EXIT (Ex utero Intrapartum Treatment) in lymphatic malformations of the head and neck: Discussion of three cases and proposal of an EXIT-TTP (Team Time Procedure) list
| Autor: | Rolf F. Maier, Piero Nicolai, Cinzia Smussi, Alexander Torossian, Daniela Recupero, Stephan Schmidt, Tullia Bazzana, Tiziana Frusca, G. Tomasoni, Stefania Stefini, Behfar Eivazi, Alessandra Cavazza, Michela Piccioni, F. Taddei, Jochen A. Werner, Susanne Wiegand, Paolo Villani |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Laryngoscopy Gestational Age Sampling Studies Young Adult Pregnancy Prenatal Diagnosis medicine Intubation Humans Hysterotomy Survival rate Patient Care Team Lymphatic Abnormalities medicine.diagnostic_test business.industry Cesarean Section malformation head and neck Gestational age General Medicine Airway obstruction medicine.disease Prognosis Magnetic Resonance Imaging Surgery Airway Obstruction Survival Rate Fetal Diseases Lymphatic system Treatment Outcome Otorhinolaryngology Head and Neck Neoplasms Pediatrics Perinatology and Child Health Female business Airway |
| Popis: | Objectives Ex utero Intrapartum Treatment (EXIT) is a technique to secure the fetal airway while oxygenation is maintained through utero-placental circulation. The aim of the study is to present three cases of fetal lymphatic malformation of the head and neck that required EXIT and to summarize EXIT details. Methods The cases were studied before the delivery and EXIT was planned with a multidisciplinary team. The key factors of EXIT are considered and the type, stage and clinical score of the three lymphatic malformations are defined. Results In the three cases of EXIT the time working on placental support to secure the airway was 9, 7, and 9 min, respectively (from the hysterotomy to clamping the umbilical cord). Procedures performed on the airway were laryngo–tracheo–bronchoscopy in the first case, laryngoscopy and intubation in the second one, laryngoscopy, drainage of the lymphatic macro-cyst, and intubation in the third case. A sketching to detail the EXIT steps are presented: EXIT-Team Time Procedure list (EXIT-TTP list). Lymphatic malformations were classified as mixed (micro/macro-cystic) in two cases, and macro-cystic in one. de Serres Stage was IV, V and II. Therapy varied in the three neonates (surgery alone, surgery + Picibanil® + Nd-YAG, or Picibanil® alone). Conclusions In case of prenatal suspicion of airway obstruction, EXIT should be planned with a multidisciplinary team. The EXIT-Team Time Procedure list (EXIT-TTP list), reviews the most critical phases of the procedure when different teams are working together. The type of lymphatic malformation, the anatomic location and the clinical score predict the outcome. |
| Databáze: | OpenAIRE |
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