Large Fetal Tongue Mass, EXIT Procedure on an Emergency Caesarean Section: a Case Report

Background: Ex Utero Intrapartum Treatment (EXIT) is a technique for cardiopulmonary support during Caesarean section while maintaining placental circulation. Indications include EXIT-to-airway, resection, extracorporeal membrane oxygenation (ECMO), and separation of conjoined twins. It involves partial fetal delivery via hysterotomy for controlled neonatal stability, enabling interventions like endotracheal intubation, tracheostomy, or mass excision. This requires a multidisciplinary team expert in fetal intervention. Case Illustration: A 25-year-old primigravida was referred at 37 weeks for suspected fetal mandibular tumor; detailed sonography suggested nasopharyngeal teratoma. Planned elective Caesarean at 39 weeks with anesthesiology, perinatology, and ENT-head-neck teams. Premature rupture of membranes at 38 weeks prompted emergency Caesarean. Fetus transverse, internal rotation to deliver head first. ENT team opted for intubation to secure airway (initial plan: tracheostomy). EXIT duration 3 minutes 30 seconds. Umbilical cord cut, placenta delivered, uterus sutured with modified B-Lynch to prevent bleeding. Baby in NICU; MRI at 2 weeks post-birth showed tongue mass 4.6 x 3 x 3.3 cm involving genioglossus, hyoglossus, superior-inferior longitudinal muscles, vascularity from lingual artery, suspected vascular tumor. Daily intake via nasogastric tube for breast milk; growth good. Discussion: EXIT successfully secured neonate's airway with preserved placental circulation. Performed under spinal anesthesia without uterotonics during EXIT, followed by modified B-Lynch post-placenta for uterine contraction. Direct examination post-head delivery changed plan from tracheostomy to intubation due to large tongue mass origin. Conclusion: EXIT is useful for neonates needing special post-birth adjustments, requiring multidisciplinary preparation.