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Ex-Utero intrapartum procedure for congenital high airway obstruction syndrome in a neonate: First case in Alexandria  [cached]
Youssef Mohammed
Journal of Indian Association of Pediatric Surgeons , 2007,
Abstract: Introduction: Large fetal neck masses can present a major challenge for securing an airway at birth with associated risks of hypoxia, brain injury and death. Teratomas of the oropharynx are rare, presenting 3% of teratomas in childhood, and are treated by surgical excision. If respiratory distress accompanies the lesion, priority must be given to the securing of the airway. Case History: We present a case of an infant who was diagnosed antenatally as having a huge oropharyngeal teratoma. The anaesthetic, surgical and neonatology teams were ready to perform surgical excision depending on the placental circulation immediately after securing the airway. The tumour weighed 1591 g and was 20 x 22 x 12 cm. The patient was a male and weighed 715 g. Histopathology showed Grade II teratoma. Conclusion: Large fetal neck masses can present a major challenge for securing an airway at birth with associated risks of hypoxia, brain injury and death. A multidisciplinary team approach combined with an accurate prenatal diagnosis obtained through fetal ultrasound is the key to a successful outcome. Ex utero intrapartum treatment (EXIT) that is based on the placental blood during intubation, tracheostomy or surgical excision is the standard procedure.
Ex Utero Intrapartum Treatment for Fetal Oropharyngeal Cyst  [PDF]
Allen W. Ayres,Suzanne K. Pugh
Obstetrics and Gynecology International , 2010, DOI: 10.1155/2010/273410
Abstract: Background. A prenatally diagnosed fetal anomaly that could compromise the fetal airway at delivery can be managed safely with the ex utero intrapartum treatment (EXIT) procedure. Case. A 26-year-old healthy primigravida was diagnosed during her midtrimester anatomic ultrasound survey with a fetal oropharyngeal cystic structure located at the base of the tongue. The neonatal airway was successfully secured intrapartum using the EXIT procedure. Conclusion. Maintenance of fetoplacental circulation until the fetal airway is secured has been described for a multitude of fetal anomalies including cystic hygroma and teratoma. The literature also recounts its use for the reversal of tracheal plugging for congenital diaphragmatic hernia. A multidisciplinary approach to the antenatal and intrapartum care is essential for the successful management of these cases. 1. Introduction A cystic mass at the base of the fetal tongue diagnosed antenatally is uncommon, relegated to case reports in the literature. Dr. Hartnick et al. [1] recently published a case report of a pregnancy complicated with a cystic mass in the mouth of the fetus measuring 2.0?cm by 2.3?cm noted on ultrasound, and because of the concern for the neonatal airway, the patient was delivered by an EXIT procedure. The procedure was successful with good outcomes for both the mother and the neonate. This case also demonstrated the importance of managing this case using a multidisciplinary approach [1]. Fetal airway obstruction at delivery is a potentially fatal complication. If a fetal oropharyngeal anomaly is noted antepartum, the neonatal airway can be secured intrapartum using the EXIT procedure, thus reducing potential neonatal morbidity and mortality [2]. Mychaliska and colleagues first described the systematic ex utero intrapartum treatment procedure to secure a fetal airway in 1997 [3]. Optimizing uteroplacental blood flow with the use of inhalational anesthetic agents and uterine tocolytics allows for the maintenance of fetal oxygenation. We report a case of a pregnancy complicated by a fetal oropharyngeal cyst and successfully securing the fetal airway using the EXIT procedure. This report demonstrates the effectiveness of this procedure in securing the fetal airway while maintaining the fetoplacental circulation and adequate fetal oxygenation. At our institution, an IRB approval is not required for a case report. 2. Case A 26-year-old primigravida presented to the Maternal Fetal Medicine (MFM) clinic for consultation regarding a 1?cm cystic structure located at the floor of the fetal mouth. The
The use of remifentanil in ex utero intrapartum treatment procedures  [PDF]
Chad Whited, Eileen Raynor
Open Journal of Pediatrics (OJPed) , 2013, DOI: 10.4236/ojped.2013.34066

Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates the fetal and maternal risks associated with inhalational general anesthesia, allows the mother to be awake, and obviates the need for and costs associated with general anesthesia and a second anesthesia team. Materials and Methods: We performed a retrospective review of all sequential patients undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia, using nitroglycerine as a tocolytic agent and remifentanil for analgesia. Variables included indication, time to secured fetal airway, complications, estimated blood loss, need for additional anesthetics, participating personnel, and survival. Results: All five of our ex utero intrapartum treatment procedures were successfully completed with combined spinal epidural remifentanil anesthetic. No patient was required additional alternative anesthetic. There were no complications with mother or fetus. Indications for procedure were arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All five mothers were conscious during their procedure. Conclusions: We report the largest series of ex utero intrapartum treatment procedures performed with remifentanil regional anesthesia. We found that the combined use of nitroglycerin and regional remifentanil anesthesia is a safe alternative to the pediatric otolaryngologist for performing ex utero intrapartum treatment procedures without the risks of general anesthesia, allowing the mother to be awake for the delivery, and reducing the cost of providing care.

Ex Utero intrapartum treatment (EXIT)  [PDF]
Srinivas Pentyala, Aleef Rahman, Pooja Mysore, Sahana Pentyala, Kyle Urbanczyk, Thomas Tumillo, John Muller, Yimei Miao, Sardar Khan
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.39A007

The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestration, cervical teratomas, or other congenital conditions. EXIT is erroneously known as a routine cesarean section (CS), but is rather an extension of CS with discernible differences. The procedure creates an opening in the anesthetized abdomen of the mother and uterus. Once EXIT is complete, the remainder of the CS proceeds. EXIT is much more complex than a routine CS, as it requires coordination between the mother and a multidisciplinary team of surgical and neonatal personnel. This review highlights current anesthetic concepts during the EXIT procedure.

EXIT: tratamiento exútero intraparto: Reporte de caso y revisión de la literatura EXIT: ex-utero intrapartum treatment: A case report and literature review  [cached]
Juan Camilo Ospina-García,Carolina Wuesthoff-Prieto,Santiago Eslava-Cerón
Revista Colombiana de Obstetricia y Ginecología , 2012,
Abstract: Introducción y objetivo: la técnica Tratamiento exútero intraparto (EXIT) permite el aseguramiento de la vía aérea fetal mientras se mantiene el soporte uteroplacentario íntegro. El objetivo de reportar este caso es describir el procedimiento y hacer una revisión de la literatura mundial respecto a consideraciones anestésicas y complicaciones asociadas. Materiales y métodos: presentamos el caso de una neonato femenina de 39 semanas de gestación que nace mediante la técnica Tratamiento exútero intraparto (EXIT) debido a una potencial obstrucción de la vía aérea detectada en una ecografía de tercer trimestre. Se realizó una búsqueda sistemática usando las palabras clave: Tratamiento exútero intraparto (EXIT), masas cervicales congénitas y CHAOS en las bases de datos Medline via Pub Med, Ovid, y la base latinoamericana SciELO. Resultados: se encontraron un total de 183 artículos, de los cuales 76 estaban relacionados directamente con el tema, de estos se seleccionaron 8 reportes de caso, 2 series de casos y 14 revisiones del tema. Conclusiones: la estrategia EXIT prueba ser una herramienta útil en el adecuado manejo de los neo-natos con obstrucciones congénitas de la vía aérea. Introduction and objective: The EXIT procedure (ex-utero intrapartum treatment) is aimed at securing the fetal high airway whilst maintaining integral uteroplacentary circulation. The purpose of reporting this case was to describe the procedure and review the worldwide literature regarding anesthetic considerations and associated complications. Materials and methods: The case of a 39-week gestation female neonate is presented; she was born at the Clínica del Country (a private highlevel healthcare general hospital located in Bogota, Colombia) by the ex-utero intrapartum treatment (EXIT) technique due to a potential obstruction of the airway detected during third-trimester echography. A systematic search was made of Medline databases via PubMed, Ovid, and the SciELO Latin-American database using the following key words: EXIT, ex-utero intrapartum treatment, congenital cervical mass, CHAOS. Results: 183 articles were found, of which 76 were directly related to the topic; 8 case reports, 2 case series and 14 reviews of the topic were selected. Conclusion: The EXIT strategy has proved to be a useful tool in the suitable management of neonates suffering congenital obstruction of the airway.
Congenital orbital teratoma
L.O Onyekwe, A.N Onwuegbuna, J.K.C Emejulu
Nigerian Journal of Clinical Practice , 2010,
Abstract: Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases of teratoma. Key Words: Congenital, Orbit, Teratoma.
Congenital Nasopharyngeal Teratoma in a Neonate
Alireza Mirshemirani,Ahmad Khaleghnejad,Leila Mohajerzadeh,Majid Samsami
Iranian Journal of Pediatrics , 2011,
Abstract: Background:Congenital germ cell tumors are uncommon. The most common site of teratoma is in the sacrococcygeal region. Teratoma arising from the head and neck comprises less than 10% of reported cases and of these, nasopharyngeal lesions are rare. Teratomas are generally benign, and have a well recognized clinical and histopathological entity. We present a case of nasopharyngeal teratoma (NPT) associated with a wide cleft palate. Case Presentation:A 20 day old female neonate with a teratoma of the nasopharyngeal area, and wide cleft palate was referred to our center. The protruded mass which measured 6×4×3cm, was of soft consistency, blocked the airway, and prevented oral feeding. Preoperative evaluation and imaging was performed and mass was excised 2 days after admission. Pathology revealed a well-differentiated mature solid teratoma (hairy polyp). The patient had no complication in the post-operative period. Cleft palate was surgically repaired when 2 years old. She is now a six year old girl with normal development. Conclusion:Congenital nasopharyngeal teratomas are usually benign. Surgery is the treatment of choice, and should be undertaken on an urgent basis, especially in a patient who presents with signs and symptoms of airway obstruction.
Congenital Cervical Teratoma  [PDF]
Fatogoma Issa Koné, Amal Hajjij, Naouma Cissé, Siaka Soumaoro, Abdoul Wahabhaidara, Samba Karim Timbo, Mohamed Amadou Keita
Surgical Science (SS) , 2019, DOI: 10.4236/ss.2019.101006
Abstract: Introduction: The word “Teratoma” derives from the Greek word “teratos” including the meaning show. Teratoid tumors derived from the transformation of multipotent germ cells. They are composed of ectodermal, endodermic and mesodermal tissues in variable proportions; hence the term “embryonic tumor”. Objectives: We are reporting the case of a mature teratoma discovered in a young child whose delivery was vaginally performed. Through this case we put in diagnostic and therapeutic highlight and we made a literature review. Case report: Patient 17 months admitted for the anterior compartment mass associated with inspiratory dyspnea. No anomaly/abnormality was detected during the follow-up of the pregnancy. The Patient with dyspnea grade 2 was admitted according to Chevaleir-Jackson classification. No abnormalities of stature ponderal developments were noted. Surgery of excision was our therapeutic alternative. Through the pathological examination a mature teratoma was found. Conclusion: Teratoma is a rare condition. Proper management of mature teratoma helps to prevent recurrence.
Congenital intracranial teratoma of the lateral ventricle.  [cached]
Sinha V,Dharker S,Pandey C
Neurology India , 2001,
Abstract: A case of lateral ventricular teratoma in neonate, where near total excision of tumour was done, is being reported with the review of literature.
Congenital orbital teratoma presenting as microphthalmos with cyst  [cached]
Singh Usha,Subramanian Aparna,Bal Amanjeet
Indian Journal of Ophthalmology , 2009,
Abstract: We report a rare case of non-communicating large orbital cyst with microphthalmos which was surgically separated from the globe and excised. Histopathology reported it to be a teratoma. Congenital cystic teratoma should be a part of the differential diagnosis in an infant presenting with a clinical picture of microphthalmos with orbital cyst, in view of the different management required.
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