life. Histological evaluation was consistent with a mature teratoma without any signs of malignancy. The further hospital course was uneventful, routine follow-up examinations at 3, 6 and 9 months of age showed no evidence of tumor recurrence.ConclusionNeonatal stridor is a frequent symptom in the neonatal period and is mostly caused by non-life-threatening pathologies. On rare occasions, however, the underlying conditions are more critical. A careful stepwise diagnostic investigation to rule out these conditions, to identify rare causes and to initiate early treatment is therefore warranted.

Challenges in removal of congenital nasopharyngeal teratoma in a 5 day old neonate

“…Teratomas are one of the main tumor types encountered in the newborn period out of which teratomain the nasopharynx is a rare entity comprising only 10% of them. 1 Teratomas are true neoplasms originating from pluripotent cells and are composed of tissues from all three germinal layers. In childhood, these teratomas are usually reported as benign and seen most commonly in association with polyhydramnios as seen in our case.…”

“…Other symptoms include failure to thrive, difficulty in feeding, dyspnea. 1 Imaging studies are helpful in aiding diagnosis in addition to showing location and extent. 3 In the present case, both CT scan and MRI with contrast, identified the nasopharyngeal mass and differentiating it from other tumours and in addition provided valuable information about skull base extension and suspected vascularity.…”

“…Tumors of the head and neck region are among the more unusual causes of airway obstruction in the neonatal period. 1 Teratomas are the common tumors encountered in the newborn period. The head and neck region is seldom involved; oropharyngeal and nasopharyngeal teratomas account for less than 10% of all neonatal germ cell tumors.…”

“…The head and neck region is seldom involved; oropharyngeal and nasopharyngeal teratomas account for less than 10% of all neonatal germ cell tumors. 1 We present the rare case of a nasopharyngeal teratoma which was not identified in utero and presented with inspiratory stridor and critical airway obstruction in a newborn at birth which was successfully removed by novel coblation technique.…”

Estridor inspiratorio en neonato por neuroblastoma cervical. Descripción de un caso

“…Otras causas como anomalías cardiovasculares, parálisis de cuerda vocal, malformaciones linfáticas, tumores sólidos etc., son menos comunes, pero presentan riesgo de obstrucción completa de la vía aérea. Por lo tanto, se requiere un examen exhaustivo e inicio precoz de un diagnóstico diferencial completo [1]. El neuroblastoma es el tumor sólido más frecuente en la infancia, representando más del 30% de cánceres infantiles.…”