Fibular dimelia and mirror polydactyly of the foot in a girl presenting additional features of the VACTERL association

Vacterl syndrome: Medical and stomatological considerations for comprehensive patient management

AIM

The VACTERL association or Syndrome consists of Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb defects. The diagnosis relies on the presence of at least three of these structural abnormalities. This study reports a single case of a patient with VACTERL Syndrome (VS), aiming to assist dentists in recognizing the general aspects, systemic changes, and oral care related to this condition.

CASE REPORT

A 14-year-old female patient medically diagnosed with VS. The study evaluated the presence of systemic alterations, medication use, behavioral deviations, cognitive development, and oral aspects. The patient exhibited cardiovascular alterations including a ventricular septal defect (C), anal atresia (A), polydactyly (considered limb alteration-L), and scoliosis (a possible indication of vertebral anomalies-V). In the intraoral examination, findings included tooth crowding, enamel hypomineralization in several teeth, a deep and atretic palate, generalized gingivitis, bleeding, gingival hyperplasia, Class III malocclusion, and a right unilateral crossbite.

CONCLUSION

Patients diagnosed with VACTERL syndrome experience significant systemic impairments. The research subject presented compromised oral health, challenges in dental management, delays in neuropsychomotor development, though these are not inherent to the syndrome. It is crucial to prevent oral diseases and provide early dental care for these patients to avoid the need for complex and invasive dental treatments due to systemic impairments.

Unilateral complete fibular dimelia and diplopodia: A case report and literature review

INTRODUCTION AND IMPORTANCE

We present a case of Congenital fibular dimelia or fibula duplication with tibial hypoplasia, talar duplication and diplopodia with two complete pre-axial rays. This association has not been published in the literature to our knowledge. We discuss the unique features and surgical management of this rare condition.

CASE PRESENTATION

The patient is a 3 year old child with congenital unilateral fibular dimelia, tibial hypoplasia, talar duplication and diplopodia who presented to us with leg length discrepancy and progressive equinovarus deformation of the right foot and ankle. She was surgically treated by excision of the medial two rays, cuneiforms, navicular, duplicate talus, os calcis and medial accessory fibula with reconstruction of the ankle joint capsule and foot reconstruction.

DISCUSSION

Due to the rarity of the condition there is no described treatment protocol. It was decided to do resection taking in consideration of the disabling and unsightly progressive deformity.

CONCLUSION

The case presented is a very rare of type of duplication deformity which we believe to be unique. The surgical treatment has been performed due to progressive deformity based on principles of management. Future follow up to observe growth and development of the lower limb joints, especially the ankle, as well as treatment for leg length equalization will be required.

A Seven Toes Foot: Case Series as an Isolated Dysplasia With Variety of Appearance

A seven toes foot is an extremely rare foot disorder. It may appear as part of a complex limb dysplasia or as an isolated deformity. We present five children with a seven toes foot. Supernumerary bones of the foot were found either as isolated duplicated great and little toe either affecting proximal bones, including the metatarsals or midtarsal bones, characterized as mirror foot. Radiological examination with X-rays was adequate for the evaluation of the affected foot. All patients had dysplasia isolated to the foot. Spine dysplasia was found in one child, and a hypoplastic unilateral little finger in another. The affected foot had a plantigrade shape without leg length discrepancy (LLD). The aesthetic of the enlarged foot with the problems of shoe wear was the main concern of the dysplasia. Surgical treatment was provided after the walking age. Surgery was demanded to provide a cosmetically acceptable foot. Removal of the supernumerary rays, either the medial or the central rays, was performed after the radiological evaluation. Our results were satisfactory, and none of our patients required additional interventions, although a mild varus position of the great toe was still observed in one patient.

The use of misoprostol in the termination of pregnancy: a review of studies carried

The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.

The use of misoprostol in the termination of pregnancy: a review of studies carried

Abstract The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.

Long term follow-up and development of foot complaints in a surgically treated mirror foot-A case report and review of literature

BACKGROUND

Mirror foot is a rare anomaly and limited long term follow-up information is available.

METHODS

Seven years after operation a mirror foot patient returned with foot complaints and was evaluated using radiographs and clinical examination. A systematic literature search was conducted to study foot complaints in mirror feet.

RESULTS

Different origins of foot pain were considered in our patient; tibia length difference, deformed talus and accessory osseous structures in the tarsal region. Literature search resulted in 118 mirror feet. Based on cases reporting osseous structures, 74.2% showed tibia abnormalities and 94.5% an abnormal tarsal region. Only three cases mentioned a normal talus. Nine cases reported a follow-up period of more than five years.

CONCLUSION

Osseous abnormalities are not always visible at birth, but are often present. Therefore, detailed examination of the affected limb in mirror foot patients with foot pain is important, in order to localize the origin.