Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure

Abstract

Oropharyngeal and neck tumors are rarely seen in fetal life. The lesions located in the area involve cystic hygroma, teratoma, ranula, epulis, hemangioma, congenital goiter, solid thyroid tumor, thyroid cyst or thyroglossal duct cyst, branchial cleft cyst, neuroblastoma and hamartoma. The most common types are cervical teratoma and cystic hygroma (1). These tumors have the potential to obstruct the airway, which can be life threatening, and endotracheal intubation can be difficult or impossible due to anatomic distortion.The aim of the ex-utero intrapartum therapy (EXIT) procedure is to maintain the newborn's airway open during placental circulation after the partial delivery of a fetus, and, in this way, to protect the fetus from hypoxia until providing an open airway (2). As fetoplacental circulation continues, endotracheal intubation is implemented for opening the airway of the fetus. If this is not possible, other interventions such as bronchoscopy or tracheostomy and excision of the mass can be applied (1-3). However, the EXIT procedure is not a treat- Background:The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. Case Report: Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. Conclusion: The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.