Introduction 

Cervical teratomas are rare tumours found in newborns around the neck. They are unusual and can pose serious health risks if not detected and treated early. These tumours are made up of tissue from all three germ cell layers: endoderm, mesoderm, and ectoderm. They can have different proportions of solid and fluid parts.¹

Early diagnosis is important because they can press on nearby structures and cause more damage.

They can press on the oropharyngeal nerves and cause issues such as difficulty swallowing, breathing problems, or even excess amniotic fluid (polyhydramnios). 

It may sometimes become cancerous if left untreated.

In this article, we’ll compare the outcomes of babies diagnosed with cervical teratomas before birth (prenatally) and those diagnosed after birth (postnatally). This will help us to understand which approach leads to better results and improved treatment planning.

Embryological and pathological basis of cervical teratomas

Cervical teratomas develop from germ cells, which normally grow into reproductive organs. When these cells grow in unusual places like the neck, they form extragonadal tumours. In children, cervical teratomas are usually non-cancerous (benign), but they can grow quickly and become life-threatening by pressing on the windpipe or other vital structures.²

Symptoms usually depend on the size of the tumour.² Smaller tumours may cause no signs, while larger ones can cause visible swelling and breathing difficulties (like stridor or shortness of breath).

In severe cases, facial disfigurement or even foetal hydrops (a serious condition with fluid buildup in the foetus) can occur.¹

Incidence and Prevalence

Cervical teratomas are very rare. They occur in about 1 in 20,000 to 1 in 40,000 live births.¹ Unlike some other teratomas, cervical teratomas occur almost equally in males and females. They are more common in newborns than in adults.² Germ cell tumours in general account for 3–5% of all childhood tumours.

Diagnostic Approaches

Prenatal Diagnosis

Ultrasound

Most cervical teratomas can be detected during routine ultrasounds in the second or third trimester of pregnancy.¹

If the ultrasound shows a mixed solid and fluid mass with calcifications in the foetal neck, a teratoma is suspected.¹ Ultrasound also helps detect changes in neck shape, such as hyperextension, which may be a warning sign.⁵

MRI

It can provide more detailed images of the tumour and its effect on nearby structures.¹

CT

It is used to assess the size and extent of the lesions.¹

Polyhydramnios 

It can also be a clue during scans. It shows that the foetus has trouble swallowing due to pressure on the oesophagus and trachea.⁵

Genetic testing 

Also done to check for any other congenital conditions.⁶

Foetal echocardiography and Doppler

This imaging helps monitor the baby’s heart and blood flow, especially in cases where there’s concern for foetal heart failure.

Postnatal Diagnosis

After birth, babies with cervical teratomas may show signs like difficulty breathing, swelling in the neck, or an abnormal neck position. Physical exams followed by imaging tests (ultrasound, CT scan, MRI) help confirm the diagnosis.¹

Doctors also check blood levels of a protein called alpha-fetoprotein (AFP). High AFP levels can indicate ongoing tumour activity or recurrence after surgery.⁶

The tumour can resemble other conditions, so doctors consider other possibilities like congenital neuroblastoma in the differential diagnosis.⁶

Treatment Modalities

Multidisciplinary Approach

The treatment of cervical teratomas requires a team of specialists, including obstetricians, anaesthesiologists, paediatric surgeons, neonatologists, and radiologists.⁵ This team works together from diagnosis through surgery and recovery.

Timing and Mode of Delivery

If a cervical teratoma is diagnosed before birth, it is important to plan the delivery. In most cases, an EXIT (Ex Utero Intrapartum Treatment) procedure is performed. This allows doctors to deliver the baby partially by caesarean section while the baby is still connected to the placenta so that they can secure the airway before the baby starts breathing on its own.⁵

FETI (Foetal Endoscopic Tracheal Intubation)

It is a new and less invasive method. It’s done through a small endoscope and may carry fewer risks for the mother, such as less bleeding and fewer complications with the uterus.⁶ However, more research is needed to confirm its safety and effectiveness.

Surgical Management and Neonatal Care

After birth, surgery is usually done to remove the tumour. In complex cases, the baby may need intensive care to support breathing and monitor vital signs before and after surgery. Follow-up care includes imaging and AFP monitoring to detect any signs of recurrence.⁶

Comparative Outcomes

Prenatally Diagnosed Cases

When a cervical teratoma is diagnosed before birth, it allows time for proper planning. Doctors can organise delivery in an appropriately equipped hospital with a team ready for immediate airway intervention and surgery.³ For example, the EXIT procedure has significantly improved survival in such cases by ensuring that the baby can breathe before the umbilical cord is cut.⁵

Prenatal MRI can also be used to map the tumour and search for complications, such as compression of vital organs or signs of foetal distress.⁴

Postnatally Diagnosed Cases

Infants, on the other hand, who are diagnosed after birth may have emergency situations of respiratory distress. Since there is no time for planning, the outcomes can be worse. There can be delays in treatment with greater surgical risks. Also, there is a greater chance of complications like airway obstruction or underdevelopment of the lungs.³

Prognostic Factors

The outcome depends on several factors:

• Tumour size and location

Larger tumours are more likely to press on the airway.

• Presence of polyhydramnios or hydrops fetalis 

These are signs of serious complications before birth.

• Risk of respiratory distress at birth
• Whether the tumour is benign or malignant

Most newborns have  benign tumours.

• Associated congenital abnormalities

Genetic testing helps detect these early.⁶

Recommendations

Advances in imaging, foetal surgery, and genetic testing are helping improve outcomes. More research is needed into less invasive alternatives like FETI. Better prenatal screening protocols, especially when polyhydramnios is detected, could lead to earlier diagnosis and better treatment planning.

Conclusion

Cervical teratomas are rare but life-threatening tumours if not diagnosed and managed early. Prenatal diagnosis allows for earlier planning, safer delivery, and improved survival. Postnatal diagnosis often leads to emergency situations and higher complication rates. Therefore, increased awareness, early diagnosis, multidisciplinary management are essential to improve outcomes in affected newborns.