Successful management of severe coronoid process hyperplasia in a patient with mucopolysaccharidosis VI: a case report

Congenital mandibular coronoid process hyperplasia and associated diseases

Coronoid process hyperplasia (CPH) is an oral and maxillofacial surgical disease that can result in restricted jaw movement due to an enlarged and elongated mandibular coronoid process. It is characterized by the painless progressive restriction of unilaterally or bilaterally mouth opening. Clinically, unexplained bilateral CPH is less common and therefore often overlooked or misdiagnosed, and coronoidectomy can be very effective on improving mouth opening. Currently, the exact etiology and mechanism of congenital CPH have not yet been fully understood, but it is generally believed to be genetically related. In this paper, the relationship of the congenital mandibular CPH with the related diseases was examined based on cases collected in our clinic and literature review for the clinical diagnosis and treatment of patients with restricted mouth opening associated with CPH.

TGFB3 gene mutation associated with mandibular coronoid process hyperplasia: a family investigation

OBJECTIVE

Coronoid process hyperplasia (CPH) of the mandible can lead to restricted mouth opening and maxillofacial deformities, which have been hypothesized to be closely associated with genetics. This study investigated the relationship between congenital CPH and TGFB3 mutation in a family of patients with CPH.

STUDY DESIGN

A limited mouth opening proband with CPH underwent whole-exome gene sequencing in November 2019, and the results confirmed compound heterozygous mutations in the TGFB3 gene. Subsequently, clinical imaging and genetic testing were performed on 10 other individuals in his family.

RESULTS

A total of 9 people in this family have CPH. Among them, 6 have the same exon compound heterozygous mutation sites of the TGFB3 gene (chr14-76446905 and chr14-76429713), accompanied by homozygous or heterozygous mutations in the 3'untranslated region (3'UTR) of the TGFB3 gene (chr14:76429555). The other 3 individuals have a homozygous mutation in the 3'untranslated region of the TGFB3 gene.

CONCLUSION

The heterogeneous compound mutation of the TGFB3 gene or the homozygous mutation of 3'UTR of the TGFB3 gene may be correlated with CPH. In addition, the specifically related mechanism needs to be confirmed by further genetic animal experiments.

Jacob's Disease: Case Series, Extensive Literature Review and Classification Proposal

Jacob's disease is a rare entity consisting of the formation of a pseudojoint between an abnormal coronoid process of the mandible and the inner surface of the zygomatic bone. First described by Jacob in 1899, its diagnosis and definition have never been entirely univocal. In this paper, we present three emblematic cases and an extensive review of the literature on Jacob's disease. Given the variability observed in the presentation of the disease, we have developed a proposal for the classification, here reported.

Orofacial abnormalities in mucopolysaccharidosis and mucolipidosis type II and III : A systematic review

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.

A systematic review of treatment and outcomes in patients with mandibular coronoid process hyperplasia

Treatment of mandibular coronoid process hyperplasia (MCPH) has been described and explored in the literature. This systematic review aims to provide a comprehensive overview of the surgical and non-surgical treatment options for MCPH in pediatric and adult populations. Three databases were searched for treatment of MCPH patients (MEDLINE, Embase, and Web of Science). Two reviewers selected case reports and case series based on titles and abstracts. Finally, 55 studies reporting a total of 127 cases were included for qualitative synthesis and data extraction. The mean age at symptom onset was 15.6 years, while the mean age at diagnosis was 23.5 years. Of the included cases, 83.7% were male, and the condition was bilateral in more than 81% of the cases. Coronoidectomy was performed in 82.7% of the included cases, while coronoidotomy was performed in 3.9% of the cases. In 85.0% of the surgically treated cases, the approach was intraoral. The mean maximal intraoperative mouth opening was 38.1 mm compared with 16.5 mm at diagnosis. The mean maximal postoperative mouth opening was 35.3 mm, and the mean follow-up period was 16.3 months. Maximum mouth opening was achieved intraoperatively, and non-surgical treatment after surgery aims to reduce the risk of relapse. Additional research with a higher level of evidence is necessary to confirm these findings.