Abstract
OBJECTIVE
1) Determine the success of initial airway management in patients with airway obstruction due to congenital head and neck teratomas. 2) Characterize late airway-related complications in children with congenital head and neck teratomas.
METHOD
Retrospective review of consecutive patients with congenital head and neck teratomas from 1988 to 2010 at an academic center. Variables examined include initial airway procurement methods and subsequent 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 (oral or retrograde) or tracheotomy. Two vaginal births required subsequent uncomplicated oral intubation within 24 hours. Eight patients required tracheotomy (3 within the delivery suite, 2 during mass excision on day of life 6 and 24 and the remaining greater than 1 month after birth). Five deaths occurred, 4 due to complications of their teratomas within several days of birth and 1 due to an airway complication on day of life 32. 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.
CONCLUSION
A multidisciplinary team and a standardized approach in the operating suite have led to successful initial airway procurement. Additionally, this study demonstrates the need for continued airway management beyond delivery, as evidenced by our experience with airway-related mortality. Airway management warrants discussion and likely operative evaluation after birth, perhaps at time of mass excision. Long-term airway complications mandate close follow-up, long after the well-planned delivery.