Apneic Episodes and Sternal Retractions in an Infant

Abstract

An infant boy known to have a secondary cleft palate presented with apneic episodes and sternal retractions. He had been delivered vaginally at term, with the pregnancy complicated by preeclampsia and oligohydraminos.On examination there was a 3-cm, smooth, whitish tan mass emanating from the right lateral pharyngeal wall (Figure, A) and protruding down through the secondary cleft palate. A contrastenhanced maxillofacial computed tomographic (CT) scan was obtained. This revealed a well-defined, round heterogeneous, midline mass obstructing the oropharynx and posterior nasopharynx (Figure, B-D). The mass had a mildly enhancing thick wall with a central focus of decreased enhancement, with attenuation similar to fluid. No discrete foci of calcification or fat were identified.The child underwent an excision of this mass using the Coblator device (Arthrocare). Intraoperatively, the mass was seen to be pedicled from the right lateral pharyngeal wall in the tonsillar fossa. Findings from nasal endoscopy were unremarkable, with the exception of the mass being visible in the nasopharynx. He tolerated this procedure well and 6 months later underwent a palatoplasty for repair of the secondary cleft palate.What is your diagnosis?