Airway Malformations or Lesions

What problems can an airway malformation cause?

Airway malformations include anomalies of the mandible (lower jaw), palate, oral cavity, or neck, or masses inside or outside the airway that compress on or obstruct the airway. In a typical pregnancy, the fetus swallows some of the amniotic fluid, which keeps the fluid level stable.

Certain types of airway problems or other lesions can prevent swallowing or block amniotic fluid from going from the baby’s mouth and into the stomach as it should. Over time, polyhydramnios, or excess amniotic fluid, can build up in the uterine cavity.

The excess amniotic fluid can lead to preterm labor, preterm premature membrane rupture, and preterm delivery.

How are airway malformations diagnosed?

They are diagnosed through an ultrasound and fetal magnetic resonance imaging (MRI).

What problems can airway malformations cause after birth?

Before they are born, babies don’t get oxygenation through their mouth, but through their umbilical cord, which is attached to the placenta. If there’s a problem with the airway, it is very dangerous when the umbilical cord is clamped in the first minute of life and the baby needs to start breathing air.

How does the Packard Children’s Hospital team typically treat a complex airway problem?

In a severe case, an ex utero intrapartum treatment (EXIT) procedure may be considered.

This is a surgical procedure we perform to deliver a baby that is similar to a cesarean section, but with a special approach aimed at allowing the ENT (Ears, Nose, and Throat) team to obtain a secure airway using either intubation or tracheostomy while the baby is still receiving oxygen via the umbilical cord.

During an EXIT procedure, general anesthesia is used in order to prevent uterine contractions and placental separation, and the uterine incision is made with a special uterine stapler that prevents the incision from bleeding while a part of the baby is delivered and airway is secured.

Who is on the care team for an EXIT procedure?

The EXIT procedure requires meticulous planning, attention to detail, and coordination among a specialized team. Our experienced team of maternal-fetal medicine specialists, pediatric surgeons, ENT specialists, anesthesiologists, and neonatologists closely coordinate care for both the mother and baby during an EXIT delivery.