1039: DIFFERENTIAL LUNG VENTILATION IN A PEDIATRIC PATIENT ON ECMO USING A BRONCHIAL BLOCKER

Abstract

Learning Objectives: Congenital cervical teratomas are rare tumors in the pediatric age. Although they can occur anywhere in the body, the neck is the least common of places. Methods: We describe the case of a 3 day old male patient who presented with noisy breathing that progressed to stridor and respiratory failure requiring intubation associated with a rapidly growing right neck tumor. Evaluation of the mass by imaging and pathology revealed a right parapharyngeal mature teratoma with glial overgrowth. Surgical excision of the mass required coordination with neurosurgery, ENT and anesthesia due to the possible compromise of the airway and cranial nerves V, VII, IX-XII due to its proximity of the structures. Patient suffered complications of a pharyngeal tear requiring prolonged intubation and PICU stay. However, was discharged home without major morbidities. Planning of surgery required the consideration of placing a temporary tracheostomy due to the proximity of the mass to the nasopharynx and the potential to cause airway damage during its excision. The aim of our paper is to describe the approach to the surgical excision of the mass along with management of the airway both pre and post surgery in the PICU and to review the etiology, pathophysiology, management and outcomes reported in the literature for congenital cervical teratomas. Results: Congenital cervical teratomas are rare tumors that can lead to death in the neonatal period due to obstruction of the airway. Prompt recognition and surgical excision of these tumors greatly affects survival and outcomes. However, surgical treatment is not always easy and may lead to permanent damage to adjacent structures and possible death.