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Nazari S, Vaezi A, Mossavarali S, Ghanavati K, Shafiee A. Cardiovascular anomalies in patients with Tessier syndrome: a systematic review. Eur J Pediatr 2024; 183:73-82. [PMID: 37924347 DOI: 10.1007/s00431-023-05322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
Tessier clefts are skeletal and soft tissue abnormalities of a neonate's facial structures. They could be classified as syndromic and non-syndromic clefts, which can be attributed to disruptions in fetal development and genetic mutations, respectively. Reported cases of these clefts typically document the presence of additional abnormalities associated with these clefts. In this systematic review, we analyzed reports of Tessier clefts accompanied by cardiovascular anomalies, as one of the commonly encountered anomalies. We systematically searched PubMed (MEDLINE), Scopus, Web of Science, Science Direct, and Google Scholar. We selected and included case reports, case series, and case reviews on patients with Tessier cleft and cardiovascular anomalies. The critical appraisal of the included studies was performed by two independent investigators using the Consensus-based Clinical Case Reporting Guideline Development (CARE) checklist. Overall, 20 reports (18 case reports and 2 case series) were eligible for inclusion in this review. Tessier clefts 3 and 30 were the most commonly observed. In addition, the most prevalent cardiovascular anomalies consisted of the ventricular septal defect (VSD), double-outlet right ventricle, and atrial septal defect (ASD). Most of the patients received cosmetic and cardiovascular surgeries. However, some were not proper candidates for cardiovascular surgery because of their unstable condition and therefore did not survive. Conclusion: Regardless of the focus placed on the cleft and subsequent plastic surgery procedures in these cases, it is important to prioritize other abnormalities that may be associated with mortality. A complete cardiovascular system and associated disorders assessment should be performed before facial cosmetic surgeries. What is Known: • Tessier clefts are congenital defects in the soft tissues and bones of the face and like many other congenital defects, they are accompanied by defects in other parts of the body. • In the current literature, the emphasis is on clefts and the cosmetic issues rather than the coinciding defects, particularly cardiovascular anomalies. What is New: • Review the cardiovascular anomalies that are commonly encountered in patients with Tessier clefts.
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Affiliation(s)
- Shiva Nazari
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Vaezi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shervin Mossavarali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimia Ghanavati
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Cardiovascular Research, Tehran Heart Center, North Kargar Ave., Tehran, 1411713138, Iran.
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Shah NR, McGoldrick DM, Sharp I. Presentation and surgical management of a patient with a true cleft mandible. J Oral Biol Craniofac Res 2021; 12:161-164. [PMID: 34824969 DOI: 10.1016/j.jobcr.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Clefts involving the mandible and lower lip are very rare, with less than 80 cases having been reported worldwide. The objective of this case report is to highlight this unusual type of facial cleft, and to present the principle features and management typically associated with it. We carefully describe our surgical planning and management of the patient alongside a compilation and comparison of different surgical techniques described in the literature thus far. In this report, we discuss a patient with a cleft of the lower lip, true cleft mandible with independent movements of his mandibular segments, ankyloglossia, and a fistula extending from the mandible to the suprasternal notch complicated with congenital heart abnormalities. We explore the different approaches of when to close the hard and soft tissues, however, there is still no clear surgical protocol for treating cleft mandibles but with more cases and their management and outcomes being reported, this is something which will be useful to develop.
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Affiliation(s)
- Nikita R Shah
- Department of Oral and Maxillofacial Surgery, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - David M McGoldrick
- Department of Oral and Maxillofacial Surgery, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Ian Sharp
- Department of Oral and Maxillofacial Surgery, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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Valk RVD, Magill S, Pellatt A, Ahmadi-Lari N, Hall SP, Cobb ARM, Walker TWM. Tessier 30 Facial Clefts-A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries. Cleft Palate Craniofac J 2021; 59:644-651. [PMID: 34192974 DOI: 10.1177/10556656211019237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Tessier 30 facial cleft is a rare anomaly presenting in the soft and hard tissues over the central lower face. Owing to the rarity of cases and difficulty of treatment, there is no universally accepted surgical management strategy. The last comprehensive literature review of Tessier 30 clefts was in 1996. This report aims to update the literature to inform decision-making on treating Tessier 30 cases. METHODOLOGY A literature search was performed. PubMed, SCOPUS, and OVID databases were searched. A total of 72 cases in 51 articles were analyzed, looking at demographics, extent of cleft, parent health, family history, procedures, follow-up, existence of other anomalies, and stages of repair. RESULTS Surgeons are increasingly choosing to repair Tessier 30 defects in one rather than multiple stages. Of the 72 cases studied, only 31 had documented the completed repair of the cleft. All completed soft tissue only defects were repaired in 1 stage of repair (n = 11). Where both soft tissue and mandible was involved (n = 20), 55% (n = 11) had undergone 1-stage repair to address the Tessier 30 cleft. DISCUSSION We argue that a single-stage approach is preferable to multistage. Primary mucogingivoperiosteoplasty should be undertaken in children at the time of management of the soft tissue cleft. The timing of this procedure should be in the latter half of the first year of life, as this is when mandibular symphyseal fusion normally occurs. We have suggested a treatment protocol and we hope that future case reports use our minimum data set.
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Affiliation(s)
- Ruben van der Valk
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London
| | - Stephen Magill
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Annie Pellatt
- Department of Oral & Maxillofacial Surgery, Bristol Children's Hospital, Dental Hospital & Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Nazanin Ahmadi-Lari
- Department of Orthodontics Kingston Hospital NHS Foundation Trust & Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon P Hall
- Academic Centre for Primary Care, University of Bristol, United Kingdom
| | - Alistair R M Cobb
- South West Cleft Service, Bristol Royal Infirmary, Dental Hospital & Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Tom W M Walker
- Bristol Royal Infirmary, Dental Hospital & Children's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Dani B, Sayad Z, Boulaadas M. [Median mandibular cleft in adults: a case report and literature review]. Pan Afr Med J 2021; 38:257. [PMID: 34104305 PMCID: PMC8164426 DOI: 10.11604/pamj.2021.38.257.26392] [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] [Received: 10/05/2020] [Accepted: 02/01/2021] [Indexed: 11/11/2022] Open
Abstract
Les fentes oro-faciales sont des malformations congénitales fréquentes. La classification la plus utilisée est celle de Tessier qui comprend 30 variantes. Dont les fentes mandibulaires médianes (fente n°30 de Tessier) isolées ou accompagnées d´une fente de la lèvre inférieure, de la langue ou rarement du sternum. Elles sont très rares, moins de 70 cas (toutes formes confondues) ont été décrits dans la littérature. Nous rapportons un cas exceptionnel d´une fente mandibulo-sternale et nous faisons une revue de la littérature.
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Affiliation(s)
- Bouchra Dani
- Service de Chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Zahra Sayad
- Service de Chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Malik Boulaadas
- Service de Chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
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Liu W, Ma L, Zhang S, Zhao T. Clinical Correction of Complete Median Cleft of the Mandible and Lower Lip: A 17-Year Follow-Up of a Case Report With Literature Review. Cleft Palate Craniofac J 2021; 58:1577-1584. [PMID: 33678058 DOI: 10.1177/1055665621990170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The median cleft of the mandible and lower lip is an extremely rare congenital maxillofacial deformity, and the therapeutic options are controversial. To evaluate the clinical characteristics and identify a better choice of treatment modes used among us and others, we reviewed 34 relevant literature and herein describe a 17-year follow-up of a case with a median cleft of the mandible and lower lip. Based on the literature and our case with good functional and aesthetical outcomes, we propose a prospective clinical treatment: Patients of Tessier 30 cleft associated with cleft of the mandible could undergo mandibular repair after puberty in conditions of a good occlusal relationship and normal maxillofacial development, even with mild masticatory dysfunction.
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Affiliation(s)
- Weidong Liu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Stomatology, The First Hospital of Zibo, Shandong, China
| | - Li Ma
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shizhou Zhang
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tengda Zhao
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Trakanant S, Nihara J, Nagai T, Kawasaki M, Kawasaki K, Ishida Y, Meguro F, Kudo T, Yamada A, Maeda T, Saito I, Ohazama A. MicroRNAs regulate distal region of mandibular development through Hh signaling. J Anat 2021; 238:711-719. [PMID: 33011977 PMCID: PMC7855062 DOI: 10.1111/joa.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
Mandibular anomalies are often seen in various congenital diseases, indicating that mandibular development is under strict molecular control. Therefore, it is crucial to understand the molecular mechanisms involved in mandibular development. MicroRNAs (miRNAs) are noncoding small single-stranded RNAs that play a critical role in regulating the level of gene expression. We found that the mesenchymal conditional deletion of miRNAs arising from a lack of Dicer (an essential molecule for miRNA processing, Dicerfl/fl ;Wnt1Cre), led to an abnormal groove formation at the distal end of developing mandibles. At E10.5, when the region forms, inhibitors of Hh signaling, Ptch1 and Hhip1 showed increased expression at the region in Dicer mutant mandibles, while Gli1 (a major mediator of Hh signaling) was significantly downregulated in mutant mandibles. These suggest that Hh signaling was downregulated at the distal end of Dicer mutant mandibles by increased inhibitors. To understand whether the abnormal groove formation inDicer mutant mandibles was caused by the downregulation of Hh signaling, mice with a mesenchymal deletion of Hh signaling activity arising from a lack of Smo (an essential molecule for Hh signaling activation, Smofl/fl ;Wnt1Cre) were examined. Smofl/fl ;Wnt1Cre mice showed a similar phenotype in the distal region of their mandibles to those in Dicerfl/fl ;Wnt1Cre mice. We also found that approximately 400 miRNAs were expressed in wild-type mandibular mesenchymes at E10.5, and six microRNAs were identified as miRNAs with binding potential against both Ptch1 and Hhip1. Their expressions at the distal end of the mandible were confirmed by in situ hybridization. This indicates that microRNAs regulate the distal part of mandibular formation at an early stage of development by involving Hh signaling activity through controlling its inhibitor expression level.
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Affiliation(s)
- Supaluk Trakanant
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan,Division of OrthodonticsFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Jun Nihara
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan,Division of OrthodonticsFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Takahiro Nagai
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Maiko Kawasaki
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Katsushige Kawasaki
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan,Center for Advanced Oral ScienceFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Yoko Ishida
- Center for Advanced Oral ScienceFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Fumiya Meguro
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Takehisa Kudo
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan,Division of OrthodonticsFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Akane Yamada
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Takeyasu Maeda
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Isao Saito
- Division of OrthodonticsFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Atsushi Ohazama
- Division of Oral AnatomyFaculty of Dentistry and Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
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