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Meazzini MC, Besana M, Tortora C, Cohen N, Rezzonico A, Ferrari M, Autelitano L. Long-term longitudinal evalutation of mandibular growth in patients with Beckwith-Wiedemann Syndrome treated and not treated with glossectomy. J Craniomaxillofac Surg 2020; 48:1126-1131. [PMID: 33087311 DOI: 10.1016/j.jcms.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study compares long-term mandibular growth between a group of Beckwith-Wiedemann Syndrome (BWS) patients who underwent glossectomy at an early age and a group of patients not operated. METHODS Cephalometric measurements were performed in BWS patients comparing the data obtained between a group of patients operated at an early age and a group of non-operated patients who declined surgery. Statistics included independent sample T-test. RESULTS Twenty-four out of 78 BWS patients followed since birth completed longitudinal cephalometric x-rays at age 5, 10 and 15. Eighteen patients needed early surgery. Eleven families accepted glossectomy at 2.3 ± 1.3 years of age; seven declined surgery. No differences in mandibular growth were found between the two groups. Inclination of maxillary incisors results were statistically greater in the non-operated group (operated compared to the non-operated group: 103.58 ± 11.30 Vs 108.98 ± 12.47; p-value 0.0168 at 5; 107.06 ± 7.98 Vs 115.14 ± 7.05; p-value 0.0206 at 10; 109.80 ± 4.68 Vs 116.75 ± 5.28; p-value 0.0233 at 15). CONCLUSION Macroglossia has no role in the post-natal mandibular overgrowth in BWS and mandibular overgrowth is part of the syndrome. Therefore, early glossectomy does not change mandibular growth and does not prevent the development of class III skeletal malocclusion in these patients.
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Affiliation(s)
- Maria Costanza Meazzini
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy; San Gerardo Hospital, Monza, Italy.
| | - Melissa Besana
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy; San Gerardo Hospital, Monza, Italy.
| | - Chiara Tortora
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Noah Cohen
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Angela Rezzonico
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Mario Ferrari
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Luca Autelitano
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
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The Utility of Early Tongue Reduction Surgery for Macroglossia in Beckwith-Wiedemann Syndrome. Plast Reconstr Surg 2020; 145:803e-813e. [PMID: 32221229 DOI: 10.1097/prs.0000000000006673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Dursun A, Kastamonı Y, Kacaroglu D, Yuzbasıoglu N, Ertekın T. Morphometric development of the tongue in fetal cadavers. Surg Radiol Anat 2019; 42:3-8. [PMID: 31401676 DOI: 10.1007/s00276-019-02301-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/03/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The tongue is a specific organ for the sense of taste. It consists of the striated muscle and mucous membrane. Furthermore, it helps the functions of speech, chewing, and swallowing. In this study, we aimed to reveal some morphometric properties of the tongue in fetal cadavers. METHODS The study was conducted on a total of 45 fetal tongues (25 male tongues, 20 female tongues) aged between 17 and 40 weeks. The fetuses were divided into three groups as trimester II, trimester III, and full term. For each tongue, the length, width, area, free tongue length, and the terminal sulcus angle were measured using Image J program. The free tongue length/tongue length ratio was examined. RESULTS The obtained data were compared according to the trimester groups and genders. It was determined that the tongue length, width, area, and free tongue length increased during the trimesters and that there was no significant difference in the terminal sulcus angle and the free tongue length/tongue length ratio between the trimesters. No significant difference was found in all parameters between the genders. CONCLUSIONS This study presented significant data on morphometric development of the tongue. These data are thought to be useful for determining the anomaly and variations of the tongue.
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Affiliation(s)
- Ahmet Dursun
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey.
| | - Yadigar Kastamonı
- Department of Anatomy, Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey
| | - Demet Kacaroglu
- Department of Medical Biology, Faculty of Medicine, Suleyman Demirel University, 32260, Isparta, Turkey
| | - Neslihan Yuzbasıoglu
- Department of Anatomy, Faculty of Medicine, Istanbul Medipol University, 34815, Istanbul, Turkey
| | - Tolga Ertekın
- Department of Anatomy, Faculty of Medicine, Afyonkarahisar Health Sciences University, 03200, Afyonkarahisar, Turkey
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4
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Naujokat H, Möller B, Terheyden H, Birkenfeld F, Caliebe D, Krause MF, Fischer-Brandies H, Wiltfang J. Tongue reduction in Beckwith-Wiedemann syndrome: outcome and treatment algorithm. Int J Oral Maxillofac Surg 2018; 48:9-16. [PMID: 30057238 DOI: 10.1016/j.ijom.2018.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/30/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022]
Abstract
Beckwith-Wiedemann syndrome is a rare congenital overgrowth disorder with macroglossia being one of the cardinal symptoms. In pronounced cases, macroglossia can lead to airway obstruction, musculoskeletal alterations and functional deficits. Surgical tongue reduction is performed at varying ages and with different techniques. This study evaluated perioperative complications, as well as long-term aesthetic and functional outcomes, in a large cohort. A total of 68 patients, treated either surgically or conservatively, were included. Depending on the severity of macroglossia, patients were divided into three groups to determine the treatment algorithm. Complications after surgical tongue reduction were prolonged intubation and revision due to dehiscence or haematoma. In the long term, no patient suffered from impaired sense of taste or paresthesia, although the shape of the tongue was disproportional in 85%. With the present treatment algorithm, operative tongue reduction exerts a positive influence on skeletal, dentoalveolar and functional development with sufficient long-term outcome and high grade of satisfaction of the patients. Supportive therapy in an interdisciplinary centre is of fundamental importance for both surgical and conservative treatment.
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Affiliation(s)
- H Naujokat
- Departments of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - B Möller
- Departments of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - H Terheyden
- Departments of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - F Birkenfeld
- Departments of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Caliebe
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M F Krause
- Departments of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - H Fischer-Brandies
- Departments of Orthodontics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Wiltfang
- Departments of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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5
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Style CC, Cruz SM, Lau PE, Lee TC, Wesson DE, Olutoye OO. Surgical Outcomes of Patients with Beckwith-Wiedemann Syndrome. J Pediatr Surg 2018; 53:1042-1045. [PMID: 29551244 DOI: 10.1016/j.jpedsurg.2018.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate treatment and surgical outcomes of patients of Beckwith-Wiedemann Syndrome (BWS) treated at a tertiary children's hospital. METHODS A retrospective review of infants evaluated at Texas Children's Hospital for BWS from August 2000 to December 2016 was performed. Data collected included demographic information, clinical presentation, genetic evaluation, fetal imaging, operative treatment, and outcomes. RESULTS Forty-seven children with a diagnosis of BWS were identified. Sixty-four percent (n=30) had a genetic mutation in an imprinting domain of chromosome 11p15. Thirty-two patients (68%) underwent at least one operation related to BWS with a median of 2 [range: 0-8] surgical procedures per patient. Sixteen underwent omphalocele repair, 12 had partial glossectomies-, 7 underwent surgeries related to hemihypertrophy, and 6 had resection of an embryonal tumor (two adrenal cortical adenoma, one Wilms' tumor, two hepatoblastoma). Overall, survival was 100% with feeding difficulty (47%) being the most frequent complication. CONCLUSION A substantial number of patients with Beckwith-Wiedemann Syndrome will require surgery. However, overall outcomes are similar between those that require surgery and those that do not. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Candace C Style
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Stephanie M Cruz
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Patricio E Lau
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Timothy C Lee
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - David E Wesson
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Oluyinka O Olutoye
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
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Alonso-Rodriguez E, Gómez E, Martín M, Muñoz JM, Hernández-Godoy J, Burgueño M. Beckwith-Wiedemann Syndrome: Open bite evolution after tongue reduction. Med Oral Patol Oral Cir Bucal 2018; 23:e225-e229. [PMID: 29476667 PMCID: PMC5911364 DOI: 10.4317/medoral.21319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/12/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Macroglossia causes functional deficits such as airway obstruction, drooling, phonation difficulties, and leads to protrusion of dentoalveolar structures resulting in an anterior open bite and a prognathic mandibular appearance. Macroglossia is present in the majority of patients with Beckwith-Wiedemann syndrome (BWS) and surgical treatment may be indicated. MATERIAL AND METHODS A retrospective review was conducted including BWS patients who underwent surgical tongue reduction between 2000 and 2015 at the Hospital Universitario La Paz, Madrid. RESULTS Out of 16 patients with BWS, surgery was performed in 11 cases. Tongue protrusion with open bite was the main indication for surgical treatment. Reduction glossectomy was performed using the keyhole technique. We analysed the relationship between age at surgery and evolution of open bite. Complications were minimal and satisfactory outcomes were observed with a decrease in anterior open bite. CONCLUSIONS In this study we have observed that surgical treatment in patients with BWS and open bite accompanied by macroglossia seems to provide positive results with a satisfactory outcome in dentoskeletal alterations.
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Affiliation(s)
- E Alonso-Rodriguez
- Paseo de la Castellana, 261, 28046 Madrid, Spain, Department of Oral and Maxillofacial Surgery,
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Ribeiro NRB, Silva LDF, Silva HFD, Reis ENRDC, Neto JQDO, Maia RN, Mello MDJR. Partial Glossectomy as an Adjunctive Method to Ortho-Surgical Treatment. J Craniofac Surg 2017; 28:e325-e327. [PMID: 28277477 DOI: 10.1097/scs.0000000000003571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The macroglossia is a rare condition, congenital or acquired, characterized by hypertrophy of the lingual muscles that can cause both aesthetic and functional changes such as mandibular prognathism and malocclusion. Diagnosis is through clinical examination. Treatment consists of excision of part of the tongue and different surgical techniques have been described in the literature. The keyhole lingual resection technique has shown satisfactory results in reducing the volume and preservation of the neurovascular bundles of the tongue. This work aims to present a clinical report of true macroglossia associated with dental-skeletal discrepancies, submitted to partial glossectomy previously to orthognathic surgery.
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Affiliation(s)
- Ney Robson Bezerra Ribeiro
- *Oral and Maxillofacial Surgery Division, Batista Memorial Hospital, Fortaleza †Araçatuba School of Dentistry, São Paulo State University-UNESP, Araçatuba ‡Ribeirão Preto School of Dentistry, São Paulo University-USP, Ribeirão Preto §Program in Oral and Maxillofacial Surgery
- Oral Surgery Division, Doc. José Frota Institute-IJF, Fortaleza, Brazil
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8
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Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016; 7:CD006937. [PMID: 27428115 PMCID: PMC6457859 DOI: 10.1002/14651858.cd006937.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. OBJECTIVES To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015. SELECTION CRITERIA We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. DATA COLLECTION AND ANALYSIS One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. MAIN RESULTS No randomised controlled trials or group studies were identified. AUTHORS' CONCLUSIONS This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Naomi K Parker
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Helen Kelly
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Nick Miller
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Taste and speech following surgical tongue reduction in children with Beckwith-Wiedemann syndrome. J Craniomaxillofac Surg 2016; 44:659-63. [PMID: 27052941 DOI: 10.1016/j.jcms.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/28/2016] [Accepted: 02/19/2016] [Indexed: 01/03/2023] Open
Abstract
Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder in which macroglossia is one of the main signs. We investigated the long-term outcome of tongue surgery reduction (TRS) on taste and speech in patients with BWS who were more than 5 years of age and had undergone surgical anterior wedge resection of the tongue. A questionnaire was used to assess medical history and to determine some aspects of speech, taste, psychological well-being, and degree of satisfaction with regard to TRS and tongue mobility. Speech sound error pattern and degree of intelligibility were measured by a speech therapist, and taste was assessed using a validated test. The degree of both intelligibility and satisfaction with the surgery was high. There were some speech errors; especially the interdental 's', addental 't', and addental 'd' were more noticed. We conclude that anterior wedge resection is an effective technique to treat macroglossia in children with BWS, and that it has no long-term consequences for intelligibility and taste perception and only limited consequences for speech.
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Núñez-Martínez PM, García-Delgado C, Morán-Barroso VF, Jasso-Gutiérrez L. [Congenital macroglossia: clinical features and therapeutic strategies in paediatric patients]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:212-216. [PMID: 29421209 DOI: 10.1016/j.bmhimx.2016.03.003] [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: 02/25/2016] [Accepted: 03/25/2016] [Indexed: 11/29/2022] Open
Abstract
Congenital macroglossia is a condition that consists in an enlarged tongue that in resting position protrudes beyond the alveolar ridge. It has been classified in two categories: true macroglossia, which occurs in congenital or acquired forms, and relative macroglossia. As this alteration may be due to different causes, its incidence is not known. It is more frequently associated to Beckwith-Wiedemann syndrome, to mucopolysaccharidosis diseases and to Pompe's disease, and it has been less frequently associated to lymphangioma, hemangioma or isolated muscular hypertrophy. Macroglossia is characterized by an enlarged and thick tongue that may have fissures and ulcers, may cause language alterations, difficulties for feeding and swallowing, sialorrhea and recurrent infections of the upper airway or even its obstruction. Its clinical evaluation must include a complete clinical chart with careful physical exploration and a pedigree of that may identify the presence or absence of a hereditary associated syndrome. Macroglossia management is complex. More than twenty different surgical options to reduce the tongue size have been proposed, however, so far there is not a general agreement in this respect. The objective of this work is to review clinical and surgical aspects related to macroglossia from the point of view of non-surgical pediatricians and genetists, addressed to the different medical specialists, including the maxillofacial surgeons involved in the management of these patients.
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Affiliation(s)
| | | | | | - Luis Jasso-Gutiérrez
- Departamento de evaluación y análisis de medicamentos, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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Mussa A, Di Candia S, Russo S, Catania S, De Pellegrin M, Di Luzio L, Ferrari M, Tortora C, Meazzini MC, Brusati R, Milani D, Zampino G, Montirosso R, Riccio A, Selicorni A, Cocchi G, Ferrero GB. Recommendations of the Scientific Committee of the Italian Beckwith-Wiedemann Syndrome Association on the diagnosis, management and follow-up of the syndrome. Eur J Med Genet 2015; 59:52-64. [PMID: 26592461 DOI: 10.1016/j.ejmg.2015.11.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/03/2015] [Accepted: 11/17/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED Beckwith-Wiedemann syndrome (BWS) is the most common (epi)genetic overgrowth-cancer predisposition disorder. Given the absence of consensual recommendations or international guidelines, the Scientific Committee of the Italian BWS Association (www.aibws.org) proposed these recommendations for the diagnosis, molecular testing, clinical management, follow-up and tumor surveillance of patients with BWS. The recommendations are intended to allow a timely and appropriate diagnosis of the disorder, to assist patients and their families, to provide clinicians and caregivers optimal strategies for an adequate and satisfactory care, aiming also at standardizing clinical practice as a national uniform approach. They also highlight the direction of future research studies in this setting. With recent advances in understanding the disease (epi)genetic mechanisms and in describing large cohorts of BWS patients, the natural history of the disease will be dissected. In the era of personalized medicine, the emergence of specific (epi)genotype-phenotype correlations in BWS will likely lead to differentiated follow-up approaches for the molecular subgroups, to the development of novel tools to evaluate the likelihood of cancer development and to the refinement and optimization of current tumor screening strategies. CONCLUSIONS In this article, we provide the first comprehensive recommendations on the complex management of patients with Beckwith-Wiedemann syndrome.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
| | - Stefania Di Candia
- Department of Pediatrics, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Russo
- Laboratory of Cytogenetics and Molecular Genetics, Istituto Auxologico Italiano, Milan, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Department of Hematology and Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luisa Di Luzio
- Obstetrics and Gynecology Unit, Niguarda Hospital, Milan, Italy
| | - Mario Ferrari
- Regional Center for CLP, Smile-House, San Paolo University Hospital, Milan, Italy
| | - Chiara Tortora
- Regional Center for CLP, Smile-House, San Paolo University Hospital, Milan, Italy
| | | | - Roberto Brusati
- Regional Center for CLP, Smile-House, San Paolo University Hospital, Milan, Italy
| | - Donatella Milani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Zampino
- Center for Rare Diseases, Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosario Montirosso
- 0-3 Center for the Study of Social Emotional Development of the at Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Andrea Riccio
- DiSTABiF, Second University of Naples and Institute of Genetics and Biophysics "A. Buzzati-Traverso" - CNR, Naples, Italy
| | - Angelo Selicorni
- Clinical Pediatric Genetics Unit, Pediatrics Clinics, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Guido Cocchi
- GC Department of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Chen J, Shcherbatyy V, Liu ZJ. Internal Kinematics of the Volume-Reduced Tongue: A Longitudinal Microsonometric Study. Anat Rec (Hoboken) 2015; 299:132-40. [PMID: 26456078 DOI: 10.1002/ar.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/18/2015] [Accepted: 08/25/2015] [Indexed: 11/09/2022]
Abstract
This study examined tongue internal kinematics during feeding over time after its volume reduction. Six ultrasonic crystals were implanted into the tongue to record distance changes in anterior width (AW), bilateral lengths (LENG), posterior thicknesses (THICK), and posterior dorsal (PDW) and ventral (PVW) widths in five sibling pairs of Yucatan minipigs (N = 10). In each pair, one received tongue volume reduction surgery (reduction), and the other had the identical incisions without tissue removal (sham). Functional deformation of the tongue from preimplanted ultrasonic crystals was recorded during natural feeding 1 day before, 7-8, 13-15, and 28-30 days after the surgery. The results revealed that feeding behavior and tongue functional deformation were unchanged over time in the sham pigs. However, at Days 7-8, more frequent and longer ingestion episodes were seen in the reduction as compared with the sham. Moreover, deformational changes in AW and LENG decreased, whereas those in THICK, PDW, and PVW increased significantly (P < 0.001). At Days 13-15, the reduced deformational changes in LENG (P < 0.01) slightly restored, and the increased deformation in THICK (P > 0.05), PDW (P < 0.01), and PVW (P < 0.05) diminished. At Days 28-30, the restoration of AW and LENG continued (P < 0.01-0.05), but previously enhanced deformations in THICK, PDW, and PVW were no longer significantly different from the baseline (P > 0.05). These results suggest that the tongue volume reduction has significant and persistent impacts on feeding behaviors and tongue internal kinematics, and the restoring capacity of internal kinematics in the anterior tongue is limited and incomplete over time.
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Affiliation(s)
- Jie Chen
- Department of Orthodontics, University of Washington, Seattle, Washington.,Department of Stomatology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Volodymyr Shcherbatyy
- Department of Genes and Behavior, Max Planck Institute for Biophysical Chemistry, Gottingen, Germany
| | - Zi-Jun Liu
- Department of Orthodontics, University of Washington, Seattle, Washington
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A multidisciplinary approach to the treatment of oral manifestations associated with Beckwith-Wiedemann syndrome: a long-term case report. J Am Dent Assoc 2012; 142:1357-64. [PMID: 22130436 DOI: 10.14219/jada.archive.2011.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Beckwith-Wiedemann syndrome (BWS) is a congenital disorder that involves a somatic overgrowth during the patient's first years of life. Exomphalos, macroglossia and gigantism are the main clinical symptoms. CASE DESCRIPTION The authors describe a 15-year follow-up in a patient with BWS. They focus on a multidisciplinary approach to treating the patient's oral manifestations from age 9 months. The approach included an initial physiotherapy treatment, a partial glossectomy, a first phase of orthopedic treatment with a tongue crib and chin cap, and a second phase of orthodontic treatment with an edgewise appliance. CLINICAL IMPLICATIONS To obtain long-term positive and stable results, an appropriate treatment plan for patients with BWS and dentoskeletal alterations, including macroglossia, requires surgical tongue reduction when the patient is young, combined with physiotherapeutic phases and orthopedic and orthodontic treatment.
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14
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Mekonnen AM. The effects of macroglossia on speech: a case study. CLINICAL LINGUISTICS & PHONETICS 2012; 26:39-50. [PMID: 21728833 DOI: 10.3109/02699206.2011.588370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article presents a case study of speech production in a 14-year-old Amharic-speaking boy. The boy had developed secondary macroglossia, related to a disturbance of growth hormones, following a history of normal speech development. Perceptual analysis combined with acoustic analysis and static palatography is used to investigate the specific articulatory compensations arising from the macroglossia. The subset of sounds chosen for study were the denti-alveolar and alveolar plosives, fricatives, ejectives, nasal, lateral and trill produced in single words, as well as in short phrases. The phonetic analysis revealed both spatial and temporal atypicalities in the realisations of the sounds in question. Speaking rate was slow relative to his peer's speech and attempts to increase speech rate resulted in dysfluent speech. Given the phonological system of Amharic, however, the atypical segmental realisations, while reducing both the intelligibility and acceptability of the participant's speech production, did not result in loss of phonological contrasts.
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