Cleft Palate and Congenital Synechiae Syndrome: A Case Report

Abstract

A 1-day-old baby girl with a cleft of the secondary palate and a soft tissue band connecting the upper and lower jaws and preventing mouth opening was referred to the cleft lip and palate team by her pediatrician. This case represents a further example of an interesting but rare anomaly known as congenital alveolar synechia syndrome that requires early management to allow normal feeding and oral development.

Epithelial integrity in palatal shelf elevation

“…Moreover, recent findings suggest that proper differentiation of the oral epithelium provides epithelial integrity for palatal elevation, and the loss of epithelial integrity results in ectopic epithelial fusion, leading to inhibition of palatal shelf elevation. These findings possibly imply human condition of intraoral synechiae associated with the development of cleft palate [5][6][7]. However, mechanisms responsible for this anomaly have not been elucidated, although in mice, the presence of oral epithelial fusion in some mutant mice strains has been reported [8][9][10][11][12][13].…”

Intubation of a neonate with glossopalatine ankylosis using a paraglossal approach and a laryngoscope with a straight blade

“…Murphy and Rea divided a soft tissue band connecting the upper and lower jaws (restricting the mouth opening) with bipolar diathermy under a brief general anaesthetic using a face mask. 7 Kothari and Gupta reported separation of the fibromuscular bands by cauterisation in a case of ankyloglossia superior. 8 Ogino et al described the resection of a cord-like adhesion band between the hard palate and the floor of the mouth, leading to restricted mouth opening and feeding problems in a one-month-old boy.…”

Congenital lateral cleft palate and lateral palatal synechiae

“…Four kinds of synechiae may be present in the mouth: the bands may extend between the ridges of the upper and lower jaws [3Á6] (syngnathia congenita syndrome); bands of mucosa may extend from the edges of a palatal cleft to the lateral parts of the tongue and the oral floor as in our case (called cleft palate-lateral synechiae syndrome) [7]; there are multiple cords or a membrane extending from the tongue to the cleft palate (persistence of buccopharyngeal membrane Á posterior palatal synechiae) [8]; and there is a subglossopalatal membrane with the cleft palate [9,10].…”