While still in the womb, doctors of Leyna Gonzalez discovered a benign tumor the size of a tennis ball growing on the unborn baby’s mouth.
University of Miami/Jackson Memorial Hospital Fetal Therapy Center fetal surgeon Ruben Quintero and his team came to the rescue. Using an endoscope guided by ultrasound they performed a first of its kind surgery and removed the tumor from the baby's mouth - in the 17th week of pregnancy!
Quintero said these types of oral tumors develop in 1 out of 100,000 pregnancies and usually it meant fetal demise or emergent surgery at birth. Instead, Leyna was born healthy, weighing 8 pounds, 1 ounce and the only sign of the surgery is a tiny scar on her mouth.
Credit and link: American Journal of Obstetrics&Gynecology
Nasopharyngeal teratomas, as in our case, are associated with an exceptionally high risk of neonatal mortality, particularly from airway obstruction. Polyhydramnios, hydrops, and cleft palate may also occur. Other tumors, such as pure oral teratomas, have also been reported. Of 15 reported cases of pure oral teratomas, fetal death occurred in 2 cases, 1 patient terminated the pregnancy, 2 other patients had cleft palate, and 1 neonate had nerve palsy. Prior to the year 2000, this type of tumor was considered essentially incompatible with life. In fact, a review article in 2008 stated that only 8 cases existed in which the teratoma had been successfully excised.Citation: Eftichia V. Kontopoulos, MD, PhD, Marc Gualtieri, MD and Rubén A. Quintero, MD, 'Successful in utero treatment of an oral teratoma via operative fetoscopy: case report and review of the literature', American Journal of Obstetrics&Gynecology, Volume 207, Issue 1 , Pages e12-e15, July 2012 doi:10.1016/j.ajog.2012.04.008 (free to read!)
Our case suggests that in utero fetoscopic management of fetuses with oral teratomas may be feasible in selected cases. In utero endoscopic assessment or treatment may allow parents to make a better educated decision about their management of the pregnancy. If done early enough, as in our case, fetoscopic removal of the teratoma may avoid further growth of the mass, distortion of the facial structures, micrognathia, development of polyhydramnios, airway obstruction, the need for an EXIT or OOPS procedure, and the need for cesarean section delivery.