DOCSLIB.ORG

Plastic Surgery Considerations for Holoprosencephaly Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Plastic Surgery Considerations for Holoprosencephaly Patients Plastic Surgery Considerations for Holoprosencephaly Patients Jennifer M. Hendi, MPH* Robert Nemerofsky, MD* Cynthia Stolman, PhD† Mark S. Granick, MD* Newark, New Jersey Holoprosencephaly (HPE) is considered the lead- and upper lip, with normal or near-normal brain de- ing abnormality of the brain and face in humans velopment. Some data indicate that patients with less and is frequently associated with a wide spectrum severe manifestations of holoprosencephaly (i.e., of specific craniofacial anomalies including mid- semilobar and lobar) have survived into adulthood.3 line facial clefts, cyclopia and nasal irregularities. A A standard course of treatment of holoprosenceph- standard course of treatment has not been devel- aly has not been developed, and treatment is symp- oped and management is symptomatic and sup- tomatic and supportive. portive. In this work, the authors discuss the wide- Few guidelines have been described for surgical ranging spectrum of HPE and propose surgical candidates, resulting in conflicting recommendations guidelines to provide more uniform and appropri- as well as ethical and practical dilemmas for sur- ate care to patients suffering from holoprosenceph- geons. Given the prevalence and the wide-ranging manifestations of this disease, surgical guidelines aly. Assessment of the patient’s brain abnormality should be established to provide more uniform and is essential in determining the extent and benefit of appropriate care to patients suffering from holo- surgical intervention. The authors discuss a median prosencephaly. Assessment of the patient’s brain ab- straight-line repair of the lip and repair of the an- normality is essential in determining the extent and terior palate in a one-year old female and review benefit of surgical intervention. the risks and benefits of surgery. Consistent with the ethical approach of surgical beneficence, the CASE REPORT authors recommend intervention at the earliest pos- sible time. primary pediatrician referred a 1-year-old fe- Amale infant with semilobar holoprosencephaly to plastic surgery for cleft lip and palate repair (Fig Key Words: Holoprosencephaly, median oral facial 1). The patient was born at 32 weeks with semilobar cleft, surgical risks, beneficence, cleft lip repair holoprosencephaly (Fig 2), an absent septum pellu- cidum, a monoventricle, fused thalami, premaxillary oloprosencephaly was first described in agenesis with a midline cleft lip, bilateral optic nerve 1963 and is considered the foremost ab- hypoplasia, and chromosome 8 deletion. The patient normality of the brain and face in human suffered from bilateral hearing loss, bilateral vision beings, with an estimated birth preva- loss, dysphagia, hypotelorism, cerebral palsy, and Hlence of 5 to 12 per 100,000 live births.1 Most cases are seizures. Developmentally, the patient exhibited no associated with severe brain malformations that are verbal output, an inability to sit up, and difficulty in incompatible with life and often cause spontaneous feeding. The mother was anxious to proceed with cor- intrauterine death. Less severely affected babies rective surgery to make the child look more normal. demonstrate a spectrum of defects and malforma- The patient was missing the prolabium and the tions of the brain and face. Holoprosencephaly is fre- anterior prolabial segment of the primary palate. The quently associated with specific craniofacial anoma- columella and nasal septum were also absent. It was lies, including midline facial clefts, cyclopia, and elected to do a repair consisting of a median straight- nasal irregularities.2 Less severe malformations in- line repair of the lip and repair of the anterior palate clude facial defects that may affect the eyes, nose, by sealing off the nasal floor and upper palate (Fig 3). The procedure used a simple straight-line repair. The From the *Division of Plastic Surgery, Department of Surgery, columella and septal deficiencies were not ad- † and Division of Medical Ethics, Department of Pediatrics, New dressed. There were no surgical complications of the Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, New Jersey. surgery, and blood loss was minimal. The patient’s Address correspondence to Dr Granick, 90 Bergen Street, DOC hospital course was prolonged to deal with feeding 7200, Newark, NJ 07103; e-mail: [email protected]. problems, social issues, and seizure control. For 1 675 THE JOURNAL OF CRANIOFACIAL SURGERY / VOLUME 15, NUMBER 4 July 2004 Fig 1 A patient with semilobar holoprosencephaly and Fig 3 The patient seen 12 months post-operatively. median oro-facial clefting. cebocephaly; median cleft lip; and less severe facial year after surgery, the patient had a satisfactory es- dysmorphism such as hypotelorism or hypertelor- thetic appearance and was independently feeding ism, lateral cleft lip, and/or iris coloboma. Associ- but had made little additional functional gain. The ated anomalies include a single maxillary central in- mother was pleased with the outcome. The patient cisor, absence of nasal septal cartilage, stenosis of the died 13 months after surgery. pyriform aperture, absence of the labial frenum, and absence of the philtral ridges.4 DISCUSSION Holoprosencephaly is caused by teratogens and oloprosencephaly has been described as the genetic factors. Maternal diabetes, alcohol, and reti- Hmost common major malformation of the brain noic acid are teratogens associated with holopros- and face in human beings. Various gradations of fa- encephaly; however, their significance has not been cial dysmorphism are commonly associated with ho- determined.5 Evidence for genetic causes of holo- loprosencephaly, including cyclopia; ethmocephaly; prosencephaly comes from nonrandom chromosom- al anomalies in regions that have been theorized to contain genes essential for normal forebrain devel- opment.5 As many as 12 chromosomal regions have been implicated in the pathogenesis of holoprosen- cephaly.5 Three classifications of the disease currently ex- ist. Alobar is considered the most severe manifesta- tion, with patients exhibiting premaxillary agenesis and unilateral or bilateral cleft lip. Approximately half of the infants born with this form of the disease die before the age of 4 to 5 months, and 20% to 30% live for at least 1 year.3 Semilobar holoprosencephaly results from less development of the anterior brain structures, with only partial separation into two hemispheres. In this form of the disease, the facial anomalies are mild or absent. Patients with lobar ho- loprosencephaly, considered the least severe expres- sion of the disease, are less clinically abnormal than patients with alobar or semilobar holoprosenceph- aly. These patients may exhibit mild or moderate developmental delay, hypothalamic-pituitary dys- function, or visual problems.6 Fig 2 CT scan demonstrating semilobar holoprosencephaly. Computed tomography findings of the brain 676 PLASTIC SURGERY CONSIDERATIONS FOR HOLOPROSENCEPHALY / Hendi et al coupled with a period of observation can help to ily interaction for a significant additional portion of distinguish patients who will benefit from surgical her life. The surgical procedure was basic and ad- intervention from those who are unlikely to thrive. dressed limited but important goals. Had the patient The degree of treatment performed may be deter- survived and the family requested repair of the col- mined by the extent of the malformation. For in- umella, this could have been accomplished with local stance, patients suffering from mild retardation may flaps.10 Holoprosencephaly patients have a greater benefit most from repair of the false median cleft lip anesthesia risk because of their altered thermoregu- and palate, whereas a patient exhibiting normal or latory ability, depressed seizure threshold, and alter- near-normal mentality with hypotelorism and naso- ation of upper airway anatomy as a result of median maxillary hypoplasia can be treated with simulta- orofacial clefting.11 Nevertheless, in a stable patient, neous midface advancement, facial bipartition ex- anesthesia can be performed safely. pansion, and nasal reconstruction.7 A classification In summary, a holoprosencephaly patient pre- system proposed by Elias et al. identifies patient sented with multiple congenital defects and physi- anomalies, with greater emphasis on the wide spec- ological derangements. The decision to undertake re- trum of midface hypoplasia and false median clefts constructive surgery requires an assessment of the that can exist in the absence of brain malformation.7 patient’s needs and specific anomalies. An assess- The differentiation of these cases from true median ment of altered respiratory, cardiac, and central ner- clefts addresses the embryological origin of the defi- vous system function is required to ensure that pa- cit and, ultimately, more precise guidelines for the tient health is not compromised. Although few surgical management of these patients. guidelines have been established for selecting surgi- Among the dilemmas faced by treating physi- cal candidates, we believe that surgery is warranted cians are the decision to operate, the timing, and the for patients with semilobar and lobar holoprosen- extent of surgery. Given the patient’s limited likeli- cephaly as soon as is practical. The goals of surgery hood of long-term survival, is it ethical to proceed are limited to improving function (i.e., feeding) and with surgery at all? Ethical considerations in support appearance to facilitate
Load more

Recommended publications
  • A Anencephaly
    Glossary of Birth Anomaly Terms: A Anencephaly: A deadly birth anomaly where most of the brain and skull did not form. Anomaly: Any part of the body or chromosomes that has an unusual or irregular structure. Aortic valve stenosis: The aortic valve controls the flow of blood from the left ventricle of the heart to the aorta, which takes the blood to the rest of the body. If there is stenosis of this valve, the valve has space for blood to flow through, but it is too narrow. Atresia: Lack of an opening where there should be one. Atrial septal defect: An opening in the wall (septum) that separates the left and right top chambers (atria) of the heart. A hole can vary in size and may close on its own or may require surgery. Atrioventricular septal defect (endocardial cushion defect): A defect in both the lower portion of the atrial septum and the upper portion of the ventricular septum. Together, these defects make a large opening (canal) in the middle part of the heart. Aniridia (an-i-rid-e-a): An eye anomaly where the colored part of the eye (called the iris) is partly or totally missing. It usually affects both eyes. Other parts of the eye can also be formed incorrectly. The effects on children’s ability to see can range from mild problems to blindness. To learn more about aniridia, go to the U.S. National Library of Medicine website. Anophthalmia/microphthalmia (an-oph-thal-mia/mi-croph-thal-mia): Birth anomalies of the eyes. In anophthalmia, a baby is born without one or both eyes.
    [Show full text]
  • Supratentorial Brain Malformations
    Supratentorial Brain Malformations Edward Yang, MD PhD Department of Radiology Boston Children’s Hospital 1 May 2015/ SPR 2015 Disclosures: Consultant, Corticometrics LLC Objectives 1) Review major steps in the morphogenesis of the supratentorial brain. 2) Categorize patterns of malformation that result from failure in these steps. 3) Discuss particular imaging features that assist in recognition of these malformations. 4) Reference some of the genetic bases for these malformations to be discussed in greater detail later in the session. Overview I. Schematic overview of brain development II. Abnormalities of hemispheric cleavage III. Commissural (Callosal) abnormalities IV. Migrational abnormalities - Gray matter heterotopia - Pachygyria/Lissencephaly - Focal cortical dysplasia - Transpial migration - Polymicrogyria V. Global abnormalities in size (proliferation) VI. Fetal Life and Myelination Considerations I. Schematic Overview of Brain Development Embryology Top Mid-sagittal Top Mid-sagittal Closed Neural Tube (4 weeks) Corpus Callosum Callosum Formation Genu ! Splenium Cerebral Hemisphere (11-20 weeks) Hemispheric Cleavage (4-6 weeks) Neuronal Migration Ventricular/Subventricular Zones Ventricle ! Cortex (8-24 weeks) Neuronal Precursor Generation (Proliferation) (6-16 weeks) Embryology From ten Donkelaar Clinical Neuroembryology 2010 4mo 6mo 8mo term II. Abnormalities of Hemispheric Cleavage Holoprosencephaly (HPE) Top Mid-sagittal Imaging features: Incomplete hemispheric separation + 1)1) No septum pellucidum in any HPEs Closed Neural
    [Show full text]
  • Prenatal Diagnosis, Phenotypic and Obstetric Characteristics of Holoprosencephaly
    Fetal Diagn Ther 2005;20:161–166 Received: August 6, 2003 DOI: 10.1159/000083897 Accepted after revision: January 15, 2004 Prenatal Diagnosis, Phenotypic and Obstetric Characteristics of Holoprosencephaly Ga´ bor J. Joo´ Artu´ r Beke Csaba Papp Erno˝To´ th-Pa´ l Zsanett Szigeti Zolta´nBa´ n Zolta´ n Papp Semmelweis University Medical School I., Department of Obstetrics and Gynecology, Budapest, Hungary Key Words Introduction Holoprosencephaly W Prenataldiagnosis W Patient’s history W Accompanying malformations In the early weeks of embryonic development, the brain consists of three parts: prosencephalon, mesenceph- alon, rhombencephalon. Between the time of neural tube Abstract closure and the 5th gestational week, the prosencephalon The diagnosis of fetal malformations, especially those of gives origin to telencephalon (cerebral hemispheres) and the central nervous system, is strikingly important in the diencephalon (thalamus and hypothalamus), the mesen- practice of genetic counseling. Early diagnosis is very cephalon forms the midbrain and rhombencephalon de- significant, not only because of the prognosis, but also velops into metencephalon (pons and cerebellum) and because of the emotional effects caused by the accompa- myelencephalon (medulla oblongata). At the time of the nying craniofacial malformations. The summary of the telencephalon/diencephalon differentiation, the prosen- obstetrical and diagnostical characteristics should be cephalon also splits longitudinally – the hemispheres de- useful in the management of holoprosencephaly. The velop on the lateral aspects of the longitudinal cerebral analysis of the 50 cases we encountered between 1981 fissure by progressive enlargement and hollowing of the and 2000, including the anatomical, diagnostic and clini- cerebral vesicles. Should the prechordal mesoderm fail to cal aspects, as well as the associated craniofacial malfor- migrate normally [1, 2], the prosencephalon remains un- mations, forms the essence of our publication.
    [Show full text]
  • Congenital Anomalies of the Nose
    133 Congenital Anomalies of the Nose Jamie L. Funamura, MD1 Travis T. Tollefson, MD, MPH, FACS2 1 Department of Otolaryngology and Communication Enhancement, Address for correspondence Travis T. Tollefson, MD, MPH, FACS, Facial Children’s Hospital Boston, Boston, Massachusetts Plastic and Reconstructive Surgery, Department of Otolaryngology- 2 Department of Otolaryngology, University of California, Davis, Head and Neck Surgery, University of California, Davis, 2521 Stockton Sacramento, California Blvd., Suite 7200, Sacramento, CA 95817 (e-mail: [email protected]). Facial Plast Surg 2016;32:133–141. Abstract Congenital anomalies of the nose range from complete aplasia of the nose to duplications and nasal masses. Nasal development is the result of a complex embryo- logic patterning and fusion of multiple primordial structures. Loss of signaling proteins or failure of migration or proliferation can result in structural anomalies with significant Keywords cosmetic and functional consequences. Congenital anomalies of the nose can be ► nasal deformities categorized into four broad categories: (1) aplastic or hypoplastic, (2) hyperplastic or ► nasal dermoid duplications, (3) clefts, and (4) nasal masses. Our knowledge of the embryologic origin ► Tessier cleft of these anomalies helps dictate subsequent work-up for associated conditions, and the ► nasal cleft appropriate treatment or surgical approach to manage newborns and children with ► nasal hemangioma these anomalies. – Congenital anomalies of the nose are thought to be relatively side1 4 (►Fig. 1A, B). The medial processes will ultimately fuse, rare, affecting approximately 1 in every 20,000 to 40,000 live contributing to the nasal septum and the medial crura of the births.1 The exact incidence is difficult to quantify, as minor lower lateral cartilages.
    [Show full text]
  • Chapter III: Case Definition
    NBDPN Guidelines for Conducting Birth Defects Surveillance rev. 06/04 Appendix 3.5 Case Inclusion Guidance for Potentially Zika-related Birth Defects Appendix 3.5 A3.5-1 Case Definition NBDPN Guidelines for Conducting Birth Defects Surveillance rev. 06/04 Appendix 3.5 Case Inclusion Guidance for Potentially Zika-related Birth Defects Contents Background ................................................................................................................................................. 1 Brain Abnormalities with and without Microcephaly ............................................................................. 2 Microcephaly ............................................................................................................................................................ 2 Intracranial Calcifications ......................................................................................................................................... 5 Cerebral / Cortical Atrophy ....................................................................................................................................... 7 Abnormal Cortical Gyral Patterns ............................................................................................................................. 9 Corpus Callosum Abnormalities ............................................................................................................................. 11 Cerebellar abnormalities ........................................................................................................................................
    [Show full text]
  • The Pathogenesis of Microcephaly Resulting from Congenital Infections: Why Is My Baby’S Head So Small?
    Eur J Clin Microbiol Infect Dis DOI 10.1007/s10096-017-3111-8 REVIEW The pathogenesis of microcephaly resulting from congenital infections: why is my baby’s head so small? L. D. Frenkel1,2 & F. Gomez3 & F. Sabahi 4 Received: 29 August 2017 /Accepted: 17 September 2017 # Springer-Verlag GmbH Germany 2017 Abstract The emergence of Zika-virus-associated congenital review, we integrate all these findings to create a unified hy- microcephaly has engendered renewed interest in the patho- pothesis of the pathogenesis of congenital microcephaly in- genesis of microcephaly induced by infectious agents. Three duced by these infectious agents. of the original “TORCH” agents are associated with an appre- ciable incidence of congenital microcephaly: cytomegalovi- rus, rubella virus, and Toxoplasma gondii. The pathology of Introduction congenital microcephaly is characterized by neurotropic infec- tious agents that involve the fetal nervous system, leading to Microcephaly has become an issue of increased interest since brain destruction with calcifications, microcephaly, sensori- the recognition that it is a consequential manifestation of con- neural hearing loss, and ophthalmologic abnormalities. The genital Zika virus infection [1–3]. Microcephaly is generally inflammatory reaction induced by these four agents has an defined as a head circumference ≤ 2 standard deviations below important role in pathogenesis. The potential role of “strain the mean for gestational age [4]. Zika virus associated micro- differences” in pathogenesis of microcephaly by these four cephaly and other clinical manifestations of vertical transmis- pathogens is examined. Specific epidemiologic factors, such sion from mother to fetus during gestation are similar to those as first and early second trimester maternal infection, and the caused by three of the original “TORCH” agents (Toxoplasma manifestations of congenital infection in the infant, shed some gondii, rubella virus, and cytomegalovirus) [3, 5–7].
    [Show full text]
  • Hydranencephaly
    Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 83-86 Case Note Hydranencephaly Pant S1, Kaur G2, JK De3 1Medical Offi cer, 2Associate Professor, 3Professor and Head, Department of Obstetrics and Gynaecology, Manipal College of Medical Sciences Abstract Hydranencephaly is a rare congenital condition where the greater portions of the cerebral hemispheres and the corpus striatum are replaced by cerebrospinal fl uid and glial tissue. The meninges and the skull are well formed, which is consistent with earlier normal embryogenesis of the telencephalon. Bilateral occlusion of the internal carotid arteries in utero is a potential mechanism. Clinical features include intact brainstem refl exes without evidence of higher cortical activity. The infant’s head size and the spontaneous refl exes such as sucking, swallowing, crying, and moving the arms and legs may all seem normal at birth. However, after a few weeks the infant usually becomes irritable and has increased muscle tone and after a few months of life, seizures and hydrocephalus (excessive accumulation of cerebrospinal fl uid in the brain) may develop. Other symptoms may include visual impairment, lack of growth, deafness, blindness, spastic quadriparesis (paralysis), and intellectual defi cits. Since the early behaviour appears to be relatively normal, the diagnosis may be delayed for months sometimes. There is no defi nitive treatment for hydranencephaly. The outlook for children with hydranencephaly is generally poor, and many children with this disorder die before their fi rst birthday. Key words: hydranencephaly, congenital anomaly, vascular disruption, thromboplastin, 19 years old, Gravida 2 Para 0 Abortion 1, presented HBV, blood sugars) were normal.
    [Show full text]
  • Holoprosencephaly: a Family Showing Dominant
    36 6J Med Genet 1993; 30: 36-40 Holoprosencephaly: a family showing dominant inheritance and variable expression J Med Genet: first published as 10.1136/jmg.30.1.36 on 1 January 1993. Downloaded from Amanda L Collins, Peter W Lunt, Christine Garrett, Nicholas R Dennis Abstract discuss the minor manifestations in probable A family with probable dominant holo- and possible gene carriers. prosencephaly is presented with five affected subjects in two sibships, the offspring of healthy sisters who are pre- sumed gene carriers. Of the affected chil- Case reports dren, three had cebocephaly and died The pedigree is shown in fig 1. The family was shortly after birth. One had left choanal ascertained through subject II.2 who sought atresia, retinal coloboma, a single central genetic advice in 1978 when 14 weeks preg- maxillary incisor, microcephaly, short nant, prompted by the birth of an abnormal stature, and learning problems. Another child (III .10) to one of her two sisters; three of had only a single central maxillary inci- the four liveborn offspring of her other sister sor. The occurrence of hypotelorism, had already had craniofacial abnormalities. microcephaly, and unilateral cleft lip These four cases are now described. and palate as minor manifestations of the gene in possible and probable gene car- riers is discussed. Wessex Clinical CASE 1 Genetics Service, (J Med Genet 1993;30:36-40) A female infant (III.6) weighed 2700 g at 38 Princess Anne weeks' gestation. She had a single nostril and Hospital, Coxford both orbits were absent. Her skull transillumi- Road, Southampton results from impaired S09 4HA.
    [Show full text]
  • Hydranencephaly
    Pavone et al. Italian Journal of Pediatrics 2014, 40:79 http://www.ijponline.net/content/40/1/79 ITALIAN JOURNAL OF PEDIATRICS REVIEW Open Access Hydranencephaly: cerebral spinal fluid instead of cerebral mantles Piero Pavone1*, Andrea D Praticò1, Giovanna Vitaliti1, Martino Ruggieri2, Renata Rizzo3, Enrico Parano4, Lorenzo Pavone1, Giuseppe Pero5 and Raffaele Falsaperla1 Abstract The authors report a wide and updated revision of hydranencephaly, including a literature review, and present the case of a patient affected by this condition, still alive at 36 months. Hydranencephaly is an isolated and with a severe prognosis abnormality, affecting the cerebral mantle. In this condition, the cerebral hemispheres are completely or almost completely absent and are replaced by a membranous sac filled with cerebrospinal fluid. Midbrain is usually not involved. Hydranencephaly is a relatively rare cerebral disorder. Differential diagnosis is mainly relevant when considering severe hydrocephalus, poroencephalic cyst and alobar holoprosencephaly. Ethical questions related to the correct criteria for the surgical treatment are also discussed. Keywords: Hydranencephaly, Holoprosencephaly, Congenital anomaly, Brain malformation, Severe hydrocephalus Introduction often misdiagnosed due to the similarities of HE to disor- Hydranencephaly (HE) is a rare, mostly isolated abnormal- ders involving the cerebral mantle (Table 1). ity, which is reported to affect about 1 out 5000 continu- The aim of our review is to report on this condition, ing pregnancies [1,2]; an accurate incidence is difficult to utilizing data from the literature, and also presenting our determine, considering how similar this condition is to experience with a patient affected by the bilateral form of others and the limited diagnostic techniques that have HE, who is still alive at the age of 36 months.
    [Show full text]
  • Increasing Number of Unusual Brain Abnormalities Seen in Rural West Virginia
    Increasing number of unusual brain abnormalities seen in rural West Virginia Abstract The incidence rate of schizencephaly is 1.5 in 100,000 live births and the rate of holoprosencephaly is 1 in 16,000 live births. Both malformations are rare, but our institution has seen a dramatic increase in both malformations in recent years with no known cause. Schizencephaly is the most severe cortical malformation and holoprosencephaly is the most common defect in the prosencephalon during development. However, it is still not very common to see a fetus with this defect live to delivery. Our institution, a regional hospital in central Appalachia, has seen four cases of schizencephaly and three cases of holoprosencephaly within two years. No two neonates seem to share a common factor. All had different co-morbidities and presentations, all mothers were of different ages and showed few risk factors if any for these deformities. This paper is a report of the cases found of these rare birth defects seen at our institution in recent years. Keywords Neonate, Holoprosencephaly, Schizencephaly Introduction Our institution, a regional hospital in central Appalachia, has seen an unusual increase in brain abnormalities over the past ten years with no obvious cause, with a cluster of severe congenital brain malformations in the last thirty months. These malformations include schizencephaly and holoprosencephaly. Schizencephaly is the most severe form of a cortical malformation.1 Schizencephaly is estimated to affect 1.5 out of 100,000 live births. The clefting of the cerebral mantle most commonly occurs in the frontal lobes but can occur in the parietal lobe as well.2 Schizencephaly symptoms include developmental delays, speech and language difficulties, brain-spinal cord communication problems, microcephaly, hydrocephalus, seizures, complete or partial paralysis, and abnormal muscle tone.
    [Show full text]
  • Established Conditions List (PDF)
    Established Conditions (Not an exhaustive list) ICD10 Genetic and Metabolic Disorders Code Albinism E70.30 Albright ’s Hereditary Osteodystrophy E20.1 Angelman Syndrome (Happy Puppet Syndrome) Q93.5 Adrenoleukodystrophy E71.529 Antley -Bixler Syndrome (Multisynostotic Osteodysgenesis, Craniosynostosis, Choanal Atresia, Radial Humeral Synostosis, Trapezoidocephaly-Multiple Q87.5 Synostosis Syndrome, ABS, Multisynostotic Osteodysgenesis with Long Bone Fractures) Apert Syndrome (Acrocephalosyndactyly) Q87.0 Arthrogryposis Multiplex Congenita Q74.3 Ataxia -Telangiectasia Syndrome (Louis -Bar Syndrome) G11.3 Canavan Disease E75.29 Cardio -Facio -Cutaneo Syndrome Q87.89 Cerebral Lip idosis E75.6 Cerebro -Oculo -Fac io -Skeletal (COFS) Syndrome Q87.8 CHARGE Syndrome/Association Q89.8 Chromosome Syndromes10p+, 13q+, 3q+, 4Q+ Q92.5 Chromosome Syndromes 11p - (this one also called Jacobsen syndrome ), 12p -, 13q -, 18q-, 21q-, 22q-, , 4q-, (this is also Wolf-Hirschhorn syndrome )5p- (already below as Q93.89 cri-du-chat syndrome) Coffin -Lowry Syndrome Q89.8 Coffin -Siris Syndrome Q03.1 Cornelia de Lange Syndrome (Brachmann de Lange ) Q87.1 Cri -du -chat Syndrome (Deletion 5p Syndrome) Q93.4 Cystic Fibrosis E84.0 Dandy Walker Syndrome Q03.1 Down Syndrome (Trisomy 21) Q90.9 Duchenne Muscular Dystrophy G71.0 Dyggve -Melchio r-Clausen Syndrome (DMC Disease, DMC Q77 .7 Syndrome, Smith-McCort Dysplasia) Fragile X Syndrome Q99.2 Fraser Syndrome (Cryptophthalmos Syndrome, Meyer -Schwickerath's syndrome, Q87.0 Fraser-Francois syndrome, Ullrich-Feichtiger syndrome) Galactosemia E74.21 Gaucher Syndrome (Glucosylceramide storage disease; GSDI) E75.22 Glutaric Aciduria Type I E72.3 Type II E71.313 Glycog en Storage Disease E74.00 Jeune Syndrome Q77.2 Joubert Syndrome Q03.1 Krabbe’s disease E75.23 Lesch -Nyhan Syndrome E79.1 Lissencephaly Syndrome (Miller -Dieker Syndrome, Agyria) Q93.88 Maple Syrup Urine E71.0 Rev.
    [Show full text]
  • Distinction of Mohr`S Syndrome from OFD Type I: Case Report and Review of the Literature
    Distinction of Mohr`s Syndrome from OFD Type I: Case Report and Review of the Literature Rahul Kathariya1, Ketkee Asnani1, Amrita Bansal1, Hansa Jain1, Archana Devanoorkar2, Nishit Kumar Shah3 1Department of Periodontics and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, India. 2Department of Periodontics, AME's Dental College and Hospital, Bijengere Road, Raichur-584103, India. 3Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Jamnagar-361006, India. Abstract The Oralfacialdigital Syndromes (OFD) results from the pleiotropic effect of a morphogenetic impairment affecting almost invariably the mouth, face and digits. In view of the different modes of inheritance and the different prognoses of the most common OFDs; OFD I, and II, it is important to establish a correct diagnosis in these patients. A case of type II OFD syndrome is being reported and the distinguishing clinico-radiological features with type I are compared. This case reports also reviews the various other types of OFD and their distinguishing characteristics and emphasizes the early diagnosis and treatment of the same. Key Words: Oralfacialdigital Syndrome, Mohr Syndrome, OFD1 Protein- Humanm, Syndactyly, Brachydactyly, Genetics, X-Linked Disease, Gene CXORF5 Introduction found to escape X-inactivation in humans, while the murine Oral-Facial-Digital Syndrome (OFD) is the collective name counterpart is subject to X-inactivation [7]. of a group of rare inherited syndromes characterized by The inheritance pattern of OFD II is autosomal recessive, malformations of the face, oral cavity, hands and feet [1]. Mohr i.e. both parents are healthy carriers of the mutated gene is credited with the first description of patients with oral- (Figure 1).
    [Show full text]