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Kanani H, Patil R, Khubchandani M, Yeluri R, Pandey R. Solitary Median Maxillary Central Incisor Syndrome: A Case Report of a Unique Dental Anomaly. Cureus 2024; 16:e58101. [PMID: 38741811 PMCID: PMC11088956 DOI: 10.7759/cureus.58101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Solitary median maxillary central incisor (SMMCI) syndrome is complex and usually develops 35-38 days postconception during the intrauterine period. A noteworthy discovery is that just one central incisor in the maxillary alveolus, found exactly on the centerline, is present in both deciduous and permanent dentitions with other congenital anomalies. Around one in every 50,000 live babies exhibits this abnormality. This report describes the case of a 13-year-old female patient with SMMCI syndrome with a complaint about an unsightly appearance due to a single large upper front tooth. We underline the importance of increasing clinician awareness of SMMCI syndrome and the need for a multidisciplinary approach to its care.
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Affiliation(s)
- Harikishan Kanani
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rutuja Patil
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Monika Khubchandani
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ramakrishna Yeluri
- Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ruchika Pandey
- Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Balasubramanian S, Haridoss S, Swaminathan K. Solitary Median Maxillary Central Incisor Syndrome: A Case Report. Int J Clin Pediatr Dent 2022; 15:458-461. [PMID: 36875972 PMCID: PMC9983595 DOI: 10.5005/jp-journals-10005-2418] [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: 12/23/2022] Open
Abstract
Aim This report intends to present a case of solitary median maxillary central incisor syndrome (SMMCI) and its multidisciplinary team approach for diagnosis of other associated anomalies, with special emphasis on their management. Background Solitary median maxillary central incisor syndrome is a unique developmental condition characterized by only maxillary central incisor and a series of developmental defects, appearing as a syndrome. The appearance of a single incisor may take place due to the union of two incisor teeth or the absence of tooth germs. The mechanism of the fusion is still uncertain. Case description A 9-year-old female child reported with a chief complaint of pain in the right lower back tooth for the past 10 days. The presence of a single maxillary central incisor was an incidental finding. Then a detailed history and multidisciplinary evaluations revealed the diagnosis of SMMCI syndrome. Conclusion The effort in diagnosing and managing this syndrome had a strong impact on the child's life of which the parent was highly motivated and got a better understanding of associated problems of overall development. Clinical significance In SMMCI syndrome, the patient requires a multidisciplinary health team in order to improve their quality of life. It is of greater importance to diagnose the syndrome and treatment of these median line deformities. How to cite this article Balasubramanian S, Haridoss S, Swaminathan K. Solitary Median Maxillary Central Incisor Syndrome: A Case Report. Int J Clin Pediatr Dent 2022;15(4):458-461.
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Affiliation(s)
- Suganya Balasubramanian
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Selvakumar Haridoss
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Kavitha Swaminathan
- Department of Pediatric and Preventive Dentistry, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Rodrigues Santos N, Mota R, Gonçalves A, Spratley J, Soares H. Upper Airway Obstruction in a Newborn: A Rare Cause of Respiratory Distress. Cureus 2022; 14:e22126. [PMID: 35291536 PMCID: PMC8918092 DOI: 10.7759/cureus.22126] [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] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
Abstract
Newborns are considered obligate nasal breathers until the eighth week of life. Therefore, upper nasal obstruction in a newborn can present as a potentially life-threatening complication. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare form of upper airway obstruction caused by a narrowing without occlusion in the most anterior opening of the bony nasal airways. According to the severity of this stenosis, early onset of respiratory symptoms can arise in the newborn. In this article, we present the case of a male term newborn with no prior relevant family history and uneventful gestation delivered in a eutocic manner with an adequate transition to the extra-uterine environment. On his first day of life, progressive respiratory distress, inability to breastfeed, and impossibility to make nasogastric probe progress through both sides of the nose were observed, leading the newborn to be admitted to a neonatal intensive care unit. During imagiological assessment with perinasal computerized tomography (CT) scan, an almost total occlusion of the pyriform aperture and a solitary median maxillary central incisor (SMMCI) were identified. Additional evaluation with brain magnetic nuclear resonance imaging (MRI) was unremarkable with no midline defects identified. Endocrine laboratory assessment was also normal. The newborn underwent pyriform aperture permeabilization surgery via a sublabial approach with bilateral nasal stent introduction, enabling total resolution of the initial respiratory symptoms. No incurrences were reported during the post-operatory follow-up period. With the present case report, the authors are trying to raise awareness for CNPAS not only as a rare cause of respiratory distress in the newborn but also as a clinical entity that can be associated with midline defects, which require further additional investigation and intervention.
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Angulo C, Jayawardena ADL, Caruso PA, Ramos D, Bonilla JA, Zablah E, Hartnick CJ. Congenital nasal piriform aperture atresia: A case report and novel finding. Int J Pediatr Otorhinolaryngol 2020; 135:110124. [PMID: 32512323 DOI: 10.1016/j.ijporl.2020.110124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
Congenital nasal piriform aperture stenosis and choanal atresia are types of nasal obstructions that can be life threatening to infants if left untreated. While there has been numerous reports on both of them there has not been a single reported case of congenital nasal piriform aperture atresia. Here, we present the first case of piriform aperture atresia that includes the diagnostic and clinical approach.
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Affiliation(s)
- Camila Angulo
- Tecnológico de Monterrey, Medical School, Guadalajara, Mexico
| | - Asitha D L Jayawardena
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology Head and Neck Surgery, Boston, MA, USA
| | - Paul A Caruso
- Massachusetts Eye and Ear Infirmary, Department of Radiology, Boston, MA, USA
| | - Daniel Ramos
- Hospital Nacional de Niños Benjamín Bloom, Department of of Otolaryngology Head and Neck Surgery, San Salvador, El Salvador
| | - José A Bonilla
- Hospital Nacional de Niños Benjamín Bloom, Department of of Otolaryngology Head and Neck Surgery, San Salvador, El Salvador
| | - Evelyn Zablah
- Benjamin Harry Peikin Foundation, Mission Coordination of Operation Airway, Boston, MA, USA
| | - Christopher J Hartnick
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology Head and Neck Surgery, Boston, MA, USA.
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Marrugo Pardo GE, Parra Charris JS, Parra Charris AE, Villa Zuluaga DF. Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Negi A, Negi A, Mohanan M. Solitary median maxillary central incisor syndrome: A rare entity. J Oral Maxillofac Pathol 2020; 24:402. [PMID: 33456262 PMCID: PMC7802849 DOI: 10.4103/jomfp.jomfp_183_19] [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: 06/11/2019] [Revised: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022] Open
Abstract
Solitary median maxillary central incisor (SMMCI) syndrome is a complex disorder and a rare dental anomaly, which is estimated to occur in approximately 1:50,000 live births. It is a unique developmental abnormality which involves the central incisor tooth germs, occurring with or without systemic involvement; hence, its early diagnosis is of great importance. The objective of this study was to discuss a case of SMMCI syndrome and various dental treatment alternatives available in management of such cases. Due to the possible association of this syndrome with other developmental problems, an early diagnosis and management becomes important. Moreover, when it is associated with other developmental malformation and defects, the management becomes multidisciplinary.
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Ruda J, Grischkan J, Allarakhia Z. Radiologic, genetic, and endocrine findings in isolated congenital nasal pyriform aperture stenosis patients. Int J Pediatr Otorhinolaryngol 2020; 128:109705. [PMID: 31606685 DOI: 10.1016/j.ijporl.2019.109705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in neonates. It can occur either associated with a solitary median maxillary central incisor (SMMCI) in 40-75% of cases or as an isolated morphogenic variant. Brain MRI is routinely performed in patients with CNPAS with a SCMMI due to the concomitant risks of intracranial midline defects of the hypothalamic-pituitary axis (HPA), holoprosencephaly, or associated endocrine dysfunction. However, the role of routine brain imaging and endocrinologic evaluation in patients with isolated CNPAS is not frequently studied given the assumption that isolated CNPAS is unlikely to be associated with any intracranial findings. OBJECTIVES To evaluate intracranial findings on dual brain MRI imaging in isolated CNPAS patients and to determine if any radiologic, endocrinologic, or genetic abnormalities existed in these patients. METHODS We performed a single-institution retrospective review and case series of patients with isolated CNPAS from 2006 to 2019. Findings from dual brain MRI imaging, cytogenetic and karyotype testing, and formal endocrinologic testing were analyzed for each patient and compared to reported findings in isolated CNPAS patients within the literature. RESULTS From 2006 to 2019, 16/29 patients were identified at our institution with isolated CNPAS. Inpatient otolaryngologic consultation, CT, and brain MRI imaging was obtained after a mean postnatal age of 3.21 days, 13.5 days, and 35.91 days, respectively. Dual brain MRI imaging was obtained in 12/16 (75%) patients. In our patients, abnormal MRI findings included hypothalamic hamartoma, pars intermedius cyst, and grades 1 and 4 germinal matrix hemorrhages. No holoprosencephaly was found in any patient. Genetic testing was performed on 10/16 (62.5%) patients. Karyotyping was normal in all patients and microarray testing was abnormal in 2/10 patients that represented a 2p16.3 deletion in one patient and a 7q36 deletion causing an unbalanced translocation mutation of the Sonic Hedgehog gene in the second patient. In the latter patient, a hypothalamic hamartoma and panhypopituitarism was found. Endocrine evaluation was performed in 5 patients and was normal in 3/5 patients. CONCLUSIONS Our case series of isolated CNPAS patients identified multiple abnormalities on radiologic, genetic, and endocrine testing; one of which that involved a defect of the HPA with panhypopituitarism resulting from a hypothalamic hamartoma. Based upon our findings, dedicated brain MRI imaging, endocrinologic, and genetic testing, should likely be considered for any newly diagnosed, isolated CNPAS patient given the uncommon but potential risk for associated intracranial abnormalities.
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Affiliation(s)
- James Ruda
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA, 43205; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, 370 W 9th Ave, Columbus, OH, USA, 43210.
| | - Jonathan Grischkan
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA, 43205; Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, 370 W 9th Ave, Columbus, OH, USA, 43210
| | - Zahir Allarakhia
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH, USA, 43210
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Shah GB, Ordemann A, Daram S, Roman E, Booth T, Johnson R, Xi Y, Mitchell R. Congenital nasal pyriform aperture stenosis: Analysis of twenty cases at a single institution. Int J Pediatr Otorhinolaryngol 2019; 126:109608. [PMID: 31374389 DOI: 10.1016/j.ijporl.2019.109608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress that is difficult to treat. The primary objective of this study was to identify factors that predict the need for initial and revision surgery for CNAPS. The secondary objective is to identify risk factors in maternal history associated with the development of CNPAS. METHODS Infants with CNPAS between 2010 and 2017 were identified by ICD- 9 and 10 codes. Demographics, maternal history, anatomic features on imaging and medical and/or surgical management were reviewed. Frequencies, means and standard deviations were calculated. A p-value <.05 was considered significant. RESULTS Twenty infants were included. All underwent flexible nasal endoscopy with inability to pass the scope in either nostril in 65% of infants. Nineteen had a CT scan and 13 had a MRI with midline defects in 76.3% and 53.8%, respectively. Solitary central mega-incisor was present in 65%. Half underwent surgical intervention at a mean age of 74.8 days, with 90% requiring revision surgery. There was no difference in pyriform aperture distance in the surgical and non-surgical patient subgroups (5.4 mm and 5.2 mm, p = .6 respectively). No specific variables were predictive of need for initial or revision surgery. Maternal diabetes mellitus (MDM) was found in 55% of mothers of infants with CNPAS. CONCLUSION Pyriform aperture distance was not a predictor of surgical intervention. MRI should be considered in all infants with CNPAS as the rate of intracranial complications is high. MDM may be a risk factor for CNPAS.
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Affiliation(s)
- Gopi B Shah
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA.
| | - Allison Ordemann
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Shiva Daram
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Emily Roman
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Tim Booth
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Romaine Johnson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ron Mitchell
- Department of Otolaryngology, University of Texas Southwestern Medical Center, 2001 Inwood Road, 6th & 7th Floors, Dallas, TX, 75390, USA
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Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:154-159. [PMID: 31495444 DOI: 10.1016/j.otorri.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal obstruction in neonates with respiratory distress manifestations. Diagnosis is made with craniofacial computed tomography, prompt and precise treatment creates good outcomes in these patients. AIM To present our experience in diagnosis and management considerations with this rare pathology and a case series of our surgically managed patients. METHODS A retrospective, analytical study of CNPAS patients surgically managed over a period of seven years. Evaluation and follow up was reviewed. RESULTS Thirteen patients were evaluated; pyriform aperture mean width was 5.5mm. Of these patients, 31% also had Congenital Midnasal Stenosis. Medical treatment failed for all the patients and they required surgical enlargement of the pyriform aperture. No complications were seen and all patients improved in symptoms and development. CONCLUSIONS Congenital nasal obstruction can be fatal in new-borns, CNPAS is a rare differential diagnosis that must be completely evaluated, properly treated with conservative management and if it fails, with well-planned and executed surgery. Follow-up shows high rates of success.
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Farag AM. Head and Neck Manifestations of Endocrine Disorders. Atlas Oral Maxillofac Surg Clin North Am 2018; 25:197-207. [PMID: 28778308 DOI: 10.1016/j.cxom.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Arwa M Farag
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, DHS #638, Boston, MA 02111, USA; Department of Oral Medicine, Faculty of Dentistry, King AbdulAziz University, 1 Umm Al Muminin Road, Jeddah 21589, Kingdom of Saudi Arabia.
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Martinez AF, Kruszka PS, Muenke M. Extracephalic manifestations of nonchromosomal, nonsyndromic holoprosencephaly. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:246-257. [PMID: 29761634 DOI: 10.1002/ajmg.c.31616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/29/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022]
Abstract
Nonchromosomal, nonsyndromic holoprosencephaly (NCNS-HPE) has traditionally been considered as a condition of brain and craniofacial maldevelopment. In this review, we present the results of a comprehensive literature search supporting a wide spectrum of extracephalic manifestations identified in patients with NCNS-HPE. These manifestations have been described in case reports and in large cohorts of patients with "single-gene" mutations, suggesting that the NCNS-HPE phenotype can be more complex than traditionally thought. Likely, a complex network of interacting genetic variants and environmental factors is responsible for these systemic abnormalities that deviate from the usual brain and craniofacial findings in NCNS-HPE. In addition to the systemic consequences of pituitary dysfunction (as a direct result of brain midline defects), here we describe a number of extracephalic findings of NCNS-HPE affecting various organ systems. It is our goal to provide a guide of extracephalic features for clinicians given the important clinical implications of these manifestations for the management and care of patients with HPE and their mutation-positive relatives. The health risks associated with some manifestations (e.g., fatty liver disease) may have historically been neglected in affected families.
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Affiliation(s)
- Ariel F Martinez
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul S Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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De Mot P, Hermans R, Jorissen M, Poorten Vander V. Congenital Nasal Piriform Aperture Stenosis or Bony Inlet Stenosis: A Report of Three Cases. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Congenital nasal piriform aperture stenosis is an uncommon disorder causing nasal obstruction in neonates. Findings on computed tomography (CT) greatly facilitate the diagnosis. Methods Three cases of congenital nasal piriform aperture stenosis are reported, with an emphasis on CT findings. Conclusions At birth, a diameter of the piriform aperture at the level of the inferior nasal meatus of ≥5 mm on CT may indicate a good chance of success using conservative treatment.
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Affiliation(s)
- Peter De Mot
- Departments of Radiology and University Hospitals Leuven, Leuven, Belgium
| | - Robert Hermans
- Departments of Radiology and University Hospitals Leuven, Leuven, Belgium
| | - Mark Jorissen
- Departments of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Poorten Vander
- Departments of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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Giri D, Vignola ML, Gualtieri A, Scagliotti V, McNamara P, Peak M, Didi M, Gaston-Massuet C, Senniappan S. Novel FOXA2 mutation causes Hyperinsulinism, Hypopituitarism with Craniofacial and Endoderm-derived organ abnormalities. Hum Mol Genet 2018; 26:4315-4326. [PMID: 28973288 DOI: 10.1093/hmg/ddx318] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022] Open
Abstract
Congenital hypopituitarism (CH) is characterized by the deficiency of one or more pituitary hormones and can present alone or in association with complex disorders. Congenital hyperinsulinism (CHI) is a disorder of unregulated insulin secretion despite hypoglycaemia that can occur in isolation or as part of a wider syndrome. Molecular diagnosis is unknown in many cases of CH and CHI. The underlying genetic etiology causing the complex phenotype of CH and CHI is unknown. In this study, we identified a de novo heterozygous mutation in the developmental transcription factor, forkhead box A2, FOXA2 (c.505T>C, p.S169P) in a child with CHI and CH with craniofacial dysmorphic features, choroidal coloboma and endoderm-derived organ malformations in liver, lung and gastrointestinal tract by whole exome sequencing. The mutation is at a highly conserved residue within the DNA binding domain. We demonstrated strong expression of Foxa2 mRNA in the developing hypothalamus, pituitary, pancreas, lungs and oesophagus of mouse embryos using in situ hybridization. Expression profiling on human embryos by immunohistochemistry showed strong expression of hFOXA2 in the neural tube, third ventricle, diencephalon and pancreas. Transient transfection of HEK293T cells with Wt (Wild type) hFOXA2 or mutant hFOXA2 showed an impairment in transcriptional reporter activity by the mutant hFOXA2. Further analyses using western blot assays showed that the FOXA2 p.(S169P) variant is pathogenic resulting in lower expression levels when compared with Wt hFOXA2. Our results show, for the first time, the causative role of FOXA2 in a complex congenital syndrome with hypopituitarism, hyperinsulinism and endoderm-derived organ abnormalities.
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Affiliation(s)
- Dinesh Giri
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,Department of Women and Children's Health, Institute in the Park, University of Liverpool, Liverpool L12 2AP, UK
| | - Maria Lillina Vignola
- Centre for Endocrinology, William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Angelica Gualtieri
- Centre for Endocrinology, William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Valeria Scagliotti
- Centre for Endocrinology, William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Paul McNamara
- Department of Women and Children's Health, Institute in the Park, University of Liverpool, Liverpool L12?2AP, UK
| | - Matthew Peak
- NIHR Alder Hey Clinical Research Facility for Experimental Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK
| | - Mohammed Didi
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Carles Gaston-Massuet
- Centre for Endocrinology, William Harvey Research Institute, Barts & the London School of Medicine, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, UK
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,Department of Women and Children's Health, Institute in the Park, University of Liverpool, Liverpool L12 2AP, UK
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A patient with chromosome 18p deletion and congenital hypoglossia. Clin Dysmorphol 2017; 27:46-48. [PMID: 29227307 DOI: 10.1097/mcd.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yang S, Orta P, Renk EM, Inman JC. Congenital nasal pyriform aperture stenosis in association with solitary median maxillary central incisor: unique radiologic features. Radiol Case Rep 2016; 11:178-81. [PMID: 27594945 PMCID: PMC4996930 DOI: 10.1016/j.radcr.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 11/18/2022] Open
Abstract
Solitary median maxillary central incisor (SMMCI) coexists in 34%-65% of patients initially diagnosed with congenital nasal pyriform aperture stenosis. SMMCI, a genetic syndrome, warrants consideration for further screening because of its high prevalence of other diagnostic possibilities—specifically central defects, like nasal obstruction and hypothalamo-pituitary axis abnormalities. We report on a presentation of SMMCI with congenital nasal pyriform aperture stenosis which highlights the unique radiologic features and notes the relationship between these two central associated findings in the literature.
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Affiliation(s)
- Sara Yang
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health System, 11234 Anderson St, Suite 256A, Loma Linda, CA 92354, USA
| | - Pedro Orta
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health System, 11234 Anderson St, Suite 256A, Loma Linda, CA 92354, USA
| | - Elizabeth M Renk
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health System, 11234 Anderson St, Suite 256A, Loma Linda, CA 92354, USA
| | - Jared C Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health System, 11234 Anderson St, Suite 256A, Loma Linda, CA 92354, USA
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Moreddu E, Le Treut-Gay C, Triglia JM, Nicollas R. Congenital nasal pyriform aperture stenosis: Elaboration of a management algorithm from 25 years of experience. Int J Pediatr Otorhinolaryngol 2016; 83:7-11. [PMID: 26968044 DOI: 10.1016/j.ijporl.2016.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/03/2016] [Accepted: 01/15/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disease presenting with neonatal respiratory distress, often associated with other anomalies. MATERIALS AND METHODS This study reports the clinical and radiological characteristics of the patients managed in The Department of Pediatric Otolaryngology Head and Neck Surgery of La Timone Children's Hospital in Marseille between 1988 and 2014. Pyriform aperture (PA) widths were measured on CT-scans, obtained by using hand calipers at the largest portion of the PA in a plan parallel to the Francfort plan. RESULTS 10 patients were included. Average PA width was 6.6mm, 5/10 patients presented with single central maxillary median incisor, 6/10 patients had associated abnormalities. 8 patients underwent a surgical intervention and 2 patients were medically managed. All the patients had satisfactory nasal airway permeability on late follow-up. A management algorithm was elaborated. CNPAS should be evoked when breathing difficulties are associated with impossibility of passing fiberscope or nasogastric tube at the nasal inlet. Craniofacial CT-scanning is necessary to make the diagnosis and look for associated abnormalities. Medical treatment associating nasal wash and decongestants should be performed. Surgical intervention is necessary when failure of the medical management. DISCUSSION AND CONCLUSIONS Our results were close to those found in the literature in terms of clinical characteristics, associated abnormalities and PA width. However, no objective criterion to decide whether a surgical intervention is necessary or not, has been established so far. The algorithm we propose offers guidelines from diagnosis to treatment, but the management should be adapted based on clinical tolerance.
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Affiliation(s)
- E Moreddu
- Department of Pediatric Otolaryngology, Head and Neck surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France.
| | - C Le Treut-Gay
- Department of Pediatric Otolaryngology, Head and Neck surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France
| | - J M Triglia
- Department of Pediatric Otolaryngology, Head and Neck surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France
| | - R Nicollas
- Department of Pediatric Otolaryngology, Head and Neck surgery, La Timone Children's Hospital, Aix-Marseille University, 264 rue Saint Pierre, F-13385 Marseille Cedex 5, France
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Chen SC, McDevitt H, Clement WA, Wynne DM, Mason A, Donaldson MDC, Ahmed SF, Shaikh MG. Early identification of pituitary dysfunction in congenital nasal pyriform aperture stenosis: recommendations based on experience in a single centre. Horm Res Paediatr 2016; 83:302-10. [PMID: 25791686 DOI: 10.1159/000369805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Congenital nasal pyriform aperture stenosis (CNPAS) is an increasingly recognised cause of upper airway obstruction associated with midline abnormalities. Studies have described pituitary dysfunction in 40% of patients. We aimed to develop guidelines for: (a) the early identification of pituitary insufficiency to minimise surgical risk and (b) to stratify patients for follow-up. METHODS Retrospective case note review of patients with CNPAS between 2000 and 2014 in a tertiary paediatric unit. RESULTS 20 patients (12 female:8 male) were analysed; 16 were diagnosed during the neonatal period while 4 were diagnosed later. There was no consistent approach in the evaluation of the pituitary axis at diagnosis. Pituitary dysfunction was identified in 3 (15%) patients, 2 of whom were found during evaluation of short stature in mid-late childhood. Hypoglycaemia and conjugated hyperbilirubinaemia, but not the degree of stenosis, were highly predictive of pituitary dysfunction (p < 0.05). Available height standard deviation score (SDS) data at 1 year of 70% of our patients identified both of the late-diagnosed growth hormone-deficient patients, with SDS of -2.6 and -3.6, respectively. CONCLUSION All CNPAS patients should have MRI of the brain and baseline endocrine investigations at diagnosis. Growth monitoring for at least 1 year is recommended as low, or falling, height SDS at 1 year is a good predictor of pituitary dysfunction.
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Affiliation(s)
- Suet Ching Chen
- Department of Paediatric Endocrinology, Royal Hospital for Sick Children, Glasgow, UK
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Lin KL, Lee KS, Yang CC, Hsieh LC, Su CH, Sun FJ. The natural course of congenital nasal pyriform aperture stenosis. Laryngoscope 2016; 126:2399-402. [PMID: 26853084 DOI: 10.1002/lary.25873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/10/2015] [Accepted: 12/21/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with congenital nasal pyriform aperture stenosis (CNPAS) may become less symptomatic with age. Therefore, we aimed to develop a growth curve of the pyriform aperture so that a more comprehensive plan can be designed for CNPAS patients who show little response to conservative treatment. STUDY DESIGN A single-institution study, retrospective review of CNPAS patients during the period November 1997 to December 2014. METHODS We measured the distances between the bilateral nasal processes of the maxilla (interprocess distance [IPD]) on three-dimensional computed tomography images and then divided the patients into five different age groups. A growth curve of the pyriform aperture was then constructed based on the distance-age relationship. RESULTS Fifty-four IPD measurements were included. The mean IPD was 3.57 mm in neonates < 1 month old, 4.08 mm in infants aged 1 to 3 months, 5.19 mm in the 4-month to 11-month age group, 6.61 mm in the 12-month to 36-month age group, and 9.20 mm in children > 36 months of age. We found that the cubic curve was the most appropriate growth curve, and that growth tended to be slower from 3.5 years to 6 years of age. CONCLUSIONS The growth curve of the pyriform aperture in children with CNPAS developed in this study can aid in treatment planning and predict clinical outcome of CNPAS patients. Although CNPAS patients may become less symptomatic with age, when the observed IPD falls progressively farther from the curve, more aggressive intervention should be considered, such as changing the management strategy from observation to conservative treatment or from conservative treatment to surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2399-2402, 2016.
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Affiliation(s)
- Kuan-Ling Lin
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Kuo-Sheng Lee
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Cheng-Chien Yang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech language pathology , Department of Medicine , Mackay Medical College, Taipei, Taiwan; Department of Medicine , Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech language pathology , Department of Medicine , Mackay Medical College, Taipei, Taiwan; Department of Medicine , Taipei Medical University, Taipei, Taiwan
| | - Chin-Hui Su
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech language pathology , Department of Medicine , Mackay Medical College, Taipei, Taiwan; Department of Medicine , Taipei Medical University, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
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Patient selection in congenital pyriform aperture stenosis repair - 14 year experience and systematic review of literature. Int J Pediatr Otorhinolaryngol 2015; 79:235-9. [PMID: 25575426 DOI: 10.1016/j.ijporl.2014.12.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 12/10/2014] [Accepted: 12/13/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of respiratory distress in neonates that may necessitate early surgical intervention. Restenosis and granulation are postoperative concerns that may prompt a return to the operating room. Reoperation places children at increased risk of perioperative complications and prolonged hospital stays. We are presenting a review of our institutional experience of 16 patients treated for CNPAS over a 14 year period and a systematic review with pooled data analysis to determine the effect of craniofacial and neurologic anomalies on surgical success. METHODS Retrospective chart review of all cases of CNPAS treated at our tertiary children's hospital between 1999 and 2013. Systematic review of English language literature was conducted adhering to the PRISMA statement to determine the effect of neurologic anomalies and craniofacial dysmorphism (CFD) on surgical failure for CNPAS treatment. Univariate and exact multiple logistic regression were used for analysis of an individual patient data analysis. RESULTS 10 patients had surgery and 6 were treated medically. Average pyriform apertures were 5.71±1.72mm for the surgical group and 4.83±1.26mm for the medical group (p=0.38). 31% had neurological impairments. 31% had craniofacial dysmorphisms (CFD). 2 patients developed restenosis and 1 required tracheotomy. Both of these patients had other CFDs. Literature review captured 63 surgical patients and 9 failures in 6 series of CNPAS. 4.6% of patients without CFD and 36.8% of patients with CFD required surgical revision (p=0.023, OR13.8). CONCLUSION When repairing CNPAS, co-morbidities must be considered. Impaired respiration, central neurologic deficits and extensive craniofacial anomalies may require additional surgeries or an alternative approach.
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Solitary median maxillary central incisor syndrome (SMMCI) with congenital nasal puriform aperture stenosis: literature review and case report with comprehensive dental treatment and 14 years follow-up. Eur Arch Paediatr Dent 2013; 14:417-23. [PMID: 23775592 DOI: 10.1007/s40368-013-0044-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Solitary median maxillary central incisor syndrome [SMMCI] is an extremely rare anomaly, especially when no other abnormalities are present. The defect is often found together with various nasal abnormalities and short stature with or without decreased levels of growth hormone. In more severe cases, SMMCI has been associated with holoprosencephaly, the CHARGE and the VACTERL association. Also, published sporadic cases have been related with rare variants of ectodermal dysplasia, chromosomal abnormalities, precocious puberty, hypothalamic hamartoma, congenital heart defects, physical/mental retardation, genital hypoplasia and ear abnormalities. For these reasons when the initial diagnosis is made by the paediatric dentist, ENT, neurological and paediatric evaluations are essential. CASE REPORT A 4-year-old boy with SMMCI was referred for dental treatment. Clinical/radiographic examination revealed a symmetrical primary and permanent SMMCI, a skeletal Class I and a unilateral crossbite. Medical history indicated respiratory distress and surgery soon after birth due to congenital nasal puriform aperture stenosis. Gradual orthodontic treatment started at the age of 4 years and completed at the age of 13 years. Following maxillary expansion, upper lateral segments were moved backwards and anterior space was created for accommodating a second central incisor. Retainers with a supplementary acrylic incisor were provided for aesthetic and functional replacement until the age of 16 years, when a fixed Maryland ceramic bridge was placed. FOLLOW-UP Two years recall, at the age of 18 years, revealed a satisfactory and stable aesthetic and functional result. CONCLUSION Successful dental management of SMMCI patients is possible, following a detailed long-lasting treatment plan requiring multidisciplinary paediatric dental, orthodontic and prosthetic approach.
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Shilpa G, Nuvvula S, Gokhale N, Yamini V. Concomitant solitary median maxillary central incisor and fused right mandibular incisor in primary dentition. Contemp Clin Dent 2012; 3:S203-5. [PMID: 23230364 PMCID: PMC3514939 DOI: 10.4103/0976-237x.101094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Solitary median maxillary central incisor (SMMCI) is a unique developmental anomaly in primary dentition. It involves central incisor tooth germs and may or may not be associated with other anomalies. Its presence, concomitant with fusion of right mandibular incisors has not previously been reported. A 5-year-old girl was presented with a single symmetrical primary maxillary incisor at the midline, with the absence of labial frenulum, an indistinct philtrum and a prominent midpalatal ridge. There was an associated fused tooth in the right incisor region and radiographic examination confirmed only one maxillary central incisor in both the dentitions. Family history revealed that the father of the girl also had a similar anomaly providing probable evidence of etiological role for heredity in SMMCI.
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Affiliation(s)
- G Shilpa
- Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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22
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Abstract
Growth hormone is of vital importance for normal growth and development. Individuals with growth hormone deficiency develop pituitary dwarfism with disproportionate delayed growth of skull and facial skeleton giving them a small facial appearance for their age. Both hyper and hypopituitarism have a marked effect on development of oro-facial structures including eruption and shedding patterns of teeth, thus giving an opportunity to treating dental professionals to first see the signs and symptoms of these growth disorders and correctly diagnose the serious underlying disease.
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Affiliation(s)
- Gaurav Atreja
- Department of Prosthodontics, MMCDSR, Mullana, Haryana, India
| | | | - Nitul Jain
- Department of Oral Pathology, EDCH, Kotputli, Rajasthan, India
| | - Urvashi Sukhija
- Department of Prosthodontics, MMCDSR, Mullana, Haryana, India
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Visvanathan V, Wynne DM. Congenital nasal pyriform aperture stenosis: a report of 10 cases and literature review. Int J Pediatr Otorhinolaryngol 2012; 76:28-30. [PMID: 22024577 DOI: 10.1016/j.ijporl.2011.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 09/16/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal upper airway obstruction. This study is to review the presentation and management of this uncommon condition in a tertiary paediatric ENT centre in Scotland, United Kingdom. METHODS Retrospective case note review between 2003 and 2011. A literature search was performed using MEDLINE and EMBASE between April and June 2011 using search terms 'pyriform aperture' in combination with diagnosis and treatment. Suitable references were also selected and reviewed. RESULTS A total of 10 cases were identified and 50% of cases were managed surgically. Surgical widening of the pyriform aperture was performed at an average of 14 days at birth. Associated malformations include holoprosencephaly, hypopituitarism, cardiac and urogenital malformations. CONCLUSION CNPAS is a treatable cause of upper airway obstruction. Early recognition is vital to appropriate management. Treatment is either conservative or surgical and depends on the severity of symptoms.
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Affiliation(s)
- V Visvanathan
- The Royal Hospital for Sick Children, Glasgow G3 8JS, United Kingdom.
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Congenital nasal pyriform aperture stenosis. Pediatr Radiol 2010; 40 Suppl 1:S83. [PMID: 20936275 DOI: 10.1007/s00247-010-1843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022]
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Gimeno-Hernández J, Iglesias-Moreno MC, Gómez-Serrano M, Poch-Broto J. Estenosis congénita del orificio piriforme y megaincisivo central único. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:455-8. [DOI: 10.1016/j.otorri.2009.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 09/21/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
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Bolan M, Derech CD, Côrrea M, Ribeiro GLU, Almeida ICS. Palatal expansion in a patient with solitary median maxillary central incisor syndrome. Am J Orthod Dentofacial Orthop 2010; 138:493-497. [PMID: 20889056 DOI: 10.1016/j.ajodo.2008.09.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 09/01/2008] [Accepted: 09/01/2008] [Indexed: 11/18/2022]
Abstract
The objective of this article was to report a clinical case of a patient with solitary median maxillary central incisor syndrome. He was treated with rapid maxillary expansion and evaluated with computed tomography. The boy, aged 6 years 7 months, had a single maxillary central incisor in the midline, posterior crossbite, prominent midpalatal ridge, indistinct philtrum, no incisive papilla, and no labial frenulum. No other systemic anomalies were found. Posteroanterior cephalometric radiography showed skeletal atresia of the maxilla that was corrected with rapid maxillary expansion. A Haas expander was used and activated twice per day (quarter turn per activation) for 15 days. The procedure was monitored with computed tomography to evaluate any effect on the intermaxillary suture and tooth. Although the crossbite was clinically corrected after the expansion, radiographs and tomographs showed no opening of the midpalatal suture. Rapid maxillary expansion resulted in neither midpalatal suture opening nor transverse increase of the maxillary skeletal base in this patient.
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Affiliation(s)
- Michele Bolan
- Adjunct assistant professor, Department of Pediatric Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Carla D'Agostini Derech
- Substitute professor, Department of Orthodontics, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcio Côrrea
- Adjunct assistant professor, Department of Radiology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Gerson Luiz Ulema Ribeiro
- Adjunct assistant professor, Department of Orthodontics, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Izabel Cristina Santos Almeida
- Adjunct assistant professor, Department of Pediatric Dentistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Blackmore K, Wynne DM. A case of solitary median maxillary central incisor (SMMCI) syndrome with bilateral pyriform aperture stenosis and choanal atresia. Int J Pediatr Otorhinolaryngol 2010; 74:967-969. [PMID: 20627328 DOI: 10.1016/j.ijporl.2010.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 05/10/2010] [Indexed: 11/25/2022]
Abstract
Solitary median maxillary central incisor syndrome is a rare disorder involving midline abnormalities. It may present with life threatening respiratory distress in the neonate secondary to nasal malformations. These include pyriform aperture stenosis and choanal atresia. We present the first reported case of simultaneous choanal atresia and pyriform aperture stenosis in a neonate with solitary median maxillary central incisor syndrome. The clinical presentation and the management of congenital pyriform aperture stenosis are discussed.
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Affiliation(s)
- Kate Blackmore
- Department of ENT, Royal Hospital for Sick Children, Dalnair Street, Glasgow, G3 8SJ, United Kingdom
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Machado E, Machado P, Grehs B, Grehs RA. Síndrome do incisivo central superior solitário: relato de caso. Dental Press J Orthod 2010. [DOI: 10.1590/s2176-94512010000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: a presença de um incisivo central superior solitário é um evento bastante incomum na população. A prevalência da chamada Síndrome do Incisivo Central Superior Solitário (SICSS) é verificada em 1:50.000 nascimentos, sendo registrado um maior acometimento no sexo feminino. Essa alteração no desenvolvimento da oclusão dentária é caracterizada por más formações estruturais, sobretudo na região de linha média do paciente. O diagnóstico precoce e o tratamento adequado dessa síndrome são de grande importância, pois essa condição talvez seja um indicativo de que o paciente pode apresentar outras más formações congênitas severas, não devendo ser a SICSS considerada uma simples anomalia dentária. Os procedimentos ortodônticos, nesses casos, variam dependendo do grau de comprometimento das estruturas ósseas da maxila, da oclusão em si, e principalmente da sutura palatina mediana. OBJETIVO: discutir, baseado em evidências científicas, aspectos importantes relacionados à SICSS, bem como apresentar um caso clínico de paciente do sexo feminino com SICSS, que foi submetida a tratamento ortodôntico na Clínica Odontológica Integrada Infantil da Universidade Federal de Santa Maria / RS. CONCLUSÃO: pela análise crítica da literatura, verifica-se ser muito importante o diagnóstico correto e precoce acerca dessa síndrome, visto que há possibilidade da mesma estar associada a outros problemas de desenvolvimento. Além disso, o paciente acometido pela SICSS deve ser assistido por uma equipe multidisciplinar de saúde, de forma a otimizar os resultados clínicos e devolver-lhe qualidade de vida.
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Congenital nasal pyriform aperture stenosis and solitary maxillary central incisor: Case report. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sanal B, Demirhan N, Koplay M, Sadikoğlu MY, Gürpinar A. Congenital nasal pyriform aperture stenosis: clinical and radiologic findings and treatment. Jpn J Radiol 2009; 27:389-91. [PMID: 19943153 DOI: 10.1007/s11604-009-0354-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 07/06/2009] [Indexed: 11/26/2022]
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is an unusual cause of airway obstruction in the newborn and infants. Immediate recognition and therapy are essential for this potentially life-threatening circumstance. CNPAS should be considered in the differential diagnosis of any infant with episodic apnea, cyclical cyanosis, and feeding difficulty. Computerized tomographic (CT) measurements and imaging features enable accurate diagnosis of this abnormality. In this report we demonstrated CT examination findings of CNPAS in a neonate.
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Affiliation(s)
- Bekir Sanal
- Department of Radiology, Acibadem Bursa Hospital, Bursa, Turkey
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31
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Abstract
This article discusses the development and anatomy of the nasal septum and structures of the lateral nasal wall. Emphasis is placed on anatomic variations associated with surgically correctable nasal obstruction. Common variations, such as deviated nasal septum, inferior turbinate hypertrophy, paradoxic middle turbinate, and concha bullosa, are discussed. Rare developmental causes of nasal obstruction are briefly outlined.
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Llanos D, Ciudad MJ, Crespo E, Arrazola J. [Congenital nasal pyriform aperture stenosis]. RADIOLOGIA 2009; 51:323-6. [PMID: 19362321 DOI: 10.1016/j.rx.2008.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 10/21/2008] [Indexed: 11/19/2022]
Abstract
Obstruction of the nasal airway is potentially lethal in newborns because they are forced to breathe through their noses. The most common cause of obstruction is atresia of the choanae; however, other entities such as congenital nasal pyriform aperture stenosis, although rare, must be considered in the differential diagnosis of a newborn that shows signs and symptoms of upper airway compromise. We report two cases of nasal pyriform aperture stenosis seen at our center; we describe the main characteristics of the condition and review the relevant literature.
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Affiliation(s)
- D Llanos
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España
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Rajaram S, Bateman N, Raghavan A. Congenital nasal piriform aperture stenosis with vestibular abnormality. Pediatr Radiol 2008; 38:1128-9. [PMID: 18607583 DOI: 10.1007/s00247-008-0934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/12/2008] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
Abstract
We present a neonate with congenital nasal piriform aperture stenosis associated with an abnormal vestibular aperture. Radiological evaluation with CT is essential to confirm the diagnosis and delineate the anatomy for surgical planning. Extension of the scan field of view to include the petrous temporal bone is essential to identify associated abnormalities of the vestibule.
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Affiliation(s)
- Smitha Rajaram
- Department of Paediatric Radiology, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.
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Al Abri R, Javad H, Kumar S, Bharga D, Koul RL, Al Futaisi A, Sankla D. Congenital nasal pyriform aperture stenosis: first case report in oman. Oman Med J 2008; 23:192-194. [PMID: 22359713 PMCID: PMC3282325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 03/21/2008] [Indexed: 05/31/2023] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a recently defined clinical entity that causes airway obstruction in the neonate as a result of narrowing of the nasal pyriform aperture. The pyriform aperture is the narrowest, most anterior portion of the nasal airway, and a slight decrease in its cross sectional area will significantly increase the nasal airway resistance. This entity should be kept in the differential diagnosis of any neonate or infant with signs and symptoms of upper air way obstruction. The CNPAS presents with symptoms of nasal airway obstruction, which are often characterized by episodic apnea and cyclic cynosis.
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Affiliation(s)
- Rashid Al Abri
- Department of Otolaryngology and Head Neck Surgery, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - Hashim Javad
- Department of Pediatrics Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - Sudesh Kumar
- Department of Otolaryngology and Head Neck Surgery, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - Deepa Bharga
- Department of Otolaryngology and Head Neck Surgery, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - RL Koul
- Department of Pediatrics Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - Amna Al Futaisi
- Department of Pediatrics Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
| | - Dilip Sankla
- Departments of Radiology, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman
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Devambez M, Delattre A, Fayoux P. Congenital nasal pyriform aperture stenosis: diagnosis and management. Cleft Palate Craniofac J 2008; 46:262-7. [PMID: 19642747 DOI: 10.1597/07-182.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To review diagnosis and treatment modalities in congenital nasal pyriform aperture stenosis in a newborn population. STUDY DESIGN A 6-year retrospective case series review. Mean follow-up of 21.8 months. SETTING University hospital, tertiary care center. PATIENTS Twenty-one consecutive patients treated for congenital nasal pyriform aperture stenosis. Diagnosis was suspected on physical examination and confirmed by computed tomography scan. Associated abnormalities were present in 15 patients. SURGICAL TREATMENT Nineteen patients underwent surgical treatment focused on external bony margins of pyriform aperture and the osseous anterior edge of the inferior turbinate, drilling by a sublabial approach and associated with a partial turbinectomy in seven cases. A stent was placed for 7 to 10 days. A conservative treatment based on topical nasal decongestants and gastroesophageal reflux treatment was proposed for two patients. RESULTS Postoperative follow-up revealed septal ulceration in five cases with septal perforation in one case and development of synechiae in two cases. Follow-up revealed normal nasal breathing and pyriform aperture growth after surgery. CONCLUSION Our experience confirmed the link described between congenital nasal pyriform aperture stenosis and holoprosencephaly, but associated extracraniofacial malformations suggest that congenital nasal pyriform aperture stenosis should be integrated in a systemic malformative syndrome or genetic disorder and lead us to propose an exhaustive dysmorphology assessment. Some infants may be treated by conservative management, and severely affected patients may undergo surgery by a sublabial approach.
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Affiliation(s)
- Marion Devambez
- Department of Otolaryngolog-Head and Neck Surgery, University Hospital of Lille, France
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Osovsky M, Aizer-Danon A, Horev G, Sirota L. Congenital pyriform aperture stenosis. Pediatr Radiol 2007; 37:97-9. [PMID: 17082934 DOI: 10.1007/s00247-006-0342-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 09/20/2006] [Accepted: 09/27/2006] [Indexed: 11/29/2022]
Abstract
Nasal airway obstruction is a potentially life-threatening condition in the newborn. Neonates are obligatory nasal breathers. The pyriform aperture is the narrowest, most anterior bony portion of the nasal airway, and a decrease in its cross-sectional area will significantly increase nasal airway resistance. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare, unusual form of nasal obstruction. It should be considered in the differential diagnosis of any neonate or infant with signs and symptoms of upper airway compromise. It is important to differentiate this level of obstruction from the more common posterior choanal stenosis or atresia. CNPAS presents with symptoms of nasal airway obstruction, which are often characterized by episodic apnea and cyclical cyanosis.
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Affiliation(s)
- Micky Osovsky
- Department of Neonatology, Schneider Pediatric Hospital, Petach Tikvah, Israel.
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Cohen MM. Holoprosencephaly: clinical, anatomic, and molecular dimensions. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2006; 76:658-73. [PMID: 17001700 DOI: 10.1002/bdra.20295] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Holoprosencephaly is addressed under the following headings: alobar, semilobar, and lobar holoprosencephaly; arrhinencephaly; agenesis of the corpus callosum; pituitary abnormalities; hindbrain abnormalities; syntelencephaly; aprosencephaly/atelencephaly; neural tube defects; facial anomalies; median cleft lip; minor facial anomalies; single maxillary central incisor; holoprosencephaly-like phenotype; epidemiology; genetic causes of holoprosencephaly; teratogenic causes of holoprosencephaly; SHH mutations; ZIC2 mutations; SIX3 mutations; TGIF mutations; PTCH mutations; GLI2 mutations; FAST1 mutations; TDGF1 mutations; and DHCR7 mutations.
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Affiliation(s)
- M Michael Cohen
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Lee JC, Yang CC, Lee KS, Chen YC. The measurement of congenital nasal pyriform aperture stenosis in infant. Int J Pediatr Otorhinolaryngol 2006; 70:1263-7. [PMID: 16540178 DOI: 10.1016/j.ijporl.2006.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 01/16/2006] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In the study we use the image of three dimensional computed tomography (3D-CT) to assess the different widths of the bony framework of congenital nasal pyriform aperture stenosis (CNPAS). METHODS We select 17 infants under 4 months old diagnosed as CNPAS for this study. There were four categories of distance measurement. The distance between the caudal end of the nasal bone (nasal tip) and the anterior nasal spine (NPAH). The distance between bilateral bony inner wall of the nasal pyriform aperture at the midpoint of the aperture height (MIVD). The interprocess distance at the level of lower 1/4 of the pyriform aperture height (IPD). The narrowest distance between the bilateral nasal processes (NIPD). RESULTS There were 17 infants, nine males and eight females. At the time of performing 3D-CT, the mean age was 49.5+/-35.9 days. The results of measurement were: NPAH: 10.9+/-1.23mm, MIVD: 8.2+/-0.89mm, IPD: 4.9+/-0.93mm, and NIPD: 4.4+/-0.73mm. The MIVD is significantly wider than both IPD and NIPD (p<0.01). There is high correlation between IPD and NIPD. There is no significant difference on age between gender in this study. However, the IPD (4.4+/-0.74) and NIPD (3.9+/-0.47) of male patients are broader, respectively, than those of female patients with significant difference (p<0.05). CONCLUSION The measurement of CNPAS by means of 3D-CT may provide useful data for evaluation of the width in different parts of nasal pyriform aperture. These may be used for evaluation of pre- and postoperative status and future investigation in CNPAS patients.
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Affiliation(s)
- Jehn-Chuan Lee
- Mackay Memorial Hospital, Department of Otolaryngology Head and Neck Surgery, 92 Chung-Shan North Road Sec. 2, 10449 Taipei, Taiwan
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Hall RK. Solitary median maxillary central incisor (SMMCI) syndrome. Orphanet J Rare Dis 2006; 1:12. [PMID: 16722608 PMCID: PMC1464380 DOI: 10.1186/1750-1172-1-12] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 04/09/2006] [Indexed: 11/10/2022] Open
Abstract
Solitary median maxillary central incisor syndrome (SMMCI) is a complex disorder consisting of multiple, mainly midline defects of development resulting from unknown factor(s) operating in utero about the 35th-38th day(s) from conception. It is estimated to occur in 1:50,000 live births. Aetiology is uncertain. Missense mutation in the SHH gene (I111F) at 7q36 may be associated with SMMCI. The SMMCI tooth differs from the normal central incisor, in that the crown form is symmetric; it develops and erupts precisely in the midline of the maxillary dental arch in both primary and permanent dentitions. Congenital nasal malformation (choanal atresia, midnasal stenosis or congenital pyriform aperture stenosis) is positively associated with SMMCI. The presence of an SMMCI tooth can predict associated anomalies and in particular the serious anomaly holoprosencephaly. Common congenital anomalies associated with SMMCI are: severe to mild intellectual disability, congenital heart disease, cleft lip and/or palate and less frequently, microcephaly, hypopituitarism, hypotelorism, convergent strabismus, oesophageal and duodenal atresia, cervical hemivertebrae, cervical dermoid, hypothyroidism, scoliosis, absent kidney, micropenis and ambiguous genitalia. Short stature is present in half the children. Diagnosis should be made by eight months of age, but can be made at birth and even prenatally at 18-22 weeks from the routine mid-trimester ultrasound scan. Management depends upon the individual anomalies present. Choanal stenosis requires emergency surgical treatment. Short stature may require growth hormone therapy. SMMCI tooth itself is mainly an aesthetic problem, which is ideally managed by combined orthodontic, prosthodontic and oral surgical treatment; alternatively, it can be left untreated.
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Affiliation(s)
- Roger K Hall
- Department of Dentistry, Royal Children's Hospital, Flemington Rd Parkville, 3052 Victoria, Australia.
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Vercruysse JP, Wojciechowski M, Koninckx M, Kurotova A, Claes J. Congenital nasal pyriform aperture stenosis: a rare cause of neonatal nasal obstruction. J Pediatr Surg 2006; 41:e5-7. [PMID: 16567165 DOI: 10.1016/j.jpedsurg.2006.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Congenital nasal pyriform aperture stenosis has been described as an unusual cause of neonatal nasal obstruction. Clinical suspicion is based on respiratory distress, cyclic cyanosis, apneas, and feeding difficulties. A bony overgrowth of the maxillary nasal processes is thought to be responsible for this deformity. This anomaly has been reported as an isolated feature or can be associated with craniofacial or central nervous system anomalies. Surgery is indicated in cases of severe respiratory distress, feeding difficulties, and when conservative methods fail.
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Abstract
Solitary median maxillary central incisor (SMMCI) is a rare finding. Growth deficiency or other systemic abnormalities may or may not be seen in children with this anomaly. Nevertheless, the growth and development of all children with SMMCI should be closely monitored. This article reports the dental findings of three Chinese girls with SMMCI, but no growth deficiency or other systemic involvement.
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Affiliation(s)
- S Y Cho
- School Dental Care Service, Department of Health, Hong Kong.
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Levison J, Neas K, Wilson M, Cooper P, Wojtulewicz J. Neonatal nasal obstruction and a single maxillary central incisor. J Paediatr Child Health 2005; 41:380-1. [PMID: 16014147 DOI: 10.1111/j.1440-1754.2005.00639.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present two neonates with nasal obstruction because of anterior choanal stenosis (congenital nasal pyriform aperture stenosis). An associated single maxillary central incisor was also shown on computed tomography imaging in the neonatal period. These midline anomalies are recognized minimal manifestations (microforms) of holoprosencephaly. We describe their neonatal investigation, multidisciplinary management and clinical course.
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Affiliation(s)
- John Levison
- Grace Centre for Newborn Care, The Children's Hospital at Westmean, Sydney, New South Wales, Australia.
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43
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Captier G, Tourbach S, Bigorre M, Saguintaah M, El Ahmar J, Montoya P. Anatomical consideration of the congenital nasal pyriform aperture stenosis: localized dysostosis without interorbital hypoplasia. J Craniofac Surg 2004; 15:490-6. [PMID: 15111817 DOI: 10.1097/00001665-200405000-00030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital nasal pyriform aperture stenosis may be isolated or associated with other midline anomalies. The aim of the study was to describe the measurements and features of the interorbital structure and midface in congenital nasal pyriform aperture stenosis. The computed tomography scans of eight patients (two girls and six boys) were retrospectively reviewed. Several distances were obtained at the orbital and midface levels and compared with normative data. The average width of the pyriform aperture was 5.5 mm +/- 1.6, and there was overgrowth of the pyriform aperture rim (nasal process of the maxilla). No skeletal anomalies were present other than the congenital nasal pyriform aperture stenosis. It was associated with a single median maxillary central incisor in two cases. The anterior and lateral interorbital distances were normal (17.4 mm and 65.4 mm, respectively). The midface was not hypoplastic. There was no brain malformation. Congenital nasal pyriform aperture stenosis is a localized dysostosis of the pyriform aperture rim without interorbital or midface hypoplasia. It may be associated with a single median maxillary central incisor but cannot be viewed as a minor form of holoprosencephaly.
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Affiliation(s)
- Guillaume Captier
- Unité de chirurgie plastique pédiatrique, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
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Inamo Y, Harada K. Agenesis of the internal carotid artery and congenital pituitary hypoplasia: proposal of a cause of congenital hypopituitarism. Eur J Pediatr 2003; 162:610-2. [PMID: 12856176 DOI: 10.1007/s00431-003-1272-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2002] [Accepted: 05/21/2003] [Indexed: 10/26/2022]
Abstract
UNLABELLED We describe a patient with microphallus without pigmentation and multiple pituitary hormone deficiencies. The left internal carotid artery and carotid canal were absent and the pituitary gland and sella turcica showed hypoplasia on MRI and magnetic resonance angiography. The internal carotid artery develops in the 4th embryonic week, while the pituitary primordium develops in the 3rd to 4th week. This suggests a possible relationship between internal carotid artery and congenital hypopituitarism. However, there is bilateral blood supply to the hypophysis via the superior and inferior hypophysial arteries, so it is unknown why pituitary hypoplasia may arise from blocking the unilateral blood supply. CONCLUSION Disruption of internal carotid artery perfusion may lead to pituitary hypoplasia with congenital hypopituitarism as a new disease entity in humans.
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Affiliation(s)
- Yasuji Inamo
- Department of General Paediatrics, Nihon University School of Medicine, Nihon University Nerima-Hikarigaoka Hospital, Hikarigaoka 2-11-1 Nerima-Ku, 179-0072 Tokyo, Japan.
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Lee KS, Yang CC, Huang JK, Chen YC, Chang KC. Congenital pyriform aperture stenosis: surgery and evaluation with three-dimensional computed tomography. Laryngoscope 2002; 112:918-21. [PMID: 12150628 DOI: 10.1097/00005537-200205000-00025] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We described the surgical efficacy of congenital pyriform aperture stenosis by measuring the width of the nasal pyriform aperture with three-dimensional computed tomography. METHODS Six patients with congenital pyriform aperture stenosis accepted surgical intervention. Three-dimensional computed tomography was performed for preoperative and postoperative evaluation of nasal pyriform aperture width. We marked the midpoint between the tip of nasal bone and the anterior nasal spine. The distances between the bilateral nasal processes of the maxilla and between the lateral rims of the pyriform aperture were measured by crossing the midpoint horizontally. RESULTS Among the six patients (three male and three female patients), the mean age was 76.2+/-23.9 days. Silicon stents were removed 6 to 7 days after operation. During 9 months of follow-up, there were no cases of restenosis, respiratory failure, or cyanosis. The mean preoperative and postoperative interprocess distances were 4.5+/-0.84 and 8.7+/-1.37 mm, respectively, and data were statistically significant at a confidence level of P <.05. The mean preoperative and postoperative interwall distances were 9.8+/-0.75 and 10.8+/-1.5 mm, respectively. CONCLUSIONS Congenital pyriform aperture stenosis should be suspected whenever there is both severe nasal obstruction and difficulty in passing a small catheter or nasogastric tube through the anterior nasal valve. Operation is the most extreme treatment, but it is effective for congenital pyriform aperture stenosis. Nasal stenting for 7 days seemed to be adequate. The use of three-dimensional computed tomography to evaluate preoperative and postoperative nasal pyriform aperture is effective and reliable.
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Affiliation(s)
- Kuo-Sheng Lee
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Losken A, Burstein FD, Williams JK. Congenital nasal pyriform aperture stenosis: diagnosis and treatment. Plast Reconstr Surg 2002; 109:1506-11; discussion 1512. [PMID: 11932589 DOI: 10.1097/00006534-200204150-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital nasal pyriform aperture stenosis is an unusual form of nasal airway obstruction in the neonate. Pediatric plastic surgeons are often involved in the management of these children and should recognize this condition and know the treatment options. Fifteen cases of children with congenital nasal pyriform aperture stenosis were reviewed for presentation of the disorder, management, and effectiveness of treatment, making it the largest series to date. There were nine male patients and six female patients in the series. They all experienced varying degrees of nasal obstruction at birth and were managed on the basis of the severity of their symptoms. Twelve patients were treated surgically in the first year of life, with a mean age at operation of 97 days (range, 3 to 362 days). Two patients required surgical intervention during their teenage years (age, 14 and 18 years) because of persistent symptoms, and one patient (age, 2 years) with mild symptoms was managed medically. Associated craniofacial anomalies were present in six cases (40 percent). Surgical enlargement of the pyriform aperture was successfully performed through an upper buccal sulcus incision in 14 patients. Preoperative symptoms of upper airway obstruction were improved in all patients at an average follow-up of 2.4 years (range, 1 month to 5 years). Congenital nasal pyriform aperture stenosis varies in presentation and severity, occurring either as an isolated congenital anomaly or in association with developmental craniofacial anomalies. It can be effectively managed by surgical enlargement of the pyriform aperture without significant recurrence or long-term morbidity.
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Affiliation(s)
- Albert Losken
- Emory University Division of Plastic Surgery and the Center for Craniofacial Disorders, Children's Healthcare of Atlanta at Scottish Rite Hospital, GA, USA
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Nanni L, Ming JE, Du Y, Hall RK, Aldred M, Bankier A, Muenke M. SHH mutation is associated with solitary median maxillary central incisor: a study of 13 patients and review of the literature. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 102:1-10. [PMID: 11471164 DOI: 10.1002/1096-8628(20010722)102:1<1::aid-ajmg1336>3.0.co;2-u] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Solitary median maxillary central incisor (SMMCI) or single central incisor is a rare dental anomaly. It has been reported in holoprosencephaly (HPE) cases with severe facial anomalies or as a microform in autosomal dominant HPE (ADHPE). In our review of the literature, we note that SMMCI may also occur as an isolated finding or in association with other systemic abnormalities. These anomalies include short stature, pituitary insufficiency, microcephaly, choanal atresia, midnasal stenosis, and congenital nasal pyriform aperture stenosis. SMMCI can also be a feature of recognized syndromes or associations or a finding in patients with specific chromosomal abnormalities. We performed a molecular study on a cohort of 13 SMMCI patients who did not have HPE. We studied two genes, Sonic Hedgehog (SHH) and SIX3, in which mutations have been reported in patients showing SMMCI as part of the HPE spectrum. A new missense mutation in SHH (I111F), segregating in one SMMCI family, was identified. Our results suggest that this mutation may be specific for the SMMCI phenotype since it has not been found in the HPE population or in normal controls. Published 2001 Wiley-Liss, Inc.
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Affiliation(s)
- L Nanni
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Vanzieleghem BD, Lemmerling MM, Vermeersch HF, Govaert P, Dhooge I, Meire F, Mortier GR, Leroy J, Kunnen MF. Imaging studies in the diagnostic workup of neonatal nasal obstruction. J Comput Assist Tomogr 2001; 25:540-9. [PMID: 11473183 DOI: 10.1097/00004728-200107000-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Twelve neonates presenting with nasal obstruction after birth were evaluated by imaging studies for diagnostic reasons. Four groups were recognized: Group I: choanal atresia (n = 5) and choanal stenosis (n = 1); Group II: congenital nasal pyriform aperture stenosis (CNPAS) (n = 3) and holoprosencephaly (n = 1); Group III: nasolacrimal duct mucocele (n = 1); Group IV: nasal hypoplasia (n = 1). Associated anomalies were found in eight patients. Four patients with choanal atresia showed manifestations of the CHARGE (coloboma, congenital heart defect, atretic choanae, retarded physical and neuromotor development associated with central nervous system anomalies, genital hypoplasia, and ear anomaly and/or deafness) association. In the fifth patient with choanal atresia, the diagnosis of amnion disruption sequence was made. One patient with CNPAS had a solitary maxillary central incisor (SMCI), a mild form of holoprosencephaly. Besides proboscis and synophthalmos, SMCI was also present in the holoprosencephaly case. The patient with severe nasal hypoplasia had warfarin embryopathy. This review emphasizes the need for performing imaging studies in the diagnostic workup of neonates born with nasal obstruction.
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Affiliation(s)
- B D Vanzieleghem
- Department of Radiology, Ghent University Hospital, Ghent, Belgium.
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Godil MA, Galvin-Parton P, Monte D, Zerah M, Purandare A, Lane AH, Wilson TA. Congenital nasal pyriform aperture stenosis associated with central diabetes insipidus. J Pediatr 2000; 137:260-2. [PMID: 10931423 DOI: 10.1067/mpd.2000.107187] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a child who has central diabetes insipidus associated with congenital nasal pyriform aperture stenosis without any apparent anterior pituitary dysfunction. This association further strengthens the concept that congenital nasal pyriform aperture stenosis may be a microform of holoprosencephaly.
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Affiliation(s)
- M A Godil
- Department of Pediatrics, State University of New York, Stony Brook 11794-8111, USA
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