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Defabianis P, Ninivaggi R, Romano F. Dentoskeletal features and growth pattern in Beckwith-Wiedemann spectrum: is surgical tongue reduction always necessary? Clin Oral Investig 2023; 27:4271-4277. [PMID: 37162568 PMCID: PMC10415414 DOI: 10.1007/s00784-023-05043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The role of tongue reduction surgery (TRS) in preventing excessive mandibular growth and anterior open bite in children with Beckwith-Wiedemann Spectrum (BWSp) is still controversial. This cross-sectional study aimed at comparing craniofacial growth pattern in children affected by BWSp either treated or not treated with early TRS for severe macroglossia. Considering the invasive nature of such surgery, the present study could help in clarifying the need for TRS to reduce or prevent growth disturbances. MATERIALS AND METHODS Orthopantomography and lateral skull x-ray images were taken either from surgically treated or non-surgically treated patients, aged 5 to 8 years, to compare dentoskeletal features and craniofacial growth by cephalometric analysis. Molecular testing results were collected from their medical records. RESULTS Eighteen BWSp patients were consecutively recruited: 8 underwent TRS at 14.9 ± 2.2 months of age, while 10 did not. Anterior open bite and dental class III were more frequently observed in the surgically treated group, but none showed skeletal class III. No statistically significant differences were observed in growth pattern, but children treated with TRS showed a tendency towards both maxillary and mandibular prognathism with protruding lower lip. Growth pattern seemed to be not related to molecular subtypes. CONCLUSIONS These preliminary data suggest that early TSR does not improve craniofacial growth pattern and dentoskeletal features in BWSp children. CLINICAL RELEVANCE Reductive glossectomy may not be justified for preventing or avoiding oro-facial deformities in BWSp; therefore, early monitoring of maxillofacial development of each affected child has a great clinical significance.
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Affiliation(s)
- Patrizia Defabianis
- Department of Surgical Sciences, Section of Pediatric Dentistry, C.I.R. Dental School, University of Turin, Via Nizza 230, 10126, Turin, Italy.
| | - Rossella Ninivaggi
- Department of Surgical Sciences, Section of Pediatric Dentistry, C.I.R. Dental School, University of Turin, Via Nizza 230, 10126, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, Section of Pediatric Dentistry, C.I.R. Dental School, University of Turin, Via Nizza 230, 10126, Turin, Italy
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Partial Glossectomy Combined With Radiofrequency Ablation for Macroglossia in Beckwith-Wiedemann Syndrome. J Craniofac Surg 2023; 34:650-655. [PMID: 36168118 DOI: 10.1097/scs.0000000000009018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE As the most common feature of Beckwith-Wiedemann syndrome (BWS), macroglossia may influence the quality of life, maxillofacial growth, and speech development of children. The retrospective study aimed to investigate the therapeutic effect of partial glossectomy combined with radiofrequency ablation (RFA) for macroglossia patients in BWS. METHODS A retrospective study was conducted in BWS-derived macroglossia patients who underwent partial glossectomy combined with RFA from May 2019 to January 2021. In total, 35 patients consisting of 17 males and 18 females met the inclusion criteria and underwent surgery by the same plastic surgeon. Demographic characteristics, BWS features, operation details, preoperative and postoperative outcomes, satisfaction evaluations, and subgroup analysis were collected and assessed. RESULTS Of the 35 patients involved, the average age at the time of surgery was 14.05±8.08 months, and the average surgery duration was 48.17±6.72 minutes. Only 1 patient suffered ventral tongue wound dehiscence, and the rest of the patients did not develop any other complications. The severity and frequency of tongue protrusion, drooling, snoring, and feeding difficulty were significantly ameliorated. The patient's parents showed satisfaction towards the overall surgery, tongue's appearance, and tongue's motor function. Tongue's height decreased from 32.09±1.16 mm before the operation to 29.29±1.33 mm after the operation. CONCLUSION The partial glossectomy combined RFA exerts a safe, effective and viable technique to treat BWS-derived macroglossia.
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Xu J, Roser SM, Avadhani V, Amin D, Melville JC. Management of MACROGLOSSIA: Case Series and Suggested Algorithm. J Oral Maxillofac Surg 2023; 81:107-119. [PMID: 36207006 DOI: 10.1016/j.joms.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Idiopathic macroglossia is a rare entity of true tongue enlargement without an underlying etiology. There are only a few case reports on the diagnosis and management of idiopathic macroglossia. This study's purpose was to present a series of patients with idiopathic macroglossia and suggest a treatment algorithm. METHODS This was a retrospective case series of a cohort of patients with macroglossia who were treated by the Oral and Maxillofacial Surgery service at the University of Texas Health Science Center at Houston (UTHealth)and Emory University. The patient's medical comorbidities, history of present illness, clinical presentation, radiographic findings, and disease management were studied. The outcome variables include normalization of the tongue size, dependence on parenteral nutrition, and tolerating tracheostomy decannulation. RESULTS Five patients with a mean age of 45 years were included in the study. All of the patients (n = 5, 100%) in our cohort developed macroglossia following prolonged oral intubation, with 3.5 weeks being the average length of intubation. All patients presented with difficulty feeding orally and breathing. The average tongue dimension was 12.20 x 6.25 cm. All tongue enlargements were located in the anterior 2/3 of the tongue, and all patients had displaced anterior dentition. In addition, 60% of the patients (n = 3) experienced altered tongue sensation (pain and/or decreased taste). These patients were surgically managed with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement followed by partial glossectomy (n = 5, 100%). We defined successful outcomes as 1) modifying the tongue to a functional, nonprotruding form, 2) tracheostomy decannulation and 3) PEG tube removal. Tracheostomy decannulation and PEG tube removal were achieved in 80% of the patients (n = 4). CONCLUSIONS In this patient cohort, we were unable to identify the cause of the pathology based on existing clinical data. When the etiology is unclear or irreversible, management should involve tracheostomy and surgical feeding access for the initial stabilization, followed by modified glossectomy to improve form, function, and cosmesis thereby improving the overall quality of life.
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Affiliation(s)
- Joyce Xu
- Resident, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, GA
| | - Vaidehi Avadhani
- Assistant Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine, Associate Chief Oral and Maxillofacial Surgery Service, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA
| | - James C Melville
- Associate Professor of Surgery, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston (UTHealth), School of Dentistry, Huston, TX
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Maxillo-Facial Morphology in Beckwith-Wiedemann Syndrome: A Preliminary Study on (epi)Genotype-Phenotype Association in Caucasians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042448. [PMID: 35206635 PMCID: PMC8872180 DOI: 10.3390/ijerph19042448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Beckwith–Wiedemann syndrome (BWS) is a congenital overgrowth disorder caused by various (epi)genetic alterations affecting the expression of genes on chromosome 11p15. Cardinal features include abdominal wall defects, macroglossia, and cancer predisposition. Several (epi)genotype–phenotype associations were described so far, but specific studies on the evolution over time of maxillo-facial phenotype in the molecular subtypes still are scanty. The aim of this cross-sectional study was to associate maxillo-facial morphology and growth pattern with genoype in 25 Caucasian children with BWS and macroglossia. Twelve patients experienced a loss of metilation at imprinting center 2 (IC2-LoM), five had mosaic paternal uniparental isodisomy of chromosome 11 (UPD(11)pat), and eight were negative. A more marked tongue enlargement was detected in patients with IC2-LoM and negative genotype, while UPD(11)pat children showed mild macroglossia (p = 0.048). A cluster analysis did not demonstrate any specific relationship between (epi)genotype and maxillo-facial phenotype, but separated BWS patients based on their cephalometric characteristics. Children with IC2-LoM or negative genotype displayed hyperdivergence values > 30°, clockwise growth tendency, and skeletal class II into the same cluster. They had a negative prognostic score. These preliminary data suggest the need for developing individualized protocols for early monitoring of the craniofacial growth in such patients.
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Ainuz BY, Geisler EL, Hallac RR, Perez JK, Seaward JR, Kane AA. Anterior "W" Tongue Reduction for Macroglossia in Beckwith-Wiedemann Syndrome. Cleft Palate Craniofac J 2021; 59:1145-1154. [PMID: 34402311 DOI: 10.1177/10556656211036607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Macroglossia occurs in 80% to 99% of patients with Beckwith-Wiedemann syndrome (BWS) and a variety of surgical techniques for tongue reduction are offered by surgeons. The purpose of this study is to evaluate the postoperative outcomes of the anterior "W" tongue reduction technique in patients with BWS. METHODS A retrospective review was conducted of all patients diagnosed with BWS that underwent an anterior "W" tongue reduction for macroglossia in the past 7 years, performed by 2 surgeons. Demographics, procedural characteristics, perioperative outcomes, and complications were assessed. RESULTS A total of 19 patients met inclusion criteria consisting of 8 male and 11 female patients. The mean age at the time of surgery was 405 days, mean surgeon operating time was 1.06 h, and mean length of follow-up was 467 days. Postoperative oral competence was observed in 100% of patients. There was no reported history of sleep apnea or airway compromise. Speech delay was seen in 4 patients pre- and postoperatively. Feeding issues decreased from 7 patients preoperatively to 1 patient postoperatively. Preoperative prevalence of class III malocclusion (53%) and isolated anterior open bite (26%) decreased postoperatively to 37% and 16%, respectively. The only reported complications were superficial tip wound dehiscence in 3 patients treated with nystatin antifungal therapy. None of the patients required revisional surgery. CONCLUSION Patients treated with the anterior "W" tongue reduction technique had low rates of perioperative complications and significant improvements in oral competence. Anterior "W" tongue reduction is safe and effective for the correction of macroglossia in patients with BWS.
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Affiliation(s)
- Bar Y Ainuz
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - Emily L Geisler
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Jeyna K Perez
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,2755Childrens Health Systems of Texas, Analytical Imaging and Modeling (AIM) Center, Dallas, TX, USA.,Department of Plastic Surgery, 2755University of Texas Southwestern School of Medicine, Dallas, TX, USA
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Harb JL, Crawford KL, Simmonds JC, Roberts C, Scott AR. Race, Income, and the Timeliness of Cleft Palate Repair in the United States. Cureus 2021; 13:e13414. [PMID: 33758709 PMCID: PMC7978132 DOI: 10.7759/cureus.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States. Design Retrospective cross-sectional study using the Kids' Inpatient Database (KID) from 1997 to 2009. Setting Inpatient. Patients Children with cleft palate with or without cleft lip undergoing inpatient cleft palate repair. Main outcome measures Age at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location. Results A total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months (95% CI 12.0-12.3). Females underwent palatoplasty at an older age (13.6 months) than males (13.2 months), a difference of 0.47 months (SE: 0.19, p=0.015). White children underwent surgery at an earlier age (12.1 months) than Black (12.9 months) (difference: 0.73 months, SE: 0.37, p=0.045), Hispanic (12.7 months) (difference: 0.57 months, SE 0.25, p=0.025), and Asian children (15.7 months) (difference: 3.60 months, SE 0.49, p<0.0001). Asian children were also found to undergo repair later than Hispanic (difference 3.03 months, SE 0.51, p<0.0001) and Black (difference: 2.87 months, SE 0.59, p<0.0001) children. Patients born into the highest income brackets were repaired 0.75 months earlier than those in the lowest bracket (SE: 0.26, p=0.005). Patients in the Midwest underwent palatoplasty later (14.3 months) than in the Northeast (12.9 months) (difference: 1.36 months, SE: 0.31, p<0.0001), South (13.2 months) (difference: 1.05 months, SE: 0.36, p=0.004), and West (13.2 months) (difference: 1.09 months, SE: 0.32, p=0.0007). Conclusions After controlling for confounding factors, our results suggest that in recent history, Black, Hispanic, and Asian children with cleft palate were repaired later than their White counterparts. In addition, children of affluent families were repaired earliest, and economically disadvantaged children were repaired later than their peers.
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Affiliation(s)
- Jennifer L Harb
- Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, USA
| | - Kayva L Crawford
- Otolaryngology - Head and Neck Surgery, University of California San Diego School of Medicine, San Diego, USA
| | - Jonathan C Simmonds
- Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, USA
| | - Cullen Roberts
- Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Andrew R Scott
- Pediatric Otolaryngology and Facial Plastic Surgery, Tufts Children's Hospital, Boston, USA
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Meazzini MC, Besana M, Tortora C, Cohen N, Rezzonico A, Ferrari M, Autelitano L. Long-term longitudinal evalutation of mandibular growth in patients with Beckwith-Wiedemann Syndrome treated and not treated with glossectomy. J Craniomaxillofac Surg 2020; 48:1126-1131. [PMID: 33087311 DOI: 10.1016/j.jcms.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study compares long-term mandibular growth between a group of Beckwith-Wiedemann Syndrome (BWS) patients who underwent glossectomy at an early age and a group of patients not operated. METHODS Cephalometric measurements were performed in BWS patients comparing the data obtained between a group of patients operated at an early age and a group of non-operated patients who declined surgery. Statistics included independent sample T-test. RESULTS Twenty-four out of 78 BWS patients followed since birth completed longitudinal cephalometric x-rays at age 5, 10 and 15. Eighteen patients needed early surgery. Eleven families accepted glossectomy at 2.3 ± 1.3 years of age; seven declined surgery. No differences in mandibular growth were found between the two groups. Inclination of maxillary incisors results were statistically greater in the non-operated group (operated compared to the non-operated group: 103.58 ± 11.30 Vs 108.98 ± 12.47; p-value 0.0168 at 5; 107.06 ± 7.98 Vs 115.14 ± 7.05; p-value 0.0206 at 10; 109.80 ± 4.68 Vs 116.75 ± 5.28; p-value 0.0233 at 15). CONCLUSION Macroglossia has no role in the post-natal mandibular overgrowth in BWS and mandibular overgrowth is part of the syndrome. Therefore, early glossectomy does not change mandibular growth and does not prevent the development of class III skeletal malocclusion in these patients.
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Affiliation(s)
- Maria Costanza Meazzini
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy; San Gerardo Hospital, Monza, Italy.
| | - Melissa Besana
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy; San Gerardo Hospital, Monza, Italy.
| | - Chiara Tortora
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Noah Cohen
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Angela Rezzonico
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Mario Ferrari
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
| | - Luca Autelitano
- University of Milan, Smile House, Regional Center for CLP, Department of Maxillo-Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142, Milan, Italy.
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Al Awadhi TM, Kaklamanos EG, Athanasiou AE. Do facial morphology, posture and function change following glossectomy? A systematic review. J Orthod Sci 2019; 8:7. [PMID: 31161130 PMCID: PMC6540768 DOI: 10.4103/jos.jos_97_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To systematically investigate and critically appraise the quality of the currently available literature regarding the morphological, postural, and functional changes observed in individuals following glossectomy. MATERIALS AND METHODS A search without restrictions in eight databases (including grey literature) and hand searching from inception until March 2018 was performed. Data on morphological, postural, and functional changes after glossectomy were reviewed. Methodological quality was evaluated using the risk of bias in nonrandomized studies of intervention tool. RESULTS Out of 835 initially identified unique records, only three articles following patients for 1 year after glossectomy fulfilled the selection criteria. Overall, no significant morphological, postural, and functional changes were observed. Only the distance between the dorsum and the nasal line increased and the freeway space decreased significantly. CONCLUSIONS Overall, no significant differences were noted in the medium term, in terms of dentofacial structures adaptation and tongue function following glossectomy. Further research is warranted in order to elucidate the consequences of the altered oral environment.
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Affiliation(s)
- Tariq M Al Awadhi
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Eleftherios G Kaklamanos
- Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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