Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta-analyses.

BACKGROUND: There has been a longstanding debate about the role of folate in the etiology of orofacial clefts (OFCs). Studies of different measures of nutritional intake or folate status have been done to investigate the possible role of folate in the prevention of OFC. Only one knowledge synthesis has attempted to bring together different types of evidence. The aim of the present work was to update it. METHODS: Evidence for associations between OFC and dietary folate, supplement use, folic acid fortification, biomarkers of folate status, and variants of MTHFR (C677T and A1298C) were included. Potentially eligible articles were systematically identified from PubMed, Medline, Embase, and Web of Science (2007-2020) and combined using random-effects meta-analysis when appropriate. Quality assessments were conducted using the Newcastle-Ottawa scale and Cochrane's risk of bias tool. RESULTS: Sixty-four studies published since the previous knowledge synthesis were identified, with eight of these identified through a supplementary search from October, 2018 to August, 2020. There was an inverse association between folic acid-containing supplement use before or during pregnancy and cleft lip with or without cleft palate (CL/P) (OR 0.60, 95% CI 0.51-0.69), with considerable between-study heterogeneity. The prevalence of CL/P showed a small decline post-folic acid fortification in seven studies (OR 0.94, 95% CI 0.86-1.02). No association was found between OFC and genetic markers of folate status. The coronavirus-19 pandemic has threatened food availability globally and therefore there is a need to maintain and even enhance surveillance concerning maternal intake of folate and related vitamins. CONCLUSIONS: The risk of non-syndromic OFC was reduced among pregnant women with folic acid-containing supplements during the etiologically relevant period. However, high heterogeneity between included studies, incomplete reporting of population characteristics and variation in timing of exposure and supplement types mean that conclusions should be drawn with caution.

Tratamiento de la sonrisa gingival con la toxina botulínica tipo A: caso clínico / Treatment of gingival smile with botulinum toxin type A: a case report

La toxina botulínica ha sido señalada recientemente en la literatura como una opción de tratamiento para la corrección de la sonrisa gingival. Este reporte de caso relata la experiencia de los autores en un caso de sonrisa gingival asociada a 4 mm de exposición gingival e hipermovilidad de la musculatura elevadora del labio superior, tratado con el uso de toxina botulínica. Controles periódicos y evaluaciones de la exposición gingival fueron realizados mensualmente tras la aplicación. El tratamiento con toxina botulínica de tipo A puede ser considerado como una posible alternativa de tratamiento en este tipo de casos (AU)

Botulinum toxin has recently been reported in the literature as a treatment option for the correction of the gummy smile. This case report describes the experience of the authors in a case of gingival smile associated with 4 mm of gingival exposure and hyper mobility of the elevator muscle of the upper lip treated with the use of botulinum toxin. Regular checks and assessments of the gingival exposure were performed monthly after the application. Treatment with botulinum toxin type A can be considered as a possible alternative of treatment in this type of cases (AU)

Oral vascular malformation in a patient with hereditary hemorrhagic telangiectasia: a case report.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited mucocutaneous disease characterized by recurrent epistaxis, lesions on skin and oral mucosa, and arteriovenous malformations of the soft tissues. This article describes the treatment of a 64-year-old woman with a bleeding nodule, which was diagnosed as an arteriovenous malformation of the gingival mucosa. She was treated using sclerotherapy. Patients with HHT can be treated in the dental office and vascular malformations of these patients can be successfully managed with sclerotherapy, which eliminates the need for invasive surgical procedures and the possibility of postsurgical complications.

Intralesional injection of Pingyangmycin for vascular malformations in oral and maxillofacial regions: an evaluation of 297 consecutive patients.

The purpose of the study was to investigate the indications and treatment results of intralesional injection of Pingyangmycin for vascular malformations in oral and maxillofacial regions. Between June 2002 and July 2007, 297 patients with oral and maxillofacial vascular malformations (except venular malformation and arteriovenous malformation) were treated with percutaneous injection of Pingyangmycin in our department. There were 159 males and 138 females aged from 8 months to 72 years (mean age 20.6 years). The types of the disease included 98 lymphatic malformations (66 microcystic and 32 macrocystic malformations), 179 venous malformations, and 20 mixed lymphatic-venular or venous malformations. The lesions were located in the oral and maxillofacial and head and neck regions, and measured 0.8 cm x 1.0 cm -12.4 cm x 10.5 cm in size. Two hundred and forty-nine patients underwent intralesional injection of Pingyangmycin alone, 30 patients had laser therapy, and 18 patients underwent surgical excision as well. The number of injection sessions was 1-5, with an average of 3.5 times. Pingyangmycin, dexamethasone, and lidocaine were mixed for injection at concentrations of 1.0mg of Pingyangmycin per milliliter for microcystic lymphatic malformation and 2.0mg of Pingyangmycin per milliliter for venous malformation and macrocystic lymphatic malformation. The patients were followed up for 1-6 years after treatment. The results were evaluated based on B-type ultrasound examinations before and after treatment. The clinical cure rate of venous malformation, macrocystic lymphatic malformation, microcystic lymphatic malformation and mixed malformation was 74.86%, 84.38%, 38.88%, and 60.0%. Five patients had fever. No ulceration, necrosis, or anaphylactic reaction was found. Intralesional injection of Pingyangmycin at an adequate concentration can be used as the therapy of choice for small and medium-sized venous malformations, macrocystic lymphatic malformations, microcystic lymphatic malformations, and mixed malformations. The advantages included a high cure rate, safety and reliability, short course, easy manipulation, and fewer side effects with satisfactory recovery of appearance and function.