Antenatally diagnosed duplication cyst of the tongue: modern imaging modalities assist perinatal management

Abstract

When a foetal abnormality is detected during routine antenatal screening, further information is required in order to plan the remainder of the pregnancy and perinatal management. If a lesion is detected in the foetal mouth or neck, there may be compromise of the foetal airway. The ex-utero intrapartum (EXIT) procedure has recently been developed to allow lifesaving foetal surgery to be performed during delivery of such cases whilst relying on placental support. Detailed antenatal assessment is essential when planning the EXIT procedure, and modern imaging modalities may be implemented. We illustrate this by reporting a rare case of enteric duplication cyst arising from the base of the tongue, which was detected on routine antenatal ultrasound scan. Subsequent imaging using foetal MRI and colour Doppler ultrasound reassured us that the foetal airway was patent, and an EXIT procedure was avoided.

A case of laryngeal ductal cyst: Antenatal diagnosis and peripartum management

“…This procedure is complex, not without risks to both mother and child, and requires a large multidisciplinary team with experience in the techniques involved. For these reasons, it should be used only in cases where there is a significant risk of total airway obstruction [4]. Alternatively, if the newborn presents a respiratory distress after delivery, tracheal intubation must be performed.…”

“…We think that caesarean section should be preferred over induced labor to plan the time of the birth, thus giving more control over the situation. According to various publications [4,5], the EXIT (Ex-Utero Intrapartum Treatment) procedure can be proposed during caesarean section. It relies on maintaining fetoplacental circulation until the fetal airway is secure.…”

Prenatal Diagnosis of Oral Cyst Caused by Foregut Duplication

“…Foregut duplication cysts in the oral cavity are rare anomalies and few cases with prenatal diagnosis have been reported [2,5] . These cysts are indistinguishable from dermoids on MRI which is helpful in the preoperative assessment of the location and extent of airway compression, but does not provide a definitive diagnosis [6] . In conclusion, foregut duplication cysts in the floor of the mouth are rare, but should be considered when a cystic mass arises at this site in a fetus.…”

Visualization of fetal tongue circulation using Doppler ultrasound

“…Hall et al . reported the presence of a duplication cyst in the tongue. Congenital ranula, caused by atresia or failure of canalization of the salivary ducts of the sublingual or submandibular glands, can affect the shape of the tongue and may be misdiagnosed as a tongue cyst.…”