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Chen S, Cui J, Ji Y, Kong L, Shen W. Application of Computer-Assisted Preoperative Planning in Treating Congenital Bilateral Zygomatico-Maxillo-Mandibular Fusion: A Case Report and Literature Review. Cleft Palate Craniofac J 2023; 60:489-493. [PMID: 35440222 DOI: 10.1177/10556656211064775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital fusion of the jaws (syngnathia) is a rare facial malformation with an unknown etiology. This disease may vary in severity with adhesion of soft tissue and bony fusion. It can be anterior fusion, unilateral or bilateral fusion, and complete fusion. The main problem of these patients is the difficulty of airway maintenance and feeding, and the most common postoperative complication is the relapse of bony fusion. Here, we report a young male patient with bony syngnathia, involving bilateral fusion of the ascending ramus and body of the mandible with the maxillary complex. We performed bone isolation by computer-assisted preoperative planning and used an insertional temporalis flap to fix the wound surface to prevent refusion of bone.
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Affiliation(s)
- Sheng Chen
- 159388Children's Hospital of Nanjing Medical University
| | - Jie Cui
- 159388Children's Hospital of Nanjing Medical University
| | - Yi Ji
- 159388Children's Hospital of Nanjing Medical University
| | | | - Weimin Shen
- 159388Children's Hospital of Nanjing Medical University
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Imai Y, Tachi M. Congenital Lateral Palatal Synechia Associated With Cleft Palate: A Case Report With Long-Term Follow-Up and Review of the Literature. Cleft Palate Craniofac J 2019; 57:778-781. [PMID: 31876173 DOI: 10.1177/1055665619896687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lateral palatal synechiae are rare congenital adhesions running from the free borders of the cleft palate to the lateral parts of the tongue or the oral cavity floor, typically found in cleft palate lateral synechiae syndrome. We present a case of congenital lateral palatal synechia associated with a cleft palate that we treated and followed up for 10 years. We present the long-term prognosis. We also discuss variations in intraoral synechiae associated with cleft palate and the etiology of lateral palatal synechiae through a literature review.
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Affiliation(s)
- Yoshimichi Imai
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Tachi
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Olusanya AA, Akadiri OA. Congenital syngnathia: review of clinical profile and proposal of a new classification-based management protocol. Int J Oral Maxillofac Surg 2019; 49:505-514. [PMID: 31590998 DOI: 10.1016/j.ijom.2019.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/20/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
Abstract
Syngnathia is a rare congenital anomaly that presents as fusion of the jaws. The aims of this study were to review the clinical profile of reported cases of syngnathia available in the literature with a view to suggesting a classification that may simplify the understanding of syngnathia and to propose an appropriate management protocol. A PubMed database search of articles published in English was conducted. Selected articles were analyzed according to year of publication, type of article, number of cases per article, patient biodata, description of syngnathia, and associated anomalies. Data were analyzed using IBM SPSS version 19; the level of statistical significance was set at P≤ 0.05. Cases were categorized according to a proposed classification, and a review of the management of congenital syngnathia from 153 previously reported cases (in 110 articles) was done to propose a treatment protocol based on the proposed classification model. The findings are presented under three headings: pre-surgical considerations, surgical (intraoperative) considerations, and post-surgical considerations. The proposed classification categorizes syngnathia into soft tissue union (type 1) and hard tissue union (type 2). These two types were found to have similar frequencies in the literature, while their management differed in terms of mode of anaesthesia and surgical approach.
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Affiliation(s)
- A A Olusanya
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - O A Akadiri
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria
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Vamvanij N, Chen ZC, Lo LJ. Patients With Cleft Lip and Palate Associated With Intraoral Fibrous Bands: A Report of 3 Cases and Review of Literature. Cleft Palate Craniofac J 2019; 57:389-394. [PMID: 31378081 DOI: 10.1177/1055665619867233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In rare instances, cleft lip and palate occur in association with synechia, intraoral fibrous bands connecting the maxilla and mandible. The main concern in synechia is a restricted mouth opening that leads to airway and feeding problems. This study reports our experience in the treatment of 3 cases and includes a review of the literature. Three patients with intraoral fibrous bands received treatment and follow-ups in our center. Division of the bands and reconstruction of the lip and palate were successfully performed. All reported cases in the literature were collected for a summary of clinical presentations and as references for management. Early management of the synechia improves the mouth opening and facilitates the treatment of associated anomalies.
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Affiliation(s)
- Natthacha Vamvanij
- Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Guishan, Taoyuan
| | - Zung-Chung Chen
- Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Guishan, Taoyuan
| | - Lun-Jou Lo
- Plastic and Reconstructive Surgery, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Guishan, Taoyuan
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Dongol A, Acharya P, Prasad JN, Jaisani MR. A veil in the oral cavity: report of two cases of oral synechiae. Int J Oral Maxillofac Surg 2016; 46:286-288. [PMID: 28041885 DOI: 10.1016/j.ijom.2016.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/29/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
An oral synechia is an adhesion between the maxilla and the mandible; these adhesions can be found at various locations in the oral cavity. The presence of oral synechiae associated with cleft palate represents a rare congenital deformity. Oral synechiae with cleft palate can have serious implications for airway management and feeding in babies, and hence requires early intervention to reduce morbidity. Two cases of congenital oral synechiae accompanied by cleft palate, in which the synechiae veiled the oral cavity restricting a detailed intraoral examination, are reported here.
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Affiliation(s)
- A Dongol
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
| | - P Acharya
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - J N Prasad
- Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - M R Jaisani
- Department of Oral and Maxillofacial Surgery, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Dongyuan L, Yiyang C, Fan L, Jiansuo H. Lateral Soft Palate Growth Deficiency: Case Report and Therapeutic Management. Cleft Palate Craniofac J 2015; 54:354-357. [PMID: 26575965 DOI: 10.1597/15-052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a girl with syndromic cleft palate, probably as part of a first branchial arch syndrome, who was unique in having almost complete unilateral aplasia of the soft palate. Rather than using soft tissue transplants or a prosthesis, we pioneered the use of a modified Furlow technique, which proved to be simple to perform, effective, and safe.
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Mukharjee S, Mitra D, Sen A, Chattopadhyay A, Kajal S, Dhankhar M. Intubation of a neonate with glossopalatine ankylosis using a paraglossal approach and a laryngoscope with a straight blade. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201181.2014.979629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Donepudi SK, Stocks RMS, Pivnick EK, Mineck C, Thompson JW. Cleft palate lateral synechia syndrome: an opportunity for unique surgical closure. Int J Pediatr Otorhinolaryngol 2009; 73:861-6. [PMID: 19368978 DOI: 10.1016/j.ijporl.2009.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 03/09/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report two cases of cleft palate lateral synechia (CPLS) syndrome in a single family and describe surgical closure using the synechia. STUDY DESIGN Case report and literature review. METHODS A case report is presented with a review of the literature of cleft palate in conjunction with lateral synechia. Clinical presentation with photographic images of surgical repair is presented as well as a genetic workup with pedigree. RESULTS A 6-week-old male presented for evaluation of a cleft palate. Mucosa-lined, fibromuscular tissue bands were noted connecting the floor of mouth and the free edges of a bilateral complete secondary cleft palate. No other craniofacial, digital, genital or limb defects were noted. The patient's 13-month-old sister had similar synechial bands and cleft palate at birth. Another older sibling had cleft palate without synechia. The patient's mother and maternal great grandmother had cleft palates at birth without synechia. The three children share a common mother but have three different fathers. Genetic analysis failed to reveal chromosomal defects or a mutation in the interferon regulatory factor 6 (IRF6) gene, a locus linked to Van der Woude syndrome. At 2 years of age, the index patient was growing and feeding well. His intra-oral bands remained intact and were incorporated in the surgical repair using a novel approach. CONCLUSIONS Since more otolaryngologists are performing cleft surgeries, the awareness of the differential diagnoses associated with a cleft palate is important. CPLS is an extremely rare condition. The report of this family supports the suspected pattern of autosomal dominant inheritance with variable expressivity. The unusual surgical approach will be discussed.
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Affiliation(s)
- Sreekrishna Kanth Donepudi
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Room 428, Memphis, TN 38163, USA
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Abstract
Cleft palate is a commonly observed congenital maxillofacial defect. One of the most important problems with clefts is the interference with feeding. An affected infant cannot produce negative pressure in the oral cavity and therefore cannot move the bolus backward to the pharynx. To obtain better nutritional intake prior to surgical correction, a palatal lift obturator is recommended. In this clinical report, a modified technique of obturator fabrication is presented. The new method uses a piece of tulle, a flexible and durable material that is frequently used in theater attire. With the help of this material, the bulb part is connected to the plate as a labile piece, and this connection acts like a natural velopharyngeal extension. Additionally, because of the softer property of the silicone elastomer, the posterior pharyngeal wall is less irritated.
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Affiliation(s)
- Banu Karayazgan
- Department of Prosthodontics, GATA Military Training Hospital, Istanbul, Turkey.
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13
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Oh AK, Thakuria J, Kimonis V, Mulliken JB. Subglossopalatal synechia in association with cardiac and digital anomalies. Cleft Palate Craniofac J 2008; 45:217-21. [PMID: 18333647 DOI: 10.1597/06-181.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 1-day-old boy in respiratory distress had a midline soft tissue band between the floor of the mouth and the posterior edge of the hard palate. There was also a soft palatal cleft, cardiac anomalies, and a hypoplastic right fifth finger and toe. Although his airway initially improved following urgent excision of the subglossopalatal band, he continued to have episodic desaturations. A tongue-lip adhesion opened his airway, and he subsequently underwent resection of juxtaductal aortic coarctation and ligation of patent ductus arteriosus and left superior vena cava. Congenital oral synechiae are uncommon. Affected infants often require prompt intervention secondary to respiratory distress and feeding difficulty. Review of the literature indicates that midline subglossopalatal synechia with cardiac and digital anomalies may be in the oromandibular-limb hypogenesis spectrum.
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Affiliation(s)
- Albert K Oh
- Craniofacial Centre, Division of Plastic Surgery, Children's Hospital, Harvard Medical School.
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Gahm C, Kuylenstierna R, Papatziamos G. Popliteal pterygium syndrome (PPS) with intra-alveolar syngnathia: a discussion of anesthetic and surgical considerations. Int J Pediatr Otorhinolaryngol 2007; 71:1613-6. [PMID: 17651819 DOI: 10.1016/j.ijporl.2007.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 05/22/2007] [Accepted: 05/22/2007] [Indexed: 11/19/2022]
Abstract
Popliteal pterygium syndrome (PPS) is a rare genetic disorder that involves the association of a popliteal web with a combination of craniofacial, genitourinary and extremity malformations. In this article, we describe a patient with PPS complicated with multiple intra-alveolar syngnathia. We discuss the anesthetic and the surgical management of this case and review the literature regarding PPS and intra-alveolar syngnathia.
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Affiliation(s)
- Caroline Gahm
- Department of ENT Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Abstract
We present 2 contrasting cases of congenital interalveolar synechiae. The first occurred in the setting of Van der Woude syndrome and was associated with a cleft palate. In the second case, it was an isolated abnormality and there was no contributory family history or syndromic associations. We review the literature on interalveolar synechiae and discuss its management, implications, and genetics. Interalveolar synechiae is a condition with an excellent prognosis; its presence necessitates careful examination for associated abnormalities and syndromes.
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Sahin U, Ozdil K, Uscetin I, Saylkan S, Oktem F, Yuce S, Velidedeoglu H, Celebioglu S. CLEFT PALATE AND CONGENITAL ALVEOLAR SYNECHIAE SYNDROME. Plast Reconstr Surg 2005; 115:1212-3. [PMID: 15793474 DOI: 10.1097/01.prs.0000157509.73723.3a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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