title: EXIT (Ex utero Intrapartum Treatment) in lymphatic malformations of the head and neck: discussion of three cases and proposal of an EXIT-TTP (Team Time Procedure) list.
abstract: OBJECTIVE
  Ex utero Intrapartum Treatment (EXIT) is a technique to secure the fetal airway while oxygenation is maintained through utero-placental circulation. The aim of the study is to present three cases of fetal lymphatic malformation of the head and neck that required EXIT and to summarize EXIT details.
  
  
  METHODS
  The cases were studied before the delivery and EXIT was planned with a multidisciplinary team. The key factors of EXIT are considered and the type, stage and clinical score of the three lymphatic malformations are defined.
  
  
  RESULTS
  In the three cases of EXIT the time working on placental support to secure the airway was 9, 7, and 9 min, respectively (from the hysterotomy to clamping the umbilical cord). Procedures performed on the airway were laryngo-tracheo-bronchoscopy in the first case, laryngoscopy and intubation in the second one, laryngoscopy, drainage of the lymphatic macro-cyst, and intubation in the third case. A sketching to detail the EXIT steps are presented: EXIT-Team Time Procedure list (EXIT-TTP list). Lymphatic malformations were classified as mixed (micro/macro-cystic) in two cases, and macro-cystic in one. de Serres Stage was IV, V and II. Therapy varied in the three neonates (surgery alone, surgery+Picibanil+Nd-YAG, or Picibanil alone).
  
  
  CONCLUSIONS
  In case of prenatal suspicion of airway obstruction, EXIT should be planned with a multidisciplinary team. The EXIT-Team Time Procedure list (EXIT-TTP list), reviews the most critical phases of the procedure when different teams are working together. The type of lymphatic malformation, the anatomic location and the clinical score predict the outcome.
authors.affiliation: Department of Otorhinolaryngology, University of Brescia - Spedali Civili of Brescia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefini
authors.forename: Tullia
authors.initials: T
authors.lastname: Bazzana
authors.forename: Cinzia
authors.initials: C
authors.lastname: Smussi
authors.forename: Michela
authors.initials: M
authors.lastname: Piccioni
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frusca
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Taddei
authors.forename: Gabriele
authors.initials: G
authors.lastname: Tomasoni
authors.forename: Daniela
authors.initials: D
authors.lastname: Recupero
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cavazza
authors.forename: Paolo
authors.initials: P
authors.lastname: Villani
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
authors.forename: Behfar
authors.initials: B
authors.lastname: Eivazi
authors.forename: Susanne
authors.initials: S
authors.lastname: Wiegand
authors.forename: Jochen Alfred
authors.initials: JA
authors.lastname: Werner
authors.forename: Stephan
authors.initials: S
authors.lastname: Schmidt
authors.forename: Rolf F
authors.initials: RF
authors.lastname: Maier
authors.forename: Alexander
authors.initials: A
authors.lastname: Torossian
mesh_terms: D000402:Airway Obstruction / Q000151:congenital* / Q000401:mortality / Q000601:surgery*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005865:Gestational Age; D006258:Head and Neck Neoplasms / Q000151:congenital / Q000473:pathology / Q000601:surgery; D006801:Humans; D044148:Lymphatic Abnormalities / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D011379:Prognosis; D012494:Sampling Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult