Large enthesophytes in teenage skulls: Mechanical,inflammatory and genetic considerations |
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| Institution: | 1. School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia;2. Sunshine Coast Radiology, Birtinya, Australia;1. Division of Oral and Maxillofacial Surgery, Alameda Health System, Highland Hospital, Oakland, CA, USA;2. University of the Pacific, Dugoni School of Dentistry, San Francisco, CA, USA;3. Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Western University of Health Sciences, Pomona, CA, USA;4. Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA;1. Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany;2. Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany;3. Ludwig Maximilians University Laboratory for Biomechanics and Experimental Orthopaedics, Campus Grosshadern, Feodor-Lynen-Straße 19, 81377 Munich, Germany;1. Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium;2. Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium;1. Beijing University of Technology, No.100, Pingleyuan, Chaoyang District, Beijing 100124, China;2. National Research Center for Rehabilitation Technical Aids, No. 1 Ronghua Middle Road, Daxing District, 100176 Beijing, China |
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| Abstract: | BackgroundThe literature implies that large enthesophytes are exclusive to genetically predisposed individuals and to Spondyloarthropathies sufferers. Accordingly, the aim of this investigation and report was to assess the involvement of genetic predisposition, inflammatory and/or mechanical influences in the development of large enthesophytes in a sample population of teenagers presenting with large enthesophytes emanating from the external occipital protuberance.MethodsAnalysis was based on four teenage males (13–16 year-old) possessing 14.5–30.5 mm enthesophytes projecting from the external occipital protuberance. This study included assessment of radiographs, MRI scans, blood-work, history, the SF-36 health survey, and the comparison of these data with the relevant literature to describe the interrelationships between the presence of enlarged external occipital protuberance, forward head protraction, active inflammation and/or genetic factors.FindingsKnown genetic markers (e.g. HLA-B27) were not detected by allele-specific primers and both ESR and CRP tests were negative. Additionally, MRI analyses failed to detect active localised inflammation at the external occipital protuberance and surrounding structures. The health survey yielded normal parameters for all participants. All participants displayed significantly large Forward Head Protraction values (>40 mm), and interviews with participants and their parents indicated that concerns related to posture were prevalent since early childhood.InterpretationThis report suggests that mechanical load has an important role in enthesophyte development, irrespective the involvement of inflammatory or genetic factors. |
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