[Giant epignathus in the newborn: report of a case and review of the literature]

Congenital teratoma of the oral cavity - the largest personal series of cases

PURPOSE

The objective of this study is to present the largest personal series of oral teratomas already published in English literature and discuss the diagnosis, neonatal management, and surgical treatment of this disorder.

METHOD

The study included patients treated by the senior author (RSF) between 2004 and 2023. Data were collected regarding prenatal evaluation, perinatal approach, surgical management, evolution, and treatment of secondary deformities. In addition, we performed a literature review on the topic.

RESULTS

Twelve patients with oral teratoma were included in this study. Seven cases did not have been submitted to any previous treatment, and five cases had already undergone some treatment in another institution. Four cases were diagnosed as epignathus (33.3%), two as true teratomas (16.6%), four as teratoid teratomas (33.3%), one as dermoid teratoma (8.3%) and one as fetus in fetus (8.3%). All patients, except for one, had the tumor surgically removed with good evolution. There was one case of recurrence, successfully operated. The most frequently associated comorbidity was 0-14 fissure, present in 66% of the cases.

CONCLUSION

The experience of our twelve cases indicates that prenatal diagnosis, associated with good multidisciplinary planning of the delivery care, and complete resection of the masses reveal high success rates in the treatment of this pathology.

CLINICAL TRIAL NUMBER

This study was performed in line with the principles of the declaration of Helsinki. Approval was granted by the Ethics Committee of Federal University of Paraná - 47102421.2.0000.5225.

Transpalatal endoscopic endonasal resection of a giant epignathus skull base teratoma in a newborn. Case report

Teratomas are neoplasms composed of tissues from all three germ layers with varying degrees of differentiation. They are most commonly found in the sacrococcygeal and gonadal regions and rarely occur in the head and neck region. A teratoma is termed "epignathus" when it arises from the skull base or hard palate and is located in the oral cavity. The authors describe a case of a giant epignathus teratoma originating in the skull base of a neonate, extending bilaterally via two pedicles throughout the hard palate and protruding through the oral cavity. The tumor was completely resected using a transpalatal endoscopic endonasal approach. The excised tumor proved to be an immature teratoma with well-differentiated yolk sac elements. At the 1-year follow-up the patient showed no evidence of tumor recurrence and the child remains neurologically intact. This report demonstrates the use of a transpalatal endonasal corridor in a preterm infant. This approach provided an ample corridor into the ventral skull base without the need for external excisions and/or disruption of osseous elements.