Fetus-in-Fetu: An Exceptional Multiple Parasitic Fetus: Epignathus and Maxillary Parasitic Fetus

Heteropagus (parasitic) twins are rare congenital anomalies characterized by a malformed parasitic twin attached to an otherwise normally developed host. Epignathus is a rare oropharyngeal mass that may represent a fetus-in-fetu and can result in life-threatening airway obstruction. We report the case of a preterm male neonate presenting with 2 fetiform masses: an intraoral epignathus obstructing the airway and a maxillary mass causing ocular proptosis. Surgical resection of the intraoral mass at 7 days of age restored airway patency. Histopathologic examination confirmed fetus-in-fetu with distinguishable fetal structures. Despite successful surgery, the presence of an encephalocele and extensive ischemic brain injury led to a decision to initiate palliative care. This case highlights the importance of early diagnosis and interdisciplinary surgical management in such complex presentations. Epignathus as a fetus-in-fetu remains exceedingly rare and may mimic teratomas. Compassionate, individualized care is essential in managing complex congenital anomalies.