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Mao Z, Tian G, Shrivastava M, Zhou J, Ye L. Complications of Mandibular Distraction Osteogenesis in Infants with Isolated Robin Sequence. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1591. [PMID: 37892254 PMCID: PMC10605000 DOI: 10.3390/children10101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Mandibular Distraction Osteogenesis (MDO) is now the preferred procedure to alleviate airway obstruction in infants with severe Robin Sequence (RS). However, there have been very few studies investigating complications related to MDO surgery performed on patients affected by isolated RS. In this study, age at distraction, weight at distraction, preoperative intubation, repeat MDO and complications associated with MDO were included as variables. Minor, moderate and major problems were evaluated and recorded as surgical site infections (SSI), injuries to the facial nerve, self-extinction hypertrophic scars, temporomandibular joint ankylosis, device failures, early ossification and fibrous non-union. One hundred and fifty one patients with isolated RS were included. At distraction, the mean age was 72 days (12-540 days) and the mean weight was 4.05 kg (2.4-12.2 kg). Only one patient needed tracheostomy after MDO, and none required further distraction. Ultimately, the complication rate was 15.23%, and there was a total of 7.95% minor, 9.27% moderate and 0% major complications. Minor incidents included surgical site infection (SSI) managed with antibiotics taken orally (n = 8), neuropraxia in the VII cranial nerve (CN) (n = 1), and hypertrophic scarring (n = 3). Incidents reported as moderate were SSIs managed with intravenous antibiotics (n = 9), incision and drainage (n = 3) and self-extubation (n = 2). There was no case of TMJ ankylosis. There were no cases of early or premature ossification, fibrous non-union and device fracture. In conclusion, MDO is an effective and appropriate management technique for infants with isolated RS and severe airway obstruction. Infections at the surgery site accounted for the vast majority of the complications. Further investigations may be needed to determine the long-term consequences of MDO.
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Affiliation(s)
- Zhe Mao
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510000, China; (Z.M.)
| | - Gabriel Tian
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mayank Shrivastava
- Orofacial Pain, TMD & Dental Sleep Medicine at Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Jiawei Zhou
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510000, China; (Z.M.)
| | - Liang Ye
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
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Patterns of Change in the Severity of Airway Obstruction with Robin Sequence in Early Infancy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4819. [PMID: 36845867 PMCID: PMC9946428 DOI: 10.1097/gox.0000000000004819] [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: 04/14/2022] [Accepted: 12/15/2022] [Indexed: 02/24/2023]
Abstract
Previous studies suggest that infants with Robin sequence show a pattern of steady improvement in the severity of airway obstruction, and of their treatment requirements, during infancy. Methods Three infants with Robin sequence and severe obstructive sleep apnea were managed with nasal continuous positive airways pressure (CPAP). Multiple measures of airway obstruction were made during infancy, including CPAP pressure evaluations and sleep studies (screening and polysomnography studies). Parameters reported include obstructive apnea-hypopnea index, oxygen desaturation parameters, and CPAP pressures required for effective airway management. Results CPAP pressure requirements increased in all three infants during their first weeks of life. Apnea indices on polysomnography did not track with the CPAP pressure requirements. Peak pressure requirements were at 5 and 7 weeks for two patients, with subsequent gradual decline and cessation of therapy CPAP at 39 and 74 weeks, respectively. The third patient had a complicated course, jaw distraction at 17 weeks, and biphasic CPAP pressure requirement (first peak at 3 weeks, but maximum pressure at 74 weeks), with cessation of CPAP at 75 weeks. Conclusions The observed pattern of early increases in CPAP pressure requirements for infants with Robin sequence adds to the complexities of managing this disorder. Factors that may lead to this pattern of change in airway obstruction are discussed.
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Mao Z, Battaglino R, Zhou J, Cui Y, Shrivastava M, Tian G, Sahebdel F, Ye L. The Effect of Timing of Mandibular Distraction Osteogenesis on Weight Velocity in Infants Affected by Severe Robin Sequence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030319. [PMID: 35327691 PMCID: PMC8947281 DOI: 10.3390/children9030319] [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: 02/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022]
Abstract
Background: Impaired weight gain is prevalent in Robin Sequence (RS) newborns. Although mandibular distraction osteogenesis (MDO) has been proven to improve oral feeding, its impact on postoperative weight gain remains unclear. The purpose of this study is to explore whether MDO can help RS babies reach a normal weight, as well as the effect of MDO timing on weight velocity. Methods: One hundred infants with severe RS and one hundred with normal controls met the inclusion criteria for the study. Included patients underwent MDO. Weights at different timing points were recorded and analyzed and compared to normal controls. Results: After the distractor removal weights of patients undergoing MDO at <1 month and 1−2 months were close to the normal control (6.81 ± 0.93 kg versus 7.18 ± 0.61 kg, p = 0.012, and 6.82 ± 0.98 kg versus 7.37 ± 0.75 kg, p = 0.033, respectively), the weights of patients undergoing MDO at 2−3 months and 3−4 months still lagged behind (7.56 ± 1.29 kg versus 8.20 ± 0.61 kg, p = 0.000206 and 7.36 ± 1.05 kg versus 8.25 ± 0.77 kg, p = 0.004, respectively). The weights of all RS infants undergoing MDO showed no significant difference compared to the controls when they aged to 1 year (9.34 ± 0.99 kg versus 9.55 ± 0.45 kg, p = 0.254 for MDO at <1 month; 9.12 ± 0.91 kg versus 9.33 ± 0.46 kg, p = 0.100 for MDO at 1 to 2 months; 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 2 to 3 months; and 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 3 to 4 months). Conclusion: The MDO procedure helped patients with severe RS to reach a normal weight; and MDO intervention was recommended at an early stage for early weight gain.
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Affiliation(s)
- Zhe Mao
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
| | - Jiawei Zhou
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Yingqiu Cui
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Mayank Shrivastava
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Gabriel Tian
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Faezeh Sahebdel
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
| | - Liang Ye
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
- Correspondence:
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Sood A, Shamim U, Kharbanda OP, Kabra M, Gupta N, Mathur A, Joshi A, Parveen S, Zahra S, Sharma P, Seth M, Khan A, Faruq M, Mishra D. Next Generation Sequencing and Cytogenetic Based Evaluation of Indian Pierre Robin Sequence Families Reveals CNV Regions of Modest Effect and a Novel LOXL3 Mutation. Cleft Palate Craniofac J 2021; 59:1329-1339. [PMID: 34787502 DOI: 10.1177/10556656211052781] [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
BACKGROUND Pierre Robin Sequence (PRS) affects approximately 1 per 8500 to 14000 new-borns worldwide. Although the clinical entity is well defined, the pathogenesis of PRS is debated. The present study aims to understand the contribution of genomic imbalances and genetic variants in patients clinically diagnosed of PRS. METHODOLOGY A total of 7 independent patients with nonsyndromic PRS thoroughly evaluated by a medical geneticist at a tertiary care hospital, were included in the study. Blood samples were collected from these patients and their family members. Array CGH was performed on all 7 patients and their respective family members for detection of underlying cytogenetic defects. Whole exome sequencing (WES) was performed for 5 families to capture single nucleotide variants or small indels. RESULTS Cytogenetic analyses did not detect any previously reported gross chromosomal aberrations for PRS in the patient cohort. However, copy number variations (CNVs) of size <1 Mb were detected in patients which may have implications in PRS. The present study provided evidence for the occurrence of de novo deletions at 7p14.1 locus in PRS patients: further validating the candidate loci susceptibility in oral clefts. WES data identified LOXL3 as candidate gene, carrying novel deleterious variant, which is suggestive of the role of point mutations in the pathogenesis of PRS. CONCLUSION The present study offered considerable insight into the contribution of cytogenetic defects and novel point mutation in the etiology of nonsyndromic PRS. Studies comprising large number of cases are required to fully elucidate the genetic mechanisms underlying the PRS phenotype.
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Affiliation(s)
- Anubhuti Sood
- Centre for Dental Education and Research, 28730All India Institute of Medical Sciences, Delhi, India
| | - Uzma Shamim
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Om P Kharbanda
- Centre for Dental Education and Research, 28730All India Institute of Medical Sciences, Delhi, India
| | | | - Neerja Gupta
- 28730All India Institute of Medical Sciences, Delhi, India
| | - Aradhana Mathur
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Aditi Joshi
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Shaista Parveen
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Sana Zahra
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Pooja Sharma
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Malika Seth
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Afreen Khan
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine, 28840CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Deepika Mishra
- Centre for Dental Education and Research, 28730All India Institute of Medical Sciences, Delhi, India
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Yang R, Li R, Huang Z, Zuo Y, Yue H, Wu H, Gu F, Wang F, He M, Bian Z. Mycn deficiency underlies the development of orofacial clefts in mice and humans. Hum Mol Genet 2021; 31:803-815. [PMID: 34590686 DOI: 10.1093/hmg/ddab288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
Non-syndromic cleft lip with or without cleft palate (NSCL/P) is the most common subphenotype of non-syndromic orofacial clefts (NSOFCs) arising from genetic and/or environmental perturbations during embryonic development. We previously identified 2p24.2 as a risk locus associated with NSCL/P in the Chinese Han population, and MYCN is a candidate risk gene in this region. To understand the potential function of MYCN in craniofacial development, we generated Wnt1-Cre;Mycnflox/flox mice that exhibited cleft palate, microglossia, and micrognathia, resembling the Pierre Robin sequence (PRS) in humans. Further analyses indicated that the cleft palate was secondary to the delayed elevation of palatal shelves caused by micrognathia. The micrognathia resulted from impaired chondrogenic differentiation in Merkel's cartilage, which limited tongue development, leading to microglossia. In terms of mechanism, Mycn deficiency in cranial neural crest cells (CNCCs) downregulated Sox9 expression by inhibiting Wnt5a in a CNCC-derived chondrogenic lineage in Merkel's cartilage. To investigate whether MYCN deficiency contributed to NSCL/P, we performed direct sequencing targeting all exons and exon-intron boundaries of MYCN in 104 multiplex families with mendelian NSCL/P and identified a novel pathogenic variant in MYCN. Taken together, our data indicate that ablation of Mycn in mouse CNCCs could resemble PRS by suppressing the Wnt5a-Sox9 signaling pathway in Merkel's cartilage and that mutations in MYCN may be novel potential causes of NSCL/P.
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Affiliation(s)
- Ruihuan Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Ruyi Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Zhuo Huang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Yining Zuo
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Haitang Yue
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Hailin Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Fan Gu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Fei Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Miao He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
| | - Zhuan Bian
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University
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Yang IH, Chung JH, Lee HJ, Cho IS, Choi JY, Lee JH, Kim S, Baek SH. Characterization of phenotypes and predominant skeletodental patterns in pre-adolescent patients with Pierre-Robin sequence. Korean J Orthod 2021; 51:337-345. [PMID: 34556588 PMCID: PMC8461384 DOI: 10.4041/kjod.2021.51.5.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the phenotypes and predominant skeletodental pattern in pre-adolescent patients with Pierre–Robin sequence (PRS). Methods The samples consisted of 26 Korean pre-adolescent PRS patients (11 boys and 15 girls; mean age at the investigation, 9.20 years) treated at the Department of Orthodontics, Seoul National University Dental Hospital between 1998 and 2019. Dental phenotypes, oral manifestation, cephalometric variables, and associated anomalies were investigated and statistically analyzed. Results Congenitally missing teeth (CMT) were found in 34.6% of the patients (n = 9/26, 20 teeth, 2.22 teeth per patient) with 55.5% (n = 5/9) exhibiting bilaterally symmetric missing pattern. The mandibular incisors were the most common CMT (n = 11/20). Predominant skeletodental patterns included Class II relationship (57.7%), posteriorly positioned maxilla (76.9%) and mandible (92.3%), hyper-divergent pattern (92.3%), high gonial angle (65.4%), small mandibular body length to anterior cranial base ratio (65.4%), linguoversion of the maxillary incisors (76.9%), and linguoversion of the mandibular incisors (80.8%). Incomplete cleft palate (CP) of hard palate with complete CP of soft palate (61.5%) was the most frequently observed, followed by complete CP of hard and soft palate (19.2%) and CP of soft palate (19.2%) (p < 0.05). However, CP severity did not show a significant correlation with any cephalometric variables except incisor mandibular plane angle (p < 0.05). Five craniofacial and 15 extra-craniofacial anomalies were observed (53.8% patients); this implicated the need of routine screening. Conclusions The results might provide primary data for individualized diagnosis and treatment planning for pre-adolescent PRS patients despite a single institution-based data.
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Affiliation(s)
- Il-Hyung Yang
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyeok Joon Lee
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | | | - Jin-Young Choi
- Departement of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Departement of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Sukwha Kim
- Departmentof Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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Murtaza M, Niamat Ali M, Hameed Zargar M. Pierre Robin sequence with a novel mutation in SOX9 gene: Case study. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sarkar S, Jafra A, Mathew P. Emergency airway management in Pierre Robin Sequence, our nightmare experiences. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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9
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Verheijen N, Suttorp CM, van Rheden REM, Regan RF, Helmich MPAC, Kuijpers-Jagtman AM, Wagener FADTG. CXCL12-CXCR4 Interplay Facilitates Palatal Osteogenesis in Mice. Front Cell Dev Biol 2020; 8:771. [PMID: 32974338 PMCID: PMC7471603 DOI: 10.3389/fcell.2020.00771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/22/2020] [Indexed: 12/19/2022] Open
Abstract
Cranial neural crest cells (CNCCs), identified by expression of transcription factor Sox9, migrate to the first branchial arch and undergo proliferation and differentiation to form the cartilage and bone structures of the orofacial region, including the palatal bone. Sox9 promotes osteogenic differentiation and stimulates CXCL12-CXCR4 chemokine-receptor signaling, which elevates alkaline phosphatase (ALP)-activity in osteoblasts to initiate bone mineralization. Disintegration of the midline epithelial seam (MES) is crucial for palatal fusion. Since we earlier demonstrated chemokine-receptor mediated signaling by the MES, we hypothesized that chemokine CXCL12 is expressed by the disintegrating MES to promote the formation of an osteogenic center by CXCR4-positive osteoblasts. Disturbed migration of CNCCs by excess oxidative and inflammatory stress is associated with increased risk of cleft lip and palate (CLP). The cytoprotective heme oxygenase (HO) enzymes are powerful guardians harnessing injurious oxidative and inflammatory stressors and enhances osteogenic ALP-activity. By contrast, abrogation of HO-1 or HO-2 expression promotes pregnancy pathologies. We postulate that Sox9, CXCR4, and HO-1 are expressed in the ALP-activity positive osteogenic regions within the CNCCs-derived palatal mesenchyme. To investigate these hypotheses, we studied expression of Sox9, CXCL12, CXCR4, and HO-1 in relation to palatal osteogenesis between E15 and E16 using (immuno)histochemical staining of coronal palatal sections in wild-type (wt) mice. In addition, the effects of abrogated HO-2 expression in HO-2 KO mice and inhibited HO-1 and HO-2 activity by administrating HO-enzyme activity inhibitor SnMP at E11 in wt mice were investigated at E15 or E16 following palatal fusion. Overexpression of Sox9, CXCL12, CXCR4, and HO-1 was detected in the ALP-activity positive osteogenic regions within the palatal mesenchyme. Overexpression of Sox9 and CXCL12 by the disintegrating MES was detected. Neither palatal fusion nor MES disintegration seemed affected by either HO-2 abrogation or inhibition of HO-activity. Sox9 progenitors seem important to maintain the CXCR4-positive osteoblast pool to drive osteogenesis. Sox9 expression may facilitate MES disintegration and palatal fusion by promoting epithelial-to-mesenchymal transformation (EMT). CXCL12 expression by the MES and the palatal mesenchyme may promote osteogenic differentiation to create osteogenic centers. This study provides novel evidence that CXCL12-CXCR4 interplay facilitates palatal osteogenesis and palatal fusion in mice.
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Affiliation(s)
- Nanne Verheijen
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christiaan M Suttorp
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - René E M van Rheden
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Raymond F Regan
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Maria P A C Helmich
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.,Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Frank A D T G Wagener
- Department of Dentistry - Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Mandibular Distraction in Robin Sequence With Multi-Level Airway Disease: Always Contraindicated? J Craniofac Surg 2020; 31:1883-1887. [DOI: 10.1097/scs.0000000000006620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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11
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Cleary B, Loane M, Addor MC, Barisic I, de Walle HEK, Matias Dias C, Gatt M, Klungsoyr K, McDonnell B, Neville A, Pierini A, Rissmann A, Tucker DF, Zurriaga O, Dolk H. Methadone, Pierre Robin sequence and other congenital anomalies: case-control study. Arch Dis Child Fetal Neonatal Ed 2020; 105:151-157. [PMID: 31229957 DOI: 10.1136/archdischild-2019-316804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
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Affiliation(s)
- Brian Cleary
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, INHR, Ulster University, Newtowanbbey, UK
| | - Marie-Claude Addor
- Division Autonome de Genetique Medicale, Registre Vaudois des Malformations, Vaud, Switzerland
| | - Ingeborg Barisic
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hermien E K de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Miriam Gatt
- Department of Health Information, Malta Congenital Anomalies Registry, G'mangia, Malta
| | - Kari Klungsoyr
- Medical Birth Register of Norway, Nasjonalt folkehelseinstitutt, Oslo, Norway
| | | | - Amanda Neville
- Azienda Ospedaliero - Universitaria di Ferrara, Registro IMER, Ferrara, Italy
| | | | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - David F Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, UK
| | - Oscar Zurriaga
- Centro Superior de Investigación en Salud Pública, Valencia, Spain.,Direccion General de Investigación y Salud Pública, Valencia, Spain
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Yekula A, Grant C, Gupta M, Santiago-Dieppa DR, Duddleston PJ, Gonda D, Levy M. Clinical and genetic characterization of patients with Pierre Robin sequence and spinal disease: review of the literature and novel terminal 10q deletion. Childs Nerv Syst 2020; 36:1367-1377. [PMID: 32399800 PMCID: PMC7300078 DOI: 10.1007/s00381-020-04642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Pierre-Robin sequence (PRS) is a pattern of congenital facial abnormalities comprising micrognathia, glossoptosis, and airway obstruction. Associated spinal pathologies have rarely been reported with PRS. METHODS We explore the molecular genetic basis of this association through a systematic review of spinal disease in patients with PRS. We also present an illustrative case of a PRS patient with tethered cord in the setting of chromosome 10q terminal deletion. RESULTS Our systematic literature review of spinal disease in patients with PRS revealed several patterns in the underlying genetic syndromes causing these conditions to co-occur. These principles are illustrated in the case of a 6-month-old female with PRS and a 14.34-Mb terminal deletion of chromosome 10q, who was found to have a sacral dimple during a routine outpatient checkup. Magnetic resonance imaging of the spine revealed a lumbar syrinx associated with tethered spinal cord. Surgical de-tethering was undertaken, with subsequent improvement in motor function and decrease in the size of the syrinx. The deletion of chromosome 10q in our patient had not previously been described in association with tethered cord or PRS. CONCLUSION Spinal pathologies are understudied contributors to disease burden in patients with PRS. The range of predisposing syndromes and mutations in patients with both PRS and spinal disorders remains poorly characterized but may be more defined than previously conceived. Clinical screening is most critical during neonatal and adolescent developmental periods with continued neurological assessment. This study emphasizes the need for early genetic testing and counseling in this patient population, in parallel with research efforts to develop molecular classifications to guide clinical management.
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Affiliation(s)
- Anudeep Yekula
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA USA
| | - Connor Grant
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA
| | - Mihir Gupta
- Department of Neurosurgery, University of California San Diego, La Jolla, CA, USA. .,, San Diego, CA, USA.
| | | | | | - David Gonda
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA ,Department of Pediatric Neurosurgery, Rady Children’s Hospital, San Diego, CA USA
| | - Michael Levy
- Department of Neurosurgery, University of California San Diego, La Jolla, CA USA ,Department of Pediatric Neurosurgery, Rady Children’s Hospital, San Diego, CA USA
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Abu-Ghname A, Masoumy M, Monson LA. Cervical Stenosis in Non-Syndromic Pierre Robin Sequence. J Craniofac Surg 2019; 30:1866-1868. [PMID: 31283644 DOI: 10.1097/scs.0000000000005727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pierre Robin sequence is a triad of micrognathia, glossoptosis, and airway obstruction that has reported associations with numerous birth defects and anomalies including craniocervical pathologies. Given the number of airway assessments and neck manipulations these neonates experience, undetected cervical instability can result in detrimental consequences. The authors present a case of a neonate with non-syndromic Pierre Robin sequence planned for mandibular distraction osteogenesis that developed abnormal motor activity following intubation. The patient was eventually diagnosed with cervical spine stenosis and craniocervical instability after radiologic investigation. This paper demonstrates the significance of preoperative cervical spine evaluation and the importance of maintaining high level of suspicion when performing neck manipulations in those high-risk infants.
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Affiliation(s)
- Amjed Abu-Ghname
- Division of Plastic Surgery at Texas Children's Hospital/ Michael E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, TX
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14
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Male individuals with Robin Sequence: emerging significant association with ABO and RhD blood group phenotypes. Hematol Transfus Cell Ther 2018; 40:354-357. [PMID: 30370413 PMCID: PMC6200685 DOI: 10.1016/j.htct.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background This study investigated the association of Robin Sequence with ABO and RhD blood group phenotypes. Methods A retrospective cross-sectional study was performed of a cohort of Robin Sequence patients of the Hospital de Reabilitação de Anomalias Craniofaciais – Universidade de São Paulo (USP), Brazil. The study group was composed of 339 individuals of both genders with Robin Sequence referred for specific treatment. A control group was composed of 1780 individuals without syndromes. The groups were compared using the Pearson’ chi-square test (χ2) with statistical significance being defined for an alpha error of 5% (p-value < 0.05). Results A comparison of gender found a significant difference for the AB phenotype between groups (p-value = 0.007). Comparing blood type by gender there was no significant difference within the same group (p-value = 0.117 and 0.388 respectively, for Robin Sequence and the control group). When comparing the AB blood type between groups, there was no difference for females (p-value = 0.577), but there was a significant difference for males (p-value = 0.0029). Conclusions This study showed that the population with Robin Sequence had different patterns related to gender concerning the phenotypic distribution of ABO and RhD blood group phenotypes. Robin Sequence is more common among females. The AB phenotype was significantly higher in males with Robin Sequence than in males of the Control Group. The prevalence of the RhD-negative phenotype is higher in individuals with Robin Sequence. This result suggests a possible association of ABO and RhD phenotypes with Robin Sequence that should be better investigated by molecular studies, as it deserves greater attention.
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15
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The Effect of Mandibular Distraction Osteogenesis on Weight Velocity in Infants With Severe Pierre Robin Syndrome. J Craniofac Surg 2018; 29:1851-1854. [DOI: 10.1097/scs.0000000000004650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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16
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Yang Y, Yuan J, Yao X, Zhang R, Yang H, Zhao R, Guo J, Jin K, Mei H, Luo Y, Zhao L, Tu M, Zhu Y. BMPR1B mutation causes Pierre Robin sequence. Oncotarget 2018; 8:25864-25871. [PMID: 28418932 PMCID: PMC5432222 DOI: 10.18632/oncotarget.16531] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/27/2017] [Indexed: 01/18/2023] Open
Abstract
Background We investigated a large family with Pierre Robin sequence (PRS). Aim of the study This study aims to determine the genetic cause of PRS. Results The reciprocal translocation t(4;6)(q22;p21) was identified to be segregated with PRS in a three-generation family. Whole-genome sequencing and Sanger sequencing successfully detected breakpoints in the intragenic regions of BMRP1B and GRM4. We hypothesized that PRS in this family was caused by (i) haploinsufficiency for BMPR1B or (ii) a gain of function mechanism mediated by the BMPR1B-GRM4 fusion gene. In an unrelated family, we identified another BMPR1B-splicing mutation that co-segregated with PRS. Conclusion We detected two BMPR1B mutations in two unrelated PRS families, suggesting that BMPR1B disruption is probably a cause of human PRS. Methods GTG banding, comparative genomic hybridization, whole-genome sequencing, and Sanger sequencing were performed to identify the gene causing PRS.
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Affiliation(s)
- Yongjia Yang
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,Institute of Emergency Medicine, People's Hospital of Hunan Province, Changsha, China
| | - Jianying Yuan
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,BGI-Shenzhen, Shenzhen, China
| | - Xu Yao
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Rong Zhang
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,Division of Neonatology, Hunan Children's Hospital, University of South China, Changsha, China
| | - Hui Yang
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,Division of Neonatology, Hunan Children's Hospital, University of South China, Changsha, China
| | - Rui Zhao
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Jihong Guo
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,State Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Ke Jin
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Haibo Mei
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Yongqi Luo
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Liu Zhao
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Ming Tu
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China
| | - Yimin Zhu
- The Laboratory of Genetics and Metabolism, Hunan Children's Research Institute , Hunan Children's Hospital, University of South China, Changsha, China.,Institute of Emergency Medicine, People's Hospital of Hunan Province, Changsha, China
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17
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Zhu X, Evans KN, El-Gharbawy A, Lee JY, Brooker JE, Jabbour N, Tyler-Kabara EC, Madan-Khertarpal S, Losee JE, Goldstein JA. Cervical Spine Injury From Unrecognized Craniocervical Instability in Severe Pierre Robin Sequence Associated With Skeletal Dysplasia. Cleft Palate Craniofac J 2018; 55:773-777. [PMID: 29489401 DOI: 10.1177/1055665618758102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pierre Robin Sequence (PRS) can be associated with skeletal dysplasias, presenting with craniocervical instability and devastating spinal injury if unrecognized. The authors present the case of an infant with PRS and a type II collagenopathy who underwent multiple airway-securing procedures requiring spinal manipulation before craniocervical instability was identified. This resulted in severe cervical cord compression due to odontoid fracture and occipitoatlantoaxial instability. This case highlights the importance of early cervical spine imaging and cautious manipulation in infants with PRS and suspected skeletal dysplasia.
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Affiliation(s)
- Xiao Zhu
- 1 Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Kelly N Evans
- 2 Division of Craniofacial Medicine, University of Washington School of Medicine, Washington, DC, USA
| | - Areeg El-Gharbawy
- 3 Division of Medical Genetics, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Jonathan Y Lee
- 1 Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Jack E Brooker
- 1 Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Noel Jabbour
- 4 Division of Pediatric Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Elizabeth C Tyler-Kabara
- 5 Division of Pediatric Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Suneeta Madan-Khertarpal
- 3 Division of Medical Genetics, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Joseph E Losee
- 1 Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - Jesse A Goldstein
- 1 Division of Pediatric Plastic Surgery, University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
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18
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Capkova P, Santava A, Markova I, Stefekova A, Srovnal J, Staffova K, Durdová V. Haploinsufficiency of BMP4 and OTX2 in the Foetus with an abnormal facial profile detected in the first trimester of pregnancy. Mol Cytogenet 2017; 10:47. [PMID: 29299063 PMCID: PMC5745897 DOI: 10.1186/s13039-017-0351-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/18/2017] [Indexed: 01/25/2023] Open
Abstract
Background Interstitial microdeletion 14q22q23 is a rare chromosomal syndrome associated with variable defects: microphthalmia/anophthalmia, pituitary anomalies, polydactyly/syndactyly of hands and feet, micrognathia/retrognathia. The reports of the microdeletion 14q22q23 detected in the prenatal stages are limited and the range of clinical features reveals a quite high variability. Case presentation We report a detection of the microdeletion 14q22.1q23.1 spanning 7,7 Mb and involving the genes BMP4 and OTX2 in the foetus by multiplex ligation-dependent probe amplification (MLPA) and verified by microarray subsequently. The pregnancy was referred to the genetic counselling for abnormal facial profile observed in the first trimester ultrasound scan and micrognathia (suspicion of Pierre Robin sequence), hypoplasia nasal bone and polydactyly in the second trimester ultrasound scan. The pregnancy was terminated on request of the parents. Conclusion An abnormal facial profile detected on prenatal scan can provide a clue to the presence of rare chromosomal abnormalities in the first trimester of pregnancy despite the normal result of the first trimester screening test. The patients should be provided with genetic counselling. Usage of quick and sensitive methods (MLPA, microarray) is preferable for discovering a causal aberration because some of the CNVs cannot be detected with conventional karyotyping in these cases. To the best of our knowledge, this is the earliest detection of this microdeletion (occurred de novo), the first case detected by MLPA and confirmed by microarray. Literature review of the genotype-phenotype correlation in similar reports leads us to the conclusion that dosage imbalance of the chromosomal segment 14q22q23 (especially haploinsuffiency of the genes BMP4 and OTX2) contributes significantly to orofacial abnormalities. Association of the region with the Pierre Robin sequence appears to be plausible.
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Affiliation(s)
- Pavlina Capkova
- Department of Medical Genetics, University Hospital Olomouc, I.P.Pavlova 6, Olomouc, Czech Republic
| | - Alena Santava
- Department of Medical Genetics, University Hospital Olomouc, I.P.Pavlova 6, Olomouc, Czech Republic
| | - Ivana Markova
- Department of Obstetrics and Gynaecology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Andrea Stefekova
- Department of Medical Genetics, University Hospital Olomouc, I.P.Pavlova 6, Olomouc, Czech Republic
| | - Josef Srovnal
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Katerina Staffova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Veronika Durdová
- Department of Obstetrics and Gynaecology, University Hospital Olomouc, Olomouc, Czech Republic
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19
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Di Pasquo E, Amiel J, Roth P, Malan V, Lind K, Chalouhi C, Soupre V, Gordon CT, Lyonnet S, Salomon LJ, Abadie V. Efficiency of prenatal diagnosis in Pierre Robin sequence. Prenat Diagn 2017; 37:1169-1175. [DOI: 10.1002/pd.5162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Elvira Di Pasquo
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
| | - Jeanne Amiel
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Philippe Roth
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
| | - Valérie Malan
- Cytogenetics Laboratory; Necker Hospital; Paris France
| | - Katia Lind
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
| | - Christel Chalouhi
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
| | | | - Christopher T. Gordon
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Stanislas Lyonnet
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Laurent J. Salomon
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Véronique Abadie
- Paris Descartes-Sorbonne Paris Cité University; Paris France
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
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20
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Resnick CM, Estroff JA, Kooiman TD, Calabrese CE, Koudstaal MJ, Padwa BL. Pathogenesis of Cleft Palate in Robin Sequence: Observations From Prenatal Magnetic Resonance Imaging. J Oral Maxillofac Surg 2017; 76:1058-1064. [PMID: 29125932 DOI: 10.1016/j.joms.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/19/2017] [Accepted: 10/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The etiology of the palatal cleft in Robin sequence (RS) is unknown. The purpose of this study was to assess the position of the fetal tongue at prenatal magnetic resonance imaging (MRI) and to suggest a potential relation between tongue position and development of the cleft palate seen in most patients with RS. MATERIALS AND METHODS This is a retrospective case-and-control study including fetuses with prenatal MRIs performed in the authors' center from 2002 to 2017. Inclusion criteria were 1) prenatal MRI of adequate quality, 2) liveborn infant, and 3) postnatal diagnosis of RS (Robin group) or cleft lip and palate (CLP group). Patients with postnatal RS without a palatal cleft were excluded. A control group with normal facial morphology was matched by gestational age. The outcome variable was tongue position at fetal MRI, described as within the cleft, along the floor of the mouth (normal), other, or indeterminate. RESULTS One hundred twenty-two patients with mean gestational age at MRI of 25.8 ± 4.9 weeks were included (Robin, n = 21 [17%]; CLP, n = 47 [39%]; control, n = 54 [44%]). The tongue was visualized within the palatal cleft in 76.2% of the Robin group and 4.3% of the CLP group. The tongue was found along the floor of the mouth (normal) in the remainder of the Robin and CLP groups and in 100% of the control group. CONCLUSION These findings suggest a relation between in utero tongue position and the development of cleft palate in RS.
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Affiliation(s)
- Cory M Resnick
- Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston; Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
| | - Judy A Estroff
- Associate Professor of Radiology, Harvard Medical School, Boston; Radiologist, Division Chief, Fetal-Neonatal Imaging, Department of Radiology, Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | - Tessa D Kooiman
- Medical Student, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carly E Calabrese
- Clinical Research Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Research Associate, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA; Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Bonnie L Padwa
- Associate Professor, Harvard School of Dental Medicine and Harvard Medical School, Boston; Oral Surgeon-in-Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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21
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Thieme F, Ludwig K. The Role of Noncoding Genetic Variation in Isolated Orofacial Clefts. J Dent Res 2017; 96:1238-1247. [DOI: 10.1177/0022034517720403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the past decade, medical genetic research has generated multiple discoveries, many of which were obtained via genome-wide association studies (GWASs). A major GWAS finding is that the majority of risk variants for complex traits map to noncoding regions. This has resulted in a paradigm shift in terms of the interpretation of human genomic sequence variation, with more attention now being paid to what was previously termed “junk DNA.” Translation of genetic findings into biologically meaningful results requires 1) large-scale and cell-specific efforts to annotate non-protein–coding regions and 2) the integration of comprehensive genomic data sets. However, this represents an enormous challenge, particularly in the case of human traits that arise during embryonic development, such as orofacial clefts (OFCs). OFC is a multifactorial trait and ranks among the most common of all human congenital malformations. These 2 attributes apply in particular to its isolated forms (nonsyndromic OFC [nsOFC]). Although genetic studies (including GWASs) have yielded novel insights into the genetic architecture of nsOFC, few data are available concerning causality and affected biological pathways. Reasons for this deficiency include the complex genetic architecture at risk loci and the limited availability of functional data sets from human tissues that represent relevant embryonic sites and time points. The present review summarizes current knowledge of the role of noncoding regions in nsOFC etiology. We describe the identification of genetic risk factors for nsOFC and several of the approaches used to identify causal variants at these loci. These strategies include the use of biological and genetic information from public databases, the assessment of the full spectrum of genetic variability within 1 locus, and comprehensive in vitro and in vivo experiments. This review also highlights the role of the emerging research field “functional genomics” and its increasing contribution to our biological understanding of nsOFC.
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Affiliation(s)
- F. Thieme
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - K.U. Ludwig
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
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22
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Bejiqi R, Retkoceri R, Xhema-Bejiqi H, Bejiqi R, Maloku A. A Giant Heart Tumor in Neonate with Clinical Signs of Pierre - Robin Syndrome. Med Arch 2017; 71:141-143. [PMID: 28790548 PMCID: PMC5511525 DOI: 10.5455/medarh.2017.71.141-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pierre Robin syndrome is a congenital condition of facial abnormalities in humans. The three main features are: cleft palate, retrognathia and glossoptosis. Rarely heart tumors are associated with syndromes, mostly are isolated. CASE REPORT In this presentation we describe a 3-weeks-old girl with Pierre-Robin syndrome and giant left ventricle tumor, diagnosed initially by transthoracic echocardiography. The purpose of this report is to review the literature on the fetuses and neonates with cardiac tumors in an attempt to determine the various ways which cardiac tumors differ clinically and morphologically in this age group.
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Affiliation(s)
- Ramush Bejiqi
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
| | - Ragip Retkoceri
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
| | | | - Rinor Bejiqi
- Medical School, University of Prishtina, Prishtina, Republic of Kosovo
| | - Arlinda Maloku
- University of Gjakova, Division of Cardiology, Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Republic of Kosovo
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23
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Takeshita S, Ueda H, Goto T, Muto D, Kakita H, Oshima K, Tainaka T, Ono T, Kazaoka Y, Yamada Y. Case report of Pierre Robin sequence with severe upper airway obstruction who was rescued by fiberoptic nasotracheal intubation. BMC Anesthesiol 2017; 17:43. [PMID: 28288578 PMCID: PMC5348775 DOI: 10.1186/s12871-017-0336-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pierre Robin sequence (PRS) refers to the association of micrognathia, glossoptosis, and airway obstruction. Cases with severe dyspnea due to upper airway obstruction immediately after birth are very rare. We here report two cases with PRS who developed severe dyspnea due to morphological abnormality immediately after birth and were rescued by fiberoptic nasotracheal intubation. CASE PRESENTATION The patient in case 1 had micrognathia and cleft palate, and his tongue protruded into the nasal cavity via a cleft palate. His invaginated tongue was considered an extreme type of glossoptosis and he was diagnosed as Pierre Robin sequence. The patient in case 2 also had micrognathia and cleft palate same as case 1 and accompanied some anomalad. Her chromosome analysis confirmed a diagnosis of 1p36 deletion syndrome and she diagnosed as 1p36 deletion syndrome complicated with Pierre Robin sequence. In both cases, tongue protruded into the nasal cavity via a cleft palate occupied pharynx and nasal cavity, resulting in severe dyspnea. Only the backside of the tongue was visible by laryngoscopy and oropharyngeal intubation was impossible. Therefore, fiberoptic nasotracheal intubation was done to secure the airway for resuscitation. CONCLUSION We conclude that extreme type of glossoptosis in PRS concludes tongue invaginated into nasal cavity which have not reported before and that such cases require resuscitation by fiberoptic intubation immediately after birth. As such, neonatologists should obtain the skill of fiberoptic intubation.
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Affiliation(s)
- Satoru Takeshita
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Hiroko Ueda
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Tatenobu Goto
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Daisuke Muto
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Hiroki Kakita
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Kazuo Oshima
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Takayuki Ono
- Oral Surgery Department, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yoshiaki Kazaoka
- Oral Surgery Department, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yasumasa Yamada
- Perinatal and Neonatal Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
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Jia ZL, He S, Jiang SY, Zhang BH, Duan SJ, Shi JY, Huang N, Zhu WC, Shi B. Rs12941170 at SOX9 gene associated with orofacial clefts in Chinese. Arch Oral Biol 2016; 76:14-19. [PMID: 28068523 DOI: 10.1016/j.archoralbio.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 10/20/2016] [Accepted: 12/27/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Non-syndromic orofacial cleftings (NSOCs) are considered as complex trait, which results from genetic and/or environmental modifiers. Current findings could only explain small portion of the NSOCs. SOX9 gene plays an important role during craniofacial development in animal models and the Pierre Robin sequence (PRS). However, its role in non-syndromic clefts remains unknown. DESIGN In this study, we selected eight SNPs in and around SOX9 gene to make maximum coverage, and genotyped them by using RFLP-PCR and ligase detection reaction (LDR) methods to test its associations among 151 NSOCs (53 NSCLP, 52 NSCLO and 46 NSCPO) from Western Han Chinese population. RESULTS Allelic TDT results showed that G allele at rs12941170 of SOX9 was under-transmitted among NSOCs (p=0.00014, OR=0.55 and 95%CI: 0.40-0.75), which could indicate that the G allele is protective against NSOCs; parent-of-origin effect analysis showed that G allele at rs12941170 was maternally under-transmitted (p=0.002), while there was no statistically difference between the maternal and paternal transmission of it. To test if the adjacent SNPs travel together from parents to the affected individual, we carried out the sliding window haplotype analysis, it is interesting to find that the haplotypes carrying the G allele at rs12941170 also was under-transmitted for NSOCs, NSCL/P, NSCLP and NSCPO (lowest p=0.00033). CONCLUSIONS This study suggested that G allele at rs12941170 was protective, which could decrease the risk for NSOCs from Western Han Chinese population, and it will provide new reference for future research and genetic counseling in NSOCs.
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Affiliation(s)
- Zhong-Lin Jia
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Sha He
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China; Department of Stomatology, The third People's hospital of Chengdu, Chengdu, PR China
| | - Shu-Yuan Jiang
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China
| | - Bi-He Zhang
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China
| | - Shi-Jun Duan
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China
| | - Jia-Yu Shi
- Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California, Los Angeles, CA 90095, United States
| | - Ning Huang
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China
| | - Wen-Chao Zhu
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China
| | - Bing Shi
- State Key Laboratory of Oral Disease, West China hospital of Stomatology, Sichuan University, Chengdu, PR China; Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu, PR China.
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25
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Basart H, van Oers HA, Paes EC, Breugem CC, Don Griot JPW, van der Horst CMAM, Haverman L, Hennekam RC. Health-related quality of life in children with Robin sequence. Am J Med Genet A 2016; 173:54-61. [DOI: 10.1002/ajmg.a.37968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 08/12/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Hanneke Basart
- Department of Pediatrics, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Department of Plastic and Reconstructive Surgery, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Hedy A. van Oers
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Emma C. Paes
- Department of Plastic and Reconstructive Surgery; Wilhelmina Pediatric Hospital; Utrecht The Netherlands
| | - Corstiaan C. Breugem
- Department of Plastic and Reconstructive Surgery; Wilhelmina Pediatric Hospital; Utrecht The Netherlands
| | - J. Peter W. Don Griot
- Department of Plastic and Reconstructive Surgery, VU Medical Center; Free University; Amsterdam The Netherlands
| | - Chantal M. A. M. van der Horst
- Department of Plastic and Reconstructive Surgery, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Raoul C. Hennekam
- Department of Pediatrics, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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26
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Gomez-Ospina N, Bernstein JA. Clinical, cytogenetic, and molecular outcomes in a series of 66 patients with Pierre Robin sequence and literature review: 22q11.2 deletion is less common than other chromosomal anomalies. Am J Med Genet A 2016; 170A:870-80. [PMID: 26756138 DOI: 10.1002/ajmg.a.37538] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/17/2015] [Indexed: 01/01/2023]
Abstract
Pierre Robin sequence (PRS) is an important craniofacial anomaly that can be seen as an isolated finding or manifestation of multiple syndromes. 22q11.2 deletion and Stickler syndrome are cited as the two most common conditions associated with PRS, but their frequencies are debated. We performed a retrospective study of 66 patients with PRS and reviewed their genetic testing, diagnoses, and clinical findings. The case series is complemented by a comprehensive literature review of the nature and frequency of genetic diagnosis in PRS. In our cohort 65% of patients had associated anomalies; of these, a genetic diagnosis was established in 56%. Stickler syndrome was the most common diagnosis, comprising approximately 11% of all cases, followed by Treacher Collins syndrome (9%). The frequency of 22q11.2 deletion was 1.5%. Chromosome arrays, performed for 72% of idiopathic PRS with associated anomalies, revealed two cases of 18q22→qter deletion, a region not previously reported in association with PRS. A review of the cytogenetic anomalies identified in this population supports an association between the 4q33-qter, 17q24.3, 2q33.1, and 11q23 chromosomal loci and PRS. We found a low frequency of 22q11.2 deletion in PRS, suggesting it is less commonly implicated in this malformation. Our data also indicate a higher frequency of cytogenetic anomalies in PRS patients with associated anomalies, and a potential new link with the 18q22→qter locus. The present findings underscore the utility of chromosomal microarrays in cases of PRS with associated anomalies and suggest that delaying testing for apparently isolated cases should be considered.
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Basart H, Paes EC, Maas SM, van den Boogaard MJH, van Hagen JM, Breugem CC, Cobben JM, Don Griot JPW, Lachmeijer AMA, Lichtenbelt KD, van Nunen DPF, van der Horst CM, Hennekam RC. Etiology and pathogenesis of robin sequence in a large Dutch cohort. Am J Med Genet A 2015; 167A:1983-92. [DOI: 10.1002/ajmg.a.37154] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/05/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Hanneke Basart
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
- Department of Plastic and Reconstructive Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Emma C. Paes
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Saskia M. Maas
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | | | | | - Corstiaan C. Breugem
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Jan Maarten Cobben
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - J. Peter W. Don Griot
- Department of Plastic; Reconstructive and Hand Surgery; VU Medical Center; Amsterdam Netherlands
| | | | - Klaske D. Lichtenbelt
- Department of Clinical Genetics; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Daan P. F. van Nunen
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Chantal M. van der Horst
- Department of Plastic and Reconstructive Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Raoul C. Hennekam
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
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Pengelly R, Upstill-Goddard R, Arias L, Martinez J, Gibson J, Knut M, Collins A, Ennis S, Collins A, Briceno I. Resolving clinical diagnoses for syndromic cleft lip and/or palate phenotypes using whole-exome sequencing. Clin Genet 2015; 88:441-9. [DOI: 10.1111/cge.12547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/13/2014] [Accepted: 11/26/2014] [Indexed: 01/19/2023]
Affiliation(s)
- R.J. Pengelly
- Genetic Epidemiology and Genomic Informatics, Faculty of Medicine; University of Southampton; Southampton UK
| | - R. Upstill-Goddard
- Genetic Epidemiology and Genomic Informatics, Faculty of Medicine; University of Southampton; Southampton UK
| | - L. Arias
- Department of Biomedical Sciences, Medical School; Universidad de La Sabana; Bogota Colombia
| | - J. Martinez
- Department of Biomedical Sciences, Medical School; Universidad de La Sabana; Bogota Colombia
| | - J. Gibson
- Centre for Biological Sciences, Faculty of Natural & Environmental Sciences; University of Southampton; Southampton UK
| | - M. Knut
- Genetic Epidemiology and Genomic Informatics, Faculty of Medicine; University of Southampton; Southampton UK
| | - A.L. Collins
- Department of Clinical Genetics; Southampton General Hospital; Southampton UK
| | - S. Ennis
- Genetic Epidemiology and Genomic Informatics, Faculty of Medicine; University of Southampton; Southampton UK
| | - A. Collins
- Genetic Epidemiology and Genomic Informatics, Faculty of Medicine; University of Southampton; Southampton UK
| | - I. Briceno
- Department of Biomedical Sciences, Medical School; Universidad de La Sabana; Bogota Colombia
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29
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Sun M, Zhang H, Li G, Wang X, Lu X, Sternenberger A, Guy C, Li W, Lee J, Zheng L, Li S. 16p13.3 duplication associated with non-syndromic pierre robin sequence with incomplete penetrance. Mol Cytogenet 2014; 7:76. [PMID: 25493098 PMCID: PMC4260201 DOI: 10.1186/s13039-014-0076-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pierre Robin sequence (PRS) is a condition present at birth. It is characterized by micrognathia, cleft palate, upper airway obstruction, and feeding problems. Multiple etiologies including genetic defects have been documented in patients with syndromic, non-syndromic, and isolated PRS. CASE PRESENTATION We report a 4-year-old boy with a complex small supernumerary marker chromosome (sSMC) who had non-syndromic Pierre Robin sequence (PRS). The complex marker chromosome, der(14)t(14;16)(q11.2;p13.13), was initially identified by routine chromosomal analysis and subsequently characterized by array-comparative genomic hybridization (array CGH) and confirmed by fluorescence in situ hybridization (FISH). Clinical manifestations included micrognathia, U-type cleft palate, bilateral congenital ptosis, upslanted and small eyes, bilateral inguinal hernias, umbilical hernia, bilateral clubfoot, and short fingers and toes. To our best knowledge, this was the first case diagnosed with non-syndromic PRS associated with a complex sSMC, which involved a 3.8 Mb gain in the 14q11.2 region and an 11.8 Mb gain in the 16p13.13-pter region. CONCLUSIONS We suggest that the duplicated chromosome segment 16p13.3 possibly may be responsible for the phenotypes of our case and also may be a candidate locus of non-syndromic PRS. The duplicated CREBBP gene within chromosome 16p13.3 is associated with incomplete penetrance regarding the mandible development anomalies. Further studies of similar cases are needed to support our findings.
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Affiliation(s)
- Mingran Sun
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
- />Key Laboratory for Molecular Enzymology and Engineering, College of Life Sciences, Jilin University, Changchun, Jilin 130012 P. R. China
| | - Han Zhang
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
- />Department of Obstetrics and Gynecology, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia V6T 1Z4 Canada
| | - Guiying Li
- />Key Laboratory for Molecular Enzymology and Engineering, College of Life Sciences, Jilin University, Changchun, Jilin 130012 P. R. China
| | - Xianfu Wang
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
| | - Xianglan Lu
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
| | - Andrea Sternenberger
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
| | - Carrie Guy
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
| | - Wenfu Li
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
| | - Jiyun Lee
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
- />Department of Pathology, College of Medicine, Korea University, Seoul, 136-701 South Korea
| | - Lei Zheng
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
- />Genetics Laboratory, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu 730050 P. R. China
| | - Shibo Li
- />Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104 USA
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30
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Kılıç SC, Kılıç N, Oktay H, Kiki A. Pierre Robin sequence from orthodontic and surgical perspective. World J Stomatol 2014; 3:30-37. [DOI: 10.5321/wjs.v3.i4.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/03/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and cleft palate that results in an obstruction of the airway on inspiration and impeding feeding. The tongue of infants with PRS fall back toward the posterior pharyngeal wall (glossoptosis) due to receding chin produced by mandibular micrognathia (small jaw) or retrognathia. This causes a serious condition with potentially severe, life-threatening airway obstruction. If untreated, this problem can lead to exhaustion, cardiac failure, and ultimately death, especially during the early months of life. Actually, in the majority of PRS infants, these symptoms can be managed by placing the infant in the prone position until adequate growth of the jaw occurs. If this type of treatment fails, the infant then should be considered for other conservative therapies or surgical interventions. This paper reviews surgical interventions such as tongue-lip adhesion, mandibular traction, mandibular distraction, tracheotomy and conservative orthodontic approaches, and presents a baby treated successfully with an orthodontic appliance.
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31
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Isolated Robin sequence in siblings: Review of current concepts. J Plast Reconstr Aesthet Surg 2014; 67:e259-65. [DOI: 10.1016/j.bjps.2014.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/30/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
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Salerno S, Gagliardo C, Vitabile S, Militello C, La Tona G, Giuffrè M, Lo Casto A, Midiri M. Semi-automatic volumetric segmentation of the upper airways in patients with pierre robin sequence. Neuroradiol J 2014; 27:487-94. [PMID: 25196625 DOI: 10.15274/nrj-2014-10067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/24/2014] [Indexed: 11/12/2022] Open
Abstract
Pierre Robin malformation is a rare craniofacial dysmorphism whose pathogenesis is multifactorial. Although there is some agreement in non-invasive treatment in less severe cases, the dispute is still open on cases with severe respiratory impairment. We present a semi-automatic novel diagnostic tool for calculating upper airway volume, in order to eventually address surgery in patients with Pierre Robin Sequence (PRS). Multidetector CT datasets of two patients and two controls were tested to assess the proposed method for ROI segmentation, upper airway volume computation and three-dimensional reconstructions. The experimental results show an irregular pattern and a severely reduced cross-sectional area (CSA) with a mean value of 8.3808 mm(2) in patients with PRS and a mean CSA value of 33.7692 mm(2) in controls (a ΔCSA of about -75%). Moreover, the similarity indexes and sensitivity/specificity values obtained showed a good segmentation performance. In particular, mean values of Jaccard and Dice similarity indexes were 91.69% and 94.07%, respectively, while the mean values of specificity and sensitivity were 96.69% and 98.03%, respectively. The proposed tool represents an easy way to perform a quantitative analysis of airway volume and useful 3D reconstructions.
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Affiliation(s)
- Sergio Salerno
- Department of Biopathology and Medical and Forensic Biotechnologies - Section of Radiological Sciences, University of Palermo; Palermo, Italy -
| | - Cesare Gagliardo
- Department of Biopathology and Medical and Forensic Biotechnologies - Section of Radiological Sciences, University of Palermo; Palermo, Italy
| | - Salvatore Vitabile
- Department of Biopathology and Medical and Forensic Biotechnologies - Section of Radiological Sciences, University of Palermo; Palermo, Italy
| | - Carmelo Militello
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR); Cefalù, Italy
| | - Giuseppe La Tona
- Department of Science for Health Promotion and Mother and Child Care, University of Palermo; Palermo, Italy
| | - Mario Giuffrè
- Department of Science for Health Promotion and Mother and Child Care, University of Palermo; Palermo, Italy
| | - Antonio Lo Casto
- Department of Biopathology and Medical and Forensic Biotechnologies - Section of Radiological Sciences, University of Palermo; Palermo, Italy
| | - Massimo Midiri
- Department of Biopathology and Medical and Forensic Biotechnologies - Section of Radiological Sciences, University of Palermo; Palermo, Italy
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Wolf ZT, Leslie EJ, Arzi B, Jayashankar K, Karmi N, Jia Z, Rowland DJ, Young A, Safra N, Sliskovic S, Murray JC, Wade CM, Bannasch DL. A LINE-1 insertion in DLX6 is responsible for cleft palate and mandibular abnormalities in a canine model of Pierre Robin sequence. PLoS Genet 2014; 10:e1004257. [PMID: 24699068 PMCID: PMC3974639 DOI: 10.1371/journal.pgen.1004257] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/04/2014] [Indexed: 02/05/2023] Open
Abstract
Cleft palate (CP) is one of the most commonly occurring craniofacial birth defects in humans. In order to study cleft palate in a naturally occurring model system, we utilized the Nova Scotia Duck Tolling Retriever (NSDTR) dog breed. Micro-computed tomography analysis of CP NSDTR craniofacial structures revealed that these dogs exhibit defects similar to those observed in a recognizable subgroup of humans with CP: Pierre Robin Sequence (PRS). We refer to this phenotype in NSDTRs as CP1. Individuals with PRS have a triad of birth defects: shortened mandible, posteriorly placed tongue, and cleft palate. A genome-wide association study in 14 CP NSDTRs and 72 unaffected NSDTRs identified a significantly associated region on canine chromosome 14 (24.2 Mb–29.3 Mb; praw = 4.64×10−15). Sequencing of two regional candidate homeobox genes in NSDTRs, distal-less homeobox 5 (DLX5) and distal-less homeobox 6 (DLX6), identified a 2.1 kb LINE-1 insertion within DLX6 in CP1 NSDTRs. The LINE-1 insertion is predicted to insert a premature stop codon within the homeodomain of DLX6. This prompted the sequencing of DLX5 and DLX6 in a human cohort with CP, where a missense mutation within the highly conserved DLX5 homeobox of a patient with PRS was identified. This suggests the involvement of DLX5 in the development of PRS. These results demonstrate the power of the canine animal model as a genetically tractable approach to understanding naturally occurring craniofacial birth defects in humans. Cleft palate is one of the most commonly occurring birth defects in children, and yet its cause is not completely understood. In order to better understand cleft palate we have turned to man's best friend, the domestic dog. Common breeding practices have made the dog a unique animal model to help understand the genetic basis of naturally occurring birth defects. A genome-wide association study of Nova Scotia Duck Tolling Retrievers with naturally occurring cleft palate led to the investigation of two homeobox genes, DLX5 and DLX6. Dogs with this mutation also have a shortened lower jaw, which resembles those who have Pierre Robin Sequence (PRS). Investigation into people with PRS identifies a mutation within a highly conserved and functional region of DLX5 that may contribute to the development of PRS. This exemplifies how the dog will help us better understand common birth defects.
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Affiliation(s)
- Zena T Wolf
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Elizabeth J Leslie
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Kartika Jayashankar
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Nili Karmi
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Zhonglin Jia
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Douglas J Rowland
- Center for Molecular and Genomic Imaging, University of California, Davis, Davis, California, United States of America
| | - Amy Young
- Department of Animal Science, University of California, Davis, Davis, California, United States of America
| | - Noa Safra
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Saundra Sliskovic
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Jeffrey C Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Claire M Wade
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Danika L Bannasch
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
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Tan TY, Kilpatrick N, Farlie PG. Developmental and genetic perspectives on Pierre Robin sequence. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:295-305. [PMID: 24127256 DOI: 10.1002/ajmg.c.31374] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pierre Robin sequence (PRS) is a craniofacial anomaly comprising mandibular hypoplasia, cleft secondary palate and glossoptosis leading to life-threatening obstructive apnea and feeding difficulties during the neonatal period. The respiratory issues require careful management and in severe cases may require extended stays in neonatal intensive care units and surgical intervention such as lengthening the lower jaw or tracheotomy to relieve airway obstruction. These feeding and respiratory complications frequently continue well into childhood, affecting not only growth and development but also impacting on long term educational attainment. The diagnosis of PRS depends on readily recognizable clinical features but the phenotypic similarity of many PRS individuals conceals considerable etiological heterogeneity. Defects in the growth of the mandible sit at the core of PRS and the natural history of PRS can be classified into two major streams: primary defects of mandibular outgrowth and elongation and issues that are external to the mandibular skeleton but that secondarily impact on its growth. These altered developmental trajectories appear to be driven by a range of influences including defects in cartilage growth, neuromuscular function and fetal constraint. Various genetic and cytogenetic associations have been made with PRS and the diversity of these associations highlights the fact that there are numerous ways to arrive at this common phenotypic endpoint.
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Abstract
Pierre Robin sequence (PRS) is classically described as a triad of micrognathia, glossoptosis, and airway obstruction. Infants frequently present at birth with a hypoplastic mandible and difficulty breathing. The smaller mandible displaces the tongue posteriorly, resulting in obstruction of the airway. Typically, a wide U-shaped cleft palate is also associated with this phenomenon. PRS is not a syndrome in itself, but rather a sequence of disorders, with one abnormality resulting in the next. However, it is related to several other craniofacial anomalies and may appear in conjunction with a syndromic diagnosis, such as velocardiofacial and Stickler syndromes. Infants with PRS should be evaluated by a multidisciplinary team to assess the anatomic findings, delineate the source of airway obstruction, and address airway and feeding issues. Positioning will resolve the airway obstruction in ~70% of cases. In the correct position, most children will also be able to feed normally. If the infant continues to show evidence of desaturation, then placement of a nasopharyngeal tube is indicated. Early feeding via a nasogastric tube may also reduce the amount of energy needed and allow for early weight gain. A proportion of PRS infants do not respond to conservative measures and will require further intervention. Prior to considering any surgical procedure, the clinician should first rule out any sources of obstruction below the base of the tongue that would necessitate a tracheostomy. The two most common procedures for treatment, tongue-lip adhesion and distraction osteogenesis of the mandible, are discussed.
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Affiliation(s)
- Noopur Gangopadhyay
- Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri
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36
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Amarillo IE, Dipple KM, Quintero-Rivera F. Familial microdeletion of 17q24.3 upstream of SOX9 is associated with isolated Pierre Robin sequence due to position effect. Am J Med Genet A 2013; 161A:1167-72. [PMID: 23532965 DOI: 10.1002/ajmg.a.35847] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/13/2012] [Indexed: 11/12/2022]
Abstract
Pierre Robin sequence (PRS) is a malformation pattern characterized by the core triad of retrognathia, glossoptosis, and cleft palate that causes difficulty in glossopharyngeal-laryngeal-vagal functions. The etiology of PRS remains largely unknown; previous reports have suggested that it is caused by intrauterine constriction or external conditions such as oligohydramnios, breech position, or abnormal uterine anatomy. Genetic causes include occurrence as a manifestation of many single gene conditions and chromosomal rearrangements. Positional effect on some loci or genes, including SOX9 has also been posited as a cause. Here, we report on an 18-month-old girl born with isolated PRS. Clinical chromosome microarray analysis (CMA) revealed a maternally inherited ~623 kb microdeletion that is -725 kb upstream of 5' SOX9 at chromosome locus 17q24.3. Her mother had cleft palate. This region, although devoid of any genes, is known to have a position effect on SOX9 due to elimination of highly conserved non-coding cis-regulatory elements. This report supports the evidence that deregulation of an intact SOX9 coding region is a cause of or associated with isolated PRS, and provides further evidence that CMA in the clinical setting is a powerful tool in detecting microdeletions in gene "desert" regions that have pathogenic position effect on specific genes.
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Affiliation(s)
- Ina E Amarillo
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
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Genetics and management of the patient with orofacial cleft. PLASTIC SURGERY INTERNATIONAL 2012; 2012:782821. [PMID: 23213504 PMCID: PMC3503281 DOI: 10.1155/2012/782821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/01/2012] [Indexed: 01/24/2023]
Abstract
Cleft lip or palate (CL/P) is a common facial defect present in 1 : 700 live births and results in substantial burden to patients. There are more than 500 CL/P syndromes described, the causes of which may be single-gene mutations, chromosomopathies, and exposure to teratogens. Part of the most prevalent syndromic CL/P has known etiology. Nonsyndromic CL/P, on the other hand, is a complex disorder, whose etiology is still poorly understood. Recent genome-wide association studies have contributed to the elucidation of the genetic causes, by raising reproducible susceptibility genetic variants; their etiopathogenic roles, however, are difficult to predict, as in the case of the chromosomal region 8q24, the most corroborated locus predisposing to nonsyndromic CL/P. Knowing the genetic causes of CL/P will directly impact the genetic counseling, by estimating precise recurrence risks, and the patient management, since the patient, followup may be partially influenced by their genetic background. This paper focuses on the genetic causes of important syndromic CL/P forms (van der Woude syndrome, 22q11 deletion syndrome, and Robin sequence-associated syndromes) and depicts the recent findings in nonsyndromic CL/P research, addressing issues in the conduct of the geneticist.
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Tan TY, Farlie PG. Rare syndromes of the head and face-Pierre Robin sequence. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2012; 2:369-77. [PMID: 23799581 DOI: 10.1002/wdev.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pierre Robin sequence (PRS) is an association of clinical features consisting of mandibular hypoplasia, cleft secondary palate, and glossoptosis leading to obstructive apnea and feeding difficulties. PRS can occur as an isolated condition or can be found in association with a range of other features in a number of conditions including Treacher collins and Stickler syndromes. The frequent association of the PRS triad suggests a common underlying developmental mechanism which impacts on each of these tissues. Isolated PRS is typically sporadic but when familial usually exhibits autosomal dominant inheritance. The term PRS is applied on the basis of the pattern of malformation rather than etiology and growing evidence indicates that the initiating genetic lesion is variable. Various chromosomal anomalies have been associated with PRS including loci on chromosomes 2, 4, and 17. Associations with genes including SOX9, a number of collagen genes and work with animal models suggest the phenotype derives from a cartilage defect during early facial growth. However, alternative theories have been proposed and these highlight the difficulty of characterising congenital anomalies of craniofacial development in which multiple etiologies can result in very similar phenotypes.
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Affiliation(s)
- Tiong Yang Tan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia
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Marino VCDC, Berti LC, Lima-Gregio AM. Características acústicas da oclusiva glotal associada à sequência de Pierre Robin: estudo de caso. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A fissura de palato, em associação à Sequência de Pierre Robin, pode favorecer o desenvolvimento de produções atípicas (compensatórias), na fala da criança, como é o caso da oclusiva glotal (golpe de glote) comumente observada em substituição aos sons oclusivos (vozeados ou não). No presente estudo, foi realizada a análise dos parâmetros fonético-acústicos da oclusiva glotal produzidas em /k/ e /g/ por uma criança do gênero feminino, com 5 anos, que apresentava fissura de palato reparada, associada à Sequência de Pierre Robin. Para isso, foram selecionadas seis palavras em que a oclusiva velar encontrava-se na posição inicial da palavra e combinada com as vogais /a/, /i/ e /u/ na posição acentuada. Foi ainda realizado julgamento perceptivo-auditivo por três fonoaudiólogos, que apresentou concordância quanto à presença da oclusiva glotal de 100% para ambas as relações (intra e inter-juízes). Na inspeção dos dados via espectrograma foi observada variabilidade dos parâmetros espectrais (burst e transição formântica) e essas variações também puderam ser computadas considerando as vogais separadamente. A análise estatística revelou diferença estatisticamente significante entre as duas consoantes velares (/k/ e /g/) nos parâmetros espectral (burst), temporal (VOT e duração relativa da oclusiva na palavra) e os relativos às características acústicas das vogais adjacentes às oclusivas (período estacionário de F3). Por fim, as características acústicas da oclusiva glotal sugeriram que a criança pode ter utilizado de estratégias para marcar contrastes fônicos na língua, ainda que os mesmos não tenham magnitude suficiente para serem resgatados auditivamente pelo ouvinte.
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Davidson TB, Sanchez-Lara PA, Randolph LM, Krieger MD, Wu SQ, Panigrahy A, Shimada H, Erdreich-Epstein A. Microdeletion del(22)(q12.2) encompassing the facial development-associated gene, MN1 (meningioma 1) in a child with Pierre-Robin sequence (including cleft palate) and neurofibromatosis 2 (NF2): a case report and review of the literature. BMC MEDICAL GENETICS 2012; 13:19. [PMID: 22436304 PMCID: PMC3359208 DOI: 10.1186/1471-2350-13-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 03/22/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pierre-Robin sequence (PRS) is defined by micro- and/or retrognathia, glossoptosis and cleft soft palate, either caused by deformational defect or part of a malformation syndrome. Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome caused by mutations in the NF2 gene on chromosome 22q12.2. NF2 is characterized by bilateral vestibular schwannomas, spinal cord schwannomas, meningiomas and ependymomas, and juvenile cataracts. To date, NF2 and PRS have not been described together in the same patient. CASE PRESENTATION We report a female with PRS (micrognathia, cleft palate), microcephaly, ocular hypertelorism, mental retardation and bilateral hearing loss, who at age 15 was also diagnosed with severe NF2 (bilateral cerebellopontine schwannomas and multiple extramedullary/intradural spine tumors). This is the first published report of an individual with both diagnosed PRS and NF2. High resolution karyotype revealed 46, XX, del(22)(q12.1q12.3), FISH confirmed a deletion encompassing NF2, and chromosomal microarray identified a 3,693 kb deletion encompassing multiple genes including NF2 and MN1 (meningioma 1).Five additional patients with craniofacial dysmorphism and deletion in chromosome 22-adjacent-to or containing NF2 were identified in PubMed and the DECIPHER clinical chromosomal database. Their shared chromosomal deletion encompassed MN1, PITPNB and TTC28. MN1, initially cloned from a patient with meningioma, is an oncogene in murine hematopoiesis and participates as a fusion gene (TEL/MN1) in human myeloid leukemias. Interestingly, Mn1-haploinsufficient mice have abnormal skull development and secondary cleft palate. Additionally, Mn1 regulates maturation and function of calvarial osteoblasts and is an upstream regulator of Tbx22, a gene associated with murine and human cleft palate. This suggests that deletion of MN1 in the six patients we describe may be causally linked to their cleft palates and/or craniofacial abnormalities. CONCLUSIONS Thus, our report describes a NF2-adjacent chromosome 22q12.2 deletion syndrome and is the first to report association of MN1 deletion with abnormal craniofacial development and/or cleft palate in humans.
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Affiliation(s)
- Tom B Davidson
- Department of Pediatrics and the Saban Research Institute at Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, California 90027-6062, USA
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Goudy S, Ingraham C, Canady J. The occurrence of velopharyngeal insufficiency in Pierre Robin Sequence patients. Int J Pediatr Otorhinolaryngol 2011; 75:1252-4. [PMID: 21782256 DOI: 10.1016/j.ijporl.2011.06.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/24/2011] [Accepted: 06/25/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Children born with Pierre-Robin Sequence (PRS) have cleft palate, micrognathia, and macroglossia. After the repair of the cleft palate, velopharyngeal insufficiency (VPI) can occur in a subset of patients. We hypothesize that the need for the surgical correction of VPI in PRS children is no different than cleft palate only (CPO) patients. METHODS A retrospective study of 21 children with non-syndromic PRS who were matched to 42 non-syndromic, CPO controls for age and sex. We reviewed incidence of VPI, the need for secondary speech surgery, and speech outcomes post-operatively. RESULTS Secondary surgery to correct VPI was necessary in 3 of 21 (14.29%) PRS patients (2 Pharyngeal Flaps, 1 Z-plasty), vs. 10 of 42 (23.81%) CPO (9 Pharyngeal Flaps, 1 Z-plasty) controls. Mean age for VPI surgery for PRS vs. controls: 5.33 vs. 6.41 years, respectively. For final speech outcomes, 73.68% of PRS vs. 71.88% of controls showed no evidence of hypernasality, 89.47% of PRS patients vs. 93.75% of controls showed no evidence of hyponasality, and 76.47% of PRS patients vs. 78.13% of controls had normal velopharyngeal competence (p>0.90 for all three measures). CONCLUSION Our findings suggest that children born with a Pierre-Robin Sequence do not have a higher rate of post-operative VPI after cleft palate repair and are no more likely to require additional surgical intervention.
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Affiliation(s)
- Steven Goudy
- Department of Otolaryngology, Vanderbilt University, Nashville, TN 37232, USA.
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Abstract
The Robin sequence, previously known as the Pierre Robin syndrome, is characterized by the sequence of clinical events that result from a small mandible. The tongue becomes posteriorly displaced (glossoptosis) and obstructs the airway. The obstructing tongue also makes oral feeding difficult and, in severe cases, impossible. Patients with Robin sequence may also present with a cleft palate, although this is not necessary to make the diagnosis. The small mandible either results from an inherent growth problem (genetic or syndromic) or is deformational where intrauterine growth of the mandible is restricted. Conditions of syndromic patients are generally more severe and difficult to treat. The phenomenon of "catch-up" growth is disputed, although it is likely to occur in deformational but not syndromic patients. Patients with Robin sequence are best managed by a multidisciplinary team familiar with the diagnoses and treatment of difficult pediatric airways. Approximately 70% of Robin infants are successfully managed by prone positioning alone. Tracheostomy is necessary in approximately 10% of these patients, especially for subglottic obstructions including laryngomalacia and tracheomalacia. Tracheostomy should be avoided if possible. Treatment of the remaining 20% remains highly contentious. Tongue-lip adhesion, nasopharyngeal airways, and distraction osteogenesis all have strong advocates. Ideally, treatment should be individualized. Patients who will have catch-up growth of the mandible will only need a tongue-lip or nasopharyngeal airway as a temporary measure. Patients who we know will not have catch-up growth will benefit from early distraction osteogenesis.
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Benko S, Gordon CT, Amiel J, Lyonnet S. [Cis-ruptions of highly conserved non-coding genomic elements distant from the SOX9 gene in the Pierre Robin sequence]. Biol Aujourdhui 2011; 205:111-124. [PMID: 21831342 DOI: 10.1051/jbio/2011010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Indexed: 05/31/2023]
Abstract
Major developmental genes, exhibiting complex expression patterns, are often embedded within a genic desert particularly rich in regions, which though non-coding are highly conserved. The developmental expression of these genes in many areas requires coordinated regulation in time and space, which is orchestrated by some of these conserved non-coding regions, acting as transcriptional regulators. SOX9 is an essential gene for many developmental processes, such as chondrogenesis, migration and differentiation of neural crest cells and testis development. In agreement with these major expression areas, SOX9 haploinsufficiency, linked to alterations in coding sequence, leads to a polymorphic malformation syndrome - campomelic dysplasia - whose major symptoms are a bone anomaly, a Pierre Robin sequence, and a sexual differentiation anomaly (Disorder of Sex Development, DSD). SOX9 is located in a ~2.5 Mb gene desert extremely rich in conserved sequences. We have used the SOX9 locus and campomelic dysplasia as a model to show that one or several endophenotypes within a complex syndrome may arise from a tissue-specific deregulation of a major developmental gene transcription. Our work has focused on one of these endophenotypes, SPR, characterized by the triad micro- and/or retrognathy, glossoptosis and cleft palate. Here we report in detail how we identified alterations (translocations, deletions, point mutations) in non-coding regions, located far away (more than 1.2 Mb) upstream and downstream of SOX9, in clustered or sporadic SPR cases.
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Affiliation(s)
- Sabina Benko
- Département de génétique, Université Paris Descartes et Inserm U-781, Hôpital Necker-Enfants Malades, Paris Cedex, France
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Mossey P, Little J. Addressing the challenges of cleft lip and palate research in India. Indian J Plast Surg 2011; 42 Suppl:S9-S18. [PMID: 19884687 PMCID: PMC2825065 DOI: 10.4103/0970-0358.57182] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The Indian sub-continent remains one of the most populous areas of the world with an estimated population of 1.1 billion in India alone. This yields an estimated 24.5 million births per year and the birth prevalence of clefts is somewhere between 27,000 and 33,000 clefts per year. Inequalities exist, both in access to and quality of cleft care with distinct differences in urban versus rural access and over the years the accumulation of unrepaired clefts of the lip and palate make this a significant health care problem in India. In recent years the situation has been significantly improved through the intervention of Non Governmental Organisations such as SmileTrain and Transforming Faces Worldwide participating in primary surgical repair programmes. The cause of clefts is multi factorial with both genetic and environmental input and intensive research efforts have yielded significant advances in recent years facilitated by molecular technologies in the genetic field. India has tremendous potential to contribute by virtue of improving research expertise and a population that has genetic, cultural and socio-economic diversity. In 2008, the World Health Organisation (WHO) has recognised that non-communicable diseases, including birth defects cause significant infant mortality and childhood morbidity and have included cleft lip and palate in their Global Burden of Disease (GBD) initiative. This will fuel the interest of India in birth defects registration and international efforts aimed at improving quality of care and ultimately prevention of non-syndromic clefts of the lip and palate.
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Affiliation(s)
- Peter Mossey
- Unit of Orthodontics, Dundee University Dental School, 1 Park Place, Dundee, DD1 4HR, Scotland, United Kingdom
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Hellwig K, Schimrigk S, Chan A, Epplen J, Gold R. A newborn with Pierre Robin sequence after preconceptional mitoxantrone exposure of a female with multiple sclerosis. J Neurol Sci 2011; 307:164-5. [PMID: 21601225 DOI: 10.1016/j.jns.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 05/03/2011] [Indexed: 01/08/2023]
Abstract
Multiple sclerosis is a common disease of young adults in which accidental and unplanned pregnancies under disease modifying or immunosuppressive therapies may occur. The experience with mitoxantrone (MIX) especially in the first trimenon is very limited, until now only one case of a pregnant woman with MS who was exposed to MIX in early pregnancy and delivered a growth restricted but healthy child was published. We report a case of a secondary progressive MS patient who was exposed periconceptionally to MIX and delivered a child with Pierre Robin Sequence (PRS), a syndrome with the main features of glossoptosis, micrognathia, and palate clefts. PRS is a very rare defect and therefore a causal relation with MIX seems possible.
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Affiliation(s)
- Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.
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46
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Evans KN, Sie KC, Hopper RA, Glass RP, Hing AV, Cunningham ML. Robin sequence: from diagnosis to development of an effective management plan. Pediatrics 2011; 127:936-48. [PMID: 21464188 PMCID: PMC3387866 DOI: 10.1542/peds.2010-2615] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The triad of micrognathia, glossoptosis, and resultant airway obstruction is known as Robin sequence (RS). Although RS is a well-recognized clinical entity, there is wide variability in the diagnosis and care of children born with RS. Systematic evaluations of treatments and clinical outcomes for children with RS are lacking despite the advances in clinical care over the past 20 years. We explore the pathogenesis, developmental and genetic models, morphology, and syndromes and malformations associated with RS. Current classification systems for RS do not account for the heterogeneity among infants with RS, and they do not allow for prediction of the optimal management course for an individual child. Although upper airway obstruction for some infants with RS can be treated adequately with positioning, other children may require a tracheostomy. Care must be customized for each patient with RS, and health care providers must understand the anatomy and mechanism of airway obstruction to develop an individualized treatment plan to improve breathing and achieve optimal growth and development. In this article we provide a comprehensive overview of evaluation strategies and therapeutic options for children born with RS. We also propose a conceptual treatment protocol to guide the provider who is caring for a child with RS.
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Affiliation(s)
- Kelly N. Evans
- Division of Craniofacial Medicine, Department of Pediatrics, ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen C. Sie
- Division of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, and ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Richard A. Hopper
- Division of Plastic Surgery, Department of Surgery, and ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Robin P. Glass
- Division of Rehabilitation Medicine, Department of Occupational Therapy, University of Washington, Seattle, Washington; ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Anne V. Hing
- Division of Craniofacial Medicine, Department of Pediatrics, ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Michael L. Cunningham
- Division of Craniofacial Medicine, Department of Pediatrics, ,Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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Abstract
The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital-centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Robin sequence.
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Affiliation(s)
- C Scully
- University College London, London, UK.
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48
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Al Kaissi A, Ganger R, Klaushofer K, Grill F. Cervico-thoracic kyphosis in a girl with Pierre Robin sequence. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2011; 9:Doc06. [PMID: 21468326 PMCID: PMC3070437 DOI: 10.3205/000129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/08/2011] [Indexed: 11/30/2022]
Abstract
Congenital cervico-thoracic kyphosis has been encountered in a girl with Pierre Robin sequence. The constellation of the spine malformation complex such as incomplete development of the vertebral bodies associated with defective ossification of the cervico-thoracic pedicles causing effectively the development of complete spinal cord injury at the kyphotic level of C7/T1 were present. Congenital kyphosis secondary to vertebral body hypoplasia has not been reported in connection with Pierre Robin sequence.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, Medical Department, Hanusch Hospital, Vienna, Austria.
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Ghassibe-Sabbagh M, Desmyter L, Langenberg T, Claes F, Boute O, Bayet B, Pellerin P, Hermans K, Backx L, Mansilla MA, Imoehl S, Nowak S, Ludwig KU, Baluardo C, Ferrian M, Mossey PA, Noethen M, Dewerchin M, François G, Revencu N, Vanwijck R, Hecht J, Mangold E, Murray J, Rubini M, Vermeesch JR, Poirel HA, Carmeliet P, Vikkula M. FAF1, a gene that is disrupted in cleft palate and has conserved function in zebrafish. Am J Hum Genet 2011; 88:150-61. [PMID: 21295280 DOI: 10.1016/j.ajhg.2011.01.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/24/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022] Open
Abstract
Cranial neural crest (CNC) is a multipotent migratory cell population that gives rise to most of the craniofacial bones. An intricate network mediates CNC formation, epithelial-mesenchymal transition, migration along distinct paths, and differentiation. Errors in these processes lead to craniofacial abnormalities, including cleft lip and palate. Clefts are the most common congenital craniofacial defects. Patients have complications with feeding, speech, hearing, and dental and psychological development. Affected by both genetic predisposition and environmental factors, the complex etiology of clefts remains largely unknown. Here we show that Fas-associated factor-1 (FAF1) is disrupted and that its expression is decreased in a Pierre Robin family with an inherited translocation. Furthermore, the locus is strongly associated with cleft palate and shows an increased relative risk. Expression studies show that faf1 is highly expressed in zebrafish cartilages during embryogenesis. Knockdown of zebrafish faf1 leads to pharyngeal cartilage defects and jaw abnormality as a result of a failure of CNC to differentiate into and express cartilage-specific markers, such as sox9a and col2a1. Administration of faf1 mRNA rescues this phenotype. Our findings therefore identify FAF1 as a regulator of CNC differentiation and show that it predisposes humans to cleft palate and is necessary for lower jaw development in zebrafish.
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Jin YR, Turcotte TJ, Crocker AL, Han XH, Yoon JK. The canonical Wnt signaling activator, R-spondin2, regulates craniofacial patterning and morphogenesis within the branchial arch through ectodermal-mesenchymal interaction. Dev Biol 2011; 352:1-13. [PMID: 21237142 DOI: 10.1016/j.ydbio.2011.01.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 01/05/2011] [Accepted: 01/05/2011] [Indexed: 12/21/2022]
Abstract
R-spondins are a recently characterized family of secreted proteins that activate Wnt/β-catenin signaling. Herein, we determine R-spondin2 (Rspo2) function in craniofacial development in mice. Mice lacking a functional Rspo2 gene exhibit craniofacial abnormalities such as mandibular hypoplasia, maxillary and mandibular skeletal deformation, and cleft palate. We found that loss of the mouse Rspo2 gene significantly disrupted Wnt/β-catenin signaling and gene expression within the first branchial arch (BA1). Rspo2, which is normally expressed in BA1 mesenchymal cells, regulates gene expression through a unique ectoderm-mesenchyme interaction loop. The Rspo2 protein, potentially in combination with ectoderm-derived Wnt ligands, up-regulates Msx1 and Msx2 expression within mesenchymal cells. In contrast, Rspo2 regulates expression of the Dlx5, Dlx6, and Hand2 genes in mesenchymal cells via inducing expression of their upstream activator, Endothelin1 (Edn1), within ectodermal cells. Loss of Rspo2 also causes increased cell apoptosis, especially within the aboral (or caudal) domain of the BA1, resulting in hypoplasia of the BA1. Severely reduced expression of Fgf8, a survival factor for mesenchymal cells, in the ectoderm of Rspo2(-/-) embryos is likely responsible for increased cell apoptosis. Additionally, we found that the cleft palate in Rspo2(-/-) mice is not associated with defects intrinsic to the palatal shelves. A possible cause of cleft palate is a delay of proper palatal shelf elevation that may result from the small mandible and a failure of lowering the tongue. Thus, our study identifies Rspo2 as a mesenchyme-derived factor that plays critical roles in regulating BA1 patterning and morphogenesis through ectodermal-mesenchymal interaction and a novel genetic factor for cleft palate.
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Affiliation(s)
- Yong-Ri Jin
- Center for Molecular Medicine, Maine Medical Center Research Institute, Maine Medical Center, 81 Research Drive, Scarborough, ME 04074, USA
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