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Altuwairgi O, Aljabab A, Makrami A, Alomar A, Alturkistany Y, Bakarsharwani A, Alhazmi B, layqah L, Alayfan G, Baharoon W. Congenital maxillomandibular fusion: Case series and review of the literature congenital syngnathia treatment approach. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Congenital bilateral zygomatico-maxillo-mandibular fusion associated with gumfusion: Case report. Int J Surg Case Rep 2021; 84:106078. [PMID: 34225063 PMCID: PMC8259410 DOI: 10.1016/j.ijscr.2021.106078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Maxillomandibular sygnathia is a rare and severe craniofacial deformity defined by gingival mucosal fusion (synechia) or bony fusion (synostosis). Case report We will present a case of complete closure of the mouth since birth from eastern Morocco treated in our department of maxillofacial surgery at the University Hospital of Casablanca. The patient was referred after two months by the pediatrician of the provincial hospital and following the placement of a nasogastric tube. On admission, she presented with facial dysmorphosis, signs of malnutrition with closure of the mouth and fusion of both gums with pro-alveoli and retromandibulia. CT scan with 3D reconstruction confirmed maxillomandibular synostosis. 5 days later, she underwent a fixed mucosal incision with osteotomy at the maxillomandibular joints with early and prolonged active physical therapy. The evolution was marked by the recurrence of mouth closure, the little girl was operated a second time and then she died by a mucous plug at the level of her tracheostomy cannula during resuscitation. Discussion Maxillomandibular sygnathia is a very rare pathology whose origin remains unknown. Very few cases published in the literature. Conclusion The therapeutic difficulties encountered outside the ideal age of the operation and the management of recurrences were also linked to socio-economic factors making it difficult to ensure adequate postoperative follow-up. Very few published cases concerning maxillomandibular sygnathia in the literature. The presence of our case and another similar case in his family makes us wonder about the influence of environmental factors on the occurrence of the disease. Even if the treatment is surgical in all cases, we note the lack of consensus on the ideal age to operate and manage recurrences and complications. Effective rehabilitation through parent training and physiotherapy is necessary to optimize results.
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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
Congenital syngnathia is a very rare condition that presents with several unique challenges. There is no consensus on the best operative approach to manage this condition. Readhesion of surgically separated tissues is a relatively common occurrence. The authors propose that the use of a vertical distraction technique helps maintain adequate separation to prevent relapse of the bony fusion. Long-term follow-up will be required to follow mandibular growth and implications of this treatment option.
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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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Friscia M, Bonavolontà P, Arena A, Committeri U, Maglitto F, Salzano G, Iaconetta G, Califano L. Syngnathia: a rare case of maxillo-mandibular fusion in an adult patient. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04955-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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] [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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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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Rubio-Palau J, Prieto-Gundin A, de Abreu Graterol LM, Vercruysse H. Maxillomandibular Syngnathia: 3D Planning and Review of the Literature. Craniomaxillofac Trauma Reconstr 2018; 11:124-130. [PMID: 29892327 DOI: 10.1055/s-0037-1606248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/29/2017] [Indexed: 10/19/2022] Open
Abstract
Congenital maxillomandibular fusion or syngnathia is a rare craniofacial disorder with only 26 cases reported in the literature. We present a case of a congenital complex zygomatico-mandibular syngnathia associated with a palatal cleft, posterior maxilla and turbinate agenesia, mild hemifacial microsomia, and a disordered dental eruption. The patient has the highest age (15 years) at diagnosis described in the literature. 3D planning of the surgery was performed to study the patient's anatomy and design the necessary osteotomies to separate the jaws. En bloc removal of the fused fragment with bilateral coronoidectomy and aggressive long-term physiotherapy for 3 months led to a stable increase in mouth opening from 0 to 21 mm inter-incisor distance. The patient reported an improvement in speech, was able to eat without restriction regarding food consistency, and could maintain a good oral hygiene.
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Affiliation(s)
- Josep Rubio-Palau
- Division of Maxillofacial Surgery, Department of Pediatric Surgery, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain.,Department of Oral Medicine and Oral Public Health, Universitat Internacional de Catalunya, Barcelona, Catalunya, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Herman Vercruysse
- Department of Craniofacial Surgery, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom
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Abdel-Hameed Elsayed S, Hegab AF, Youssif Alkatsh SS. Does Surgical Release of TMJ Bony Ankylosis Increase the Risk of Trigeminocardiac Reflex? A Retrospective Cohort Study. J Oral Maxillofac Surg 2018; 77:391-397. [PMID: 30712536 DOI: 10.1016/j.joms.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The exact frequency of the trigeminocardiac (TGC) reflex in temporomandibular joint (TMJ) surgery is still controversial. The purpose of the present report was to estimate the frequency of and identify the risk factors for TGC reflex among patients undergoing operative management of TMJ ankyloses. PATIENTS AND METHODS A retrospective cohort study was conducted of patients who had undergone gap arthroplasty for TMJ ankyloses at Al-Azhar University Hospital, Cairo, Egypt, from 2001 to 2015. The predictor variables were patient demographic data (age and sex), ankylosis type, and surgery type. The outcome variable was the occurrence of the TGC reflex (yes vs no). The data analysis included descriptive statistics and χ2 tests to compare the categorical variables. Binary regression logistic model analysis was performed to identify the associated predictor variable. P values were considered statistically significant at ≤ .05. RESULTS The sample included 55 subjects. The mean ± standard deviation age of the patients was 21.3 ± 9.855 years, and 43.6% were males. The frequency of TGC reflex was 12.7%. The factors associated with an increased risk of TGC reflex were type IV bony ankylosis (P = .012) and the need for repeat surgery (P = .016.). A multivariable binary regression model analysis demonstrated that the recurrence of surgery was the most significant predictor factor affecting the frequency of the TGC reflex. The computed variance ranged from 13 to 25%. However, other variables, including age, gender, side, and ankylosis type, were not associated with reflex onset (odds ratio, 0.028; 95% confidence interval, 0.001 to 0.911; P = .044). CONCLUSIONS Recurrent ankylosis surgery carries a high risk of TGC reflex. Preoperative risk factor identification and close monitoring are crucial to prevent the occurrence of this reflex in susceptible patients. Future research projects should include more variables in the study.
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Affiliation(s)
- Shadia Abdel-Hameed Elsayed
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Dental College and Hospital, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia; and Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University (Girls Branch), Cairo, Egypt.
| | - Ayman F Hegab
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Saeed Salem Youssif Alkatsh
- Lecturer, Department of Anaesthesia and Intensive Care, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
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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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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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Yew CC, Rahman SA, Alam MK. Temporomandibular joint ankylosis in a child: an unusual case with delayed surgical intervention. BMC Pediatr 2015; 15:169. [PMID: 26546159 PMCID: PMC4635686 DOI: 10.1186/s12887-015-0495-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background The Temporomandibular Joint (TMJ) ankylosis in child is rare and yet the causes still remain unclear. This condition that affects the feeding and possible airway obstruction do not only worry the parents, but also possesses as a great challenge to the surgeons. Furthermore, it interferes with the facial skeletal and dento-alveolar development in the on growing child. Case presentation In this case report, we presented the management of a 7 year old with left TMJ ankylosis discovered since infant. Clinical and imaging investigations were consistent with left temporomandibular joint ankylosis (Type IV) possible secondary to childhood septic arthritis. Left gap arthroplasty via modified Al Kayat Bramley and retromandibular approach was performed, with interpositional arthroplasty placement of temporalis fascia graft. No complications from the surgery except reduced mouth opening were seen. Possible contributing factors to this less than satisfactory mouth opening are adressed. Conclusion We describe here, an unusual childhood temporomandibular joint ankylosis possible due to septic arthritis with delayed surgical intervention. The aetiology, classifications, timing and choice of surgical techniques along with its considerations and complications are discussed. Although there is no consensus on the surgical treatment of TMJ ankylosis, early mobilisation, aggressive physiotherapy and close follow-up are advocated by many authors for successful treatment.
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Affiliation(s)
- Ching Ching Yew
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia. .,Oral and Maxillofacial Surgery Department, School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Shaifulizan Ab Rahman
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Mohammad Khursheed Alam
- School of Dental Sciences, University Science Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
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Mascarella MA, Schwartz J, Manoukian JJ. Congenital intra-oral adhesions: a surgical approach to cleft palate lateral synechia syndrome. Int J Pediatr Otorhinolaryngol 2015; 79:769-72. [PMID: 25819497 DOI: 10.1016/j.ijporl.2015.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
An array of genetic syndromes has been associated with intra-oral adhesions in neonates. The primary medical issues arise from airway obstruction, feeding difficulties and poor oral development, specifically with cleft palate lateral synechia syndrome (CPLSS). Despite this, a paucity of data exists for the clinical management of intra-oral adhesions in this population. We report the cases of a father and daughter diagnosed with CPLSS who presented with respiratory and feeding difficulties at birth undergoing surgical correction. Early surgical ligation of intra-oral bands allows for a stabilization of the airway, improved feeding and oral development with a good long-term outcome.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
| | - Joseph Schwartz
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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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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Mahgoub L, Joynt C, Bhargava R, Davies D, El-Hakim H, Dobrovolsky W. Postnatal Diagnosis of a Baby With Multiple Rare Congenital Anomalies Including Syngnathia, Brain Dysmorphism, and Skin Pigmentation. Cleft Palate Craniofac J 2014; 52:e201-4. [PMID: 25325328 DOI: 10.1597/14-069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Syngnathia is a rare congenital disorder of jaw fusion with a paucity of literature from developed countries. We present a case of an infant noted to have multiple anomalies at birth including syngnathia, microcephaly with a variant of brain abnormality between holoprosencephaly and syntelencephaly, optic nerve hypoplasia, ear canal anomalies, hemi-vertebrae, and suspected hypomelanosis of Ito. To our knowledge, this patient with syngnathia and multiple anomalies is the first to be reported, but whether they are a coincidence, a pathogenetic association, or a new syndrome remains unknown. This case is discussed with a brief review of the literature.
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Congenital unilateral maxillomandibular fusion. Br J Oral Maxillofac Surg 2014; 52:e20. [PMID: 24447347 DOI: 10.1016/j.bjoms.2013.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/19/2013] [Indexed: 11/20/2022]
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Rattan V. Congenital maxillomandibular fusion: report of three cases. Int J Oral Maxillofac Surg 2013; 42:546-7. [PMID: 23415894 DOI: 10.1016/j.ijom.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/14/2013] [Indexed: 11/18/2022]
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