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Clinical Challenge
December 27, 2018

Newborn With a Sublingual Mass

Author Affiliations
  • 1Medical student, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
  • 2Department of Otolaryngology–Head & Neck Surgery, Tufts Medical Center, Boston, Massachusetts
  • 3Division of Pediatric Otolaryngology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online December 27, 2018. doi:10.1001/jamaoto.2018.2568

A 1-week-old, full-term male newborn presented with increasingly labored breathing, xerostomia, and poor bowel movements. He had been born after an uncomplicated pregnancy, during which routine prenatal ultrasonography had not detected any anatomical abnormalities or lesions. On physical examination, there were no abnormalities other than symmetrical submucosal swelling of the floor of the mouth and a midline external punctum present in the submental area (Figure, A). The tongue was displaced posteriorly and superiorly. Contrast-enhanced magnetic resonance imaging of the neck and face performed shortly after presentation showed a midline sublingual lesion extending inferiorly through the mylohyoid muscle (Figure, B-D). The intrinsic muscles of the tongue appeared minimally displaced without obvious infiltration; however, the genioglossus muscle was difficult to locate relative to the mass. A thin-walled, multiloculated lesion was identified, measuring approximately 2.0 × 2.5 × 3.2 cm. The mass was bright on T2-weighted imaging and dark on T1-weighted imaging and did not enhance with intravenous gadolinium. There were no obvious fluid-fluid levels or calcifications. When in-phase and out-of-phase images were compared, there was no significant signal intensity drop, suggesting an absence of fat within the lesion.