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特纳综合征女性的综合口腔诊断与管理

Comprehensive Oral Diagnosis and Management for Women with Turner Syndrome.

作者信息

Tallón-Walton Victoria, Sánchez-Molins Meritxell, Hu Wenwen, Martínez-Abadías Neus, Casado Aroa, Manzanares-Céspedes María Cristina

机构信息

Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain.

Odonto-Stomatology Department, University of Barcelona, 08907 Barcelona, Spain.

出版信息

Diagnostics (Basel). 2024 Apr 5;14(7):769. doi: 10.3390/diagnostics14070769.

DOI:10.3390/diagnostics14070769
PMID:38611682
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11011770/
Abstract

Turner Syndrome (TS) is a rare genetic disorder that affects females when one of the X chromosomes is partially or completely missing. Due to high genetic and phenotypic variability, TS diagnosis is challenging and is often delayed until adolescence, resulting in poor clinical management. Numerous oral, dental and craniofacial anomalies have been associated with TS, yet a comprehensive description is still lacking. This study addresses this gap through a detailed analysis of oral health and craniofacial characteristics in a cohort of 15 females with TS and their first-degree relatives. Subjects with TS ranged from 3 to 48 years old, none showed evidence of periodontal disease and only the youngest was in mixed dentition. Using the Multifunction System, we identified an aggregation of multiple signs and symptoms in each TS subject, including tooth anomalies (supernumerary molars, agenesis, microdontia, enamel defects, alterations in eruption patterns -advanced and delayed for chronological age-, crowding, rotations and transpositions), malocclusion (class II/1 and II/2) and Class II facial profile, while relatives exhibited fewer manifestations. The early detection of these signs and symptoms is crucial for appropriate referral and the optimal clinical management of TS, especially during the critical period of 9 to 10 years when congenital dental anomalies appear. The use of an established taxonomy to describe these phenotypic features is essential for early detection. Multidisciplinary teams are required to ensure holistic care management in rare diseases like TS.

摘要

特纳综合征(TS)是一种罕见的遗传性疾病,当女性的一条X染色体部分或完全缺失时就会受到影响。由于高度的遗传和表型变异性,TS的诊断具有挑战性,而且往往会延迟到青春期,导致临床管理不善。许多口腔、牙齿和颅面异常都与TS有关,但仍缺乏全面的描述。本研究通过对15名患有TS的女性及其一级亲属队列中的口腔健康和颅面特征进行详细分析,填补了这一空白。患有TS的受试者年龄在3至48岁之间,均未表现出牙周疾病的迹象,只有最年轻的受试者处于混合牙列期。使用多功能系统,我们在每个TS受试者中发现了多种体征和症状的聚集,包括牙齿异常(多生磨牙、牙缺失、过小牙、釉质缺陷、萌出模式改变——按年龄顺序提前和延迟、拥挤、旋转和移位)、错牙合(II类/1和II类/2)和II类面型,而亲属表现出的症状较少。这些体征和症状的早期发现对于TS的适当转诊和最佳临床管理至关重要,尤其是在9至10岁这个先天性牙齿异常出现的关键时期。使用既定的分类法来描述这些表型特征对于早期发现至关重要。需要多学科团队来确保对TS等罕见疾病进行全面的护理管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/012adc17184a/diagnostics-14-00769-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/3288b70085e8/diagnostics-14-00769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/f66f1d698abc/diagnostics-14-00769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/1613e086aeac/diagnostics-14-00769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/012adc17184a/diagnostics-14-00769-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/3288b70085e8/diagnostics-14-00769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/f66f1d698abc/diagnostics-14-00769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/1613e086aeac/diagnostics-14-00769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f823/11011770/012adc17184a/diagnostics-14-00769-g004.jpg

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本文引用的文献

1
Development and validation of a computable phenotype for Turner syndrome utilizing electronic health records from a national pediatric network.利用国家儿科网络的电子健康记录开发和验证特纳综合征的可计算表型。
Am J Med Genet A. 2024 Apr;194(4):e63495. doi: 10.1002/ajmg.a.63495. Epub 2023 Dec 8.
2
"Liu-Liang-Chung" syndrome with multiple congenital anomalies and the distinctive craniofacial features caused by dominant ZEB2 gene gain mutation.刘-梁-钟综合征伴多发先天畸形及显性 ZEB2 基因突变所致特征性颅面特征。
BMC Pediatr. 2023 Sep 21;23(1):480. doi: 10.1186/s12887-023-04314-5.
3
Developmental enamel defects and dental anomalies of number and size in children with growth hormone deficiency.
生长激素缺乏症儿童的发育性牙釉质发育缺陷和牙齿数目及大小异常。
Sci Rep. 2023 Sep 7;13(1):14707. doi: 10.1038/s41598-023-41892-x.
4
Predicted health care profile after transition to adult care in Turner syndrome children-experience of single center.特纳综合征患儿向成人护理过渡后的预测医疗状况——单中心经验
Front Pediatr. 2023 May 30;11:1173419. doi: 10.3389/fped.2023.1173419. eCollection 2023.
5
Craniofacial dysmorphology in Down syndrome is caused by increased dosage of Dyrk1a and at least three other genes.唐氏综合征患者的颅面畸形是由 Dyrk1a 基因和至少另外三个基因的剂量增加引起的。
Development. 2023 Apr 15;150(8). doi: 10.1242/dev.201077. Epub 2023 Apr 26.
6
Craniofacial growth and function in achondroplasia: a multimodal 3D study on 15 patients.成骨不全症患者的颅面生长和功能:15 例患者的多模态 3D 研究。
Orphanet J Rare Dis. 2023 Apr 18;18(1):88. doi: 10.1186/s13023-023-02664-y.
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Dental anomalies in an Albanian orthodontic sample: a retrospective study.阿尔巴尼亚正畸样本中的牙齿异常:一项回顾性研究。
BMC Oral Health. 2023 Jan 28;23(1):47. doi: 10.1186/s12903-023-02711-x.
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Associations between 44 nonmetric permanent dental traits or anomalies with skeletal sagittal malocclusions and sex, besides correlations across the variations or abnormalities.除了变异或异常之间的相关性外,还探讨了 44 项非度量性永久性牙齿特征或异常与骨骼矢状面错颌畸形以及性别的关系。
BMC Oral Health. 2022 Nov 26;22(1):544. doi: 10.1186/s12903-022-02481-y.
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Children (Basel). 2022 Nov 16;9(11):1755. doi: 10.3390/children9111755.
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Mutations in LRP6 highlight the role of WNT signaling in oral exostoses and dental anomalies.LRP6 基因突变提示 WNT 信号通路在颌骨外生性骨疣和牙齿畸形中的作用。
Arch Oral Biol. 2022 Oct;142:105514. doi: 10.1016/j.archoralbio.2022.105514. Epub 2022 Jul 30.