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de Bode CJ, Dogterom EJ, Rozeboom AVJ, Langendonk JJ, Wolvius EB, van der Ploeg AT, Oussoren E, Wagenmakers MAEM. Orofacial abnormalities in mucopolysaccharidosis and mucolipidosis type
II
and
III
: A systematic review. JIMD Rep 2022; 63:621-629. [PMID: 36341168 PMCID: PMC9626671 DOI: 10.1002/jmd2.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Mucopolysaccharidoses (MPSs) and mucolipidosis II and III (ML II and III) often manifest with orofacial (progressive) abnormalities, which may have a major impact on quality of life. However, because these patients have multiple somatic health issues, orofacial problems are easily overlooked in clinical practice and available literature on this topic solely consists of case reports, small case series, and small cohort studies. The aim of this systematic review was to gain more insight in the nature and extent of orofacial abnormalities in MPS, ML II, and III. A systematic review of all previously published articles addressing orofacial abnormalities in MPS, ML II, and III was performed. Both clinical studies and case reports were included. Outcome was the described orofacial abnormalities, subdivided into abnormalities of the face, maxilla, mandible, soft tissues, teeth, and occlusion. The search resulted in 57 articles, describing orofacial features in 340 patients. Orofacial abnormalities were present in all subtypes of MPS, ML II, and III, and consisted of thickened lips, a hypoplastic midface, a high‐arched palate, hypoplastic condyles, coronoid hyperplasia, macroglossia, gingival hyperplasia, thick dental follicles, dentigerous cysts, misshapen teeth, enamel defects, and open bite. Orofacial abnormalities are present in all subtypes of MPS, ML II, and III. As orofacial abnormalities may cause complaints, evaluation of orofacial health should be part of routine clinical care.
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Affiliation(s)
- Chiel J. de Bode
- Department of Oral & Maxillofacial Surgery Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Emma J. Dogterom
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Antoinette V. J. Rozeboom
- Department of Oral & Maxillofacial Surgery Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Janneke J. Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Eppo B. Wolvius
- Department of Oral & Maxillofacial Surgery Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Ans T. van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Esmée Oussoren
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Margreet A. E. M. Wagenmakers
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
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Nagpal R, Georgi G, Knauth S, Schmid-Herrmann C, Muschol N, Braulke T, Kahl-Nieke B, Amling M, Schinke T, Koehne T, Petersen J. Early enzyme replacement therapy prevents dental and craniofacial abnormalities in a mouse model of mucopolysaccharidosis type VI. Front Physiol 2022; 13:998039. [PMID: 36213247 PMCID: PMC9532570 DOI: 10.3389/fphys.2022.998039] [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: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Mucopolysaccharidosis VI (MPS VI) is a hereditary lysosomal storage disease caused by the absence of the enzyme arylsulfatase B (ARSB). Craniofacial defects are common in MPS VI patients and manifest as abnormalities of the facial bones, teeth, and temporomandibular joints. Although enzyme replacement therapy (ERT) is the treatment of choice for MPS VI, the effects on the craniofacial and dental structures are still poorly understood. In this study, we used an Arsb-deficient mouse model (Arsbm/m) that mimics MPS VI to investigate the effects of ERT on dental and craniofacial structures and compared these results with clinical and radiological observations from three MPS VI patients. Using micro-computed tomography, we found that the craniofacial phenotype of the Arsbm/m mice was characterized by bone exostoses at the insertion points of the masseter muscles and an overall increased volume of the jaw bone. An early start of ERT (at 4 weeks of age for 20 weeks) resulted in a moderate improvement of these jaw anomalies, while a late start of ERT (at 12 weeks of age for 12 weeks) showed no effect on the craniofacial skeleton. While teeth typically developed in Arsbm/m mice, we observed a pronounced loss of tooth-bearing alveolar bone. This alveolar bone loss, which has not been described before in MPS VI, was also observed in one of the MPS VI patients. Interestingly, only an early start of ERT led to a complete normalization of the alveolar bone in Arsbm/m mice. The temporomandibular joints in Arsbm/m mice were deformed and had a porous articular surface. Histological analysis revealed a loss of physiological cartilage layering, which was also reflected in an altered proteoglycan content in the cartilage of Arsbm/m mice. These abnormalities could only be partially corrected by an early start of ERT. In conclusion, our results show that an early start of ERT in Arsbm/m mice achieves the best therapeutic effects for tooth, bone, and temporomandibular joint development. As the MPS VI mouse model in this study resembles the clinical findings in MPS VI patients, our results suggest enzyme replacement therapy should be started as early as possible.
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Affiliation(s)
- Rohit Nagpal
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gina Georgi
- Department of Orthodontics, University of Leipzig Medical Center, Leipzig, Germany
| | - Sarah Knauth
- Department of Orthodontics, University of Leipzig Medical Center, Leipzig, Germany
| | - Carmen Schmid-Herrmann
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Braulke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bärbel Kahl-Nieke
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Koehne
- Department of Orthodontics, University of Leipzig Medical Center, Leipzig, Germany
- *Correspondence: Julian Petersen, ; Till Koehne,
| | - Julian Petersen
- Department of Orthodontics, University of Leipzig Medical Center, Leipzig, Germany
- *Correspondence: Julian Petersen, ; Till Koehne,
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Nicolas-Jilwan M. Imaging features of mucopolysaccharidoses in the head and neck. Int J Pediatr Otorhinolaryngol 2020; 134:110022. [PMID: 32251975 DOI: 10.1016/j.ijporl.2020.110022] [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: 01/17/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Ear, Nose and Throat (ENT) involvement by mucopolysaccharidoses is very common, affecting over 90% of patients, and occurs early in the course of the disease. Airway narrowing secondary to glycosaminoglycan deposition results in greatly increased morbidity, mortality and risk of anesthetic complications in these patients. Macroglossia, restricted mouth opening, tracheobronchomalacia, adenotonsillar hypertrophy along with other factors such as a short, rigid and unstable cervical spine, cardiac disease and increased susceptibility to respiratory infections result in a high perioperative mortality and morbidity. Imaging is most beneficial for evaluation of the airway, in particular in patients with obstructive symptoms and prior to intubation. We review the ENT manifestations of mucopolysaccharidoses including airway involvement, otological, oral and dental complications. 3-D reconstructions of the trachea, which is routinely captured on CT imaging of the spine, can be of great value for planning intubation in this patient population.
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Affiliation(s)
- Manal Nicolas-Jilwan
- Department of Radiology, Division of Neuroradiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Identification of eleven different mutations including six novel, in the arylsulfatase B gene in Iranian patients with mucopolysaccharidosis type VI. Mol Biol Rep 2019; 46:3417-3426. [PMID: 30982216 DOI: 10.1007/s11033-019-04804-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/08/2019] [Indexed: 01/05/2023]
Abstract
Mucopolysaccharidosis VI is a rare autosomal recessive disorder caused by the deficiency of enzyme Arylsulfatase B. The enzyme deficiency leads to the accumulation of dermatan sulfate in connective tissue which causes manifestations related to MPS VI. Up to now, three different disease causing variants are reported in Iranian patients. In this study, we scanned ARSB gene of 13 Iranian patients from 12 families in whom all parents were consanguineous and from the same ethnicity except one family that were not consanguineous but co-ethnic. We found six not previously reported disease causing variants. We extracted DNA from peripheral blood samples of patients that were previously confirmed as MPS VI by clinical, biochemical and enzymatic assays including berry-spot test and fluorimetry, followed by PCR and direct sequencing. Computational approaches were used to analyze novel variants in terms of their impact on the protein structure. 11 disease causing variants and 15 polymorphisms were found. Six disease causing variants were novel and five were previously reported of which three were in Iranian population. Four of patients, who were unrelated, two by two had the same disease causing variant and polymorphisms, which indicates a possible founder effect. Our study also implicates genotype-phenotype correlation. Computational structural modeling indicated these disease causing variants might affect structural stability and function of the protein. Data of this study confirms the existence of mutational heterogeneity in the ARSB between Iranian patients. Disease causing variants with high frequency can be used in the prenatal diagnosis and genetic counseling. Also, the existence of the same variants and polymorphisms in some of the unrelated patients indicates a possible founder effect.
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A novel compound heterozygote mutation in the ARSB gene in a patient with Maroteaux-Lamy syndrome and its Insilico evaluation. Meta Gene 2018. [DOI: 10.1016/j.mgene.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Ferreira Dos Reis M, Pinheiro LR, Pinheiro MDGR, de Almeida HA, Feio PDSQ, de Almeida SC, de Souza ICN, Giugliani R, Schwartz IVD, Cavaleiro RMDS, Pinheiro JDJV, da Silva LCS. Mucopolysaccharidosis VI and effects on growth of the apical bases: a case report. SPECIAL CARE IN DENTISTRY 2018; 38:176-184. [PMID: 29722897 DOI: 10.1111/scd.12290] [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] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mucopolysaccharidosis (MPS) VI is a rare disorder caused by an autosomal recessive mutation in the short arm of chromosome 5 (5q12-13) leading to an N-acetylgalactosamine-sulfatase lysosomal enzyme deficiency and numerous systemic clinical changes. The oral and maxillofacial complex may exhibit tooth eruption anomalies, macroglossia, gingival hypertrophy, mouth breathing, increased lower facial height, open bite, retrognathia, and progressive TMJ arthrosis. This report describes craniofacial growth changes in two MPS VI patients, sisters and daughters of outbred parents, who were longitudinally monitored from 11 to 15 years of age. STUDY DESIGN Skull lateral teleradiography and cephalometric tracings were performed. The measurements were assessed in the anteroposterior and vertical directions based on protocols by McNamara and Usp/Unicamp and compared to the normal reported ranges. RESULTS A similar skeletal class III malocclusion was observed in both patients. The jaw was retruded, the anterior skull base decreased, and the mandibular body was normal or larger than normal. The vertical growth direction differed between the patients; one was hyperdivergent, while the other was hypodivergent. CONCLUSIONS By understanding the craniofacial growth changes in MPS VI patients, new treatment options may be developed for affected patients.
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Affiliation(s)
- Moema Ferreira Dos Reis
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Pará, Belém, PA, Brazil
| | - Lucas Rodrigues Pinheiro
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | | | | | | | - Roberto Giugliani
- Medical Genetics Service, Clinical Hospital de Porto Alegre/Department of Genetics, Federal University of Rio Grande do Sul/INAGEMP, Porto Alegre, RS, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Medical Genetics Service, Clinical Hospital de Porto Alegre/Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rosely Maria Dos Santos Cavaleiro
- Department of Dentistry for Patients with Special Needs, School of Dentistry, Federal University of Pará and School of Dentistry, University Center of Pará, Belém, PA, Brazil
| | - João de Jesus Viana Pinheiro
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Pará, Guamá, CEP, Belém, PA, Brazil
| | - Luiz Carlos Santana da Silva
- Laboratory of Inborn Errors of Metabolism, Institute of Biological Sciences, Federal University of Pará, Guamá, CEP, Belém, PA, Brazil
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Andreu-Arasa VC, Chapman MN, Kuno H, Fujita A, Sakai O. Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach. Radiographics 2018; 38:890-911. [PMID: 29624481 DOI: 10.1148/rg.2018170145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- V Carlota Andreu-Arasa
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Margaret N Chapman
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Hirofumi Kuno
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Akifumi Fujita
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Osamu Sakai
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
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8
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Evaluation of oral manifestations of patients with mucopolysaccharidosis IV and VI: clinical and imaging study. Clin Oral Investig 2017; 22:201-208. [DOI: 10.1007/s00784-017-2100-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
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10
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Arjona-Amo M, Torres-Carranza E, Batista-Cruzado A, Serrera-Figallo MA, Crespo-Torres S, Belmonte-Caro R, Albisu-Andrade C, Torres-Lagares D, Gutiérrez-Pérez JL. Kissing molars extraction: Case series and review of the literature. J Clin Exp Dent 2016; 8:e97-e101. [PMID: 26855716 PMCID: PMC4739378 DOI: 10.4317/jced.52741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/05/2015] [Indexed: 12/18/2022] Open
Abstract
Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle.
We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction.
We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process.
Key words:Impacted molar, kissing molar, surgical extraction.
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Affiliation(s)
- Manuel Arjona-Amo
- Master in Oral Surgery - University Hospital "Virgen del Rocío" Seville, Spain
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11
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de Santana Sarmento DJ, de Carvalho SHG, Melo SLS, Fonseca FRA, Diniz DN, Bento PM, Mesquita GDQTB, de Melo DP. Mucopolysaccharidosis: radiographic findings in a series of 16 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:e240-6. [PMID: 26455293 DOI: 10.1016/j.oooo.2015.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/25/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the radiographic findings of mucopolysaccharidoses (MPS) on panoramic radiographs in a series of 16 patients. STUDY DESIGN This retrospective cross-sectional study included panoramic radiographs of 16 patients with cytogenetically diagnosed MPS. Two blinded, previously calibrated observers evaluate the presence or absence of the following features: type of dentition; stage of dental age in comparison with chronologic age; delayed exfoliation of deciduous teeth; supernumerary teeth; teeth impaction; enlarged, cyst-like dental crypt; hypercementosis; taurodontism; generalized enamel hypoplasia; enlargement of the bone marrow spaces; thinning of cortical bone; unusual morphology of condyles; and flattening of the condylar head. RESULTS The final sample was composed of 8 MPS IV, 7 MPS VI, and 1 MPS I cases. All patients presented unusual morphology of condyles. Cyst-like dental crypt (75%), taurodontism, and teeth impaction (68.75% each) were also overall common findings. Generalized enamel hypoplasia was exclusively identified in patients with MPS IV (75% of those patients). CONCLUSIONS Radiographic features of oral and maxillofacial manifestations in patients with MPS frequently encountered by dentists may help recognize the disorder. However, because of sample size limitations, it was not possible to infer any statistical relationship between the radiographic features and the types of MPS.
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Affiliation(s)
| | | | - Saulo Leonardo Sousa Melo
- Department of Oral Pathology, Radiology and Medicine, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | | | - Denise Nóbrega Diniz
- Department of Oral Diagnosis, Paraíba Dental School, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Patrícia Meira Bento
- Department of Oral Diagnosis, Paraíba Dental School, Paraíba State University, Campina Grande, Paraíba, Brazil
| | | | - Daniela Pita de Melo
- Department of Oral Diagnosis, Paraíba Dental School, Paraíba State University, Campina Grande, Paraíba, Brazil
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Ribeiro EM, Fonteles CSR, Freitas AB, da Silva Alves KS, Monteiro AJ, da Silva CAB. A clinical multicenter study of orofacial features in 26 brazilian patients with different types of mucopolysaccharidosis. Cleft Palate Craniofac J 2014; 52:352-8. [PMID: 24919127 DOI: 10.1597/13-204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study aimed to describe the orofacial features of 26 unrelated Brazilian patients with mucopolysaccharidosis and to verify any possible associations between these findings and specific types of mucopolysaccharidosis. METHODS Patients were diagnosed with mucopolysaccharidosis and clinically evaluated. Following consent, a clinical assessment form was completed. Facial and intraoral examination was performed by evaluating facial pattern, malocclusions, dental caries, and tooth identification. RESULTS Midface deficiency, increased lower facial third, anterior open bite, convex profile, macroglossia, gingival enlargement, and spaced arches were the most frequently observed features. These findings did not allow a differential diagnosis among the different types of mucopolysaccharidosis, except for pitting enamel, which significantly associated with mucopolysaccharidosis IVA (P < .001). Open bite was associated with mucopolysaccharidosis types I, II, III, and VI; however, only one patient with mucopolysaccharidosis IVA expressed this feature (P = .043). CONCLUSIONS Our results suggest that pitted enamel in patients with mucopolysaccharidosis is most likely a feature of mucopolysaccharidosis type IVA; whereas, open bite is rarely observed in these patients. Orofacial features in mucopolysaccharidosis may help pediatric dentists recognize this disorder and minimize the delay between the initial signs/symptoms and diagnosis of the disease. Future studies should focus on the longitudinal manifestations, expression, and severity of mucopolysaccharidosis-associated orofacial anomalies.
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13
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Dentomaxillofacial manifestations of mucopolysaccharidosis VI: clinical and imaging findings from two cases, with an emphasis on the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:e141-8. [PMID: 23849382 DOI: 10.1016/j.oooo.2013.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/11/2013] [Accepted: 04/26/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Using a clinical survey, panoramic, cone-beam computed tomography (CBCT), and magnetic resonance (MR) imaging, this study was conducted to ascertain primary maxillofacial abnormalities in patients with mucopolysaccharidosis VI (MPS VI). STUDY DESIGN Two patients previously diagnosed with MPS VI underwent clinical and imaging surveys (panoramic radiographs, CBCT, and MR imaging). RESULTS Jaw involvement was present in all patients. The most prevalent findings were enlarged marrow spaces, osteopenia, dentigerous cyst-like follicles, effacement of the jaw structures, and osteosclerosis. This is the first study to describe temporomandibular joint (TMJ) involvement for MPS VI. CONCLUSIONS CBCT and MR imaging were needed to observe features that were not clear in conventional radiographs. Both patients reported symptoms in the TMJ and demonstrated involvement during their examinations. A multicenter study is necessary to better document maxillofacial involvement in MPS VI.
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14
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Antunes LAA, Nogueira APB, Castro GF, Ribeiro MG, de Souza IPR. Dental findings and oral health status in patients with mucopolysaccharidosis: a case series. Acta Odontol Scand 2013; 71:157-67. [PMID: 22376155 DOI: 10.3109/00016357.2011.654255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To present a mucopolysaccharidosis (MPS) case series evaluating oral manifestations (clinical and radiographic), oral health status and discussing its implications. PATIENTS AND METHODS All patients with MPS attending the Genetics clinic/Brazil were evaluated by means of anamnesis, clinical and radiographic examinations. RESULTS The final sample consisted of 12 subjects (nine males and three females), with ages ranging from 3-31 years old. Concerning oral health, it was observed high levels of caries and periodontal problems. About oral manifestations, this study clinically observed more cases of delayed tooth eruption, thickness of alveolar process and thick lips. Radiographically, it was observed alterations on condyle, mandibular ramus and joint fossa. CONCLUSION The dental changes in MPS population are high and consequently it is important to know them for differential diagnoses, early treatment intervention, prevention and education of both patients and parents/caregivers about oral health.
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Affiliation(s)
- Lívia Azeredo Alves Antunes
- Department of Specific Formation, School of Dentistry, Fluminense Federal University, Nova Friburgo, Brazil.
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15
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James A, Hendriksz CJ, Addison O. The oral health needs of children, adolescents and young adults affected by a mucopolysaccharide disorder. JIMD Rep 2011; 2:51-8. [PMID: 23430854 PMCID: PMC3509840 DOI: 10.1007/8904_2011_46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/14/2011] [Accepted: 03/16/2011] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND As one of the 4 United Kingdom national centres for Lysosomal Storage Disorders, Birmingham Children's Hospital (BCH) cares for 49 patients with a mucopolysaccharide (MPS) disorder. Presently, their oral health needs have never been fully investigated. Enzyme therapies are revolutionising medical treatment, and will prolong life expectancy. Therefore, oral health and its impact on quality of life are increasingly important. HYPOTHESIS Patients with an MPS disorder have greater oral health needs in comparison with the general population. DESIGN Forty-six patients with an MPS disorder were investigated for caries, gingival health and enamel opacities. Questionnaires to establish the utilisation of dental services and assess the perceived difficulties in achieving adequate oral health care were completed. RESULTS Patients with an MPS disorder have specific oral health needs depending on the type of MPS experienced. This study found 76% of patients with MPS IV had experienced dental caries and they all showed evidence of a generalised unspecified enamel defect. Subjects with MPS I, II and III did not have an increased caries rate; 50% of the study group had received dental treatment in the past, of which 74% (17, n = 23) required a general anaesthetic. CONCLUSION The MPS disorders can have a significant effect on the developing dentition. Subjects with MPS IV do have an increased oral health need in comparison with the general population and the other MPS groups due to their increased caries rate and enamel defects. Further research is required to fully assess their needs and investigate any structural tooth defects.
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Affiliation(s)
- Alison James
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK,
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Abstract
Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome) is a lysosomal storage disease that is characterized by systemic clinical manifestations and significant functional impairment. Diagnosis and management are often challenging because of the considerable variability in symptom presentation and rate of progression. The optimal standard of care should be based on evidence from randomized, controlled trials, meta-analyses, systematic reviews, and expert opinion. In support of this goal, comprehensive management guidelines have been drafted by an international group of experts in the management of patients with mucopolysaccharidosis VI. The guidelines provide a detailed outline of disease manifestations by body system, recommendations for regular assessments, and an overview of current treatment options.
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Affiliation(s)
- Roberto Giugliani
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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17
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Abstract
Cystic fibrosis (CF) is associated with mutation and abnormal function of the cystic fibrosis transmembrane conductance regulator (CFTR) that affects cellular chloride transport. Clinically, CF of the lung is associated with excessive accumulation of secretions, including the sulfated glycosaminoglycans, chondroitin sulfate and dermatan sulfate (DS), both of which contain sulfated N-acetylgalactosamine residues. The sulfatase enzymes, which are a highly conserved group of enzymes with high specificity for designated sulfate groups, include arylsulfatase B, a lysosomal enzyme. Arylsulfatase B, also known as N-acetyl galactosamine 4-sulfatase, can degrade DS and chondroitin-4 sulfate. Previously reported data demonstrated diminished activity of arylsulfatase B in lymphoid cell lines of patients with CF compared to normal control subjects. Frequent infections with Pseudomonas, a sulfatase-producing organism, occur in patients with CF, whereas infections with Mycobacterium tuberculosis, which lacks sulfatase activity, are infrequent. Additional investigation to determine if diminished function of arylsulfatase B is a consistent finding in cells of patients with CF may be informative, and may help to correlate the molecular, biochemical, and clinical characteristics of CF.
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Affiliation(s)
- Joanne K Tobacman
- Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA 52242, USA.
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18
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Monroy MA, Ross FP, Teitelbaum SL, Sands MS. Abnormal osteoclast morphology and bone remodeling in a murine model of a lysosomal storage disease. Bone 2002; 30:352-9. [PMID: 11856642 DOI: 10.1016/s8756-3282(01)00679-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mucopolysaccharidosis type VII (MPS VII) is a heritable lysosomal storage disease caused by a deficiency in beta-glucuronidase (GUSB) activity, leading to progressive accumulation of undegraded glycosaminoglycans in many tissues. Clinical features include growth and mental retardation, hearing and visual defects, shortened lifespan, and skeletal deformities. A murine model of MPS VII has been described that shares many of the manifestations of the human disease, including the skeletal dysplasia. In this study we describe abnormalities in the cellular morphology and function of osteoclasts and a localized defect in bone formation rate in the MPS VII mouse. Ultrastructural analysis revealed that MPS VII osteoclasts fail to form ruffled border membranes and many appeared to be detached from the bone surface. Following bone marrow transplantation, osteoclasts derived from wild-type donors showed normal morphology and were closely associated with the bone surface in MPS VII recipients. In vitro bone resorption assays demonstrated that MPS VII osteoclasts formed significantly smaller and fewer pits than those formed by osteoclasts derived from normal mice of the same strain. Although osteoclast morphology and function appeared to be abnormal in the MPS VII mouse, interleukin-1 (IL-1)-induced osteoclastogenesis in vivo was not affected. In addition to the osteoclast defects, MPS VII mice demonstrated a slower rate of bone matrix deposition in the epiphysis by in vivo calcein labeling experiments. These data suggest that abnormal morphology and function of MPS VII osteoclasts, combined with deficient matrix deposition, may contribute to the skeletal defects observed in this lysosomal storage disease.
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Affiliation(s)
- M A Monroy
- Department of Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA
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19
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Yonemochi H, Noda T, Saku T. Pericoronal hamartomatous lesions in the opercula of teeth delayed in eruption: an immunohistochemical study of the extracellular matrix. J Oral Pathol Med 1998; 27:441-52. [PMID: 9790098 DOI: 10.1111/j.1600-0714.1998.tb01982.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Opercula of teeth delayed in eruption were examined histopathologically and immunohistochemically to determine the possible causes for tooth eruption failure. Specimens were obtained from 58 patients with non-erupted teeth by surgical removal of their gingival opercula. Among the 61 specimens, 31 (50.8%) were diagnosed as pericoronal myxofibrous hyperplasia (PMH), 8 (13.1%) as infantile ameloblastic fibromatosis (IAF), and 19 (31.2%) as odontomas. Histopathologically, PMH is characterized by hyperplasia of odontogenic mesenchymal tissues with a myxoid appearance in which odontogenic epithelial islands and mesenchymal multinucleated giant cells are scattered randomly. Between the mucosal epithelium and the PMH, there is a layer of fibrosis, whose matrix is strongly immunopositive for tenascin. The PMH seems to induce its overlying gingival mucosa to remodel the connective tissue, which obstructs tooth eruption. IAF is usually located adjacent to the PMH and shows an ameloblastic fibroma-like histology with atrophic ameloblastic components and poor encapsulation. The findings suggest that IAF associated with PMH is not a true neoplasm and should be distinguished from ameloblastic fibromas by the name of IAF, and that both lesions are included in the range of hamartomas formed only in the pericoronal tissue of teeth in eruption. We propose to categorize these lesions into a new disease entity of pericoronal hamartomas of odontogenic origin.
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Affiliation(s)
- H Yonemochi
- Department of Pathology, Niigata University School of Dentistry, Japan
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