(Glossopalatal ankylosis, Cosack syndrome )

Unknown prevalence. Congenital adhesion of the tongue to the hard palate. Often associated with anomaly of a limb, more rarely a cleft palate, the absence of certain teeth or jejunal or ileal atresia. It is probably a form of oromandibular - hypogenesis of a limb syndrome as  in the aglossia-adactyly (Hanhart) or Charlie M syndrome. Some cases could be due to the presence of amniotic bands in the mouth.

Anesthetic implications:

difficult laryngoscopy. Ideally nasotracheal intubation with a fibroscope. Some patients have been intubated by using the retromalar (paraglottic) approach. Retromolar intubation consists in sliding the laryngoscope blade between a palato-lingual adhesion and the alveolar arcade.  

References : 

• Sunder RA, Manikandan R, Kumar M.
  Airway management of a neonate with a rare congenital palatoglossal synechiae.
  Pediatr Anesth 2008; 18: 980-2.
• Batra YK, Rakesh SV, Menon P, Rao KLN.
  Successful airway management with left-molar laryngoscopy in glossopalatal ankylosis: a case report.
• Acta Anaesth Belg 2010; 61: 215-6
• Mukharjee S, Mitra D, Sen A, Chattopadhyay A, Kajal S, Dhankhar M.
• Intubation of a neonate with glossopalatine ankylosis using a paraglossal approach and a laryngoscope with a straight blade.
• S Afr J Anaesth Analg 2014; 20: 218-9
• Shay S, West AN.
  Ankyloglossia superior syndrome : case report and updated literature review.
  Int J Pediatr Otorhinolaryngol 2016; 86: 1-3.
• Robbins A, Zarate YA, Hartzell LD.
  Combined tongue-palate fusion with alveolar bands in a patient with Pierre Robin sequence and Van der Woude syndrome.
  Cleft Palate-Craniofac J 2019 ; 56 : 123-6

Updated: February 2020