(Persistence of the buccopharyngeal  membrane)

Extremely rare. It is the persistence of the oropharyngeal membrane that separates the stomodeum from the primitive gut: it is located at the junction of the anterior 2/3 and the posterior 1/3 of the tongue, and is attached to the soft palate and the anterior pillars of the tonsils. It normally subsides during the 3rd week of life.

Clinic:

-         polyhydramnios

-         breathing and feeding problems from birth

-         lack of visualization of the pharynx at laryngoscopy.

attached uvula to the buccopharyngeal membrane

Possibly associated anomalies: unilateral choanal atresia, cleft palate, craniofacial dysostosis, cardiac malformation (ASD, patent ductus arteriosus, TGA)

Anesthetic implications: 

difficult intubation, which can only be done by nasal route: a nasopharyngeal airway is inserted in one nostril to ensure oxygenation and anesthesia while  fiberoptic intubation is realized through the other nostril; sometimes: temporary tracheostomy. A case of lucky blind intubation through a slit in the membrane has been reported.

References : 

-         Gartlan MG, Davies J, Smith RJH.
Congenital oral synechiae.
Ann Otol Rhinol Laryngol 1993; 102: 187-97.

-        Lim EH, Tan S, Lim S-L. 
Anesthesia for a neonate with persistent buccopharyngeal membrane and unilateral choanal atresia.
Pediatr Anesth 2005; 15: 509-11.

-         Lee HC, O-Lee TJ, Mdan A, Koltai P. 
Oropharyngeal atresia in a preterm infant: a case report and review of the literature. 
Int J Pediatr Otorhinolaryngol 2007; 71: 1485-9.

-        Pirat A, Candan S, Unlukaplan A, Komurcu O, Kuslu S, Arslan G.
Percutaneous dilational tracheotomy for airway management in a newborn with Pierre-robin syndrome and a glossopharyngeal web.
Resp Care 2012; 57: 627-30.

Updated: January 2018