Medial tongue cleft associated with intraoral hamartoma—case report and review of literature

Bilateral lipomatous hamartoma of the tongue: A case report in a child with oral-facial-digital syndrome type VI

A hamartoma is a benign proliferation of typical mature cells specific to a particular anatomical site. In the oral cavity, they may occur as isolated cases or be associated with genetic syndromes. Oral-facial-digital syndrome type VI is a rare genetic disorder with an estimated incidence of one in 50,000-250,000 newborns. Here, we report a case of a 2-year-old boy diagnosed with oral-facial-digital syndrome type VI who was referred for evaluation of a bilateral and normochromic to slightly pinkish nodule on the lateral surface of the tongue. Clinically, the child presented hypotonia, low visual acuity, absence of oculocephalic reflex, delay in neuropsychomotor development, and polydactyly in the feet. Excisional biopsies of both sides of the tongue were performed using a 1.5 W high-power diode laser (wavelength of 980 nm), and histopathological analysis revealed abundant mature adipocytes predominantly arranged in lobules that mainly surrounded the minor salivary gland parenchyma. The surgical sites healed with no complications and the patient remains under follow-up for 10 months. Due to the limited literature on this syndrome and the frequent presence of tongue hamartomas in children, dentists need to be familiar with them.

A Rare Case of Cleft Palate Associated With Tongue Hamartoma: A Case Report and Systematic Review

INTRODUCTION

Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review.

OBJECTIVE

To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma.

DESIGN

A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions.

PATIENTS, PARTICIPANTS

Studies reporting patients with cleft palate and tongue hamartoma were included.

MAIN OUTCOME MEASURE(S)

Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted.

Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome.

Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty.

Mutations in the TBX15-ADAMTS2 pathway associate with a novel soft palate dysplasia

We reported de novo variants in specific exons of the TBX15 and ADAMTS2 genes in a hitherto undescribed class of patients with unique craniofacial developmental defects. The nine unrelated patients represent unilateral soft palate hypoplasia, lost part of the sphenoid bone in the pterygoid process, but the uvula developed completely. Interestingly, these clinical features are contrary to the palate's anterior-posterior (A-P) developmental direction. Based on developmental characteristics, we suggested that these cases correspond to a novel craniofacial birth defect different from cleft palate, and we named it soft palate dysplasia (SPD). However, little is known about the molecular mechanism of the ADAMTS2 and TBX15 genes in the regulation of soft palate development. Phylogenetic analysis showed that the sequences around these de novo mutation sites are conserved between species. Through cellular co-transfections and chromatin immunoprecipitation assays, we demonstrate that TBX15 binds to the promoter regions of the ADAMTS2 gene and activates the promoter activity. Furthermore, we show that TBX15 and ADAMTS2 are colocalization in the posterior palatal mesenchymal cells during soft palate development in E13.5 mice embryos. Based on these data, we propose that the disruption of the TBX15-ADAMTS2 signaling pathway during embryogenesis leads to a novel SPD.

Tooth Structure and Replacement of the Triassic Keichousaurus (Sauropterygia, Reptilia) From South China

The small-sized sauropterygian Keichousaurus hui was one of the most abundant marine reptiles from the Triassic Yangtze Sea in South China. Although Keichousaurus has been studied in many aspects, including the osteology, ontogeny, sexual dimorphism, and reproduction, the dentition of this marine reptile was only briefly described in external morphology. In this study, we provide new information on Keichousaurus tooth implantation, histology, and replacement based on a detailed examination of well-preserved specimens collected in the past decades. The tooth histology has been investigated for the first time by analyzing cross-sections of premaxillary teeth and the tooth attachment and implantation have been further revealed by X-ray computed microtomography. We refer the tooth replacement of Keichousaurus to the iguanid replacement type on the basis of the observed invasion of small replacement tooth into the pulp cavity of the functional tooth. Given the resemblance to other extinct and modern piscivorous predators in the morphology and structure of teeth, Keichousaurus might mainly feed on small or juvenile fishes and some relatively soft-bodied invertebrates (e.g., mysidacean shrimps) from the same ecosystem.

Diagnosis and management of congenital floor of mouth masses: A systematic review

OBJECTIVES

Determine the utility of preoperative imaging and the optimal course of management for congenital floor of mouth (FOM) cysts in infants.

METHODS

A systematic review of the literature was performed conforming to PRISMA guidelines. Pubmed, Embase and Cochrane Library databases were queried to identify cases of infants with congenital floor of mouth masses. Patient demographics, presenting findings, imaging, management, complications, and outcomes were determined.

RESULTS

85 patients were evaluated. 98% of patients presented at 16 months of age or younger. The most common presenting symptom was submental mass or swelling, 31.3%. Among the patients that underwent imaging, the suspected diagnosis obtained from imaging findings was consistent with the final pathologic diagnosis 59% of the time reported and inaccurate 34% of the time. There were multiple definitive treatment modalities described in the literature review including surgical excision, 82.3%, marsupialization, 12.9%, chemical injection 2.3%, sclerotherapy 1.2%,% and radiation, 1.2%. Recurrence rate after initial definitive treatment was as follows, surgical excision, 8.8%, marsupialization, 80%, sclerotherapy, 100%, chemical injection, 50%, and radiation, 100%.

CONCLUSION

Preoperative imaging studies should not be relied upon alone to determine suspected pathology and subsequent management in pediatric patients with FOM masses. It may be beneficial for these patients to undergo primary surgical excision regardless of imaging studies or suspected pathology. Needle aspiration offers limited addition to pathologic diagnosis and should only be performed in the setting of acute symptomatic management. Surgical excision should be considered as definitive treatment modality in all patients with FOM masses, regardless of the suspected diagnosis of ranula. Further multi-institutional cohort studies could be invaluable to elucidate definitive treatment guidelines in this patient population.

Giant sublingual hamartoma with medial cleft tongue: a case report and literature review

Hamartomas commonly occur in respiratory and digestive organs, such as the lungs, pancreas, and liver; they rarely occur in the oral cavity, especially in the sublingual region. This report describes a 5-month-old boy who presented with a giant sublingual hamartoma and medial cleft tongue. He underwent corrective operations at 5 months, 11 months, and 31 months of age. Histopathological analysis revealed features suggestive of hamartoma. There have been no signs of recurrence. The boy exhibited normal speech development at 3 years of age; all other oral functions were unaffected at that time. This report includes a review of relevant literature. The findings in this report and previous literature suggest that a multidisciplinary approach, carefully planned staged surgery, and rehabilitation are needed to achieve favorable outcomes in patients with hamartoma in the oral cavity.

[Progress on clinical application of orthodontic-implant combined therapy]

For complex implant cases, simple implantation could not achieve the desired therapeutic effect, and a multidisciplinary approach has become a general trend. Orthodontic treatment before implantation creates favorable conditions for subsequent implantation by increasing restoring three-dimensional space, improving occlusion of patients. It also stimulates the increase of autologous soft and hard tissue while biological potential of periodontal ligament is fully developed. The choice of operation time is vital to keep the level of soft and hard tissue at the implantation site, which improves the curative effect of implantation in terms of function and aesthetics. In this article, the orthodontic-implant combined therapy is briefly reviewed focusing on the three-dimensional space optimization, implant site enhancement by orthodontic extrusion and delayed orthodontic space opening.

Huge nasopharyngeal teratoma with a cleft palate and bifid tongue in a patient with pierre robin syndrome

PURPOSE

Nasopharyngeal teratoma is a very rare neoplasm that develops on the oronasal cavity as an expanding and cavity-filling lesion. We present a rare case of nasopharyngeal teratoma associated with a cleft palate and bifid tongue in a patient with Pierre Robin syndrome.

METHODS

A preterm male neonate of 33 weeks and 6 days was referred to our department. A protruding solid mass with approximately 7.0 × 4.0-cm size arising from the vomer and combined cleft palate and tongue covered with pinkish skin with lanugo were observed. In addition, there was a bandlike tissue connecting vomer and sublingual area, which divided and restricted the anterior portion of the tongue.

RESULTS

An early surgical intervention was decided because of problems with airways and nutrition caused by the mass. The mass was completely removed from the vomer. The histologic examination of the mass was consistent with mature teratoma. After his first operation, he was finally diagnosed with the Pierre Robin syndrome. After 4 months, a tongue reduction was conducted for macroglossia, and after 9 months, remnant teratoma excision and a palate repair were conducted using 2-flap palatoplasty.

CONCLUSIONS

A nasopharyngeal teratoma is a rare case and induces a cleft palate and bifid tongue in a preterm infant, leading to severe airway and nutritional problems. A teratoma interferes with the fusion of embryonic tissues in the early developmental period, in particular, with the palatal fusion severely prevented if the teratoma is accompanied by a Pierre Robin syndrome such as in this case.

Congenital Tongue Mass With Concomitant Cleft Palate and Bifid Tongue: A Case Report and Review of the Literature

A case report of a congenital, lingual, salivary gland choristoma with bifid tongue and cleft palate is presented. The patient was born with airway obstruction in supine positioning. Laryngoscopy revealed a midline tongue mass that extended into the hypopharyx and pathological examination showed a congenital ectopic salivary gland. The bifid tongue was repaired at the time of surgical excision. Literature review revealed nine additional cases of congenital lingual mass, bifid tongue, and cleft palate. The most common tongue mass reported was hamartoma (40%), but the differential diagnoses include hamartoma, teratoma, and salivary choristoma.

Oropharyngeal teratoma, oral duplication, cervical diplomyelia and anencephaly in a 22-week fetus: A review of the craniofacial teratoma syndrome

BACKGROUND

Oropharyngeal teratoma may occur by itself or together with other craniofacial malformations, most commonly cleft palate. Oropharyngeal teratoma may be also seen in association with frontonasal dysplasia and/or various degrees of craniofacial duplication. The nosology of these sporadic disorders is poorly defined.

CASE AND REVIEW

We report on a 22-week fetus with a protruding nasopharyngeal teratoma, partial oral duplication, anencephaly, multiple costo-vertebral segmentation defects, and cervical diplomyelia. A review of the literature identified 48 patients published from 1931 to 2013 with co-existing clefting and duplication anomalies of the cephalic pole. Thoracic and abdominal midline anomalies were reported 13 times.

CONCLUSION

The term "craniofacial teratoma syndrome" is introduced to define this phenotype as a recognizable developmental field defect of the cephalic pole. Developmental pathogenesis is discussed with a focus on pleiotropy and stereotaxis. The observation of midline findings suggestive of holoprosencephaly in a few previously reported cases suggests a role for the sonic hedgehog signaling pathway in this malformation pattern.

Oral-facial-digital syndrome type I: surgical approach and a case report

PURPOSE

Oral-facial-digital (OFD) syndromes constitute a heterogeneous group of embrionary development disorders. There are at least 11 different forms, with a broad spectrum of clinical features, causing an important problem with the diagnosis. There are only a few reports in the recent literature, and there is no surgical technique described for its correction.

MATERIALS AND METHODS

We present a newborn female referred to the Cleft Lip and Palate Division of our hospital with facial dysmorphology; her mother was affected by an incomplete form of this syndrome. Genetic investigation showed a mutation not reported before in the literature. We present the clinical features and a new surgical approach for its correction.

RESULTS

OFD syndrome type I (OFD I) is characterised by several clinical features, including incomplete central upper lip cleft, bifid tongue, intraoral hamartomas, upper lip frenula and soft palate cleft. With this technique, we get a good aesthetic result.

CONCLUSION

OFD I is extremely infrequent and it is important to differentiate it from other forms of OFD. We want to emphasise the importance of performing a correct differential diagnosis in patients affected by palate cleft who have intraoral masses or feeding problems, to rule out incomplete forms of this syndrome. Surgical correction of the malformations associated with this syndrome is a challenge for the paediatric surgeon, because none of the previously reported techniques approach the reparation of this central labial defect.

A Unique Case of Tessier 30 and Bilateral Cleft Lip and Palate: A New Clinical Syndrome?

Background

Tessier 30 cleft is rare and sparsely reported in the literature. A unique case of an infant with a Tessier 30 cleft, bilateral cleft lip and palate, and other anomalies is presented. In addition to craniofacial anomalies, he had cardiac, gastrointestinal, and genitourinal defects. The constellation of these findings suggests the possibility of a new clinical syndrome. We present these findings and postoperative results following surgical treatment.

Patient and Methods

A 37-week gestational male infant with multiple congenital anomalies is presented. Findings on clinical exam were notable for Tessier 30 median mandibular cleft, bilateral cleft of the lip and palate, and bifid tongue. Further workup revealed levocardia, perimembranous moderate-to-large ventricular septal defect, patent foramen ovale, double outlet right ventricle, intestinal malrotation, and bilateral undescended testicles. There were no extremity anomalies, and cytogenetic studies for 22q deletion were negative.

Results

The preoperative, intraoperative, and postoperative findings and images are discussed.

Conclusion

We present a unique case of a child with a Tessier 30 cleft associated with bilateral cleft lip and palate in the absence of intraoral masses or limb anomalies. Previous reports of median facial clefts have occurred either in the presence of intraoral hamartomas, suggesting the palatal defects are a result of sequence abnormalities, or in association with extremity findings consistent with the spectrum of orofaciodigital syndrome. The case we present is distinct and may represent a new clinical syndrome.

Angiomyolipomatous hamartoma of the upper lip: a rare case in an 8-month-old child and differential diagnosis

Hamartoma is a proliferation of normal tissues that are considered endogenous to the site of occurrence. In the head and neck region, hamartomas composed of other tissues different from blood and lymphatic vessels (hemangiomas and lymphangiomas) are very uncommon. We report an unusual case of upper lip angiomyolipomatous hamartoma in an 8-month-old patient. The patient underwent surgical treatment and the 1-year follow-up revealed no signs of recurrence. Angiomyolipomatous hamartoma is a very rare condition in the paediatric population group, especially in the head and neck region. It should be considered in the differential diagnosis of congenital lesions in childhood.