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 language | English |
|---|---|
| Pages (from-to) | 733-739 |
| Journal | Journal of Pediatric Surgery |
| Volume | 54 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2019 |
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Keywords
- Airway
- EXIT
- Head and neck
- Lymphatic malformation
- Prenatal diagnosis
- Teratoma
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health
Cite this
Multidisciplinary management of congenital giant head and neck masses : Our experience and review of the literature. / Gaffuri, Michele; Torretta, Sara; Iofrida, Elisabetta; Cantarella, Giovanna; Borzani, Irene Maria; Ciralli, Fabrizio; Calderini, Edoardo; Leva, Ernesto; Iurlaro, Enrico; Mosca, Fabio; Pignataro, Lorenzo.
In: Journal of Pediatric Surgery, Vol. 54, No. 4, 2019, p. 733-739.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85055503866&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055503866&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2018.09.018
DO - 10.1016/j.jpedsurg.2018.09.018
M3 - Article
AN - SCOPUS:85055503866
VL - 54
SP - 733
EP - 739
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 4
ER -