Intriguing mass associated with cleft palate.

Nasopharyngeal teratomas are rare and represent only 2% of all teratomas. They can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate with few reported cases of this association in the literature. We report the case of a 14-month-old girl with this atypical association.

Teratoma is a tumor representing differentiation from all embryonic germ layers, ectoderm, mesoderm, and endoderm.

Nasopharyngeal teratoma (NPT) can extend to the sphenoidal, endobuccal, and pharyngeal regions. The most common associated abnormality is cleft palate (CP).

A 14‐month‐old newborn girl was referred to our department for CP. Oral examination revealed a firm mass of 1 × 1.5 cm, appended to the ethmoid (Figure 1A). A head computed tomography scan revealed a well‐delimited tumor with calcifications and fat tissue, expanding to the sphenoid (Figure 1C,D).

FIGURE 1

(A) Firm and polylobed mass with cleft palate (CP) in a 14‐month‐old girl, (B) post‐operative photography, (C) pre‐operative head CT scan of nasopharyngeal teratoma (NPT) appended to the vomer bone and the sphenoid (sagittal view), (D) pre‐operative head CT scan showing the tumor and the CP (coronal view, bone window).

Tumor excision was performed immediately (Figure 1B). Histologically, the tumor was a true teratoma according to the Wittstock et al. classification. The reconstruction of the velar and the palatal defect was performed 6 months later to ensure a complete excision. No recurrence of the mass has been observed during 2 years of follow‐up.

The hypothesis of mechanical origin of the association of NPT and CP is the most plausible. In fact, when located centrally in the oro‐nasal region, NPT is likely to be an obstacle for fusion of the palatal shelves during the development of the mammalian palate. This anomaly is likely to lead to a cleft of the palate which will require repair after tumor excision.

AUTHOR CONTRIBUTIONS

All the authors contributed to the writing of the manuscript.

CONFLICT OF INTEREST

None.

CONSENT

Written informed consent was obtained from the patient's legal guardian to publish this report in accordance with the journal's patient consent policy.