Oral and maxillofacial outcomes in children with microcephaly associated with the congenital Zika syndrome

Oral conditions of children with microcephaly associated with congenital Zika syndrome: a cross-sectional study

The aim of the present study was to compare the oral conditions of children with congenital Zika syndrome (CZS)-associated microcephaly, non-CZS-associated microcephaly, and normotypical children, as well as to characterize their sociodemographic aspects and medical history. A paired cross-sectional study was carried out on 14 children with CZS-associated microcephaly and 24 age-matched controls, in Belo Horizonte, in southeastern Brazil. Children's oral conditions were assessed: dental caries experience (dmft/DMFT indices); developmental defects of enamel (DDE) index; dental anomalies; mucosal changes; lip sealing, and malocclusion (overjet, overbite, and/or posterior crossbite alterations). The quality of oral hygiene was analyzed by the simplified oral hygiene index. The children's mothers also answered a questionnaire about sociodemographic and medical history data. The variables were analyzed descriptively. Female participants were more prevalent (60.5%), and the mean age of the participants was 4.9 years (±1.4) (range: 2-8 years) and 92.1% of their exhibited some oral condition. All participants with CZS-associated microcephaly showed absence of lip sealing and had malocclusion (100.0%). When compared to the other groups, children with CZS had a higher percentage of dental anomalies (35.7%), mucosal changes (71.4%), and unsatisfactory oral hygiene (64.3%). In a sample composed mainly of female participants aged less than 5 years, the prevalence of oral conditions and unsatisfactory oral hygiene was higher in the group with CZS-associated microcephaly, followed by the group with non-CZS-associated microcephaly. Normotypical children had the highest percentage of dental caries experience.

Congenital Zika Virus Syndrome: Microcephaly and Orofacial Anomalies

The progressive reappearance of Zika virus (ZIKV) infections since October 2013 and its circulation in >70 countries and territories (from French Polynesia to Brazil and other countries in the Americas, with sporadic spread in Europe and the East) has long been reported as a global public health emergency. ZIKV is a virus transmitted by arthropods (arboviruses), mainly by Aedes mosquitoes. ZIKV can also be transmitted to humans through mechanisms other than vector infection such as sexual intercourse, blood transfusions, and mother-to-child transmission. The latter mode of transmission can give rise to a severe clinical form called congenital Zika syndrome (CZS), which can result in spontaneous abortion or serious pathological alterations in the fetus such as microcephaly or neurological and orofacial anomalies. In this study, beside a succinct overview of the etiological, microbiological, and epidemiological aspects and modes of transmission of Zika virus infections, we have focused our attention on the pathogenetic and histopathological aspects in pregnancy and the pathogenetic and molecular mechanisms that can determine microcephaly, and consequently the clinical alterations, typical of the fetus and newborns, in a subject affected by CZS.

Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study

Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.

Comparative 3D study of dental arches in children with microcephaly associated with congenital Zika syndrome, orofacial cleft, and without craniofacial anomalies

INTRODUCTION

The dentist participates in the treatment protocol for craniofacial anomalies in individuals from the first months of life.

OBJECTIVE

to compare in a retrospective cohort study the morphometry of the edentulous palate of children microcephaly associated with congenital Zika syndrome (CZS), unilateral complete cleft lip and alveolus (UCL), and without craniofacial anomalies.

METHODS

Forty-five digitized dental molds composed the sample divided into three groups: CZS; UCL; and without craniofacial anomalies (control group). The following measurements were evaluated: intercanine and intertuberosity distances; dental arch length, area, volume, and mismatch superimposition. Parametric and non-parametric tests were applied (α = 5%).

RESULTS

CZS group showed the smallest means of intercanine distance and area than those of the other groups (p = .001 and p = .010, respectively). The dental arch length was greater in the CZS group than in the control group (p = .020). The evaluation of the mismatch superimposition showed that the CZS group had the lowest means of maximum distance and root mean square than that of the UCL group (p = .025 and p = .005, respectively).

CONCLUSION

CZS participants tended to palatal narrowing, while UCL individuals had parameters similar to those of the control group, despite the alveolus defect.

Craniofacial and dental features in children aged 3-5 years with congenital Zika syndrome

OBJECTIVE

Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction, dysphagia among other previously described severe health complications. CZS is usually diagnosed postpartum by evident/apparent neural development problems. Although there are some reports of craniofacial/dentition development in CZS, several clinical oral aspects are still unknown. This study describes some structural and functional characteristics of facial and cranial growth and deciduous dentition in CZS-affected children.

MATERIAL AND METHODS

Some cranial, facial and dental characteristics were determined in 14 children with CZS aged 3-5 years and compared them against 12 apparently healthy children paired by age and gender.

RESULTS

Fourteen CZS cases presented microcephaly, maxillary prognathism, altered facial thirds, asymmetric pupillary line, bruxism (p = 0.006), deep and anterior open bite and distal step decidual molar relationship (p = 0.031). CZS children cannot feed by themselves and most cannot walk and have not develop coordinated and intelligible language according to their chronological age. In contrast, controls presented normal skull features, have autonomous locomotion skills, speak intelligible language, feed by themselves, presented a harmonic intermaxillary relationship and have symmetrical facial thirds.

CONCLUSION

Microcephaly, dysphagia, bruxism, mandibular retrognathia, altered facial proportions and malocclusion are the main craniofacial and oral features at CZS.

CLINICAL RELEVANCE

The complications of CZS including those related with the face and the oral cavity are still being identified. This study revealed some cranial, facial and oral features in children affected by CSZ. Interdisciplinary rehabilitation protocols must address these syndromic features that could improve children and parents living conditions.

Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta-analyses

AIMS

To synthesize the oral alterations observed in children with microcephaly associated with congenital Zika virus syndrome (CZS), and to compare the oral alterations of these children to a normotypic healthy controls.

METHODS AND RESULTS

A search was performed in six electronic databases. Observational studies published that reported oral alterations in children with CZS were selected. Two authors independently extracted data, assessed study quality, using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-one studies were included in this systematic review and meta-analysis. The pooled crude occurrence showed 88% of increased salivation (95%CI: 82%-94%), 83% of biofilm (95%CI: 75%-91%), and 73% of bruxism (95%CI: 52%-95%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 12.92; 95%CI: 3.42-48.78), with very low certainty.

CONCLUSION

There are several oral alterations found among children with CZS-associated microcephaly. They are more prone to present some of these alterations, such as difficulty in lip sealing, although with very low certainty of evidence.

Influence of Adenoid Hypertrophy on Malocclusion and Maxillofacial Development in Children

Objective

To investigate the effect of adenoid hypertrophy on malocclusion and maxillofacial development in children.

Methods

Total of 102 children with malocclusion or maxillofacial dysplasia admitted to our hospital from March 2017 to June 2020 were selected as the research subjects. All children were divided into a control group (50 cases with adenoid hypertrophy) and an observation group (52 cases without adenoid hypertrophy) according to the presence or absence of adenoid hypertrophy. The incidence of malocclusion was compared between the two groups, and lateral cranial radiographs were taken in both groups to measure and compare the malocclusion angle, jaw angle, and jaw length indexes between the two groups.

Results

The incidence of malocclusion in the observation group (71.15%) was higher than that in the control group (42.00%), and the difference was statistically significant (P < 0.05). The angle between the long axis of the upper central incisor and the nasal root point and the upper alveolar base point (U1-NA), the angle between the long axis of the lower central incisor and the nasal root point and the lower alveolar base point (L1-NB), the angle between mandibular plane and anterior cranial base plane (MP-SN), the angle between the long axis of upper central incisor and anterior cranial base plane (U1-SN), the angle between the long axis of lower central incisor and mandibular plane (L1-MP), the angle of Y axis, the overall height (N-Me), lower height (ANS-Me), overall height/back height (N-Me/S-Go), and lower height/overall height (ANS-Me/N-Me) values in the observation group were higher than those in the control group, while the mandibular length (Go-Gn) values in the observation group were lower than those in the control group (P < 0.05).

Conclusion

Adenoid hypertrophy can increase the incidence of malocclusion in children and can also increase the steepness and overall height and lower height of the mandible, resulting in the lengthening of the facial shape and the development of the maxillofacial deformity.

Might Zika virus-associated microcephaly's severity impact deciduous tooth eruption and orofacial structures?

OBJECTIVE

to investigate the impact of the severity of microcephaly caused by the Zika virus (MCZ) on tooth eruption and orofacial structures of children.

DESIGN

This case series study developed the research at the Mens Sana Rehabilitation Center, Arcoverde, Brazil. The study included 27 children diagnosed with MCZ. We performed the data collection in June 2018 through a questionnaire answered by the legal guardians, followed by a clinical examination of the children. The data were analyzed by the Mann-Whitney and Fisher's Exact tests (p = 0.05).

RESULTS

The final sample was composed of 20 children. Of these, 13 (35.0%) had severe microcephaly, 5 (30.0%) had altered sequence of tooth eruption, 10 (50.0%) had delayed eruption, and the mean number of decayed teeth was 2.3. The most identified orofacial changes were teeth grinding habit (65.0%), difficult chewing (50.0%), and non-nutritive sucking (50.0%). Mann-Whitney test showed that the severity of microcephaly did not affect tooth eruption (p = 0.581). Fisher's exact test showed that the severity of microcephaly was not associated with orofacial changes (p > 0.05).

CONCLUSIONS

The severity of MCZ does not seem to influence changes in deciduous tooth eruption and the presence of orofacial anomalies.

"Anatomical, behavioral, and physiological analyses of craniofacial development by cineradiographic imaging in marmosets"

BACKGROUND

Nonhuman primates are the closest animal models to humans regarding genetics, physiology, and behavior. Marmoset monkeys in particular are one of the most versatile species for biomedical research.

OBJECTIVE

To assess the craniofacial growth and development of the masticatory function in the common marmoset (Callithrix jacchus), from birth to the fourth month of life through minimally invasive cineradiographic imaging.

METHODS

Ten individuals were followed-up from zero to four months of age regarding craniofacial growth and masticatory function assessed by cineradiography. For the experimental procedure, we used a microfocal x-ray source apparatus and a beryllium fast-response image-intensifier.

RESULTS

The duration of the masticatory cycles was stable across age groups. Chewing a very soft Castella cake or the slightly harder Marshmallow did not change the masticatory cycle in the time domain. On the other hand, linear and angular measurements of the jaw-opening movement showed a tendency for bigger movements at the latter stages of craniofacial growth. Qualitative analysis showed that marmosets had a small preference for Castella over Marshmallow, that they most often bit off pieces of food to chew with their posterior teeth, that they manipulated the food with their hands, and that they chewed the food continuously.

CONCLUSION

We observed critical developmental events during the first three months of life in marmosets. Cineradiographic imaging in marmosets may provide valuable information on craniofacial form and function for basic and preclinical research models.

Cross-sectional study of the anthropometric characteristics of children with congenital Zika syndrome up to 12 months of life

Background

Little is known about physical development of children with Congenital Zika Syndrome (CZS). This study aims to evaluate the anthropometric characteristics of children with CZS up to 12 months.

Methods

This is a cross-sectional study developed with 46 children with CZS living in Bahia. We used the Public Health Events Register, Live Births Information System and Childcare Records of Primary Health Care Services. Descriptive analysis was performed by distributing absolute and relative frequencies and median and interquartile range. The Weight/Age (W/A), Length/Age (L/A), Weight/Length (W/L) and Head Circumference/Age (HC/A) indexes were calculated for each month and expressed in z-score values, and the results were evaluated individually and by group average. Values between ≥ − 2 and ≤ 2 standard deviations were used as reference. T-Student and Spearman’s Correlation Tests were applied to verify the existence of any relationship between maternal and children’s variables with the anthropometric indexes weight/age and height/age at birth and at 3, 6 and 12 months of age.

Results

The studied children had high proportions of low birth weight (23.9%), dysphagia (56.8%) and seizures (53.5%). The mean z-score for the HC/A index at birth was − 3.20 and remained below − 3 z-scores throughout the assessed period. The analysis of the indices equivalent to every single child’s anthropometric measurement showed a deficit in 20.4% of the W/A, 39.1% of the L/A, 9.2% of the W/L and 85.7% of the HC/A measurements. Distribution of the mean values of these anthropometric indices revealed a risk of delayed stature growth (L/A < -1 z-score). There was a statistically significant association between L/A at 12 months and dysphagia (p = 0.0148) and a positive correlation between breastfeeding time and W/A. No statistically significant correlation was found between any other tested variables.

Conclusions

We observed a deficit in the HC/A index, which is a common feature in CZS, but also a high proportion of W/A and L/A deficit. The average group z-score highlighted the risk of delay in stature growth for age, which calls attention to the need for health interventions, as this condition exposes them to a higher risk of morbidity and mortality.