Prenatal Diagnosis of a Large Oropharyngeal Teratoma and Airway Management with EXIT: A Case Report

We present a rare case of a large fetal oropharyngeal teratoma (epignathus) diagnosed during the third trimester and managed successfully with a planned ex utero intrapartum treatment (EXIT) procedure followed by neonatal surgical resection. A 30-year-old pregnant woman was referred to our department at 29 weeks of gestation due to polyhydramnios and the detection of an oropharyngeal mass on ultrasound. Fetal magnetic resonance imaging confirmed a 5×5 cm heterogeneous mass filling the oral cavity, raising concern for airway obstruction at birth. At 32 weeks, spontaneous pre-term labor necessitated urgent EXIT. While fetoplacental circulation was maintained, a tracheostomy was performed to secure the airway, allowing for safe delivery and ventilation of the neonate. The newborn subsequently underwent successful transoral surgical excision of the mass, which was confirmed histologically as an immature teratoma. Postoperative recovery was uneventful, and the infant remained free of recurrence during a 24-month follow-up period. This case highlights the importance of prenatal diagnosis, fetal imaging, and multidisciplinary planning in the management of airway-compromising lesions. It also introduces the EXIT procedure to otolaryngologists as a critical and effective approach for ensuring airway patency in selected high-risk cases of congenital head and neck tumors.