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Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature.
J Pediatr Surg. 2019 Apr; 54(4):733-739.JP

Abstract

BACKGROUND

Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review.

METHODS

The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass.

RESULTS

The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients.

CONCLUSIONS

The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment.

LEVEL OF EVIDENCE

IV.

Authors+Show Affiliations

Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. Electronic address: michele.gaffuri@policlinico.mi.it.Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.Radiology Unit Pediatric Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30955589

Citation

Gaffuri, Michele, et al. "Multidisciplinary Management of Congenital Giant Head and Neck Masses: Our Experience and Review of the Literature." Journal of Pediatric Surgery, vol. 54, no. 4, 2019, pp. 733-739.
Gaffuri M, Torretta S, Iofrida E, et al. Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature. J Pediatr Surg. 2019;54(4):733-739.
Gaffuri, M., Torretta, S., Iofrida, E., Cantarella, G., Borzani, I. M., Ciralli, F., Calderini, E., Leva, E., Iurlaro, E., Mosca, F., & Pignataro, L. (2019). Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature. Journal of Pediatric Surgery, 54(4), 733-739. https://doi.org/10.1016/j.jpedsurg.2018.09.018
Gaffuri M, et al. Multidisciplinary Management of Congenital Giant Head and Neck Masses: Our Experience and Review of the Literature. J Pediatr Surg. 2019;54(4):733-739. PubMed PMID: 30955589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature. AU - Gaffuri,Michele, AU - Torretta,Sara, AU - Iofrida,Elisabetta, AU - Cantarella,Giovanna, AU - Borzani,Irene Maria, AU - Ciralli,Fabrizio, AU - Calderini,Edoardo, AU - Leva,Ernesto, AU - Iurlaro,Enrico, AU - Mosca,Fabio, AU - Pignataro,Lorenzo, Y1 - 2018/10/10/ PY - 2018/02/16/received PY - 2018/09/23/revised PY - 2018/09/25/accepted PY - 2019/4/9/entrez PY - 2019/4/9/pubmed PY - 2019/5/21/medline KW - Airway KW - EXIT KW - Head and neck KW - Lymphatic malformation KW - Prenatal diagnosis KW - Teratoma SP - 733 EP - 739 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 54 IS - 4 N2 - BACKGROUND: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. METHODS: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. RESULTS: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. CONCLUSIONS: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. LEVEL OF EVIDENCE: IV. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/30955589/Multidisciplinary_management_of_congenital_giant_head_and_neck_masses:_Our_experience_and_review_of_the_literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(18)30659-6 DB - PRIME DP - Unbound Medicine ER -