Oral and maxillofacial considerations in Gardner's syndrome: a report of two cases

A role for total alloplastic temporomandibular joint replacement in Gardner syndrome

Gardner syndrome (GS) is a rare autosomal dominant disorder that can present with craniomaxillofacial abnormalities. The identification of osteomas or craniomaxillofacial abnormalities can therefore serve as a marker of this condition, facilitating early referral and diagnosis. A 17-year-old female with GS was referred for the management of severe limited mouth opening, causing a major problem for routine endoscopy to monitor the gastrointestinal alterations of GS. Clinical and radiological evaluations showed multiple osteomas in the mandibular angle, condylar and coronoid regions bilaterally and maximum mouth opening of 8 mm. The patient underwent surgery for osteoma removal and bilateral customized alloplastic total temporomandibular joint replacement (TMJ-TJR). At the 2-year follow-up, the patient showed improvements in quality of life, with a maximum mouth opening of 34 mm, allowing routine upper endoscopy to be performed. This is the first report of GS, a rare and challenging craniomaxillofacial abnormality, treated with TMJ-TJR. A comprehensive overview of the patient's clinical presentation, diagnostic assessment, treatment planning, and outcomes is provided.

A novel APC mutation associated with Gardner syndrome in a Chinese family

Gardner syndrome (GS) is a specific form of familial adenomatous polyposis (FAP), which manifests as colorectal polyps, multiple osteomas and soft tissue tumors, and in the oral cavity as osteomas of the jaws, odontomas, and abnormal tooth counts. The underlying cause of GS is attributed to mutations in the APC gene. Mutations in this gene disrupt the normal functioning of the protein and lead to the development of GS. To further investigate GS, a family affected by the syndrome was selected from Dongguan, Guangdong Province. The family members underwent a comprehensive survey, which involved collecting clinical data and peripheral venous blood samples. The samples were then used for genetic analysis. Whole exome sequencing (WES) and Sanger sequencing techniques were utilized to screen and identify specific mutation sites in the APC gene. The clinical findings for the GS family included the presence of gastrointestinal polyps and odontomas. After analyzing the genetic sequencing results, a novel mutation site c.4266dupA on the APC gene was found in the patients, which leading to the APC protein truncation. As a result of this study, it is suggested that odontoma may be an early indicator of GS. Additionally, the identification of this novel mutation site in the APC gene expands the known spectrum of genetic mutations associated with the disease. This discovery has significant implications for the early diagnosis of GS, thus enabling timely intervention to reduce the risk of developing colon cancer and other related diseases.

Assessment of risk factors and molecular biomarkers in children with supernumerary teeth: a single-center study

Background

Supernumerary teeth are considered one of the commonly observed dental anomalies in children. Several theories have been proposed to explain the presence of supernumerary teeth, including environmental and genetic factors. This study aimed to identify the different risk factors and molecular biomarkers in patients presented with supernumerary teeth.

Methods

This case–control study included 240 children, 6 to 12-year-old. They were divided into a test group (n = 120 children presented with supernumerary teeth) and a control group (n = 120 children with no supernumerary teeth). Questionnaires were distributed to assess demographics and exposure to several environmental factors. Ten extracted supernumerary teeth from the test group were processed for histopathological analysis.

Results

Male gender, dental history of severe oral infection or medical history of chemotherapy treatment, previous history of taking medication or illness during pregnancy, family history of neoplastic disorders, use of electronic devices, and living beside agricultural fields or industrial areas were found to be statistically significant associated with the risk of supernumerary teeth development. Immunohistochemistry panel revealed that supernumerary teeth showed enhanced expression of wingless (Wnt) and sonic hedgehog (SHH) proteins as well as a reduced expression of adenomatous polyposis coli (APC) protein, denoting molecular derangement in a group of pathways classically believed to be involved in its pathogenesis.

Conclusions

Males were more frequently affected by supernumerary teeth than females. Several risk factors were notably correlated with the existence of supernumerary teeth. Additionally, molecular biomarkers assessment demonstrated a high expression level of pro-tumorigenic proteins such as Wnt and SHH in patients with supernumerary teeth.

Rare giant complex composite odontoma of mandible in mixed dentition: Case report with 3-year follow-up and literature review

Introduction

and importance: Complex odontomas are hamartomas representing a conglomeration of all dental tissues. When developed, they rarely become giant and even more rare to become giant in children. This report presented an unusual giant mandibular complex odontoma in very young patient. It also provided a literature analysis and better understanding of clinical features of such giant lesions in the mandible.

Case presentation

An 8-year-old boy presented with swelling in the right side of the mandible. After clinical and radiological exams, a provisional diagnosis of giant composite odontoma was made. This lesion led to jaw expansion, asymmetrical face, and teeth eruption alterations. Surgical excision of the lesion was performed, and histopathological examination confirmed the diagnosis. The patient's follow-up showed that normal jaw size and facial symmetry was restored with no evidence of recurrence for 3 years.

Clinical discussion

A literature review of reported mandibular large odontomas was made. All published reported cases of giant odontoma in the mandible caused bone expansion with or without pain. According to the literature, this paper described the youngest patient with giant complex odontoma in the mandible. This was also the first reported case from Syria.

Conclusion

Giant complex composite odontoma of the mandible can develop at any age causing facial asymmetry, however, with good prognosis and predictable surgical treatment.

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This report presented an unusual giant mandibular complex odontoma in a young patient.

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It provided a literature analysis and better understanding of clinical features of such giant lesions in the mandible.

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According to literature, this is the youngest patient with giant odontoma in the mandible, and the first from Syria.

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Odontomas tend to expand the jaw when they become giant.

Longitudinal investigation of idiopathic osteosclerosis lesions of the jaws in a group of Chinese orthodontically-treated patients using digital panoramic radiography

Background/purpose

Idiopathic osteosclerosis (IO) is an intraosseous lesion of asymptomatic, non-expansive, radiopaque. The study aimed to investigate the prevalence and morphometric parameters of IO in orthodontic patients and variations in longitudinal observations and to assess the relationship between IO and orthodontic treatment.

Materials and methods

Five hundred and seventy-one orthodontically-treated patients were reviewed. A cross-sectional study was performed with the evaluated parameters, including the age and sex of patients, as well as the number, shape, location and morphometric data of IO observed in panoramic radiography. Long-term behaviour of IO and orthodontic tooth movement were also observed. Also, a control group was set up for comparisons.

Results

Sixty-eight (11.3%) patients had 78 lesions all in the mandible with premolar/molar preference and no sex predilection. Lesions were located more commonly at apical and separate sites related to teeth. A large majority of lesions enlarged in the 10–19 years old group, while most lesions had no change in the 30–39 years old group. Hindrances of tooth movement and external root resorption around IO were not found in affected patients.

Conclusion

IO is labile lesion that may develop in early stages of life, with little change occurring once the affected individual is mature and being relatively stable in the middle stage of life. Our study supports the hypothesis that IO may be developmental anatomic variations of normal bone. However, no obvious association between IO and orthodontic treatment was found in patients, which may be due to the limitations of two-dimensional shooting of panoramic radiography and the sample size.

Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview

Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease.

Genodermatoses with teeth abnormalities

Many genodermatoses exhibit abnormal teeth findings. Studies examining these entities are scarce and narrow in their scope. This paper reviews the evolution, development, and structure of the tooth and provides a summary of genodermatoses with aberrant dental findings. The latter are classified according to the abnormal dental findings: periodontal disease, anodontia/oligodontia/hypodontia, polydontia, enamel hypoplasia, natal teeth, dental pits, and others. Finally, we provide an algorithm that dermatologists and dentists can follow to better recognize genodermatoses with dental involvement.

Gardner syndrome with maxillofacial manifestation: A case report

Gardner syndrome is a hereditary disease in which patients develop gastrointestinal polyps, osteomas, desmoid tumors, epidermoid cysts, fibromas, lipomas, and retinal lesions. Dental abnormalities such as supernumerary or impacted teeth, odontomas and dentigerous cysts are also reported. The most serious concern in this syndrome is the extremely high risk of gastrointestinal polyps undergoing malignant transformation. Since the maxillofacial findings usually precede gastrointestinal polyps, the dentist plays a crucial role in the diagnosis of Gardner syndrome, and panoramic radiography is an important tool in the diagnosis of the disease. We report here a case of Gardner syndrome in a patient showing mandibular osteomas and impacted teeth. Also, cases of Gardner syndrome with maxillofacial manifestations reported in the literature were reviewed and compared with ours. According to the findings, osteomas are important manifestations of this syndrome, and regardless of the absence of family history of intestinal polyposis, their occurrence should prompt diagnostic evaluation for this disease.

[Gardner syndrome with chronic osteomyelitis of the jaw: a case report]

Gardner syndrome is a rare autosomal dominant disease. Its symptoms include multiple intestinal polyps, soft tissue tumors, dental disorders, osteoma, and congenital hypertrophy of the retinal pigment epithelium. Here, we present a patient with Gardner syndrome and chronic osteomyelitis of the jaw to highlight the serious damage that can be caused by Gardner syndrome.