Identification of a de novo PUF60 variant associated with craniofacial microsomia

Craniofacial microsomia (CFM), also known as the oculo-auriculo-vertebral spectrum, is a congenital disorder characterized by hypoplasia of the mandible and external ear due to tissue malformations originating from the first and second branchial arches. However, distinguishing it from other syndromes of branchial arch abnormalities is difficult, and causal variants remain unidentified in many cases. In this report, we performed an exome sequencing analysis of a Brazilian family with CFM. The proband was a 12-month-old boy with clinical findings consistent with the diagnostic criteria for CFM, including unilateral mandibular hypoplasia, microtia, and external auditory canal abnormalities. A heterozygous de novo nonsense variant (c.713C>G, p.S238*) in PUF60 was identified, which was predicted to be pathogenic in silico. PUF60 has been reported as a causal gene in Verheij syndrome, but not in CFM. Although the boy showed craniofacial abnormalities and developmental delay that overlapped with Verheij syndrome, the facial asymmetry with unilateral hypoplasia of the mandible observed in this case did not match the previously reported phenotypes of PUF60 variants. Our findings expand the phenotypic range of PUF60 variants that cover CFM and Verheij syndrome.

Robin Sequence Facial Profile After Conservative Treatment: A Long-Term Follow-Up

INTRODUCTION

Robin sequence (RS) is a congenital clinical condition characterized by micrognathia, glossoptosis, and respiratory distress. Conservative methods could be responsible for releasing feeding and respiratory impairment but little information about mandibular growth is known in long-term follow-up.

OBJECTIVE

Assessing the longitudinal behavior of the facial profile of individuals with isolated RS who underwent conservative micrognathia treatment using photographs during the whole craniofacial growth.

METHODS

Photographs of the right facial profile of 100 patients were used (50 individuals with isolated RS and 50 individuals without craniofacial anomaly). The individuals with RS were evaluated at 3 different times (T1: infant, T2: mixed dentition, T3: permanent dentition) by measuring the facial convexity angle (FCA; G.Sn.Pog´). A comparison between T3 and control group (C), individuals without craniofacial anomalies and in permanent dentition, was also performed, checking the FCA, nasolabial angle (Ls.Sn.Cm), mentolabial fold (Li.Si.Pog´), facial inferior third (Sn.Gn´.C) angles and the ratio between middle anterior facial height and lower anterior facial height.

RESULTS

The T3 group showed an increased angle of facial convexity and increased facial inferior third angle and middle anterior facial height/lower anterior facial height ratio compared with the control group. In the longitudinal evaluation of individuals with isolated RS, significant differences were identified between T1 and T2 groups and T1 and T3 groups showing that the increased facial convexity was higher in the infants and that did not change significantly between the phases of mixed and permanent dentition.

CONCLUSIONS

RS showed increased facial convexity in all phases evaluated, but their convexity decreased with growth. When compared with individuals without craniofacial anomalies, the individuals continue to exhibit retrognathism in the permanent dentition. The lack of a mandible projection has led to a considerable number of orthognathic surgeries for the correction of discrepancies.

Oculoauriculofrontonasal syndrome: Refining the phenotype through a new case series and literature review

The oculoauriculofrontonasal syndrome (OAFNS) is a rare condition, with unknown etiology, characterized by the association of frontonasal dysplasia (FND) and oculoauriculovertebral spectrum (OAVS). Main clinical findings include widely spaced eyes, epibulbar dermoid, broad nose, mandibular hypoplasia, and preauricular tags. Here, we describe a case series of 32 Brazilian individuals with OAFNS and review the literature ascertaining individuals presenting phenotypes compatible with the diagnosis of OAFNS, aiming to refine the phenotype. This series emphasizes the phenotypic variability of the OAFNS and highlights the occurrence of rare craniofacial clefts as a part of the phenotype. The ectopic nasal bone, a hallmark of OAFNS, was frequent in our series, reinforcing the clinical diagnosis. The absence of recurrence, consanguinity, chromosomal, and genetic abnormalities reinforces the hypothesis of a nontraditional inheritance model. The phenotypic refinement provided by this series contributes to an investigation regarding the etiology of OAFNS.

Craniofacial and airway morphology of individuals with oculoauriculovertebral spectrum

OBJECTIVES

The objectives of this study were to characterize the craniofacial and airway morphology of oculo-auriculo-vertebral spectrum (OAVS) individuals using computed tomography (CT) examination.

SETTING AND SAMPLE POPULATION

This sample included individuals in the age range from 5 to 14 years, consisted of a group of 18 OAVS individuals (12 females and 6 males), Pruzansky-Kaban¹ IIB and III and by a paired control group matched by age and sex for comparison of morphometric and airway variables.

MATERIALS AND METHODS

Through the CT examination, airway analysis was performed using Dolphin Imaging® Software, and seven morphometric measurements were performed to evaluate craniofacial morphology by Materialize Mimics® Software. To compare airway and morphometric variables, the control group was used. Student's t test and Mann-Whitney U test were performed to compare differences between the groups.

RESULTS

Statistically significant differences were showed between the control and OAVS groups for the variables: total airway (TA) area, volume and MAA, RP area, RP volume, RP MAA, RG volume, RG MAA, total posterior height diff, Md incl and y-axis asymmetry. Pearson and Spearman's correlation showed mostly moderate correlations between Mand Occlusal canting AS with TA area and RP volume, Ax-Gn with TA area and Hy-C3 with TA volume.

CONCLUSIONS

The OAVS's airway was altered and worse than the control group. Our results suggest that the contralateral side of OAVS individuals is unaffected; however, longitudinal assessments are needed to confirm it. Hyoid bone and postural measures play an important role in interpreting airway features of individuals with and without OAVS.

Congenital Midline Cervical Cleft: A Variant of Tessier Number 30 Cleft Causing Micrognathia

Congenital midline cervical cleft is a rare and generally isolated malformation of the ventral neck region with no clear etiology established. Mandibular deformities, such as micrognathia, could be considered as a consequence of a cleft cervical contracture. Complete surgical excision of the subcutaneous fibrous cord at an early age is the primary treatment modality, minimizing growth development problems on surrounding affected tissue. The aim of this study is to describe the clinical, surgical, and histological findings in a female child with congenital midline cervical cleft along with a relevant literature review. Three years follow-up after surgery exhibited satisfactory functional and cosmetic results.

Comparison Between Treacher Collins Syndrome and Pierre Robin Sequence: A Cephalometric Study

OBJECTIVE

The aim of this study was to compare the dentoskeletal pattern of Treacher Collins syndrome (TCS) and nonsyndromic Pierre Robin sequence (PRS).

DESIGN

Retrospective.

SETTING

Single center.

PATIENTS

Eighteen patients diagnosed with TCS (Group TCS) or PRS (Group PRS) in rehabilitation treatment at a single center. Group TCS was composed of 9 patients (4 male, 5 female) with a mean age of 12.9 years (standard deviation = 4.8). Group PRS was composed of 9 patients paired by age and sex with group TCS.

MAIN OUTCOME MEASURE(S)

Cone beam computed tomography-derived cephalometric images taken before the orthodontic or the orthodontic-surgical treatment were analyzed using Dolphin Imaging (Dolphin Imaging 11.0 & Management Solutions). Variables evaluating the cranial base, the maxillary and mandibular skeletal components, maxillomandibular relationship, the vertical components and the dentoalveolar region were measured. Intergroup comparisons were performed using t tests. The significance level considered was 5%.

RESULTS

Intergroup differences in the mandible size and growth pattern were observed. Group TCS showed a smaller mandibular length (Co-Go, Co-Gn) and a higher palatal plane (SN-Palatal Plane) and mandibular plane angles (SN-Go.Gn) compared to group PRS. No differences between TCS and PRS were observed for the sagittal position of the maxilla, maxillomandibular relationship, and dental components.

CONCLUSIONS

Treacher Collins syndrome presented a decreased mandible and a more severe vertical growth pattern compared to PRS.

Can palatal splint improve stability of segmental Le Fort I osteotomies?

OBJECTIVES

The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies.

SETTING AND SAMPLE POPULATION

Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21).

MATERIALS AND METHODS

Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test.

RESULTS

Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm.

CONCLUSIONS

The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.

Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

Introduction

This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods.

Methods

Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches.

Results

During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period.

Conclusions

Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

Análise de Bolton: uma proposta alternativa para a simplificação de seu uso

INTRODUÇÃO: as discrepâncias entre o tamanho mesiodistal dos dentes superiores e inferiores e seus efeitos sobre a oclusão têm sido relatados há muito tempo. O método proposto por Bolton para o diagnóstico de discrepância de tamanho dentário é, inegavelmente, um dos mais difundidos no meio ortodôntico, devido à sua relativa simplicidade. Entretanto, a aplicação desse método requer cálculos matemáticos e o uso de tabelas que, muitas vezes, inviabilizam a sua utilização durante a avaliação clínica. OBJETIVO: avaliar o método proposto por Wolford, que não requer o uso de tabelas, como alternativa ao método tradicional de Bolton. MÉTODOS: a amostra foi composta por 90 pares de modelos dentários iniciais de pacientes adultos, com diferentes más oclusões. A proporção entre os dentes inferiores e superiores foi calculada para cada paciente, resultando na obtenção de dois índices (a razão total e a razão anterior). Os índices foram obtidos por meio do método originalmente proposto por Bolton e por um método alternativo, composto por duas fórmulas (uma simplificada e a variação da mesma), que foram analisadas separadamente. RESULTADOS: comparadas ao método de Bolton, as fórmulas simplificadas mostraram uma tendência de superestimar as discrepâncias dentárias inferiores (total e anterior), embora em pequena proporção. CONCLUSÕES: ambas as fórmulas do método alternativo podem ser utilizadas em substituição ao método tradicional, uma vez que mostraram diferenças médias menores que 0,58mm quando comparadas ao método de Bolton, não apresentando, portanto, significância clínica.