Hypomandibular faciocranial dysostosis in consanguineous parents revealed by ultrasound prenatal diagnosis

Morphometric Development of the Mandible in Fetal Cadavers

PURPOSE

The aim of this study is to present reliable data by measuring the morphometric properties of the mandible in the fetal period.

METHODS

A study was performed on mandibles of 35 fetuses (18 male fetuses and 17 female fetuses), aged between 21 and 40 weeks of gestation. Fetuses were examined in 3 groups according to their developmental stages: 2nd trimester, 3rd trimester, and full-term. Morphometric measurements were performed for both the right and left sides of each mandible. The measurements of the mental foramen were performed using a digital caliper, and other measurements were performed using the ImageJ program. The data obtained were analyzed using the SPSS 20 for Windows program.

RESULTS

There was no significant gender difference for all parameters. When the parameters were compared by the trimesters, no significant difference was determined in the 2nd trimester - 3rd trimester, 3rd trimester-full-term, and second trimester - full-term comparisons of the angle of the mandible, and there was a significant difference in all other parameters (P < 0.05). According to the trimesters, all parameters, except the angle of the mandible, increased naturally with the development of the mandible. It was observed that the angle of the mandible decreased from the 2nd trimester to the 3rd trimester and increased from the 3rd trimester to the full term. When the right and left measurements were compared, no significant difference was found for all parameters in both general and trimester groups.

CONCLUSION

The present study includes fetal mandibular parameters that have not been reported elsewhere. It is thought that the obtained data will contribute to the determination of anomalies, pathologies, and variations.

Agnathia-otocephaly complex: a case report and examination of the OTX2 and PRRX1 genes

Agnathia-otocephaly is a rare, often lethal malformation characterized by absence or hypoplasia of the mandible, microstomia, hypoglossia/aglossia, and variable anterior midline fusion of the ears (melotia, synotia). Etiologies have been linked to both genetic and teratogenic factors and to date, a definitive, commonly identifiable cause has not been recognized. Mouse and human genetic studies have implicated OTX2 and PRRX1 as potential candidate genes for agnathia-otocephaly. In this study we report a sporadic case of agnathia-otocephaly complex with associated features of maldevelopment and examine the roles of OTX2 and PRRX1. The proband, a male born at 31 weeks, displayed severe micrognathia, microstomia, posteriorly-rotated and low set ears, and downward slanting palpebral fissures. Mutation analysis was performed after sequencing the entire coding regions of OTX2 and PRRX1 genes isolated from the proband and his parents. After thorough analysis, no DNA variations were detected. This suggests that mutations in different genes or environmental causes are responsible.

Persistent buccopharyngeal membrane: report of a case and review of the literature

A persistent buccopharyngeal membrane is a rare entity with 23 reported cases in the literature. Patients often present at birth in airway distress with diagnosis initially unrecognized. The otolaryngologist is frequently consulted in the delivery room to establish a secure airway after attempts at direct laryngoscopy are unsuccessful. Historically, definitive treatment has proved challenging. This article presents a new case and thoroughly reviews the literature for previous cases. Embryology, presentation, and treatment options are outlined.

Oropharyngeal atresia in a preterm infant: a case report and review of the literature

Oropharyngeal atresia is a rare and often fatal condition that presents soon after birth with severe respiratory distress. We present a case of a premature infant who initially was suspected to have tracheo-esophageal atresia due to prenatal ultrasound findings of polyhydramnios and absent stomach bubble, but was found instead to have oropharyngeal atresia and a complete persistent buccopharyngeal membrane. This case is the first described in which the patient was successfully intubated through a small slit in the persistent membrane.

Determination of dimensions and angles of mandible in the fetal period

The aim of the present study was to determine the dimensions of the mandible during the fetal period, the relationship between the growth rates of the angle of the mandible and the dimensions of the mandible. Furthermore the angle of union of the two halves of the body of the mandible on the horizontal mandibular plane, which was not described elsewhere, is explored in this study. One hundred and sixty-one human fetuses (83 males and 78 females) without any cranio-facial or mandibular asymmetry, external pathology or anomaly and aged between 9 and 40 weeks of gestation were used in the study. Cases were stratified into four groups according to their developmental ages, that is, first trimester, second trimester, third trimester, and term fetuses. Cranio-facial parameters in addition to bi-condylar, bi-gonial, bi-mental tubercular, condyle-gonion, gonion-mental tubercle, condyle-mental tubercle, gonion-pogonion distances were measured. The degree of the angle of the mandible, angle of union of the two halves of the body of the mandible and sagittal length of the base of the mandible were calculated. The means of the parameters with respect to gestational weeks and groups were computed. While there were no sex differences in any of the parameters (P>0.05) there were very significant relationships between gestational age and parameters (P<0.001). The mean degree of the angle of the mandible during the fetal period was 122+/-8 degrees . The mean alpha angle of the base of the mandible was 65+/-8 degrees . None of these angles varied significantly throughout the fetal period. Height of the ramus of the mandible increased more than the length of the body of the mandible and bi-gonial distance in the first and second trimesters while in the third trimester and term period they increased at the same rate. Comparisons of groups for the ratio of the transverse to the sagittal lengths of the mandible revealed significant differences between first and second trimesters with term group (P<0.05). Accordingly, bi-gonial distance of the mandible increased more during the third trimester and term time than the first and second trimesters, compared with the sagittal length of the mandible. The morphometric features and architectural changes observed in the mandible do not totally occur during the fetal period but continue later in childhood and adulthood.

Anesthesia for a neonate with persistent buccopharyngeal membrane and unilateral choanal atresia

We report our anesthetic management of a neonate who presented with complete persistent buccopharyngeal membrane and unilateral choanal atresia, and underwent examination under anesthesia. Maintaining airway patency and spontaneous respiration were our priority. Intravenous propofol was used to maintain adequate anesthetic depth for flexible laryngotracheoscopy and nasotracheal intubation through the only patent passage. We encountered problems of bradycardia and hypotension. Tracheostomy was performed. Definitive management of the persistent buccopharyngeal membrane was carried out on day 14.