title: Prenatal consultation with the pediatric otolaryngologist.
abstract: OBJECTIVE
  To examine the spectrum of fetal head and neck anomalies that may prompt prenatal referral and to determine the frequency of these consultations.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  The billing databases of two urban pediatric otolaryngology practices were queried for ICD-9 codes corresponding to fetal anomalies between January 2010 and December 2012. The pediatric otolaryngology practices in this study evaluate all fetal head and neck anomalies referred to their respective institutions, including craniofacial disorders.
  
  
  RESULTS
  Over a three-year period, 53 women presented for fetal otolaryngology consultation, with each practice seeing approximately one consultation every 6 weeks (every 5 weeks (JDS) and every 7 weeks (ARS)). The average maternal and gestational age at presentation were 28.7 years and 27.2 weeks, respectively. 83% of the cases (n = 44) involved some form of cleft lip with or without cleft palate. Other head and neck anomalies included fetal goiter/other congenital neck mass (9% (n = 5)) and micrognathia (6% (n = 3)). Macroglossia (n = 1) and facial cleft (n = 1) each accounted for 2% of cases. Cleft mothers presented earlier in pregnancy (average 26.8 weeks) than those with a neck mass (average 32.3 weeks) (p < 0.05). Only 3 cases (6%) merited ex utero intrapartum treatment.
  
  
  CONCLUSIONS
  Depending on the referral practices at a given medical center, craniofacial surgeons rather than pediatric otolaryngologists may be evaluating the majority of fetal head and neck anomalies, as orofacial clefts account for most prenatal consultations. The wide spectrum of congenital neck masses may or may not demand monitoring of the airway during the peripartum period.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery and Facial Plastic Surgery, Floating Hospital for Children - Tufts Medical Center, Boston, MA, United States. Electronic address: ascott@tuftsmedicalcenter.org.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Scott
authors.affiliation: University of Minnesota Medical School, Minneapolis, MN, United States.
authors.forename: Huy
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Tufts Medical Center, Boston, MA, United States.
authors.forename: Jeannie C
authors.initials: JC
authors.lastname: Kelly
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, University of Minnesota, Minneapolis, MN, United States; Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States.
authors.forename: James D
authors.initials: JD
authors.lastname: Sidman
mesh_terms: D000328:Adult; D002971:Cleft Lip / Q000000981:diagnostic imaging* / Q000601:surgery; D002972:Cleft Palate / Q000000981:diagnostic imaging* / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000000981:diagnostic imaging; D016208:Databases, Factual; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005315:Fetal Diseases / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D010036:Otolaryngology / Q000706:statistics & numerical data; D010372:Pediatrics; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult
keywords: Cleft lip and palate; Ex utero intrapartum treatment (EXIT); Fetal diagnosis; Micrognathia; Prenatal consultation