The sweet smile
of success
AFCC team removes oral teratoma
Miracles do happen—just ask Tricia and Matt Coblentz.
In the spring of 2002, with Tricia just four months into her
second pregnancy, the Coblentz's local obstetrician indicated
that an ultrasound had revealed a sizable, solid mass growing
from their baby girl's mouth. Scared and uncertain, the couple
turned to Children's Hospital Boston to determine what this meant
for their unborn child.
Tricia and Matt were referred to the Advanced
Fetal Care Center (AFCC), where mom and fetus underwent a
series of diagnostic tests to establish the cause of the mass.
A magnetic
resonance imaging (MRI) scan confirmed the baby's diagnosis
of a congenital oral teratoma—a rare type of germ cell tumor
that can hold serious implications for both the baby and mother.
The couple met with a multidisciplinary team of AFCC specialists,
who shed some light on the diagnosis, as well as treatment options
for the baby. "The team determined that it was critical for
Tricia to carry the baby until she reached a viable stage for
delivery, as the longer the baby remained in her mother's womb,
the greater her chance for survival," says Reza
Rahbar, DMD, MD, associate in Otolaryngology, who
managed much of the baby's care.
A little more than seven months into Tricia's pregnancy, another
MRI revealed that the mass had grown, extending down into Gracie's
throat and obstructing her airway. Fearing that her windpipe would
be completely blocked if the mass grew any larger, the team performed
an ex
utero intrapartum treatment (EXIT) procedure just two days
later.
"An EXIT procedure is a special method of delivery in which
the head and shoulders of the baby are extracted," explains
Dr. Rahbar. "The lower body remains in the womb so the baby
can continue to receive oxygen through the placenta until the
windpipe has been cleared and an effective airway established."
Clinicians usually have up to 45 minutes to create an airway
for the baby. However, Tricia's placenta ruptured, leaving Dr.
Rahbar with only a few moments to perform a tracheotomy so Gracie
could breathe on her own.
She was then fully delivered and taken to a separate operating
room where the majority of the teratoma was removed from her mouth.
Photographs taken immediately after the delivery show that the
mass extending from Gracie's mouth had grown to nearly half the
size of her body. Following the removal of the mass, she weighed
just two pounds, nine ounces and remained in the Neonatal Intensive
Care Unit for three months.
"I only saw Gracie for a moment after she was born,"
recalls Tricia. "But right away she had so much spirit and
fight in her. She was definitely a survivor from that very first
day."
Gracie has since undergone 11 operations, including removal of
the remaining teratoma from her mouth, reconstruction of her windpipe
to remove her tracheotomy tube and repair of her cleft palate,
but only minor evidence of her once-serious diagnosis remains.
"Gracie has been tremendously successful thanks to the dedicated
efforts of countless physicians, nurses and social workers,"
says Dr. Rahbar.
Today, the 1-year-old is thriving, with smiles for everyone she
meets. "Gracie is really doing wonderfully," says Tricia.
"She is eating normally and making all kinds of noises. She
is such a happy baby. We can't thank Dr. Rahbar and all the amazing
caregivers at Children's enough." "This is one of those
once in a lifetime cases," adds Dr. Rahbar. "Gracie
truly is a miracle baby."
