title: The impact of 3-dimensional ultrasonography on perinatal management of a large epignathus teratoma without ex utero intrapartum treatment.
abstract: We report a case of epignathus teratoma diagnosed at 22 weeks of gestation in which 3-dimensional ultrasound (3DUS) was useful to plan perinatal management. A significant enlargement of the tumor, associated with polyhydramnios and preterm labor, was observed at 35 weeks of gestation. After amniotic fluid evacuation, 3DUS was performed in the presence of pediatricians, obstetricians, and otolaryngologists. Three-dimensional ultrasound revealed that great part of the tumor was located outside the fetal mouth and anterior to fetal mandible, suggesting that the newborn could breathe spontaneously by nasal via. A cesarean section with longitudinal hysterotomy was performed at 36 weeks followed by an immediate extirpation of the tumor and the intubation of the newborn. The management of this rare case illustrates that the ex utero intrapartum treatment (EXIT) procedure is not always necessary in this situation. Besides, the actual prenatal goal consists on carefully selecting fetuses with epignathus teratoma that will need the EXIT procedure from those that will not. Three-dimensional ultrasound and magnetic resonance imaging in association with 2DUS can be helpful in this prenatal selection.
authors.affiliation: Maternité, Hôpital Necker-Enfants Malades AP-HP, Université de Paris V, France, 75743 Paris Cedex 15, France. rodrigoruano@hotmail.com
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.forename: Marie-Cecile
authors.initials: MC
authors.lastname: Aubry
authors.forename: Sophie
authors.initials: S
authors.lastname: Parat
authors.forename: Marc
authors.initials: M
authors.lastname: Dommergues
authors.forename: Yves
authors.initials: Y
authors.lastname: Manach
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D013724:Teratoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D016216:Ultrasonography, Prenatal