Formation on the neck
A large tumor on the front or side surface of the neck of a fetus or newborn.
CONDITION / JAWS, MOUTH AND NECK
Head and neck teratoma.
Teratoma of the head and neck is a rare congenital tumor, usually benign. It is often noticed on ultrasound during pregnancy. The main danger is the pressure on the respiratory tract of the newborn, so childbirth and surgery are planned in advance.
CONCEPTUAL VISUALIZATION- What it is
- Congenital tumor of the neck, mouth, nasopharynx or face; usually benign.
- When noticed
- Often on ultrasound during pregnancy — sometimes from the 15th to 16th week.
- What is dangerous?
- Can put pressure on the respiratory tract: in a survey of 137 children, 58% needed help with breathing.
- Treatment
- Early complete removal; most children are cured with one operation.
01 / WHAT IS ITWhat is
What is
head and neck teratoma.
Teratoma is a tumor from the group of so-called germinogenic tumors, that is, those that develop from germ cells. A child is born with it. It is mostly a benign tumor, and the head and neck account for less than 4% of all congenital teratomas.
Most often, teratoma grows on the neck, less often - in the mouth, nasopharynx, nose or face. Doctors call one form of teratoma in the mouth epignathous.
The prognosis mostly depends on whether the tumor threatens the newborn's breathing, how far it has spread, and whether there are signs of malignancy. A large teratoma can compress the airways, and the baby has difficulty breathing from the first minute after birth. Therefore, childbirth is prepared in advance, together with a team that knows how to ensure the breathing of a newborn.
This is general information. What will suit your child, the doctor will tell after the examination and examinations.
02 / SIGNSHow
How
teratoma presents.
Teratoma is often discovered before childbirth. If it is not seen on ultrasound, it is noticed immediately after birth.
A formation in the mouth or nose
A tumor in the mouth, nasopharynx, or nose can interfere with breathing and sucking.
It's hard to breathe
In a review of 137 children, the majority (58%) urgently needed a breathing tube or tracheostomy after birth.
Many waters
Too much amniotic fluid is the most common complication of pregnancy with fetal head and neck tumors (26.3% in a review of 306 cases).
Cleft palate
Nasopharyngeal teratoma can prevent the palate from growing together before birth.
Cleft palate03 / REASONSWhy does it occur?
Why does it occur?
and what happens
Teratoma is formed before birth; the authors of the systematic review write that its causes are multifactorial.
Ripe and immature
According to the structure, teratomas are mature and immature. In a series of 20 children, the immatures were larger, more often grew on the anterior surface of the neck, and the level of alpha-fetoprotein (AFP) in the blood was higher.
Rarely - malignant
In the US tumor registry for the years 1975–2016, 63 malignant teratomas of the head and neck were found; 79% of them were found in infants. The prognosis for them is worse than for malignant teratomas of other areas in children, so treatment is planned together with an oncologist.
Other defects
The authors of the review consider it mandatory to analyze fetal chromosomes and search for other malformations in each teratoma.
Similar works
On the neck of young children there are most often cysts - median, lateral or dermoid. Among 306 fetal head and neck tumors, hemangiomas and lymphangiomas accounted for 42.1%, teratomas — 29.7%.
Vascular malformations and lymphangiomas
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If a formation on the neck or in the mouth of the fetus is seen on ultrasound, the birth is planned in a center where the child will be immediately helped to breathe. After birth and after surgery, some symptoms require immediate care.
103 immediately if:
- the child has difficulty breathing or breathes very often - croaks or pulls in the stomach during inhalation;
- during inhalation, a high-pitched whistling sound is heard or breathing is interrupted by pauses;
- the lips, tongue or throat are swollen and it is difficult for the child to swallow or make sounds;
- blue, gray, pale, or marbled skin, lips, or tongue;
- skin cold and moist to the touch;
- a rash appeared that does not fade if you press on it;
- temperature of 38 °C and above in a child under 3 months or 39 °C and above in a child of 3–6 months;
- the temperature is below 36 °C, the child is cold to the touch or shivering;
- the child cries weakly, shrillly or continuously;
- the child has fainted, it is difficult to wake him or he cannot be woken up;
- the child did not urinate for 12 hours;
- convulsions began;
- it is very difficult for an older child or adult to breathe - the person gasps for air, suffocates or cannot utter words;
- the neck or face quickly swells and it becomes difficult to breathe;
- bleeding from the wound after surgery does not stop or the blood is gushing.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after the operation, pain or swelling in the wound area increases, the wound is reddened or pus is released from it. On the same day: the baby does not eat, sucks poorly or chokes during feeding; you are worried about the condition of the child and do not know what to do. In the coming days: if you saw a lump on the neck, mouth, or face of the fetus on an ultrasound during pregnancy, make an appointment at the perinatal center to have time to do an MRI of the fetus and plan the birth. In the near future: a lump on the neck in an older child or adult is growing, hard and does not move, does not go away for 2 weeks, or has reappeared where the tumor has already been removed.
05 / DIAGNOSTICSAs defined,
As defined,
what it is and how to act.
- Ultrasound during pregnancy
A teratoma can be seen from the 15th to 16th week; a conventional ultrasound is usually enough for the diagnosis.
- MRI of the fetus
It shows where the tumor spreads, whether it enters the skull cavity and whether it compresses the airways.
- Genetic examination
Analysis of fetal chromosomes and search for other malformations.
- Birth plan
The team decides if EXIT and an airway surgeon are needed at the delivery table.
- After birth
Examination, pictures, blood analysis on AFP; after removal, histology shows whether the tumor is mature or immature.
06 / TREATMENTHow we treat
How we treat
teratoma
The main thing in treatment is to first provide the child with breathing, and then to completely remove the tumor as soon as possible. In a review of 137 children, teratoma was removed on average (median) on the 4th day after birth.
01
birth
The delivery is prepared in advance in the center with the respiratory team.
- EXIT
- During a caesarean section, the baby still receives oxygen through the placenta, while the doctors provide it with breathing — inserting a breathing tube or making a tracheostomy. The authors suggest considering EXIT if, in the third trimester, the images show that the tumor is compressing the airways.
- EXIT risks
- In a review of 235 such births due to the threat of fetal airway obstruction (teratoma in 46% of them), the most frequent complication in the mother was postpartum hemorrhage (4.7%), the mothers did not die; the fetus or newborn died in 17% of cases. The authors emphasize that the risks of the procedure are significant; it is done in specialized centers.
- The surgeon is nearby
- If the images do not show compression, but there is polyhydramnios or a dense tumor, the authors advise that a respiratory surgeon be present during delivery.
02
Removal
The goal is to remove the tumor as completely as possible to prevent it from returning.
- Complete removal
- In a series of 14 newborns, the tumor returned in one; the authors write that after complete removal, relapse is rare. In a series of 6 children, in all of whom the first operation was not completely successful, the tumor later returned.
- One operation
- The authors of a review of 137 children write that most children are cured with one operation; another intervention was required in 19%.
- Chemotherapy
- According to the examination of germinogenic tumors in children, mature and immature teratomas are treated only with surgery. Chemotherapy is rarely added — in a review of 137 children, 4% received it.
03
After surgery
- Complications
- In a review of 137 children, the most frequent were vocal fold paralysis (3%), bleeding (2%), and softness of the tracheal walls (2%); two children died after the operation (2%).
- Distant consequences
- In a series of 20 children after removal, some had difficulty swallowing (33.3%), paresis or paralysis of the facial nerve, i.e. weakness of facial muscles (16.7%), tracheostomy (16.7%).
- Supervision
- The tumor can return: in a review of 137 children, 6% had a recurrence for a median of 24 months of observation, half of them with spread to the cranial cavity. Therefore, follow-up examinations are required both after mature and after immature teratoma.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Teratoma of the head and neck at Dr. Valikhnovskyi's Institute of Surgery is part of the "Oncosurgery of soft tissues" direction. The perinatal center and the children's hospital take care of the newborn, whose tumor prevents him from breathing: there they plan the birth, EXIT and the first days of life. The clinic advises on the removal and restoration of tissues; if the tumor is malignant, treatment is planned together with an oncologist.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- MRI and CT — the pictures allow you to see the size of the tumor and its borders even before the operation.
- 3D modeling — MRI and CT data are combined into a three-dimensional model if necessary — it is visible how the tumor lies in relation to blood vessels, nerves and bones.
- Edge control — the goal is to remove the tumor completely; the pathologist finally evaluates whether the edges are clean.
- Closure of the defect with a flap — if the wound cannot be simply sutured after removal, it is closed with its own tissues, often in the same operation.
- Post-operative care — regular examinations and MRI of the surgical site in order to detect the return of the tumor in time.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Pictures onlineSend ultrasound, MRI, discharges and histology, if available - the doctor will pre-evaluate the situation.
- ConsultationReview; if necessary, MRI or CT.
- PlanIs an operation necessary, to what extent and whether the tissues need to be restored; if necessary, together with the oncologist.
- SurgeryRemoval of the tumor with evaluation of the edges and, if necessary, closure of the defect.
- SupervisionFollow-up examinations and imaging over the years, because the teratoma can return.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is teratoma dangerous for a child?
It is usually a benign tumor, but a large teratoma can make breathing difficult. In a review of 137 children, the majority (58%) required a breathing tube or tracheostomy immediately after birth. Therefore, childbirth is planned in advance.
What is EXIT?
This is a cesarean delivery method, when the baby still receives oxygen through the placenta, and doctors provide it with breathing during this time. The procedure has significant risks for the mother and child, so it is performed only as indicated in specialized centers.
When is a teratoma removed?
As early as possible, when the child is already breathing stably. In a review of 137 children, the tumor was removed on average (median) on the 4th day after birth.
Can a teratoma come back?
Maybe, especially if it was not completely removed. In a review of 137 children, 6% relapsed over a median of 2 years of follow-up. Therefore, control examinations are required after the operation.
Can a teratoma be malignant?
Rarely. Most teratomas of the head and neck are benign. Malignant tumors occur more often in infants and are treated together with an oncologist.
Is chemotherapy necessary?
Mostly no: both mature and immature teratomas are treated with surgery. In a review of 137 children, 4% required chemotherapy.
Where to give birth if a tumor was found on the neck of the fetus on ultrasound?
In the center, where there is a team of various specialists, in particular a respiratory surgeon, and where they can immediately ensure the newborn's breathing. What exactly is needed is decided by an MRI of the fetus.
Sources
19 sources · reviews, guidelines and researchshowCollapse
- International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstructionInternational Journal of Pediatric Otorhinolaryngology, 2020doi:10.1016/j.ijporl.2020.110281 ↗
- Surgical Management and Outcomes of Pediatric Congenital Head and Neck Teratomas: A Scoping ReviewOTO Open, 2023doi:10.1002/oto2.66 ↗
- Cervical and oral teratoma in the fetus: a systematic review of etiology, pathology, diagnosis, treatment and prognosisArchives of Gynecology and Obstetrics, 2010doi:10.1007/s00404-010-1500-7 ↗
- Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 yearsJournal of Perinatal Medicine, 2017doi:10.1515/jpm-2016-0074 ↗
- EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literatureJournal of Pediatric Surgery, 2020doi:10.1016/j.jpedsurg.2020.02.011 ↗
- Ex utero intrapartum treatment (EXIT) for fetal neck masses: A tertiary center experience and literature reviewInternational Journal of Pediatric Otorhinolaryngology, 2019doi:10.1016/j.ijporl.2019.109642 ↗
- Teratoma of the neonatal head and neck: A 41-year experienceInternational Journal of Pediatric Otorhinolaryngology, 2017doi:10.1016/j.ijporl.2017.02.011 ↗
- Mature and immature pediatric head and neck teratomas: A 15-year review at a large tertiary centerInternational Journal of Pediatric Otorhinolaryngology, 2018doi:10.1016/j.ijporl.2017.11.031 ↗
- Head and neck teratoma: From diagnosis to treatmentJournal of Cranio-Maxillofacial Surgery, 2014doi:10.1016/j.jcms.2014.04.028 ↗
- A SEER database study of malignant teratomas in the head and neck regionInternational Journal of Pediatric Otorhinolaryngology, 2021doi:10.1016/j.ijporl.2021.110672 ↗
- Pediatric germ cell tumorsSeminars in Pediatric Surgery, 2012doi:10.1053/j.sempedsurg.2011.10.005 ↗
- Pediatric Teratoma and Dermoid CystsOtolaryngologic Clinics of North America, 2015doi:10.1016/j.otc.2014.09.009 ↗
- Management of nasopharyngeal teratomas associated with cleft palateInternational Journal of Oral and Maxillofacial Surgery, 2019doi:10.1016/j.ijom.2018.07.024 ↗
- The Ex-utero intrapartum treatment procedure: a narrative reviewFrontiers in Pediatrics, 2025doi:10.3389/fped.2025.1601963 ↗
- Congenital Neck MassesClinics in Perinatology, 2018doi:10.1016/j.clp.2018.07.012 ↗
- When to get urgent medical help for babies and children under 5NHS, 2026nhs.uk/baby/health/when-to-get-urgent-medical-help-for-babies-and-children-under-5 ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
The figures on the page are from these sources.
It was found on ultrasound
neck tumor?
Send pictures and statements. The doctor will tell you what examinations are needed and how to plan the treatment.