Two- and three-dimensional ultrasound for assessing potential airway obstruction in congenital epulis.

Epulis, or congenital granular cell tumor, is a rare benign tumor of the soft tissue in the oral cavity. Antenatal diagnosis has been reported rarely in the literature and incomplete evaluation is not uncommon1–3. Recently, a report on three clinical cases suggested that an ex-utero intrapartum treatment (EXIT) procedure may be useful when congenital epulis is diagnosed antenatally4. This procedure, however, requires a multidisciplinary team and is not completely devoid of complications, thus, should be chosen only after strict antenatal evaluation. We report on the case of a 24-year-old primigravida with no significant medical history. Findings on sonography at 12 and 23 weeks were normal. On routine ultrasound examination at 30 weeks’ gestation, a solitary, homogeneous, vascularized solid mass (17×20 mm) was discovered protruding from the fetal oral cavity. Subsequent twoand three-dimensional (2D/3D) sonographic evaluation at 34 and 36 weeks’ gestation revealed a mass (20×25 mm) attached to the left mandibular ridge by a pedicle, vascularized from the lower maxillary artery (Figures 1 and 2). There was no involvement of any adjacent oral or oropharyngeal structures and both nares were unobstructed on both 2D and 3D color Doppler ultrasonography. The nasal amniotic flow and streaming of fluid in the nasopharynx during breathing movements was unaffected and detected as bidirectional. Amniotic fluid volume was normal, as were the results of dynamic evaluation of fetal swallowing and the fetal stomach bubble was visualized. No other associated morphological abnormalities were identified. Based on these findings, the risk for mechanical airway obstruction