Intraoral Synechiae or Bands in Cleft Palate: Systematic Review With a Proposed Classification

Abstract

Background

Intraoral synechiae (bands) associated with cleft palate are rare, often reported in case studies or small series, with heterogeneous presentation and terminology complicating management. This review aims to synthesize evidence, propose a standardized 7-subtype classification, and include an illustrative case to enhance clinical understanding.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review searched PubMed, Embase, MEDLINE, SciELO, Google Scholar, 3 registries, and grey literature up to August 2024, including case reports/series on intraoral synechiae with cleft palate, without language restrictions. Eligibility included clinical data; additional studies were identified via references. Risk of bias was assessed qualitatively, focusing on selection and reporting biases. Results were synthesized narratively due to heterogeneity.

Results

Sixty-six articles reported 90 cases, predominantly neonatal (77.8%), with 50.0% male. Common outcomes included restricted mouth opening (55.6%), feeding difficulties (44.4%), and speech impairment (11.1%). A classification (A1: lateral palatofloor bands, 33.3%; A2: lateral palatoglossal membrane, 4.5%; B1: glossopalatal membrane, 20.0%; B2: subglosso-palatal membrane, 6.7%; C: multiple/mixed bands, 17.8%; D: syndromic complex, 14.4%; E: cleft palate-lateral synechia phenotype without bands, 3.3%) covered 100% of cases. Early excision with palatoplasty improved outcomes in 77.8%.

Discussion

Limitations include potential bias toward severe cases and inconsistent speech data. The classification standardizes reporting, guiding management, with implications for multidisciplinary care and multicenter research.