An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report

Miyamoto,Sho; Ntege,Edward Hosea; Chinen,Yasutsugu; Goto,Takahiro; Shirakawa,Jumpei; Goto,Shimpei; Kawano,Toshihiro; Shimizu,Yusuke; Nakanishi,Koichi; Nakamura,Hiroyuki

doi:10.3892/br.2022.1547

An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report

Authors:
- Sho Miyamoto
- Edward Hosea Ntege
- Yasutsugu Chinen
- Takahiro Goto
- Jumpei Shirakawa
- Shimpei Goto
- Toshihiro Kawano
- Yusuke Shimizu
- Koichi Nakanishi
- Hiroyuki Nakamura
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Affiliations: Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903‑0215, Japan, Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903‑0215, Japan, Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903‑0215, Japan, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903‑0215, Japan, Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903‑0215, Japan
Published online on: June 7, 2022 https://doi.org/10.3892/br.2022.1547
Article Number: 64
Copyright: © Miyamoto et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Oral/dental surgical care in patients with chronic medical comorbidities, such as isovaleric acidemia (IVA), can be challenging. In addition to technical complications, different comorbidities also present a complex range of concerning factors/challenges, which can increase the incidence of morbidity and mortality associated with surgery. IVA, a congenital error of metabolism, is a rare organic acidemia with a predisposition towards acute acidosis and life‑threatening metabolic decompensation during stressful conditions, such as prolonged fasting and surgery. In addition, schizophrenia, a major neurological disorder, can result in manifestation of severe dental or periodontal conditions, including pericoronitis. The condition is associated with significant risk factors of postoperative complications, such as dangerous behaviors and adverse interactions between antipsychotic drugs and anesthetic agents. A case of comorbid dental disease with two coexisting chronic and life‑threatening medical conditions, one of which is rare, is an unusual encounter in oral/dental surgery that is seldomly published. Moreover, implementing a safe and effective surgical intervention in such patients requires several informed considerations. However, only a few reported experiences or guidelines exist, reporting appropriate perioperative management strategies to minimize risks. Hence, in this case report, our experience of managing one of these rare encounters of a 20‑year‑old man who suffered from bilaterally partially erupted third molars, associated with chronic pericoronitis and dental caries of both the maxilla wisdom teeth with coexisting IVA and schizophrenia comorbidities is described. Additionally, the presentation and anticipated complications of the comorbid disorders of the patient are briefly reviewed. In this case, the pericoronitis and dental caries were treated by surgically removing the impacted third molars and the antagonist maxilla wisdom teeth under regional anesthesia and application of antibiotics for 3 days. The patient recovered without any postoperative complications after 1 year of follow‑up.

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1	Schmidt J, Kunderova M, Pilbauerova N and Kapitan M: A review of evidence-based recommendations for pericoronitis management and a systematic review of antibiotic prescribing for pericoronitis among dentists: Inappropriate pericoronitis treatment is a critical factor of antibiotic overuse in dentistry. Int J Environ Res Public Health. 18(6796)2021.PubMed/NCBI View Article : Google Scholar
2	Singh P, Nath P, Bindra S, Rao SS and Reddy KR: The predictivity of mandibular third molar position as a risk indicator for pericoronitis: A prospective study. Natl J Maxillofac Surg. 9:215–221. 2018.PubMed/NCBI View Article : Google Scholar
3	Nitzan DW, Tal O, Sela MN and Shteyer A: Pericoronitis: A reappraisal of its clinical and microbiologic aspects. J Oral Maxillofac Surg. 43:510–516. 1985.PubMed/NCBI View Article : Google Scholar
4	McArdle LW and Renton T: The effects of NICE guidelines on the management of third molar teeth. Br Dent J. 213(E8)2012.PubMed/NCBI View Article : Google Scholar
5	World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems. 10th revision. WHO, Geneva, pICD-10, 2010.
6	Phillips C, Norman J, Jaskolka M, Blakey GH, Haug RH, Offenbacher S and White RP Jr: Changes over time in position and periodontal probing status of retained third molars. J Oral Maxillofac Surg. 65:2011–2017. 2007.PubMed/NCBI View Article : Google Scholar
7	Maruta T and Matsumoto C: Renaming schizophrenia. Epidemiol Psychiatr Sci. 28:262–264. 2019.PubMed/NCBI View Article : Google Scholar
8	Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A and Haukka J: 11-year follow-up of mortality in patients with schizophrenia: A population-based cohort study (FIN11 study). Lancet. 374:620–627. 2009.PubMed/NCBI View Article : Google Scholar
9	World Health Organization (WHO): Chapter 5: Mental and behavioral disorders-Schizophrenia, schizotypal and delusional disorders. In: International Statistical Classification of Diseases and Related Health Problems. 10th Revision. WHO, Geneva, ppF20-F29, 2019. https://icd.who.int/browse10/2019/en.
10	Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O and Tran N: Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZJ Psychiatry. 50:410–472. 2016.PubMed/NCBI View Article : Google Scholar
11	Kay SR, Fiszbein A and Opler LA: The positive and negative syndrome scale (PANSS) for Schizophrenia. Schizophr Bull. 13:261–276. 1987.PubMed/NCBI View Article : Google Scholar
12	Chua-Tuan JL: Surgical adverse outcomes in patients with Schizophrenia: A population-based study. J Emerg Med. 5:1061–1062. 2013.PubMed/NCBI View Article : Google Scholar
13	Kudoh A: Perioperative management for chronic schizophrenic patients. Anaesth Analg. 101:1867–1872. 2005.PubMed/NCBI View Article : Google Scholar
14	Tanaka K, Budd MA, Efron ML and Isselbacher KJ: Isovaleric acidemia: A new genetic defect of leucine metabolism. Proc Natl Acad Sci USA. 56:236–242. 1966.PubMed/NCBI View Article : Google Scholar
15	Lin WD, Wang CH, Lee CC, Lai CC, Tsai Y and Tsai FJ: Genetic mutation profile of isovaleric acidemia patients in Taiwan. Mol Genet Metab. 90:134–139. 2007.PubMed/NCBI View Article : Google Scholar
16	Ensenauer R, Vockley J, Willard JM, Huey JC, Sass JO, Edland SD, Burton BK, Berry SA, Santer R, Grünert S, et al: A common mutation is associated with a mild, potentially asymptomatic phenotype in patients with isovaleric acidemia diagnosed by newborn screening. Am J Hum Genet. 75:1136–1142. 2004.PubMed/NCBI View Article : Google Scholar
17	Grünert SC, Wendel U, Lindner M, Leichsenring M, Schwab KO, Vockley J, Lehnert W and Ensenauer R: Clinical and neurocognitive outcome in symptomatic isovaleric acidemia. Orphanet J Rare Dis. 7(9)2012.PubMed/NCBI View Article : Google Scholar
18	Tanaka K and Isselbacher KJ: The isolation and identification of N-isovalerylglycine from urine of patients with isovaleric acidemia. J Biol Chem. 242:2966–2972. 1967.PubMed/NCBI
19	Vockley J and Ensenauer R: Isovaleric acidemia: New aspects of genetic and phenotypic heterogeneity. Am J Med Genet C Semin Med Genet. 142:95–103. 2006.PubMed/NCBI View Article : Google Scholar
20	Newman CG, Wilson BD, Callaghan P and Young L: Neonatal death associated with isovalericacidaemia. Lancet. 2:439–442. 1967.PubMed/NCBI View Article : Google Scholar
21	Berry GT, Yudkoff M and Segai S: Isovaleric acidemia: Medical and neurodevelopmental effects of long-term therapy. J Pediatr. 113 (1 Pt 1):58–64. 1998.PubMed/NCBI View Article : Google Scholar
22	Tanaka K: Isovaleric acidemia: Personal history, clinical survey and study of the molecular basis. Prog Clin Biol Res. 321:273–290. 1990.PubMed/NCBI
23	Yeoh C, Teng H, Jackson J, Hingula L, Irie T, Legler A, Levine C, Chu I, Chai C and Tollinche L: Metabolic disorders and anaesthesia. Curr Anesthesiol Rep. 9:340–359. 2019.PubMed/NCBI View Article : Google Scholar
24	Mrad S, El Tawil C, Sukaiti WA, Bou Chebl R, Abou Dagher G and Kazzi Z: Cardiac arrest following liposuction: A case report of lidocaine toxicity. Oman Med J. 34:341–344. 2019.PubMed/NCBI View Article : Google Scholar
25	Weinberg GL, Laurito CE, Geldner P, Pygon BH and Burton BK: Malignant ventricular dysrhythmias in a patient with isovaleric acidemia receiving general and local anaesthesia for suction lipectomy. J Clin Anaesth. 9:668–670. 1997.PubMed/NCBI View Article : Google Scholar
26	Holme E, Greter J, Jacobson CE, Lindstedt S, Nordin I, Kristiansson B and Jodal U: Carnitine deficiency induced by pivampicillin and pivmecillinam therapy. Lancet. 2:469–473. 1989.PubMed/NCBI View Article : Google Scholar
27	Porto GG, Vasconcelos BC, Gomes AC and Albert D: Evaluation of lidocaine and mepivacaine for inferior third molar surgery. Med Oral Patol Oral Cir Bucal. 12:E60–E64. 2007.PubMed/NCBI
28	Šarac Z, Zovko R, Ćurlin M and Filaković P: Dental medicine and psychiatry: The need for collaboration and bridging the professional gap. Psychiatr Danub. 32:151–158. 2020.PubMed/NCBI View Article : Google Scholar
29	Šimunović Filipčić I and Filipčić I: Schizophrenia and physical comorbidity. Psychiatr Danub. 30 (Suppl 4):S152–S157. 2018.PubMed/NCBI
30	Jakovljevic M and Borovecki F: Epigenetics, resilience, comorbidity and treatment outcome. Psychiatr Danub. 30:242–253. 2018.PubMed/NCBI View Article : Google Scholar
31	Kudoh A, Katagai H, Takase H and Takazawa T: Effect of preoperative discontinuation of antipsychotics in schizophrenic patients on outcome during and after anaesthesia. Eur J Anaesthesiol. 21:414–416. 2004.PubMed/NCBI View Article : Google Scholar
32	Vreken P, Van Lint AE, Bootsma AH, Overmars H, Wanders RJ and Van Gennip AH: Quantitative plasma acylcarnitine analysis using electrospray tandem mass spectrometry for the diagnosis of organic acidaemias and fatty acid oxidation defects. J Inherit Metab Dis. 22:302–306. 1999.PubMed/NCBI View Article : Google Scholar
33	Kelleher JF Jr, Yudkoff M, Hutchinson R, August CS and Cohn RM: The pancytopenia of isovaleric acidemia. Pediatrics. 65:1023–1027. 1980.PubMed/NCBI
34	Macfarlane AJR, Gitman M, Bornstein KJ, El-Boghdadly K and Weinberg G: Updates in our understanding of local anaesthetic systemic toxicity: A narrative review. Anaesthesia. 76 (Suppl 1):S27–S39. 2021.PubMed/NCBI View Article : Google Scholar
35	Elvir-Lazo OL, White PF, Cruz Eng H, Yumul F, Chua R and Yumul R: Impact of chronic medications in the perioperative period-anesthetic implications (Part II). Postgrad Med. 133:920–938. 2021.PubMed/NCBI View Article : Google Scholar