Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature

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Abstract

Background: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. Methods: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. Results: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. Conclusions: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. Level of evidence: IV

Original languageEnglish
Pages (from-to)733-739
JournalJournal of Pediatric Surgery
Volume54
Issue number4
DOIs
Publication statusPublished - 2019

Fingerprint

Airway Obstruction
Neck
Head
Sclerotherapy
Teratoma
Therapeutics
Tracheotomy
Facial Paralysis
Facial Nerve
Sirolimus
Prenatal Diagnosis
Necrosis
Magnetic Resonance Imaging
Parturition
Newborn Infant
Recurrence

Keywords

  • Airway
  • EXIT
  • Head and neck
  • Lymphatic malformation
  • Prenatal diagnosis
  • Teratoma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{feafc974c94d42c98d7c2aa5b92b56f5,
title = "Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature",
abstract = "Background: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. Methods: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. Results: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. Conclusions: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. Level of evidence: IV",
keywords = "Airway, EXIT, Head and neck, Lymphatic malformation, Prenatal diagnosis, Teratoma",
author = "Michele Gaffuri and Sara Torretta and Elisabetta Iofrida and Giovanna Cantarella and Borzani, {Irene Maria} and Fabrizio Ciralli and Edoardo Calderini and Ernesto Leva and Enrico Iurlaro and Fabio Mosca and Lorenzo Pignataro",
year = "2019",
doi = "10.1016/j.jpedsurg.2018.09.018",
language = "English",
volume = "54",
pages = "733--739",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Multidisciplinary management of congenital giant head and neck masses

T2 - Our experience and review of the literature

AU - Gaffuri, Michele

AU - Torretta, Sara

AU - Iofrida, Elisabetta

AU - Cantarella, Giovanna

AU - Borzani, Irene Maria

AU - Ciralli, Fabrizio

AU - Calderini, Edoardo

AU - Leva, Ernesto

AU - Iurlaro, Enrico

AU - Mosca, Fabio

AU - Pignataro, Lorenzo

PY - 2019

Y1 - 2019

N2 - Background: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. Methods: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. Results: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. Conclusions: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. Level of evidence: IV

AB - Background: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. Methods: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. Results: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. Conclusions: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. Level of evidence: IV

KW - Airway

KW - EXIT

KW - Head and neck

KW - Lymphatic malformation

KW - Prenatal diagnosis

KW - Teratoma

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U2 - 10.1016/j.jpedsurg.2018.09.018

DO - 10.1016/j.jpedsurg.2018.09.018

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VL - 54

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JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

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