Congenital Unilateral Zygomatico-Maxillo-Mandibular Fusion:

Early Surgical Intervention of Congenital Syngnathia

Congenital syngnathia is a rarely reported malformation when there is a fusion between the maxilla and the mandible. It is necessary to modify it in childhood because congenital syngnathia causes incongruity in pronunciation, diet, and esthetics during the growth process. In this case report, 1 case of syngnathia, a rare craniofacial anomaly, is presented with a review of reports. Prompt diagnosis and surgery were performed right after birth for the present case. A partial limitation point was resolved for further growth. Herein, the authors present the case of a female infant (7 d after birth) diagnosed with congenital syngnathia and treated by early surgical intervention.

Congenital bilateral zygomatico-maxillo-mandibular fusion associated with gumfusion: Case report

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.

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Very few published cases concerning maxillomandibular sygnathia in the literature.

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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.

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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.

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Effective rehabilitation through parent training and physiotherapy is necessary to optimize results.