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

Suvashis Dash1, Nandini Singh Tanwar1, Archana Sinha2

  • 1Department of Plastic Reconstructive Burn Surgery, All India institute of Medical Sciences, New Delhi, India.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|November 17, 2025
PubMed
Summary

Intraoral synechiae (bands) in cleft palate patients are rare but can cause feeding and speech issues. A new classification system and early surgical intervention improve patient outcomes.

Keywords:
classification systemcleft palatecongenital bandsintraoral synechiaesurgical management

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Area of Science:

  • Craniofacial Surgery
  • Pediatric Surgery
  • Otolaryngology

Background:

  • Intraoral synechiae (bands) associated with cleft palate are uncommon, presenting with varied terminology and management challenges.
  • Existing literature often consists of case studies or small series, lacking standardized classification.

Purpose of the Study:

  • To systematically review evidence on intraoral synechiae in cleft palate patients.
  • To propose a standardized 7-subtype classification system for these synechiae.
  • To enhance clinical understanding through a comprehensive review and illustrative case.

Main Methods:

  • A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Searched multiple databases (PubMed, Embase, MEDLINE, SciELO, Google Scholar) and grey literature up to August 2024.
  • Narrative synthesis of data from 66 articles reporting 90 cases due to heterogeneity.

Main Results:

  • Ninety cases of intraoral synechiae with cleft palate were identified, predominantly in neonates (77.8%) and males (50.0%).
  • Common clinical manifestations included restricted mouth opening (55.6%), feeding difficulties (44.4%), and speech impairment (11.1%).
  • A novel 7-subtype classification system (A1-E) was proposed, encompassing 100% of reported cases; early excision and palatoplasty improved outcomes in 77.8% of patients.

Conclusions:

  • The proposed classification standardizes the reporting of intraoral synechiae in cleft palate, aiding in consistent management.
  • Early surgical intervention, specifically excision with palatoplasty, is associated with improved patient outcomes.
  • The findings have implications for multidisciplinary care coordination and future multicenter research in this rare condition.