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Gisbert de la Cuadra L, Torres RJ, Beltrán LM, Sánchez A, Puig JG. Development of new forms of self-injurious behavior following total dental extraction in Lesch-Nyhan disease. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2017; 35:524-528. [PMID: 27906614 DOI: 10.1080/15257770.2016.1184276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report two Lesch-Nyhan Disease (LND) patients who developed new forms of self-injurious behavior following total dental extraction. Patients 1 and 2 were submitted to total teeth extraction at the age of 13 and 8 years, respectively, due to continuous self-biting, not prevented by mouth guards. Severity of dystonia was markedly reduced and quality of life improved. After 12 and 17 months, respectively, patient 1 started rubbing one foot against other and scratching toenails with his hands, and patient 2 stuck his legs and feet against hard objects. These forms of self-injury behavior could be easily prevented with protective materials, according to the mothers.
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Affiliation(s)
- Livia Gisbert de la Cuadra
- a Department of Internal Medicine , Metabolic-Vascular Unit, La Paz University Hospital, IdiPaz , Madrid , Spain
| | - Rosa J Torres
- b Department of Biochemistry , La Paz University Hospital, IdiPaz and Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII , Madrid , Spain
| | - Luis M Beltrán
- a Department of Internal Medicine , Metabolic-Vascular Unit, La Paz University Hospital, IdiPaz , Madrid , Spain
| | - Arantxa Sánchez
- a Department of Internal Medicine , Metabolic-Vascular Unit, La Paz University Hospital, IdiPaz , Madrid , Spain
| | - Juan G Puig
- a Department of Internal Medicine , Metabolic-Vascular Unit, La Paz University Hospital, IdiPaz , Madrid , Spain
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Tewari N, Mathur VP, Sardana D, Bansal K. Lesch-Nyhan syndrome: The saga of metabolic abnormalities and self-injurious behavior. Intractable Rare Dis Res 2017; 6:65-68. [PMID: 28357186 PMCID: PMC5359358 DOI: 10.5582/irdr.2016.01076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder of purine metabolism caused by a mutation in Xq26.2-q26.3 (OMIM 308000.0004). The presence of the diagnostic triad, i.e. signs of self-injurious behavior (SIB) and results of pedigree analysis and novel molecular biology & genetic testing, confirms the diagnosis of LNS. With a level of hypoxanthine guanine phosphoribosyl-transferase 1 (HPRT1) enzyme activity < 2%, patients develop neurological, neurocognitive, and neuromotor symptoms along with SIB. Described here is a case of 4-year-old boy who was diagnosed with LNS. The boy displayed SIB, i.e. biting of the lips and fingers, and he had cerebral venous sinus thrombosis caused by LNS.
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Affiliation(s)
- Nitesh Tewari
- Pedodontics & Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
- Address correspondence to: Dr. Nitesh Tewari, Division of Pedodontics & Preventive Dentistry, 6th Floor, Center for Dental Education & Research, All India Institute of Medical Sciences, New Delhi-110029, India. E-mail:
| | - Vijay Prakash Mathur
- Pedodontics & Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Divesh Sardana
- Pedodontics & Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Bansal
- Pedodontics & Preventive Dentistry, Center for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Autoextraction of Permanent Incisors and Self-Inflicted Orodental Trauma in a Severely Burned Child. Case Rep Dent 2015; 2015:425251. [PMID: 26843993 PMCID: PMC4710927 DOI: 10.1155/2015/425251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/20/2015] [Indexed: 11/17/2022] Open
Abstract
Autoextraction is one type of self-injurious behaviour. In the literature, self-injurious behaviours are observed in syndromes and genetic conditions. However, to the best of our knowledge, SIB and autoextraction in a severely burned patient have not been reported to date. This report describes the self-inflicted trauma and autoextraction in a severely burned child, and the management of the child during and after burn treatment.
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Goodman EM, Torres RJ, Puig JG, Jinnah HA. Consequences of Delayed Dental Extraction in Lesch-Nyhan Disease. Mov Disord Clin Pract 2014; 1:225-229. [PMID: 25419535 DOI: 10.1002/mdc3.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with Lesch-Nyhan disease (LND) often engage in self-injurious biting. This problem requires difficult management choices, sometimes including removal of the teeth. Although many health care professionals are reluctant to remove teeth in a child because of the permanent negative cosmetic consequences of the edentulous state, disfigurement of the face and tongue from self-biting can be worse. We analyzed the records of 5 LND patients who used mouth guards to spare the teeth. Success was variable, and dental extraction ultimately was required in 4 cases. We also reviewed previously published cases on the use of dental devices to spare teeth in LND. Various devices have been recommended, but failure rates are high, and tooth extraction often is still needed. Although dental extraction is not required in all cases, it should not be delayed when biting is severe.
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Affiliation(s)
- Emily M Goodman
- Department of Neurology, Emory University, Atlanta, Georgia 30322 USA
| | - Rosa J Torres
- Division of Clinical Biochemistry, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Juan G Puig
- Division of Internal Medicine, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - H A Jinnah
- Departments of Neurology, Human Genetics & Pediatrics, Emory University, Atlanta, Georgia 30322 USA
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Abstract
OBJECTIVES Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. METHODS We undertook a review of all published cases of facial self-mutilation (1960-2011). RESULTS We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target--seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation. CONCLUSIONS Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.
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Schalka MMS, Corrêa MSNP, Ciamponi AL. Congenital insensitivity-to-pain with anhidrosis (CIPA): A case report with 4-year follow-up. ACTA ACUST UNITED AC 2006; 101:769-73. [PMID: 16731398 DOI: 10.1016/j.tripleo.2005.07.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 07/14/2005] [Accepted: 07/28/2005] [Indexed: 11/21/2022]
Abstract
Congenital Insensitivity-to-pain with anhidrosis (CIPA) is a rare disorder in which pain perception is absent from birth, despite the fact that all other sensory modalities remain intact or minimally impaired and tendon reflexes are present. The challenge in dentistry is to manage the self-mutilation behavior avoiding serious damages especially to oral structures, hands and fingers. A Brazilian case of CIPA is presented and discussed with clinical documentation of the oral-related problems over a 4-year follow-up. A conservative treatment (mouthguard-like appliance) was proposed with the objective to avoid full mouth extraction.
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Abstract
Lesch-Nyhan syndrome (LNS), first described in 1964 by Lesch and Nyhan, is a rare X-linked genetic disorder involving (near) absence of the enzyme hypoxanthine-guanine phosphoribosyl transferase (HPRT). It occurs in 1:100,000 to 380,000 live births (1, 2). The deficiency of HPRT activity leads to an excessive uric acid production resulting in neurological, renal and musculoskeletal manifestations. Death usually occurs in the second or third decade from infection or renal failure. Clinical presentation is characterized by mental retardation, choreoathetosis, spasticity, hyperuricemia and cerebral palsy. A characteristic feature of LNS is the appearance of intractable self-injurious behaviour (SIB), usually in the form of severe lip and finger biting, gouging of eyes, face scratching and head banging requiring extreme management techniques such as the application of restraints and or extraction of teeth at an early age. In this case report a unique approach of SIB in LNS is presented.
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Affiliation(s)
- R G E C Cauwels
- Department of Paediatric Dentistry, Centre for Special Care, Paecamed Research, Ghent University, Ghent, Belgium.
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Yasui EM, Kimura RK, Kawamura A, Akiyama S, Morisaki I. A modified oral screen appliance to prevent self-inflicted oral trauma in an infant with cerebral palsy: a case report. ACTA ACUST UNITED AC 2004; 97:471-5. [PMID: 15088031 DOI: 10.1016/j.tripleo.2003.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Self-inflicted oral trauma occurs in a number of conditions with different etiologic and clinical characteristics. The management of such trauma also varies depending on the medical history of the patient; the etiology of the behavior; and the severity, frequency, and method of inflicting injury. This case report describes a modified oral screen placed in a 10-month-old female infant with cerebral palsy who had been having feeding problems caused by self-inflicted oral trauma. The modified oral screen effectively protected the wounds against further oral trauma to the lower lip and tongue without being fixed to the dentition.
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Abstract
Leigh disease is an inherited progressive mitochondrial neurodegenerative disease that affects the neurological, respiratory and cardiovascular systems and is associated with retardation of the intellectual and physical development. This report describes the case of a 4-year-old boy with Leigh disease who presented with self-inflicted traumatic injury to the teeth, alveolar bone, lips and tongue during repeated episodes of intense orofacial spasms. Conservative management of the injury included repositioning the fractured alveolar bone, splinting the traumatized teeth and planning for a mouthguard. However, after a second incident of severe self-induced injury to the teeth and alveolar bone, extraction of the anterior teeth became inevitable to protect the child from further self-mutilation and to allow healing of the injured tissues.
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Affiliation(s)
- M Diab
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Escard E, Barret L. Sévices à des enfants ou insensibilité congénitale à la douleur? Paediatr Child Health 2003; 8:151-4. [DOI: 10.1093/pch/8.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zaenglein AL, Chang MW, Meehan SA, Axelrod FB, Orlow SJ. Extensive Riga-Fede disease of the lip and tongue. J Am Acad Dermatol 2002; 47:445-7. [PMID: 12196759 DOI: 10.1067/mjd.2002.117213] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Riga-Fede disease presents in early infancy and is characterized by firm, verrucous plaques arising on the oral mucosal surfaces. These histologically benign lesions occur as a result of repetitive trauma of the oral mucosal surfaces by the teeth. Early recognition of this entity is important, because it may be the presenting sign of an underlying neurologic disorder. We report the case of a 10-month-old boy with extensive Riga-Fede disease involving the lip and tongue that prompted a diagnosis of congenital autonomic dysfunction with universal pain loss.
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Affiliation(s)
- Andrea L Zaenglein
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York 10016, USA
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Coyne BMC, Montague T. Teeth grinding, tongue and lip biting in a 24-month-old boy with meningococcal septicaemia. Report of a case. Int J Paediatr Dent 2002; 12:277-80. [PMID: 12121539 DOI: 10.1046/j.1365-263x.2002.00371.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper describes the management of a 24-month-old boy who presented with self-inflicted trauma to his lower lip and tongue, and teeth grinding, 21 days after developing meningococcal septicaemia. A decision to observe and prescribe palliative therapy was made. Extraction of the lower right deciduous canine, which had become non-vital, possibly due to bruxism, was carried out.
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Affiliation(s)
- B M C Coyne
- Royal Manchester Children's Hospital, Pendlebury, UK
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Abstract
Hallervorden-Spatz disease (HSD) is a rare neurodegenerative disorder characterized by abnormally high deposits of iron in the brain. This report describes a child with HSD who presented with self-inflicted ulceration of the lip and tongue, which was initiated during periods of intense oro-facial spasms. Other findings included dental caries and trauma to the primary incisors. Comprehensive dental care was carried out under general anaesthesia. The self-mutilation of the oro-facial mucosa was eliminated by placement of upper and lower soft resin bite guards.
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Affiliation(s)
- E C Sheehy
- Department of Orthodontics and Paediatric Dentistry, Guy's Hospital, London, UK.
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