Localized jaw enlargement in renal osteodystrophy: report of a case and review of the literature

Enamel renal syndrome: A case report with review of literature

Amelogenesis imperfecta (AI) is a developmental, inherited disorder affecting dental enamel. Preterm and low birth weight children are prone to many serious medical problems during the neonatal period, which may affect the development of oral tissues. We report a case of AI presenting with renal disease and thereby highlighting the importance of early diagnosis of this possible association to prevent renal failure and death of the patient.

Expansive renal osteitis fibrosa: a case report

Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment. The pathogeneses and multidisciplinary management of ROD are discussed with a brief literature review. Eight years after the conservative treatment of exuberant jaw lesions, no noticeable bone changes were observed in the patient. A multidisciplinary therapy is essential for correct diagnosis of ROD and optimal multimodality treatment. The conservative management was an efficient alternative for the success of the case reported.

Dental Manifestations of Pediatric Bone Disorders

PURPOSE OF REVIEW

Several bone disorders affecting the skeleton often are manifest in the maxillofacial region. This review presents the most common bone disorders in children and their dental-oral manifestations: fibrous dysplasia, Paget's disease, osteogenesis imperfecta, renal osteodystrophy, hypophosphatasia, and osteoporosis. The specific intraoral characteristics will reviewed in detail.

RECENT FINDINGS

Recent studies confirmed the close relationship between the mandible and the maxilla with the most prevalent systemic bone disorders in children. This review will help practitioners to integrate the oral health into the systemic health and improve the multidisciplinary approach of pediatric patients between medicine and dentistry.

Estrogen Deficiency Leads to Further Bone Loss in the Mandible of CKD Mice

Background

Chronic kidney disease (CKD) has been regarded as a grave public health problem. Estrogen is a critical factor for both renal protection and bone remodeling. Our previous study demonstrated that CKD impairs the healing of titanium implants. The aim of this study was to investigate the effects of estrogen deficiency on the mandibular bone in CKD mice.

Methods

Forty eleven-week-old female C57BL mice were used in this study. Uremia and estrogen deficiency were induced by 5/6 nephrectomy and ovariectomy (OVX), respectively. After 8 weeks, the mice were sacrificed, and their mandibles were collected for micro-CT analysis and histological examination.

Results

All the mice survived the experimental period. Serum measurements confirmed a significant increase in BUN in the CKD group that was further increased by OVX. OVX led to significant decreases in both the BV/TV and cortical thickness of the mandibular bone in CKD mice.

Conclusion

In summary, our findings indicate that estrogen deficiency leads to further mandibular bone loss in CKD mice.

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

Renal osteodystrophy (ROD) is the bone pathology that occurs as an uncommon complication related to the several alterations in mineral metabolism present in patients with chronic kidney disease (CKD). This paper describes two cases of severe ROD affecting the maxilla and mandible and causing facial disfigurement of a young and a middle-aged female patient with CKD. Both patients had a history of secondary hyperparathyroidism, previously treated by surgery. The pathogenesis of the disease, as well as its clinical, imaging, and histopathological features, and management of the patient are discussed.

Oral manifestations in a renal osteodystrophy patient - a case report with review of literature

Renal Osteodystrophy (ROD) is a common complication of chronic renal disease (CRD) and is the part of a broad spectrum of disorders of mineral metabolism that occurs in the clinical setting. It occurs early in the course of chronic renal failure and progresses as the kidney function deteriorates. It is an osseous alteration believed to arise from increased parathyroid function associated with inappropriate calcium, phosphorus and vitamin D metabolism. Involvement of the jaws is common and radiographic alterations are often one of the earliest signs of chronic renal failure. Herein, reporting a case of Chronic Renal Failure (Bilateral Grade I Neuropathy) with ROD presenting oral manifestations in an 11-year -old male child.

Brown tumor at the jaw in patients with secondary hyperparathyroidism due to chronic renal failure

Brown tumors are bony lesions caused by rapid osteoclastic activity, which rare involved jaws. Renal osteodystrophy (ROD) is associated with different pathogenetic mechanisms--disorder of calcium-phosphate metabolism, impaired metabolism of vitamin D, increased parathyroid activity that lead to extreme concentrations of parathormone. The authors report two cases of jaw enlargement in patients received haemodialysis with excessive increase values of alkaline phosphatase and parathormone in serum. The patients were treated surgically with corrective procedures in maxillo-facial area. ROD of the jaws could be severe complication in dialysis patients with end stage of CKD if no appropriate care aimed at correction or prevention of parathyroid hyperfunction was applied to them.

Radiopaque jaw lesions: an approach to the differential diagnosis

Radiopaque jaw lesions are frequently encountered at radiography and computed tomography, but they are usually underevaluated or underdescribed in radiology reports. A systematic approach to the evaluation of radiopaque jaw lesions is necessary to diagnose the lesion or at least provide a meaningful differential diagnosis. To evaluate a radiopaque jaw lesion, the first, most important step is to categorize the lesion according to its attenuation, its relationship to the teeth, and its location with respect to the tooth. These basic observations are essential to the evaluation of any type of jaw lesion. Once these observations have been made, it is easy to create a proper differential diagnosis. The presence of important characteristics, such as margination, a perilesional halo, bone expansion, and growth pattern, as well as whether the lesion is sclerotic, has ground-glass attenuation, or is mixed lytic and sclerotic, further narrows the differential diagnosis. It is important to note that some radiopaque jaw lesions may be entirely lucent early in their evolution. Awareness of the demographic distribution of these lesions and their associated clinical features, as well as the radiologic approach, is important to explore the "terra incognita" of radiopaque jaw lesions.

Cephalometric craniofacial features of growing patients with chronic renal failure

INTRODUCTION

Chronic renal failure (CRF) in growing children can affect their physical growth status. The objective of this research was to study the craniofacial morphology of children with CRF as evaluated by cephalometric analysis.

METHODS

Twenty-three growing children with CRF were included in this study. They were divided into three groups according to age ranges. The age ranges were >5-11 (group 1); >11-14 (group 2); >14-16 (group 3). Another twenty-three matching controls (in age and gender) were also included. Lateral cephalometric radiographs were taken as part of these children's orthodontic records. Lateral cephalometric radiographs were corrected for magnification distortion, digitized, and cephalometric analysis was performed. Data were analysed using ANOVA test.

RESULTS

The results showed that CRF patients in all age groups have statistically significantly decreased posterior cranial base lengths. Posterior facial heights showed a significant decrease in CRF patients in groups 1 and 2. Younger CRF patients (group 1) showed statistically significant increased gonial angle and FH-Mandibular plane angle, SN-Mandibular plane angle and decreased posterior to anterior face height ratio, total anterior facial height (N-Me), Mandibular body length (Go-Me), upper anterior facial height (N-ANS), Y axis length, pterygomaxillary-A point length.

CONCLUSION

Younger children (groups 1 and 2) with CRF showed a decrease in posterior facial growth (posterior facial height and posterior cranial base) when compared to matching normal controls. This decrease is not significant in older group (group 3). This finding suggests that children with CRF might catch up in growth with normal subjects and most of the earlier retarded growth features disappear with age.

Localized mandibular enlargement in end-stage renal disease: two case reports and a review of the literature

Enlargement of the jaws is an infrequently reported complication of chronic kidney disease mineral and bone disorder (CKD-MBD). Two cases of localized mandibular swellings in young patients with histories of end-stage renal disease are discussed with a review of the literature. Although 17 of the first 19 cases that were reported exhibited diffuse enlargement, these reports increase the number of localized swellings to 8 and support the contention that localized expansion of the jaws as a manifestation of CKD-MBD is more common than originally recognized.

Amelogenesis imperfecta with renal disease--a report of two cases

Amelogenesis imperfecta (AI) is a collective term for a number of developmental conditions characterized by abnormal enamel formation. AI is usually not associated with generalized findings; however, a few cases of AI associated with syndromes and metabolic disorders have been reported in the literature. We report two cases of AI presenting with renal disease and thereby highlight the importance of recognizing this possible association at an early stage, as AI in some cases, may be a marker of renal disease.

Macrognathia secondary to dialysis-related renal osteodystrophy treated successfully by parathyroidectomy

Renal osteodystrophy (ROD) is one of the most common complications affecting patients with chronic renal failure both before and after the initiation of maintenance dialysis, but macrognathia secondary to ROD is rare. Usually, enlarged jaws due to ROD do not return to their normal contours after the treatment of hyperparathyroidism. To the authors' knowledge, this article describes the second case of macrognathia secondary to dialysis-related ROD treated successfully by parathyroidectomy. Immunohistochemical study of the maxilla confirmed that parathyroidectomy could stop maladaptive parathyroid hormone stimulation, which leads not only to the formation of osteoblastic progenitors that become fibroblast-like cells but also to osteoclast formation.

Systemic conditions, oral findings and dental management of chronic renal failure patients: general considerations and case report

Chronic renal failure is a relatively common systemic disease. Systemic abnormalities such as anemia, platelet disorders and hypertension as well as oral manifestations including xerostomia, uremic stomatitis, periodontal disease and maxillary and mandibular radiographic alterations can be observed in individuals with chronic renal disease. In view of its frequent occurrence and the need of knowledge by dentists dealing with this condition, this paper discusses the most important issues regarding chronic renal failure, addressing its systemic and oral manifestations and the dental management of chronic renal patients. A case report is presented.