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Yu L, Zhao Y. Adenoidectomy in a child with Crouzon syndrome complicated with severe obstructive sleep apnea: Case report and review of literature. Medicine (Baltimore) 2024; 103:e38534. [PMID: 38847734 PMCID: PMC11155574 DOI: 10.1097/md.0000000000038534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/05/2023] [Indexed: 06/10/2024] Open
Abstract
RATIONALE Crouzon syndrome is an extremely rare craniofacial dysplasia, which is mainly caused by the early ossification and closure of the coronal suture of the skull. Craniofacial deformities can cause stenosis of the nasal cavity and posterior nasal meatus, resulting in sleep apnea. PATIENT CONCERNS A 9-year-old boy with sleep snoring for 6 years, progressive aggravation in the past 1 month and accompanied by apnea during sleep. DIAGNOSES This case was diagnosed with Crouzon syndrome complicated with severe obstructive sleep apnea and severe hypoxemia. INTERVENTIONS After adenoidectomy, he was admitted to the pediatric intensive care unit with ventilator-assisted respiration. During this period, the blood oxygen saturation fluctuated greatly. After trying to extubate, the blood oxygen was difficult to maintain and had to be intubated again. After active treatment, extubation was successful. OUTCOMES The wound of nasopharynx recovered well and the sleep state was significantly improved 3 months postoperation. LESSONS It is suggested that the time of ventilator-assisted breathing should be prolonged and the perioperative airway management should be strengthened in order to reduce the risk of postoperative complications.
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Affiliation(s)
- Lei Yu
- Department of Otolaryngology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuliang Zhao
- Department of Otolaryngology, Second Hospital of Hebei Medical University, Shijiazhuang, China
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Harmon KA, Ferraro J, Rezania N, Carmona T, Figueroa AA, Tragos C. Crouzon Syndrome Spanning Three Generations: Advances in the Treatment of Syndromic Midface Deficiency. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5296. [PMID: 38033876 PMCID: PMC10684202 DOI: 10.1097/gox.0000000000005296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/07/2023] [Indexed: 12/02/2023]
Abstract
Background Crouzon syndrome is an autosomal dominant genetic disorder characterized by craniosynostosis, midface retrusion, and exophthalmos. Over the past century, the treatment of craniofacial disorders like Crouzon syndrome has evolved significantly. Methods An institutional review board-approved retrospective study was conducted to ascertain the treatment of three individuals with Crouzon syndrome from one family, complemented with a series of literature searches to examine the evolution of craniofacial surgical history. Results Dr. David Williams Cheever developed the Le Fort I level to correct malocclusion, maxillomandibular malformations, and midface hypoplasia. Later, Dr. Paul Tessier introduced the Le Fort II and III osteotomies to treat syndromic midface hypoplasia. In 1978, Dr. Fernando Ortiz-Monasterio and Dr. Antonio Fuente del Campo published the first series of monobloc osteotomies, allowing for simultaneous correction of supraorbital and midface malformations, although complicated by blood loss and high infection rates. In 1992, McCarthy et al introduced the concept of gradual distraction to the craniofacial skeleton. In 1995, Polley et al performed the first monobloc advancement using external distraction. Subsequently, in 1997, Polley and Figueroa introduced a rigid external distraction device with multiple vector control to manage severe cleft maxillary hypoplasia. The technique was further refined and applied to treat syndromic midface hypoplasia, reducing complication rates. Currently, either external or internal distraction approaches are used to safely treat this challenging group of patients. Conclusion The treatment of syndromic midface deficiency has significantly evolved over the past 50 years, as evidenced by this report of three generations of Crouzon syndrome.
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Affiliation(s)
- Kelly A. Harmon
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | - Jennifer Ferraro
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | - Nikki Rezania
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | | | - Alvaro A. Figueroa
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
| | - Christina Tragos
- From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Ill
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Palominos MF, Muhl V, Richards EJ, Miller CT, Martin CH. Jaw size variation is associated with a novel craniofacial function for galanin receptor 2 in an adaptive radiation of pupfishes. Proc Biol Sci 2023; 290:20231686. [PMID: 37876194 PMCID: PMC10598438 DOI: 10.1098/rspb.2023.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Understanding the genetic basis of novel adaptations in new species is a fundamental question in biology. Here we demonstrate a new role for galr2 in vertebrate craniofacial development using an adaptive radiation of trophic specialist pupfishes endemic to San Salvador Island, Bahamas. We confirmed the loss of a putative Sry transcription factor binding site upstream of galr2 in scale-eating pupfish and found significant spatial differences in galr2 expression among pupfish species in Meckel's cartilage using in situ hybridization chain reaction (HCR). We then experimentally demonstrated a novel role for Galr2 in craniofacial development by exposing embryos to Garl2-inhibiting drugs. Galr2-inhibition reduced Meckel's cartilage length and increased chondrocyte density in both trophic specialists but not in the generalist genetic background. We propose a mechanism for jaw elongation in scale-eaters based on the reduced expression of galr2 due to the loss of a putative Sry binding site. Fewer Galr2 receptors in the scale-eater Meckel's cartilage may result in their enlarged jaw lengths as adults by limiting opportunities for a circulating Galr2 agonist to bind to these receptors during development. Our findings illustrate the growing utility of linking candidate adaptive SNPs in non-model systems with highly divergent phenotypes to novel vertebrate gene functions.
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Affiliation(s)
- M. Fernanda Palominos
- Department of Integrative Biology, University of California, 3101 Valley Life Sciences Building, Berkeley, CA 94720, USA
- Museum of Vertebrate Zoology, University of California, Berkeley, CA 94720, USA
| | - Vanessa Muhl
- Department of Integrative Biology, University of California, 3101 Valley Life Sciences Building, Berkeley, CA 94720, USA
- Museum of Vertebrate Zoology, University of California, Berkeley, CA 94720, USA
| | - Emilie J. Richards
- Department of Ecology, Evolution, and Behavior, University of Minnesota, Minneapolis, MN, USA
| | - Craig T. Miller
- Department of Molecular & Cell Biology, University of California, Berkeley, CA, USA
| | - Christopher H. Martin
- Department of Integrative Biology, University of California, 3101 Valley Life Sciences Building, Berkeley, CA 94720, USA
- Museum of Vertebrate Zoology, University of California, Berkeley, CA 94720, USA
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Grenier-Chartrand F, Taverne M, James S, Guida L, Paternoster G, Loiselet K, Beccaria K, Dangouloff-Ros V, Levy R, de Saint Denis T, Blauwblomme T, Khonsari RH, Boddaert N, Benichi S. Mobility Assessment Using Multi-Positional MRI in Children with Cranio-Vertebral Junction Anomalies. J Clin Med 2023; 12:6714. [PMID: 37959181 PMCID: PMC10650482 DOI: 10.3390/jcm12216714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE This study aimed to assess the relevance of using multi-positional MRI (mMRI) to identify cranio-vertebral junction (CVJ) instability in pediatric patients with CVJ anomalies while determining objective mMRI criteria to detect this condition. MATERIAL AND METHODS Data from children with CVJ anomalies who underwent a mMRI between 2017 and 2021 were retrospectively reviewed. Mobility assessment using mMRI involved: (1) morphometric analysis using hierarchical clustering on principal component analysis (HCPCA) to identify clusters of patients by considering their mobility similarities, assessed through delta (Δ) values of occipito-cervical parameters measured on mMRI; and (2) morphological analysis based on dynamic geometric CVJ models and analysis of displacement vectors between flexion and extension. Receiver operating characteristics (ROC) curves were generated for occipito-cervical parameters to establish instability cut-off values. (3) Additionally, an anatomical qualitative analysis of the CVJ was performed to identify morphological criteria of instability. RESULTS Forty-seven patients with CVJ anomalies were included (26 females, 21 males; mean age: 10.2 years [3-18]). HCPCA identified 2 clusters: cluster №1 (stable patients, n = 39) and cluster №2 (unstable patients, n = 8). ΔpB-C2 (pB-C2 line delta) at ≥2.5 mm (AUC 0.98) and ΔBAI (Basion-axis Interval delta) ≥ 3 mm (AUC 0.97) predicted instability with 88% sensibility and 95% specificity and 88% sensitivity and 85% specificity, respectively. Geometric CVJ shape analysis differentiated patients along a continuum, from a low to a high CVJ motion that was characterized by a subluxation of C1 in the anterior direction. Qualitative analysis found correlations between instability and C2 anomalies, including fusions with C3 (body p = 0.032; posterior arch p = 0.045; inferior articular facets p = 0.012; lateral mass p = 0.029). CONCLUSIONS We identified a cluster of pediatric patients with CVJ instability among a cohort of CVJ anomalies that were characterized by morphometric parameters with corresponding cut-off values that could serve as objective mMRI criteria. These findings warrant further validation through prospective case-control studies.
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Affiliation(s)
- Flavie Grenier-Chartrand
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Neurosurgery, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, 1070 Bruxelles, Belgium
| | - Maxime Taverne
- Craniofacial Growth and Form, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Syril James
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Lelio Guida
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
| | - Klervie Loiselet
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
| | - Volodia Dangouloff-Ros
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Raphaël Levy
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Timothée de Saint Denis
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
| | - Roman Hossein Khonsari
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Craniofacial Growth and Form, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
- Department of Maxillofacial Surgery and Plastic Surgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
| | - Nathalie Boddaert
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Department of Pediatric Imaging, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France;
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France; (F.G.-C.); (S.J.); (L.G.); (G.P.); (K.B.); (T.d.S.D.); (T.B.)
- School of Medicine, Paris-Cité University, 75006 Paris, France; (K.L.); (R.H.K.); (N.B.)
- Reference Center for Rare Diseases C-MAVEM (Chiari, Spinal Cord and Vertebral Diseases), Necker-Enfants Malades University Hospital, AP-HP, 75015 Paris, France
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Palominos MF, Muhl V, Richards EJ, Miller CT, Martin CH. Jaw size variation is associated with a novel craniofacial function for galanin receptor 2 in an adaptive radiation of pupfishes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.02.543513. [PMID: 37333213 PMCID: PMC10274624 DOI: 10.1101/2023.06.02.543513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Understanding the genetic basis of novel adaptations in new species is a fundamental question in biology that also provides an opportunity to uncover new genes and regulatory networks with potential clinical relevance. Here we demonstrate a new role for galr2 in vertebrate craniofacial development using an adaptive radiation of trophic specialist pupfishes endemic to San Salvador Island in the Bahamas. We confirmed the loss of a putative Sry transcription factor binding site in the upstream region of galr2 in scale-eating pupfish and found significant spatial differences in galr2 expression among pupfish species in Meckel's cartilage and premaxilla using in situ hybridization chain reaction (HCR). We then experimentally demonstrated a novel function for Galr2 in craniofacial development and jaw elongation by exposing embryos to drugs that inhibit Galr2 activity. Galr2-inhibition reduced Meckel's cartilage length and increased chondrocyte density in both trophic specialists but not in the generalist genetic background. We propose a mechanism for jaw elongation in scale-eaters based on the reduced expression of galr2 due to the loss of a putative Sry binding site. Fewer Galr2 receptors in the scale-eater Meckel's cartilage may result in their enlarged jaw lengths as adults by limiting opportunities for a postulated Galr2 agonist to bind to these receptors during development. Our findings illustrate the growing utility of linking candidate adaptive SNPs in non-model systems with highly divergent phenotypes to novel vertebrate gene functions.
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Affiliation(s)
- M Fernanda Palominos
- Department of Integrative Biology, University of California, Berkeley
- Museum of Vertebrate Zoology, University of California, Berkeley
| | - Vanessa Muhl
- Department of Integrative Biology, University of California, Berkeley
- Museum of Vertebrate Zoology, University of California, Berkeley
| | - Emilie J Richards
- Department of Ecology, Evolution, and Behavior, University of Minnesota
| | - Craig T Miller
- Department of Molecular & Cell Biology, University of California, Berkeley
| | - Christopher H Martin
- Department of Integrative Biology, University of California, Berkeley
- Museum of Vertebrate Zoology, University of California, Berkeley
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Coombes K, Yeakle M, Kwiatkowska M, Kwiatkowski M. Mysterious Bilateral Foot Pain in a Child With Crouzon Syndrome. Cureus 2023; 15:e36999. [PMID: 37139018 PMCID: PMC10150616 DOI: 10.7759/cureus.36999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
Crouzon syndrome (CS) is a rare autosomal dominant disorder that requires care from a multidisciplinary team and early surgical management to minimize complications. Despite the shared similarities across craniosynostoses, CS can be differentiated by the presence of normal bone development of the hands and feet and hypertelorism (large distance between the eyes). Other common features include midface hypoplasia, shallow orbits, ocular proptosis, and dental abnormalities including possible bifid uvula or V-shaped maxillary arch. In this report, we present a case of prolonged foot pain in a four-year and two-month-old boy with CS; we also engage in a brief review of the literature. The patient's physical exam and laboratory work were unremarkable on the initial presentation. Radiographic films showed signs of potential demineralization of bone tissue. He was prescribed calcium and vitamin D supplementation with complete resolution of his symptoms at the three-month follow-up visit.
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Kamikonya T, Inokuchi G, Tatehara S, Yui M, Nibu KI. Surgical treatment of bony nasal airway stenosis in a patient with adult Crouzon’s syndrome. J Surg Case Rep 2022; 2022:rjac358. [PMID: 35919695 PMCID: PMC9341303 DOI: 10.1093/jscr/rjac358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/13/2022] Open
Abstract
Crouzon’s syndrome is associated with the respiratory impairment of the upper airway due to mid-facial hypoplasia. We managed an adult Crouzon patient who wanted us to treat his choanal and nasopharyngeal stenosis for obstructive sleep apnea relief and tracheostomy tube extubation. We drilled out the abnormal maxillary bone and created a new nasal passage to the pharynx. Epithelialization of the new nasal cavity was completed within a month, and the patient was able to breathe through the nose and his sense of smell improved somewhat after the surgery. Although the apnea-hypopnea index had decreased, sleep apnea remained.
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Affiliation(s)
- Tatsuhiko Kamikonya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Go Inokuchi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Shun Tatehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Mitsuko Yui
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Kobe , Japan
| | - Ken-ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine , Kobe , Japan
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Rare Genetic Syndromes and Oral Anomalies: A Review of the Literature and Case Series with a New Classification Proposal. CHILDREN 2021; 9:children9010012. [PMID: 35053637 PMCID: PMC8774676 DOI: 10.3390/children9010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
Rare genetic syndromes, conditions with a global average prevalence of 40 cases/100,000 people, are associated with anatomical, physiological, and neurological anomalies that may affect different body districts, including the oral district. So far, no classification of oral abnormalities in rare genetic syndromes is present in the literature. The aim of this narrative review is to analyze literature on rare genetic syndromes affecting dento-oro-maxillofacial structures (teeth, maxillary bones, oral soft tissues, or mixed) and to propose a classification according to the detected oral abnormalities. In addition, five significant cases of rare genetic syndromes are presented. The Scale for the Assessment of Narrative Review Articles (SANRA) was followed for this review. From 674 papers obtained through PubMed search, 351 were selected. Sixty-two rare genetic syndromes involving oral manifestations were found and classified. The proposed classification aims to help the clinician to easily understand which dento-oro-maxillofacial findings might be expected in the presence of each rare genetic syndrome. This immediate framework may both help in the diagnosis of dento-oro-maxillofacial anomalies related to the underlying pathology as well as facilitate the drafting of treatment plans with the involvement of a multidisciplinary team.
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Tripathi T, Srivastava D, Bhutiani N, Rai P. Comprehensive management of Crouzon syndrome: A case report with three-year follow-up. J Orthod 2021; 49:71-78. [PMID: 34100307 DOI: 10.1177/14653125211019412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crouzon syndrome is one of the most common craniosynostosis facial syndromes caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Less commonly, there is a mutation of the FGFR3 gene which results in Crouzon syndrome syndrome with acanthosis nigricans. It involves the premature fusion of sutures of the cranial vault, base, orbital and maxillary region. The clinical presentation of this congenital deformity depends on the pattern and timing of sutural fusion. The present report describes the features and management of this syndrome in an 18-year-old woman. The patient presented with a hypoplastic maxilla, deficient midface, exorbitism due to shallow orbits, severe crowding and bilateral crossbite. A multidisciplinary approach involving orthodontics and surgical intervention with distraction osteogenesis brought about marked improvement in the facial profile, occlusion and upper airway. The aesthetics and function were greatly enhanced, and the results were found to be stable at the end of three years.
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Affiliation(s)
- Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Dhirendra Srivastava
- Oral and Maxillofacial Surgery, Esic Dental College and Hospital, New Delhi, India
| | - Neha Bhutiani
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopedics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Bautista G. Craniosynostosis: Neonatal Perspectives. Neoreviews 2021; 22:e250-e257. [PMID: 33795400 DOI: 10.1542/neo.22-4-e250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Craniosynostosis is the premature fusion of 1 or more sutures that normally separate the bony plates of an infant's skull and occurs in about 1 in 2,000 to 2,500 live births. Primary or congenital craniosynostoses represent the majority of cases and consist of single-suture and multisuture synostoses. Multisuture synostoses are typically associated with distinct craniofacial syndromes, including Muenke syndrome, Apert syndrome, Crouzon syndrome, and Pfeiffer syndrome, and are thus categorized under syndromic craniosynostoses. Secondary causes of craniosynostoses include metabolic or hematologic disorders that affect bone metabolism and typically present much later than primary synostoses. The severity of the deformity and the presence of increased intracranial pressure dictate the need for early surgical intervention, prompting the importance of early recognition and timely referral. Infants with craniosynostosis are also at increased risk for neurodevelopmental impairment and thus require close follow-up and monitoring. The early recognition and referral of craniosynostosis is imperative for the optimization of management and minimization of potential neurologic impairments that may develop.
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Affiliation(s)
- Geoanna Bautista
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Mattel Children's Hospital and the David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Long Term Speech Outcomes Following Midface Advancement in Syndromic Craniosynostosis. J Craniofac Surg 2020; 31:1775-1779. [PMID: 32502111 DOI: 10.1097/scs.0000000000006581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Midface advancement by distraction osteogenesis (DO) is commonly performed in patients with craniosynostosis for indications including midface hypoplasia, exorbitism, obstructive sleep apnea, class III malocclusion, and overall aesthetic facial deficiency. There is evidence to suggest that maxillary LeFort I advancement increases the risk of velopharyngeal dysfunction in the cleft palate population, yet few studies have investigated changes in speech following LeFort III or monobloc midface advancement in patients with syndromic craniosynostosis. The purpose of this study was to examine the effect of midface DO on speech as indicated by the Pittsburgh Weighted Speech Score in patients with Apert, Crouzon, and Pfeiffer Syndrome. Among 73 midface advancement cases performed during the study period, 19 cases met inclusion criteria. Overall, the highest post-advancement Pittsburgh Weighted Speech Score (PWSS) was significantly higher than the pre-advancement PWSS (0.52 versus 2.42, P = 0.01), indicating an acute worsening of VPI post-advancement. Specifically, the PWSS components nasal emission and nasality were significantly higher post-advancement than pre-advancement (nasal emission: 1.16 versus 0.21, P = 0.02) (nasality: 0.68 versus 0.05, P = 0.04). However, there was no significant difference between pre-advancement PWSS and the latest post-advancement PWSS (P = 0.31). Midface distraction is associated with an acute worsening of VPI post-operatively that is followed by improvement, and often resolution over time. Future work with additional patient accrual is needed to determine the effect of different advancement procedures and syndromes on VPI rates and profundity.
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Petelin Gadze Z, Vuksic M, Bujan Kovac A, Nankovic S, Sulentic V. Sleep-related hypermotor epilepsy in a patient with mild Crouzon syndrome. Acta Neurol Belg 2020; 120:391-393. [PMID: 29235060 DOI: 10.1007/s13760-017-0871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Zeljka Petelin Gadze
- Department of Neurology, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Marija Vuksic
- Polyclinic for Neurology and Diagnostic Neurophysiology, Neuropsychiatric Hospital "Dr Ivan Barbot", Popovaca, Croatia.
| | - Andreja Bujan Kovac
- Department of Neurology, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Sibila Nankovic
- Department of Neurology, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Vlatko Sulentic
- Department of Neurology, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
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Umezu T, Fujita N, Yagi M, Tsuji O, Nagoshi N, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Surgical Correction of Severe Kyphoscoliosis Associated with Crouzon Syndrome with Serious Postoperative Respiratory Problems: A Case Report. JBJS Case Connect 2019; 7:e98. [PMID: 29280899 DOI: 10.2106/jbjs.cc.17.00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 12-year-old girl with Crouzon syndrome presented to our hospital with scoliosis (114°) and kyphosis from T8 to T12 (138°). After she had been in halo-gravity traction for 2 weeks, we performed posterior correction and fusion surgery from T3 to L3, with a posterior vertebral column resection of T10. She experienced postoperative respiratory failure and remained on a ventilator for 4 weeks. With rehabilitation, the respiratory function had recovered by postoperative week 8. At the 2-year follow-up, there was no loss of correction or any other complication. CONCLUSION Serious perioperative respiratory complications may occur when a patient with Crouzon syndrome is treated surgically.
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Affiliation(s)
- Taro Umezu
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Improvement of Color Vision Following Posterior Cranial Vault Distraction for Crouzon Syndrome. J Craniofac Surg 2018; 29:868-870. [PMID: 29485554 DOI: 10.1097/scs.0000000000004353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Crouzon syndrome (CS) is one of the craniosynostosis syndromes that leads to early fusion of cranial sutures and increased intracranial pressure. Intracranial hypertension is a serious complication that may lead to vision loss and cognitive impairment. Early detection and management are necessary to prevent complications. The authors present a patient with CS who underwent posterior cranial vault reconstruction with internal distraction after multiple episodes of headache and papilledema. The patient was unaware of any loss of color vision before the surgery; however, he noted an improvement in his color vision after the surgery. Color vision deficits may be an early sign of intracranial hypertension and finding these deficits using noninvasive testing methods may be an indication for early intervention.
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Holmes G, Zhang L, Rivera J, Murphy R, Assouline C, Sullivan L, Oppeneer T, Jabs EW. C-type natriuretic peptide analog treatment of craniosynostosis in a Crouzon syndrome mouse model. PLoS One 2018; 13:e0201492. [PMID: 30048539 PMCID: PMC6062116 DOI: 10.1371/journal.pone.0201492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
Activating mutations of fibroblast growth factor receptors (FGFRs) are a major cause of skeletal dysplasias, and thus they are potential targets for pharmaceutical intervention. BMN 111, a C-type natriuretic peptide analog, inhibits FGFR signaling at the level of the RAF1 kinase through natriuretic peptide receptor 2 (NPR2) and has been shown to lengthen the long bones and improve skull morphology in the Fgfr3Y367C/+ thanatophoric dysplasia mouse model. Here we report the effects of BMN 111 in treating craniosynostosis and aberrant skull morphology in the Fgfr2cC342Y/+ Crouzon syndrome mouse model. We first demonstrated that NPR2 is expressed in the murine coronal suture and spheno-occipital synchondrosis in the newborn period. We then gave Fgfr2cC342Y/+ and Fgfr2c+/+ (WT) mice once-daily injections of either vehicle or reported therapeutic levels of BMN 111 between post-natal days 3 and 31. Changes in skeletal morphology, including suture patency, skull dimensions, and long bone length, were assessed by micro-computed tomography. Although BMN 111 treatment significantly increased long bone growth in both WT and mutant mice, skull dimensions and suture patency generally were not significantly affected. A small but significant increase in the relative length of the anterior cranial base was observed. Our results indicate that the differential effects of BMN 111 in treating various skeletal dysplasias may depend on the process of bone formation targeted (endochondral or intramembranous), the specific FGFR mutated, and/or the specific signaling pathway changes due to a given mutation.
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Affiliation(s)
- Greg Holmes
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lening Zhang
- BioMarin Pharmaceutical, Novato, California, United States of America
| | - Joshua Rivera
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ryan Murphy
- BioMarin Pharmaceutical, Novato, California, United States of America
| | - Claudia Assouline
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lorraine Sullivan
- BioMarin Pharmaceutical, Novato, California, United States of America
| | - Todd Oppeneer
- BioMarin Pharmaceutical, Novato, California, United States of America
| | - Ethylin Wang Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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16
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Abstract
Summary
Crouzon syndrome is a rare genetic disorder with autosomal dominant inheritance. The underlying pathological process is premature synostosis of the cranial sutures with subsequent phenotypic alterations of the affected person. A review of the literature has been conducted in order to resume the overall characteristics of Crouzon syndrome such as craniomaxillofacial malformations, clinical features, dentoalveolar characteristics, aesthetic impairments, and psychological background, as well as, the different therapeutic procedures, which combine surgical and orthodontic interventions. Facial and functional malformations in individuals with Crouzon syndrome could be significantly improved after a series of surgical and orthodontic procedures in almost all cases. A multidisciplinary treatment approach would provide the best outcomes in affected patients.
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17
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Khominsky A, Yong R, Ranjitkar S, Townsend G, Anderson PJ. Extensive phenotyping of the orofacial and dental complex in Crouzon syndrome. Arch Oral Biol 2017; 86:123-130. [PMID: 29223639 DOI: 10.1016/j.archoralbio.2017.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Fibroblast growth factor receptor 2 (FGFR2) C342Y/+ mutation is a known cause of Crouzon syndrome that is characterised by craniosynostosis and midfacial hypoplasia. Our aim was to conduct extensive phenotyping of the maxillary, mandibular and dental morphology associated with this mutation. MATERIALS AND METHODS Morphometric data were obtained from 40 mice, representing two genotypes (Crouzon and wild-type) and two sexes (males and females) (n=10 in each group). Dental analysis further categorised the first molars into the two jaws (maxillary and mandibular) (n=20 in each group). Maxillary, mandibular and dental morphology was compared by analysing 23 linear landmark-based dimensions in three-dimensional micro-computed tomography reconstructions. RESULTS Compared with wild-type, Crouzon (FGFR2C342Y/+) maxillae were significantly shorter in maximum height, anterior and posterior lengths and middle width, but larger in posterior width (p<0.05 for height; p<0.001 for other comparisons). In the Crouzon mandible, the ascending and descending heights, effective and mandibular lengths, and intercoronoid and intercondylar widths were significantly shorter, whereas intergonial width was larger (p<0.01 for intercondylar width; p<0.001 for other comparisons). Crouzon teeth were significantly smaller mesiodistally, but larger in crown height (p<0.001 for each comparison). All Crouzon mice presented with bifid mandibular condyles and a quarter presented with expansive bone lesions in the mandibular incisor alveolus. CONCLUSIONS Our findings of hypoplasia in all three planes in Crouzon maxillae and mandibles, together with the presence of bifid mandibular condyles and expansive bone lesions, may be relevant to maxillofacial surgery and orthodontics. Beyond skeletal effects, the FGFR2C342Y/+ mutation is now implicated in affecting tooth development. This study's skeletal phenomics data also provides baseline data against which the effect of various treatments can now be assessed.
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Affiliation(s)
- Alexander Khominsky
- Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Robin Yong
- Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Sarbin Ranjitkar
- Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - Grant Townsend
- Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Peter J Anderson
- Adelaide Dental School, The University of Adelaide, Adelaide, SA 5005, Australia; Australian Craniofacial Unit, Women's and Children's Hospital, 72 King William St, Adelaide, SA 5006, Australia
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18
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Sargar KM, Singh AK, Kao SC. Imaging of Skeletal Disorders Caused by Fibroblast Growth Factor Receptor Gene Mutations. Radiographics 2017; 37:1813-1830. [DOI: 10.1148/rg.2017170017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kiran M. Sargar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (K.M.S.); Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Tex (A.K.S.); and Department of Radiology, University of Iowa College of Medicine, Iowa City, Iowa (S.C.K.)
| | - Achint K. Singh
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (K.M.S.); Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Tex (A.K.S.); and Department of Radiology, University of Iowa College of Medicine, Iowa City, Iowa (S.C.K.)
| | - Simon C. Kao
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (K.M.S.); Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, Tex (A.K.S.); and Department of Radiology, University of Iowa College of Medicine, Iowa City, Iowa (S.C.K.)
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19
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Peskett E, Kumar S, Baird W, Jaiswal J, Li M, Patel P, Britto JA, Pauws E. Analysis of the Fgfr2C342Y mouse model shows condensation defects due to misregulation of Sox9 expression in prechondrocytic mesenchyme. Biol Open 2017; 6:223-231. [PMID: 28069589 PMCID: PMC5312100 DOI: 10.1242/bio.022178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Syndromic craniosynostosis caused by mutations in FGFR2 is characterised by developmental pathology in both endochondral and membranous skeletogenesis. Detailed phenotypic characterisation of features in the membranous calvarium, the endochondral cranial base and other structures in the axial and appendicular skeleton has not been performed at embryonic stages. We investigated bone development in the Crouzon mouse model (Fgfr2C342Y) at pre- and post-ossification stages to improve understanding of the underlying pathogenesis. Phenotypic analysis was performed by whole-mount skeletal staining (Alcian Blue/Alizarin Red) and histological staining of sections of CD1 wild-type (WT), Fgfr2C342Y/+ heterozygous (HET) and Fgfr2C342Y/C342Y homozygous (HOM) mouse embryos from embryonic day (E)12.5-E17.5 stages. Gene expression (Sox9, Shh, Fgf10 and Runx2) was studied by in situ hybridisation and protein expression (COL2A1) by immunohistochemistry. Our analysis has identified severely decreased osteogenesis in parts of the craniofacial skeleton together with increased chondrogenesis in parts of the endochondral and cartilaginous skeleton in HOM embryos. The Sox9 expression domain in tracheal and basi-cranial chondrocytic precursors at E13.5 in HOM embryos is increased and expanded, correlating with the phenotypic observations which suggest FGFR2 signalling regulates Sox9 expression. Combined with abnormal staining of type II collagen in pre-chondrocytic mesenchyme, this is indicative of a mesenchymal condensation defect. An expanded spectrum of phenotypic features observed in the Fgfr2C342Y/C342Y mouse embryo paves the way towards better understanding the clinical attributes of human Crouzon-Pfeiffer syndrome. FGFR2 mutation results in impaired skeletogenesis; however, our findings suggest that many phenotypic aberrations stem from a primary failure of pre-chondrogenic/osteogenic mesenchymal condensation and link FGFR2 to SOX9, a principal regulator of skeletogenesis.
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Affiliation(s)
- Emma Peskett
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Samin Kumar
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - William Baird
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Janhvi Jaiswal
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Ming Li
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Priyanca Patel
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Jonathan A Britto
- Craniofacial Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Erwin Pauws
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
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20
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Graul-Neumann LM, Klopocki E, Adolphs N, Mensah MA, Kress W. Mutation c.943G>T (p.Ala315Ser) in FGFR2 Causing a Mild Phenotype of Crouzon Craniofacial Dysostosis in a Three-Generation Family. Mol Syndromol 2017; 8:93-97. [PMID: 28611549 DOI: 10.1159/000455028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 02/03/2023] Open
Abstract
Crouzon syndrome craniofacial dysostosis type I [OMIM 123500] is caused by mutations in the gene encoding fibroblast growth factor receptor-2 (FGFR2). An overlapping phenotype with Muenke and Crouzon syndrome with acanthosis nigricans (FGFR3 mutations) is known. The clinical diagnosis can be corroborated by molecular studies in about 80-90% of the cases. No clear genotype/phenotype correlation has been identified yet. Here, we describe a second family with a mild phenotype in which the FGFR2 mutation c.943G>T leading to the amino acid substitution p.Ala315Ser was detected. Five affected family members showed craniofacial dysostosis without overt craniosynostosis. They all had midface hypoplasia. Crouzonoid appearance with mild protrusion of bulbi was only apparent in our index patient as well as obstructive sleep apnea episodes leading to reduced oxygen saturation; therefore, surgical intervention was suggested. One other affected family member additionally had iris coloboma.
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Affiliation(s)
| | - Eva Klopocki
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | | | - Martin A Mensah
- Institut für Medizinische Genetik und Humangenetik, Charité Universitätsmedizin Berlin, Berlin, Würzburg, Germany
| | - Wolfram Kress
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
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21
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Whelan EC, Nwala AC, Osgood C, Olariu S. Selective mutation accumulation: a computational model of the paternal age effect. Bioinformatics 2016; 32:3790-3797. [PMID: 27531106 DOI: 10.1093/bioinformatics/btw528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/12/2016] [Accepted: 08/09/2016] [Indexed: 11/14/2022] Open
Abstract
MOTIVATION As the mean age of parenthood grows, the effect of parental age on genetic disease and child health becomes ever more important. A number of autosomal dominant disorders show a dramatic paternal age effect due to selfish mutations: substitutions that grant spermatogonial stem cells (SSCs) a selective advantage in the testes of the father, but have a deleterious effect in offspring. In this paper we present a computational technique to model the SSC niche in order to examine the phenomenon and draw conclusions across different genes and disorders. RESULTS We used a Markov chain to model the probabilities of mutation and positive selection with cell divisions. The model was fitted to available data on disease incidence and also mutation assays of sperm donors. Strength of selective advantage is presented for a range of disorders including Apert's syndrome and achondroplasia. Incidence of the diseases was predicted closely for most disorders and was heavily influenced by the site-specific mutation rate and the number of mutable alleles. The model also successfully predicted a stronger selective advantage for more strongly activating gain-of-function mutations within the same gene. Both positive selection and the rate of copy-error mutations are important in adequately explaining the paternal age effect. AVAILABILITY AND IMPLEMENTATION C ++/R source codes and documentation including compilation instructions are available under GNU license at https://github.com/anwala/NicheSimulation CONTACT: ewhel001@odu.eduSupplementary information: Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Eoin C Whelan
- Department of Biology, Old Dominion University, Norfolk, VA, USA
| | - Alexander C Nwala
- Department of Computer Science, Old Dominion University, Norfolk, VA 23529, USA
| | | | - Stephan Olariu
- Department of Computer Science, Old Dominion University, Norfolk, VA 23529, USA
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Rubio EI, Blask A, Bulas DI. Ultrasound and MR imaging findings in prenatal diagnosis of craniosynostosis syndromes. Pediatr Radiol 2016; 46:709-18. [PMID: 26914936 DOI: 10.1007/s00247-016-3550-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/20/2015] [Accepted: 01/17/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Craniosynostosis syndromes are uncommonly encountered in the prenatal period. Identification is challenging but important for family counseling and perinatal management. OBJECTIVE This series examines prenatal findings in craniosynostosis syndromes, comparing the complementary roles of US and MRI and emphasizing clues easily missed in the second trimester. MATERIALS AND METHODS Six prenatal cases evaluated from 2002 through 2011 were retrospectively reviewed. Referral history, gestational age, and sonographic and MRI findings were reviewed by three pediatric radiologists. Abnormalities of the calvarium, hands, feet, face, airway and central nervous system were compared between modalities. RESULTS The diagnosis was Apert syndrome in three, Pfeiffer syndrome in two and Carpenter syndrome in one. The gestational age at evaluation ranged from 21 to 33 weeks. All six were evaluated by MRI and US, with two undergoing repeat evaluation in the third trimester, yielding a total of eight MRIs and US exams. The referral history suggested cloverleaf skull in two cases but did not suggest craniosynostosis syndrome in any case. In four, the referral suggested central nervous system (CNS) findings that were not confirmed by MRI; additional CNS findings were discovered in the remaining two. In four cases, developing turricephaly resulted in a characteristic "lampshade" contour of the fetal head. Hypertelorism and proptosis were present in five, with proptosis better appreciated by MRI. Digit abnormalities were present in all, seen equally well by MRI and US. Lung abnormalities in the second trimester in one fetus resolved by the third trimester. CONCLUSION Prenatal diagnosis of craniosynostosis syndromes is difficult prior to the third trimester. MRI and US have complementary roles in evaluation of these patients.
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Affiliation(s)
- Eva I Rubio
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA.
| | - Anna Blask
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dorothy I Bulas
- Department of Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA
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23
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Kourelis K, Haronis V, Konandreas I, Kontrafouri A, Asimakopoulos A. Atypical post-adenoidectomy Grisel's syndrome in Crouzon child with kyphotic skull base. Auris Nasus Larynx 2015; 42:416-8. [PMID: 25805067 DOI: 10.1016/j.anl.2015.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 11/30/2022]
Abstract
Crouzon syndrome is characterized by abnormal craniofacial growth due to craniosynostosis. Skull base may also be involved in the pattern of malformations. Grisel's syndrome, an inflammation-mediated atlanto-axial instability occurs rarely in children after adenoidectomy. We report a 9-year-old female Crouzon patient, without vertebral anomalies, who developed severe torticollis few days after adenoid curettage. A deformity of the skull base alone might have induced an irregular arrangement of the craniocervical junction elements, thus increasing the susceptibility to cervical spine complications.
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Affiliation(s)
- Konstantinos Kourelis
- Department of Otolaryngology, Children Hospital of Patras "Karamandaneio", Erythrou Stavrou 40 str., 26331 Patras, Greece.
| | - Vasileios Haronis
- Department of Radiology, Children Hospital of Patras "Karamandaneio", Erythrou Stavrou 40 str., 26331 Patras, Greece
| | - Ioannis Konandreas
- Department of Otolaryngology, Children Hospital of Patras "Karamandaneio", Erythrou Stavrou 40 str., 26331 Patras, Greece
| | - Athina Kontrafouri
- Department of Radiology, Children Hospital of Patras "Karamandaneio", Erythrou Stavrou 40 str., 26331 Patras, Greece
| | - Athanasios Asimakopoulos
- Department of Otolaryngology, Children Hospital of Patras "Karamandaneio", Erythrou Stavrou 40 str., 26331 Patras, Greece
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