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\begin{document}

\title{An intriguing mass associated with a cleft palate.}



\author[1]{Malek Daldoul}%
\author[1]{Sirine  Tritar}%
\author[1]{Samia Ayachi}%
\author[1]{Ramzi Moatemri}%
\author[1]{Habib Khochteli}%
\affil[1]{Sahloul University Hospital}%


\vspace{-1em}



  
  \date{June 17, 2024}


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\selectlanguage{english}
\begin{abstract}
Nasopharyngeal teratomas (NPT) are rare and represent only 2\% of all
teratomas. They can lead to an embryopathogenic mechanical obstacle
responsible for a cleft palate (CP). We report the case of a
14-month-old female with NPT associated with a CP.%
\end{abstract}%



\sloppy


Teratoma is a tumor representing differentiation from all three
embryonic~germ layers, ectoderm, mesoderm, and endoderm\selectlanguage{ngerman}¹. Nasopharyngeal
teratoma (NPT) can extend to the sphenoidal, endobuccal and pharyngeal
regions. The most common associated abnormality is cleft palate (CP)².

A 14-month-old newborn girl was referred to out department for a large
CP. She was born by caesarean delivery for previous uterine scar at 40
weeks of amenorrhea with birth weight 3kg. Oral examination revealed a
firm mass of 1x1.5cm, appended to the ethmoid (Figure 1.A). A head
computed tomography scan revealed a well-delimited and heterogeneous
tumor with calcifications and fat tissue, expanding to the sphenoid
(Figure 1.C, 1.D).

Surgical excision of the tumor was performed immediately (Figure 1.B).
The hard and soft palates were cleft with the mass occupying the space
between the palatal shelves. Histologically the tumor was a true
teratoma according to the Wittstock \emph{et} al classification².

The reconstruction of the velar and the palatal defect were performed 6
months later to ensure a complete excision. No recurrence of the mass
has been observed during two years of follow-up.

NPT is rare and CP is the most common associated abnormality. The
factors that may promote this association remain uncertain but the
hypothesis of mechanical origin is the most plausible.

NPT could be an obstacle for the fusion of the palatal shelves during
the development of the mammalian palate. It is also possible that the
tumor may coexist with CP.

\textbf{References~:}

1. He J, Wang Y, Zhu H, Qiu W, He Y. Nasopharyngeal teratomas associated
with cleft palate in newborn: report of 2 cases. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2010;109:211-6.

2. C Diakité, H Bénateau, S Dakpé, P Guerreschi, P Galinier, A
Veyssière. Management of nasopharyngeal teratomas associated with clefts
palate. Int J Oral Maxillofac Surg 2019;48:291-297.\selectlanguage{english}
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