Reconstruction of a “Double Pathology” on a Soft Palate

Abstract

Hairy polyps of the head and neck are rare congenital tumors that may cause upper aerodigestive tract impairment in newborn. Although cleft palate is a common congenital anomaly, hairy polyp with cleft palate is extremely rare in the newborn. We aimed to present the planning of reconstruction in a patient who has an incomplete cleft palate and defect due to hairy polyp excision on soft palate in this report. A 9-month-old child was admitted to our clinic due to cleft palate. In the clinical examination, incomplete cleft palate plus a defect on the posterior side of the left soft palate was observed. On the history, the patient had been operated urgently at the newborn period for a hairy polyp localized on the left soft palate which had obstructed the airway. Wardill-Kilner-Veau technique was modified for the reconstruction of the defect on the soft palate and incomplete cleft palate. No complication was seen on postoperative period. The speech ability was evaluated on the late postoperative controls after 3 years and adequate speech intelligibility was obtained. A case of hairy polyp of nasopharynx with incomplete cleft palate in a neonate and its reconstruction techniques are discussed. The etiology of hairy polyp, hamartoma, teratoma, dermoid cyst and epignathus, their nomenclature, histopathology, clinical features, and management in neonates are also discussed briefly.

Hairy Polyp, a Clinicopathologic Study of Four Cases

“…HPs present as skin covered polypoidal masses which can arise from nasopharynx or oropharynx but are also reported to arise from a number of surrounding structures including soft palate [2,4,13], hard palate [5], tonsils [6][7][8], eustacheantube [9], middle ear cavity [10] and tongue [11]. The polyps in our series show diverse distribution, two of them were located in nasopharynx, one in soft and hard palate and one in lower lip.…”

“…Large polyps cause obstruction and commonly result in respiratory distress and feeding difficulties. Other symptoms include hearing loss, otorrhea, vomiting, earache, bleeding, snoring and recurrent ear infections [4][5][6][7][8][9][10][11].…”

“…HP can arise from any of the naso-oropharyngeal structures (including tonsils, eustachean tube and tongue) as a skin covered polypoidal mass [2][3][4][5][6][7][8][9][10][11]. Owing to its bi-germinal layer origin, it is characterized by skin (ectoderm) covering a (mesodermal) core of adipocytes, smooth muscle and cartilage [12].…”

“…Depending upon the size and location, these lesions may be asymptomatic or present with respiratory distress, difficulty in feeding, etc. [4][5][6][7][8][9][10][11]. Almost all patients recover uneventfully after surgical excision [1].…”

Adult nasopharyngeal hairy polyp presenting with middle ear effusion

“…HP of infancy commonly present with respiratory distress, feeding difficulties and less frequently with middle ear effusion. Intensity of the symptoms depends on the site of the involvement and size of the lesion [5,6]. Adult presentation of HP is very rare and according to our knowledge only 5 cases has been reported so far.…”