they may be seen in midline or para - axial location , from the brain to the sacral area . they display a particular tendency to locate in the sacrococcygeal and pre - sacral regions . reported incidence of tumors at these sites the oropharyngeal cavity is exceedingly rare for teratomas , 2% of all teratomas , present as large masses protruding from the oropharyngeal area . though oropharyngeal teratomas have a benign histopathology , they are potentially lethal as they may cause airway obstruction and respiratory compromise . so , principles of management in such patients comprise of the immediate postpartum establishment of a secure airway , if needed via tracheostomy and complete surgical resection of the mass . a 1980 g female infant born to 22-year - old mother after 38 weeks gestation presented with a growth in oral cavity associated with respiratory distress . the mother had undergone ultrasonography examination during pregnancy , but the report of the same was unavailable . on examination , cleft palate was present and a palatal tumor of size 4 cm  3 cm was found in the cleft area [ figure 1 ] . it was hampering feeding . computed tomography scan  showed mass lesion in the palatal region ( attached to the palate , more on the right side ) . no intracranial extension [ figure 2 ] . computed tomography scan image after due preparation , the patient was operated , and the mass was excised in toto [ figure 3 ] . histopathologic examination  revealed a teratoma composed of mature glial tissue , choroid plexus , glands lined by respiratory type , columnar mucin secreting , and melanin pigment bearing epithelium . pools of myxoid matrix bearing physaliferous cells are present ( notochord  like / chondroid areas ) [ figures 4 and 5 ] . microscopic picture 1 microscopic picture 2 following excision , patient recovered faster and gained weight . now , the patient is under routine follow - up , and palatoplasty has been done . teratomas are the tumors which contain tissues derived from all three germ layers . these contain tissues foreign to the anatomical site of origin . most of the teratomas in the pediatric age group are benign , but reports of malignant teratoma do exist . basic histological classifications which are widely used ( arnold 's system ) are : 
 dermoid tumors : these are composed of ectoderm plus mesoderm . this is the most common form of teratomateratoids : these are poorly differentiated tumors and contain all three germ layersteratomas : these also contain tissue from all three germ layers . they are histologically more identifiableepignathus : these are tumors which contain fully developed organs and appendages . the large cervical and nasopharyngeal teratomas which obstruct fetal swallowing of amniotic fluid may contribute to polyhydramnios . this is the most common form of teratoma teratoids : these are poorly differentiated tumors and contain all three germ layers teratomas : these also contain tissue from all three germ layers . they are histologically more identifiable epignathus : these are tumors which contain fully developed organs and appendages . the large cervical and nasopharyngeal teratomas which obstruct fetal swallowing of amniotic fluid may contribute to polyhydramnios . other imaging technique such as magnetic resonance imaging , is useful in finding out the anatomical relationship of these tumors . clinical differential diagnoses of oropharyngeal teratoma are cystic hygroma , lymphangioma , duplications and neuroblastoma . moreover , the histopathological differential diagnosis includes hamartoma , dermoid cyst , and a heterotopic gastrointestinal cyst . with growth , oral teratomas that is why , the respiratory distress may be less . the neonates with oral teratomas the basic principle of management of oropharyngeal teratomas is the establishment and maintenance of a secure airway . if an oropharyngeal teratoma is diagnosed antenatally , elective delivery or lower segment cesarean section is carried out . if orotracheal / nasotracheal intubation is failed / or difficult , tracheostomy must be done . surgical goal is to remove the complete mass in toto , as a residual tumor may cause recurrence . associated cleft palate can be repaired when the child grows up , that is , at the age of 1 years . during follow - up , afp should be monitored . in our case , all the afp levels were within normal range . early diagnosis , the establishment of the good airway , complete excision of tumor and timely follow - up should increase the survival of newborns with oral teratomas .
for congenital teratomas , oropharyngeal cavity is one of the rarest sites ( 2% of all teratomas ) . 
 they are rarely picked up by prenatal ultrasonography . 
 postnatally , newborns present with respiratory distress and at this point role of pediatricians is very crucial in establishing secure airway after which they need to be carefully evaluated and surgically managed . 
 we present a female neonate with palatal teratoma which was treated successfully with surgery .