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Uchi R, Koto M, Nakao A, Hosokawa M, Ukawa T, Tsurisawa C, Hisaeda Y, Amagata S. Congenital Maxillomandibular Synechia with Multiple Malformations in a Very-Low-Birth-Weight Infant: A Case Report. AJP Rep 2023; 13:e35-e39. [PMID: 37215368 PMCID: PMC10198758 DOI: 10.1055/a-2070-8590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/23/2023] [Indexed: 05/24/2023] Open
Abstract
Congenital maxillomandibular synechia is a rare malformation that is characterized by a fusion of the maxilla and mandible. The fusion is fibrous or bony and prevents mouth opening, which causes difficulties in feeding and occasionally in breathing. Although extremely rare, neonatologists must understand the disease because it can be fatal and require emergency treatment after birth. We report the case of a very-low-birth-weight (VLBW) infant with congenital maxillomandibular synechia and other malformations, including cleft palate, syndactyly, and cryptorchidism. The patient presented with extremely limited mouth opening, and endotracheal intubation seemed impossible; fortunately, the patient did not have respiratory distress syndrome. The patient underwent surgical release of the fibrous bands on days 10 and 17, and good mouth opening was achieved. The patient was able to consume breast milk orally and was discharged home at a corrected gestational age of 1 month without recurrence of difficulty in mouth opening or any sequelae. This is the first reported case of a VLBW infant with congenital maxillomandibular synechia who required more complicated management of feeding, surgical intervention, and anesthesia.
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Affiliation(s)
- Ryosuke Uchi
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
- Department of Neonatology, Yokohama City University Medical Center, Yokohama, Japan
| | - Mayu Koto
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Miku Hosokawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshiko Ukawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Chisa Tsurisawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshiya Hisaeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shusuke Amagata
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan
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Kumar V, Rattan V, Rai S. Congenital Maxillomandibular Syngnathia: Review of Literature and Proposed New Classification System. J Maxillofac Oral Surg 2021; 20:19-36. [PMID: 33584038 PMCID: PMC7855147 DOI: 10.1007/s12663-019-01308-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Maxillomandibular fusion (syngnathia) is a rare craniofacial anomaly. It occurs as either fibrous (synechiae) or bony (synostosis) fusion of jaw or fusion of mandible to zygoma, tuberosity, hard palate and temporal bone. There are several documentations delineating this condition but owing to its varying presentation, association with both intraoral and extraoral anomalies and syndromes, reviewing it has been as uphill task. The non-unanimous description of cases in the literature and the use of different nomenclatures make it difficult to classify this condition. METHODS Extensive search of the literature was done from the year 1936 to 2018 which included a total of 118 cases with 62 cases of bony fusion, 48 cases of fibrous fusion and 8 cases of combined fusion, i.e., fibrous on one site and bony on another side. RESULTS This paper proposes a novel, simple and explicit classification system on the basis of nature of fusing tissues, location and extent, association with syndrome after reviewing the existing literature. Furthermore, this review reports 4 new cases of syngnathia along with their clinical, radiographic features and their management protocol. CONCLUSIONS This classification can be generalized to all the cases of syngnathia and can further facilitate in its appropriate diagnosis and treatment plan.
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Affiliation(s)
- Vijay Kumar
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Abstract
Syngnathia is a rare facial anomaly associated with neonatal problems, including a compromised airway, and the inability to take in solids and/or liquids. Syngnathia is included within the spectrum of oromandibular limb hypogenesis syndrome, an extremely rare condition characterized by varying degrees of congenital malformation involving the tongue, mandible, and limbs. In this report, we describe the case of a 41-day-old Caucasian female infant who was unable to open her mouth beginning at birth. The authors performed osteotomies to separate fused bone, and placed a bite block at the osteotomy sites to prevent bone fusion recurrence. At 2 years of follow-up patient remained with 14 mm of mouth opening.
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Abstract
Syngnathia is a congenital fusion of the upper and lower jaws. Its occurrence poses a significant challenge to feeding and its management is challenging to both the surgeon and the anaesthetist. Reports in the literature are mainly clinical reports or case series. To the knowledge of the authors and from the available literature, this is only the fourth report from Nigeria. The presentation and successful management of a Nigerian female neonate with congenital syngnathia is described and reviewed with literature.
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Mohan A. Syngnathia-Congenital Maxillomandibular fusion: Case Report and Literature Review. J Oral Maxillofac Surg 2018; 76:1096.e1-1096.e6. [PMID: 29447830 DOI: 10.1016/j.joms.2018.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/18/2022]
Abstract
Congenital maxillomandibular fusion is a rare disorder of the craniofacial region. Maintenance of the airway and difficulty in feeding are the main concerns for such patients. We performed a PubMed search to identify reported cases of syngnathia. With reference to the site of fusion and corresponding anomalies, the available studies were reviewed. The maxillomandibular fusion can be anterior fusion, unilateral or bilateral fusion, and complete fusion. The condition can be an isolated problem or associated with a syndrome. The condition requires immediate attention because it can be fatal. A case of isolated unilateral syngnathia, with the detailed review of the published data, is reported.
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Affiliation(s)
- Amit Mohan
- Faculty, Department of Oral and Maxillofacial Surgery, Manav Rachna Dental College, Faridabad, Haryana, India; and Director, SmileKraft Clinic, NIT, Faridabad, India.
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Tak HJ, Park TJ, Piao Z, Lee SH. Separate development of the maxilla and mandible is controlled by regional signaling of the maxillomandibular junction during avian development. Dev Dyn 2016; 246:28-40. [PMID: 27756109 DOI: 10.1002/dvdy.24465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Syngnathia is a congenital craniofacial disorder characterized by bony or soft tissue fusion of upper and lower jaws. Previous studies suggested some causative signals, such as Foxc1 or Bmp4, cause the disruption of maxillomandibular identity, but their location and the interactive signals involved remain unexplored. We wanted to examine the embryonic origin of syngnathia based on the assumption that it may be located at the separation between the maxillary and mandibular processes. This region, known as the maxillomandibular junction (MMJ), is involved in segregation of cranial neural crest-derived mesenchyme into the presumptive upper and lower jaws. RESULTS Here we investigated the role of Fgf, Bmp, and retinoid signaling during development of MMJ in chicken embryos. By changing the levels of these signals with bead implants, we induced syngnathia with microstomia on the treated side, which showed increased Barx1 and neural cell adhesion molecule (NCAM) expression. Redistribution of proliferating cells was also observed at the proximal region to maxillary and mandibular arch around MMJ. CONCLUSIONS We propose that interactive molecular signaling by Fgfs, Bmps, and retinoids around MMJ is required for normal separation of the maxilla and mandible, as well as the proper positioning of beak commissure during early facial morphogenesis. Developmental Dynamics 246:28-40, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hye-Jin Tak
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Tae-Jin Park
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
| | - Zhenngu Piao
- Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Guangzhou Medical College, GuangZhou City, China
| | - Sang-Hwy Lee
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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Congenital Bilateral Zygomatico-Maxillo-Mandibular Fusion Associated With Gum Fusion. J Craniofac Surg 2016; 27:e20-3. [PMID: 26703053 DOI: 10.1097/scs.0000000000002293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
A congenial syngnathia is very rare condition. It can be simple mucosal fusion (synechiae), or complete bony fusion (synostosis) between the maxilla or zygoma and the mandible. Fusion of the ascending ramus of mandible to maxilla and zygoma is less common than fusions of the alveolar ridges of the mandible to the maxilla. Bony syngnathia is either isolated or complex in form. There are 59 cases of congenital bony syngnathia reported in the literature: the first report was by Burket in 1936. There are 16 reported cases of zygomatico-maxillo-mandibular fusion. In the reported cases, women expressed the isolated form more commonly whereas men demonstrated a more complex pattern of disease. The authors present another patient of bony syngnathia involving bilateral fusion of the ascending ramus and body of the mandible with the maxillary complex in a young man. Early surgery was performed to release the bony and soft tissue fusion on the eighth day from the baby's birth. A second operation was performed for recurrence when the baby was 2.5 months old. A customized splint, an intense postoperative program of mouth exercises, and close follow-up aims to prevent further refusion.
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Patel SD, Porras S, Lypka M. Journey to chew: a case of maxillary duplication and bony syngnathia. J Craniomaxillofac Surg 2014; 43:57-61. [PMID: 25487671 DOI: 10.1016/j.jcms.2014.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/12/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022] Open
Abstract
Tessier no 3 cleft, bony syngnathia, and maxillary duplication are rare as independent anomalies and have never been reported together in a single case. Here we present a patient with congenital bony syngnathia, maxillary duplication, and a Tessier no. 3 nasal cleft. Other abnormalities included situs inversus, dextrocardia, coarctation of the aorta, left choanal stenosis, left coloboma, and hypertelorbitism. Given the unique presentation, we present our early surgical management to this complex problem.
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Affiliation(s)
| | - Susana Porras
- Oral and Maxillofacial Surgery, UT Houston, Houston, TX, USA
| | - Michael Lypka
- University of Missouri, Kansas City School of Medicine, Children's Mercy Hospital, Kansas City, USA
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Reddy MP, Raghu SR. Congenital fusion of jaw and ankyloblepharon filiforme adnatum: malformation and multiple systems anomaly. Indian J Plast Surg 2013; 45:557-9. [PMID: 23450463 PMCID: PMC3580361 DOI: 10.4103/0970-0358.105977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Congenital fusion of jaw and its association with ankyloblepharon filiforme adnatum is reported but is a quite rare congenital benign anomaly. It may be unilateral or bilateral and can present with a single system or multiple systems involvement. This report concentrates on describing the clinical features of above disease, likely aetiological causes, and embryogenesis with classification, diagnostic, and, treatment modality, anesthesia problems and review of literature.
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Affiliation(s)
- Mallika P Reddy
- Department of Oral and Maxillofacial Surgery, K G F College of Dental Sciences, Bangalore, Karnataka, India
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Martín LP, Pérez MM, García EG, Martín-Moro JG, González JIR, García MB. Atypical case of congenital maxillomandibular fusion with duplication of the craniofacial midline. Craniomaxillofac Trauma Reconstr 2012; 4:113-20. [PMID: 22655122 DOI: 10.1055/s-0031-1279674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report the first case of syngnathia with hypophyseal duplication and describe the central nervous system (CNS) and craniofacial anomalies associated with hypophyseal duplication in the reported autopsy case. We studied clinical reports, scanner images, and autopsy results of a 2-months-old female baby. The propositus had frontonasal dysmorphism, retrognathia, and bifid tongue. She also presented maxillomandibular bony fusion (syngnathia) and an intraoral hairy polyp. In the cranium, the sella turcica was broadened, with two complete hypophyses and two infundibulums. The CNS had both olfactory bulbs and corpus callosum agenesis. There are 27 previous cases of maxillomandibular fusion and seven previous autopsy cases of hypophyseal duplication associated with other frontonasal malformations. As far as the authors know, this is the first case reported in the literature that associates syngnathia with duplication of the craniofacial midline including hypophyseal duplication.
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Bozdag S, Erdeve O, Konas E, Tuncbilek G, Dilmen U. Management of serious isolated gingival synechia in a newborn: case report and review of the literature. Int J Oral Maxillofac Surg 2011; 40:1428-31. [DOI: 10.1016/j.ijom.2011.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 04/22/2011] [Accepted: 05/05/2011] [Indexed: 11/29/2022]
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Naikmasur VG, Sattur AP, Joshi S, Rai A. Congenital Syngnathia: Case Report and Review of Literature. Cleft Palate Craniofac J 2010; 47:654-60. [DOI: 10.1597/09-090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Congenital bony fusion of the maxilla and mandible, especially as an isolated occurrence, is a very rare condition. The very few cases reported in the literature are mostly inadequate in description and confusing in nomenclature. An isolated case of syngnathia in a 60-year-old female patient with unilateral bony fusion (synostosis) of the maxilla and mandible associated with fibrous adhesions (synechiae) of the opposite site is reported. The existent literature is also reviewed.
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Affiliation(s)
| | - Atul P. Sattur
- Department of Oral Medicine and Radiology, S.D.M. College of Dental Sciences & Hospital
| | - S.K. Joshi
- Department of Radiodiagnosis, S.D.M. College of Medical Sciences & Hospital
| | - Arpita Rai
- Department of Oral Medicine and Radiology, S.D.M. College of Dental Sciences & Hospital, Dharwad, Karnataka, India
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Konaş E, Tunçbilek G, Kaykçoğlu A, Özgür F. Congenital Bony Syngnathia With Unilateral Palatal Shelf and Soft Palate Agenesis. J Craniofac Surg 2010; 21:1645-7. [DOI: 10.1097/scs.0b013e3181ef6b1f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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El-Hakim I, Al-Sebaei M, Abuzennada S, AlYamani A. Congenital fusion of the maxilla and mandible (congenital bony syngnathia). Int J Oral Maxillofac Surg 2010; 39:933-6. [DOI: 10.1016/j.ijom.2010.04.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 03/12/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
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Fallahi HR, Naeini M, Mahmoudi M, Javaherforoosh F. Congenital zygomatico-maxillo-mandibular fusion: a brief case report and review of literature. Int J Oral Maxillofac Surg 2010; 39:930-3. [PMID: 20466517 DOI: 10.1016/j.ijom.2010.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/23/2010] [Accepted: 04/06/2010] [Indexed: 11/18/2022]
Abstract
Congenital maxillomandibular fusion (syngnathia) is rare. The first case was reported in 1936. By 2004, only 25 cases of syngnathia had been reported including 6 cases with fusion of the ascending rami of the mandible with the maxilla and zygomatic complex. This report concerns a 6-month-old girl with a type of congenital fusion of the ascending rami of the mandible with the upper alveolar arch and zygomatic complex that leads to restriction of mouth opening. The clinical features of this anomaly and a brief review of literature are presented.
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Affiliation(s)
- H R Fallahi
- Department of Oral and Maxillofacial Surgery, Jondishapour University of Medical Sciences, Imam Khomeini Medical Center, Ahvaz, Iran.
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Visscher SH, Schortinghuis J, Bos RR. Congenital Mandibular Hypomobility: A Rare Condition With Little Consensus—A Case Report. J Oral Maxillofac Surg 2009; 67:444-7. [DOI: 10.1016/j.joms.2008.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 04/01/2008] [Accepted: 06/17/2008] [Indexed: 11/16/2022]
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