Introduction
Congenital cervical teratomas are rare neonatal tumours, occurring in approximately 1 in 30,000 live births. They pose significant diagnostic and management challenges due to the risk of life-threatening airway obstruction. Antenatal polyhydramnios may be an early indicator of upper aerodigestive tract compression; however, prenatal diagnosis can be missed. Early recognition and surgical intervention are essential to optimise outcomes.
Methods
A neonate was delivered at a peripheral hospital with an 8x7x7cm lateral neck mass that had not been identified antenatally despite documented polyhydramnios. Within hours of birth, the infant developed acute respiratory distress progressing to periods of apnoea. Following resuscitation and intubation, the patient was transferred to a tertiary paediatric intensive care unit (PICU). MRI demonstrated a large mixed solid-cystic lesion with vascular components, with a broad differential diagnosis.
Results
Following multidisciplinary team discussion, definitive surgical excision was performed on day four of life. Complete macroscopic resection was achieved. Histopathology confirmed a mature cervical teratoma. The infant was extubated post-operatively but required reintubation 48 hours later following seizure activity. Successful extubation was subsequently achieved, and the patient was discharged from PICU six days postoperatively. A vocal cord palsy and feeding difficulties resolved with conservative management, including nasogastric feeding and speech and language therapy.
Conclusion
Congenital cervical teratomas should be suspected in neonates presenting with a lateral neck mass and a history of polyhydramnios. Antenatal diagnosis allows consideration of Ex-utero intrapartum treatment (EXIT) when airway compromise is anticipated. Early multidisciplinary involvement and surgical excision in a specialist centre are critical.