Palatoglossal Synechia in a Neonate Causing Severe Feeding Problems and Respiratory Distress: First Case Report from Somalia

Abstract

Background: Palatoglossal synechia (glossopalatal fusion) is an exceptionally rare congenital anomaly characterized by abnormal adhesion between the tongue and palate. Severe forms present in the neonatal period with restricted oral opening, feeding difficulty, and airway compromise. To our knowledge, this represents the first documented case of complete palatoglossal synechia reported from Somalia. Case Presentation: We report the case of a seven-day-old full-term female neonate who presented with severe feeding difficulty and persistent respiratory distress since birth. Feeding attempts were associated with choking and intermittent cyanotic episodes. On examination, the neonate was tachypneic with increased work of breathing and nasal flaring. Oral cavity examination revealed complete palatoglossal synechia associated with cleft palate, resulting in near-complete restriction of oral opening and absent tongue mobility. Initial management included supplemental oxygen via nasal cannula and nasogastric tube feeding for nutritional support. Following stabilization, the patient underwent successful surgical release of the adhesion under general anesthesia using electrocautery after nasopharyngeal intubation. Postoperatively, the infant showed marked improvement in feeding ability, respiratory status, and oral function. At two-month follow-up, the patient demonstrated effective breastfeeding, normal tongue mobility, appropriate weight gain, and no evidence of respiratory compromise or recurrence. Conclusion: Complete palatoglossal synechia is an exceptionally rare congenital condition that may cause significant neonatal feeding and airway difficulties. Careful oral examination is crucial for early diagnosis in neonates with unexplained respiratory distress and feeding impairment. Early multidisciplinary management and timely surgical intervention can result in excellent clinical outcomes, even in resource-limited settings. Keywords: palatoglossal synechia, glossopalatal fusion, cleft palate, neonatal airway obstruction, Somalia, resource-limited setting