Double palate D. S. Gupta, D.Orthodont.(Toronto), DENTAL

COLLEGE

AND

M.S.(Detroit),#

Lucknow,

India

HOSPITAL

A unique congenital anomaly was observed in a 7-year-old boy, who presented a normal mandible but duplication of the maxillary arch, palate, and uvula. Overgrowth of the upper lip and deviation of the nose and nasal septum with defective speech were also found.

C

ongenital malformations have been defined as abnormalities resulting from disturbances of growth and development prior to birth.l Such anomalies of the mouth and face are not of infrequent occurrence. Most of the anomalies seen are well known and are easily diagnosed, such as clefts in the orofacial regions, supernumerary teeth, and many of the syndromes of the face. Certain anomalies are of extremely rare occurrence, and the reported cases do not resemble each other. The present case is a unique one in which there was duplication of the palate and of the maxillary dental arches. CASE REPORT A 7-year-old Muslim boy was brought to my office with a history of a double row of teeth and a defective palate. The child had earlier received treatment for.chronic dacryocystitis of the right side. The child and his parents had not noticed the dental defect until the ophthalmic surgeon brought this to their attention and advised them to consult a dentist. On examination, it was found that the child had occlusal hypertelorism; the nose was deviated to the left side, there was an overgrowth of the upper lip near the’right angle of the mouth, and a fullness in the midfacial region was noticeable (Fig. 1). There were two dental arches, two palates (hard as well as soft), and a double uvula (Fig. 2). On the left side the maxillary arch presented a dentition normal for the patient’s age. On the right side the incisor teeth were absent, indicating the possible absence of the premaxillary segment. The two arches were well formed but not well developed in width, resulting in an unusual depth of the two palates in the midpalatal areas. The mandibular arch did not show any significant abnormality. Although there was hardly any occlusion between the maxillary and mandibular teeth, the boy had no difficulty in eating. Two sets of dental arches with deciduous and permanent teeth were distinctly visible in the intraoral occlusal radiograph of the maxillary segment (Fig. 3). A posteroanterior roentgenogram of the head showed a single nasal septum pushed to the left side (Fig. 4). The family history revealed nothing significant concerning the developmental anomalies. The *Professor

and

Head

of the Division

of Orthodontics.

53

54

Oral July,

Gfipta

Fig. 1. Clinical appearance of patient showing double rows of teeth in occlusion. Pig. 8. Occlusal view of the dental arches showing absence of incisor teeth side, double palate, and deepening of the midpalatal regions.

Pig.

3. Occlusal

radiograph

of

maxillary

arch

showing

absence

of

incisors

Surg. 1975

on the

right

on the

right

side.

child, the oldest in the family, has two siblings, both normal. The patient was born when his mother was only 14 years old. No immediate treatment was rendered, since the condition did not cause any problem to the child, except for a speech defect. It was thought that the only treatment possible was gradual removal of teeth from the middle dental segments and plastic repair of the palate, follorved by orthodontic correction.

DISCUSSION

An extensive search of the available literature revealed no case similar to the one reported here. One condition which demonstrated replication of the jawbone segment containing teeth has been termed polygnathism.’ It has also been

Volume Number

Double

40 1

Fig.

4. Radiograph

showing

deviation

and

attachment

of the nasal

septum

palate

55

of the left

side.

mentioned that the occurrence of supernumerary mouths or jaws is very rare, and the few cases reported differed enough from one another to make each case rather unique. In the present case the maxillary arch was duplicated, with two distinct palates (soft as well as hard), two uvulas, and two well-formed dental arches. There was only one mouth, with duplication of the upper jaw alone. The one on the left seemed to be the normal maxillary arch as there was a full complement of teeth and the nasal septum showed attachment to that side. The one on the right showed an absence of the premaxillary segment. An overgrowth of the upper lip on the right side confirmed that the structures on the right side were additional ones. It has been reported3 that the presence of an accessory growth center in the right mandibular process could lead to anomalies of such a type on the right side. The present case in which duplication of palate and uvula and slight duplication of the right upper lip was found suggests that the defect had occurred in the maxillary processes which are responsible for the formation of the above-mentioned structures. CONCLUSION While developmental anomalies of the mouth and face are not rare, this case of double palate, to our knowledge, is unique and is the first reported case of its type. REFERENCES

1. Bhaskar, S. N.: Synopsis of Oral Pathology, Company, p. 495. 2. Gorlin, R. J., and Goldman, H. M.: Thoma’s C. V. Mosby Company, pp. 25, 122. 3. Beatty, H. G.: A Report of a Case of an Plast. Reconstr. Surg. 17: 297-303, 1956. Reprint requests to: Dr. D. S. Gupta Division of Orthodontics Dental College and Hospital Lucknom, India

ed. Oral Unusual

3, St. Pathology,

Louis,

1967,

The

C. V.

ed. 6, St. Louis,

Embryological

Defect

Mosby

1970, of

the

The Face,