Congenital Cyst of the Newborn November 10 th

Congenital Cyst of the Newborn November 10 th, 2010

Newborn • • • Full term baby girl Mom 38 yo, gestational diabetes Normal prenatal screens NSVD, Apgars 9/9 Mom developed chorioamnionitis – Baby had 48 hr rule out with antibiotics and did well

Day of life 1: • Noisy breathing, strange “guttural” cry – No cyanosis. Feeding well • On exam: LGA (4. 3 kg) – Palate intact – No neck masses – Clear lungs, no increased work of breathing – No skin lesions

Bedside Laryngoscopy Ø Epiglottis displaced anterior and laterally Ø Need to determine if the lesion is vascular

Differential Diagnosis neoplasm • rhabdomyoma • granular cell tumor • squamous cell carcinoma laryngocele supraglottic hemangioma congenital cyst of the newborn papilloma

MRI Ø Lesion consistent with congenital cyst Ø Compressing the airway Ø Not vascular

Plan • The child looks very well, is feeding without difficulty, and breathing comfortably • However, this child is at extremely high risk for severe respiratory distress in the setting of a cold due to the markedly narrowed glottic opening Ø Plan for surgical aspiration

s/p stab/decompression and marsupalization

One week later • New grunting/gurgling – stridor while sleeping – supraclavicular retractions • Laryngoscopy revealed recurrence of the cyst • Otolaryngology reevaluation in OR

suspension microlaryngoscopy with CO 2 laser ablation of laryngeal cyst • Risks of laser ablation: – Scarring – Swallowing dysfunction – aspiration ØWarrants close follow up