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A New Era in the Diagnosis and Management of Fetal Airway Obstruction Because of Advances in Prenatal Imaging

Reza Rahbar, DMD, MD; Adam Vogel, MD; Laura B. Myers, MD; Linda A. Bulich, MD; Louise Wilkins-Haug, MD; Carol B. Benson, MD; Ian A. Grable, MD; Deborah Levine, MD; Steven J. Fishman, MD; Russell W. Jennings, MD; Judy A. Estroff, MD; Carol E. Barnewolt, MD

Arch Otolaryngol Head Neck Surg. 2005;131:393-398.

Objective  To evaluate the efficacy, safety, and outcome of prenatal imaging and fetal surgery in the diagnosis and management of fetal airway obstruction caused by cervical teratoma or lymphatic malformation.

Setting  Tertiary care medical center.

Patients  A retrospective study of all consecutive fetal patients with cervical teratoma or lymphatic malformation between January 2001 and December 2003.

Results  The indication was potential airway obstruction due to a fetal neck mass in 8 patients. Prenatal images were obtained by ultrasonography and magnetic resonance imaging, and were consistent with teratoma in 4 patients. The mean cervical mass was 8.3 x 7.3 x 6.7 cm, with airway obstruction suspected in all 4 patients. All 4 patients were successfully delivered by ex utero intrapartum treatment, during which 3 newborns required tracheotomy and 1 was successfully intubated. Prenatal images were consistent with lymphatic malformation in the remaining 4 patients. The mean cervical mass was 4.6 x 4.4 x 3.4 cm. There was no indication of airway obstruction based on prenatal images. All 4 patients had an uncomplicated vaginal delivery.

Conclusions  Technological advances in prenatal ultrasonography and magnetic resonance imaging have improved the ability to diagnose congenital abnormalities in utero. This allows for proper assessment of the airway to prevent any unexpected problems at delivery. We believe that many airway emergencies can be avoided by prenatal imaging and initiation of airway management in the prenatal period.

Author Affiliations: Departments of Otolaryngology (Dr Rahbar), Surgery (Drs Vogel, Fishman, and Jennings), Anesthesia (Drs Myers and Bulich), and Radiology (Drs Estroff and Barnewolt), Children’s Hospital, Harvard Medical School, Boston, Mass; Departments of Obstetric and Gynecology (Dr Wilkins-Haug) and Radiology (Dr Benson), Brigham and Women’s Hospital, Harvard Medical School; and Departments of Obstetric and Gynecology (Dr Grable) and Radiology (Dr Levine), Beth Israel Deaconess Medical Center, Harvard Medical School.

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