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Kumari K, Saleh I, Taslim S, Ahmad S, Hussain I, Munir Z, Javed T, Virk MFI, Javed S, Bisharat P, Ur Rehman U. Unraveling the Complexity of Apert Syndrome: Genetics, Clinical Insights, and Future Frontiers. Cureus 2023; 15:e47281. [PMID: 38021759 PMCID: PMC10656109 DOI: 10.7759/cureus.47281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Apert syndrome (AS), also known as type I acrocephalosyndactyly, is a rare congenital condition characterized by craniosynostosis resulting from missense mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. This comprehensive review delves into AS, covering its clinical manifestations, genetics, diagnosis, medical management, psychosocial considerations, and future research directions. AS presents with distinct features, including a brachycephalic skull, midface hypoplasia, and limb anomalies such as syndactyly. It follows an autosomal dominant inheritance pattern with mutations in the FGFR2 gene. Prenatal diagnosis is possible through advanced imaging techniques and molecular testing. The multidisciplinary approach to AS management involves surgical interventions, orthodontics, and psychological support. Although no curative treatment exists, early interventions can significantly improve function and aesthetics. The quality of life for AS patients is influenced by psychosocial factors, necessitating comprehensive support for both patients and their families. Future research directions include gene therapy, understanding cellular responses to FGFR2 mutations, and addressing genetic heterogeneity. Collaborative efforts are vital to advancing knowledge about AS and its genetic underpinnings. Overall, this review serves as a valuable resource for healthcare professionals, educators, and researchers, contributing to a deeper understanding of AS and facilitating advancements in diagnosis and treatment.
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Affiliation(s)
- Kajol Kumari
- Dentistry, Jinnah Sindh Medical University, Karachi, PAK
| | - Inam Saleh
- Paediatrics, University of Kentucky College of Medicine, Lexington, USA
| | - Sanzida Taslim
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
| | - Sana Ahmad
- Psychiatry, TIME Organization, Inc., Baltimore, USA
| | - Iqbal Hussain
- Internal Medicine, Khyber Medical University, Peshawar, PAK
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Zainab Munir
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | - Tamleel Javed
- Emergency Department, Imran Idrees Teaching Hospital, Sialkot, PAK
| | | | - Saleha Javed
- Emergency Department, Sheikh Zayed Hospital, Rahim Yar Khan, PAK
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Droubi L, Laflouf M, Tolibah YA, Comisi JC. Apert Syndrome: Dental management considerations and objectives. J Oral Biol Craniofac Res 2022; 12:370-375. [DOI: 10.1016/j.jobcr.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/16/2021] [Accepted: 04/09/2022] [Indexed: 10/18/2022] Open
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López-Estudillo AS, Rosales-Bérber MA, Ruiz-Rodríguez S, Pozos-Guillén A, Noyola-Frías MÁ, Garrocho-Rangel A. Dental approach for Apert syndrome in children: a systematic review. Med Oral Patol Oral Cir Bucal 2017; 22:e660-e668. [PMID: 29053644 PMCID: PMC5813983 DOI: 10.4317/medoral.21628] [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: 09/06/2016] [Accepted: 05/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background Apert Syndrome (AS), or type I acrocephalosyndactyly, is a rare, congenital craniosynostosis condition resulting from missense mutations in the gene encoding fibroblast growth factor receptor 2. It is characterized by three specific clinical features: brachycephalic skull; midface hypoplasia, and limb abnormalities (syndactyly of hands and feet). The disorder exhibits variable presentations in bones, brain, skin, internal organs, and in the oral/maxillofacial region. The aim of the present paper was to show the main results from a systematic review of AS. Material and Methods A search of the literature was performed from April to June 2016 in five electronic databases. Clinical interventional or observational studies, reviews, and case reports were included. The present systematic review was carried out strictly following PRISMA and Cochrane Collaboration criteria. Results A total of 129 potential references were identified. After reviewing titles and abstracts, 77 of these did not meet the desired criteria and were discarded. The full text of the remaining 52 manuscripts was critically screened. Finally, 35 relevant papers were identified for inclusion in the present systematic review and classified according to topic type. Conclusions According to the information gathered, dentistry practitioners must be able to supply an early diagnosis through the recognition of AS clinical features and provide correct oral management. Additionally, they should be integrated in a multidisciplinary medical care team in order to improve the quality of life of the affected patients. Key words:Apert syndrome, acrocephalosyndactyly, craniosynostosis, skeletal dysplasias, systematic review.
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Affiliation(s)
- A-S López-Estudillo
- Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, Av. Dr. Manuel Nava #2, Zona Universitaria, C.P. 78290; San Luis Potosí, S.L.P. México,
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Hermann CD, Hyzy SL, Olivares-Navarrete R, Walker M, Williams JK, Boyan BD, Schwartz Z. Craniosynostosis and Resynostosis: Models, Imaging, and Dental Implications. J Dent Res 2016; 95:846-52. [PMID: 27076448 DOI: 10.1177/0022034516643315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Craniosynostosis occurs in approximately 1 in 2,000 children and results from the premature fusion of ≥1 cranial sutures. If left untreated, craniosynostosis can cause numerous complications as related to an increase in intracranial pressure or as a direct result from cranial deformities, or both. More than 100 known mutations may cause syndromic craniosynostosis, but the majority of cases are nonsyndromic, occurring as isolated defects. Most cases of craniosynostosis require complex cranial vault reconstruction that is associated with a high risk of morbidity. While the first operation typically has few complications, bone rapidly regrows in up to 40% of children who undergo it. This resynostosis typically requires additional surgical intervention, which can be associated with a high incidence of life-threatening complications. This article reviews work related to the dental and maxillofacial implications of craniosynostosis and discusses clinically relevant animal models related to craniosynostosis and resynostosis. In addition, information is provided on the imaging modalities used to study cranial defects in animals and humans.
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Affiliation(s)
- C D Hermann
- School of Medicine, Emory University, Atlanta, GA, USA
| | - S L Hyzy
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - R Olivares-Navarrete
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - M Walker
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Georgia Institute of Technology, Atlanta, GA, USA
| | - J K Williams
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - B D Boyan
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Georgia Institute of Technology, Atlanta, GA, USA
| | - Z Schwartz
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Dental anomalies in Apert syndrome. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ercoli G, Bidondo MP, Senra BC, Groisman B. Apert syndrome with omphalocele: A case report. ACTA ACUST UNITED AC 2014; 100:726-9. [DOI: 10.1002/bdra.23270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Gabriel Ercoli
- National Registry of Congenital Anomalies of Argentina (RENAC); National Center of Medical Genetics, National Ministry of Health; Buenos Aires Argentina
| | - María Paz Bidondo
- National Registry of Congenital Anomalies of Argentina (RENAC); National Center of Medical Genetics, National Ministry of Health; Buenos Aires Argentina
| | - Blanca Cristina Senra
- Hospital Municipal Materno Infantil de San Isidro; Dr. Carlos Gianantonio Buenos Aires Argentina
| | - Boris Groisman
- National Registry of Congenital Anomalies of Argentina (RENAC); National Center of Medical Genetics, National Ministry of Health; Buenos Aires Argentina
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Anderson PJ, Yong R, Surman TL, Rajion ZA, Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 2014; 59 Suppl 1:174-85. [DOI: 10.1111/adj.12154] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- PJ Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - R Yong
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - TL Surman
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - ZA Rajion
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - S Ranjitkar
- School of Dentistry; The University of Adelaide; South Australia Australia
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Multiple radiopaque mandibular lesions in a patient with Apert syndrome. J Endod 2012; 38:1639-43. [PMID: 23146653 DOI: 10.1016/j.joen.2012.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 06/28/2012] [Accepted: 06/30/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Apert syndrome (acrocephalosyndactyly) is a rare congenital malformation characterized by craniosynostosis, craniofacial anomalies, and symmetric syndactyly of the hands and feet. Oral manifestations usually include bifid uvula, a Byzantine arch palate associated with lateral swellings of the palatine processes, severe maxillary dental crowding associated with teeth malposition, severe open bite, dental caries, and gingival and periodontal disorders. Florid osseous dysplasia is an asymptomatic lesion mostly encountered during casual dental radiographic examinations as multiple sclerotic masses in 2 or more quadrants, usually in tooth-bearing regions. METHODS A 32-year-old woman diagnosed with Apert syndrome was seen in our department for a routine dental examination. Radiographic evaluation showed multiple radiopaque lesions in the mandible. All teeth with radiopaque lesions gave positive responses to vitality tests, and the patient did not report any symptoms. Based on the clinical and radiographic findings, the diagnosis of florid osseous dysplasia in a patient with Apert syndrome was made. Because there were no signs of an intraoral infectious process or endodontic needs, the patient was followed during revisions for Apert syndrome, and the only treatment provided was conservative management of the many carious lesions observed during the clinical examination. CONCLUSIONS To our knowledge, this is the first study reporting the occurrence of florid osseous dysplasia in a patient with Apert syndrome. Conservative management should be performed in asymptomatic cases. Although rare, our case report highlights the importance of florid osseous dysplasia as a condition that may mimic lesions with an endodontic origin in patients with Apert syndrome.
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