BritishJournalofOralandMaxillofacialSurgery55(2017)211–212
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Letter
to
the
Editor
Unilateralcomplexsyngnathiaofthemaxilla,mandible, andzygomaticcomplexinanewbornbaby
Syngnathiaisararecongenitalfusionofthehardandsoft tissuesofthejaw.Earlyinterventionafterbirthisessential becausewithoutit thebabycannotfeed,andfacialgrowth andfunctionwillbeseverelyaffected.1
A3-day-oldbabyboywasreferredtotheoraland maxillo-facialsurgeryclinicfromaperipheralhospital.Hepresented withhisupperandlowergumscompletelyattachedandso hadtobefedthroughanasogastrictube.Hishistoryshowed that his parents were related by blood, but there was no evidenceof syngnathia, systemic disease, trauma, or drug treatmentotherthanroutinedrugsandanalgesics(for exam-ple,paracetamol)duringpregnancy.
Hewasreferredtothepaediatricnewbornintensivecare clinicforfurtherevaluation,buttherewerenogenetic, con-genital,orsystemicproblems.Hischinwasdeviatedtothe left,and he hadretrusion of the mandible. Intraorally the leftsideofhismaxillaandmandiblewerefusedatgumlevel (Fig.1),buttherewasnocleftpalateandnosyndrome appar-ent.WeclassifiedthedeformityasaType2aaccordingtothe Lasterclassification,2 andnotedthat he wasmalnourished
andhadalowbodyweight. Hisleft ascendingramusand thealveolarprocessofhismandiblewerefusedtotheupper alveolarprocessandzygomaticcomplex.Maxillofacial com-putedtomographyshowedazygomaticomaxillaryfusionof theleftside(Fig.2),andtherighttemporomandibularjoint
Fig.1.Preoperativeintraoralviewofthepatient.Maxillaryandmandibular archeswerefusedandfeedingwasonlypossiblethroughanasogastrictube. Intraoperativeintraoralviewaftertheremovaloftheattachedbonyandsoft tissues.
Fig.2.Zygomaticomaxillaryandmandibularbonyfusionmarkedbyarrows.
(TMJ)spacewasclearwithoutanybonyfusion.Wedecided tokeephiminhospitaluntilaftertheoperation.
We operated under general anaesthesia when he was 25-days-old,usedlocalanaesthesia(2%lidocaine0.5mlwith 1/200000adrenaline)intravenouslyintothebuccalsulcusof the affectedtissue, and made an intraoral incision 15mm longintotheposteriorbuccalregion.Weraiseda mucope-riostealflapandexcisedthebonewithasagittalsaw,andused tinyosteotomesbetweenthealveolarprocesses,mandibular ramus,andzygomaticomaxillarycomplex.Separationofthe bonysegmentshadtobegentleandwell-controlled,using minimalforcebecauseofhissmallsizeandslightbuild.We achievedamouthopeningof22mm(Fig.1).
Differentmaterialsincludingsiliconesheets,blocks,and sterile gauzepacks are usually inserted between the bony segments during operation,buttheyfailed inthisinstance because of occlusal pressure and instability.3 Instead we planned to maintain the opening afterwards with contin-uous function. We closed the mandibular and maxillary bonysegmentsusingtheraisedmucoperiostealflapsand4/0 polyglactin910(Vicryl,Ethicon)sutures.Hisparentswere
http://dx.doi.org/10.1016/j.bjoms.2016.06.007
212 LettertotheEditor/BritishJournalofOralandMaxillofacialSurgery55(2017)211–212
giveninstructionsonbreastandbottle-feedingtomaintain nutrition,andjawexercisestoavoidreankylosis.
Early detection and intervention in syngnathia enable functionandhelpmaintain qualityof life.Strict followup andphysiotherapywillpostponeorevenavoidreankylosis.
Conflictofinterest
Wehavenoconflictsofinterest.
Ethicsstatement/confirmationofpatient’spermission Weobtainedtheparent’spermissiontousetheinformation andimagesinthispaper.
References
1.ElMadiA,KhattalaK,RamiM,etal.Bilateralmaxillo-mandibular syn-gnathiainanewborn.JNeonatalSurg2014;3:53.
2.LasterZ,TemkinD,ZarfinY,etal.Completebonyfusionofthemandible tothezygomaticcomplexandmaxillarytuberosity:casereportandreview.
Int.J.OralMaxillofac.Surg2001;30:75–9.
3.Konas E, AliyevA,Tunc¸bilekG.Congenital maxillomandibular syn-gnathia:anewmanagementtechnique usingdistraction techniques.J.
Craniofac.Surg2015;26:e68–70.
AbdullahÖzel GamzeS¸enolGüven EmrahDilaver SinaUc¸kan∗ MedipolUniversity,TEMAvrupaOtoyoluGoztepeCikisi No:1Bagcilar34214Istanbul,Turkey ∗Correspondingauthorat:SinaUc¸kan,Prof.Dr.,Medipol University,TEMAvrupaOtoyoluGoztepeCikisiNo:1 Bagcilar34214Istanbul,Turkey. E-mailaddresses:aozel@medipol.edu.tr(A.Özel), gguven@medipol.edu.tr(G.S¸.Güven), emrahdilaver@me.com(E.Dilaver),suckan@yahoo.com (S.Uc¸kan) Availableonline30June2016
