title: Management of a prenatally diagnosed huge teratoma arising from the soft palate.
abstract: Teratomas arising from the oral cavity are relatively rare and can cause life-threatening airway obstruction immediately after birth. We report a case of a huge teratoma arising from the soft palate detected prenatally. To save the patient, a caesarean section and ex utero intrapartum treatment (EXIT) were planned at 29 weeks of gestation. However, during EXIT, the patient's cardiopulmonary status deteriorated due to unstable cord blood flow secondary to uterine contractions. EXIT was abandoned, the patient was delivered and an emergency tracheotomy performed. The tumour was successfully excised 4 hours after tracheotomy. The tumour weighed 1,591 g and was 20 x 22 x 12 cm. The patient, a female, weighed 715 g. Histopathology showed Grade II teratoma. The postoperative course was uneventful and she is now 5 years old with no neurological sequelae. EXIT is indicated in patients who have a high risk for airway obstruction immediately after birth. However, if EXIT must be abandoned, as in this case, urgent tracheotomy is mandatory. Planned prevention of airway obstruction at delivery is indispensable for successful outcome and requires excellent coordination among obstetricians, neonatologists, anaesthesiologists and paediatric surgeons.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tamura
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
authors.forename: Tadaharu
authors.initials: T
authors.lastname: Okazaki
authors.forename: Yataro
authors.initials: Y
authors.lastname: Hosoda
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyano
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010157:Palatal Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D010160:Palate, Soft; D011247:Pregnancy; D011296:Prenatal Diagnosis; D013724:Teratoma / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*