Highlights
- •
Reporting this case to the scientific community is essential for everyone to have access to the occurrence and diagnosis of oral synechia.
- •
To recognize this alteration, because it may occur in the oral cavity of newborns and the professionals need to be able to handle the case.
- •
To demystify the use of surgical treatment of the synechia, as well as the use of local anesthetics and the different advanced infant management techniques.
1
Introduction
Congenital alterations of the oral cavity are not uncommon findings at birth , although the true incidence is uncertain , the congenital anomalies has been reported as high as 1 in 100 births, with the majority being ankyloglossia .
The synechia is an anomaly rarely observed in the oral cavity, and may be composed of epithelial adhesions, connective tissue and muscle tissue . It is a congenital oral abnormality found in newborns . The etiology remains uncertain . The persistence of buccopharyngeal membrane and an abnormality in the formation of the membrane subglossopalatal are the main theories accepted . Generally, they are accompanied by one or more additional congenital defects such as cleft palate, cleft lip, microglossia, micrognathia, temporomandibular joint ankylosis, or limb anomalies .
The adhesion between the upper and lower alveolar ridges may interfere with feeding and sucking, leading to severe nutritional problems , airway compromise and consequences for oral development. Oral synechia may be an isolated mouth abnormality or may more commonly associated with syndromes . The syndromes which are commonly related with synechia oral are Van der Woude syndrome , popliteal pterygium syndrome (PPS) , clef palate lateral alveolar synechia syndrome , orofacial digital syndrome (OFDS) and Fryns syndrome . The treatment consists in surgical intervention, and the goal of surgery is to divide adhesions to allow normal mouth opening and oral development, and also aids to secure the airway as well as the ability to feed . The objective of this study was to report the clinical case of an infant diagnosed with unilateral oral synechia.
2
Case report
A female patient, born premature with 28 weeks, delivered through a cesarean, weighing 640 g, measuring 30 cm and being the third of a multiple pregnancy. During pregnancy, the mother presented with cholestasis of pregnancy and gestational diabetes. No family members had general health problems. The child was diagnosed at birth with delayed psychomotor development and presented other associated diseases, such as patent ductus arteriosus with hemodynamic repercussion, cardiac murmur without repercussion, flat hemangioma on hemithorax law, bronchopulmonary dysplasia and hearing deficit on the right side. The mother was carrying triplets, however, the other children did not present any alteration. After the birth, the patient remained in the intensive care unit for 4 months. The child was evaluated and verified the presence of a membrane between the hard palate and the mouth floor, and she was referred for dental evaluation.
At the first dental consultation, a detailed anamnesis was performed to determine the general state of health and the main issues. During intraoral examination it was observed absence of cleft palate and confirmed the presence of right side oral synechia connecting the mouth floor and hard palate with possible interference in sucking and swallowing ( Fig. A.1 ). Due to the health condition of the child, the opinion of the pediatrician was requested.
