Prenatal Diagnosis and Staged Reconstruction of a Large Oropharyngeal Teratoma: A Longitudinal Case Report

Abstract

Introduction: An oropharyngeal teratoma, or epignathus, is a congenital tumor, most commonly found in neonates, that is believed to result from abnormal migration of primordial cells in the mediastinum or hypothalamic regions. Although benign, a feared complication of an epignathus is neonatal airway obstruction, thereby necessitating aggressive airway management and thorough resection. Methods: We report the case of a 19 week and 2 day old fetus prenatally diagnosed with an oropharyngeal teratoma. We describe this patient’s surgical trajectory from birth through the most recent stages of oropharyngeal reconstruction. Post-surgical outcomes, including feeding, speech, and facial growth, were monitored longitudinally. Results: Prenatal imaging was utilized to monitor and diagnose the mass, guide prenatal counseling, and enable preoperative planning. The patient was delivered via ex utero intrapartum treatment (EXIT) procedure at 35w5d due to concern for airway obstruction. Surgical management began with an immediate tracheostomy followed by resection of the 260 mL tumor. Staged reconstructive surgeries, including palate repair via two buccal flaps, a Furlow Z-plasty, and a posterior pharyngeal flap, were performed to address right-sided hard and soft palate defects. The patient required specialized, multidisciplinary care which included orthodontic interventions, bilateral myringotomy with tubes, gastric tube placement, and ongoing speech behavioral health therapy. Surgical management spanned 3.5 years and the length of follow-up was 8.13 years. Conclusion: This case demonstrates the importance of early diagnosis, the utility of local tissue rearrangement in hemipalate lesions, and the need for a multidisciplinary approach in managing oropharyngeal teratomas. Longitudinal care requires coordinated efforts guided by facial growth and milestones to ensure optimal functional outcomes.