Maxillary Third Molar Concrescence with Isolated Cleft Palate in a Phenotype Suggestive of Robinow Syndrome: A Clinicopathologic Report

Abstract

Robinow syndrome is a rare genetically heterogeneous skeletal dysplasia characterized by mesomelic limb shortening, vertebral segmentation defects, brachydactyly, and distinctive craniofacial features. Although several oral and dental manifestations have been reported, developmental dental anomalies such as concrescence are exceedingly rare in association with this condition. We report the case of a 25-year-old male who presented with pain in the left posterior maxillary region. Clinical and radiographic examination of an infected maxillary third molar revealed an unusual morphology, and subsequent evaluation demonstrated cemental fusion of the roots of adjacent molars without dentinal continuity, confirming the diagnosis of concrescence. Further systemic assessment revealed short stature, mesomelic shortening of the limbs, brachydactyly, mild vertebral disproportion, and a history of surgically repaired isolated cleft palate. Craniofacial examination showed mild midfacial retrusion with a normally contoured nasal bridge, while cognitive function was normal. Correlation of the clinical, radiographic, and phenotypic findings suggested a Robinow syndrome spectrum phenotype. This case highlights the importance of recognizing uncommon dental developmental anomalies as potential indicators of underlying skeletal dysplasia. Identification of concrescence in association with characteristic skeletal and craniofacial abnormalities should prompt comprehensive systemic evaluation and multidisciplinary management, facilitating early diagnosis and appropriate long-term care.