Congenital Oral Synechiae in a 32-Year-Old Female: A Case Report

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 4, August – 2025, Page No. : 102 - 105 Corresponding Author: Dr Samanvitha Upadhya, ijdsir, Volume – 8 Issue - 4, Page No. : 102 - 105 Page102 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Congenital Oral Synechiae in a 32-Year-Old Female: A Case Report 1Dr Shreyas Sorake, Reader, Department of Oral and maxillofacial Surgery, A.J Institute of Dental Sciences, Mangalore 2Dr Samanvitha Upadhya, Post Graduate, Department of Oral and maxillofacial Surgery, A.J Institute of Dental Sciences, Mangalore 3Dr Sameeksha Saoor, Post Graduate, Department of Oral and maxillofacial Surgery, A.J Institute of Dental Sciences, Mangalore Corresponding Author: Dr Samanvitha Upadhya, Post Graduate, Department of Oral and maxillofacial Surgery, A.J Institute of Dental Sciences, Mangalore. Citation of this Article: Dr Shreyas Sorake, Dr Samanvitha Upadhya, Dr Sameeksha Saoor, “Congenital Oral Synechiae in a 32-Year-Old Female: A Case Report”, IJDSIRAugust – 2025, Volume – 8, Issue – 4, P. No. 102 – 105. Copyright: © 2025, Dr Samanvitha Upadhya, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Case Report Conflicts of Interest: Nil Abstract Background: Congenital oral synechiae are rare developmental anomalies characterized by abnormal fibrous bands connecting oral structures, most commonly between the tongue and floor of the mouth or between the buccal mucosa and alveolar ridges. These malformations can significantly impact speech, mastication, and oral hygiene. Case Presentation: We report a case of a 32-year-old female presenting with congenital oral synechiae causing functional limitations in speech articulation and oral hygiene maintenance. The patient underwent surgical correction with favorable outcomes. Conclusion: Early recognition and appropriate surgical management of congenital oral synechiae can significantly improve patient quality of life and prevent secondary complications. Keywords: congenital oral synechiae, oral malformation, surgical correction, speech therapy, Intraoral adhesions, Rare oral malformations Introduction Congenital oral synechiae represent a spectrum of developmental anomalies involving abnormal fibrous connections between oral structures. These conditions occur due to incomplete separation of embryonic tissue layers during the 6th to 12th weeks of intrauterine development.1 The incidence is estimated at 1 in 15,000 to 1 in 25,000 live births, with varying degrees of severity. Common types include lingual synechiae (tongue-to-floor connections), buccal synechiae (cheekto-alveolar ridge connections), and labial synechiae (lipto-gum connections). Dr Samanvitha Upadhya, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Page103 Case Presentation Patient Information: A 32-year-old female presented to our oral and maxillofacial surgery department with chief complaints of difficulty in opening mouth, speech articulation and challenges maintaining adequate oral hygiene. The patient reported these issues had been present since birth but had become increasingly bothersome in recent years. Clinical History The patient presented with difficulty in mouth opening and speech articulation. Family history was negative for congenital oral anomalies or syndromic conditions. She had no history of trauma, infection, or previous oral surgery. The patient reported progressive worsening of speech clarity and increasing difficulty with dental cleaning, particularly in the posterior regions. Physical Examination Extraoral Examination Facial symmetry was normal with no visible deformities or scars. Temporomandibular joint function was within normal limits. Intraoral Examination  Restricted mouth opening was seen (18mm).  The fibrous bands were approximately 2-3mm in width and demonstrated limited elasticity which was all over both right and left buccal mucosa.  Oral hygiene was compromised with visible plaque accumulation in areas difficult to access due to restricted tongue movement.  Dentition was otherwise normal with no associated dental anomalies. Diagnostic Assessment Imaging: Panoramic radiography revealed normal dental and bony structures with no associated skeletal anomalies. Biopsy: Biopsy revealed oral tissue with thickened surface layer, increased basal cells, dense fibrous tissue with prominent blood vessels, and degenerating muscle - findings consistent with oral synechiae. Speech Evaluation: Formal speech assessment by a speech-language pathologist documented:  Reduced tongue tip elevation affecting lingual consonants.  Compensatory articulation patterns.  Normal voice quality and resonance. Functional Assessment Oral function evaluation revealed:  Restricted tongue protrusion (maximum 8mm beyond incisal edges)  Limited lateral tongue movement.  Compromised oral cleaning ability.  Normal swallowing function. Treatment Plan A multidisciplinary approach was planned involving: 1. Surgical release of oral synechiae. 2. Post-operative speech therapy. 3. Enhanced oral hygiene protocol. Intervention Surgical Procedure: Under general anesthesia, bilateral buccal synechiae release was performed using fibrotomy.4 Buccal pad of fat reconstruction was performed over the fibrotomy region. Primary closure was achieved, and bacitracin gauze dressing was applied. Dr Samanvitha Upadhya, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Page104 Post-operative Care  Post operatively, antibiotics and analgesics were prescribed for 5 days.  Chlorhexidine mouthwash 0.12% four times daily for 2 weeks.  Soft diet for 1 week. Follow-up and Outcomes Immediate Post-operative (1 week): Healing progressed normally with minimal discomfort. Improvement in mouth opening was observed. Long-term Follow-up (6 months)  Sustained functional improvement  Speech assessment showed marked improvement in lingual consonant production.  Patient satisfaction scores: 9/10 for speech improvement, 8/10 for oral hygiene ease .  No evidence of re-formation of synechiae. Discussion Congenital oral synechiae result from failure of programmed cell death during embryonic development, leading to persistent connections between oral structures. The condition can occur in isolation or as part of syndromic presentations such as popliteal pterygium syndrome or van der Woude syndrome.5 The functional impact varies depending on the location, thickness, and number of synechiae.6 Common complications include speech articulation disorders, compromised oral hygiene leading to periodontal disease, restricted dietary choices, and psychosocial effects related to appearance and function. Surgical management remains the gold standard for symptomatic cases.7 The timing of intervention depends on functional impact, with early correction recommended to prevent compensatory patterns and secondary complications. Key surgical principles include complete release of restricting bands while preserving normal anatomy and preventing recurrence through appropriate wound management. Post-operative speech therapy is crucial for optimal outcomes, helping patients develop normal articulation patterns and maximize functional gains.8 Long-term follow-up is essential to monitor for recurrence and ensure sustained functional improvement. Conclusion This case demonstrates the successful management of congenital oral synechiae in an adult patient through surgical correction and multidisciplinary care. Early recognition and appropriate treatment can significantly improve functional outcomes and quality of life. The case highlights the importance of individualized treatment planning and the value of multidisciplinary collaboration in managing complex oral anomalies. Patient Consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images. References 1. Gartlan MG, Davies J, Smith RJ. Congenital oral synechiae. Ann Otol Rhinol Laryngol. 1993;102(3):186-197. Dr Samanvitha Upadhya, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 Page105 2. Moore MH, Proudman TW, Haan EA, David DJ. Congenital maxillomandibular fusion (syngnathia). Cleft Palate Craniofac J. 1993;30(1):39-42. 3. Vargervik K, Ousterhout DK, Farias M. Congenital maxillo-mandibular synechiae with fusion of maxilla and mandible. Cleft Palate J. 1986;23(3):182-190. 4. 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