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Perinatal management of enteric duplication cysts of the tongue
Insights
Large intra-oral enteric duplication cysts can obstruct a newborn's airway. Prompt management, including cyst aspiration for intubation and preparation for tracheostomy, is crucial for safe delivery and treatment.
Area of Science:
- Pediatric Surgery
- Neonatology
- Developmental Biology
Background:
- Intra-oral enteric duplication cysts are rare congenital anomalies.
- Large sublingual enteric duplication cysts pose a significant risk of airway obstruction in neonates.
Observation:
- Two infants with prenatally diagnosed large sublingual enteric duplication cysts were treated.
- Antenatal aspiration was unsuccessful in one case.
- Cyst aspiration facilitated oropharyngeal access for intubation in both infants.
Findings:
- Complete cyst excision was successful in one infant.
- Marsupialization and laser ablation led to recurrence in the other infant, requiring later excision.
- Pathological examination confirmed columnar-lined mucosa consistent with enteric duplication cysts.
Implications:
- Antenatal diagnosis of these cysts allows for optimized delivery preparation.
- Cyst aspiration can be a critical step to secure the airway in neonates.
- Complete surgical excision is the definitive treatment for intra-oral enteric duplication cysts.
Abstract:
Intra-oral enteric duplication cysts are rare. We recently treated two infants with prenatally diagnosed large sublingual enteric duplication cysts. Antenatal aspiration of the cyst was attempted in one infant without success. Because of the potential for airway obstruction and respiratory distress at delivery, preparation for an immediate tracheostomy was made in case oral intubation was impossible. Fortunately, aspiration of the cyst provided adequate access to the oropharynx for intubation in both infants. The placental cord was not divided until the airway was secured to minimize the potential for anoxic injury. Complete excision of the cyst was subsequently done in one patient. The other infant had an initial marsupialization and laser ablation of the cyst mucosa but the cyst recurred. Cyst excision at 9 months of age resolved the problem. Pathological examination revealed columnar-lined mucosa consistent with enteric duplication cysts. An enteric duplication cyst may present as a large sublingual mass with potential for airway obstruction in the newborn infant. Antenatal diagnosis allows for the proper preparation of personnel and equipment in the management of these neonates during delivery. If the airway is compromised, aspiration of the cyst can be done to improve the access to the oropharynx for intubation. Preparation for emergent tracheostomy should be done before delivery in case oral intubation is not possible. Subsequent complete cyst excision is the treatment of choice.