Received July 13, 2006, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York USA. Revision requested July 18, 2006. Revised manuscript accepted for publication July 19, 2006. Address correspondence to David M. Sherer, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098 USA. E-mail: dmsherer@aol.com Abbreviations EXIT, ex utero intrapartum treatment; 3D, 3-dimensional n 18-year-old nulliparous patient was seen for a second opinion at the State University of New York Downstate Medical Center after the diagnosis of a fetal “neck tumor” at 35 weeks’ gestation. Real-time 2-dimensional sonography and 3-dimensional (3D) sonography (Philips Medical Systems, Bothell, WA; iU22 sonography machine with a 2to 6-MHz 3D broadband curved array transducer) depicted an appropriatefor-gestational-age singleton fetus with an 11 × 10 × 9-cm (calculated volume, 900 mL) multilobulated, semisolid, semicystic mass protruding from the oral orifice (Figures 1–3). Smaller tumors of similar consistency protruded from and completely obstructed both nostrils (Figure 3). The fetal stomach was visualized, yet polyhydramnios was suggestive of impaired (obstructed) swallowing. The fetal neck and other anatomic structures appeared normal. An epignathus (congenital teratoma) involving the oropharynx and nasopharynx was diagnosed.1 Because of the anticipated neonatal upper airway obstruction at delivery, the patient was transferred to a fetal surgery center. Ultrafast fetal magnetic resonance imaging confirmed the presence of a large, multilobulated mass in the nasopharynx, oropharynx, oral cavity, and nasal cavities projecting outside the fetus. At 36 weeks’ gestation after spontaneous rupture of membranes, a female fetus weighing 2348 g was born by cesarean delivery and a successful ex utero intrapartum treatment (EXIT) procedure (tracheotomy).2 In the early neonatal period, the tumor emanating from the oral orifice (the hard palate) was partially resected. Histopathologic examination showed a teratoma. Later, the smaller nasopharyngeal and residual oropharynx tumors were resected. The infant subsequently had swallowing and feeding difficulties and severe gastroesophageal reflux. Accordingly, gastric fundoplication and gastrostomy were planned.