An Approach to Nasopharyngeal Mass in Newborns: Case Series and Systematic Literature Review.

Roee Noy,Arie Gordin,Liron Borenstein-Levin

doi:10.5041/rmmj.10463

Abstract

ObjectiveCongenital nasopharyngeal masses (CNMs) are rare. Presenting symptoms vary, and the differential diagnoses cover a wide spectrum of possibilities. As it is uncommon, most examples discussed in literature are described as case reports or series. Guidelines on CNM patient management do not exist. In this study, we present two (2) cases of neonates with CNMs that were encountered at our tertiary center. Additionally, to best elaborate a comprehensive, case-based approach to CNM management, we offer an up-to-date, diagnosis-to-treatment review of current literature.MethodsCase series and systematic literature review.ResultsTwenty-eight (28) studies are included since January 2000 to October 2021, with a total of 41 cases. Most common diagnosis was teratoma (78%). Female-to-male ratio was 2.5:1. Twenty percent of cases presented prenatally with polyhydramnios or elevated alpha-fetoprotein. Postnatally, the presenting symptoms most frequently encountered were respiratory distress (78%), oral mass (52%), and feeding difficulties (29%). Seventy-five percent of affected newborns showed symptoms within the first 24 hours of life. Forty percent of cases had comorbidities, especially in the head and neck region.ConclusionsCongenital nasopharyngeal masses can be detected antenatally, or symptomatically immediately after birth. Airway protection is a cornerstone in the management. Selecting the right imaging modality and convening a multidisciplinary team meeting are important toward the planning of next steps/therapeutic approach. Typically, a transnasal or transoral surgical approach will be deemed sufficient to address the problem, with a good overall prognosis.

Highlights

The nasopharynx—the embryonic intersection of the neural axis and alimentary and respiratory tracts—is subject to a variety of congenital anomalies
Airway protection is a cornerstone in the management
While feeding difficulties may be the only presenting symptom in patients with smaller lesions, larger congenital nasopharyngeal mass (CNM) usually present with acute respiratory distress and may require emergent airway protection

Summary

Introduction

The nasopharynx—the embryonic intersection of the neural axis and alimentary and respiratory tracts—is subject to a variety of congenital anomalies. Congenital head and neck irregularities are rare, with a 5.5% prevalence among all congenital anomalies.[1] Congenital nasopharyngeal masses (CNMs) can be divided into two categories, such as benign neoplasm versus malignant neoplasm (Table 1). 2. As opposed to anterior nasal masses, which are usually seen on external examination of the nose, posterior nasal cavity and nasopharyngeal masses are often difficult to visualize. CNM diagnosis can be delayed since signs and symptoms are seldom specific and may mimic other upper respiratory tract problems. While feeding difficulties may be the only presenting symptom in patients with smaller lesions, larger CNMs usually present with acute respiratory distress and may require emergent airway protection. As newborns are obligate nasal breathers, it is essential to quickly diagnose and treat situations with nasopharyngeal obstruction

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