Neonatal cervical teratoma with critical airway compression: A case report

Neonatal cervical teratomas are rare congenital tumors that may cause life-threatening airway compromise despite their predominantly benign histology. We report a male neonate born at 38 weeks of gestation by elective Caesarean section due to a large prenatal neck mass and polyhydramnios. Shortly after birth, the infant developed severe respiratory distress requiring endotracheal intubation following transfer to our institution. Contrast-enhanced computed tomography demonstrated a 10 × 12 × 13.5 cm heterogeneous mass centered within the oropharyngeal/oral cavity and submandibular spaces with extension into the anterior cervical region and upper chest wall, containing cystic and solid components, fat, and calcifications, causing marked tracheal compression and displacement without intracranial extension. Preoperative serum alpha-fetoprotein (AFP) was 14,432.78 ng/mL. Complete surgical excision was performed on day 4 of life through a transverse cervical incision while preserving major cervical structures. Histopathological examination confirmed mature cystic teratoma composed of mature glial tissue, cartilage, adipose tissue and squamous epithelium without immature elements. The patient had a good postoperative recovery and was discharged on the 35th postoperative day. Follow-up evaluation revealed normal serum calcium and parathyroid hormone levels, while thyroid function tests indicated subclinical hypothyroidism needing levothyroxine replacement therapy. At 5 months, there was no recurrence and AFP had decreased to 44.64 ng/mL. This case underscores the importance of early airway stabilization, detailed imaging, complete surgical excision, and multidisciplinary postoperative surveillance in neonatal cervical teratomas.