Epignathus: a germ-cell tumour presenting as neonatal respiratory distress

A full-term neonate developed acute upper airway obstruction immediately af ter birth secondary to a polypoidal mass in the oropharynx. After the child 's airway had been secured, the mass was excised and found to be a nasophar yngeal teratoma, a rare congenital germ cell tumour which is frequently ass ociated with other congenital malformations. It is sometimes possible to di agnose these tumours in utero, thereby enabling appropriate precautions to be taken during the delivery, otherwise if the diagnosis is unknown, then i t is essential for any attending clinician to urgently secure the airway by means of either intubation or tracheostomy. Such a case is presented with a review of the possible management options. This case emphasises the fact that although many conditions are uncommon, the total incidence of rare con ditions is surprisingly high, and that care needs to be taken at all times in the management of patients, in order not to overlook such life-threateni ng diagnoses. (C) 1999 Published by Elsevier Science Ireland Ltd. All right s reserved.