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Ge S, Wang N, Shang W, Feng Y. Success in Emergency Treatment of Neonatal Giant Teratoma with Cleft Palate: A Case Report. Cleft Palate Craniofac J 2023; 60:1659-1664. [PMID: 35746844 DOI: 10.1177/10556656221109753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neonatal teratoma, a common congenital malformation, rarely occurs in the head and neck region, especially not within the oral cavity. This report presents a case of neonatal giant teratoma in the oral cavity and oropharynx along with cleft palate, which caused postnatal airway obstruction and respiratory distress and required postnatal resection in a female newborn. After the delivery and routine neonatal examination, the anesthesiologist conducted orotracheal intubation to establish the airway, and tumor resection was immediately done under local anesthesia. The optimal treatment of neonatal teratoma is exclusive emergent surgery. Immediate postnatal resection is necessary to prevent airway obstruction.
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Affiliation(s)
- Shengyou Ge
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Shandong Province, China
| | - Ning Wang
- Department of Pathology, Basic Medical College of Qingdao University, Qingdao, Shandong, China
| | - Wei Shang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Shandong Province, China
| | - Yuanyong Feng
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Shandong Province, China
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2
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Trevisani V, Balestri E, Napoli M, Caraffi SG, Baroni MC, Peluso F, Colonna A, Iughetti L, Gargano G, Superti-Furga A, Garavelli L. Diprosopus: A Rare Case of Craniofacial Duplication and a Systematic Review of the Literature. Genes (Basel) 2023; 14:1745. [PMID: 37761885 PMCID: PMC10530716 DOI: 10.3390/genes14091745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
In 1990, Gorlin et al. described four types of craniofacial duplications: (1) single mouth with duplication of the maxillary arch; (2) supernumerary mouth laterally placed with rudimentary segments; (3) single mouth with replication of the mandibular segments; and (4) true facial duplication, namely diprosopus. We describe a newborn born with wide-spaced eyes, a very broad nose, and two separate mouths. Workup revealed the absence of the corpus callosum and the presence of a brain midline lipoma, wide sutures, and a Chiari I malformation with cerebellar herniation. We conducted a systematic review of the literature and compared all the cases described as diprosopus. In 96% of these, the central nervous system is affected, with anencephaly being the most commonly associated abnormality. Other associated anomalies include cardiac malformations (86%), cleft palate (63%), diaphragmatic hernia (13%), and disorder of sex development (DSD) (13%). Although the facial features are those that first strike the eye, the almost obligate presence of cerebral malformations suggests a disruptive event in the cephalic pole of the forming embryo. No major monogenic contribution has been recognized today for this type of malformation.
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Affiliation(s)
- Viola Trevisani
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Eleonora Balestri
- Neonatal Intensive Care Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
| | - Maria Chiara Baroni
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesca Peluso
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
| | - Anna Colonna
- Department of Biomedical Technologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Lorenzo Iughetti
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Livia Garavelli
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
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3
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Duplication of the Pituitary Gland: CT, MRI and DTI Findings and Updated Review of the Literature. Brain Sci 2022; 12:brainsci12050574. [PMID: 35624961 PMCID: PMC9139653 DOI: 10.3390/brainsci12050574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
Duplication of the pituitary gland (DPG) is an extremely rare malformation. DPG is associated with a wide variety of midline and central nervous system malformations (DPG-plus syndrome). We present the computed tomography (CT), magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) findings of a rare case of DPG with associated tuberomammillary fusion resulting in a hypothalamic mass-like configuration, oropharyngeal teratoma, cleft palate, hypertelorism, duplicated/broad sella, duplication/low bifurcation of the basilar artery, and craniovertebral midline anomalies. Qualitative interpretation of DTI yielded normal white matter organization of the brain. The duplication of the prechordal plate and the rostral end of the notochordal plate/notochord is thought to be the main factor leading to a duplication of the pituitary primordium and resulting in the formation of two morphologically normal glands. The time of induction of the teratogenic influence, the extent of the prechordal plate and notochordal plate/notochord abnormalities, and the faulty interactions are believed to be the reason for the wide spectrum of associated midline abnormalities.
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4
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Wang Y, Liu H, Zhang N, Luo E. Partial duplication of the jaw: case reports and review of relevant publications. Br J Oral Maxillofac Surg 2019; 58:34-42. [PMID: 31735399 DOI: 10.1016/j.bjoms.2019.10.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023]
Abstract
Craniofacial duplication is a rare congenital malformation with a wide phenotypic range. The signs and symptoms range from partial craniofacial duplication to bicephalus. We describe two cases of partial duplication of jaw: a girl with a duplication of the maxilla, and a boy with duplication of the mandible. We review the relevant publications and discuss the pathogenesis.
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Affiliation(s)
- Y Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
| | - H Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
| | - N Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
| | - E Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University.
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5
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Carvalho CHPD, Nonaka CFW, Elias CTV, Matheus RDCS, Dias RMB, Souza LBD, Pinto LP. Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up. Braz Dent J 2018; 28:256-261. [PMID: 28492758 DOI: 10.1590/0103-6440201701368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/20/2017] [Indexed: 05/13/2023] Open
Abstract
Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.
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Affiliation(s)
| | | | | | | | | | - Lélia Batista de Souza
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Leão Pereira Pinto
- Department of Oral Pathology, Dental School, UFRN - Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Saeger W, Ebrahimi A, Beschorner R, Spital H, Honegger J, Wilczak W. Teratoma of the Sellar Region: a Case Report. Endocr Pathol 2017; 28:315-319. [PMID: 28102527 DOI: 10.1007/s12022-016-9465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The case report describes a teratoma of the sellar region with a gland forming and an immature, relatively clear undifferentiated component without signs of anaplasia. Both components express TTF-1 indicating their presumable origin in the neurohypophysis as part of the circumventricular organs. The differential diagnosis includes pituitary adenoma and spindle cell oncocytoma with inclusion of Rathke's cleft cyst, pituitary blastoma, yolk sac tumor, and other germ cell tumors. The prognosis is the same as in the immature teratomas in the gonads, specifically unclear.
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Affiliation(s)
- Wolfgang Saeger
- Institutes of Pathology and Neuropathology of the University of Hamburg, UKE, Martinistraße 52, 20246, Hamburg, Germany.
| | - Azadeh Ebrahimi
- Department of Neuropathology, Institute of Pathology and Neuropathology of the University of Tübingen, 72076, Tübingen, Germany
| | - Rudi Beschorner
- Department of Neuropathology, Institute of Pathology and Neuropathology of the University of Tübingen, 72076, Tübingen, Germany
| | | | - Jürgen Honegger
- Clinic of Neurosurgery of the University of Tübingen, 72076, Tübingen, Germany
| | - Waldemar Wilczak
- Institute of Pathology of the University of Hamburg, UKE, 20246, Hamburg, Germany
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7
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Surgical Management of Duplication of the Pituitary Gland-Plus Syndrome With Epignathus, Cleft Palate, Duplication of Mandible, and Lobulated Tongue. J Craniofac Surg 2017; 28:e141-e144. [DOI: 10.1097/scs.0000000000003324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chiloiro S, Giampietro A, Bianchi A, De Marinis L. Clinical management of teratoma, a rare hypothalamic-pituitary neoplasia. Endocrine 2016; 53:636-42. [PMID: 26701679 DOI: 10.1007/s12020-015-0814-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
Intracranial teratomas are rare and comprise about 0.5 % of all intracranial tumours. Actually, a total of 15 cases of sellar-suprasellar teratoma have been described in the last 24 years. Although rare, hypothalamic-pituitary teratomas should be taken into account in the differential diagnosis of hypothalamic-pituitary region tumours. The current review focuses on the clinical and therapeutic management of pituitary region teratomas. Teratomas occur more frequently in children and young adults than in the older population and in males as compared to females. Symptoms at diagnosis are usually neurological defects, diabetes insipidus and hypopituitarism. Teratoma diagnosis can be suggested though neuroimaging findings. Magnetic resonance imaging remains the preferred modality for assessment of teratoma. Neuro-radiological findings of mixed-density mass, usually with mixed cystic and solid components or inclusions of teeth, fat and calcification can be suggestive. Tumour markers as beta-HCG and alpha-FP can be useful at teratoma diagnosis for distinguishing immature teratomas, mixed GCTs and mature teratomas with immature or malignant components. Optimal treatment for mature teratoma is neurosurgical excision. Radical excision is advocated as recurrence rate for a mature teratoma is extremely low in cases of complete resection and long-term outcome is excellent. During post-treatment follow-up, in cases of healing, according to tumour marker evaluation and contrasted MRI findings, hormone replacement therapy should be considered, also for secondary hypogonadism and GH deficit, with a more intense follow-up. However, as actually few evidence are available, safety data have to be confirmed also trough a surveillance study.
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Affiliation(s)
- S Chiloiro
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - A Giampietro
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A Bianchi
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - L De Marinis
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
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9
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Abstract
Duplication of the pituitary gland (DPG) is a very rare developmental anomaly that is often associated with other anomalies – the DPG-plus syndrome and occurs due to splitting of the rostral notochord and prechordal plate during blastogenesis. DPG with the constellation of associated anomalies as in our patient has not been reported previously. This article illustrates the importance of imaging the brain in all patients with obvious midline facial anomalies and the complementary role of MRI and CT in such cases.
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Affiliation(s)
- Debraj Sen
- Department of Radiodiagnosis, Military Hospital, Amritsar, India
| | - Vijinder Arora
- Department of Radiodiagnosis, Nijjer Scan and Diagnostic Centre, Amritsar, India
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10
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Azurara L, Marçal M, Vieira F, Tuna ML. DPG-plus syndrome: new report of a rare entity. BMJ Case Rep 2015; 2015:bcr-2015-212416. [PMID: 26564114 DOI: 10.1136/bcr-2015-212416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pituitary gland duplication is a particularly rare finding. Different theories have been proposed to explain its pathogenesis, however, this phenomenon is not yet totally understood. Recently, duplication of the pituitary gland (DPG)-plus syndrome has been described, associating DPG with other blastogenic defects. We present the clinical and imaging findings of a newborn girl with DPG, associated with multiple other midline anomalies, including a nasopharyngeal teratoma, palate cleft deformity, bifid nasal bridge, tongue and uvula, hypoplasia of the basis pontis and corpus callosum, duplication of the basilar artery and hypothalamic hamartoma. We describe our patient's multidisciplinary team approach and emphasise the importance of reporting upcoming cases, in order to give more insight into the understanding of this complex entity.
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Affiliation(s)
- Laura Azurara
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mónica Marçal
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Filipa Vieira
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Madalena Lopo Tuna
- Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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11
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Giant epignatus combined with cleft palate and macrostomy. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Morabito R, Colonna MR, Mormina E, Stagno d'Alcontres F, Salpietro V, Blandino A, Longo M, Granata F. Accessory oral cavity associated with duplication of the tongue and the mandible in a newborn: A rare case of Diprosopus. Multi-row detector computed tomography diagnostic role. J Craniomaxillofac Surg 2014; 42:1924-8. [DOI: 10.1016/j.jcms.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/02/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022] Open
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Morlino S, Castori M, Servadei F, Laino L, Silvestri E, Grammatico P. Oropharyngeal teratoma, oral duplication, cervical diplomyelia and anencephaly in a 22-week fetus: A review of the craniofacial teratoma syndrome. ACTA ACUST UNITED AC 2014; 103:554-66. [PMID: 25360518 DOI: 10.1002/bdra.23327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Oropharyngeal teratoma may occur by itself or together with other craniofacial malformations, most commonly cleft palate. Oropharyngeal teratoma may be also seen in association with frontonasal dysplasia and/or various degrees of craniofacial duplication. The nosology of these sporadic disorders is poorly defined. CASE AND REVIEW We report on a 22-week fetus with a protruding nasopharyngeal teratoma, partial oral duplication, anencephaly, multiple costo-vertebral segmentation defects, and cervical diplomyelia. A review of the literature identified 48 patients published from 1931 to 2013 with co-existing clefting and duplication anomalies of the cephalic pole. Thoracic and abdominal midline anomalies were reported 13 times. CONCLUSION The term "craniofacial teratoma syndrome" is introduced to define this phenotype as a recognizable developmental field defect of the cephalic pole. Developmental pathogenesis is discussed with a focus on pleiotropy and stereotaxis. The observation of midline findings suggestive of holoprosencephaly in a few previously reported cases suggests a role for the sonic hedgehog signaling pathway in this malformation pattern.
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Affiliation(s)
- Silvia Morlino
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Francesca Servadei
- Unit of Fetal and Neonatal Pathology, Division of Pathology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luigi Laino
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
| | - Evelina Silvestri
- Unit of Fetal and Neonatal Pathology, Division of Pathology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy
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Warm A, Cordaro S, Manti S, Barberi I. An extra mouth in a newborn: a unique case of facial duplication. Arch Dis Child Fetal Neonatal Ed 2014; 99:F342-3. [PMID: 24249693 DOI: 10.1136/archdischild-2013-305036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An accessory mouth is a very rare condition, with approximately 15 cases reported in the literature to date. We describe another unique case and discuss its possible embryopathogenesis.
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