Approach for oxygenation of the newborn with airway obstruction due to a cervical mass

Large congenital cervical neck masses present major difficulties in management of the neonatal airway at delivery and in the perinatal period. With ultrasound, these lesions can be predicted prenatally. An airway treatment plan can then be formulated and modified in relation to the airway presentation at birth. We describe a case of a massive cervical-mediastinal teratoma and our management plan. Preparation involved a multidisciplinary approach including endoscopy to secure the airway while the neonate remained on fetal circulation and an extracorporeal membrane oxygenation system was available. Once the infant's condition was stable, a cervical approach with resection of the massive teratoma with mediastinal dissection without sternotomy was successful. A differential diagnosis of cervical neck masses and review of cervical teratomas is presented.