Congenital Oral Mucosal Abnormalities in True Umbilical Cord Knots

Abstract

Objective: The pathogenesis and clinical significance of true umbilical cord knots remain controversial. Here, we tested the hypothesis of the presence of congenital oral mucosal changes in newborns with true umbilical cord knots. Study design: Seven consecutive infants with true umbilical cord knots and 50 gestational age- and sex-matched controls were enrolled. The proportion of oral frenulum abnormalities and the two-dimensional vascular network geometry [fractal dimension, D, at two scales: D(1–46), and D(1–15), with the relative Lempel-Ziv complexity, (L-Z)], were analyzed. Results: Infants with true umbilical cord knots showed significantly higher proportions of mandibular frenulum agenesis compared to controls (p = 0.000006). The oral vascular networks of these infants exhibited a significantly higher D(1–46) and D(1–15) (p < 0.0001, respectively), and higher L-Z values (p < 0.0001) than control networks. Conclusion: These findings indicate the presence of significant congenital oral mucosal changes in newborn infants with true umbilical cord knots, thus suggesting a previously unrecognized association between true umbilical cord knots and a subclinical extracellular matrix disorder.

Fractals in dentistry

“…De Felice et al [151] proved it for Ehlers-Danlos II/III syndrome. De Felice et al [152] reported an increased vascular complexity in neonates with true umbilical cord knots. Parrini et al [153] did it for infantile hypertrophic pyloric stenosis.…”

Letters to the Editor

“…To deal with this problem, we always rely on independent observations by experienced odontostomatologists and record the findings with standard, high resolution photographs. Although this line of research has yielded valuable observations in EDS II/III (6) and true umbilical cord knots (7), we do not consider it the most appropriate IHPS screening method. We hypothesized that the most likely reason for MF abnormalities observed in our IHPS population was a hitherto unrecognized underlying extracellular matrix (ECM) abnormality.…”