Caught in a web: congenital anterior and posterior oral synechiae with concurrent diaphragmatic hernia and atypical cleft palate

Abstract

Congenital oral synechiae are rare fibrous bands connecting the maxillary and mandibular structures. We report a male neonate referred to our oral and maxillofacial surgery service at 16 days of age with bilateral anterior and posterior oral synechiae, an atypical submucous cleft palate, and a concurrent left-sided congenital diaphragmatic hernia. The synechiae were undetected prenatally and obstructed neonatal intubation in the delivery suite, compounding the immediate airway demands of the diaphragmatic hernia. This triad has not been previously described, and comprehensive genetic testing identified no causative mutation. Following surgical repair of the hernia and release of the synechiae, oral feeding was established. Two years of follow-up demonstrate persistent challenges with feeding, speech, hearing, and recurrent infection, driven primarily by an unrepaired atypical palatal cleft. This case highlights the importance of recognizing oral synechiae when neonatal intubation fails unexpectedly, and the need for co-ordinated multidisciplinary care.