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Kado I, Ogashira S, Ono S, Koizumi K, Nakagawa T, Yoshimi Y, Kunimatsu R, Ito S, Koizumi Y, Ogasawara T, Aikawa T, Tanimoto K. Surgical Orthodontic Treatment for Skeletal Maxillary Protrusion in Sturge-Weber Syndrome: A Case Report and Review of the Literature. Cureus 2024; 16:e59964. [PMID: 38854229 PMCID: PMC11162147 DOI: 10.7759/cureus.59964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Sturge-Weber syndrome (SWS) is characterized by hemangiomas, glaucoma, and central nervous system disorders. Here, we report the case of a 15-year-old boy with SWS and upper-lip hypertrophy who underwent surgical orthodontic treatment for correction of a large overjet and deep overbite. In addition to the a large overjet and deep overbite, interdental spacing was observed in both the arches. The mandible was retrognathic and deviated to the right side. No maxillary occlusal canting or temporomandibular joint symptoms were observed. The patient was diagnosed with skeletal maxillary protrusion with spaced dentition and mandibular deviation to the right due to SWS. After presurgical orthodontic treatment using a multibracket appliance, we performed a sagittal split ramus osteotomy (SSRO) alone due to the presence of a hemangioma around the maxilla. No abnormal bleeding or cerebral hemorrhage due to increased blood pressure was observed during the SSRO. Postoperatively, the maxillary and mandibular arches were well-aligned, the deep overbite and excessive overjet improved, and bilateral angle class I molar and canine relationships were established. Furthermore, mandibular deviation improved, and the midlines of both arches approximately coincided with the facial midline. In conclusion, orthognathic surgery is feasible in patients with SWS after carefully evaluating the sites and sizes of the hemangiomas.
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Affiliation(s)
- Isamu Kado
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shintaro Ogashira
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shigehiro Ono
- Department of Oral and Maxillofacial Surgery, Hiromashi University Hospital, Hiroshima, JPN
| | - Koichi Koizumi
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Takayuki Nakagawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yuki Yoshimi
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Ryo Kunimatsu
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shota Ito
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Yuma Koizumi
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomohiro Ogasawara
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomonao Aikawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Kotaro Tanimoto
- Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Martins ML, Letieri ADS, Lenzi MM, Agostini M, Castro GF. Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge-Weber syndrome. SPECIAL CARE IN DENTISTRY 2019; 39:324-329. [PMID: 30865332 DOI: 10.1111/scd.12372] [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: 11/25/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
The aim of this report was to describe an approach for a child with phakomatosis pigmentovascularis Type IIb associated with bilateral Sturge-Weber syndrome and autistic spectrum disorder. A 6-year-old boy was referred to the Special Care Dental Clinic with the main complaints of "damaged teeth and pain." The physical examination revealed bilateral port-wine staining on the face, neck, and upper and lower limbs, congenital dermal melanocytosis on the back, and dilated blood vessels in the sclera. Intraoral examination revealed hypertrophy of the maxillary bone, diffuse and intense redness of the oral mucosa, crowding, anterior open bite, and carious lesions in the left and right upper second primary molars. The medical team was consulted prior to dental treatment to assess the risk of bleeding, and anesthesia was contraindicated. Instruction about brushing technique and procedures for a suitable oral environment were then carried out using a minimally invasive restorative treatment. The patient did not exhibit collaborative behavior, and follow up continues with the patient receiving preventive treatments. Therefore, a multidisciplinary approach to these patients is fundamental to avoid complications during dental intervention. Moreover, regular visits to the dentist reduce the need for invasive treatments and improve the well-being of these individuals.
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Affiliation(s)
- Mariana Leonel Martins
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aline Dos Santos Letieri
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michele Machado Lenzi
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Pathology and Oral Diagnosis, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gloria Fernanda Castro
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Correction of Facial Deformity in Sturge-Weber Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e843. [PMID: 27622111 PMCID: PMC5010334 DOI: 10.1097/gox.0000000000000843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/29/2016] [Indexed: 01/06/2023]
Abstract
Background: Although previous studies have reported soft-tissue management in surgical treatment of Sturge–Weber syndrome (SWS), there are few reports describing facial bone surgery in this patient group. The purpose of this study is to examine the validity of our multidisciplinary algorithm for correcting facial deformities associated with SWS. To the best of our knowledge, this is the first study on orthognathic surgery for SWS patients. Methods: A retrospective chart review included 2 SWS patients who completed the surgical treatment algorithm. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: According to the Roach classification, the first patient was classified as type I presenting with both facial and leptomeningeal vascular anomalies without glaucoma and the second patient as type II presenting only with a hemifacial capillary malformation. Considering positive findings in seizure history and intracranial vascular anomalies in the first case, the anesthetic management was modified to omit hypotensive anesthesia because of the potential risk of intracranial pressure elevation. Primarily, both patients underwent 2-jaw orthognathic surgery and facial bone contouring including genioplasty, zygomatic reduction, buccal fat pad removal, and masseter reduction without major complications. In the second step, the volume and distribution of facial soft tissues were altered by surgical resection and reposition. Both patients were satisfied with the surgical result. Conclusions: Our multidisciplinary algorithm can systematically detect potential risk factors. Correction of the asymmetric face by successive bone and soft-tissue surgery enables the patients to reduce their psychosocial burden and increase their quality of life.
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Medeiros MAB, do Nascimento LEAG, Lau TCL, Mineiro ALBB, Pithon MM, Sant'Anna EF. Effects of laser vs ultrasound on bone healing after distraction osteogenesis: A histomorphometric analysis. Angle Orthod 2014; 85:555-61. [DOI: 10.2319/061414-431.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Objective:
To assess the effects of low-level laser irradiation vs ultrasound irradiation on bone healing after distraction osteogenesis.
Materials and Methods:
Distraction osteogenesis was performed with rapid maxillary expansion devices (Hyrax-Morelli, Sorocaba, São Paulo Brazil) in 24 rabbits (Oryctolagus cuniculus). After a 2-day latency period, the distraction devices were activated for 10 days at a rate of 1 mm/d. Four groups of six animals were treated as follows: (1) control, (2) laser irradiation on the right side, (3) ultrasound irradiation on the right side, and (4) laser irradiation on the right side and ultrasound on the left side. Histomorphometric analysis was used to assess the bone healing area. Analysis of variance was used to perform the statistical analyses.
Results:
The influence of low-intensity laser associated with ultrasound irradiation on bone healing was statistically significant. The analyses showed the greatest amount of bone healing in the jaws of animals in group 4, which received treatment with both ultrasound and laser.
Conclusion:
This study concluded that bone healing is accelerated with the application of laser irradiation. The greatest effects were observed with combined ultrasound and laser treatment.
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Affiliation(s)
| | | | - Thiago Chon Leon Lau
- Student, Department of Orthodontics, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil; and Visiting Professor, Department of Orthodontics, Universidade Federal do Piauí, UFPI, Brazil
| | - Ana Lys Bezerra Barradas Mineiro
- Professor, Department of Clinical and Surgical Veterinary Medicine, Universidade Federal do Piauí, UFPI, Teresina, Piauí, Brazil
| | - Matheus Melo Pithon
- Professor, Orthodontics Healthy I Department, Southwest Bahia State University, UESB, Jequié, Bahia, Brazil
| | - Eduardo Franzotti Sant'Anna
- Associate Professor of Paediatric Dentistry and Orthodontics, Department of Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil
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