Cleft palate in Williams syndrome

Short Report: Lack of Diurnal Variation in Salivary Cortisol Is Linked to Sleep Disturbances and Heightened Anxiety in Adolescents with Williams Syndrome

Objective: The aim of the current study was to examine the potential relationship between sleep patterns, cortisol levels, and anxiety profiles in adolescents with Williams Syndrome (WS) compared to typically developing adolescents. Method: Thirteen adolescents with WS and thirteen TD adolescents (age range 12–18 years) were recruited. Participants were provided with a “testing kit”, containing instructions for collecting data through a sleep diary, MotionWare actigraphy, the Childhood Sleep Habits Questionnaire (CSHQ), and the Spence Children’s Anxiety Scale, and a salivary cortisol collection kit. Results: Adolescents in the WS group did not show diurnal variation in salivary cortisol. Significantly higher scores were reported for two CSHQ subsections, night wakings and parasomnias, in the WS group. Regarding the actigraphy, only significantly longer sleep latency was observed in the WS group. In comparison to the TD group, the WS group had significantly higher anxiety. As expected, the TD group showed typical diurnal variation in cortisol, whereas the WS group showed a flattened cortisol profile throughout the day. Conclusions: From the developmental perspective, this study provides new data supporting the conclusion that sleep problems are not transient but continue to persist into adolescence in WS. Future studies ought to consider examining the role of cortisol and its interplay with anxiety levels and sleep problems across the lifespan in individuals with WS.

TFII-I and AP2α Co-Occupy the Promoters of Key Regulatory Genes Associated with Craniofacial Development

OBJECTIVES

The aim of this study is to define the candidate target genes for TFII-I and AP2α regulation in neural crest progenitor cells.

DESIGN

The GTF2I and GTF2IRD1 genes encoding the TFII-I family of transcription factors are prime candidates for the Williams-Beuren syndrome, a complex multisystem disorder characterized by craniofacial, skeletal, and neurocognitive deficiencies. AP2α, a product of the TFAP2A gene, is a master regulator of neural crest cell lineage. Mutations in TFAP2A cause branchio-oculo-facial syndrome characterized by dysmorphic facial features and orofacial clefts. In this study, we examined the genome-wide promoter occupancy of TFII-I and AP2α in neural crest progenitor cells derived from in vitro-differentiated human embryonic stem cells.

RESULTS

Our study revealed that TFII-I and AP2α co-occupy a selective set of genes that control the specification of neural crest cells.

CONCLUSIONS

The data suggest that TFII-I and AP2α may coordinately control the expression of genes encoding chromatin-modifying proteins, epigenetic enzymes, transcription factors, and signaling proteins.

Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams-Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years

Williams–Beuren syndrome (WBS) is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient's malocclusion. The patient's mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course.

High-resolution single nucleotide polymorphism arrays identified an atypical microdeletion of the Williams-Beuren syndrome interval in a patient presenting with a different phenotype

The present study aimed to identify the mutation causing an atypical syndrome. High-resolution single nucleotide polymorphism (SNP) arrays are considered to be a major detection method for submicroscopic chromosomal rearrangements smaller than 5 Mb in size. Genomic DNA samples of the patient and his parents were converted to a final concentration of 50 ng/ml. The Illumina BeadScan genotyping system and the HumanOmni1‑Quad Chip were employed to obtain the signal intensities of SNP probes. The patient presented with congenital heart disease, autism, mental retardation, growth retardation, hypercalcemia, nephroliths and cleft palate. The karyotypes of the patient and his parents were normal. The present study employed high‑resolution SNP arrays to analyze the whole genome for copy number variations (CNVs). A total of 309 CNVs were discovered. A de novo 1.5 Mb gain of chromosome 7q11.23 (Chr7: 72,357,322‑73,856,472) was identified following exclusion of CNVs presented in the Database of Genomic Variants. In conclusion, to the best of our knowledge, the current study describes the first case of a patient presenting with Williams‑Beuren syndrome alongside supravalvular aortic stenosis, autism and cleft palate, and identifies an atypical deletion at 7q11.23.

A Patient With Pansynostosis and Williams-Beuren Syndrome

BACKGROUND

Williams-Beuren syndrome (WBS) is a multisystemic genetic disorder caused by a gene deletion at gene locus 7q11.23. This article presents the first described case of a patient with WBS and simultaneous pansynostosis.

CASE PRESENTATION

This article presents the management of this young Caucasian boy from birth until the age of 12 years and provides an overview of previously described manifestations of WBS in the craniofacial region.

CONCLUSIONS

This case demonstrates the surgical treatment of pansynostosis in a child with WBS and might provide interesting aspects in the diagnostics and management of this rare malformation.

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

Clinical evaluation with 18 months follow-up of new PTTM enhanced dental implants in maxillo-facial post-oncological patients

AIM

The aim of this study is to present 18 months follow-up results of porous tantalum trabecular metal-enhanced titanium dental implant (PTTM) in implant supported prosthesis in post-oncological patients.

MATERIALS AND METHODS

A total of 25 PTTM implants were placed in each jaw of 6 patients that met specific inclusion and exclusion criteria. Resonance Frequency Analysis (RFA) was conducted and Implant stability was recorded in ISQ values (Osstell ISQ, Osstell AB, Goteborg, Sweden) at implant placement and after 2,4,6,12 and 18 months of functional loading. Mean bone loss was also evaluated at the same interval of time on each periapical radiographs, bone levels were calculated by measuring the distance from the implant shoulder to the first bone to implant contact.

RESULTS

Cumulative implant survival rate is 100% (n=25/25) to date and mean ISQ values recorded were: 72.14±5.61 (range= 50-81) at surgery, 64.39±8.12 (range=44-74) after 2 months, 74.26±7.14 (range=44-74) after 4 months, 76.84±7.65 (range=60-83) after 6 months, 78.13±4.14 (range=64-84) after 12 months and 80.22±6.23 (range=68-89) after 18 months of functional loading. Mean crestal marginal bone loss was 0.19±0.25 mm after 2 months of functional loading on periapical radiographs, 0.22±0.4 mm at 4 months, 0.3±0.46 mm at 6 months, 0.57±0.62 at 1 year and 0.64±0.60 mm after 18 months.

CONCLUSIONS

The results of this study, even if limited by the number of implants placed indicate that PTTM dental implants have a clinical efficacy in prosthetic rehabilitation of post-oncological patients, due to trabecular structure of the porous Ta metal that increases bone-implant connection values.