| Oct 22, 2009
The baby was two days old and it was clear its clasp on life was tenuous. Its skin was wrinkled leather, its cry a distant bleat. The mother stood, uncomplaining, beside her baby lying on the examining table. She was helpless, her baby wouldn’t drink from her breasts.
The baby had been born with a large skin tag in the middle of its chin. The midwife had tied it off and removed it. What she hadn’t done was look in the baby’s mouth. Under the tongue was a cyst so large that it pushed the tongue against the roof of the baby’s mouth preventing it from sucking. If this baby couldn’t feed it was going to die - soon.
I had never seen anything like this cyst. It was soft and had an opaque surface. I suspected it was a mucous filled cyst. I had read about congenital midline cysts in medical school but had never seen one. If I could deflate this cyst, the tongue would have more room and the baby might be able to suck.
We decided to give the baby some intravenous fluids. It needed rehydration and I needed some time. What was I getting into? What were the possible complications?
Three hours later I checked on my little prune of a baby in our treatment tent. Its skin was less flacid, it had more bounce when I gently pinched it. I could now hear a cry, still weak but louder.
It was time. Deanna, one of the nurses on our team held the baby’s head while I took the largest needle I could find and plunged it into the white shiny cyst wall. The baby cried. I sucked back on the syringe and nothing happened. None of the mucous that I suspected was in the cyst came into the syringe. Perhaps it was too thick for the size of the needle. I was using the largest we had. I asked for a scalpel to cut into the cyst. We had scalpels somewhere in the clinic but no one could find them.
Janey, the other nurse on our team, had brought some old surgical instruments from home. She carried the box into the room. I fished through the instruments, most were too big for a baby’s mouth, then I found what looked like a tiny pointed pair of pliers. These would have been used to pull tiny slivers of wood out of skin. Janey then pulled out a tiny pair of nail shears. These would have to do.
First I grabbed the wall of the cyst with the pointed pliers. The tissue was tough and stretchy and wouldn’t break. So I then pulled at the wall of the cyst and used the nail shears to cut into the cyst. Finally it gave way and a clear jelly like material poured out of the cyst. We wiped it away but the cyst was no smaller. I pushed the pointed pliers into the hole I had made. More clear thick jelly oozed out of the cyst. I stretched the hole some more, then suddenly blood began to pour out of the baby’s mouth. I took some gauze and pressed tightly against the cyst. Blood and mucous poured out around my fingers. We turned the baby’s head over so it wouldn’t choke. My fingers filled the mouth. Fortunately babies breath easily through their nose. My little friend was still breathing. I waited, then slowly took my fingers out of the baby’s mouth.
The bleeding had stopped. The cyst was still present but it was smaller. I could see the surface of the baby's tongue and the back of his throat. Did we have success? Would the baby be able to suck? We put the baby up to the mother's breast, she squeezed out some milk and the baby made some swallowing movements. Was this going to be enough for the baby to feed itself?
We kept the mother and baby in our treatment tent overnight with the intravenous dripping fluid into the baby’s veins. The next morning the mother smiled as we approached. The baby was struggling with the nipple but it was getting some milk. The cyst was smaller that the day before and the baby’s cry much louder. The baby was going to live.