TORONTO -- A baby girl was born with an 鈥渆xtremely rare鈥� complication: a second mouth protruding from the side of her face, complete with teeth and a tongue that moved in synchronicity with her normal tongue.
This unique case of 鈥渃raniofacial duplication鈥� was described in in mid-May by BMJ Journals, a database for medical journals.
Doctors first noticed an unusual mass on the right side of the infant鈥檚 face during an ultrasound in the third trimester of the mother鈥檚 pregnancy, but were unsure what it was.
It wasn鈥檛 until the baby was delivered successfully that doctors realized the 1-2-centimetre mass of tissue on the side of the baby鈥檚 chin appeared to be a 鈥渞udimentary duplicated mouth.鈥�
Photos of the baby at five weeks show a lump of flesh protruding from the right side of the baby鈥檚 face, underneath the corner of her mouth. The mass has what appears to be a shiny strip of lip, as well as a tiny opening.
But did the baby actually have two mouths? Yes, and no.
Inside the mass, there was an opening in the tissue called a sinus tract, the report describes, but it was only 13 millimetres deep, and didn鈥檛 connect to the baby鈥檚 regular oral cavity, or airways. The baby鈥檚 other mouth also had no issues.
But a CT scan of the baby鈥檚 skull at two weeks revealed a bone structure for the additional mouth, and showed that there were extra teeth inside the soft tissue of the mass. The second mouth even had its own tongue, which seemed to move in parallel to the baby鈥檚 actual tongue.
鈥淎 small accessory tongue appeared to protrude from the opening of the sinus tract and was noted to move in synchronisation with the oral tongue when the infant was feeding,鈥� the journal stated.
Occasionally, the additional mouth would weep a clear fluid, but no tests were performed to figure out if it was saliva, as was the guess.
Essentially, the mass had many of the characteristics of a mouth, but without a connection to the rest of the respiratory system, it couldn鈥檛 function the way the main mouth could; no breathing, drinking, eating or speaking.
Duplication of facial features or structures, such as noses, mouths or ears, is very rare, the report said. Around 35 cases of partial or complete facial duplication have been reported since 1900. Although some have involved structures in the brain, the mildest of which being a pituitary gland duplication, partial duplication most often involves the top and bottom halves of the jaw or the oral cavity itself.
This specific phenomenon was first reported in 1948, the report said, when a two-day old infant was found to have a 鈥渄uplication of the mouth and tongue鈥� very similar to this new case.
At two weeks old, the baby with two mouths seemed to have no idea that she was a medical marvel: she was healthy, feeding well, and gaining weight without any issues. Having an additional mouth didn鈥檛 seem to disrupt any of these regular functions.
At six months old, the baby was taken into surgery to correct the second mouth.
Doctors removed the bone and tissue making up the additional mouth, and closed up the opening in the soft tissue by transferring over adjacent tissue. During the surgery, they discovered the second mouth had salivary glands and a mucosal lining. When they peeled the mucosal lining off of the mandible, they uncovered yet more teeth 鈥渇acing towards the duplicate oral cavity.鈥�
The teeth were pulled, and the sockets were 鈥渄rilled down鈥� to contour the lower jaw back to a normal size. Doctors took care to preserve the facial nerves as they closed up the opening with other tissue.
A photo taken one month after the infant's surgery shows a slight swelling on the right side of the face where the mouth used to be. At her six-month followup after surgery, the incisions were healed and she could feed without difficulty, but doctors noted that she had some trouble moving her bottom lip.
There are numerous causes for craniofacial duplication, according to the report. Often it鈥檚 part of another syndrome. This recent case, the report said, appeared to be an 鈥渋solated anomaly鈥� on an otherwise healthy baby.
