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News Americas

At 20 weeks' gestation the ultrasound image showed a complex mass protruding from the unborn child's mouth. (DTI/Photo courtesy of Jackson Health System, USA)
Jun 27, 2012 | News Americas

Surgeons perform first in utero removal of oral tumor

by Dental Tribune International

MIAMI, Fla., USA: For the first time in the history of fetal medicine, doctors have successfully removed a large oral tumor from the mouth of a four-month-old fetus in a pioneering in utero surgery. Last week, media representatives were invited to meet the child, who is now 20 months old, at a press conference.

As reported at the Jackson Memorial Hospital's press conference on June 21, a 37-year-old woman was diagnosed as having a fetus with a mass protruding from the fetal mouth, during a routine ultrasound in the twentieth week of her second pregnancy. According to the doctors, the findings were suggestive of an oral teratoma, a rare tumor that arises from all three embryonic germ layers.

After serious consideration, the procedure was carried out in May 2010 by Ruben Quintero, professor of obstetrics and gynecology, and Eftichia Konopoulus, assistant professor of obstetrics and gynecology, at the Jackson Memorial Hospital in Miami, Fla. Using an endoscope, guided by ultrasound, and a laser, the tumor was resected in utero without any maternal or fetal complications in a 68-minute operation under local anesthetic.

Five months after surgery, the patient went into spontaneous labor and delivered a healthy female infant without complication. Inspection of the lips and mouth at birth showed no evidence of clefting, injury or residual mass. The only sign of the surgery was a tiny scar on the baby's mouth, the doctors said.

At the conference, the mother thanked the doctors and their team for their help. "They saved our daughter. Without them, she wouldn't be here," she said.

According to the surgeons, nasopharyngeal teratomas are associated with an exceptionally high risk of neonatal mortality, particularly from airway obstruction. If done early enough, as in the present case, fetoscopic removal of the teratoma can avoid growth of the tumor mass, distortion of the facial structure, excess amniotic fluid, edema and the risk of a stillbirth, they said.

The doctors added that survival rates typically range from 30 to 40 percent. Should the fetus survive pregnancy, delivery will most probably require cesarean section and the baby will need immediate tracheotomy in order to breathe, and undergo multiple surgeries afterwards.

"The experience in this case suggests that fetoscopy can be of use in the detailed assessment of the lesion, as well as potentially allowing resection of the mass in utero in selected cases," the researchers concluded.

The case report was published online on April 9 in the American Journal of Obstetrics and Gynecology ahead of print.

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