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Peter J. Catalano, MD; Mark L. Urken, MD; Manuel Alvarez, MD; Karen Norton, MD; Joshua Wedgewood, MD; lan Holzman, MD; Hugh F. Biller, MD

Arch Otolaryngol Head Neck Surg. 1992;118(3):306-309.

Abstract
• Epignathus is a rare tumor of newborns that is associated with a high mortality secondary to airway obstruction in the neonatal period. Due to recent advances in prenatal ultrasound and magnetic resonance imaging techniques, accurate in utero diagnosis of this rare teratoma will enable the health care team to prepare for "emergency" management of a difficult airway. We present a case of a newborn with a large epignathus diagnosed prenatally who underwent tracheotomy with intact maternal-fetal circulation. After airway stabilization, maternal-fetal circulation was interrupted and the epignathus was successfully removed. To our knowledge, this is the first extrauterine surgical procedure successfully performed using this technique. A new approach to airway management in "high risk" neonates involving the cooperative efforts of pediatricians, neonatologists, anesthesiologists, and otolaryngologists is presented.

(Arch Otolaryngol Head Neck Surg. 1992;118:306-309)

Author Affiliations
From the Departments of Otolaryngology (Drs Catalano, Urken, and Biller), Obstetrics and Gynecology (Dr Alvarez), Radiology (Dr Norton), and Pediatrics, Division of Neonatology (Drs Wedgewood and Holzman), Mount Sinai Medical Center, New York, NY.

Footnotes
Accepted for publication August 14, 1991.

Reprint requests to the Mount Sinai Medical Center, Department of Otolaryngology, Box 1189, 1 Gustave L. Levy PI, New York, NY 10029 (Dr Catalano).

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