Congenital thyroid teratoma: Airway management and operative outcome

Objectives: To highlight the uncommon presentation of congenital thyroid teratoma undetected by prenatal ultrasound and to review airway and operative management for congenital cervical teratomas Study Design: A retrospective case review of a single patient with congenital teratoma of the left neck. Methods: The history, physical, imaging, operative, and follow-up findings of the patient are reviewed. Airway and operative management for congenital teratoma are discussed. Results: A 37-week gestation female was born by spontaneous vaginal delivery and found to have a large left neck mass. One minute Apgar score was 2 and the infant was intubated with a 2.5 ETT. 18-week prenatal ultrasound had not detected a neck mass. Preoperative CT and MRI revealed a 7 × 6 × 6 cm left neck mass consistent with congenital teratoma. Initial alpha fetoprotein level was 47,000 ng/ml. On day of life #5, the patient was taken to the OR for surgical removal. Direct laryngoscopy revealed moderate tracheal compression. The mass was completely excised, appearing to arise from the left thyroid lobe. Continuous left recurrent laryngeal nerve monitoring revealed absence of activity as it was thinned by the teratoma. Pathology was consistent with primary congenital thyroid teratoma. At 18-month follow-up the patient has persistent left vocal cord paralysis with no stridor or feeding difficulties. There is no evidence of recurrent teratoma and a normal alpha fetoprotein level. Conclusions: Congenital teratomas of the neck are uncommon anomalies that require careful management of the airway to ensure survival. Operative technique can successfully remove the mass and relieve the airway obstruction.