PERINATAL MANAGEMENT OF ENTERIC DUPLICATION CYSTS OF THE TONGUE

Intra-oral enteric duplication cysts are rare. We recently treated two infants with prenatally diagnosed large sublingual enteric duplicatio n cysts. Antenatal aspiration of the cyst was attempted in one infant without success. Because of the potential for airway obstruction and r espiratory distress at delivery, preparation for an immediate tracheos tomy was made in case oral intubation was impossible. Fortunately, asp iration of the cyst provided adequate access to the oropharynx for int ubation in both infants. The placental cord was not divided until the airway was secured to minimize the potential for anoxic injury. Comple te excision of the cyst was subsequently done in one patient. The othe r infant had an initial marsupialization and laser ablation of the cys t mucosa but the cyst recurred. Cyst excision at 9 months of age resol ved the problem. Pathological examination revealed columnar-lined muco sa consistent with enteric duplication cysts. An enteric duplication c yst may present as a large sublingual mass with potential for airway o bstruction in the newborn infant. Antenatal diagnosis allows for the p roper preparation of personnel and equipment in the management of thes e neonates during delivery. If the airway is compromised, aspiration o f the cyst can be done to improve the access to the oropharynx for int ubation. Preparation for emergent tracheostomy should be done before d elivery in case oral intubation is not possible. Subsequent complete c yst excision is the treatment of choice.