Fetal magnetic resonance imaging (MRI) at 38 weeks’ gestation shows a large soft tissue mass involving the anterior neck with mass effect causing narrowing of the trachea/subglottic airway (Fig 1).

Physical examination reveals a large nodular anterior neck mass, which is largely mobile. A finger can fit inferior to the mass where the sternal notch is palpable, but the inferior margin is not easily visible without significant extension (Fig 2). The neonate is admitted to the NICU and maintained on intravascular fluids, fentanyl, midazolam, and vecuronium while receiving conventional ventilation to stabilize the critical airway.

Computed tomographic (CT) imaging (Fig 3) is performed for further delineation of the anatomy of the mass before surgery. It reveals a large, multispatial, heterogeneously enhancing mass centered within the soft tissues of the anterior neck. The mass involves the floor of the mouth superiorly and extends to the...

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