A case report: maxillary deformity with intra-oral teratoma-anesthetic considerations.

Intubation and management of a compromised airway is not an infrequent anesthetic occurrence. Causative factors can be many and varied; however, an intra-oral teratoma with maxillary attachment is rare. A teratoma, a true tumor composed of normal tissues not ordinarily present at the site of occurrence, originates from all three germ layers (ectodermal, mesodermal, and endodermal). Present in varying proportions, such tumors tend to occur in the midline of the body.1 A review of the literature confirms that teratomas of the oropharynx and nasopharynx are rare.2 More than one-half occur in infants under one year of age and females are afflicted more than males, by a ratio of 6-7:1.8*4 The clinical outlook depends upon the size and location of the tumor. Some infants will be born with the tumor protruding from the mouth.5 The case A 10-hour-old 3.9 kg infant, the product of a 40-week, uncomplicated, and uneventful pregnancy, presented with a large lesion which completely filled the oral cavity and extended anteriorly, compressing the left nostril (Figure 1). No other anomalies were noted. Adequate airway ventilation due to the size and location of the mass was a major concern. However, the infant was ventilating adequately, apparently through the right nostril. The infant was premedicated with atropine 0.1 mg intramuscularly (IM) and brought to the operating room with an IV in place. Routine monitoring equipment was applied (precordial stethoscope, DinemappTM Neonatal Blood Pressure monitor, ECG monitor, and skin temperature monitor,) and the infant was positioned with the neck slightly extended. A flexible Olympus bronchoscope was gently passed down the left nostril, affording a clear view of the larynx and cords. Nasotracheal intubation was believed possible. A no. 1.5 Miller blade was gently inserted on the right side of the mouth, with the tumor being gently elevated anteriorly and to the left. Then, a 3.5 mm nasotracheal tube was passed down the left nostril and through the vocal cords; this was achieved without difficulty. The tube was taped in place on the anterior surface of the nose (Figure 2). The infant remained hemodynamically stable during the procedure.