Síndrome de Apert: alternativas de tratamiento ortodóntico - quirúrgico y tiempos de ejecución. Una revisión de la literatura
Apert Syndrome: Orthodontic - Surgical treatment alternatives and execution times. A review of the literature
Palabras clave:
síndrome de Apert, tratamiento ortodóntico, procedimiento quirúrgico, atención odontológica (es)Apert Syndrome, Orthodontic treatment, Surgical procedures, Dental care (en)
Objetivo: realizar una revisión de la literatura acerca de los tratamientos ortodónticos y quirúrgicos del síndrome de Apert durante las diferentes etapas de crecimiento y desarrollo. Métodos: se llevó a cabo una búsqueda en las bases de datos MedLine (PubMed), Science Direct, Scopus y Wiley Online Library con la combinación de los siguientes términos: Syndromic craniosynostosis, Dental treatment, orthodontic treatment, Apert Syndrome, surgical treatment, dental care. Se incluyeron revisiones sistemáticas y de literatura, estudios retrospectivos, longitudinales y de cohorte, series y revisiones de caso publicados entre 1990 y 2020 en español o inglés; se excluyeron artículos relacionados con otros síndromes, así como estudios en animales. Los artículos fueron seleccionados según su pertinencia y disponibilidad de texto completo; hallazgos repetidos fueron eliminados; adicionalmente, se utilizó el sistema bola de nieve en los artículos seleccionados; la calidad de la evidencia fue evaluada mediante el sistema GRADE. Resultados: 34 artículos fueron incluidos (calidad alta: 2, moderada: 1, baja: 19 y muy baja: 12). Entre estos, se identificaron discusiones relacionadas con la etapa de crecimiento a la que se recomienda realizar los procedimientos quirúrgicos requeridos para minimizar sus impactos negativos. La mayoría de los artículos apoyan el manejo terapéutico ejecutado por equipos multidisciplinarios. Conclusiones: un plan de tratamiento combinado de ortodoncia y cirugía ortognática se presentó como la mejor opción para obtener los mejores resultados funcionales y estéticos para la población en cuestión. El momento adecuado durante el crecimiento y desarrollo de los individuos para implementar cada fase de tratamiento fue decidido por cada equipo multidisciplinario.
Objective: Carry out a literature review about the orthodontic and surgical treatments of Apert Syndrome, during the different stages of growth and development. Methods: A search was made in the MedLine (PubMed), Science Direct, Scopus, and Wiley Online Library databases with the combination of the following terms: Syndromic craniosynostosis; Dental treatment; orthodontic treatment; Apert Syndrome; surgical treatment; dental care. Types of the study included: Systematic and literature reviews, retrospective, longitudinal, and cohort studies, series, and case reviews that were published between 1990-2020 in Spanish or English; articles related to other syndromes and animal, or laboratory studies were excluded. The articles were selected according to relevance and availability of full text; repeated findings were eliminated; additionally, the snowball system was used in the selected articles; the quality of the evidence was evaluated using the GRADE system. Results: 34 articles were included (High Quality: 2; Moderate: 1; Low: 19; Very Low: 12). Controversies were found related to the stage of growth to which it is recommended to perform the required surgical procedures to minimize the negative impacts. Most of the articles support therapeutic management by multidisciplinary teams. Conclusions: A combined orthodontic and orthognathic surgery treatment plan was presented as the indicated option to obtain the best possible functional and aesthetic results for the population in question. The appropriate time during the growth and development of individuals to implement each treatment phase was decided by each multidisciplinary team.
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Siminel MA, Neamţu CO, Diţescu D, Forţofoiu MC, Comănescu AC, Novac MB, et al. Apert syndrome - clinical case. Rom J Morphol Embryol. 2017; 58(1): 277–280. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28523332/
Reséndiz–Martínez IA, Nava–Uribe E. Síndrome de Apert. Acta Medica Grup Angeles. 2013; 11(4): 173–179. Disponible en: https://www.medigraphic.com/pdfs/actmed/am-2013/am134b.pdf
Wenger TL, Hing A V, Evans KN. Apert Syndrome. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Gripp KW, et al., editors. Seattle (WA); 1993. Available from: https://pubmed.ncbi.nlm.nih.gov/31145570/
Cohen SR, de Chalain TM, Burstein FD, Hudgins R, Boydston W. Turribrachycephaly: a technical note. Ann Plast Surg. 1995; 35(6): 627–630. Disponible en: https://pubmed.ncbi.nlm.nih.gov/8748346/
Bachmayer DI, Ross RB, Munro IR. Maxillary growth following LeFort III advancement surgery in Crouzon, Apert, and Pfeiffer syndromes. Am J Orthod Dentofac Orthop. 1986; 90(5): 420–430. https://doi.org/10.1016/0889-5406(86)90007-7
Ousterhout DK, Vargervik K. Aesthetic improvement resulting from craniofacial surgery in craniosynostosis syndromes. J Craniomaxillofac Surg. 1987; 15(4): 189–197. https://doi.org/10.1016/s1010-5182(87)80048-3
Ousterhout DK, Vargervik K, Clark S. Stability of the maxilla after Le Fort III advancement in craniosynostosis syndromes. Cleft Palate J. 1986; 23(1): 91–101. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3469047/
Castro–Coyotl DM, Rosas–Huerta XO, Sánchez–Vázquez JJ, Díaz–Sánchez MI, Rodríguez–Peralta JS, Tetitla–Munive JM et al. Guía de práctica clínica para el diagnóstico, tratamiento y rehabilitación de craneosinostosis no sindrómica en los 3 niveles de atención. Cir Cir. 2017; 85(5): 401–410. https://doi.org/10.1016/j.circir.2016.10.028
Broek JL, Akl EA, Alonso–Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009; 64(5): 669–677. https://doi.org/10.1111/j.1398-9995.2009.01973.x
López–Estudillo AS, Rosales-–Bérber MÁ, Ruiz–Rodríguez S, Pozos–Guillén A, Noyola–Frías Á, Garrocho–Rangel A. Dental approach for apert syndrome in children: A systematic review. Med Oral Patol Oral Cir Bucal. 2017; 22(6): 660–668. https://dx.doi.org/10.4317%2Fmedoral.21628
Saltaji H, Altalibi M, Major MP, Al–Nuaimi MH, Tabbaa S, Major PW, et al. Le Fort III distraction osteogenesis versus conventional le Fort III osteotomy in correction of syndromic midfacial hypoplasia: A systematic review. J Oral Maxillofac Surg. 2014; 72(5): 959–972. https://doi.org/10.1016/j.joms.2013.09.039
Kaloust S, Ishii K, Vargervik K. Dental Development in Apert Syndrome. Cleft Palate Craniofac J. 1997; 34(2): 117–121. https://doi.org/10.1597/1545-1569_1997_034_0117_ddias_2.3.co_2
Letra A, Fraga de Almeida ALP, Kaizer R, Esper LA, Sgarbosa S, Granjeiro JM. Intraoral features of Apert’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103(5): 38–41. https://doi.org/10.1016/j.tripleo.2006.04.006
Allam KA, Wan DC, Khwanngern K, Kawamoto HK, Tanna N, Perry A, et al. Treatment of apert syndrome: A long-term follow-up study. Plast Reconstr Surg. 2011; 127(4):1601–1611. https://doi.org/10.1097/prs.0b013e31820a64b6
Woods E, Parekh S, Evans R, Moles DR, Gill D. The dental development in patients with Aperts syndrome. Int J Paediatr Dent. 2015; 25(2): 136–143. https://doi.org/10.1111/ipd.12114
Wery MF, Nada RM, Van Der Meulen JJ, Wolvius EB, Ongkosuwito EM. Three-dimensional computed tomographic evaluation of le Fort III distraction osteogenesis with an external device in syndromic craniosynostosis. Br J Oral Maxillofac Surg. 2015; 53(3): 285–291. https://doi.org/10.1016/j.bjoms.2014.12.016
Oberoi S, Hoffman WY, Vargervik K. Craniofacial team management in Apert syndrome. Am J Orthod Dentofac Orthop. 2012; 141(4): 82–87. https://doi.org/10.1016/j.ajodo.2012.01.003
Vargervik K, Rubin MS, Grayson BH, Figueroa AA, Kreiborg S, Shirley JC, et al. Parameters of care for craniosynostosis: Dental and orthodontic perspectives. Am J Orthod Dentofacial Orthop. 2012; 141(4): 68–73. https://doi.org/10.1016/j.ajodo.2011.12.013
Fadda MT, Lerardo G, Ladniak B, Di Giorgio G, Caporlingua A, Raponi I, Silvestri A, et al. Treatment timing and multidisciplinary approach in Apert syndrome. Ann Stomatol (Roma). 2015; 6(2): 58–63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26330906/
Vilan–Xavier AC, Pinto–Silva LC, Oliveira P, Villamarim–Soares R, De Almeida Cruz R. A review and dental management of persons with craniosynostosis anomalies. Spec Care Dent. 2008; 28(3): 96–100. https://doi.org/10.1111/j.1754-4505.2008.00019.x
Hoyos–Serrano M, Rojas–Mamani J. Síndrome de Apert (SA). Rev Act Clin Med. 2014; 64.
Ferrano NF. Dental, orthodontic, and oral/maxillofacial evaluation and treatment in Apert syndrome. Clin Plast Surg. 1991; 18(2): 291–307. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2065490/
Prahl–Andersen B. Controversies in the management of craniofacial malformations. Semin Orthod. 2005; 11(2): 67–75. https://doi.org/10.1053/j.sodo.2005.02.004
Blount JP, Louis RG, Tubbs RS, Grant JH. Pansynostosis: A review. Childs Nerv Syst. 2007; 23(10): 1103–1109. https://doi.org/10.1007/s00381-007-0362-1
Panchal J, Uttchin V. Management of craniosynostosis. Plast Reconstr Surg. 2003; 111(6): 2032–2048. https://doi.org/10.1097/01.prs.0000056839.94034.47
Azoulay–Avinoam S, Bruun R, MacLaine J, Allareddy V, Resnick CM, Padwa BL. An Overview of Craniosynostosis Craniofacial Syndromes for Combined Orthodontic and Surgical Management. Oral Maxillofac Surg Clin North Am. 2020; 32(2): 233–247. https://doi.org/10.1016/j.coms.2020.01.004
Susami T, Fukawa T, Miyazaki H, Sakamoto T, Morishita T, Sato Y, et al. A survey of orthodontic treatment in team care for patients with syndromic craniosynostosis in Japan. The Cleft Palate-Craniofacial Journal. 2018; 55(4): 479–486. https://doi.org/10.1177/1055665617747703
Fearon JA, Podner C. Apert syndrome: Evaluation of a treatment algorithm. Plast Reconstr Surg. 2013; 131(1): 132–142. https://doi.org/10.1097/prs.0b013e3182729f42
Carpentier S, Schoenaers J, Carels C, Verdonck A. Cranio-maxillofacial, orthodontic and dental treatment in three patients with Apert syndrome. Eur Arch Paediatr Dent. 2014; 15(4): 281–289. https://doi.org/10.1007/s40368-013-0105-9
Posnick JC, Armstrong D, Bite U. Crouzon and Apert syndromes: intracranial volume measurements before and after cranio-orbital reshaping in childhood. Plast Reconstr Surg. 1995; 96(3): 539–548. Disponible en: https://pubmed.ncbi.nlm.nih.gov/7638278/
Da Silva–Dalben G, Das Neves LT, Gomide MR. Oral findings in patients with Apert syndrome. J Appl Oral Sci. 2006; 14(6): 465–469. https://doi.org/10.1590/s1678-77572006000600014
Ko EWC, Chen PKT, Tai ICH, Huang CS. Fronto-facial monobloc distraction in syndromic craniosynostosis. Three-dimensional evaluation of treatment outcome and facial growth. Int J Oral Maxillofac Surg. 2012; 41(1): 20–27. https://doi.org/10.1016/j.ijom.2011.09.012
Laure B, Joly A, Moret A, Travers N, Listrat A, Goga D. Frontofacial monobloc advancement with simultaneous frontal cranioplasty in adolescents with residual apert syndrome deformations. J Craniofac Surg. 2015; 26(7): 2059–2061. https://doi.org/10.1097/scs.0000000000001942
Ponniah AJT, Witherow H, Richards R, Evans R, Hayward R, Dunaway D. Three-dimensional image analysis of facial skeletal changes after monobloc and bipartition distraction. Plast Reconstr Surg. 2008; 122(1): 225–231. https://doi.org/10.1097/prs.0b013e3181774308
Hohoff, A, Joos U, Meyer U, Ehmer U, Stamm T. The spectrum of Apert syndrome: phenotype, particularities in orthodontic treatment, and characteristics of orthognathic surgery. Head Face Med. 2007; 3(10). https://dx.doi.org/10.1186%2F1746-160X-3-10
Khonsari RH, Way B, Nysjö J, Odri GA, Olszewski R, Evans RD, et al. Fronto-facial advancement and bipartition in Crouzon–Pfeiffer and Apert syndromes: Impact of fronto-facial surgery upon orbital and airway parameters in FGFR2 syndromes. J Cranio-Maxillofacial Surg. 2016; 44(10): 1567–1575.https://doi.org/10.1016/j.jcms.2016.08.015
Glass GE, Ruff CF, Crombag GAJC, Verdoorn MHAS, Koudstaal M, Anguilla F, et al. The role of bipartition distraction in the treatment of apert syndrome. Plast Reconstr Surg. 2018; 141(3): 747–750. https://doi.org/10.1097/prs.0000000000004115
Shetye PR, Kapadia H, Grayson BH, McCarthy JG. A 10-year study of skeletal stability and growth of the midface following le Fort III advancement in syndromic craniosynostosis. Plast Reconstr Surg. 2010; 126(3): 973–981. https://doi.org/10.1097/prs.0b013e3181e60502
Reitsma JH, Balk–Leurs IH, Ongkosuwito EM, Wattel E, Prahl–Andersen B. Dental maturation in children with the syndrome of crouzon and apert. Cleft Palate Craniofac J. 2014; 51(6): 639–644. https://doi.org/10.1597/13-071
Meazzini MC, Allevia F, Mazzoleni F, Ferrari L, Pagnoni M, Iannetti G, et al. Long-term follow-up of syndromic craniosynostosis after le Fort III halo distraction: A cephalometric and CT evaluation. J Plast Reconstr Aesthetic Surg. 2012; 65(4): 464–472. https://doi.org/10.1016/j.bjps.2011.09.048
Shin K, Moreno–Uribe LM, Allareddy V, Burton RG, Menezes AH, Fisher MD, et al. Multidisciplinary care for a patient with syndromic craniosynostosis: A case report with 20 years of special care. Spec Care Dent. 2020; 40(1): 127–133. https://doi.org/10.1111/scd.12437
Miyazaki H, Katada H, Ichinokawa Y, Hirabayashi S, Sueishi K. Orthodontic treatment in combination with Le Fort II bone distraction in patient with Apert syndrome. Bull Tokyo Dent Coll. 2013; 54(1): 9–17. https://doi.org/10.2209/tdcpublication.54.9
Kahnberg KE, Hagberg C. Orthognathic surgery in patients with craniofacial syndrome. I. A 5-year overview of combined orthodontic and surgical correction. J Plast Surg Hand Surg. 2010; 44(6): 282–288. https://doi.org/10.3109/2000656x.2010.516594
Shetye PR, Kapadia H, Grayson BH, McCarthy JG. A 10-year study of skeletal stability and growth of the midface following le Fort III advancement in syndromic craniosynostosis. Plast Reconstr Surg. 2010; 126(3): 973–981. https://doi.org/10.1097/prs.0b013e3181e60502
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