AIRWAY MANAGEMENT OF NEONATES WITH ANTENATALLY DETECTED HEAD AND NECKANOMALIES

Five cases of prenatally detected neck masses chat had a potential for airway obstruction at birth are described. The various options for ma nagement of the airway are discussed, including using maternal-fetal c irculation until intubation, rigid bronchoscopy, tracheotomy, cyst asp iration, or extracorporeal membrane oxygen support. Congenital abnorma lities involving the fetal face or neck are extremely rare. With techn ical advances in ultrasonography, these masses were first noted on pre natal ultrasound in the late 1970s. Before that period, they were dete cted at delivery. These masses are solid or cystic and may cause asphy xia because of airway obstruction at the time of delivery. The surviva bility of these neonates without immediate intervention at birth is 0% to 20%. If a neck mass is detected in the fetus by prenatal ultrasono graphy, then a strategic plan for these types of cases should be devel oped early in the prenatal period. The airway management plan should b e tailored for each individual case. Coordination and the expertise of an obstetrician, neonatologist, anesthesiologist, and pediatric otola ryngologist are needed to manage these complex situations.