Congenital orbital teratoma: a case report with preservation of the globe and 18 years of follow-up

Background Congenital orbital teratomas are extremely rare, usually benign neoplasms, comprised of cells originating from all three germ cell layers. Clinically the tumor appears solid, most of the times is intraconal and presents as a rapidly growing mass leading to a massive unilateral axial proptosis, chemosis, exposure keratopathy, markedly distended eyelids and often, loss of vision. To prevent these complications, tumor excision usually involves enucleation or even orbital exenteration. Case presentation We report a case of a 1-day old infant who presented with dramatic proptosis at birth due to a true congenital orbital teratoma. We describe the clinical findings, the preoperative neuroimaging, the surgical management which included complete tumor resection with preservation of the globe to allow for optimal orbital growth, the histopathological evaluation, and the clinical course during 18 years of follow up. Conclusion Every effort to salvage the globe should be made to achieve the best possible orbito-facial development. Furthermore, the value of prompt surgical management with a less invasive transconjunctival globe sparing procedure can be appreciated in our case.

Relating multivariate shapes to genescapes using phenotype-biological process associations for craniofacial shape

Realistic mappings of genes to morphology are inherently multivariate on both sides of the equation. The importance of coordinated gene effects on morphological phenotypes is clear from the intertwining of gene actions in signaling pathways, gene regulatory networks, and developmental processes underlying the development of shape and size. Yet, current approaches tend to focus on identifying and localizing the effects of individual genes and rarely leverage the information content of high dimensional phenotypes. Here, we explicitly model the joint effects of biologically coherent collections of genes on a multivariate trait-craniofacial shape - in a sample of n = 1,145 mice from the Diversity Outbred (DO) experimental line. We use biological process gene ontology (GO) annotations to select skeletal and facial development gene sets and solve for the axis of shape variation that maximally covaries with gene set marker variation. We use our process-centered, multivariate genotype-phenotype (process MGP) approach to determine the overall contributions to craniofacial variation of genes involved in relevant processes and how variation in different processes corresponds to multivariate axes of shape variation. Further, we compare the directions of effect in phenotype space of mutations to the primary axis of shape variation associated with broader pathways within which they are thought to function. Finally, we leverage the relationship between mutational and pathway-level effects to predict phenotypic effects beyond craniofacial shape in specific mutants. We also introduce an online application which provides users the means to customize their own process-centered craniofacial shape analyses in the DO. The process-centered approach is generally applicable to any continuously varying phenotype and thus has wide-reaching implications for complex-trait genetics.

Fissura Labiopalatina e Câncer: uma Conexão Verdadeira

Multifactorial cleft lip and palate is relatively common in populations (1 in every 700 livebirths). Individuals born with clefts require lifelong treatment after initial surgical repair and data suggested that their lifespan is shorter, possibly due to cancer or psychiatric conditions. Molecular defects that alter facial development in utero appear to later in life predispose to cancer. Common polymorphisms in e-cadherin and an endoplasmic reticulum transmembrane sensor gene appear to hold the promise to be biomarkers that may help to define individual risks to cancer, in the presence or not of family history of clefts.

GATA3 is essential for separating patterning domains during facial morphogenesis

Neural crest cells (NCCs) within the mandibular and maxillary prominences of the first pharyngeal arch are initially competent to respond to signals from either region. However, mechanisms that are only partially understood establish developmental tissue boundaries to ensure spatially correct patterning. In the Hinge and Caps model of facial development, signals from both ventral prominences (the caps) pattern the adjacent tissues while the intervening region, referred to as the maxillomandibular junction (the hinge), maintains separation of the mandibular and maxillary domains. One cap signal is GATA3, a member of the GATA family of zinc-finger transcription factors with a distinct expression pattern in the ventral-most part of the mandibular and maxillary portions of the first arch. Here we show that disruption of Gata3 in mouse embryos leads to craniofacial microsomia and syngnathia (bony fusion of the upper and lower jaws) that results from changes in BMP4 and FGF8 gene regulatory networks within NCCs near the maxillomandibular junction. GATA3 is thus a crucial component in establishing the network of factors that functionally separate the upper and lower jaws during development.

Hearing Loss in Treacher-Collins Syndrome

Treacher Collins Syndrome is a craniofacial disorder that has dominant autosomal disorder in facial development, found 1 in every 50,000 births. The common manifestations can be mandibulofacial disorder, microtia, atresia of the ear canal, and hearing loss. This syndrome is also accompanied by malformations of the ossicular chain of bone in the middle ear, which can lead to conductive hearing loss up to 50% of cases and sensory neural hearing loss. The aim of this report was to present one case of Treacher-Collins Syndrome at the Audiology - Vestibular clinic Dr. Hasan Sadikin General Hospital Bandung. The main complaint of the patient is micrognathia and microtia with hearing loss in both ears. The right ear is smaller than the left ear, and supported to 2nd grade of Microtia. The patient had performed reconstruction ear surgery in the right ear, and had improvement from audiological examination after the 2nd stage of reconstruction. There was TCOF 1 gene mutation involved from this case. Conclusion: Treacher Collins syndrome is a rare inherited disorder, but the diagnose can be easily enforced. Early intervention with hearing rehabilitation, audio-verbal rehabilitation, and reconstruction ear surgery must be carried out for a better quality of life. Keyword : Treacher collins syndrome, micrognathia, microtia, hearing loss

AP-2α and AP-2β cooperatively function in the craniofacial surface ectoderm to regulate chromatin and gene expression dynamics during facial development.

The facial surface ectoderm is essential for normal development of the underlying cranial neural crest cell populations, providing signals that direct appropriate growth, patterning, and morphogenesis. Despite the importance of the ectoderm as a signaling center, the molecular cues and genetic programs implemented within this tissue are understudied. Here we show that removal of two members of the AP-2 transcription factor family, AP-2α and AP-2β, within the early embryonic ectoderm leads to major alterations in the mouse craniofacial complex. Significantly, there are clefts in both the upper face and mandible, accompanied by fusion of the upper and lower jaws in the hinge region. Comparison of ATAC-seq and RNA-seq analyses between controls and mutants revealed significant changes in chromatin accessibility and gene expression centered on multiple AP-2 binding motifs associated with enhancer elements within these ectodermal lineages. In particular, loss of these AP-2 proteins affects both skin differentiation as well as multiple signaling pathways, most notably the WNT pathway. The role of reduced Wnt signaling throughput in the mutant phenotype was further confirmed using reporter assays and rescue experiments involving Wnt1 ligand overexpression. Collectively, these findings highlight a conserved ancestral function for AP-2 transcription factors in ectodermal development and signaling, and provide a framework from which to understand the gene regulatory network operating within this tissue that directs vertebrate craniofacial development.

Correction of an anterior and posterior crossbite case with a modified McNamara appliance: A case report

Anterior and posterior crossbites are malocclusions in the sagittal and transversal dimensions, respectively. As self-correction is rare in these alterations, early interception is recommended to allow normal occlusion and facial development. This case report aimed to discuss the treatment of an eight-year-old boy with an increased inferior facial third, who was submitted for rapid maxillary expansion with a modified bonded appliance to solve both transversal and anteroposterior deficiencies. The correctionof both malocclusions was achieved within 21 days. The advantages of this procedure were to gain space in both arches, enlarge the maxillary arch, and improve nasal breathing. The interceptive therapy, as well as a well-planned appliance, proved to be effective and important for retrieving the patient ́s normal condition and quality of life.

The people behind the papers – Adrian Danescu, Lisanne Rens and Joy Richman

During vertebrate face development, bilateral streams of neural crest cells migrate from the neural tube to give rise to the facial prominences. A new study in Development combines high-resolution live imaging of chick facial development with a mathematical examination of cell behaviour to understand the dynamics of facial symmetry. We caught up with Adrian Danescu, Lisanne Rens and corresponding author Joy Richman (Professor and Director of the Pediatric Dentistry Graduate Program in the University of British Columbia in Vancouver, Canada) to find out more about the work.