International Journal of Clinical Pediatric Dentistry

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VOLUME 16 , ISSUE 2 ( March-April, 2023 ) > List of Articles

CASE REPORT

Craniofacial and Dental Manifestations in Pediatric Patients with Achondroplasia: A Case Report and Clinical View

Amal Almutiry, Fares Alotaibi, Bashayer Almutiry, Mannaa K Aldowsari, Maha Alotaibi, Aboubekri Boucelham

Keywords : Achondroplasia, Craniofacial, Fibroblast growth factor receptor

Citation Information : Almutiry A, Alotaibi F, Almutiry B, Aldowsari MK, Alotaibi M, Boucelham A. Craniofacial and Dental Manifestations in Pediatric Patients with Achondroplasia: A Case Report and Clinical View. Int J Clin Pediatr Dent 2023; 16 (2):409-415.

DOI: 10.5005/jp-journals-10005-2589

License: CC BY-NC 4.0

Published Online: 12-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: The aim of this case report is to describe the dentofacial manifestations of achondroplasia and highlight concerns associated with dental management of pediatric patients with achondroplasia. Background: Achondroplasia is the most common form of skeletal dysplasia (dwarfism) with clinical manifestations including disproportionate limb shortening and stunted stature. The craniofacial characteristics of achondroplasia are relative macrocephaly, depression of the nasal bridge, and maxillary hypoplasia. Special precautions are necessary during dental management of pediatric patients with achondroplasia due to a large head size, implanted shunts, airway obstruction, and difficulty in head control. Case description: A 6 years and 7 months male, the patient was diagnosed with achondroplasia, currently receiving vitamin D, no known drug allergy, and a mixed dentition stage with multiple caries, mouth breather, and a high risk of further caries based on a caries risk assessment due to poor oral hygiene. As the patient was uncooperative and required extensive dental care, dental rehabilitation was conducted under general anesthesia using oral intubation due to nasal obstruction. Future examinations were planned for every 3 months. Conclusion: The current case demonstrated that the characteristics of achondroplasia might cause respiratory, neurological, skeletal, orthodontic, and psychological difficulties. Pediatric dentists who treat these patients must be able to detect these characteristics and difficulties, as dental treatment is limited by practical issues associated with this condition. Clinical significance: The characteristic features of achondroplasia are attributed to skeletal, respiratory, neurologic, orthodontic, and psychosocial issues. The dentist should be aware of the features of achondroplasia, which can potentially restrict dental management.


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  1. Jones KL. Achondroplasia Smith's recognizable patterns of human malformation. 4th ed. Philadelphia, PA: W B Saunders; 1988.
  2. Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.
  3. Shiang R, Thompson LM, Zhu YZ, et al. Mutations in the transmembrane domain of FGFR3 cause the most common genetic form of dwarfism, achondroplasia. Cell 1994;78(2):335–342. DOI: 10.1016/0092-8674(94)90302-6
  4. Rousseau F, Bonaventure J, Legeai-Mallet L, et al. Mutations in the gene encoding fibroblast growth factor receptor-3 in achondroplasia. Nature 1994;371(6494):252–254. DOI: 10.1038/371252a0
  5. Boulet S, Althuser M, Nugues F, et al. Prenatal diagnosis of achondroplasia: new specific signs. Prenat Diagn 2009;29(7):697–702. DOI: 10.1002/pd.2280
  6. Hoover-Fong JE, Schulze KJ, McGready J, et al. Age-appropriate body mass index in children with achondroplasia: interpretation in relation to indexes of height. Am J Clin Nutr 2008;88(2):364–371. DOI: 10.1093/ajcn/88.2.364
  7. Langer LO Jr, Baumann PA, Gorlin RJ. Achondroplasia. Am J Roentgenol Radium Ther Nucl Med 1967;100(1):12–26. DOI: 10.2214/ajr.100.1.12
  8. Steinbok P, Hall J, Flodmark O. Hydrocephalus in achondroplasia: the possible role of intracranial venous hypertension. J Neurosurg 1989;71(1):42–48. DOI: 10.3171/jns.1989.71.1.0042
  9. Ireland PJ, Pacey V, Zankl A, et al. Optimal management of complications associated with achondroplasia. Appl Clin Genet 2014;7:117–125. DOI: 10.2147/TACG.S51485
  10. Shirley ED, Ain MC. Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg 2009;17(4):231–241. DOI: 10.5435/00124635-200904000-00004
  11. Aldegheri R, Dall'Oca C. Limb lengthening in short stature patients. J Pediatr Orthop B 2001;10:238–247.
  12. Seino Y, Yamanaka Y, Shinohara M, et al. Growth hormone therapy in achondroplasia. Horm Res 2000;53(Suppl 3):53–56. DOI: 10.1159/000023534
  13. Thompson NM, Hecht JT, Bohan TP, et al. Neuroanatomic and neuropsychological outcome in school-age children with achondroplasia. Am J Med Genet 1999;88(2):145–153. DOI: 10.1002/(sici)1096-8628(19990416)88:2<145::aid-ajmg10>3.0.co;2-b
  14. Ohba T, Ohba Y, Tenshin S, et al. Orthodontic treatment of class II division 1 malocclusion in a patient with achondroplasia. Angle Orthod 1998;68(4):377–382. DOI: 10.1043/0003-3219(1998)068<0377:OTOCID>2.3.CO;2
  15. Celenk P, Arici S, Celenk C. Oral findings in a typical case of achondroplasia. J Int Med Res 2003;31(3):236–238. DOI: 10.1177/147323000303100311
  16. Horton WA, Hall JG, Hecht JT. Achondroplasia. Lancet 2007;370(9582):162–172. DOI: 10.1016/S0140-6736(07)61090-3
  17. Sobetzko D, Braga S, Rüdeberg A, et al. Achondroplasia with the FGFR31138g–>a (G380R) mutation in two sibs sharing a 4p haplotype derived from their unaffected father. J Med Genet 2000;37:958–959. DOI: 10.1136/jmg.37.12.958
  18. Rohilla S, Kaushik A, Vinod VC, Tanwar R, Kumar M. et al. Orofacial manifestations of achondroplasia. Excli J 2012;11:538–542.
  19. Trotter TL, Hall JGAmerican Academy of Pediatrics Committee on Genetics. Health supervision for children with achondroplasia. Pediatrics 2005;116(3):771–783. DOI: 10.1542/peds.2005-1440
  20. Hunter AG, Bankier A, Rogers JG, et al. Medical complications of achondroplasia: a multicentre patient review. J Med Genet 1998;35(9):705–712. DOI: 10.1136/jmg.35.9.705
  21. Vaccaro AR, Albert TJ. Master cases: Spine surgery. New York: Thieme Medical Publishers; 2001:481.
  22. Dunbar JP, Goldin B, Subtelny JD. An American Board of orthodontics case report. Correction of class I crowding in an achondroplastic patient. Am J Orthod Dentofac Orthop 1989;96(3):255–263. DOI: 10.1016/0889-5406(89)90463-0
  23. Stephen L, Holmes H, Roberts T, et al. Orthodontic management of achondroplasia in South Africa. S Afr Med J 2005;95(8):588–589.
  24. Wagaiyu EG, Ashley FP. Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11-14 year-old schoolchildren. J Clin Periodontol 1991;18(9):698–702. DOI: 10.1111/j.1600-051x.1991.tb00112.x
  25. Onodera K, Sakata H, Niikuni N, et al. Survey of the present status of sleep-disordered breathing in children with achondroplasia. Part I. A questionnaire survey. Int J Pediatr Otorhinolaryngol 2005;69(4):457–461. DOI: 10.1016/j.ijporl.2004.11.005
  26. Rimoin DL. Variable expressivity in the skeletal dysplasias. Birth Defects Orig Artic Ser 1979;15(5B):91–112.
  27. Kalla GN, Fening E, Obiaya MO. Anaesthetic management of achondroplasia. Br J Anaesth 1986;58(1):117–119. DOI: 10.1093/bja/58.1.117
  28. Butler MG, Hayes BG, Hathaway MM, et al. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg 2000;91(4):837–855. DOI: 10.1097/00000539-200010000-00014
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