1 - Neonatal Intensive Care Unit, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Portugal;
2 – Department of Paediatric Surgery, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Portugal;
3 – Otorhinolaringology Service, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Portugal;
4 – Speech and Language Therapy Unit, Department of Physical Medicine and Rehabilitation, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Portugal;
5 – Department of Anatomopathology, Hospital de São José, Centro Hospitalar de Lisboa Central, Portugal;
6 – Unit of Paediatric Gastroenterology, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Portugal.
Apresentado como Poster nas VI Jornadas Internacionais de Neonatologia/ XLIV Jornadas Nacionais de Neonatologia em Novembro de 2015 em Évora.
Background. Large congenital cervical tumours are rare, severe conditions, causing both airway patency and surgical excision problems. Great prematurity further increases its complexity.
Case Report. A female neonate was born at 28 weeks, weighting 1030g, in a tertiary perinatal centre, due to spontaneous labour. This primigesta had medical vigilance and sonography was considered normal shortly before delivery. A large cervical mass causing respiratory distress led to prompt intubation in the delivery room, followed by mild ventilator support. Early sonography suggested cervical haemangioma and she was referred to a medico-surgical neonatal unit. Further pre-operative imagiology also suggested lymphangioma. At the 5th day of life, the tumour was almost completely excised and close contact with para-oesophageal and tracheal structures was noted. Histopathology revealed an immature cervical teratoma. She required non-invasive ventilatory support after extubation 4 days after surgery, due to stridor and respiratory effort. Laryngoscopy (direct and fibroscopy) revealed paralysis of the right vocal cord and paresis of the left. Full enteral feeding by tube was slowly achieved with anti-reflux formula and intermittent nasal pressure support with oxygen was required and criteriae for chronic lung disease were achieved. Follow-up laryngoscopies showed recovery of the left vocal cord paresis. In spite of intensive speech therapy, after videofluroscopic swallowing study, gastrostomy was performed at age 7½ months
Discussion. The differential diagnosis of congenital cervical tumours must include teratoma. Their surgical excision is technically challenging, therefore stridor and dyspnoea should suggest laryngeal nerve lesion and the consequent diagnostic and rehabilitation protocol must be followed.
Key-Words: Gastrostomy, great prematurity, imature cervical teratoma, videofluroscopic swallowing study, vocal cord paralysis.