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Xue XM, Liu YQ, Pang P, Sun CF. Congenital Loss of Permanent Teeth in a Patient With Congenital Insensitivity to Pain With Anhidrosis due to 2 Novel Mutations in the NTRK1 Gene. J Oral Maxillofac Surg 2018; 76:2582.e1-2582.e9. [DOI: 10.1016/j.joms.2018.06.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 01/24/2023]
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Prabhu S, Fortier K, Newsome L, Reebye UN. Office-Based Anesthetic and Oral Surgical Management of a Child With Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report. Anesth Prog 2018; 65:181-186. [PMID: 30235436 DOI: 10.2344/anpr-65-03-07] [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: 11/11/2022] Open
Abstract
Hereditary sensory and autonomic neuropathy type IV (HSAN IV), or congenital insensitivity to pain with anhidrosis, is an exceptionally rare genetic disorder that results in the complete loss of pain and temperature sensation as well as anhidrosis. Anesthetic management of these patients can be difficult because of significantly increased risks during general anesthesia. Literature on perioperative anesthetic management is typically written in the context of a hospital setting. As such, our case presents a unique report on the anesthetic management of a HSAN IV patient who presented for extraction of 2 teeth in an office-based setting. In determining how to safely manage the procedure, we decided against general anesthesia as we lacked the facilities and equipment to safely handle previously reported complications. We were successful in providing sedation with nitrous oxide in oxygen and applying 20% benzocaine topical ointment on the surgical site in lieu of administering general anesthesia. We had an anesthesiologist present and obtained intravenous access prior to the surgery to help manage any complications. This report provides support that simple dental extractions can be accomplished safely in the HSAN IV patient in the office-based setting, thereby avoiding unnecessary risk.
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Affiliation(s)
- Shamit Prabhu
- Master of Physiology Candidate, North Carolina State University, Raleigh, North Carolina
| | - Kevin Fortier
- DMD Candidate, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Lisa Newsome
- Anesthesiologist; Triangle Implant Center, Durham, North Carolina
| | - Uday N Reebye
- Oral and Maxillofacial Surgeon, Triangle Implant Center, Durham, North Carolina
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Aboutanos SZ, McAndrew K, Unkle J, Wornom IL. Pontine Tegmental Cap Dysplasia and Challenges in Facial Reconstructive Surgery. Cleft Palate Craniofac J 2018; 55:127-131. [PMID: 34162062 DOI: 10.1177/1055665617721924] [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] Open
Abstract
Pontine tegmental cap dysplasia (PTCD) is a rare condition that affects the brain stem and multiple cranial nerves, which can result in bilateral facial palsies, hearing loss, bilateral trigeminal nerve dysfunction, oculomotor apraxia, feeding difficulties, seizures, hypotonia, and undeveloped speech. We document a case in which a patient with PTCD presents with a challenging lip deformity and requires multidisciplinary treatment to improve reconstructive surgical success and treatment outcomes. An extensive literature review was conducted. This report serves to increase awareness of PTCD and the need for multidisciplinary teams to participate in reconstruction of facial defects in a complex medical setting.
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Affiliation(s)
| | - Karen McAndrew
- The Cleft and Craniofacial Team at St. Mary's, Richmond, VA, USA
| | - John Unkle
- The Cleft and Craniofacial Team at St. Mary's, Richmond, VA, USA
| | - Isaac L Wornom
- The Cleft and Craniofacial Team at St. Mary's, Richmond, VA, USA
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Elhennawy K, Reda S, Finke C, Graul-Neumann L, Jost-Brinkmann PG, Bartzela T. Oral manifestations, dental management, and a rare homozygous mutation of the PRDM12 gene in a boy with hereditary sensory and autonomic neuropathy type VIII: a case report and review of the literature. J Med Case Rep 2017; 11:233. [PMID: 28807049 PMCID: PMC5556355 DOI: 10.1186/s13256-017-1387-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hereditary sensory and autonomic neuropathy type VIII is a rare autosomal recessive inherited disorder. Chen et al. recently identified the causative gene and characterized biallelic mutations in the PR domain-containing protein 12 gene, which plays a role in the development of pain-sensing nerve cells. Our patient's family was included in Chen and colleagues' study. We performed a literature review of the PubMed library (January 1985 to December 2016) on hereditary sensory and autonomic neuropathy type I to VIII genetic disorders and their orofacial manifestations. This case report is the first to describe the oral manifestations, and their treatment, of the recently discovered hereditary sensory and autonomic neuropathy type VIII in the medical and dental literature. CASE PRESENTATION We report on the oral manifestations and dental management of an 8-month-old white boy with hereditary sensory and autonomic neuropathy-VIII over a period of 16 years. Our patient was homozygous for a mutation of PR domain-containing protein 12 gene and was characterized by insensitivity to pain and thermal stimuli, self-mutilation behavior, reduced sweat and tear production, absence of corneal reflexes, and multiple skin and bone infections. Oral manifestations included premature loss of teeth, associated with dental traumata and self-mutilation, severe soft tissue injuries, dental caries and submucosal abscesses, hypomineralization of primary teeth, and mandibular osteomyelitis. CONCLUSIONS The lack of scientific knowledge on hereditary sensory and autonomic neuropathy due to the rarity of the disease often results in a delay in diagnosis, which is of substantial importance for the prevention of many complications and symptoms. Interdisciplinary work of specialized medical and dental teams and development of a standardized treatment protocols are essential for the management of the disease. There are many knowledge gaps concerning the management of patients with hereditary sensory and autonomic neuropathy-VIII, therefore more research on an international basis is needed.
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Affiliation(s)
- Karim Elhennawy
- Center for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Seif Reda
- Center for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Christian Finke
- Center for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Luitgard Graul-Neumann
- Ambulantes Gesundheitszentrum, Campus Virchow Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité Campus Virchow, Department of Human Genetics, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Paul-Georg Jost-Brinkmann
- Center for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Theodosia Bartzela
- Center for Dental and Craniofacial Sciences, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
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Varma AV, McBride L, Marble M, Tilton A. Congenital insensitivity to pain and anhidrosis: Case report and review of findings along neuro-immune axis in the disorder. J Neurol Sci 2016; 370:201-210. [DOI: 10.1016/j.jns.2016.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/30/2016] [Accepted: 09/20/2016] [Indexed: 12/19/2022]
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Ravichandra KS, Kandregula CR, Koya S, Lakhotia D. Congenital Insensitivity to Pain and Anhydrosis: Diagnostic and Therapeutic Dilemmas revisited. Int J Clin Pediatr Dent 2015; 8:75-81. [PMID: 26124587 PMCID: PMC4472877 DOI: 10.5005/jp-journals-10005-1288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/02/2014] [Indexed: 11/23/2022] Open
Abstract
First described in 1932 by Dearborn as 'congenital pure analgesia', congenital insensitivity to pain and anhydrosis (CIPA) or hereditary sensory and autonomic neuropathy (HSAN) type IV is an extremely rare autosomal recessive disorder. A 7-year-old female child who is an established case of congenital insensitivity to pain and anhydrosis visited the department of pediatric medicine with osteoarthritic neuropathy. A multidisciplinary team approach was utilized to treat the child under general anesthesia. This article also discusses the diagnostic and therapeutic dilemmas involved in treating this type of children. How to cite this article: Ravichandra KS, Kandregula CR, Koya S, Lakhotia D. Congenital Insensitivity to Pain and Anhydrosis: Diagnostic and Therapeutic Dilemmas revisited. Int J Clin Pediatr Dent 2015;8(1):75-81.
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Affiliation(s)
- K S Ravichandra
- Professor and Head, Department of Pedodontics and Preventive Dentistry, Drs Sudha and Nageswara Rao Siddhartha Institute of Health Sciences, Chinnoutpalli, Andhra Pradesh, India
| | - Chaitanya Ram Kandregula
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
| | - Srikanth Koya
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
| | - Disha Lakhotia
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
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Congenital Insensitivity to Pain without Anhidrosis: Orodental Problems and Management. Case Rep Dent 2015; 2015:179892. [PMID: 26457210 PMCID: PMC4592712 DOI: 10.1155/2015/179892] [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] [Received: 04/20/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
This paper reports the case of a 4-year-old male patient who was brought by parents requesting for replacement of multiple missing anterior teeth. The patient suffered from congenital insensitivity to pain without anhidrosis and presented with full blown sequelae of the condition in the form of oral self-mutilation leading to loss of teeth, tongue tip amputation, finger tips destruction, and lower limb wound infections. Dental and orthopaedic treatment consists of local management of oral wound and prevention from further oral and finger injuries that takes the form of dental splints and finger sleeve splints, constant feet coverage with shoes, and behavioural medical therapy. The age of the patient and parents’ education present challenges in managing this condition to avoid morbidity and premature mortality.
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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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Abstract
BACKGROUND Self-inflicted oral injuries of organic origin are particularly common in certain diseases, syndromes, and systemic disorders. In this article, we discuss the characteristics of these oral lesions and their treatment. LITERATURE SEARCH The authors have reviewed the most relevant literature relating to oral self-injury through a search in textbooks and published articles included in the Medline database for the years 1970-2010, and selected published cases from the last two decades. RESULTS The majority of the literature on oral self-injury is in the form of case reports. Self-injury is particularly prevalent in patients with Lesch-Nyhan syndrome, a heterogeneous group of neurological disorders, congenital insensitivity to pain with anhidrosis, and mental retardation. It is most common in males in the early years of life, and the sites most frequently involved are the lower lip and the tongue. Therapeutic approaches in these patients have included psychological and pharmacological treatment, intraoral devices, and surgical procedures. CLINICAL IMPLICATIONS Intraoral devices are the best therapeutic option for self-injury of organic origin, although this approach is not free of complications. The current lack of standardized treatment protocols for oral self-injury means that therapy must be individualized.
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Affiliation(s)
- Jacobo Limeres
- Special Needs Unit, School of Medicine and Dentistry, Santiago de Compostela University, Spain Department of Stomatology, School of Medicine and Dentistry, Santiago de Compostela University, Spain
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Safari A, Khaledi AA, Vojdani M. Congenital Insensitivity to Pain with Anhidrosis (CIPA): A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:134-8. [PMID: 22737448 PMCID: PMC3371914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/20/2010] [Accepted: 08/02/2010] [Indexed: 11/12/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disorder characterized by episodes of fever and the inability to sense of pain despite the fact that all other sensory modalities remain intact or minimally impaired. The patient also may exhibit the signs of self-mutilation, mental retardation and little or no perspiration. We present a 10 years old Iranian patient diagnosed with CIPA with the above-mentioned clinical characteristics. The prosthetic treatment and the subsequent six month follow-up are discussed. Follow-up of the patient revealed that, with the use of this prosthesis, the patient's oral function and esthetics were established and the mouth lesions improved. Therefore especial dental management of CIPA patients according to their mental status, age, oral and dental condition is essential for solving the specific problems each case may present and the full mouth teeth extraction should be considered as the last treatment.
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Affiliation(s)
- A Safari
- Department of Prosthodontic, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A A Khaledi
- Department of Prosthodontic, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Amir Ali Reza Khaledi, DMD, MSC, Department of Prosthodontic, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-917-3148061, Fax: +98-711-2307594, E-mail:
| | - M Vojdani
- Department of Prosthodontic, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Nociceptors, Pain, and Spinal Manipulation. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Padmanabhan MY, Pandey RK, Aparna R, Radhakrishnan V. Neonatal sublingual traumatic ulceration - case report & review of the literature. Dent Traumatol 2010; 26:490-5. [DOI: 10.1111/j.1600-9657.2010.00926.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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