ON EPIGNATHUS 1 7 



place of origin has been in the stomodaeum. Thus would be included 

 amongst the epignathi certain teratomata which lie outside the dura 

 mater in the middle fossa of the skull, the germ of which may have been 

 in connection with the buccal evagination of the pituitary body. 



E. Schwalbe (20) arranges the epignathi in four chief groups, at the 

 same time admitting that there are transitional forms between the several 

 groups. These groups are as follows : — 



Group I. — A second foetus is attached, by its umbilical cord, to the 

 palate or near the palate of a foetus. This second foetus may be more or 

 less well developed. 



Group II. — From the mouth of a foetus there hang parts of the body 

 of a second foetus, which parts can readily be recognised as fully formed 

 portions of a foetus, e.g., lower extremities, external sexual organs, etc. 



Group III. — Out of the mouth of a foetus there projects a formless 

 mass in which no parts similar to foetal organs are to be recognised. 

 Microscopic examination gives the structure of a teratome. 



Group IV. — A larger or smaller tumour is found attached to the 

 palate or in the mouth cavity of the foetus. Microscopic examination 

 shows that the tumour is composed of several tissues, and is of the type 

 of the mixed tumours. 



Examples of Group I. are very rare. Ahlfeld describes and illustrates 

 a case recorded by Baart de la Faille. In this case there was a typical 

 epignathus attached to the base of the skull of a practically normal foetus. 

 In addition to this, there were two acardici acephali — pelves with lower 

 extremities, with fork-like umbilical cords attached to the palate of the 

 first well-formed foetus. 



Examples of Group II. are more common. The case now described 

 belongs to this group as it shows quite recognisable foetal parts — a nostril, 

 mouth. Wasserthal describes an epignathus with a lower extremity 

 attached. Otto (^9) describes the case of a male foetus with an epignathus 

 showing male external genital organs. Kreutzmann (^^) records the case 

 of a female foetus with an epignathus showing female external genital 

 organs. 



In examples of Group III. there are no recognisable organs, although 

 the tumour is usually more or less covered by epidermis, and, like a 

 teratome, may contain fibrous tissue, cartilage, bone, muscle, gut 



(190 



