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Schoenmaker T, Dahou Bouchankouk A, Özkan S, Gilijamse M, Bouvy-Berends E, Netelenbos C, Lobbezoo F, Eekhoff EMW, de Vries TJ. Limitations of Jaw Movement in Fibrodysplasia Ossificans Progressiva: A Review. Front Med (Lausanne) 2022; 9:852678. [PMID: 35391888 PMCID: PMC8980542 DOI: 10.3389/fmed.2022.852678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by heterotopic ossification (HO) of the skeletal muscles, fascia, tendons and ligaments. Patients often experience limitations in jaw function due to HO formation in the maxillofacial region. However, no studies have yet analyzed the age of onset and location of HO and the type of restrictions it may yield in the maxillofacial region. The aim of this study was to evaluate all existing literature on the site of onset of HO and associated functional restrictions of the jaw. To this end, a scoping review was performed focusing on limitations of jaw movement in FOP patients. The literature search resulted in 725 articles, of which 30 articles were included for full study after applying the exclusion criteria. From these articles 94 FOP patients were evaluated for gender, age, presence and age at which HO started in the maxillofacial region, location of HO, whether HO was caused spontaneous or traumatic and maximum mouth opening. Formation of HO is slightly more common in female patients compared to male patients, but the age of HO onset or the maximum mouth opening does not differ between genders. Trauma-induced HO occurred at a significantly younger age than spontaneous HO. Interestingly, a difference in maximum mouth opening was observed between the different ossified locations in the maxillofacial region, with ossification of the masseter muscle resulting in the smallest and ossification of the zygomatic arch resulting in the largest maximum mouth opening. This review revealed that the location of the maxillofacial region affected by HO determines the degree of limitations of the maximum mouth opening. This finding may be important for establishing clinical guidelines for the dental management of FOP patients.
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Affiliation(s)
- Ton Schoenmaker
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Amine Dahou Bouchankouk
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Semih Özkan
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Marjolijn Gilijamse
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centre (UMC), Location Free University Medical Centre (VUmc), Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Elinor Bouvy-Berends
- Dutch Fibrodysplasia Ossificans Progressiva (FOP) Foundation and Former Centre Special Care Dentistry Rijnmond, Rotterdm, Netherlands
| | - Coen Netelenbos
- Department of Internal Medicine Section Endocrinology, Amsterdam University Medical Centre (UMC), Location Free University Medical Centre (VUmc), Amsterdam Movement Sciences, Amsterdam Bone Centre, Amsterdam, Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Elisabeth Marelise W Eekhoff
- Department of Internal Medicine Section Endocrinology, Amsterdam University Medical Centre (UMC), Location Free University Medical Centre (VUmc), Amsterdam Movement Sciences, Amsterdam Bone Centre, Amsterdam, Netherlands
| | - Teun J de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
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Kapoor K, Shadamarshan Rengasayee A, Sharma R, Agrawal N. Temporomandibular joint ankylosis-"Knowing when not to operate": Case report and qualitative systematic review of literature. Clin Case Rep 2022; 10:e05556. [PMID: 35280078 PMCID: PMC8898821 DOI: 10.1002/ccr3.5556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2022] [Indexed: 11/08/2022] Open
Abstract
Temporomandibular joint ankyloses (TMJA) may manifest in patients with several predisposing systemic conditions. A case of extraarticular TMJA is presented in a patient diagnosed with fibrodysplasia ossificans progressive (FOP) is presented. The features, diagnosis, and management of TMJA superimposed on this condition are presented through a qualitative systematic review of literature.
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Affiliation(s)
- Kavish Kapoor
- Department of Radiodiagnosis and ImagingMilitary HospitalJalandharIndia
| | | | - Rohit Sharma
- Command Military Dental Centre (Western Command)Chandi MandirIndia
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Hietanen B, Sullivan M, Frustino J, Cantie S, Kapral E. Dental management of a 26-year-old female with fibrodysplasia ossificans progressiva: A case report. SPECIAL CARE IN DENTISTRY 2021; 42:194-199. [PMID: 34558083 DOI: 10.1111/scd.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/17/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the report is to present a rare case of clinical management of a 26-year-old patient with fibrodysplasia ossificans progressiva (FOP), and discuss treatment options and possible outcomes. SUMMARY FOP is a rare autosomal dominant genetic disorder of the connective tissue that affects one in two million people. It is characterized by multiple areas of progressive heterotopic endochondral ossifications. The symptoms typically begin with painful soft tissue swellings in the patient's first decade, which frequently occur after minor trauma, but may also happen spontaneously. The soft tissue swellings eventually form hard bony masses that cause joint limitations, growth defects, skeletal deformities, and chronic pain. The results are severely limiting to the activities of daily living and overall quality of life with the average life expectancy being 40 years of age. Medical and dental treatment, including the use of general anesthesia, may be complicated by increased risk of ossification of the soft tissues in the airway and lungs. The following case report focuses on a 26-year-old Caucasian female, with FOP. The patient presented to the Erie County Medical Center Dental clinic in Spring 2019 with generalized dental pain. She reported a history of multiple dental infections over many years which were periodically treated with antibiotics. A thorough intraoral exam and radiographs were not able to be completed upon initial presentation due to severe trismus and mobility limitations. The patient was a wheelchair user, verbal, and maintained a completely liquid diet by mouth. The patient also had a medical history significant for dysphagia and aspiration. After a substantial pre-operative optimization process, the patient was brought to the operating room for full mouth dental extractions. At the 2-week follow-up from surgery the patient showed excellent healing. CONCLUSION While there are greater potential risks with placing a patient with FOP patient under general anesthesia, proper management of dental disease can relieve the patient from recurrent infections and discomfort.
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Affiliation(s)
| | - Maureen Sullivan
- Dentistry/Division of Oral Oncology & Maxillofacial Prosthetics, Erie County Medical Center, Buffalo, New York, USA
| | - Jennifer Frustino
- Oral Cancer Screening and Diagnostics, Erie County Medical Center, Buffalo, New York, USA
| | - Shawn Cantie
- Erie County Medical Center, Buffalo, New York, USA
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Kannu P, Levy CE. Evolving Management of Fibrodysplasia Ossificans Progressiva. J Pediatr 2021; 232S:S9-S15. [PMID: 33896451 DOI: 10.1016/j.jpeds.2021.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/07/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Peter Kannu
- The Hospital for Sick Children and Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada; University of Alberta, Toronto, Ontario, Canada.
| | - Charles E Levy
- Center for Arts in Medicine, College of the Arts, University of Florida, Gainesville, FL
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Geddis-Regan A. Severe trismus and contraindicated exodontia in a patient with fibrodysplasia ossificans progressiva: case report. Br J Oral Maxillofac Surg 2018; 56:427-429. [PMID: 29730069 DOI: 10.1016/j.bjoms.2018.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/29/2018] [Indexed: 11/29/2022]
Abstract
Fibrodysplasia ossificans progressiva is a rare genetic disease of connective tissue in which muscles, ligaments, and tendons ossify either spontaneously or after trauma. Patients can develop physical disabilities and restriction of respiratory function. A patient attended a maxillofacial surgery outpatient clinic with severe trismus and mouth opening limited to 2mm. The risks of intervention were many from both anaesthetic and surgical perspectives, which prevented the extraction of carious teeth. The patient was referred to a special care dentistry team who provided endodontic stabilisation without local anaesthesia. In the case of severe infection, surgical intervention would be challenging to justify.
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Affiliation(s)
- A Geddis-Regan
- Newcastle University, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, NE2 4BW; Carlisle Dental Centre, Cumbria Partnership NHS Foundation Trust, Infirmary Street, Carlisle, CA2 7AN.
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Carvalho DR, Farage L, Speck-Martins CE. The signature of craniofacial deformation in fibrodysplasia ossificans progressiva. Am J Med Genet A 2012; 158A:2977-8; author reply 2979-80. [DOI: 10.1002/ajmg.a.35617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/24/2012] [Indexed: 11/09/2022]
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Susami T, Mori Y, Tamura K, Ohkubo K, Nagahama K, Takahashi N, Uchino N, Uwatoko K, Haga N, Takato T. Facial morphology and occlusion of a patient with fibrodysplasia ossificans progressiva (FOP): a case report. SPECIAL CARE IN DENTISTRY 2012; 32:165-70. [DOI: 10.1111/j.1754-4505.2012.00260.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hammond P, Suttie M, Hennekam RC, Allanson J, Shore EM, Kaplan FS. The face signature of fibrodysplasia ossificans progressiva. Am J Med Genet A 2012; 158A:1368-80. [PMID: 22581580 DOI: 10.1002/ajmg.a.35346] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 01/26/2012] [Indexed: 11/11/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) causes extensive heterotopic bone formation due to heterozygous mutations in the glycine-serine activation domain of ACVR1 (ALK2), a bone morphogenetic protein type I receptor. Anecdotal observations of facial similarity have been made by clinicians and parents, but no objective quantitative analysis of the faces of FOP patients has ever been undertaken. We delineated the common facial characteristics of 55 individuals with molecularly confirmed FOP by analyzing their face signature (face shape difference normalized against age and sex matched controls) and associated face signature graphs (with face signatures as vertices and adjacency corresponding to greatest similarity). Our analysis identified 10 affected individuals whose face signature is more homogeneous than others with FOP. This distinct subgroup showed the previously identified reduced mandible as well as newly identified features: underdevelopment of the upper orbit/supra-orbital ridge; infra-orbital prominence; and, low-set ears. These findings strongly suggest that the canonical FOP mutation variably affects the postnatal morphogenesis of the normotopic cranial skeleton in the upper midface and mandible and may have important diagnostic and functional implications.
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Affiliation(s)
- Peter Hammond
- Molecular Medicine Unit, UCL Institute of Child Health, London, UK.
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Carvalho DR, Farage L, Martins BJAF, Speck-Martins CE. Craniofacial findings in fibrodysplasia ossificans progressiva: computerized tomography evaluation. ACTA ACUST UNITED AC 2011; 111:499-502. [PMID: 21420641 DOI: 10.1016/j.tripleo.2010.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 11/05/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was the evaluation by using computerized tomography (CT) of craniofacial abnormalities in fibrodysplasia ossificans progressiva (FOP) patients regarding jaw restriction and retrognathia. STUDY DESIGN Seven FOP patients were evaluated retrospectively in this observational study. Inclusion criteria were detection of ACVR1 gene mutation and complete craniofacial CT examination. The age of jaw restriction and presence of retrognathia were clinically determined. The features analyzed were skull base structures and heterotopic ossification (HO). RESULTS Of this group (age range 4-23 years), the 3 oldest patients presented with jaw restriction and retrognathia as well as displayed elongation of the lateral pterygoid plate with HO of the pterygoid muscles that reached the medial surface of the right mandibular ramus. They had significant history of trauma or surgery. The other 4 patients did not have retrognathia or HO involving the facial or masticatory muscles, and the mouth opening was normal. CONCLUSIONS CT evaluation can reveal HO of the pterygoid muscles that probably may cause jaw restriction and retrognathia in older FOP patients.
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Roberts T, Stephen L, Scott C, Urban M, Sudi S, Beighton P. Fibrodysplasia ossificans progressiva (FOP) in South Africa: dental implications in 5 cases. ACTA ACUST UNITED AC 2011; 112:11-8. [DOI: 10.1016/j.tripleo.2011.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/01/2011] [Accepted: 03/05/2011] [Indexed: 11/30/2022]
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Extraction of 6 Molars Under General Anesthesia in Patient With Fibrodysplasia Ossificans Progressiva. J Oral Maxillofac Surg 2011; 69:1905-10. [DOI: 10.1016/j.joms.2010.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 10/24/2010] [Accepted: 12/21/2010] [Indexed: 11/23/2022]
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Mandibular hypoplasia in fibrodysplasia ossificans progressiva causing obstructive sleep apnoea with pulmonary hypertension. Clin Dysmorphol 2010; 19:69-72. [PMID: 20190637 DOI: 10.1097/mcd.0b013e32833734f9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
There are a number of diseases and conditions that prevent the sufferer from adequately opening the mouth. The danger of inanition, malnutrition, chronic periodontal disease, caries, and abscessed teeth are very real to this population. Dental treatment issues include inadequate access to the oral cavity, inability to locally anesthetize mandibular posterior teeth, inability to gain access for traditional operative dentistry, and lack of clearance for most oral surgery procedures. The purpose of this article is to provide the reader with a discussion of the various conditions and then discuss the dental and anesthesia issues for this unique population.
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Affiliation(s)
- Burton L Nussbaum
- Dentistry for Special People, 1910E Marlton Pike, Suite 9, Cherry Hill, NJ 08003, USA.
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Leavitt BD, Teeples TJ, Viozzi CF. Submandibular space swelling in a patient with fibrodysplasia ossificans progressiva: a diagnostic dilemma. J Oral Maxillofac Surg 2009; 67:668-73. [PMID: 19231799 DOI: 10.1016/j.joms.2008.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 07/02/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Bryce D Leavitt
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Young JM, Diecidue RJ, Nussbaum BL. Oral management in a patient with fibrodysplasia ossificans progressiva. SPECIAL CARE IN DENTISTRY 2007; 27:101-4. [PMID: 17658184 DOI: 10.1111/j.1754-4505.2007.tb01748.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant disorder of connective tissue. FOP results in debilitating heterotopic ossification of the axial and appendicular skeleton. Permanent ankylosis of the temporomandibular joint (TMJ) is a common late finding, but is usually preceded by specific inciting trauma. Extreme care must be exercised when carrying out routine dental care to prevent soft tissue trauma. Oral health care for patients with FOP is usually complex. There are additional considerations when oral surgical procedures, such as extractions, are needed. Maintaining a balance between oral health and disease progression in these patients is challenging, as they frequently present with advanced oral disease. Fiber optic-assisted placement of the nasoendotracheal tube is the standard of care. Intramuscular injections including mandibular blocks must be avoided. Permanent fusion of the TMJ leads to malnutrition, inanition, and aspiration of food. In patients with complete TMJ ankylosis, dental extractions can be safely and effectively performed while accessing teeth from the buccal aspect. This approach has successfully resulted in decreased morbidity in these patients as well as others with limited oral opening.
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Affiliation(s)
- Justin M Young
- Department of Oral and Maxillofacial Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
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Debeney-Bruyerre C, Chikhani L, Lockhart R, Favre-Dauvergne E, Weschler B, Bertrand JC, Guilbert F. Myositis ossificans progressiva: five generations where the disease was exclusively limited to the maxillofacial region. A case report. Int J Oral Maxillofac Surg 1998; 27:299-302. [PMID: 9698179 DOI: 10.1016/s0901-5027(05)80619-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myositis ossificans progressiva is an unusual autosomal-dominant inherited disease characterized by congenital malformations and osseous metaplasia of the fascia of the muscles and connective tissue leading to ossification of the relevant area. The case report is remarkable in that eight members of the same family over five generations manifested the exclusive localization of the disease in the maxillofacial region.
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Affiliation(s)
- C Debeney-Bruyerre
- Clinique et UFR de Stomatologie et de Chirurgie Maxillo-facial, Hôpital de la Salpêtrière, Paris, France.
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Janoff HB, Zasloff MA, Kaplan FS. Submandibular Swelling in Patients with Fibrodysplasia Ossificans Progressiva. Otolaryngol Head Neck Surg 1996; 114:599-604. [PMID: 8643271 DOI: 10.1016/s0194-59989670253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrodysplasia ossifcans progressiva (FOP) is a rare genetic disorder characterized by congenital malformation of the great toes and by progressive heterotopic ossification of soft tissues. Although ankylosis of the temporomandibular joint occurs commonly in the late stages of the disease, only one well-documented case of submandibular heterotopic ossification in a patient who had FOP exists. Twelve (11%) of our 107 patients who have FOP had submandibular heterotopic ossification that was mistaken initially in seven of the patients for mumps, angioneurotic edema, abscess, mononucleosis, or neoplasm. Two male patients and 10 female patients ranging in age from 6 to 47 years (mean, 21 years) were studied. Ten patients survived following assiduous precautionary measures. One patient who required emergency tracheostomy and ventilatory support also survived. Another patient died of inanition from chronic swallowing difficulty. An effective treatment program includes early identification of the submandibular flare-up, nutritional support, and glucocorticoid therapy. Submandibular swelling in patients who have FOP can be a medical emergency and requires intensive precautionary measures to avoid catastrophic clinical deterioration. These measures include avoidance of lesional manipulation, airway monitoring, and aspiration precautions. Submandibular swelling should be recognized as a variable feature of FOP.
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Affiliation(s)
- H B Janoff
- Department of Orthopaedic Surgery, The University of Pennsylvania School of Medicine, Philadelphia, 19104, USA
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Luchetti W, Cohen RB, Hahn GV, Rocke DM, Helpin M, Zasloff M, Kaplan FS. Severe restriction in jaw movement after routine injection of local anesthetic in patients who have fibrodysplasia ossificans progressiva. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:21-5. [PMID: 8850477 DOI: 10.1016/s1079-2104(96)80141-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship of dental procedures to immediate ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva. STUDY DESIGN A mail survey was conducted of the 60 patient-members of the International Fibrodysplasia Ossificans Progressiva Association. All 41 patients (18 males, 23 females) who responded were examined. Instantaneous exact hazard rates for ossification of the jaw were calculated by the Weibull model. RESULTS Thirty-six patients had dental procedures performed. Twenty-one (58%) patients had received an injection of local anesthetic. Five (24%) patients had an immediate flare-up of fibrodysplasia ossificans progressiva with ossification and permanent ankylosis of the jaw (expected occurrence, 0.031; p < 0.0001). None of the 12 patients who had comparable dental work without injections developed heterotopic ossification (expected occurrence, 0.019; not significant). CONCLUSION Injections of local anesthetic during dental procedures pose serious and immediate risk for inciting heterotopic ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva and should be assiduously avoided.
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Affiliation(s)
- W Luchetti
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, USA
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Affiliation(s)
- P U Ele
- College of Health Sciences, Nnamdi Azikiwe University, Anambra State, Nigeria
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20
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Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare, congenital disorder characterized by diffuse ossification of extraskeletal connective tissue. The classical features and progression of the disease are described and three cases are presented which fall into the general pattern of FOP clinically and radiologically. A constant feature seen was a slight metaphyseal flaring with spiking at the edges of the metaphyses, compatible with minor alteration in bone morphology during growth. These changes cannot be seen after epiphyseal fusion. The major abnormalities persist into adult life.
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Affiliation(s)
- M O'Reilly
- Royal National Orthopaedic Hospital, London, UK
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21
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Kabala JE, Watt I, Hollingworth P, Ross JW. Trismus and multifocal soft tissue ossification. A presentation of fibrodysplasia ossificans progressiva? Clin Radiol 1989; 40:523-7. [PMID: 2507212 DOI: 10.1016/s0009-9260(89)80273-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 21-year-old female patient presented with trismus, initially diagnosed as related to pericoronitis. Computed tomography demonstrated heterotopic soft tissue ossification involving both medial pterygoids which was later followed by similar features in the submandibular muscles and right quadriceps. A variant of fibrodysplasia ossificans progressiva was considered the likeliest diagnosis. The computed tomographic features of the condition and the importance of early diagnosis are stressed.
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Affiliation(s)
- J E Kabala
- Department of Radiodiagnosis, Bristol Royal Infirmary
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22
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Nunnelly JF, Yussen PS. Computed tomographic findings in patients with limited jaw movement due to myositis ossificans progressiva. J Oral Maxillofac Surg 1986; 44:818-21. [PMID: 3463712 DOI: 10.1016/0278-2391(86)90162-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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23
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Lello GE, Makek M. Traumatic myositis ossificans in masticatory muscles. JOURNAL OF MAXILLOFACIAL SURGERY 1986; 14:231-7. [PMID: 3461100 DOI: 10.1016/s0301-0503(86)80295-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
3 cases of traumatic myositis ossificans circumscripta, located within the masticatory muscles are presented. Two of the lesions involved the masseter muscle, and exceptionally, 1 involved the temporalis muscle. Three pathognomonic histological zones, permitting the differential diagnosis of myositis ossificans from sarcomatous lesions, are described, and treatment incorporating ideally early surgical intervention with wide excisional biopsy of the lesion is stressed.
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24
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Jonathan DA, Jefferis AF. Fibrodysplasia ossificans progressiva presenting acutely as a submandibular swelling. J Laryngol Otol 1985; 99:721-4. [PMID: 4020266 DOI: 10.1017/s0022215100097541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
A disseminated disorder of epimysial connective tissue characterized by hyperplasia and ossification causing atrophy and displacement of skeletal muscles, entrapment of vessels and nerves, and progressive immobility is described in three domestic cats. The condition has some features in common with fibrodysplasia ossificans progressiva in man.
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