Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature

Gaffuri, Michele; Torretta, Sara; Iofrida, Elisabetta; Cantarella, Giovanna; Borzani, Irene; Ciralli, Fabrizio; Calderini, Edoardo; Leva, Ernesto; Iurlaro, Enrico; Mosca, Fabio; Pignataro, Lorenzo

doi:10.1016/j.jpedsurg.2018.09.018

Cited by 25 publications

(23 citation statements)

References 33 publications

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“…Prognosis of fetal lymphatic malformation has been related to lesion size, cystic and solid components, and presence of septations. 20,26,[28][29][30][31] In the 13 cases presented, we found no association whatsoever between location, lesion size or classification 20…”

Section: Discussionmentioning

confidence: 56%

Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years

Ulm

Muin

Scharrer

et al. 2020

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 56%

Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years

Ulm

Muin

Scharrer

et al. 2020

Acta Obstet Gynecol Scand

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“…El algoritmo de la técnica EXIT se describe en la figura 3. La incisión quirúrgica puede ser mediana abdominal o transversal inferior (tipo Pfannenstiel) y posterior a la histerotomía transversal inferior (tipo Keer), se extrae la cabeza fetal, la parte superior del tórax y al menos una extremidad superior 4 . Como es necesario evitar el esfuerzo respiratorio y los movimientos del cuerpo para lograr la intubación orotraqueal, puede ser necesario administrar anestesia fetal justo después de extraer un miembro superior, por vía intramuscular en el deltoides 17,18 .…”

Section: Discussionunclassified

“…Para esto se requiere la intervención de un equipo multidisciplinar de neonatólogos, otorrinolaringólogo, anestesiólogo, gineco-obstetra, cirujano pediatra, enfermeros y terapeutas respiratorios entrenados en cuidado materno-fetal. Por ello, el diagnóstico prenatal a través de una resonancia magnética (RM) es fundamental 4 .…”

Section: Introductionunclassified

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello

Mosquera-Hernández

Ardila-Giraldo

et al. 2020

Rev Chil Pediatr

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Las masas congénitas de cabeza y cuello se asocian a asfixia perinatal e injuria cerebral con elevada mortalidad. La técnica EXIT (Ex Útero Intrapartum Treatment) consiste en asegurar la vía aérea del neonato, sin interrumpir la oxigenación y perfusión materno-fetal a través del soporte placentario. Esta técnica no ha sido estandarizada en países de medianos ingresos.Objetivo: Describir el caso clínico de 2 neonatos manejados mediante la técnica EXIT.Caso Clínico: Se reportan dos casos, uno con malformación linfática diagnosticada a la semana 20 gestación y el segundo con tiromegalia y polihidramnios diagnosticados a la semana 35 de gestación. En ambos casos, durante la cesárea se realizó la técnica EXIT con un equipo conformado por neonatólogo, ginecólogo, anestesiólogo, cirujano pediatra, otorrinolaringólogo, enfermero y terapeuta respiratorio. En los dos pacientes se logró asegurar la vía aérea mediante intubación orotraqueal al primer intento. En el caso 1 se confirmó la malformación linfática y recibió escleroterapia, y en el caso 2 se diagnosticó hipotiroidismo congénito asociado a bocio, que fue manejado con levotiroxina. Los pacientes se mantuvieron 7 y 9 días con ventilación mecánica invasiva respectivamente y egresaron sin complicaciones respiratorias.Conclusiones: La técnica EXIT en estos casos fue un procedimiento seguro, llevado a cabo sin inconvenientes. Se necesita un equipo multidisciplinario y la disponibilidad de una unidad de cuidados intensivos neonatales, con el objetivo de reducir potenciales complicaciones y garantizar el manejo postnatal. Para lograr su ejecución, es indispensable el diagnóstico prenatal oportuno.

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“…8 In such instances where EXIT-to-airway or EXIT-toresection is needed, prenatal consultation with a multidisciplinary team including otolaryngology and obstetrics is required to understand patient-specific factors, interpret in-utero imaging, and anticipate delivery timing and needs. 9,10 While in-utero imaging has improved since EXIT procedures were first performed in the early 1990s, identification of specific findings indicating the need for EXIT has been difficult. This is due to the rarity of these procedures, making randomized trials impossible, as well as the lack of standardized data reporting, and paucity of long-term follow-up data.…”

Section: Introductionmentioning

confidence: 99%

Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT

et al. 2020

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Objective: Detection of fetal airway compromise through imaging raises the possible need for ex utero intrapartum treatment (EXIT) procedures. Despite EXIT procedures involving massive resource utilization and posing increased risk to the mother, decisions for EXIT are usually based on anecdotal experience. Our objectives were to analyze prenatal consultations with potential fetal airway obstruction for imaging and obstetric findings used to determine management strategy. Methods: Retrospective chart review was performed for prenatal abnormal fetal airway consults between 2004-2019 at a quaternary pediatric facility. Data collected included demographics, imaging characteristics, delivery information, and airway management. Our primary outcome was EXIT performance and the secondary outcome was postnatal airway management. Fisher's exact test was used to compare management decisions, outcomes, and imaging findings. Results: Thirty-seven patients met inclusion criteria. The most common diagnoses observed were lymphatic malformation, teratoma, and micrognathia. Of the imaging findings collected, only midline neck mass location was associated with EXIT procedure performance. Factors associated with invasive airway support at birth were mass-induced in-utero neck extension and neck vessel compression, polyhydramnios, and micrognathia. Conclusions: Multidisciplinary input and interpretation of prenatal imaging can guide management of fetal airway-related pathology. EXIT is an overall safe procedure and can decrease risk due to airway obstruction at birth. We identified in-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios as better indicators of a need for invasive airways measures at birth and suggest use of these criteria in combination with clinical judgement when recommending EXIT.

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Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature

Cited by 25 publications

References 33 publications

Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years

Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years

Técnica EXIT como manejo de la vía aérea en masas gigantes congénitas de cuello

Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT

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