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Paltoglou G, Ziakas N, Chrousos GP, Yapijakis C. Cephalometric Evaluation of Children with Short Stature of Genetic Etiology: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:792. [PMID: 39062241 PMCID: PMC11275085 DOI: 10.3390/children11070792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Introduction: A plethora of biological molecules regulate chondrogenesis in the epiphyseal growth plate. Disruptions of the quantity and function of these molecules can manifest clinically as stature abnormalities of various etiologies. Traditionally, the growth hormone/insulin-like growth factor 1 (IGF1) axis represents the etiological centre of final stature attainment. Of note, little is known about the molecular events that dominate the growth of the craniofacial complex and its correlation with somatic stature. Aim: Given the paucity of relevant data, this review discusses available information regarding potential applications of lateral cephalometric radiography as a potential clinical indicator of genetic short stature in children. Materials and Methods: A literature search was conducted in the PubMed electronic database using the keywords: cephalometric analysis and short stature; cephalometric analysis and achondroplasia; cephalometric analysis and hypochondroplasia; cephalometric analysis and skeletal abnormalities; cephalometr* and SHOX; cephalometr* and CNP; cephalometr* and ACAN; cephalometr* and CNVs; cephalometr* and IHH; cephalometr* and FGFR3; cephalometr* and Noonan syndrome; cephalometr* and "Turner syndrome"; cephalometr* and achondroplasia. Results: In individuals with genetic syndromes causing short stature, linear growth of the craniofacial complex is confined, following the pattern of somatic short stature regardless of its aetiology. The angular and linear cephalometric measurements differ from the measurements of the average normal individuals and are suggestive of a posterior placement of the jaws and a vertical growth pattern of the face. Conclusions: The greater part of the existing literature regarding cephalometric measurements in short-statured children with genetic syndromes provides qualitative data. Furthermore, cephalometric data for individuals affected with specific rare genetic conditions causing short stature should be the focus of future studies. These quantitative data are required to potentially establish cut-off values for reference for genetic testing based on craniofacial phenotypes.
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Affiliation(s)
- George Paltoglou
- Unit of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Nickolas Ziakas
- Unit of Orofacial Genetics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Christos Yapijakis
- Unit of Orofacial Genetics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
- University Research Institute of Maternal and Child Health and Precision Medicine, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
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Evlice B, Duyan Yuksel H, Evlice A, Koc F. The effect of myotonic dystrophy type 1 on temporomandibular joint and dentofacial morphology: A CBCT analysis. J Oral Rehabil 2023; 50:958-964. [PMID: 37294889 DOI: 10.1111/joor.13533] [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: 04/14/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a neuromuscular multisystem disease. Early involvement of facial muscles may produce an extra load on the temporomandibular joint (TMJ) in DM1. OBJECTIVES This study aimed to investigate the morphological analyses of the bone components of temporomandibular joint (TMJ), and dentofacial morphology in myotonic dystrophy type 1 (DM1) patients by cone-beam computed tomography (CBCT). METHODS Sixty-six individuals (33 DM1, and 33 healthy subjects) age ranging from 20 to 69 were included in the study. Clinical examinations of the patients' TMJ regions and evaluation of dentofacial morphology (maxillary deficiency, open-bite, deep palate and cross-bite) were performed. Dental occlusion was determined based on Angle's classification. CBCT images were evaluated regarding mandibular condyle morphology (convex, angled, flat and round) and osseous changes observed in the condyle (normal, osteophyte, erosion, flattening, sclerosis). DM1-specific morphological and bony TMJ alterations were determined. RESULTS DM1 patients showed a high prevalence of morphological and osseous TMJ changes, and statistically significant skeletal alterations. The analysis of CBCT scans indicated the prevalent condylar shape among patients with DM1 was flat, the main osseous abnormality was flattening, there was a tendency towards skeletal Class II and a posterior cross-bite was frequently detected in DM1 patients. There was no statistically significant difference between the genders on the parameters evaluated in both groups. CONCLUSION Adult patients with DM1 presented a high frequency of crossbite, tendency to skeletal Class II and morphological osseous alterations of TMJ. The analysis of the morphological condylar alterations in patients with DM1 may be beneficial in the diagnosis of TMJ disorders. This study reveals DM1-specific morphological and osseous TMJ alterations to provide an appropriate orthodontic/orthognathic treatment planning to patients.
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Affiliation(s)
- Burcu Evlice
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Hazal Duyan Yuksel
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Ahmet Evlice
- Department of Neurology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Filiz Koc
- Department of Neurology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Havner C, Roussakis AÖ, Sjögreen L, Westerlund A. Open Bite Malocclusion and Orofacial Dysfunction in Patients with Myotonic Dystrophy Type 1 and Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023; 10:885-896. [PMID: 37334614 PMCID: PMC10578289 DOI: 10.3233/jnd-230025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Open bite (OB) is a common malocclusion in individuals with orofacial dysfunction and syndromes, especially in neuromuscular diseases. OBJECTIVES The objectives were to explore the prevalence of OB in myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD) and to create and compare orofacial dysfunction profiles. METHODS In this database study, 143 individuals with DM1 and 99 with DMD were included. The Mun-H-Center questionnaire and observation chart were used together with the Nordic Orofacial Test -Screening (NOT-S) to create orofacial dysfunction profiles. OB was categorised as: lateral (LOB); anterior (AOB); severe anterior (AOBS); or both types of anterior OB (AOBTot). Descriptive and multivariate statistics were used to compare the OB prevalence and to study associations with orofacial variables, respectively. RESULTS There was a statistically significant difference in OB prevalence between the DM1 (37%) and DMD (49%) groups (p = 0.048). LOB was seen in < 1% of DM1 and 18% of DMD. LOB was associated with macroglossia and closed mouth posture, AOB with hypotonic lips, and open mouth posture and AOBS with hypotonic jaw muscles. The orofacial dysfunction profiles showed similar patterns, although the mean NOT-S total scores for DM1 and DMD were 4.2±2.8 (median 4.0, min-max 1-8) and 2.3±2.0 (median 2.0, min-max 0-8), respectively. LIMITATIONS The two groups were not age- or gender-matched. CONCLUSION OB malocclusion is common in patients with DM1 and DMD and is associated with different types of orofacial dysfunction. This study highlights the need for multi-disciplinary assessments to support tailored treatment strategies that improve or sustain orofacial functions.
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Affiliation(s)
- Christina Havner
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Anna Ödman Roussakis
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Lotta Sjögreen
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Westerlund
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Usseglio J, Pagès E, Touzet-Roumazeille S, Brie J, Salle L, Ferri J. Dental and maxillofacial manifestations of Steinert's myotonic dystrophy: A retrospective case series and therapeutic investigation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e995-e1001. [PMID: 35752440 DOI: 10.1016/j.jormas.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
This retrospective study was performed to analyse the facial features and occlusal anomalies in 18 patients with Steinert's myotonic dystrophy (MD1). Medical and surgical management issues noted in this study may contribute to clinical decision-making. This series included 18 patients with MD1 who presented for maxillofacial consultations. For all patients, the following characteristics were assessed: sex, age, intellectual ability, oral condition, initial assessment of the occlusion and facial aspect. In total, 11 of 18 patients underwent surgery (10 achieved occlusion modification, whereas one did not). amongst patients who underwent surgery and achieved occlusion modification, six had stable class I results and four had unstable results or exhibited a slight degradation. Facial muscles play an important role in craniomaxillofacial development and facial aspects. A high prevalence of malocclusions is present in patients with MD1. Orthodontics and orthognathic surgery can improve the quality of life for affected patients. However, the long-term results of these treatments may be disappointing, and relapse can occur in patients with the most severe disease. Aspects of disease to consider while planning for surgery include oral health, risks of instability and relapse, and risks involving anaesthesia.
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Affiliation(s)
- Julie Usseglio
- Department of Stomatology and Maxillo-Facial Surgery, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France.
| | - Esther Pagès
- Department of Stomatology and Maxillo-Facial Surgery, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | | | - Joel Brie
- Department of Stomatology and Maxillo-Facial Surgery, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Laurence Salle
- Department of Endocrinology, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Joel Ferri
- Department of Stomatology and Maxillo-Facial Surgery, CHU Salengro, Rue Emile Laisne, 59037 Lille, France
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Konstantonis D, Kekou K, Papaefthymiou P, Vastardis H, Konstantoni N, Athanasiou M, Svingou M, Margariti A, Panousopoulou A. Orofacial Muscle Weakening in Facioscapulohumeral Muscular Dystrophy (FSHD) Patients. CHILDREN (BASEL, SWITZERLAND) 2022; 9:96. [PMID: 35053721 PMCID: PMC8774153 DOI: 10.3390/children9010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy is the third most commonly found type of muscular dystrophy. The aim of this study was to correlate the D4Z4 repeat array fragment size to the orofacial muscle weakening exhibited in a group of patients with a genetically supported diagnosis of FSHD. METHODS Molecular genetic analysis was performed for 52 patients (27 female and 25 male) from a group that consisted of 36 patients with autosomal dominant pedigrees and 16 patients with either sporadic or unknown family status. The patients were tested with the southern blotting technique, using EcoRI/Avrll double digestion, and fragments were detected by a p13E-11 telomeric probe. Spearman's correlation was used to compare the fragment size with the degree of muscle weakening found in the forehead, periocular and perioral muscles. RESULTS A positive non-significant correlation between the DNA fragment size and severity of muscle weakness was found for the forehead (r = 0.27; p = 0187), the periocular (r = 0.24; p = 0.232) and the left and right perioral (r = 0.29; p = 0.122), (r = 0.32; p = 0.085) muscles. CONCLUSIONS Although FSHD patients exhibited a decrease in muscular activity related to the forehead, perioral, and periocular muscles the genotype-phenotype associations confirmed a weak to moderate non-significant correlation between repeat size and the severity of muscle weakness. Orofacial muscle weakening and its association with a D4Z4 contraction alone may not have the significance to serve as a prognostic biomarker, due to the weak to moderate association. Further studies with larger sample sizes are needed to determine the degree of genetic involvement in the facial growth in FSHD patients.
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Affiliation(s)
- Dimitrios Konstantonis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, GR-115 27 Athens, Greece;
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland
| | - Kyriaki Kekou
- Laboratory of Medical Genetics, Children’s Hospital Agia Sophia, National and Kapodistrian University of Athens, GR-115 27 Athens, Greece; (K.K.); (M.S.)
| | - Petros Papaefthymiou
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul 34854, Turkey;
| | - Heleni Vastardis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, GR-115 27 Athens, Greece;
| | - Nikoleta Konstantoni
- ATX Braces & Smile Aligners, In Private Practice of Orthodontics, 1601 E Pflugerville Pkwy Building 2, Pflugerville, TX 78660, USA;
| | - Maria Athanasiou
- Athensbestsmiles, In Private Practice of Orthodontics, 49 Alopekis, GR-106 76 Athens, Greece;
| | - Maria Svingou
- Laboratory of Medical Genetics, Children’s Hospital Agia Sophia, National and Kapodistrian University of Athens, GR-115 27 Athens, Greece; (K.K.); (M.S.)
| | - Anastasia Margariti
- Department of Elderly Medicine, University Hospital Sussex NHS Foundation Trust, St. Richard’s Hospital, Spitalfield Ln, Chichester PO19 6SE, UK;
| | - Angeliki Panousopoulou
- Department of Neurology, Korgialenio-Benakio Hellenic Red Cross Hospital, GR-115 26 Athens, Greece;
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Fontinha C, Engvall M, Sjögreen L, Mårtensson Å, Ekström AB, Kiliaridis S. Occlusal traits and longitudinal dental changes in children and adolescents with congenital or childhood onset myotonic dystrophy. Eur J Orthod 2021; 43:527-533. [PMID: 33196085 DOI: 10.1093/ejo/cjaa068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES This research aimed to study the malocclusions of children and adolescents with myotonic dystrophy type 1 (DM1), in respect to healthy individuals, and trace the occlusal changes that occurred in these individuals during growth. MATERIALS/METHODS Thirty-six dental casts, from children and adolescents with DM1 living in western and southern Sweden, were compared with a control group of 50 healthy individuals. To identify potential changes in occlusal traits, 26 casts were assessed and followed-up over a median time of 9 years. Independent samples t-tests were used to compare the two groups and their changes over time. Paired samples t-tests tested changes over time within each group (P < 0.05). RESULTS DM1 patients had a higher prevalence of anterior open bite, posterior crossbite, and Class III malocclusions. When compared to controls, patients presented smaller upper and lower intermolar as well as intercanine widths. In both groups, the individuals revealed longitudinal changes with a decrease in both upper and lower arch lengths and an increase on the palatal vault height. During the follow-up period, the prevalence of malocclusions remained almost the same, only significantly differing regarding the changes that occurred between groups referred to the upper intermolar width, which decreased among DM1 patients. CONCLUSIONS/IMPLICATIONS In comparison to healthy controls, children and adolescents with DM1 have shown already at an early age a higher prevalence of both anterior open bite and posterior crossbite. These occlusal traits did not change with time apart from the upper narrow intermolar width, which further decreased with time.
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Affiliation(s)
- Clara Fontinha
- Department of Orthodontics, University of Geneva, Geneva, Switzerland
| | - Monica Engvall
- Mun-H-Center National Orofacial Resource Center for Rare Diseases, Public Dental Service in Västra Götaland, Gothenburg
| | - Lotta Sjögreen
- Mun-H-Center National Orofacial Resource Center for Rare Diseases, Public Dental Service in Västra Götaland, Gothenburg
| | - Åsa Mårtensson
- Mun-H-Center National Orofacial Resource Center for Rare Diseases, Public Dental Service in Västra Götaland, Gothenburg
| | - Anne-Berit Ekström
- Regional Pediatric Rehabilitation Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
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Pucciarelli V, Gibelli D, Mastella C, Bertoli S, Alberti K, De Amicis R, Codari M, Dolci C, Battezzati A, Baranello G, Sforza C. 3D Facial morphology in children affected by spinal muscular atrophy type 2 (SMAII). Eur J Orthod 2021; 42:500-508. [PMID: 31529029 DOI: 10.1093/ejo/cjz071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The main objective of this study was to assess the three-dimensional facial characteristics of children affected by spinal muscular atrophy (SMA), a severe muscular disorder characterized by hypotonia, areflexia, weakness, and respiratory impairment. MATERIALS/METHODS Stereophotogrammetric facial scans from 22 SMA type II patients aged 2-7 years were obtained. Data were analysed using both inter-landmark distances and principal component analysis and compared with data collected from matched control subjects. RESULTS Patients had wider transverse facial diameters, but smaller biocular width. Middle and lower anterior face heights were increased, whereas the mandibular ramus was shorter, with a reduced posterior-to-anterior face height ratio. Facial width-to-length ratio was reduced. In the sagittal plane, mandibular body length, and facial divergence were increased, whereas the gonial angles were decreased. In the horizontal plane, lower facial convexity was greater in patients, whereas mandibular convexity was smaller. Patients had smaller and down-slanted eye fissures, with a larger and more vertically developed nose. LIMITATIONS This study assessed a relatively small number of patients, due to the rare frequency of SMA type II. CONCLUSIONS/IMPLICATIONS SMA type II children possess peculiar facial alterations that may be due to the altered muscular activity. As feeding problems may derive also by malocclusion and masticatory muscular alterations, a detailed assessment of the craniofacial individual alterations should be considered in the standards of care of these patients.
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Affiliation(s)
- Valentina Pucciarelli
- LAFAS, Laboratory of Functional Anatomy of the Stomatognathic System, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Daniele Gibelli
- LAFAS, Laboratory of Functional Anatomy of the Stomatognathic System, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Chiara Mastella
- SAPRE, Parents Early Habilitation Service, Fondazione IRCCS Ca' Granda, Policlinico Hospital, Milan, Italy
| | - Simona Bertoli
- ICANS, International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Katia Alberti
- SAPRE, Parents Early Habilitation Service, Fondazione IRCCS Ca' Granda, Policlinico Hospital, Milan, Italy
| | - Ramona De Amicis
- ICANS, International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marina Codari
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Claudia Dolci
- LAFAS, Laboratory of Functional Anatomy of the Stomatognathic System, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Alberto Battezzati
- ICANS, International Center for the Assessment of Nutritional Status, Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiarella Sforza
- LAFAS, Laboratory of Functional Anatomy of the Stomatognathic System, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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