Romain Nicot

ACTN3 R577X genotypes associate with Class II and deepbite malocclusions.

INTRODUCTIONnα-Actinins are myofibril anchor proteins that influence the contractile properties of skeletal muscles. ACTN2 is expressed in slow type I and fast type II fibers, whereas ACTN3 is expressed only in fast fibers. ACTN3 homozygosity for the 577X stop codon (ie, changing 577RR to 577XX, the R577X polymorphism) results in the absence of α-actinin-3 in about 18% of Europeans, diminishes fast contractile ability, enhances endurance performance, and reduces bone mass or bone mineral density. We have examined ACTN3 expression and genetic variation in the masseter muscle of orthognathic surgery patients to determine the genotype associations with malocclusion.nnnMETHODSnClinical information, masseter muscle biopsies, and saliva samples were obtained from 60 subjects. Genotyping for ACTN3 single nucleotide polymorphisms, real-time polymerase chain reaction quantitation of muscle gene message, and muscle morphometric fiber type properties were compared to determine statistical differences between genotype and phenotype.nnnRESULTSnMuscle mRNA expression level was significantly different for ACTN3 single nucleotide polymorphism genotypes (Pxa0<0.01). The frequency of ACTN3 genotypes was significantly different for the sagittal and vertical classifications of malocclusion, with the clearest association being elevated 577XX genotype in skeletal Class II malocclusion (Pxa0=xa00.003). This genotype also resulted in significantly smaller diameters of fast type II fibers in masseter muscles (Pxa0=xa00.002).nnnCONCLUSIONnACTN3 577XX is overrepresented in subjects with skeletal Class II malocclusion, suggesting a biologic influence during bone growth. ACTN3 577XX is underrepresented in subjects with deepbite malocclusion, suggesting that muscle differences contribute to variations in vertical facial dimensions.

Visualization of fetal lips and palate using a surface‐rendered oropalatal (SROP) view in fetuses with normal palate or orofacial cleft lip with or without cleft palate

In the presence of an orofacial cleft detected at routine midtrimester antenatal screening, precise characterization of the malformation is necessary, as this will affect the medical work-up and help in informing the parents1. The best method with which to analyze the palate is still under debate. Evaluation is usually based on multiplanar or tomographic reconstructions obtained with three-dimensional (3D) ultrasonography. Analysis of the posterior palate is impeded by artifacts due to acoustic shadowing by the anterior bony structures of the maxilla2. Various specific views have been advocated to overcome this difficulty, such as the ‘reverse face’ view, the intraoral ‘en face’ view, the ‘flipped face’ view, ‘angled insonation’, the ‘axial underside’ view and the ‘oblique face’ view (reviewed by To3). However, none has received general agreement. Our group has shown that the use of all three traditional orthogonal planes is necessary to examine thoroughly the different landmarks, in order to differentiate the involvement of the lip, alveolus and posterior hard palate. Lip analysis necessitates visualization of the coronal planes, and, in the case of bilateral clefts, the midsagittal plane. The palate (alveolus, maxilla, secondary palate) is best analyzed using coronal and axial planes4,5. However, 3D multiplanar reconstructions are impeded by certain drawbacks: to convey the information necessitates multiple scans; they focus on the bony defect of the palate; and they are difficult to interpret, in particular by lay people, in contrast with the more readily understood surface-rendered views6. To overcome these flaws, we have developed a surface-rendered representation, corresponding to the submental intraoral photograph of the neonatal palate that is used by orofacial surgeons to visualize clefts7,8 : the surface-rendered oropalatal (SROP) sonographic view. The SROP sonographic view is oriented in an oblique direction, transoral and directed upwards, from cephalad to caudal. Image reconstruction utilizes the surface rendering mode, which combines representation of the

Prenatal diagnosis of cleft lip/palate: The surface rendered oro-palatal (SROP) view of the fetal lips and palate, a tool to improve information-sharing within the orofacial team and with the parents

The ultrasonographic surface rendered oro-palatal (SROP) view is a 3D reconstructed view of the fetal perioral region, which combines ultrasound insonation in a trans oral, upward directed axial direction and the surface rendered mode. It allows the simultaneous visualization on a single scan of the superior lip, alveolar ridge and secondary palate. It corresponds prenatally to the submental intra oral photography of the palate of neonates. The aim of the study was to demonstrate the benefice of using the SROP view in the management of cleft lip with or without cleft palate, uni- or bi-lateral, diagnosed prenatally (22-28 gestational weeks). The SROP view allowed the representation on a single view of the characteristics of the defect useful to the different members of the orofacial team to exactly evaluate the difformity and to plan the ulterior therapeutic steps (e.g. side, extension of the cleft to the secondary palate, tooth organization). Also, being easier to read by lay people thanks to the use of a surface rendered representation rather than the usual multiplanar reconstructions in the three traditional orthogonal planes, the SROP view makes it easier to bring exact information to the parents about the malformation and its consequences.

ENPP1 and ESR1 genotypes influence temporomandibular disorders development and surgical treatment response in dentofacial deformities

UNLABELLEDnDentofacial deformities are dys-morpho-functional disorders involving the temporomandibular joints (TMJ). Many authors have reported a TMJ improvement in dysfunctional subjects with malocclusion after orthodontic or combined orthodontic and surgical treatment particularly for the relief of pain. In particular, few studies have highlighted the demographic and clinical predictors of response to surgical treatment. To date, no genetic factor has yet been identified as a predictor of response to surgical treatment. The aim of this cohort study is therefore to identify single-nucleotide polymorphisms associated with postoperative temporomandibular disorders (TMD) or with TMJ symptoms after orthognathic surgery. Here, we found the AA genotype of SNP rs1643821 (ESR1 gene) as a risk factor for dysfunctional worsening after orthognathic surgery. In addition, we have identified TT genotype of SNP rs858339 (ENPP1 gene) as a protective factor against TMD in a population of patients with dentofacial deformities. Conversely, the heterozygous genotype AT was identified as a risk factor of TMD with respect to the rest of our population. All these elements are particularly important to bring new screening strategies and tailor future treatment.nnnPERSPECTIVEnThis study allows us to identify sub-populations at high risk of developing postoperative temporomandibular disorders after orthognathic surgery procedures. Many other genes of interest could be potential factors influencing the dysfunctional response to orthognathic surgery, particularly genes of the Opera cohort.

[Do anti-inflammatory drugs worsen odontogenic cervico-facial cellulitis?].

OBJECTIVEnThe aim of this prospective study was to determine the influence of anti-inflammatory drugs on the severity of odontogenic cellulitis in patients admitted to our hospital emergency unit.nnnSTUDY DESIGNnThe study was made from April 30 to October 31 2006. The clinical and pharmacological data was prospectively collected at admission, during hospitalization, and during systematic follow-up. We first studied the whole population and then compared the 2 groups: patients having received anti-inflammatory drugs before admission or not.nnnRESULTSnTwo hundred and sixty-seven patients were included. The only severity criterion significantly different between the 2 groups was spreading of cervical lymphangitis (P=0.028). None of the 4 studied parameters was identified as a risk factor for spreading of cervical lymphangitis in multivariate analysis: anti-inflammatory use (OR=5.99, 95%CI [0.71-50.88]), alcohol abuse (OR=4.00, 95%CI [0.66-24.12]), dental hygiene (OR=1.53, 95%CI [0.36-6.56]), and tobacco use (OR=0.27, 95%CI [0.57-1.28]).nnnDISCUSSIONnThe use of anti-inflammatory drugs during the initial phase of an odontogenic infection was not related to the severity of infection.

Ameloblastoma of the jaws: Management and recurrence rate

INTRODUCTIONnAmeloblastoma is a rare, benign odontogenic tumour associated with a high recurrence rate. It accounts for 1% of all tumours of the jaws. The purpose of this study was to compare the ameloblastoma recurrence rate according to the type of treatment: radical or conservative.nnnPATIENTS AND METHODSnAll patients with a diagnosis of ameloblastoma between 1991 and 2013 were retrospectively identified in order to extract topographic, radiological, and histological data and the type of treatment: conservative (marsupialization, enucleation, curettage) or radical (segmental resection) and to compare the recurrence rate according to the type of treatment.nnnRESULTSnTwenty-seven patients were included, managed by conservative treatment (CT) in 22xa0cases and radical treatment (RT) in 14xa0cases. The recurrence rate was 90.9% in the CT group and 9.1% in the RT group (P=0.025) with a mean follow-up of 56.2xa0months.nnnDISCUSSIONnThe recurrence rate after conservative treatment was higher than that after radical treatment. These results are similar to those reported in the literature. The choice of treatment must be adapted to the macroscopic and histological characteristics of each tumour and to the patient.

Fetal dental panorama on three-dimensional ultrasound imaging.

Technological advances in the field of fetal ultrasound have allowed us to push the boundaries of what can be visualized. Improvement in image quality has enabled us to study the dental organ within the jaws during fetal development. A dental ultrasound image, which we call a ‘fetal dental panorama’, could help determine normal and pathological development of the dental organ, and, consequently, aid in the diagnosis of syndromes involving dental dysmorphology.

Using three dimensional ultrasound to perform a fetal dental panoramic

Technological advances in the field of fetal ultrasound have allowed us to push the boundaries of what can be visualized. Improvement in image quality has enabled us to study the dental organ within the jaws during fetal development. A dental ultrasound image, which we call a ‘fetal dental panorama’, could help determine normal and pathological development of the dental organ, and, consequently, aid in the diagnosis of syndromes involving dental dysmorphology.

Nodal pathway genes are down-regulated in facial asymmetry.

Purpose Facial asymmetry is a common comorbid condition in patients with jaw deformation malocclusion. Heritability of malocclusion is advancing rapidly, but very little is known regarding genetic contributions to asymmetry. This study identifies differences in expression of key asymmetry-producing genes that are down-regulated in patients with facial asymmetry. Methods Masseter muscle samples were collected during bilateral sagittal split osteotomy orthognathic surgery to correct skeletal-based malocclusion. Patients were classified as class II or III and open or deep bite malocclusion with or without facial asymmetry. Muscle samples were analyzed for gene expression differences on Affymetrix HT2.0 microarray global expression chips. Results Overall gene expression was different for asymmetric patients compared with other malocclusion classifications by principal component analysis (P < 0.05). We identified differences in the nodal signaling pathway, which promotes development of mesoderm and endoderm and left-right patterning during embryogenesis. Nodal and Lefty expression was 1.39- to 1.84-fold greater (P < 3.41 × 10−5), whereas integral membrane Nodal modulators Nomo1,2,3 were −5.63 to −5.81 (P < 3.05 × 10−4) less in asymmetry subjects. Fold differences among intracellular pathway members were negative in the range of −7.02 to −2.47 (P < 0.003). Finally Pitx2, an upstream effector of Nodal known to influence the size of type II skeletal muscle fibers was also significantly decreased in facial asymmetry (P < 0.05). Conclusions When facial asymmetry is part of skeletal malocclusion, there are decreases in nodal signaling pathway genes in masseter muscle. This data suggest that the nodal signaling pathway is down-regulated to help promote development of asymmetry. Pitx2 expression differences also contributed to both skeletal and muscle development in this condition.

Le Fort II Setback Osteotomy to Correct Naso-Ethmoido-Maxillary Protrusion.

Background:Marked class II dentofacial deformity associated with centrofacial protrusion may be difficult to treat successfully. The purpose of this article was to report on Le Fort II setback osteotomy (LIISBO) to correct Naso-Ethmoido-Maxillary Protrusion (NEMP), to describe its indications and surgical techniques, and to analyze aesthetic and occlusal changes. Materials and methods:From November 2011 to November 2014, patients with NEMP, treated with LIISBO, were included in the study. Cephalometric analysis of Delaire was performed before and 1 year after surgery. Skeletal and soft tissues movements were measured between preoperative and postoperative lateral cephalographs. Results:Fourteen patients were treated in our department by LIISBO. Ten patients were analyzed and presented a stable class I occlusion with reliable aesthetic results. The mean maxillary setback was −2.8u200amm at nasopalatal point (Np), −3.1u200amm at A point, and −3.7u200amm at Pti (inferior pterygomaxilar point). The mean maxillary impaction was −2.4u200amm at Np, −3u200amm at A point, and −0.6u200amm at Pti. The B, mental, and pogonion points showed an advancement with an average of +7.4, +7.9, and +7.7u200amm, respectively. Measured soft tissues variations showed a backward movement of the nasal tip, the subnasal point, and the upper lip of −1.5, −1.6, and −0.7u200amm, respectively. The lower lip, sublabial point, and the skin pogonion were advanced by +3.2, +5.4, and +6.2u200amm, respectively. Conclusions:Le Fort II setback osteotomy may be regarded as the ideal treatment for adult patient presenting a NEMP syndrome.