1
|
Pak S, Bous RM, Acosta Lenis C, Kumar AR, Valiathan M. A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia. Cleft Palate Craniofac J 2024; 61:1157-1163. [PMID: 36891580 DOI: 10.1177/10556656231158984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). DESIGN This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. RESULTS Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P > .05), but an increase in the mean values were observed. CONCLUSION Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.
Collapse
Affiliation(s)
- Sarah Pak
- Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Rany M Bous
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Claudia Acosta Lenis
- Department of Craniofacial and Special Care Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Anand R Kumar
- Department of Plastic and Reconstructive Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Manish Valiathan
- Department of Craniofacial and Special Care Orthodontics, Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| |
Collapse
|
2
|
Solis RN, Aulakh SS, Velazquez-Castro OS, Farber NI, Olarewaju AM, Nandalike K, Tollefson TT, Senders CW, Funamura JL. Utility of Screening for Obstructive Sleep Apnea with the Pediatric Sleep Questionnaire (PSQ) in Children with Craniofacial Anomalies. Cleft Palate Craniofac J 2024; 61:882-887. [PMID: 36572962 DOI: 10.1177/10556656221147815] [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: 02/17/2024] Open
Abstract
OBJECTIVE To determine the accuracy of the Pediatric Sleep Questionnaire (PSQ) as a screening tool for obstructive sleep apnea in children with craniofacial anomalies. DESIGN Retrospective cohort study. SETTING Multidisciplinary cleft and craniofacial clinic at a tertiary care center. PATIENTS Children with craniofacial anomalies 2 to ≤18 years of age who both completed a PSQ screen and underwent polysomnography (PSG) without interval surgery. MAIN OUTCOME MEASURES Sensitivity and specificity of the PSQ in detecting an obstructive apnea-hypopnea index (AHI) ≥ 5 events/hour. RESULTS Fifty children met study criteria, with 66% (n = 33) having an associated syndrome. Mean patient age at time of PSQ was 9.6 + 4.0 years. Overall, 33 (64%) screened positive on the PSQ, while 20 (40%) had an AHI ≥ 5. The sensitivity and specificity for identifying AHI ≥ 5 was 70% and 40%, respectively. With subgroup analysis, the sensitivity and specificity were higher (100% and 50%) in children with non-syndromic palatal clefting but lower (65% and 31%) in children with a syndrome or chromosomal anomaly. There was no correlation detected between PSQ score and AHI severity (p = 0.25). The mean obstructive AHI in the study population was 10.1 ± 22.7 despite 44% (n = 22) undergoing prior adenotonsillectomy. CONCLUSIONS The PSQ was less sensitive and specific in detecting an AHI ≥ 5 in children with craniofacial anomalies than in a general population, and particularly poor in for children with syndrome-associated craniofacial conditions. Given the high prevalence of OSA in this patient population, a craniofacial-specific validated screening tool would be beneficial.
Collapse
Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Sukhkaran S Aulakh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Oscar S Velazquez-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Nicole I Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Adebola M Olarewaju
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Kiran Nandalike
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of California, Davis, Sacramento, California, USA
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Craig W Senders
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Jamie L Funamura
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| |
Collapse
|
3
|
Sato Y, Yoshioka E, Saijo Y, Kato Y, Nagaya K, Takahashi S, Ito Y, Kobayashi S, Ait Bamai Y, Yamazaki K, Itoh S, Miyashita C, Ikeda-Araki A, Kishi R. Null Association Between Isolated Orofacial Clefts and Sleep Duration: A Cohort Study From the Japan Environment and Children's Study. Cleft Palate Craniofac J 2024; 61:383-390. [PMID: 36163681 DOI: 10.1177/10556656221128425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although children with orofacial clefts have an increased risk for sleep-disordered breathing, no studies have examined the association of sleep duration. Thus, this study aimed to examine associations between orofacial clefts and sleep duration at 1 month, 6 months, 1 year, and 3 years of age in Japan. A cohort study from the Japan Environment and Children's Study. This study consisted of 91 497 children, including ones with isolated cleft lip and palate (n = 69), isolated cleft lip only (n = 48), and isolated cleft palate only (n = 37), for which recruitment was undertaken during 2011 to 2014. Seep durations (hours per day) at 1 month, 6 months, 1 year, and 3 years of age, as reported by their mothers. In the control group, mean sleep durations and standard deviations at 1 month, 6 months, 1 year, and 3 years of age were 15.2 (2.5), 13.6 (1.9), 12.9 (1.6), and 11.6 (1.2) h, respectively. Compared to the control group, linear regression models reported effect sizes and 95% confidence intervals shorter than 1 h for sleep duration of each type of isolated orofacial cleft at each time point. This study suggested null associations between isolated orofacial clefts and sleep duration at 1 month, 6 months, 1 year, and 3 years of age. Children with isolated orofacial clefts had sufficient mean sleep duration.
Collapse
Affiliation(s)
- Yukihiro Sato
- Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Eiji Yoshioka
- Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yasuaki Saijo
- Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Yasuhito Kato
- Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Ken Nagaya
- Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | | | - Yoshiya Ito
- Japanese Red Cross Hokkaido College of Nursing, Kitami, Hokkaido, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yu Ait Bamai
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsuko Ikeda-Araki
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Hokkaido University, Sapporo, Hokkaido, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
4
|
Read N, Jennings C, Hare A. Obstructive sleep apnoea-hypopnoea syndrome. Emerg Top Life Sci 2023; 7:467-476. [PMID: 38130167 DOI: 10.1042/etls20180939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/25/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a common disorder characterised by repetitive episodes of the complete or partial collapse of the pharyngeal airway during sleep. This results in cessation (apnoea) or reduction (hypopnoea) of airflow, leading to oxygen desaturation and sleep fragmentation. An individual's disposition to develop OSAHS depends on the collapsibility of a segment of the upper airway. The degree of collapsibility can be quantified by the balance between occluding or extraluminal pressures of the surrounding tissues. Patients can experience snoring, unrefreshing sleep, witnessed apnoeas, waking with a choking sensation and excessive daytime sleepiness. OSAHS has a broad range of consequences, including cardiovascular, metabolic, and neurocognitive sequelae. Treatment options include lifestyle measures, in particular weight loss, and strategies to maintain upper airway patency overnight, including continuous positive airway pressure, mandibular advancement devices and positional modifiers.
Collapse
Affiliation(s)
- Nicola Read
- Royal Brompton Hospital, Kings Health Partnership, London, U.K
| | - Callum Jennings
- Royal Brompton Hospital, Kings Health Partnership, London, U.K
| | - Alanna Hare
- Royal Brompton Hospital, Kings Health Partnership, London, U.K
| |
Collapse
|
5
|
Brown KW, Edwards SR, Hoppe IC. Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series. Craniomaxillofac Trauma Reconstr 2023; 16:301-305. [PMID: 38047148 PMCID: PMC10693261 DOI: 10.1177/19433875221142676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design Retrospective observational study. Objective The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement. Methods After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care. Results Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation. Conclusions The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.
Collapse
Affiliation(s)
- Kathryn W. Brown
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Shelley R. Edwards
- Department of Neuroscience, School of Graduate Studies in Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ian C. Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
6
|
Harada Y, Kanazawa Y, Tobaru T, Wada K, Takanashi S. 22q11.2 Deletion Syndrome Diagnosed 47 Years After Surgery for Tetralogy of Fallot. Cureus 2023; 15:e48206. [PMID: 38050519 PMCID: PMC10693745 DOI: 10.7759/cureus.48206] [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: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
A 51-year-old man presented with severe hydrocele testis, dyspnea on exertion, and systemic edema. He had a history of surgery for tetralogy of Fallot (TOF). On the second day of admission, he presented with severe nose bleeding followed by CO2 narcosis. Blood gas analysis revealed an extremely low level of Ca2+. An echocardiogram revealed an excessively enlarged right ventricle and severe pulmonary valve regurgitation (PR). Hypocalcemia, history of TOF, and characteristic facial features suggested 22q11.2 deletion syndrome, which was confirmed by fluorescence in-situ hybridization (FISH) chromosome test. Open heart redo-surgery was performed for severe PR. The surgery revealed a severely hypoplastic pulmonary valve, which is characteristic of 22q11.2 deletion syndrome. 22q11.2 syndrome thus could be overlooked until age over 50 and therefore become critical.
Collapse
Affiliation(s)
- Yuko Harada
- Cardiology, Kawasaki Municipal Ida Hospital, Kawasaki, JPN
| | - Yasuhiko Kanazawa
- Diabetes and Endocrinology, Kawasaki Municipal Ida Hospital, Kawasaki, JPN
| | | | - Kenji Wada
- Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kawasaki, JPN
| | | |
Collapse
|
7
|
Marincak Vrankova Z, Krivanek J, Danek Z, Zelinka J, Brysova A, Izakovicova Holla L, Hartsfield JK, Borilova Linhartova P. Candidate genes for obstructive sleep apnea in non-syndromic children with craniofacial dysmorphisms - a narrative review. Front Pediatr 2023; 11:1117493. [PMID: 37441579 PMCID: PMC10334820 DOI: 10.3389/fped.2023.1117493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of the upper airway is considered a risk factor for POSA development. The craniofacial features associated with sleep-related breathing disorders (SRBD) - craniosynostosis, retrognathia and micrognathia, midface and maxillary hypoplasia - have high heritability and, in a less severe form, could be also found in non-syndromic children suffering from POSA. As genetic factors play a role in both POSA and craniofacial dysmorphisms, we hypothesize that some genes associated with specific craniofacial features that are involved in the development of the orofacial area may be also considered candidate genes for POSA. The genetic background of POSA in children is less explored than in adults; so far, only one genome-wide association study for POSA has been conducted; however, children with craniofacial disorders were excluded from that study. In this narrative review, we discuss syndromes that are commonly associated with severe craniofacial dysmorphisms and a high prevalence of sleep-related breathing disorders (SRBD), including POSA. We also summarized information about their genetic background and based on this, proposed 30 candidate genes for POSA affecting craniofacial development that may play a role in children with syndromes, and identified seven of these genes that were previously associated with craniofacial features risky for POSA development in non-syndromic children. The evidence-based approach supports the proposition that variants of these candidate genes could lead to POSA phenotype even in these children, and, thus, should be considered in future research in the general pediatric population.
Collapse
Affiliation(s)
- Zuzana Marincak Vrankova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Jan Krivanek
- Department of Histology and Embryology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdenek Danek
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Jiri Zelinka
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Brysova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lydie Izakovicova Holla
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - James K. Hartsfield
- E. Preston Hicks Professor of Orthodontics and Oral Health Research, University of Kentucky Center for the Biologic Basis of Oral/Systemic Diseases, Hereditary Genetics/Genomics Core, Lexington, KE, United States
| | - Petra Borilova Linhartova
- Clinic of Stomatology, Institution Shared with St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Clinic of Maxillofacial Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| |
Collapse
|
8
|
Hirsch S, Gaultney J. Sleep disturbances in individuals with down syndrome: An overview. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231173011. [PMID: 37105757 DOI: 10.1177/17446295231173011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.
Collapse
Affiliation(s)
- Sophie Hirsch
- Department of Psychological Science and Health Psychology PhD Program, University of North Carolina at Charlotte, USA
| | - Jane Gaultney
- Department of Psychological Science and Health Psychology PhD Program, University of North Carolina at Charlotte, USA
| |
Collapse
|
9
|
Ho ACH, Savoldi F, Wong RWK, Fung SC, Li SKY, Yang Y, Gu M. Prevalence and Risk Factors for Obstructive Sleep Apnea Syndrome Among Children and Adolescents with Cleft lip and Palate: A Survey Study in Hong Kong. Cleft Palate Craniofac J 2023; 60:421-429. [PMID: 34939456 DOI: 10.1177/10556656211068306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). DESIGN Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). SETTINGS Multicenter study in two public hospitals. PATIENTS A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. MAIN OUTCOME MEASURE Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. RESULTS A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p = .034), had cleft involving embryonic secondary palate (PSQ-22, p = .009), and history of fixed orthodontic treatment (ESS, p = .002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p = .015). CONCLUSIONS OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment.
Collapse
Affiliation(s)
- A C H Ho
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - F Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - R W K Wong
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S C Fung
- 36621Department of Dentistry & Maxillofacial Surgery, United Christian Hospital, Hong Kong SAR
| | - S K Y Li
- Clinical Research Center, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Y Yang
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - M Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| |
Collapse
|
10
|
Discussion of Furlow Palatoplasty and Tonsillectomy for Treating Patients with Submucous Cleft Palate and Tonsilar Hypertrophy: A One-Stage Procedure. J Craniofac Surg 2023; 34:e78-e79. [PMID: 36608088 DOI: 10.1097/scs.0000000000008870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/10/2022] [Indexed: 12/31/2022] Open
|
11
|
Frange C, Franco AM, Brasil E, Hirata RP, Lino JA, Mortari DM, Ykeda DS, Leocádio-Miguel MA, D’Aurea CVR, Silva LOE, Telles SCL, Furlan SF, Peruchi BB, Leite CF, Yagihara FT, Campos LD, Ulhôa MA, Cruz MGDR, Beidacki R, Santos RB, de Queiroz SS, Barreto S, Piccin VS, Coelho FMS, Studart L, Assis M, Drager LF. Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines. Sleep Sci 2022; 15:515-573. [PMID: 36419815 PMCID: PMC9670776 DOI: 10.5935/1984-0063.20220083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 08/13/2024] Open
Abstract
This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.
Collapse
Affiliation(s)
- Cristina Frange
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
| | - Aline Marques Franco
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Neurociências e Ciências do
Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de
São Paulo (FMRP-USP) - Ribeirão Preto - SP - Brazil
| | - Evelyn Brasil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Terapia Intensiva, Hospital Israelita Albert
Einstein (HIAE) - São Paulo - SP - Brazil
| | - Raquel Pastrello Hirata
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Pesquisa em Fisioterapia Pulmonar,
Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL) - Londrina -
PR - Brazil
| | - Juliana Arcanjo Lino
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Ciências Médicas, Universidade Federal do
Ceará (UFC) - Fortaleza - CE - Brazil
| | - Daiana Moreira Mortari
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal do Rio Grande do Sul - Porto Alegre - RS -
Brazil
| | - Daisy Satomi Ykeda
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Curso de Fisioterapia, Universidade Estadual do Piauí
(UESPI) - Teresina - PI - Brazil
| | - Mario André Leocádio-Miguel
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisiologia e Comportamento, Universidade Federal do
Rio Grande do Norte - Natal - RN - Brazil
| | | | - Luciana Oliveira e Silva
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Ciências da Saúde, Universidade
Federal de Uberlândia (UFU) - Uberlândia - MG - Brazil
| | | | - Sofia Fontanello Furlan
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
| | - Bruno Búrigo Peruchi
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório de Neurociência, Universidade do Estado
de Santa Catarina (UNESC) - Criciúma - SC - Brazil
| | - Camila Ferreira Leite
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, UFC; Programas de Mestrado em
Fisioterapia e Funcionalidade, e Mestrado em Ciências Cardiovasculares, UFC -
Fortaleza - CE - Brazil
| | - Fabiana Tokie Yagihara
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Setor de Neurofisiologia Clínica, Departamento de
Neurologia e Neurocirurgia, EPM, UNIFESP - São Paulo - SP - Brazil
| | | | - Melissa Araújo Ulhôa
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto Metropolitano de Ensino Superior, Faculdade de Medicina
do Vale do Aço (UNIVAÇO) - Ipatinga - MG - Brazil
| | | | - Ricardo Beidacki
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Faculdade Inspirar, Unidade Porto Alegre - Porto Alegre - RS -
Brazil
| | - Ronaldo Batista Santos
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Fisioterapia, Hospital Universitário, USP -
São Paulo - Brazil
| | | | - Simone Barreto
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Instituto do Sono, Associação Fundo Incentivo
à Pesquisa - São Paulo - Brazil
| | - Vivien Schmeling Piccin
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Laboratório do Sono, Divisão de Pneumologia do
Instituto do Coração (InCor), FMUSP, USP - São Paulo - SP -
Brazil
| | - Fernando Morgadinho Santos Coelho
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de
Medicina (EPM), Universidade Federal de São Paulo (UNIFESP) - São
Paulo - SP - Brazil
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Departamento de Psicobiologia, EPM, UNIFESP - São Paulo -
SP - Brazil
| | - Luciana Studart
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Universidade Federal de Pernambuco - Recife - PE - Brazil
| | - Marcia Assis
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Clínica do Sono de Curitiba, Hospital São Lucas -
Curitiba - PR - Brazil
| | - Luciano F. Drager
- Associação Brasileira do Sono - São Paulo - SP
- Brazil
- Unidade de Hipertensão, Instituto do Coração
(InCor), Faculdade de Medicina, Universidade de São Paulo (USP) - São
Paulo - SP - Brazil
| |
Collapse
|
12
|
Guerin S, Blanchon S, de Halleux Q, Bayon V, Ferry T. Long term NIV in an infant with Hallermann-Streiff syndrome: A case report and overview of respiratory morbidity. Front Pediatr 2022; 10:1039964. [PMID: 36405833 PMCID: PMC9669373 DOI: 10.3389/fped.2022.1039964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Hallermann-Streiff syndrome (HSS) is a rare congenital syndrome with different anomalies including midface hypoplasia, beak nose and micrognathia. The upper airways narrowness can lead to severe respiratory complications such as obstructive sleep apnoea syndrome (OSAS), particularly in infancy. The management of these severe OSAS is difficult and poorly documented in literature. We report the case of an infant with HSS complicated by severe and early OSAS successfully managed with non-invasive ventilation (NIV), provide an overview of respiratory morbidities and discuss treatment options for HSS-related OSAS.
Collapse
Affiliation(s)
- S Guerin
- Unité de Pneumologie et Mucoviscidose Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
- Correspondence: S. Guerin
| | - S Blanchon
- Unité de Pneumologie et Mucoviscidose Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| | - Q de Halleux
- Unité de Physiothérapie Pédiatrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse
| | - V Bayon
- Centre d’Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| | - T Ferry
- Soins Intensifs Pédiatriques, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Suisse
| |
Collapse
|
13
|
Munawar S, Marston AP, Patel T, Nguyen SA, White DR. Outcomes Assessment of Multi-Level Sleep Surgery in Syndromic Versus Non-Syndromic Children. Ann Otol Rhinol Laryngol 2020; 129:556-564. [PMID: 31920116 DOI: 10.1177/0003489419900201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery. METHODS Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal-Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square. RESULTS Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all P < .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, P < .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, P > .05). CONCLUSION The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.
Collapse
Affiliation(s)
- Suqrat Munawar
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R White
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
14
|
Lin Y, Ma X, Teng L. [Progress of diagnosis and treatment of upper respiratory obstruction in patients with Treacher Collins syndrome]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1578-1583. [PMID: 31823562 DOI: 10.7507/1002-1892.201903041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the progress of diagnosis and treatment of upper respiratory obstruction in patients with Treacher Collins syndrome (TCS). Methods The domestic and abroad literature about the diagnosis and treatment of upper respiratory obstruction in patients with TCS was extensively reviewed and analyzed. Results TCS is an autosomal-dominant craniofacial developmental syndrome. It is often accompanied by midface and/or mandibular hypoplasia, soft tissue hypertrophy, and other respiratory tissue developmental abnormalities, which can lead to different degrees of upper respiratory obstruction symptoms. Respiratory obstruction in patients with TCS is affected by many factors, and the obstructive degree are different. Early detection of the causes and obstructive sites and adopted targeted treatments can relieve the symptoms of respiratory obstruction and avoid severe complications. Conclusion Due to the low incidence of TCS, there is still a lack of high-quality research evidence to guide clinical treatment. Large-scale and prospective clinical studies are needed to provide new ideas for the treatment and prevention of upper respiratory obstruction.
Collapse
Affiliation(s)
- Yanxian Lin
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P.R.China
| | - Xiaoyang Ma
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P.R.China
| | - Li Teng
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144,
| |
Collapse
|
15
|
Yu JL, Afolabi‐Brown O. Updates on management of pediatric obstructive sleep apnea. Pediatr Investig 2019; 3:228-235. [PMID: 32851328 PMCID: PMC7331384 DOI: 10.1002/ped4.12164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/20/2019] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) affects about 1%-5% of the pediatric population. The consequences of untreated OSA in children include neurocognitive deficits, behavioral problems, poor school performance as well as systemic and pulmonary hypertension. The treatment options for pediatric OSA are numerous with a variety of surgical and non-surgical interventions. As our understanding of the complexities of OSA grows, the options for management have continued to expand as well. The objectives of this review are to describe the commonly prescribed treatments for pediatric OSA including adenotonsillectomy as well as use of positive airway pressure. We also highlight other surgical and non-surgical interventions available. In addition, we provide updates on current research focusing on newer diagnostic and experimental treatment modalities.
Collapse
Affiliation(s)
- Jason L. Yu
- Department of Otorhinolaryngology‐Head and Neck SurgeryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Division of Sleep MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Olufunke Afolabi‐Brown
- Division of Pulmonary MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| |
Collapse
|
16
|
Bergeron M, Cohen AP, Maby A, Babiker HE, Pan BS, Ishman SL. The Effect of Cleft Palate Repair on Polysomnography Results. J Clin Sleep Med 2019; 15:1581-1586. [PMID: 31739847 PMCID: PMC6853397 DOI: 10.5664/jcsm.8016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES In view of the risk that surgical repair of cleft palate may induce or worsen obstructive sleep apnea (OSA), the goal of this study was to assess presurgical and postsurgical polysomnography (PSG) results for children who underwent primary palatoplasty. METHODS Retrospective case-control series for children with cleft palate repair performed between January 2008 and December 2016 at a tertiary pediatric center. Children underwent PSG before and after surgery. RESULTS Sixty-four children (53.1% female) with a mean age of 2.0 ± 2.8 years (range 0.6-16.4) were included in the study. Pierre-Robin sequence was the most common comorbidity (67%). Before palatal repair, the mean obstructive apnea-hypopnea index (oAHI) was 3.4 ± 3.9 (range 0-17.9) events/h; this did not significantly change, with 5.9 ± 14.5 (range 0-105.7) events/h after surgery (P = 0.30). However, 34.4% of patients had a worsening of more than 1 obstructive event/h and 18.9% had a worsening of 5 or more obstructive events/h. The presence of a concomitant syndrome (eg, Treacher Collins) was a risk factor for postoperative OSA (odds ratio 4.2, 95% confidence interval 1.1-15.8, P = .03). CONCLUSIONS OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA.
Collapse
Affiliation(s)
- Mathieu Bergeron
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
- Sainte-Justine Hospital, Department of Pediatric Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Aliza P Cohen
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Alexandra Maby
- Laval University, Department of Otolaryngology-Head and Neck Surgery, Quebec City, Quebec, Canada
| | - Haithem E Babiker
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Plastic Surgery, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Division of Plastic, Reconstructive, Hand, and Burn Surgery, Cincinnati, Ohio
| | - Brian S Pan
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Plastic Surgery, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Division of Plastic, Reconstructive, Hand, and Burn Surgery, Cincinnati, Ohio
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| |
Collapse
|
17
|
Abstract
While medical technology is continuing to improve healthcare outcomes and quality of life for patients, the number of people affected by medical device-related skin damage is increasing. In many cases, life-preserving medical devices used in interventions such as nasal continuous positive airway pressure or oxygen therapy can cause significant skin damage, with negative consequences including pain, infection and delayed hospital discharge. This article outlines methods that nurses can use to minimise the risk of skin damage, focusing primarily on the prevention of pressure ulcers. It also examines how nurses can work collaboratively with patients, manufacturers and regulatory bodies to reduce the risk of medical device-related skin damage in the future.
Collapse
|
18
|
Gorucu-Coskuner H, Saglam-Aydinatay B, Aksu M, Ozgur FF, Taner T. Comparison of Positive Screening for Obstructive Sleep Apnea in Patients With and Without Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:364-370. [PMID: 31529989 DOI: 10.1177/1055665619875321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. DESIGN Prospective, cross-sectional study. PARTICIPANTS One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. INTERVENTIONS The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. RESULTS The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group (P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate (P = .020). CONCLUSIONS Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).
Collapse
Affiliation(s)
- Hande Gorucu-Coskuner
- Faculty of Dentistry, Department of Orthodontics, Hacettepe University, Ankara, Turkey
| | - Banu Saglam-Aydinatay
- Faculty of Dentistry, Department of Orthodontics, Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Faculty of Dentistry, Department of Orthodontics, Hacettepe University, Ankara, Turkey
| | - Fatma Figen Ozgur
- Faculty of Medicine, Department of Plastic, Reconstructive and Esthetic Surgery, Hacettepe University, Research and Application Center for the Treatment of Cleft Lip and Palate and Craniomaxillofacial Deformities, Ankara, Turkey
| | - Tulin Taner
- Faculty of Dentistry, Department of Orthodontics, Hacettepe University, Ankara, Turkey
| |
Collapse
|
19
|
Affiliation(s)
- Kevin Gipson
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| | - Mengdi Lu
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| | - T Bernard Kinane
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
| |
Collapse
|
20
|
Greenlee CJ, Scholes MA, Gao D, Friedman NR. Obstructive Sleep Apnea and Sleep Position: Does It Matter for Infants With a Cleft Palate? Cleft Palate Craniofac J 2018; 56:890-895. [DOI: 10.1177/1055665618817664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective:To determine whether nonsupine sleep improves obstructive sleep apnea (OSA) in infants with cleft palate undergoing polysomnography (PSG).Design:Retrospective chart review.Setting:Tertiary care pediatric hospital.Patients:Twenty-seven infants (1 month to 1 year) with cleft palate with or without cleft lip (CP ± L) undergoing PSG testing for suspected OSA were included.Main Outcome Measures:Polysomnography measures included obstructive apnea–hypopnea index (OAHI), central apnea–hypopnea index (CAHI), oxygen saturation (SpO2) nadir, SpO2, and end-tidal carbon dioxide (ETCO2).Results:Twenty-three PSGs with at least 20 minutes of sleep in both the supine and the nonsupine positions were analyzed. The supine OAHI (mean: 16.8 events/hour; standard deviation [SD]: 18.5) and nonsupine OAHI (mean: 12.6 events/hour; SD: 12.6) did not differ significantly ( P = .10). The supine CAHI (mean: 1.9 events/hour; SD: 2.7) and nonsupine CAHI (mean: 3.1 events/hour; SD: 3.7; P = .15), the supine SpO2nadir (mean: 81.2%; SD: 6.3) and nonsupine SpO2nadir (mean: 81.8%; SD: 5.3; P = .70), the supine mean SpO2(mean: 95.5%; SD: 1.9) and nonsupine mean SpO2saturation (mean: 95.3%; SD: 2.4; P = .34), and the supine ETCO2(mean: 45.4 mm Hg; SD: 5.3) and nonsupine ETCO2(mean: 42.5 mm Hg; SD: 10.1; P = .24) were also similar.Conclusions:There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP ± L. Prior to recommending nonsupine positioning which increases infant’s exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.
Collapse
Affiliation(s)
| | - Melissa A. Scholes
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dexiang Gao
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Norman R. Friedman
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
21
|
Xu XY, Wei XW, Ma W, Gu H, Liu D, Yuan ZW. Genome-Wide Screening of Aberrant Methylation Loci for Nonsyndromic Cleft Lip. Chin Med J (Engl) 2018; 131:2055-2062. [PMID: 30127215 PMCID: PMC6111694 DOI: 10.4103/0366-6999.239305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The pathogenicity of cleft lip (CL) is pretty complicated since it is influenced by the interaction of environment and genetic factors. The purpose of this study was to conduct a genome-wide screening of aberrant methylation loci in partial lesion tissues of patients with nonsyndromic CL (NSCL) and preliminarily validate candidate dysmethylated genes associated with NSCL. Methods: Fifteen healthy and sixteen NSCL fetal lip tissue samples were collected. The Infinium HumanMethylation450 BeadChip was used to screen aberrant methylation loci in three NSCL and three healthy lip tissues. The differential methylation sites and functions of the annotated genes between NSCL and healthy lip tissues were analyzed using minfi package of R software, cluster analysis, Gene Ontology (GO) annotation, and metabolic pathway annotation. Gene expression was assessed in nine differentially methylated genes by real-time polymerase chain reaction (PCR). The transcriptions mRNA levels of three out of nine candidate genes were downregulated remarkably in NSCL lip tissues, and these three genes’ abnormal methylation loci were validated by pyrosequencing in 16 NSCL cases and 15 healthy cases. Results: In total, 4879 sites in the genes of NSCL odinopoeia fetuses showed aberrant methylation when compared with normal lip tissue genome. Among these, 3661 sites were hypermethylated and 1218 sites were hypomethylated as compared to methylation levels in healthy specimens. These aberrant methylation sites involved 2849 genes and were widely distributed among the chromosomes. Most differentially methylated sites were located in cytosine-phosphoric acid-guanine islands. Based on GO analysis, aberrantly methylated genes were involved in 11 cellular components, 13 molecular functions, and a variety of biological processes. Notably, the transcription of DAB1, REELIN, and FYN was significantly downregulated in lesion tissues of NSCL fetus (P < 0.05). Pyrosequencing results validated that there were two loci in DAB1 with high methylation status in patient tissues (P < 0.05). Conclusions: We detected numerous aberrantly methylated loci in lesion tissues of NSCL fetus. Aberrant gene expression in the REELIN signaling pathway might be related with NSCL. Decreased transcription of DAB1, a member of REELIN signal pathway, resulted from its abnormal high methylation, which might be one of the factors underlying the occurrence of NSCL.
Collapse
Affiliation(s)
- Xiao-Yan Xu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| | - Xiao-Wei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| | - Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| | - Zheng-Wei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, China
| |
Collapse
|
22
|
Roberti D, Conforti R, Giugliano T, Brogna B, Tartaglione I, Casale M, Piluso G, Perrotta S. A Novel 12q13.2-q13.3 Microdeletion Syndrome With Combined Features of Diamond Blackfan Anemia, Pierre Robin Sequence and Klippel Feil Deformity. Front Genet 2018; 9:549. [PMID: 30524470 PMCID: PMC6262175 DOI: 10.3389/fgene.2018.00549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022] Open
Abstract
Diamond-Blackfan anemia (DBA) is a rare congenital erythroid aplasia with a highly heterogeneous genetic background; it usually occurs in infancy. Approximately 30–40% of patients have other associated congenital anomalies; in particular, facial anomalies, such as cleft palate, are part of about 10% of the DBA clinical presentations. Pierre Robin sequence (PRS) is a heterogeneous condition, defined by the presence of the triad of glossoptosis, micrognathia and cleft palate; it occurs in 1/8500 to 1/14,000 births. Klippel Feil (KF) syndrome is a complex of both osseous and visceral anomalies, characterized mainly by congenital development defects of the cervical spine. We describe the case of a 22-years-old woman affected by DBA, carrying a de novo deletion about 500 Kb-long at 12q13.2-q13.3 that included RPS26 and, at least, others 25 flanking genes. The patient showed craniofacial anomalies due to PRS and suffered for KF deformities (type II). Computed Tomography study of cranio-cervical junction (CCJ) drew out severe bone malformations and congenital anomalies as atlanto-occipital assimilation (AOA), arcuate foramen and occipito-condylar hyperplasia. Foramen magnum was severely reduced. Atlanto-axial instability (AAI) was linked to atlanto-occipital assimilation, congenital vertebral fusion and occipito-condyle bone hyperplasia. Basilar invagination and platybasia were ruled out on CT and Magnetic Resonance Imaging (MRI) studies. Furthermore, the temporal Bone CT study showed anomalies of external auditory canals, absent mastoid pneumatization, chronic middle ear otitis and abnormal course of the facial nerve bones canal. The described phenotype might be related to the peculiar deletion affecting the patient, highlighting that genes involved in the in the breakdown of extracellular matrix (MMP19), in cell cycle regulation (CDK2), vesicular trafficking (RAB5B), in ribonucleoprotein complexes formation (ZC3H10) and muscles function (MYL6 and MYL6B) could be potentially related to bone-developmental disorders. Moreover, it points out that multiple associated ribosomal deficits might play a role in DBA-related phenotypes, considering the simultaneous deletion of three of them in the index case (RPS26, PA2G4 and RPL41), and it confirms the association among SLC39A5 functional disruption and severe myopia. This report highlights the need for a careful genetic evaluation and a detailed phenotype-genotype correlation in each complex malformative syndrome.
Collapse
Affiliation(s)
- Domenico Roberti
- Department of Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli" Naples, Italy
| | - Renata Conforti
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Teresa Giugliano
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Barbara Brogna
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Immacolata Tartaglione
- Department of Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli" Naples, Italy
| | - Maddalena Casale
- Department of Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli" Naples, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Silverio Perrotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli" Naples, Italy
| |
Collapse
|
23
|
Marulanda J, Murshed M. Role of Matrix Gla protein in midface development: Recent advances. Oral Dis 2018; 24:78-83. [PMID: 29480643 DOI: 10.1111/odi.12758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 12/23/2022]
Abstract
Craniofacial development is a delicate process that involves complex interactions among cells of multiple developmental origins, their migration, proliferation, and differentiation. Tissue morphogenesis of the craniofacial skeleton depends on genetic and environmental factors, and on specific signaling pathways, which are still not well understood. Developmental defects of the midface caused by the absence, delays, or premature fusion of nasal and maxillary prominences vary in severity; leading to clefts, hypoplasias, and midline expansion. In the current review, we focus on the importance of the chondrocranium in craniofacial growth and how its impaired development leads to midface hypoplasia. More importantly, we reported how Matrix Gla protein (MGP), a potent inhibitor of extracellular matrix mineralization, facilitates midface development by preventing ectopic calcification of the nasal septum. In fact, MGP may act as a common link in multiple developmental pathologies all showing midface hypoplasia caused by abnormal cartilage calcification. This brief review discusses the gap in knowledge in the field, raises pertinent questions, which remain unanswered, and sheds light on the future research directions.
Collapse
Affiliation(s)
- J Marulanda
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - M Murshed
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
- Shriners Hospital for Children, Montreal, QC, Canada
| |
Collapse
|
24
|
di Palmo E, Gallucci M, Tronconi E, Bergamaschi R, Cazzato S, La Scola C, Ricci G, Pession A. Carbonic Anhydrase II Deficiency: A Rare Case of Severe Obstructive Sleep Apnea. Front Pediatr 2018; 6:213. [PMID: 30109220 PMCID: PMC6079206 DOI: 10.3389/fped.2018.00213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/11/2018] [Indexed: 11/16/2022] Open
Abstract
The term osteopetrosis describes a group of rare hereditary diseases of the skeleton, characterized by an increase in bone density, caused by a defect in the development or function of osteoclasts. It comprises a clinically and genetically heterogeneous conditions ranging from infantile onset life-threatening forms to mildest adult onset forms. "Malignant" osteopetrosis is characterized by bone fragility, short stature, compressive neuropathies, hypocalcaemia, pancytopaenia. The deficiency of carbonic anhydrase II causes a moderate form, presenting classically as a triad of osteopetrosis, renal tubular acidosis (RTA), and cerebral calcification. This condition leads to specific craniofacial dysmorphisms associated with upper airway obstruction that may result in obstructive sleep apnea. Herein we report a case of osteopetrosis with RTA associated with severe OSAS successfully treated with continuous positive airway pressure (CPAP).
Collapse
Affiliation(s)
- Emanuela di Palmo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcella Gallucci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Tronconi
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Rosalba Bergamaschi
- Pediatric Emergency Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Claudio La Scola
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
25
|
Sun B, Cloonan YK, Collett BR, Speltz ML. Sleep Outcomes in Children With Single-Suture Craniosynostosis Compared With Unaffected Controls. Cleft Palate Craniofac J 2017; 54:734-738. [PMID: 27518405 PMCID: PMC7039619 DOI: 10.1597/16-090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare risk for sleep-disordered breathing between children with and without single-suture craniosynostosis. PARTICIPANTS A total of 184 children with single-suture craniosynostosis and 184 controls. MAIN OUTCOME MEASURES Parent reported sleep-disordered breathing-related symptoms. RESULTS Current sleep problems were reported in 19% of patients with single-suture craniosynostosis and 14% of controls (adjusted odds ratio = 1.6; 95% CI, 0.9 to 2.8). Ever having sleep problems was reported in 25% and 23% of cases and controls, respectively (adjusted odds ratio = 1.2; 95% CI, 0.7 to 1.9). Overall, snoring was statistically associated with single-suture craniosynostosis (P = .01) and was more often reported as 2+ nights per week (versus never) in patients with single-suture craniosynostosis (13%) than in controls (4%) (adjusted odds ratio = 3.5; 95% CI, 1.5 to 8.2). CONCLUSIONS Though preliminary, increased presence of snoring during sleep in children with single-suture craniosynostosis compared with controls suggests that children with isolated single-suture craniosynostosis may be at increased risk for sleep-disordered breathing. Further study using standardized assessments of sleep-disordered breathing is needed.
Collapse
|
26
|
Kang KT, Koltai PJ, Lee CH, Lin MT, Hsu WC. Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2017; 143:561-568. [PMID: 28208178 DOI: 10.1001/jamaoto.2016.4274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted. Objective To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA. Data Sources The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016. Study Selection The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child. Data Extraction and Synthesis Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA. Main Outcomes and Measures Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5. Results This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia. Conclusions and Relevance Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.
Collapse
Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Peter J Koltai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Chia-Hsuan Lee
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan5Sleep Center, National Taiwan University Hospital, Taipei
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei5Sleep Center, National Taiwan University Hospital, Taipei
| |
Collapse
|
27
|
Páez-Moya S, Vega-Osorio PA. Factores de riesgo y asociados al síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Los avances alcanzados en la medicina del sueño y en los trastornos respiratorios del sueño han permitido conocer y entender los mecanismos fisiopatológicos que favorecen la aparición de estos últimos, a la par que han ayudado a determinar cuáles son los factores de riesgo anatómicos, morfológicos, poblacionales, demográficos, raciales y sindromáticos relacionados.Conocer los factores de riesgo de los trastornos del sueño permite desarrollar medidas terapéuticas enfocadas a su origen. Tienen especial importancia aquellos factores modificables como el sobrepeso/obesidad, el tabaquismo y el consumo de depresores del sistema nervioso central, ya que prevenirlos puede tener un impacto en la prevención de la aparición del síndrome de apnea-hipopnea obstructiva del sueño
Collapse
|
28
|
Marulanda J, Eimar H, McKee MD, Berkvens M, Nelea V, Roman H, Borrás T, Tamimi F, Ferron M, Murshed M. Matrix Gla protein deficiency impairs nasal septum growth, causing midface hypoplasia. J Biol Chem 2017; 292:11400-11412. [PMID: 28487368 PMCID: PMC5500805 DOI: 10.1074/jbc.m116.769802] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/01/2017] [Indexed: 12/31/2022] Open
Abstract
Genetic and environmental factors may lead to abnormal growth of the orofacial skeleton, affecting the overall structure of the face. In this study, we investigated the craniofacial abnormalities in a mouse model for Keutel syndrome, a rare genetic disease caused by loss-of-function mutations in the matrix Gla protein (MGP) gene. Keutel syndrome patients show diffuse ectopic calcification of cartilaginous tissues and impaired midface development. Our comparative cephalometric analyses of micro-computed tomography images revealed a severe midface hypoplasia in Mgp-/- mice. In vivo reporter studies demonstrated that the Mgp promoter is highly active at the cranial sutures, cranial base synchondroses, and nasal septum. Interestingly, the cranial sutures of the mutant mice showed normal anatomical features. Although we observed a mild increase in mineralization of the spheno-occipital synchondrosis, it did not reduce the relative length of the cranial base in comparison with total skull length. Contrary to this, we found the nasal septum to be abnormally mineralized and shortened in Mgp-/- mice. Transgenic restoration of Mgp expression in chondrocytes fully corrected the craniofacial anomalies caused by MGP deficiency, suggesting a local role for MGP in the developing nasal septum. Although there was no up-regulation of markers for hypertrophic chondrocytes, a TUNEL assay showed a marked increase in apoptotic chondrocytes in the calcified nasal septum. Transmission electron microscopy confirmed unusual mineral deposits in the septal extracellular matrix of the mutant mice. Of note, the systemic reduction of the inorganic phosphate level was sufficient to prevent abnormal mineralization of the nasal septum in Mgp-/-;Hyp compound mutants. Our work provides evidence that modulation of local and systemic factors regulating extracellular matrix mineralization can be possible therapeutic strategies to prevent ectopic cartilage calcification and some forms of congenital craniofacial anomalies in humans.
Collapse
Affiliation(s)
- Juliana Marulanda
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hazem Eimar
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Marc D McKee
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
- the Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec H3A 0C7, Canada
| | - Michelle Berkvens
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Valentin Nelea
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Hassem Roman
- the Department of Anatomy and Cell Biology, Faculty of Medicine, McGill University, Montreal, Quebec H3A 0C7, Canada
- the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Teresa Borrás
- the Department of Ophthalmology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27516
| | - Faleh Tamimi
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada
| | - Mathieu Ferron
- the Institut de Recherches Cliniques de Montréal, Montréal, Quebec H2W 1R7, Canada, and
| | - Monzur Murshed
- From the Faculty of Dentistry, McGill University, Montreal, Quebec H3A 1G1, Canada,
- the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
- the Shriners Hospital for Children, Montreal, Quebec H4A 0A9, Canada
| |
Collapse
|
29
|
Fitz-James Antoine I, Carullo V, Hernandez CK, Tepper O. Anatomic Approach to Airway Management of the Syndromic Child. Int Anesthesiol Clin 2016; 55:52-64. [PMID: 27941366 DOI: 10.1097/aia.0000000000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ingrid Fitz-James Antoine
- *Department of Anesthesiology, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York †Department of Plastic Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York
| | | | | | | |
Collapse
|
30
|
Neuropsychological Functioning in Individuals with Noonan Syndrome: a Systematic Literature Review with Educational and Treatment Recommendations. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2015. [DOI: 10.1007/s40817-015-0005-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
31
|
Operative Management of OSAS in a Complex Case of Proteus Syndrome. Case Rep Otolaryngol 2015. [PMID: 26199778 PMCID: PMC4493299 DOI: 10.1155/2015/137589] [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] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia.
Collapse
|