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June 1997

Airway Management of Neonates With Antenatally Detected Head and Neck Anomalies

Author Affiliations

From the Departments of Otolaryngology—Head and Neck Surgery (Drs Stocks, Woodson, and Thompson) and Obstetrics and Gynecology (Dr Egerman), University of Tennessee, and LeBonheur Children's Medical Center (Drs Stocks, Woodson, and Thompson), Memphis; and Department of Otolaryngology—Head and Neck Surgery, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (Drs Bower and Wiet).

Arch Otolaryngol Head Neck Surg. 1997;123(6):641-645. doi:10.1001/archotol.1997.01900060093016

Five cases of prenatally detected neck masses that had a potential for airway obstruction at birth are described. The various options for management of the airway are discussed, including using maternal-fetal circulation until intubation, rigid bronchoscopy, tracheotomy, cyst aspiration, or extracorporeal membrane oxygen support. Congenital abnormalities involving the fetal face or neck are extremely rare. With technical advances in ultrasonography, these masses were first noted on prenatal ultrasound in the late 1970s. Before that period, they were detected at delivery. These masses are solid or cystic and may cause asphyxia because of airway obstruction at the time of delivery. The survivability of these neonates without immediate intervention at birth is 0% to 20%. If a neck mass is detected in the fetus by prenatal ultrasonography, then a strategic plan for these types of cases should be developed early in the prenatal period. The airway management plan should be tailored for each individual case. Coordination and the expertise of an obstetrician, neonatologist, anesthesiologist, and pediatric otolaryngologist are needed to manage these complex situations.

Arch Otolaryngol Head Neck Surg. 1997;123:641-645