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Ainuz BY, Geisler EL, Hallac RR, Perez JK, Seaward JR, Kane AA. Anterior "W" Tongue Reduction for Macroglossia in Beckwith-Wiedemann Syndrome. Cleft Palate Craniofac J 2021; 59:1145-1154. [PMID: 34402311 DOI: 10.1177/10556656211036607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Macroglossia occurs in 80% to 99% of patients with Beckwith-Wiedemann syndrome (BWS) and a variety of surgical techniques for tongue reduction are offered by surgeons. The purpose of this study is to evaluate the postoperative outcomes of the anterior "W" tongue reduction technique in patients with BWS. METHODS A retrospective review was conducted of all patients diagnosed with BWS that underwent an anterior "W" tongue reduction for macroglossia in the past 7 years, performed by 2 surgeons. Demographics, procedural characteristics, perioperative outcomes, and complications were assessed. RESULTS A total of 19 patients met inclusion criteria consisting of 8 male and 11 female patients. The mean age at the time of surgery was 405 days, mean surgeon operating time was 1.06 h, and mean length of follow-up was 467 days. Postoperative oral competence was observed in 100% of patients. There was no reported history of sleep apnea or airway compromise. Speech delay was seen in 4 patients pre- and postoperatively. Feeding issues decreased from 7 patients preoperatively to 1 patient postoperatively. Preoperative prevalence of class III malocclusion (53%) and isolated anterior open bite (26%) decreased postoperatively to 37% and 16%, respectively. The only reported complications were superficial tip wound dehiscence in 3 patients treated with nystatin antifungal therapy. None of the patients required revisional surgery. CONCLUSION Patients treated with the anterior "W" tongue reduction technique had low rates of perioperative complications and significant improvements in oral competence. Anterior "W" tongue reduction is safe and effective for the correction of macroglossia in patients with BWS.
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Affiliation(s)
- Bar Y Ainuz
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - Emily L Geisler
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Jeyna K Perez
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
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The Utility of Early Tongue Reduction Surgery for Macroglossia in Beckwith-Wiedemann Syndrome. Plast Reconstr Surg 2020; 145:803e-813e. [PMID: 32221229 DOI: 10.1097/prs.0000000000006673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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The effectiveness of Wilms tumor screening in Beckwith-Wiedemann spectrum. J Cancer Res Clin Oncol 2019; 145:3115-3123. [PMID: 31583434 DOI: 10.1007/s00432-019-03038-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE It is well documented that patients with Beckwith-Wiedemann spectrum (BWS) have a significantly higher risk of developing Wilms tumor (WT) than the general population. There has been little research on the timing of WT diagnosis in BWS in regard to optimizing suggested screening protocols. METHODS A literature search was performed to identify all reports of patients with BWS and WT. These data were combined with unpublished data from patients in the authors' cohorts. Age at WT diagnosis was compared against data collected through the NIH Surveillance, Epidemiology, and End Results Program (SEER) registry. RESULTS Patients with BWS had a significantly higher incidence of WT diagnoses between age 12 and 84 months compared to patients in the SEER registry. Patients with BWS and WT diagnosed through screening had significantly lower stages at diagnosis compared to patients with BWS that were not screened. CONCLUSIONS Screening until age 7 years is effective in detecting close to 95% of all WT in patients with BWS.
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New surgical method of tongue reduction for macroglossia: technical note. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:e1-e7. [DOI: 10.1016/j.oooo.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/27/2018] [Indexed: 11/23/2022]
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Style CC, Cruz SM, Lau PE, Lee TC, Wesson DE, Olutoye OO. Surgical Outcomes of Patients with Beckwith-Wiedemann Syndrome. J Pediatr Surg 2018; 53:1042-1045. [PMID: 29551244 DOI: 10.1016/j.jpedsurg.2018.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate treatment and surgical outcomes of patients of Beckwith-Wiedemann Syndrome (BWS) treated at a tertiary children's hospital. METHODS A retrospective review of infants evaluated at Texas Children's Hospital for BWS from August 2000 to December 2016 was performed. Data collected included demographic information, clinical presentation, genetic evaluation, fetal imaging, operative treatment, and outcomes. RESULTS Forty-seven children with a diagnosis of BWS were identified. Sixty-four percent (n=30) had a genetic mutation in an imprinting domain of chromosome 11p15. Thirty-two patients (68%) underwent at least one operation related to BWS with a median of 2 [range: 0-8] surgical procedures per patient. Sixteen underwent omphalocele repair, 12 had partial glossectomies-, 7 underwent surgeries related to hemihypertrophy, and 6 had resection of an embryonal tumor (two adrenal cortical adenoma, one Wilms' tumor, two hepatoblastoma). Overall, survival was 100% with feeding difficulty (47%) being the most frequent complication. CONCLUSION A substantial number of patients with Beckwith-Wiedemann Syndrome will require surgery. However, overall outcomes are similar between those that require surgery and those that do not. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Candace C Style
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Stephanie M Cruz
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Patricio E Lau
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Timothy C Lee
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - David E Wesson
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Oluyinka O Olutoye
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
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Wild A, Vorperian HK, Kent RD, Bolt DM, Austin D. Single-Word Speech Intelligibility in Children and Adults With Down Syndrome. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:222-236. [PMID: 29214307 PMCID: PMC5968330 DOI: 10.1044/2017_ajslp-17-0002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 10/11/2017] [Indexed: 05/06/2023]
Abstract
PURPOSE A single-word identification test was used to study speech production in children and adults with Down syndrome (DS) to determine the developmental pattern of speech intelligibility with an emphasis on vowels. METHOD Speech recordings were collected from 62 participants with DS aged 4-40 years and 25 typically developing participants aged 4-7 years. Panels of 5 adult lay listeners transcribed the speech recordings orthographically, and their responses were scored in comparison with the speakers' target words. RESULTS Speech intelligibility in persons with DS improved with age, especially between the ages of 4 and 16 years. Whereas consonants contribute to intelligibility, vowels also played an important role in reduced intelligibility with an apparent developmental difference in low versus high vowels, where the vowels /æ/ and/ɑ/ developed at a later age than /i/ and /u/. Interspeaker variability was large, with male individuals being generally less intelligible than female individuals and some adult men having very low intelligibility. CONCLUSION Results show age-related patterns in speech intelligibility in persons with DS and identify the contribution of dimensions of vowel production to intelligibility. The methods used clarify the phonetic basis of reduced intelligibility, with implications for assessment and treatment.
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Affiliation(s)
- Alyssa Wild
- 433 Waisman Center, University of Wisconsin-Madison
| | | | - Ray D. Kent
- 433 Waisman Center, University of Wisconsin-Madison
| | - Daniel M. Bolt
- Department of Educational Psychology, University of Wisconsin-Madison
| | - Diane Austin
- 433 Waisman Center, University of Wisconsin-Madison
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Cielo CM, Duffy KA, Vyas A, Taylor JA, Kalish JM. Obstructive sleep apnoea and the role of tongue reduction surgery in children with Beckwith-Wiedemann syndrome. Paediatr Respir Rev 2018; 25:58-63. [PMID: 28366681 PMCID: PMC5890299 DOI: 10.1016/j.prrv.2017.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/16/2017] [Indexed: 11/25/2022]
Abstract
Beckwith-Wiedemann syndrome (BWS) is a rare paediatric overgrowth disorder. Associated macroglossia is a feature of many children with BWS and is felt to be a risk factor for obstructive sleep apnoea (OSA). Sleep-disordered breathing is highly variable in this population. The relationship between degree of macroglossia or other genotypic or phenotypic factors and OSA severity has not been established. The natural history of OSA in this population is unknown; a variety of conservative and surgical therapies have been used to treat OSA in children with BWS but none have been studied systematically. Tongue reduction is the mainstay of surgical therapy for macroglossia associated with BWS, but limited data are available regarding its efficacy in treating OSA or its effect on speech and swallowing. More research is needed to better identify which children with BWS are at risk for OSA and the most effective treatment for these patients.
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Affiliation(s)
- Christopher M. Cielo
- Division of Pulmonary Medicine, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - Kelly A. Duffy
- Division of Human Genetics, Children’s Hospital of Philadelphia
| | - Aesha Vyas
- Division of Human Genetics, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard Philadelphia, PA 19104, USA.
| | - Jesse A. Taylor
- Department of Surgery, Children’s Hospital of Philadelphia,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania
| | - Jennifer M. Kalish
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania,Division of Human Genetics, Children’s Hospital of Philadelphia
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Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016; 7:CD006937. [PMID: 27428115 PMCID: PMC6457859 DOI: 10.1002/14651858.cd006937.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. OBJECTIVES To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015. SELECTION CRITERIA We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. DATA COLLECTION AND ANALYSIS One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. MAIN RESULTS No randomised controlled trials or group studies were identified. AUTHORS' CONCLUSIONS This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Naomi K Parker
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Helen Kelly
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Nick Miller
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Taste and speech following surgical tongue reduction in children with Beckwith-Wiedemann syndrome. J Craniomaxillofac Surg 2016; 44:659-63. [PMID: 27052941 DOI: 10.1016/j.jcms.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/28/2016] [Accepted: 02/19/2016] [Indexed: 01/03/2023] Open
Abstract
Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder in which macroglossia is one of the main signs. We investigated the long-term outcome of tongue surgery reduction (TRS) on taste and speech in patients with BWS who were more than 5 years of age and had undergone surgical anterior wedge resection of the tongue. A questionnaire was used to assess medical history and to determine some aspects of speech, taste, psychological well-being, and degree of satisfaction with regard to TRS and tongue mobility. Speech sound error pattern and degree of intelligibility were measured by a speech therapist, and taste was assessed using a validated test. The degree of both intelligibility and satisfaction with the surgery was high. There were some speech errors; especially the interdental 's', addental 't', and addental 'd' were more noticed. We conclude that anterior wedge resection is an effective technique to treat macroglossia in children with BWS, and that it has no long-term consequences for intelligibility and taste perception and only limited consequences for speech.
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Impact of fixed implant prosthetics using the ‘all-on-four’ treatment concept on speech intelligibility, articulation and oromyofunctional behaviour. Int J Oral Maxillofac Surg 2012; 41:1550-7. [DOI: 10.1016/j.ijom.2012.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 03/19/2012] [Accepted: 05/16/2012] [Indexed: 11/20/2022]
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