Congenital Salivary Gland Anlage Tumor of the Nasopharynx

Objective. Nasal and upper respiratory tract obstruction in the neonatal period can result from a variety of conditions, and may present with variable symptoms. In the absence of dysmorphic features or other abnormalities, causes of nasal obstruction may be difficult to differentiate on initial examination. We report an unexpected and potentially life-threatening condition arising during the work-up of this common neonatal complaint. Design. Case report with literature review. Results. A male neonate presented with complaints of nasal obstruction and feeding difficulties. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. Cannulation of the nasal cavity to rule out choanal atresia resulted in a burst of bleeding from the nose and mouth. A finger sweep of the oropharynx produced a dislodged mass lesion. Pathology revealed a salivary gland anlage tumor of the nasopharynx. Conclusions. The diagnosis of a nasopharyngeal mass lesion should be considered in neonates with nasal obstructive symptoms. It is wise to place an index finger in the oropharynx when passing catheters to rule out choanal atresia to feel a dislodged mass lesion before it can become an airway foreign body. Should passage of nasal catheters result in bleeding and/or respiratory distress, the possibility of a displaced mass lesion must be considered immediately to institute prompt intervention. Pediatrics 2003;112:e66–e69. URL: http://www.pediatrics. org/cgi/content/full/112/1/e66; nasopharyngeal tumor, salivary gland tumor, congenital tumor, nasal obstruction. ABBREVIATIONS. SGAT, salivary gland anlage tumor; EMA, epithelial membrane antigen; CT, computed tomography. Nasal and upper respiratory tract obstruction in the neonatal period can result from a variety of congenital malformations, inflammatory conditions, hamartomas, and tumors. Obligate nose breathing in neonates makes nasal obstruction potentially life-threatening. Respiratory difficulties may be present at birth, or develop over the first few weeks or months of life. Neonates may present with symptoms ranging from nasal discharge to feeding difficulties to severe respiratory distress and hypoxia. The causes of nasal obstruction in the neonatal period are varied. These include bony abnormalities, cystic lesions, meningoencephalocele, glioma, nasal mucosal edema, and several infectious causes. Nasopharyngeal neoplasms less commonly cause nasal obstruction in this age group, but may occur with similar, nonspecific presenting features. In the absence of dysmorphic features or other abnormalities, causes of nasal obstruction may difficult to differentiate on initial examination. Salivary gland anlage tumor (SGAT), also referred to as congenital pleomorphic adenoma, is a benign congenital tumor of the nasopharynx, which may produce nasal obstruction and other associated, nonspecific symptoms. We report a case of SGAT causing nasal obstruction and feeding difficulties in the neonatal period. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. The differential diagnosis and clinical approach to managing neonates with symptoms of nasal obstruction is discussed.