1
|
Amina, Ahmed S, Rajput G, Abdullah S. A Unique Appliance for Median Facial Cleft Management With Sleep Apnea due to Undeveloped Nasal Septum: A Rare Case Report. Cleft Palate Craniofac J 2024; 61:523-526. [PMID: 36254400 DOI: 10.1177/10556656221131896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The role of a prosthodontist in the management of facial cleft patients is the restoration of feeding, respiration, facial harmony, dental harmony and phonation. This case report presents the fabrication of an appliance for a pediatric patient with congenital median facial cleft who had sleep apnea due to the absence of nasal septum, which is a rare condition, with a unique method that fulfilled the patient's needs and improved quality of life. The patient also had median cleft lip and premaxilla along with hypertelorism.
Collapse
Affiliation(s)
- Amina
- Department of Prosthodontics, Crown & Bridge, Dr. Ziauddin Ahmad Dental College & Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Saad Ahmed
- Department of Oral Pathology & Microbiology, Rama Dental College, Kanpur, Uttar Pradesh, India
| | - Geeta Rajput
- Department of Prosthodontics, Crown & Bridge, Dr. Ziauddin Ahmad Dental College & Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Sabzar Abdullah
- Department of Prosthodontics, Crown & Bridge, Dr. Ziauddin Ahmad Dental College & Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| |
Collapse
|
2
|
Aslan BI, Uzuner FD, Taskaldıran ES, Tuter G, Gulsen A, Güngör K, Ucuncu N. Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients. Cleft Palate Craniofac J 2023:10556656231212033. [PMID: 37926978 DOI: 10.1177/10556656231212033] [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: 11/07/2023] Open
Abstract
AIM This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. MATERIALS AND METHODS 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. RESULTS In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). CONCLUSION In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.
Collapse
Affiliation(s)
- Belma Isık Aslan
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Fatma Denız Uzuner
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Ezgi Sila Taskaldıran
- Department of Periodontology, Dentistry Faculty, Istanbul Aydin University, Istanbul, Turkey
| | - Gulay Tuter
- Department of Periodontolgy, Gazi University, Ankara, Turkey
| | - Ayse Gulsen
- Department of Plastic Reconstructive and Estethic Surgery, Faculty of Medicine, University of Gazi, Ankara, Turkey
| | - Kahraman Güngör
- Department of Dentomaxillofacial Radiology, Gazi Universitesi, Ankara, Turkey
| | - Neslihan Ucuncu
- Department of Orthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| |
Collapse
|
3
|
Abirami S, Panchanadikar NT, Muthu MS, Swaminathan K, Vignesh KC, Agarwal A, Kirubakaran R. Dental Caries Experience among Children and Adolescents with Cleft Lip and/or Palate: An Umbrella Review. Int J Clin Pediatr Dent 2022; 15:S261-S268. [PMID: 35645513 PMCID: PMC9108836 DOI: 10.5005/jp-journals-10005-2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To assess the systematic reviews and meta-analyses investigating the dental caries experience in children with cleft lip and/or palate (CL/P). Study design and methodology A systematic search was carried out from MEDLINE Via PubMed, JBI Database of Systematic Reviews and Implementation Reports, EMBASE, OVID, Cochrane Database of Systematic Review, and Epistemonikos databases. Two independent reviewers carried out the collection and analysis of the study data. Methodological quality was assessed by ROBIS (Risk of bias assessment in systematic review) tool. Review results An initial search of electronic databases yielded a total of 25 relevant reviews, of which only three systematic reviews were taken into consideration for qualitative synthesis. The total number of unique primary studies among the three included systematic reviews were 25, of which overlap of the studies was calculated using citation matrix. The corrected covered area (CCA) was estimated to be 0.26. Based on the ROBIS tool, only one systematic review reported with low risk of bias. Conclusion Individuals with CL/P report more decayed, missing, or filled teeth/surfaces than those without CL/P in primary, mixed, and permanent dentition. Future studies should focus on the factors which could modify the caries risk of an individual with CL/P. Clinical significance This umbrella review offers a more reliable and balanced view regarding the dental caries experience among individuals with cleft lip and/or palate. This paper also highlights the important role of pediatric dentist in multidisciplinary health care team in implementing first dental visit and anticipatory guidance to consider early diagnosis and specific preventive interventions for Early Childhood Caries (ECC) in individuals with CL/P. How to cite this article Abirami S, Panchanadikar NT, Muthu MS, et al. Dental Caries Experience among Children and Adolescents with Cleft Lip and/or Palate: An Umbrella Review. Int J Clin Pediatr Dent 2022;15(S-2):S261-S268.
Collapse
Affiliation(s)
- S Abirami
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Noopur Tushar Panchanadikar
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - MS Muthu
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Kavitha Swaminathan
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - KC Vignesh
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richard Kirubakaran
- Department of Biostatistics, BVMC, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
4
|
Zhang K, Zhou X, Qin J, Zhang W, Pan Y, Wang H, Lin J, Liu L, Jia Y. Dynamic Change in Oral Microbiota of Children With Cleft Lip and Palate After Alveolar Bone Grafting. Cleft Palate Craniofac J 2021; 59:1352-1360. [PMID: 34524929 DOI: 10.1177/10556656211044396] [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: 11/17/2022] Open
Abstract
To investigate the longitudinal influence of alveolar bone grafting on the oral microbiota of children with cleft lip and palate (CLP). Twenty-eight children with nonsyndromic CLP were recruited and underwent secondary alveolar bone grafting at the first time. Unstimulated saliva and plaque samples were collected from the subjects preoperatively and at 2 days, 1 month, and 3 months postoperatively. The v3-v4 hypervariable regions of the 16S rRNA gene from bacterial DNA were sequenced using the Illumina MiSeq sequencing platform. The alpha diversity of the saliva and plaque microbiota was significantly decreased at 2 days postoperatively and then increased at 1 and 3 months postoperatively. The saliva and plaque microbiota compositions at 2 days postoperatively differed from those at the other time points, and the microbiota compositions at 1 and 3 months postoperatively showed a gradual shift toward the preoperative composition. The saliva, but not plaque, microbiota composition 3 months postoperatively was similar to that preoperatively. The effect of secondary alveolar bone grafting on the plaque microbiota in children with CLP lasted longer than the saliva microbiota. Alveolar bone grafting altered the saliva microbiota in children with CLP within 3 months postoperatively.
Collapse
Affiliation(s)
- Kejia Zhang
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Xuan Zhou
- 159460Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Jinwei Qin
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Weibing Zhang
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Yongchu Pan
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Hua Wang
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Jiuxiang Lin
- 159460Peking University School and Hospital of Stomatology, Beijing, P.R. China
| | - Luwei Liu
- 168284The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, P.R. China.,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, P.R. China.,12461Jiangsu Province Engineering Research Center of Stomatological Translation Medicine, Nanjing, P.R. China
| | - Yilin Jia
- 159460Peking University School and Hospital of Stomatology, Beijing, P.R. China
| |
Collapse
|
5
|
Kalaskar R, Bhaje P, Sharma P, Balasubramanian S, Ninawe N, Ijalkar R. Comparative evaluation of nasal and alveolar changes in complete unilateral cleft lip and palate patients using intraoral and extraoral nasoalveolar molding techniques: randomized controlled trial. J Korean Assoc Oral Maxillofac Surg 2021; 47:257-268. [PMID: 34462383 PMCID: PMC8408650 DOI: 10.5125/jkaoms.2021.47.4.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/04/2021] [Indexed: 11/07/2022] Open
Abstract
Objectives Cleft lip and palate is a common congenital anomaly that impairs the aesthetics, speech, hearing, and psychological and social life of an individual. To achieve good aesthetic outcomes, presurgical nasoalveolar molding (NAM) has become important. Currently, the intraoral NAM technique is widely practiced. Numerous modifications have been made to intraoral NAM techniques, but the original problem of compliance leading to discontinuation of treatment remains unsolved. Therefore, the present study compared an extraoral NAM technique with the intraoral NAM technique. Materials and Methods Twenty infants with complete unilateral cleft lip and palate were included and divided into two equal groups. Group A received the intraoral NAM technique, and Group B received the extraoral NAM technique. Pre- and postoperative extraoral and intraoral measurements were recorded. Results Groups A and B did not differ significantly in any extraoral or intraoral parameter. Conclusion The extraoral NAM technique is as effective as the intraoral NAM technique in achieving significant nasal and alveolar changes in com-plete unilateral cleft lip and palate patients. Additionally, it reduces the need for frequent hospital visits for activation and the stress associated with the insertion and removal of the intraoral NAM plate, thereby improving compliance.
Collapse
Affiliation(s)
- Ritesh Kalaskar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Bhaje
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Priyanka Sharma
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Shruti Balasubramanian
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Nupur Ninawe
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| | - Rajesh Ijalkar
- Department of Pediatric and Preventive Dentistry, Government Dental College & Hospital, Nagpur, India
| |
Collapse
|
6
|
Abirami S, Panchanadikar N, Muthu MS, Balasubramanian S, Murthy J, Mohan A, Haridoss S, Subbalekshmi T. Effect of Sustained Interventions from Infancy to Toddlerhood in Children with Cleft Lip and Palate for Preventing Early Childhood Caries. Caries Res 2021; 55:554-562. [PMID: 34293739 DOI: 10.1159/000517210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
The study aimed to evaluate the effectiveness of sustained interventions in children with cleft lip and palate (CLP) for preventing early childhood caries (ECC). This prospective, nonrandomized interventional cohort study was conducted in infants aged 0-12 months with congenital CLP. Interventions were given to parents/primary caregivers in the form of combined oral health-care measures (sterile wet gauze piece, finger brush, toothbrush, and toothpaste) by a motivational interviewing approach. Education of primary caregivers on oral hygiene was provided by audiovisual aids and demonstration. Reinforcement of the prescribed regimen was done through daily short message services in caregivers' preferred language and bimonthly telephone calls. Participants were followed up for 9-32 months from the time of recruitment, with a mean period of 18.3 ± 5.1 months. Rates of dental caries were represented as prevalence rates, incidence density, and transitional probability. The distribution of the International Caries Detection and Assessment System (ICDAS) scores on different tooth surfaces affected in the intervention group was compared descriptively with that of the age- and sex-matched historical control groups. On analysis of surface-wise distribution of the ICDAS scores in the intervention group (n = 1,919), 1.2% (n = 24) had noncavitated lesions (ICDAS codes 1 and 2), 0.88% (n = 17) had cavitated lesions (ICDAS codes 3-6), and 0.26% (n = 5) had both cavitated and noncavitated lesions (ICDAS codes 1-6). The incidence density of caries-affected children observed at the first and last follow-ups was 1.2 persons/100 person-months and 1.3 persons/100 person-months of observation, respectively. The incidence density of new caries-affected tooth surfaces at the first and last follow-ups was 0.163 surfaces/100 surface-months and 0.062 surfaces/100 surface-months, respectively. Maxillary first molars had the maximum transition from sound to the cavitated lesion (11.5%), followed by maxillary incisors from sound to noncavitated (7.5%) at the last follow-up. Based on the newly developed assessment criteria in our study, sustained interventions proved to be significantly effective in preventing ECC in children with CLP.
Collapse
Affiliation(s)
- Sivasubramanian Abirami
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Noopur Panchanadikar
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Murugan Satta Muthu
- Department of Pediatric and Preventive Dentistry, Head, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, India.,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | | | - Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Anusha Mohan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Selvakumar Haridoss
- Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | |
Collapse
|
7
|
Reiser SC, Tellermann J, Akota I, Pilmane M. Profiling and Characterization of Localized Cytokine Response in Congenital Cleft Affected Lip Tissue. Life (Basel) 2021; 11:life11060556. [PMID: 34199238 PMCID: PMC8232006 DOI: 10.3390/life11060556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: Despite cleft lips and palates belonging to the most common orofacial congenital anomalies, their morphopathogenesis is not yet fully understood. The study aimed to determine the distribution and relation of cytokines interferon-γ (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-2, IL-7, IL-12, and IL-13 in the cleft affected mucosa of the lip. (2) Materials and Methods: Twenty cleft lip (CL) mucosal samples and seven control tissues of oral cavity mucosa were included in the study. Specimen were obtained during reconstruction surgeries and processed by hematoxylin and eosin staining and immunohistochemistry for IFN-γ, TNF-α, IL-2, IL-7, IL-12, and IL-13. (3) Results: The distribution of cytokines was higher overall in the cleft affected epithelium compared to the connective tissue, with TNF-a, IL-2, and IL-12 displaying the highest number of immunopositive cells. With the exception of IL-2, CL specimen showed higher immunoreactivity. IFN-γ displayed only minor immunoreactivity, with no expression in the control epithelium. Correlation analysis was strongest between CL epithelial IL-13 and IFN-γ (z = 0.71, p < 0.0001). (4) Conclusions: The CLP affected epithelium displays high degrees of plasticity in expressing different cytokines, pointing towards the stimulation of a local adaptive immune response based on consistent inflammatory processes.
Collapse
Affiliation(s)
- Sophie Charlotte Reiser
- Institute of Anatomy and Anthropology, Riga Stradins University, Kronvalda Boulevard 9, LV-1010 Riga, Latvia; (J.T.); (M.P.)
- Correspondence: ; Tel.: +49-157-8363-8902
| | - Jonas Tellermann
- Institute of Anatomy and Anthropology, Riga Stradins University, Kronvalda Boulevard 9, LV-1010 Riga, Latvia; (J.T.); (M.P.)
| | - Ilze Akota
- Institute of Stomatology, Riga Stradins University, Dzirciema Street 20, LV-1007 Riga, Latvia;
| | - Māra Pilmane
- Institute of Anatomy and Anthropology, Riga Stradins University, Kronvalda Boulevard 9, LV-1010 Riga, Latvia; (J.T.); (M.P.)
| |
Collapse
|
8
|
Vale F, Correia L, Guimarães A, Caramelo F, Francisco I. Salivary counts of Streptococcus mutans and Lactobacillus in patients with and without cleft lip and/or palate undergoing orthodontic treatment: A meta-analysis. Int J Dent Hyg 2021; 20:112-119. [PMID: 33818912 DOI: 10.1111/idh.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct a systematic review with meta-analysis to assess if cleft lip and palate (CLP) patients undergoing orthodontic treatment have a higher colonization of Streptococcus mutans and Lactobacillus than patients without this condition. METHODS Five electronic databases were searched systematically. The inclusion criteria were as follows: randomized clinical trials, non-randomized, or quasi-randomized controlled trials, prospective and retrospective studies published until March, 2021; articles that evaluated S. mutans and Lactobacillus profile in patients with and without cleft lip and palate undergoing orthodontic treatment. The random-effect model was used to perform the analysis of all the data collected. Statistic heterogeneity was evaluated with I2 test. RESULTS In this systematic review, 2 cohort studies were included. The data analysis from 160 patients revealed that patients without cleft lip and palate had 4.5 times more predisposition to oral colonization with S. mutans than CLP patients. No statistical significant difference was found between these patients for colonization with Lactobacillus. CONCLUSIONS Despite the limitations in the included studies, this systematic review suggested that CLP patients have a lower predisposition to oral colonization with S. mutans when compared to healthy patients.
Collapse
Affiliation(s)
- Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Liliana Correia
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Adriana Guimarães
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Caramelo
- Institute of Clinical and Biomedical Research of Coimbra (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
9
|
Escobar Arregocés FM. Mucogingival Surgery in the Interdisciplinary Management of Patients with Palato-alveolar Cleft Defects. Contemp Clin Dent 2020; 11:203-207. [PMID: 33110339 PMCID: PMC7583534 DOI: 10.4103/ccd.ccd_118_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/23/2018] [Accepted: 03/11/2020] [Indexed: 11/04/2022] Open
Abstract
Here will present a mucogingival technique for interdisciplinary management in patients with palato-alveolar cleft defect sequelae. Mucogingival continuity is sought in these patients by means of an extended laterally positioned flap. Achieving a mucogingival seal in the cleft area would be of great value in interdisciplinary management, favoring the prognosis of subsequent treatments, such as alveolar bone grafts, orthodontics, and rehabilitation, to achieve more esthetic and functional and harmonious results for the patients' dentogingival complex.
Collapse
Affiliation(s)
- Francina Maria Escobar Arregocés
- Department of Periodontal, Faculty of Dentistry, School of Odontology, Pontifical Xavierian University (Pontificia Universidad Javeriana), Bogotá, Colombia
| |
Collapse
|
10
|
Bittermann GKP, van Es RJJ, de Ruiter AP, Frank MH, Bittermann AJN, van der Molen ABM, Koole R, Rosenberg AJWP. Incidence of complications in secondary alveolar bone grafting of bilateral clefts with premaxillary osteotomy: a retrospective cohort study. Clin Oral Investig 2019; 24:915-925. [PMID: 31250194 DOI: 10.1007/s00784-019-02977-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate factors affecting incidence of complications after secondary alveolar bone grafting with premaxillary osteotomy (SABG + PO) in children with complete bilateral cleft of lip and palate (BCLP). MATERIALS AND METHODS Data were collected from children with BCLP treated with SABG + PO from 2004 to 2014 at our institute. Preoperative parameters included age, donor site, race, gingival health, bone quality around cleft-related teeth, premaxilla position, graft timing, presence of canines in the cleft, and presence of deciduous teeth around the cleft area. Logistic regression and the chi-squared test were used to assess correlations and the incidence of complications. RESULTS In the 64 patients, a significant correlation was found between complication rate and timing of bone grafting with respect to early versus late SABG + PO (p = 0.041), age > 12 years (p = 0.011; odds ratio (OR) 5.9; 95% confidence interval (CI) 1.49-23.93), malposition of the premaxilla (p = 0.042; OR 3.3; 95% CI 1.04-10.13), and preoperative bone quality around cleft-related teeth (p = 0.005; OR 5.3; 95% CI 1.6-17.2). CONCLUSIONS The timing of SABG + PO is essential, as early SABG + PO is associated with fewer complications. A malpositioned premaxilla and poor bone quality around cleft-related teeth are associated with more complications. Therefore, preoperative orthodontic repositioning of the malpositioned premaxilla before SABG + PO should be considered. CLINICAL RELEVANCE Analysis of treatment protocols and complications for BCLP patients underscores that proper timing of SABG + PO and correct premaxilla repositioning help reduce complications.
Collapse
Affiliation(s)
- Gerhard K P Bittermann
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands.
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Adrianus P de Ruiter
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Michael H Frank
- Department of Oral and Maxillofacial Surgery, Haaglanden Medical Centre, PO Box 432, 2501 CK, The Hague, The Netherlands
| | - Arnold J N Bittermann
- Department of Pediatric Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB, Utrecht, The Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Ron Koole
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, Wilhelmina Children's Hospital Cleft Team, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, The Netherlands
| |
Collapse
|
11
|
Al-Namankany A, Alhubaishi A. Effects of cleft lip and palate on children's psychological health: A systematic review. J Taibah Univ Med Sci 2018; 13:311-318. [PMID: 31435341 PMCID: PMC6694901 DOI: 10.1016/j.jtumed.2018.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the psychological effects of cleft lip and palate (CLP) on children and their parents and to determine any relationship between social support and timing of surgical repairs for these defects. METHODS A systematic review that followed the problem, intervention, comparison, outcome and setting (PICOS) method was used. The participants were children with CLP, interventions were surgical corrections and/or social support, comparison occurred with children with neither surgical corrections nor social support, outcomes were psychological effects and the study design was a systematic review. Four electronic databases, EBSCO, ProQuest, Science Direct, and PsycInfo were used to search for studies over the period of ten years (January 2007 until January 2017). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2009 guidelines on systematic review reporting were used for this study. RESULTS Searching through four databases revealed 53,346 articles; however, only 26 articles that met the inclusion criteria were included. There were few articles about children. CONCLUSIONS CLP is not only connected to psychological effects which distress children's self-esteem and psychological functions, it also extends to their parents, particularly their mothers. However, parental and social support seem to have positive influences by reducing these psychological effects.
Collapse
Affiliation(s)
- Abeer Al-Namankany
- Paediatric Dentistry Department, Taibah University, Almadinah Almunawwarah, KSA
| | | |
Collapse
|
12
|
Sundell AL, Ullbro C, Marcusson A, Twetman S. Comparing caries risk profiles between 5- and 10- year-old children with cleft lip and/or palate and non-cleft controls. BMC Oral Health 2015. [PMID: 26208495 PMCID: PMC4514989 DOI: 10.1186/s12903-015-0067-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have suggested that children with oral clefts may have higher caries prevalence in comparison with non-cleft controls but the relative importance of the potential risk factors is not clear. The aim of this study was to compare the caries risk profiles in a group of cleft lip and/or palate (CL(P)) children with non-cleft controls in the same age using a computerized caries risk assessment model. METHODS The study group consisted of 133 children with CL(P) (77 subjects aged 5 years and 56 aged 10 years) and 297 non-cleft controls (133 aged 5 years and 164 aged 10 years). A questionnaire was used to collect data concerning the child's oral hygiene routines, dietary habits and fluoride exposure. Oral hygiene was assessed using Quigley-Hein plaque Index and the caries prevalence and frequency was scored according to the International Caries Detection and Assessment System. Whole saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rate. The risk factors and risk profiles were compared between the groups with aid of Cariogram and the estimated risk for future caries was categorized as "high" or "low". RESULTS Children with CL(P) (the entire study group) had significantly higher counts of salivary lactobacilli (p < 0.05) and displayed less good oral hygiene (p < 0.05). More 10-year-old children in the CL(P) group had low secretion rate but this difference was not significant. The average chance to avoid caries ranged from 59 to 67% but there were no significant differences between the groups. The odds of being categorized with high caries risk in the CL(P) group was significantly elevated (OR = 1.89; 95% CI = 1.25-2.86). In both groups, children in the high risk category had a higher caries experience than those with low risk. CONCLUSION Children with CL(P) displayed increased odds of being categorized at high caries risk with impaired oral hygiene and elevated salivary lactobacilli counts as most influential factors. The results suggest that a caries risk assessment model should be applied in the routine CL(P) care as a basis for the clinical decision-making and implementation of primary and secondary caries prevention.
Collapse
Affiliation(s)
- Anna Lena Sundell
- Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Box 1030, SE, 551 11, Jönköping, Sweden.
| | - Christer Ullbro
- Institute for Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Agneta Marcusson
- Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital, Linköping, Sweden.
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
13
|
Shashni R, Goyal A, Gauba K, Utreja AK, Ray P, Jena AK. Comparison of risk indicators of dental caries in children with and without cleft lip and palate deformities. Contemp Clin Dent 2015; 6:58-62. [PMID: 25684913 PMCID: PMC4319347 DOI: 10.4103/0976-237x.149293] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To test the hypothesis that there are no differences in various risk factors of dental caries among children with cleft lip and palate when compared to non-cleft high caries risk and non-cleft caries free children. Design: Seventy-three children in the age range of 4–9 years comprised three groups; Group-I (n = 23, children with cleft lip and palate), Group-II (n = 25, non-cleft high caries risk children) and Group-III (n = 25, non-cleft caries free children). Various risk factors for dental caries like type of oral hygiene practice, sugar exposures/day, developmental defects of enamel, caries activity, salivary streptococci mutans levels and lactobacilli levels were evaluated and compared among the three groups of children. Results: The mean deft score among Group-II children was significantly more (P < 0.01) as compared to the Group-I children. The mean deft + DMFT score among Group-I and Group-II children was comparable (P = 0.149). Developmental enamel defects were more among Group-I children as compared to Group-II and Group-III children (P < 0.01). Hypoplasia of the maxillary anterior teeth was more common among Group-I children as compared to Group-II (P < 0.05) and Group-III children (P < 0.001). The association between hypoplastic teeth and dental caries was significant (P < 0.05). The salivary acidogenic potential as evaluated by Snyder test was comparable among Group-I and Group-II children. The salivary streptococcus mutans levels in Group-I and Group-II children were higher when compared to lactobacillus counts. Conclusion: The risk factors of dental caries among children with cleft lip and palate were more as compared to non-cleft high caries risk and non-cleft caries free children.
Collapse
Affiliation(s)
- Rubina Shashni
- Department of Pedodontics, ACPM Dental College, Dhule, Maharashtra, India
| | - Ashima Goyal
- Unit of Pediatric Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishan Gauba
- Unit of Pediatric Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Utreja
- Unit of Orthodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Jena
- Unit of Orthodontics, Department of Dental Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
14
|
Mutthineni RB, Nutalapati R, Kasagani SK. Comparison of oral hygiene and periodontal status in patients with clefts of palate and patients with unilateral cleft lip, palate and alveolus. J Indian Soc Periodontol 2011; 14:236-40. [PMID: 21731249 PMCID: PMC3118074 DOI: 10.4103/0972-124x.76928] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 09/15/2010] [Indexed: 11/04/2022] Open
Abstract
Aim: This study was conducted to analyze and compare the oral hygiene and periodontal status in patients with clefts of palate (CP) and patients with unilateral cleft lip, palate and alveolus (UCLPA). Materials and Methods: The study group consisted of 120 cleft patients. Subjects were divided into two groups of 60 each. Group I - patients with UCLPA and Group II - patients with CP. For comparison, all the four quadrants were defined, Q1-right upper quadrant, Q2-left upper quadrant, Q3-left lower quadrant and Q4-right lower quadrant, in both groups and the following parameters were recorded: Plaque Index (PI, Silness and Loe), Sulcus Bleeding Index (SBI, Muhlemann and Son), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Mobility Index (Miller) and Radiographic Amount of Bone Loss. Results: The periodontal destruction was seen to be higher in UCLPA patients compared with CP patients. The poor oral hygiene status, as indicated by higher values of PI, and the periodontal status, evaluated by SBI, PPD, CAL, mobility and Radiographic Amount of Bone Loss, were higher in patients with UCLPA than in patients with CP. Conclusion: In this study, patients with cleft lip, palate and alveolus had poor oral hygiene and periodontal status compared with patients with cleft palate.
Collapse
Affiliation(s)
- Ramesh Babu Mutthineni
- Department of Periodontics, Mamata Dental College and Hospital, Khammam, Andhra Pradesh, India
| | | | | |
Collapse
|
15
|
Women are more susceptible to caries but individuals born with clefts are not. Int J Dent 2011; 2011:454532. [PMID: 21747859 PMCID: PMC3124302 DOI: 10.1155/2011/454532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022] Open
Abstract
The identification of individuals at a higher risk of developing caries is of great interest. Isolated forms of cleft lip and palate are among the most common craniofacial congenital anomalies in humans. Historically, several reports suggest that individuals born with clefts have a higher risk for caries. Caries continues to be the most common infectious noncontagious disease worldwide and a great burden to any health system. The identification of individuals of higher susceptibility to caries is of great interest. In this paper, we assessed caries experience of 1,593 individuals from three distinct populations. The study included individuals born with clefts, their unaffected relatives, and unrelated unaffected controls that were recruited from areas with similar cultural pressures and limited access to dental care. DMFT/dmft scores were obtained, and caries experience rates were compared among the three groups in each geographic area. Individuals born with clefts did not present higher caries experience in comparison to their unaffected relatives or unrelated unaffected controls. Women tend to present higher caries rates in comparison to men. Our work provides strong evidence that individuals born with clefts are not at higher risk to caries; however, women tend to have more severe caries experience.
Collapse
|
16
|
Dental caries prevalence in children with cleft lip/palate aged between 6 months and 6 years in the West of Scotland. Eur Arch Paediatr Dent 2011; 11:236-41. [PMID: 20932398 DOI: 10.1007/bf03262754] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To compare the prevalence of dental caries in children with cleft lip/palate with national data at the same age. METHOD Ethical approval was granted from the West of Scotland Ethics Committee. Children attending the Oral Orthopaedic Clinic were examined for caries according to the criteria of the British Association for the Study of Community Dentistry (BASCD) by two trained and calibrated examiners (KB, RW). Subjects were divided into five age groups: 0.5-1.49; 1.5-2.49; 2.5-3.49; 3.5-4.49 and 4.5-6.0 years. Mean dmft scores were compared with available national data (National Dental Inspection Program of Scotland) for nursery [NDIP 3-year-old survey 2008, unpublished] and 5-year-old children in Scotland [NDIP, 2008]. RESULTS 209 subjects were examined (participation rate of 87.4%); 45.9% were female, 54.1% male; 21 children (10%) had a recognised syndrome and were reported separately. Cleft Palate (CP) was the most commonly occurring cleft in both syndromic and non-syndromic groups, followed in decreasing numbers by Unilateral Cleft Lip and Palate (UCLP), Bilateral Cleft Lip and Palate (BCLP), Unilateral Cleft Lip (UCL) and Bilateral Cleft Lip (BCL). The only age group with a significantly higher level of dental caries compared with national data was the 4.5-6.0 year-olds where only 37.2% of the children with clefts were caries free compared with the national figure of 57.7% (p=0.004). This same age group had a mean dmft for the cleft group of 3.24 compared with 1.86 nationally. The other age groups had similar dmft and percentages of subjects caries free compared with the national data. The differences did not reach significance. Caries was more common in the anterior teeth of the youngest two age groups, but in the posterior teeth of the two oldest age groups. CONCLUSION By the age of 4.5 years, children with cleft lip/palate in the West of Scotland have significantly more caries than their non-cleft peers.
Collapse
|
17
|
Boloor V, Thomas B. Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus. J Indian Soc Periodontol 2010; 14:168-72. [PMID: 21760670 PMCID: PMC3100859 DOI: 10.4103/0972-124x.75911] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 06/17/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft subjects, especially in those with cleft lip, alveolus and palate (CLAP), maintenance of oral hygiene is a difficult task for the patients because of the patent oro-nasal communication. Crowding of teeth in cleft patients is a common finding, especially in those with CLAP and those with cleft palate (CP). In the case of multiple tooth-malpositions, transverse deficiency, arch length deficiency and primary cross-bite; periodontal trauma increases and is detrimental to periodontal health. According to literature, a critical periodontal situation was found in patients with CLAP. Hence a study was conducted to analyze the periodontal status of patients with cleft lip (CL); those with cleft palate; and those with cleft lip, alveolus and palate. MATERIALS AND METHODS The present study consisted of 60 cleft subjects divided into 3 groups: those with cleft lip; those with cleft palate; and those with cleft lip, alveolus and palate. Subjects with permanent dentition were selected, and the clinical examination included determination of oral hygiene status using Oral Hygiene Index - Simplified (OHI-S) index and periodontal status using community periodontal index (CPI). RESULTS Statistically significant increase in the periodontal disease in the CLAP group as compared with the other 2 groups, and the oral hygiene was seen to be generally poor with the CLAP group. INTERPRETATION AND CONCLUSION Individuals with clefts are more prone to periodontal disease due to the presence of cleft, which causes retention of food in the defect sites and inability to maintain good oral hygiene; but the severity of periodontal disease is more if the defect is large and involving the lip, alveolus and palate.
Collapse
Affiliation(s)
- Vinita Boloor
- Department of Periodontics, Yenepoya Dental College, Deralakatte, Mangalore - 575 018, India
| | - Biju Thomas
- A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore - 575 018, India
| |
Collapse
|
18
|
Boles MK, Wilkinson BM, Wilming LG, Liu B, Probst FJ, Harrow J, Grafham D, Hentges KE, Woodward LP, Maxwell A, Mitchell K, Risley MD, Johnson R, Hirschi K, Lupski JR, Funato Y, Miki H, Marin-Garcia P, Matthews L, Coffey AJ, Parker A, Hubbard TJ, Rogers J, Bradley A, Adams DJ, Justice MJ. Discovery of candidate disease genes in ENU-induced mouse mutants by large-scale sequencing, including a splice-site mutation in nucleoredoxin. PLoS Genet 2009; 5:e1000759. [PMID: 20011118 PMCID: PMC2782131 DOI: 10.1371/journal.pgen.1000759] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 11/09/2009] [Indexed: 12/13/2022] Open
Abstract
An accurate and precisely annotated genome assembly is a fundamental requirement for functional genomic analysis. Here, the complete DNA sequence and gene annotation of mouse Chromosome 11 was used to test the efficacy of large-scale sequencing for mutation identification. We re-sequenced the 14,000 annotated exons and boundaries from over 900 genes in 41 recessive mutant mouse lines that were isolated in an N-ethyl-N-nitrosourea (ENU) mutation screen targeted to mouse Chromosome 11. Fifty-nine sequence variants were identified in 55 genes from 31 mutant lines. 39% of the lesions lie in coding sequences and create primarily missense mutations. The other 61% lie in noncoding regions, many of them in highly conserved sequences. A lesion in the perinatal lethal line l11Jus13 alters a consensus splice site of nucleoredoxin (Nxn), inserting 10 amino acids into the resulting protein. We conclude that point mutations can be accurately and sensitively recovered by large-scale sequencing, and that conserved noncoding regions should be included for disease mutation identification. Only seven of the candidate genes we report have been previously targeted by mutation in mice or rats, showing that despite ongoing efforts to functionally annotate genes in the mammalian genome, an enormous gap remains between phenotype and function. Our data show that the classical positional mapping approach of disease mutation identification can be extended to large target regions using high-throughput sequencing.
Collapse
Affiliation(s)
- Melissa K. Boles
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Bonney M. Wilkinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Laurens G. Wilming
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Bin Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Frank J. Probst
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jennifer Harrow
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Darren Grafham
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Kathryn E. Hentges
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Lanette P. Woodward
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Andrea Maxwell
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Karen Mitchell
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Michael D. Risley
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Randy Johnson
- The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Karen Hirschi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Texas Children's Hospital, Houston, Texas, United States of America
| | - Yosuke Funato
- Laboratory of Intracellular Signaling, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Hiroaki Miki
- Laboratory of Intracellular Signaling, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Pablo Marin-Garcia
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Lucy Matthews
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Alison J. Coffey
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Anne Parker
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Tim J. Hubbard
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Jane Rogers
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Allan Bradley
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - David J. Adams
- The Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
- * E-mail: (MJJ); (DJA)
| | - Monica J. Justice
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (MJJ); (DJA)
| |
Collapse
|