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Extended Maxillotomy for Nasopharynx Access in Infantile Immature Teratoma. J Craniofac Surg 2019; 31:77-78. [PMID: 31449225 DOI: 10.1097/scs.0000000000005875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infantile immature teratoma located in the nasopharynx is a rare congenital tumor that is not easily removed. Three surgeries and chemotherapy for recurrence of the tumor have been performed since a male infant with a nasopharyngeal mass was born at a gestational age of 35 weeks. Extended maxillotomy combining Le Fort I osteotomy with midline palatal split was performed at 2 years and 6 months of age. Residual tumor left in the intracranial region had not increased as of 4 years of age. Careful follow-up is needed until the patient reaches adulthood.
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Abstract
A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.
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Affiliation(s)
- Alexis Veyssière
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
| | - Libor Streit
- b Department of Plastic and Aesthetic Surgery , St Anne University Hospital , Brno , Czech Republic
| | - Hamady Traoré
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
| | - Hervé Bénateau
- a Department of Maxillofacial and Plastic Surgery , Caen University Hospital , France>
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Huge nasopharyngeal teratoma with a cleft palate and bifid tongue in a patient with pierre robin syndrome. J Craniofac Surg 2015; 25:e588-90. [PMID: 25376137 DOI: 10.1097/scs.0000000000001070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Nasopharyngeal teratoma is a very rare neoplasm that develops on the oronasal cavity as an expanding and cavity-filling lesion. We present a rare case of nasopharyngeal teratoma associated with a cleft palate and bifid tongue in a patient with Pierre Robin syndrome. METHODS A preterm male neonate of 33 weeks and 6 days was referred to our department. A protruding solid mass with approximately 7.0 × 4.0-cm size arising from the vomer and combined cleft palate and tongue covered with pinkish skin with lanugo were observed. In addition, there was a bandlike tissue connecting vomer and sublingual area, which divided and restricted the anterior portion of the tongue. RESULTS An early surgical intervention was decided because of problems with airways and nutrition caused by the mass. The mass was completely removed from the vomer. The histologic examination of the mass was consistent with mature teratoma. After his first operation, he was finally diagnosed with the Pierre Robin syndrome. After 4 months, a tongue reduction was conducted for macroglossia, and after 9 months, remnant teratoma excision and a palate repair were conducted using 2-flap palatoplasty. CONCLUSIONS A nasopharyngeal teratoma is a rare case and induces a cleft palate and bifid tongue in a preterm infant, leading to severe airway and nutritional problems. A teratoma interferes with the fusion of embryonic tissues in the early developmental period, in particular, with the palatal fusion severely prevented if the teratoma is accompanied by a Pierre Robin syndrome such as in this case.
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İsmi O, Görür K, Arpacı RB, Vayisoglu Y, Özcan C. Hairy polyp of the supratonsillar fossa causing intermittent airway obstruction. Int Arch Otorhinolaryngol 2015; 19:90-2. [PMID: 25992158 PMCID: PMC4392509 DOI: 10.1055/s-0034-1387812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Dermoids frequently called “hairy polyps” and their nature have not been completely clarified. Objectives To discuss the unusual presentation, symptoms, incidence, histology, and perioperative management of hairy polyps in the light of a case and current literature. Resumed Report A 3-year-old boy presented with intermittent respiratory distress since birth. Oropharyngeal examination revealed a nasopharyngeal mass originating from the supratonsillar fossa. The mass was so mobile that it moved between the oropharynx and the nasopharynx during swallowing. The radiologic and pathologic examinations confirmed the mass as a hairy polyp. Conclusion In a pediatric age group with airway obstruction, hairy polyps of the oropharyngeal region must also be included in the differential diagnosis.
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Affiliation(s)
- Onur İsmi
- Assistant Professor; Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin
| | - Kemal Görür
- Professor; Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin
| | - Rabia Bozdoğan Arpacı
- Assistant Professor; Department of Pathology, Faculty of Medicine, University of Mersin
| | - Yusuf Vayisoglu
- Professor; Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin
| | - Cengiz Özcan
- Professor; Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin
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Successful in utero treatment of an oral teratoma via operative fetoscopy: case report and review of the literature. Am J Obstet Gynecol 2012; 207:e12-5. [PMID: 22541612 DOI: 10.1016/j.ajog.2012.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/27/2012] [Accepted: 04/03/2012] [Indexed: 11/21/2022]
Abstract
The prenatal diagnosis of a nasopharyngeal teratoma carries a very grave prognosis. Although these tumors constitute only 9% of all teratomas, all previous cases diagnosed antenatally have been associated with either fetal demise or emergent surgery at birth. Of the fetuses that survive to birth, delivery can be associated with airway obstruction and multiple postnatal surgeries. These complications could be averted if the tumor could be safely treated in utero. We hereby report the successful treatment of an oral teratoma via operative fetoscopy, with the birth of a healthy infant at term.
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Kim R, John S, Law A, Barber C, Douglas R. Endoscopic resection of neonatal nasopharyngeal teratoma. ANZ J Surg 2012; 82:80-1. [PMID: 22507503 DOI: 10.1111/j.1445-2197.2011.05943.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Raymond Kim
- Auckland City Hospital, Auckland, New Zealand
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A teratoma that causes cleft palate. J Plast Reconstr Aesthet Surg 2008; 62:e514-5. [PMID: 18848817 DOI: 10.1016/j.bjps.2008.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 08/24/2008] [Accepted: 08/28/2008] [Indexed: 11/20/2022]
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8
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Işken T, Alagöz MS, Günlemez A, Unal C, Sen C, Onyedi M, Işil E, Izmirli H, Yücel E. A congenital true teratoma with cleft lip, palate, and columellar sinus. J Craniofac Surg 2007; 18:1083-5. [PMID: 17912088 DOI: 10.1097/scs.0b013e3181572637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Teratomas, the most common extragonadal germ cell tumor of childhood, involve at least two of the ectodermal, mesodermal, and endodermal layers. Of the teratomas seen in the first 2 months of life, 82% are sacrococcygeal. The head and neck region is the second most common location for teratomas in early infancy, accounting for five (14%) of those cases. We describe a female neonate with a teratoma of the nasopharyngeal area, bilateral cleft palate/lip, and columellar sinus pathologies. The mass, which was 8 x 5 x 7 cm and soft in consistency, blocked the airway and prevented oral feeding. On macroscopic examination of the excised mass, there was a notable typical cilia arrangement and lower eyelid appearance. The patient, who was diagnosed with a well-differentiated teratoma after the pathologic examination, did not have any complications in the postoperative period.
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Affiliation(s)
- Tonguç Işken
- Department of Plastic and Reconstructive Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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9
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Zhang GZ, Din GC, Zhao YF. Giant Epignathus Teratoma: Report of a Case. J Oral Maxillofac Surg 2007; 65:337-40. [PMID: 17236946 DOI: 10.1016/j.joms.2005.05.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 05/10/2005] [Indexed: 11/24/2022]
Affiliation(s)
- Guo Zhi Zhang
- Department of Oral and Maxillofacial Surgery, Shenzhen People's Hospital, Medical School of Jinan University, Shenzhen, GD, PR China.
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10
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Becker S, Schön R, Gutwald R, Otten JE, Maier W, Hentschel R, Jüttner E, Gellrich NC. A congenital teratoma with a cleft palate: report of a case. Br J Oral Maxillofac Surg 2005; 45:326-7. [PMID: 16377040 DOI: 10.1016/j.bjoms.2005.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 11/03/2005] [Accepted: 11/04/2005] [Indexed: 11/22/2022]
Abstract
Teratomas are benign tumors containing cells from ectodermal, mesodermal and endodermal layers. They occur in about 1 in every 4000 births and most commonly in the sacrococcygeal region, followed by the ovaries. Congenital epignathus teratomas are rare embryological neoplasms localised in the region of head and neck. An epignathus is found in approximately 1:35,000 to 1:200,000 live births. This accounts for 2-9% of all teratomas. Size and location of the neoplasm in the oronasopharynx is variable. Teratomas are partly undiagnosed at the time of birth. They may exist with an intracranial extension or as small polyps. Large epignathi can lead to difficult management during and after birth. The case of a newborn girl with a combination of an epignathus and a cleft palate is described. The epignathus presented as a huge mass extending out of the mouth of the infant girl. On the day of birth debulking of the extraoral portion of the tumor, followed by intraoral exstirpation, was performed. The results of the histologic examination indicated a congenital epignathus. Six months later a recurrence was found.
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Affiliation(s)
- S Becker
- Department of Oral-, Maxillo- and Craniofacial Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany.
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Abstract
A 4-year-old girl presented with hypernasal speech. On examination, in addition to velopharyngeal incompetence noted by speech examination, a palatal tumor was found in between the cleft palate. The computed tomographic and magnetic resonance imaging examinations were suspicious for midline teratoma. Total excision of the nasopalatal tumor was performed, and the pathology revealed benign teratoma. After 6 months of follow-up, no recurrence was noted. A two-flap palatoplasty with a superior-based pharyngeal flap was then performed to reconstruct the palatal defect and to correct the velopharyngeal incompetence. An anterior oronasal fistula developed after the operation, but a tongue flap was transferred to cover the defect successfully. The purpose of this case report is to present the relationship between a congenital midline nasopalatal tumor and cleft palate.
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Affiliation(s)
- Chi-Cheng Liang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Beverstock GC, Mollevanger P, Baaij M, Lind J, van Ieperen L, Bartelings MM, Teunissen K, Brandenburg H, Van Opstal D, Los F. Nasopharyngeal teratoma and mosaic tetrasomy 1q detected at amniocentesis. A case report and review of the literature. CANCER GENETICS AND CYTOGENETICS 1999; 115:11-8. [PMID: 10565293 DOI: 10.1016/s0165-4608(99)00084-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The occurrence of nasopharyngeal teratomas (NPT) is an infrequent event and prenatal detection of such tumors is even rarer. We present a case report and review of the literature (N = 78 cases), in which we describe the cytogenetic, DNA, and pathological findings of a fetus with a mature NPT which was detected prenatally by ultrasound investigation following complaints of severe polyhydramnios by the mother.
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Affiliation(s)
- G C Beverstock
- Department of Clinical Cytogenetics, Leiden University Medical Centre, The Netherlands
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Mylanus EA, Marres HA, Vlietman J, Kollée LA, Freihofer HP, Thijssen HO, de Vries J, Wesseling P. Transalar sphenoidal encephalocele and respiratory distress in a neonate: a case report. Pediatrics 1999; 103:E12. [PMID: 9917492 DOI: 10.1542/peds.103.1.e12] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present a full-term newborn infant who suffered from immediate postpartum severe respiratory distress. The infant had an inspiratory stridor as a result of a swelling of the soft palate, extending from the roof of the nasopharynx. Transoral endotracheal intubation resulted in normal saturation levels. Histologic examination after an open biopsy showed mature neuroglial tissue. Radiology demonstrated the presence of a right parapharyngeal process obstructing the nasopharynx and oropharynx and extending to the right middle and posterior fossa, via the foramen ovale. After transoral debulking, the infant was extubated successfully. After an uneventful period of 5 months, the patient was readmitted at our hospital for treatment of meningitis. Subsequently, the inspiratory stridor recurred, and staged surgery was performed. First, a transcranial approach was used to remove a large intradural part of the process and close the defect at Meckel's cave. Two weeks later the retro- and parapharyngeal part of the process were removed transorally. Given the site of the defect of the skull base and the intradural location of the process, the diagnosis is a transalar sphenoidal encephalocele. This is a rare type of basal encephalocele, and has never been reported in an infant nor known to present with respiratory distress. The pathogenesis, clinical presentation, pathology, and therapeutic implications of basal encephaloceles are discussed.
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Affiliation(s)
- E A Mylanus
- Department of Otorhinolaryngology. University Hospital, Nijmegen, The Netherlands
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14
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Abstract
We report the case of a newborn girl who presented with an inspiratory stridor and apneic episodes due to a mass in the oropharynx. On flexible pharyngo-laryngoscopy, it appeared that on inspiration this swelling, originating from the oropharynx, was sucked into the larynx, obstructing the airway. After intubation under flexible optic control the swelling was excised using the CO2-laser. Histopathological examination showed a teratoma of the oropharynx. The postoperative course was uneventful. Teratomas of the oropharynx are rare and are treated by surgical excision. If respiratory distress accompanies the lesion, priority must be given to securing the airway.
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Affiliation(s)
- R de Bree
- Department of Otolaryngology/Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands
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15
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Abstract
A case of neonatal respiratory distress due to a pedunculated nasopharyngeal dermoid is presented with its MRI assessment. The dermoid was removed without complications. Nasopharyngeal teratomas are uncommon, consisting of tissues from all three germ layers with varying degrees of differentiation. Symptoms arise during the neonatal period and are associated with airway obstruction. MRI can be performed for contemporary assessment. The first goal of management is to establish a safe and protected airway using complete surgical excision.
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Affiliation(s)
- F T Kayhan
- Department of ENT and Head and Neck Surgery, Bakirkoy State Hospital, Istanbul, Turkey
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16
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 14-1995. A 12-year-old boy with progressive nasal obstruction. N Engl J Med 1995; 332:1285-91. [PMID: 7708074 DOI: 10.1056/nejm199505113321908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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17
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Dehner LP, Mills A, Talerman A, Billman GF, Krous HF, Platz CE. Germ cell neoplasms of head and neck soft tissues: a pathologic spectrum of teratomatous and endodermal sinus tumors. Hum Pathol 1990; 21:309-18. [PMID: 1690172 DOI: 10.1016/0046-8177(90)90232-t] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Germ-cell neoplasms, in particular teratomas with immature and mature somatic type tissues, are some of the most commonly found tumors in children. Approximately 5% of these neoplasms appear in one of several extracranial sites in the head and neck region. This study reports the clinical, pathologic and immunohistochemical findings in six germ-cell neoplasms occurring in the neck and facial areas. A mass was recognized at birth in five children, and the sixth patient was 2 1/2 years old at diagnosis. Four of the six neoplasms contained one or another element of endodermal sinus tumor; two of these had a mixed pattern of endodermal sinus tumor and teratoma. The other two cases were purely teratomas. The serum alpha-fetoprotein was known to be elevated in three children whose tumors had endodermal sinus elements; it returned to normal level in two of the children, but remained high in the one fatal case. Placental alkaline phosphatase and alpha-fetoprotein were demonstrated immunohistochemically in two of the three cases, with available tissue containing endodermal sinus tumor. Teratomatous metastases in ipsilateral cervical lymph nodes were found in one patient with a pure teratoma; that patient is disease-free one year after surgery. Only nine previous examples of endodermal sinus tumor have been reported in the head and neck region, exclusive of the central nervous system. There is one other case in the literature of a congenital cervicothyroidal teratoma with metastatic disease. These six neoplasms illustrate the clinical and pathologic spectrum in this nosologically homogeneous, but morphologically diverse, category of tumors.
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Affiliation(s)
- L P Dehner
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
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Wiatrak BJ, Myer CM, Bratcher GO. Report of a nasopharyngeal teratoma evaluated with magnetic resonance imaging. Otolaryngol Head Neck Surg 1990; 102:186-90. [PMID: 2113247 DOI: 10.1177/019459989010200218] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- B J Wiatrak
- Department of Otolaryngology and Maxillofacial Surgery, University of Cincinnati, OH
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