Heterotopic neuroglial tissue causing airway obstruction in the newborn.
BACKGROUND
Heterotopic neuroglial (brain) tissue is a rare cause of airway obstruction in newborns. Fewer than 30 cases have been reported in the English literature. Brain heterotopias can mimic more common congenital anomalies of the head and neck.


OBJECTIVE
To review our experience in the diagnosis and treatment of children with heterotopic pharyngeal neuroglial tissue.


METHODS
Case series.


METHODS
Tertiary care children's hospital.


METHODS
Four newborns with airway obstruction caused by heterotopic neuroglial tissue.


RESULTS
All patients were infants (3 full-term girls and a 32 weeks' gestation boy) who had airway obstruction in the newborn period. All patients underwent preoperative computed tomography and magnetic resonance imaging, which revealed a heterogeneous mass involving the pharynx, neck, and parapharyngeal space. Bony deformities of the skull base and mandible were present in all patients, although intracranial connection was absent. Multiple surgical procedures were performed in all 4 patients. Tracheotomy was performed in 2 patients, gastrostomy tube placement was required in 3, and a nasopharyngeal tube was used in 1. Combined cervicofacial and transoral approaches were used for resection, preserving vital structures. Histopathologic evaluation revealed mature glial tissue and choroid plexus-like structures.


CONCLUSIONS
Heterotopic neuroglial tissue must be considered in the differential diagnosis of airway obstruction in the newborn. Management is surgical resection, with attention to vital structures and function-analogous to surgery for lymphangioma. Multiple surgical procedures might be necessary in the treatment of these patients.
Behar
P M
PM
Department of Pediatric Otolaryngology, The Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222, USA. pmbehar@aol.com
Muller
S
S
Gerber
M E
ME
Todd
N W
NW
D000402:Airway Obstruction / Q000151:congenital* / Q000209:etiology; D002828:Choristoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009457:Neuroglia; D010608:Pharyngeal Diseases / Q000150:complications* / Q000151:congenital / Q000000981:diagnostic imaging; D011859:Radiography