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(A) Frontal and (B) profile patient photos.
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The patient (Fig. 1A and 1B) presented for treatment in a university odontological clinic because of many carious lesions and consequent pain.
Intraoral photos: (A) oral floor view and (B) mandibular dental arch.
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Physical examination of the 8-year-old girl revealed the oropharynx (Fig. 2A) and the complete absence of the tongue (Fig. 2B). The speech therapist noted phonoarticulatory structures in resting posture, lip tonus and mobility, cheek; mouth floor muscles, hard palate, soft palate, and uvula were observed (Fig. 2A). In intraoral view of the oral cavity and oropharynx, the absence of tongue could be seen (Fig. 2A). Many teeth had dental caries, mainly the deciduous ones: first right maxillary molar, second right lower molar, first left lower molar, and two central lower incisors, which can be observed in Fig. 2B.
Intraoral photos: (A) right side; (B) left side; (C) frontal views.
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In lateral view (Fig. 3A and 3B), the facial profile was strongly convex, with the lower lip slightly subverted and regular nasolabial angle. Fig. 3C shows a frontal view, with narrowing of the upper and lower arch. This medical condition is more concerning when related to the fact that both maxillary and mandibular dental arches had high-level atresia (Fig. 3A, 3B, and 3C). Also, the increase in the horizontal distance between the anterior maxillary and lower teeth created a space in which the lip was placed either in resting posture or in functions of the stomatognathic system (Fig. 3B).
(A) Normal lateral teleradiography and (B) panoramic radiography.
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 Fig. 4A shows the panoramic X-ray depicting the absence of mandibular lateral incisors and one mandibular central incisor. The lateral cephalometric radiography (Fig. 4B) and cone beam computed tomography (Fig. 5) revealed that the maxilla and mandible were regular size in the sagittal view and were related to each other, also shown in Figs. 6A, B, C and 7A, B, C.
(A, B, C) Axial coronal slices, mandible.
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The lateral cephalometric radiography (Fig. 4B) and cone beam computed tomography (Fig. 5) revealed that the maxilla and mandible were regular size in the sagittal view and were related to each other, also shown in Figs. 6A, B, C and 7A, B, C. This fact, together the high tooth inclination to buccal surface of maxillary incisors (Fig. 6A), provided a very accentuated overjet.
(A, B, C) Axial coronal slices, maxilla.
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The lateral cephalometric radiography (Fig. 4B) and cone beam computed tomography (Fig. 5) revealed that the maxilla and mandible were regular size in the sagittal view and were related to each other, also shown in Figs. 6A, B, C and 7A, B, C. Transversely, high maxillary atresia was observed mainly in the mandible (Fig. 7B).