title: Comprehensive airway management of neonatal head and neck teratomas.
abstract: OBJECTIVE
  To determine the success of initial airway management and to characterize late airway-related complications in patients with airway obstruction due to congenital head and neck teratomas.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary airway referral institution.
  
  
  METHODS
  Review of consecutive patients with congenital head and neck teratomas from 1988 to 2010. Variables examined include initial airway stabilization at time of birth and perinatal airway management. Outcomes include short- and long-term complications.
  
  
  RESULTS
  Fourteen cases were reviewed. In 12 patients, initial airway management was accomplished on placental support with either intubation or tracheotomy. Two vaginal births required subsequent uncomplicated oral intubation within 24 hours. Nine patients required tracheotomy (3 within the delivery suite, 2 during mass excision on day of life 6 and 24, and the remaining 4 occurred at days 29, 32, 92, and 100). Five deaths occurred, 4 within several days of birth due to complications related to the cervical teratomas and 1 on day of life 32 due to an airway-related complication. Follow-up for surviving patients ranged from 1 month to 18 years. Long-term airway complications ranged from vocal cord paralysis to stenosis requiring laryngotracheoplasty.
  
  
  CONCLUSIONS
  This study demonstrates that a multidisciplinary team and a standardized approach in the operating suite have led to successful initial airway stabilization. Furthermore, this study demonstrates the need for continued airway management after delivery. Reassessment of the airway after delivery and an airway management planning meeting with the multidisciplinary team may help decrease morbidity and mortality.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, and Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA. neidicmj@ucmail.uc.edu
authors.forename: Marci J
authors.initials: MJ
authors.lastname: Neidich
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Prager
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Clark
authors.forename: Ravindhra G
authors.initials: RG
authors.lastname: Elluru
mesh_terms: D058109:Airway Management / Q000379:methods*; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D011379:Prognosis; D012189:Retrospective Studies; D013724:Teratoma / Q000150:complications / Q000601:surgery / Q000628:therapy*; D014140:Tracheotomy / Q000379:methods*