cause not all family members were available fordirect questioning.

Hetch and Jarvinen2 first described a patient inwho laterally based oral webs extended from themaxillary tuberosity to the mandible. Wynne and

colleagues,3 in 1982, described a patient with asail-like membrane that extended from the pre-maxilla to the floor of the mouth, which wasdivided surgically soon after birth.

Congenital intraoral bands may consist of epi-thelium supported by varying amounts of con-nective tissue. If they just include soft tissuesthey are called synechiae; if bone is present thecondition is defined as syngnathia.4 Proposedembryological explanations for synechia forma-tion are either failure of division (persistent oro-pharyngeal membrane) or abnormal epithelialbehavior.5

These bands have been corrected without anes-thetic in the nursery using surgical instruments6

or silk ligatures,5 under local anesthesia with anasopharyngeal airway by division with scis-sors,7 divided surgically under mask ventilationand oxygenation on the second day of life afterfailed attempts at nasotracheal intubation,8 andagain with oxygen by mask under direct visionwith insulated needle tip cautery.9 In anotherpatient a tracheostomy was performed at 1 weekof age, followed by division of the bands with ascalpel.10

The first problem with this condition is placingan endotracheal tube. We recommend a settingwith optimal anesthesia equipment, including afiberoptic endoscope. When general anesthesia isachieved, division of the intraoral bands can beperformed easily.

We report the first patient in whom posteriororal fibrous bands, neither visible nor approach-able via an open view, were diagnosed and thendivided surgically under endoscopic direct vi-sion. We recommend this simple, safe, and direct

Fig 1. Facial abnormalities and restricted mouthopening.

Fig 2. Endoscopic view of the intraoral synechiae.

Fig 3. Division of the synechiae.

Fig 4. Postoperative mouth opening.

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approach to detect and correct intraoral anoma-lies that are limiting suction or oral feeding.

References

1. Hamamoto J, Matsumoto T. A case of facio-genito-popli-teal syndrome. Ann Plast Surg 1984;13(3):224–229

2. Hecht F, Jarvinen JM. Heritable dysmorphic syndromewith normal intelligence. J Pediatr 1967;70(6):927–937

3. Wynne JM, Fraser AG, Herman R. Massive oral membranein the popliteal web syndrome. J Pediatr Surg 1982;17(1):59–60

4. Gartlan MG, Davies J, Smith RJ. Congenital oral synechiae.Ann Otol Rhinol Laryngol. 1993;102(3 Pt. 1):186–197

5. Shaw WC, Simpson JP. Oral adhesions associated withcleft lip and palate and lip fistulae. Cleft Palate J 1980;17(2):127–131

6. Verdi GD, O’Neal B. Cleft palate and congenital alveolarsynechia syndrome. Plast Reconstr Surg 1984;74(5):684–686

7. Randall P. Discussion. Cleft palate and congenital alveo-lar synechia syndrome. Plast Reconstr Surg 1984;74(5):686.

8. Deskin RW, Sawyer DG. Popliteal pterygium syndrome.Int J Pediatr Otorhinolaryngol 1988;15(1):17–22

9. Valnicek SM, Clarke HM. Syngnathia: a report of twocases. Cleft Palate Craniofac J 1993;30(6):582–585

10. Snijman PC, Prinsloo JG. Congenital fusion of the gums.Case report. Am J Dis Child 1966;112(6):593–595

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Case Report: Schonauer et al: Endoscopy in Popliteal Pterygium Syndrome

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