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Cui Y, Yin S, Yin X, Liu Y, Zhao B. Removal of a congenital corneal dermoid through tumor excision and lamellar keratoplasty in a young child: A case report. Medicine (Baltimore) 2021; 100:e27981. [PMID: 34889242 PMCID: PMC8663910 DOI: 10.1097/md.0000000000027981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Corneal dermoids are a rare cause of corneal opacification, consisting of abnormal mesoblastic tissue surrounded by epithelium. Here, we describe the case of a 1-year-old child who had a congenital corneal dermoid in the left eye since birth; thus, the patient underwent tumor excision followed by keratoplasty. PATIENT CONCERN A 1-year-old girl was brought to the hospital by her parents, who had been noticing a mass on the surface of her left eyeball since birth. The patient had no other previous or concurrent disease nor family history for dermoids. CLINICAL FINDINGS No abnormalities were present in the cornea and the anterior and posterior segments of the right eye. Eye movement, intraocular pressure, and the position of the upper eyelid of the left eye were normal. No signs of conjunctival hyperemia were present. The tumor presented as a yellowish-pink mass with hair and veins on the surface. DIAGNOSE The patient was initially diagnosed with a keratoconjunctival tumor of the left eye by a clinical doctor. INTERVENTIONS Corneal tumor resection combined with keratoplasty was performed in the patient. Eye drops with 1% cyclosporine were administered 3 times per day to prevent immune rejection. OUTCOMES Based on postoperative pathological examinations, the final diagnosis was a corneal dermoid. The patient had an uneventful healing process and rapid corneal re-epithelization. The ocular surface was stable during the follow-up visits, and no complications emerged. LESSONS We report a rare case of congenital corneal dermoid. We learned that close follow-up is needed after surgery in such cases.
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Affiliation(s)
- Yanyan Cui
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shan Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xuewei Yin
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yonghui Liu
- Liaocheng People's Hospital, Liaocheng, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome. J Craniofac Surg 2021; 32:e217-e218. [PMID: 33705079 DOI: 10.1097/scs.0000000000006919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.
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Gopal M, Ramappa M, Mohamed A, Dhakal R, Chaurasia S. Quantitative corneal neural imaging using in vivo confocal microscopy in cases of congenital corneal anesthesia: A prospective analysis and clinical correlation. Indian J Ophthalmol 2021; 69:262-266. [PMID: 33463569 PMCID: PMC7933903 DOI: 10.4103/ijo.ijo_1252_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: Congenital corneal anesthesia (CCA) is a rare clinical entity that poses a diagnostic dilemma, particularly in the pediatric age group with very little literature on this. Accurate initial diagnosis, evaluation, early identification of risk factors, aggressive systemic workup, and appropriate therapy are paramount to prevent visual loss due to long-term complications of corneal anesthesia. The purpose of the study was to estimate and compare the corneal neural architecture using real time, in vivo confocal microscopy (IVCM) in patients with CCA as against a control population. Methods: This was a retrospective nonconsecutive, comparative clinical case series in a tertiary hospital in South India from June 2015 to December 2018. Methods: IVCM was accomplished in cooperative children in whom central cornea was relatively clear. The clearest three to five images from each eye were selected, and the nerves were analyzed for length, thickness, density, dichotomous pattern, and beading. Statistical analysis was done using Origin v7.0 (Origin Lab Corporation, Northampton, MA, USA). Results: In total, 15 eyes of 11 cases and 20 eyes of 10 controls were imaged. Measurements on corneal nerve density showed a significant difference (P = 0.0005), cases having a lower mean (3.85 ± 1.38 mm per mm2) compared to the controls (6.74 ± 1.75 mm per mm2). Measurements on corneal nerve length (P = 0.28), thickness (P = 0.45), and presence of beading (P = 0.97) and dichotomous pattern (P = 0.07) did not reveal a significant difference between cases and controls. Conclusion: There is a strong relationship between the functional loss (absent corneal sensation) and anatomical decrease (reduced subbasal nerve density) of corneal nerves in congenital corneal anaesthesia.
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Affiliation(s)
- Madhumita Gopal
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Muralidhar Ramappa
- The Cornea Institute; Centre for Rare Eye Diseases and Ocular Genetics; Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit Dhakal
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- The Cornea Institute; Centre for Rare Eye Diseases and Ocular Genetics; Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
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Lateral canthal choristomas associated with colobomas of lateral canthus. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ocular and adnexal anomalies in craniofacial microsomia: Type and prevalence in a multicentre cohort study. Int J Oral Maxillofac Surg 2021; 50:1303-1311. [PMID: 33752938 DOI: 10.1016/j.ijom.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 11/22/2022]
Abstract
The aim of this multicentre retrospective cohort study was to describe and categorize the types of ocular and adnexal anomalies seen in patients with craniofacial microsomia (CFM) and to determine their prevalence. In addition, the relationship between the OMENS-Plus and Pruzansky-Kaban classification for each patient and the presence of ocular anomalies was investigated. A total of 881 patients with CFM from four different craniofacial centres were included. Data on ocular anomalies were gathered from the patient charts. Ocular anomalies were present in 33.9% of patients. Four subgroups of ocular and adnexal anomalies were identified. Type I ocular anomalies were present in 22.2%, type II in 19.0%, type III in 18.4%, and type IV in 14.5%. Several potentially preventable and treatable ocular anomalies were identified. Higher OMENS-Plus classification orbit and soft tissue scores and Pruzansky-Kaban classification mandible scores were associated with an increased risk of ocular anomalies. Based on these results and the clinical implications ocular anomalies may have, we underline the importance of targeted ophthalmological screening in CFM. Healthcare professionals should be aware of the possibility of ocular anomalies in these patients, especially during the critical period for visual development.
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Choudhary DS, Agrawal N, Hada M, Paharia N. Massive corneal-epibulbar dermoid managed with pre-descemetic DALK and SLET. GMS OPHTHALMOLOGY CASES 2021; 11:Doc05. [PMID: 33654652 PMCID: PMC7894126 DOI: 10.3205/oc000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Management of large corneal-epibulbar dermoids always poses a challenge to the surgeons due to deeper corneal involvement. Also, there is a risk of limbal stem cell deficiency and formation of pseudopterygium with larger areas of limbal involvement. We report a novel surgical technique for the management of giant corneal-epibulbar dermoid with pre-descemetic deep anterior lamellar keratoplasty (DALK) and simple limbal epithelial transfer (SLET).
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Affiliation(s)
| | - Nikhil Agrawal
- Department of Ophthalmology, AIIMS, Bathinda, Punjab. India
| | - Maya Hada
- Department of Ophthalmology, SMS Medical College, Jaipur, India
| | - Nidhi Paharia
- Department of Ophthalmology, AIIMS, Bathinda, Punjab. India
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Rooijers W, Caron C, Loudon S, Padwa B, Dunaway D, Forrest C, Koudstaal M. Ocular and adnexal anomalies in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2020; 49:1107-1114. [DOI: 10.1016/j.ijom.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
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Castellino A, Rayamajhi P, Kurkure R, Kameswaran M. Posterior semi-circular canal electrode misplacement in Goldenhar's syndrome. Cochlear Implants Int 2020; 22:56-60. [PMID: 32762309 DOI: 10.1080/14670100.2020.1802905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature documents the incidence of electrode misplacement within the range of 0.2% to 5.8% with the superior SCC as the most common site, followed by the vestibule. In this report, we present the finding of electrode misplacement in the posterior SCC in a child with Goldenhar syndrome which was subsequently corrected. This child with bilateral congenital profound SNHL presented for unilateral cochlear implant surgery. Intraoperatively, the lateral SCC bulge, stapes, oval window, round window niche and pyramid were noted absent, leading to a surgical decision in favour of a subtotal petrosectomy. Using the aberrant facial nerve and jugular bulb as critical landmarks, a cochleostomy was performed in the posteroinferior aspect of the promontory bulge. Although electrode insertion was smooth and complete, NRT was absent in the presence of normal electrode impedance. A post-operative HRCT scan showed the electrodes in the posterior SCC. Repositioning of the electrodes was carried out by creating a new cochleostomy anteroinferior to the previous one. Complete correct electrode insertion was accomplished via this cochleostomy complimented by robust NRT tracings. Cochlear implant electrode insertion should be supported by correct identification of surgical landmarks. Intraoperative impedance testing and NRT help confirm device integrity and correct placement, the absence of which may raise the suspicion of malposition. In the presence of such a suspicion, the post-operative HRCT scan is a useful retrospective guide to corrective action, in a low-cost setting lacking intra-operative imaging facilities like X-ray, Fluoroscopy, Flat Panel CT & CBCT. Abbreviations, BERA: Brainstem Evoked Response Audiometry; CBCT: Cone Beam Computed Tomography; EAC: External Auditory Canal; ITD: Insertion Test Device; LSCS: Lower Segment Caesarean Section; MDT: Multi-Disciplinary Team; NICU: Neonatal Intensive Care Unit; NRT: Neural Response Telemetry; OAE: Oto-Acoustic Emissions; PIH: Pregnancy Induced Hypertension; SCC: Semi-Circular Canal; SNHL: Sensori-Neural Hearing Loss.
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Affiliation(s)
| | | | - Rahul Kurkure
- Madras ENT Research Foundation (P) Ltd, Chennai, India
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Singh M, Kaur M, Grewal AM, Yangzes S, Yadav D, Zadeng Z, Gupta P. Ophthalmic features and management outcomes of 30 children having Goldenhar syndrome. Int Ophthalmol 2019; 40:667-675. [DOI: 10.1007/s10792-019-01227-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/14/2019] [Indexed: 01/02/2023]
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Hoffman S, Sadler L, Totman T, Bagne L. A Possible case of Facio-Auriculo-Vertebral sequence (FAVs) in an adult female from medieval Iceland (13th-16th Century). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:41-47. [PMID: 30265886 DOI: 10.1016/j.ijpp.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This paper presents a possible case of Facio-Auriculo-Vertebral sequence (FAVs) in an adult female from Haffjarðarey, Western Iceland (1200-1563 CE) and a brief review of associated terminology. MATERIALS The skeletal remains of a single adult female (HFE-A-34, 18-24 years old), excavated in 1945 by the National Museum of Iceland. METHODS We carried out macroscopic examination of the cranium and mandible in 2017. RESULTS Right side unilateral asymmetric craniofacial dysplasia was identified on the cranium and mandible of HFE-A-34. CONCLUSIONS This individual presents with anomalous craniofacial asymmetry consistent with a clinical diagnosis of FAVs. SIGNIFICANCE This paper offers a visually distinct case of an under-represented and under-documented congenital condition for future identification within paleopathology. LIMITATIONS Infra-cranial skeletal manifestations of FAVs would strengthen this possible diagnosis, but at this time it is not possible to definitively link the cranium and mandible of HFE-A-34 to any of the infra-cranial remains excavated from Haffjarðarey. SUGGESTIONS FOR FURTHER RESEARCH In addition to further clarifying the variable nature of FAVs in archaeological remains, a detailed discussion of disability and the perception of disabled individuals within the medieval North Atlantic is necessary in order to understand the lived experiences of affected individuals.
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Affiliation(s)
- Sarah Hoffman
- The University at Buffalo, Department of Anthropology, Buffalo, New York, United States.
| | - Laurie Sadler
- Division of Genetics, Department of Pediatrics, Oishei Children's Hospital, Jacobs School of Medicine and Biomedical Studies, University of Buffalo, Buffalo, New York, United States
| | - Trevor Totman
- The University at Buffalo, Department of Anthropology, Buffalo, New York, United States
| | - Lea Bagne
- Independent Researcher and Photographer, Buffalo, New York, United States
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Nishimoto S, Sotsuka Y, Kawai K, Ide YH, Kakibuchi M. Congenital lipomatous tumour, presented as a polypoidal projection on upper eyelid. J Surg Case Rep 2017; 2017:rjx139. [PMID: 28775837 PMCID: PMC5534016 DOI: 10.1093/jscr/rjx139] [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: 05/14/2017] [Accepted: 07/01/2017] [Indexed: 11/23/2022] Open
Abstract
A Japanese baby was born with a polypoidal projection with hair, on the lateral corner of upper eyelid. The tumour had extent to bulbar sub-conjunctival area. He presented no other malformation nor pathological symptoms. There was no sign of association with Goldenhar, hemifacial macrosomia, epidermal nevus or linear nevus sebaceous syndromes. The tumour was resected at his age of 4 months. The ocular conjunctiva was incised but not excised. Histopathologically, it was mainly consisted of multi-lobuled mature adipose tissue, dense fibrous tissue was observed at the centre of mass, assumed to be the link of palpebral tarsal plate to lateral canthal ligament. As for the location and component, the tumour was diagnosed as a lipomatous hamartoma. Detached tarsal plate was reattached to the lateral canthal ligament. Satisfactory result was achieved aesthetically and functionally. Congenital lipomatous hamartoma, with protuberant appendage appearance on eyelid, without syndromic association, is presented.
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Affiliation(s)
- Soh Nishimoto
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yohei Sotsuka
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kenichiro Kawai
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshi-Hiro Ide
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Masao Kakibuchi
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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Goldenhar Syndrome with Dextrocardia and Right Pulmonary Hypoplasia: An Unusual Association. Case Rep Genet 2017; 2017:2625030. [PMID: 28377826 PMCID: PMC5362707 DOI: 10.1155/2017/2625030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/02/2017] [Indexed: 11/17/2022] Open
Abstract
Goldenhar syndrome (GS), a rare condition, occurring due to defect in development of first and second branchial arches, is characterized by a combination of various anomalies involving face, eyes, ears, vertebrae, heart, and lungs. The etiology of GS is not fully known, although various hypotheses have been proposed along with its genetic association and many other causes. Facial asymmetry and hypoplasia of the mandible are characteristic features of GS along with microtia and preauricular appendages and pits. Dextrocardia or pulmonary hypoplasia in GS has previously been reported separately. We report a 7-year-old female child of GS with combination of anomalies, dextrocardia, and pulmonary hypoplasia, which is a rare association.
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Jakobiec FA, Stagner AM, Katowitz WR, Eagle RC. A microanatomic abnormality of the lacrimal gland associated with Goldenhar syndrome. Surv Ophthalmol 2016; 61:654-63. [DOI: 10.1016/j.survophthal.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/26/2022]
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Walker BA, Saltzman BS, Herlihy EP, Luquetti DV. Phenotypic characterization of epibulbar dermoids. Int Ophthalmol 2016; 37:499-505. [PMID: 27405313 DOI: 10.1007/s10792-016-0285-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 07/02/2016] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to characterize the phenotypic presentation, clinical course, and outcomes of epibulbar dermoids (EpDs) which are the most common congenital eye tumor in children. Sixty-eight dermoids were identified in 58 eyes of 48 patients of Seattle Children's Hospital between 1981 and 2014 via electronic medical record search. Patients were organized into: "EpD-Only" [patients without other congenital anomalies (n = 13)], "EpD-CFM" [patients with a craniofacial microsomia (CFM) diagnosis (n = 25)], and "EpD-Other" [patients with other congenital anomalies (n = 10)]. All EpD in the EpD-Only group were unilateral and singular, while the EpD-CFM group had six cases with multiple unilateral EpD and five cases with bilateral EpD. In the EpD-Only group, 69 % of EpD were left sided, whereas in the EpD-CFM group, there was no side predisposition. Among both groups, the majority of EpD were limbal or lipodermoids in the inferotemporal quadrant of the eye. Surgery was more common and at a younger age in the EpD-CFM group than the EpD-Only group (56 vs. 38 %, 5.2 vs. 7.0 years). Follow-up surgeries occurred only in the EpD-CFM group (21 %). EpDs were most commonly associated with preauricular tags, congenital heart defects, genitourinary, and nervous system anomalies. Whereas the location and type of EpDs did not significantly differ between the groups, the phenotype in the EpD-Only group appears to be less complex. This may indicate an important difference between EpDs in isolation and those within CFM. Additional studies will further characterize these phenotypes and outcomes.
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Affiliation(s)
- Brian A Walker
- University of Washington School of Medicine, Seattle, WA, USA.
- Seattle Children's Research Institute, Seattle, WA, USA.
| | - Babette S Saltzman
- Seattle Children's Research Institute, Seattle, WA, USA
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin P Herlihy
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Department of Surgery, Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA
| | - Daniela V Luquetti
- Seattle Children's Research Institute, Seattle, WA, USA
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Craniofacial Microsomia: Goldenhar Syndrome in Association with Bilateral Congenital Cataract. Case Rep Ophthalmol Med 2015; 2015:435967. [PMID: 26635984 PMCID: PMC4617704 DOI: 10.1155/2015/435967] [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: 07/06/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022] Open
Abstract
Craniofacial microsomia (CFM) includes a spectrum of malformations primarily involving structures derived from the first and second branchial arches. Patients with hemifacial microsomia and epibulbar dermoids are said to have Goldenhar syndrome (GHS). Four-month-old boy with whitish pupillary reflex presented with the features of GHS in pediatric ophthalmology clinic. The child had ocular and auricular manifestations. There were no vertebral anomalies, but he had bilateral congenital cataract. The peculiarity of this case is the presence of the bilateral total congenital cataract, in association with CFM. There is absence of epibulbar dermoid or lipodermoid in the eyes, although the child had features of GHS. In addition to it, anesthetic intubation was smooth in this case. Any case diagnosed with CFM and/or GHS needs treatment through multidisciplinary approach, consultation in ophthalmology department is one of them.
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Abstract
Ocular lipodermoid cysts and solid dermoid tumors are choristomas which are described as normal tissue growth in an abnormal location. Congenital epibulbar lipodermoid comprises adipose tissue that is covered by connective tissue. They are usually located superotemporally, and basically tend not to involve the peripheral cornea. If the dermoid or lipodermoid is accompanied by other systemic conditions or ocular anomalies in young children, a consultation with an Internist or pediatrician is required to rule out Goldenhar syndrome which is a oculoauriculovertebral dysplasia. This paper reports a unilateral lipodermoid cyst which is remarkable regarding its caruncular origin, in an otherwise healthy adult female.
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Affiliation(s)
- Mohammad Taher Rajabi
- Department of Ophthalmic Plastic and Reconstructive Surgery, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Koosha Ramezani
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
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Congenital upper eyelid coloboma: embryologic, nomenclatorial, nosologic, etiologic, pathogenetic, epidemiologic, clinical, and management perspectives. Ophthalmic Plast Reconstr Surg 2015; 31:1-12. [PMID: 25419956 PMCID: PMC4334304 DOI: 10.1097/iop.0000000000000347] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: To review the recent literature and describe the authors’ experience with congenital upper eyelid coloboma. Methods: In this review, we will summarize the embryologic and etiopathogenetic bases of congenital upper eyelid coloboma, and study the published clinical reports. We will also attempt to briefly shed some light on the rarer syndromic curiosities associated with upper eyelid coloboma. Results: Congenital upper eyelid colobomas are one of the few nontraumatic oculoplastic emergencies that may occasionally present in the first few days of life with a corneal ulcer and may even present with impending perforation. They can present with or without corneopalpebral adhesions, may be isolated findings or a part of a larger spectrum of congenital anomalies as in the case of Fraser syndrome or Goldenhar syndrome, or could be associated with other rare curiosities that could challenge the clinician with a huge diagnostic dilemma. Conclusions: Existing literature dealing with congenital colobomas of the upper eyelid is fraught with nosologic problems, confusing etiologies, and overlapping clinical features. We attempted to clarify the salient clinical features, outline the management principles, and until a time in the not-so-distant future where advances in molecular genetic testing would help redefine the etiology and the diverse clinical spectrum of genetic diseases associated with upper eyelid colobomas, we propose a simplified classification scheme based on the relation of the coloboma to the cornea, the presence or absence of systemic features, and all the syndromic and nonsyndromic associations of congenital coloboma of the upper eyelid known today. In this review, the authors will describe the pathogenesis of upper eyelid coloboma, suggest a new simplified classification system, describe the clinical picture in detail, clarify the various syndromic associations of upper eyelid coloboma, and lay out the basic surgical principles of management.
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Feeding difficulties in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015; 44:732-7. [DOI: 10.1016/j.ijom.2015.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/30/2022]
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Caron C, Pluijmers B, Joosten K, Mathijssen I, van der Schroeff M, Dunaway D, Wolvius E, Koudstaal M. Obstructive sleep apnoea in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2015; 44:592-8. [DOI: 10.1016/j.ijom.2015.01.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/26/2022]
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Manara R, Brotto D, Ghiselli S, Mardari R, Toldo I, Schifano G, Cantone E, Bovo R, Martini A. Cranial Nerve Abnormalities in Oculo-Auriculo-Vertebral Spectrum. AJNR Am J Neuroradiol 2015; 36:1375-80. [PMID: 25814660 DOI: 10.3174/ajnr.a4273] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/29/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cranial nerve abnormalities might be observed in hemifacial microsomia and microtia (oculo-auriculo-vertebral spectrum), but the rate, features, and relationship with functional impairment or phenotype severity have not yet been defined. This study aimed at investigating absence/asymmetry, abnormal origin, morphology and course of cranial nerves, and presence/asymmetry of the foramen ovale and inferior alveolar nerve canal in a cohort of oculo-auriculo-vertebral spectrum patients. MATERIALS AND METHODS Twenty-nine patients with oculo-auriculo-vertebral spectrum (mean age, 7 years; age range, 0.2-31 years; 12 females) underwent brain MR imaging, CT, and neurologic evaluation; 19 patients had a more severe phenotype (Goldenhar syndrome). RESULTS Cranial nerve abnormalities were detected only in patients with Goldenhar syndrome (17/19, bilaterally in 8) and were involved the second (4/19), third (1/18), fifth (11/19), sixth (8/16), seventh (11/18), and eighth (8/18) cranial nerves. Multiple cranial nerve abnormalities were common (11/17). Eleven patients showed bone foramina abnormalities. Trigeminal and facial nerve dysfunctions were common (44% and 58%, respectively), especially in patients with Goldenhar syndrome. Trigeminal abnormalities showed a good correlation with ipsilateral dysfunction (P = .018), which further increased when bone foramina abnormalities were included. The facial nerve showed a trend toward correlation with ipsilateral dysfunction (P = .081). Diplopia was found only in patients with Goldenhar syndrome and was associated with third and sixth cranial nerve abnormalities (P = .006). CONCLUSIONS Among patients with oculo-auriculo-vertebral spectrum, cranial nerve morphologic abnormalities are common, correlate with phenotype severity, and often entail a functional impairment. The spectrum of cranial nerve abnormalities appears wider than simple hypo-/aplasia and includes an anomalous cisternal course and partial/complete fusion of diverse cranial nerves.
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Affiliation(s)
- R Manara
- From Neuroradiology (R.Manara), University of Salerno, Salerno Italy
| | - D Brotto
- Departments of Neuroscience (D.B., S.G., G.S., R.B., A.M.)
| | - S Ghiselli
- Departments of Neuroscience (D.B., S.G., G.S., R.B., A.M.)
| | - R Mardari
- Neuroradiology (R.Mardari), University Hospital of Padova, Padova, Italy
| | - I Toldo
- Pediatrics (I.T.), University of Padova, Padova, Italy
| | - G Schifano
- Departments of Neuroscience (D.B., S.G., G.S., R.B., A.M.)
| | - E Cantone
- Ear Nose and Throat Section (E.C.), Department of Neurosciences, "Federico II" University, Napoli, Italy
| | - R Bovo
- Departments of Neuroscience (D.B., S.G., G.S., R.B., A.M.)
| | - A Martini
- Departments of Neuroscience (D.B., S.G., G.S., R.B., A.M.)
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Khong JJ, Hardy TG, McNab AA. Prevalence of Oculo-auriculo-vertebral Spectrum in Dermolipoma. Ophthalmology 2013; 120:1529-32. [DOI: 10.1016/j.ophtha.2013.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/18/2012] [Accepted: 01/09/2013] [Indexed: 10/26/2022] Open
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Glaser TS, Rauen KA, Jeng LJB, de Alba Campomanes AG. Lipodermoid in a patient with Emanuel syndrome. J AAPOS 2013; 17:211-3. [PMID: 23528375 DOI: 10.1016/j.jaapos.2012.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Abstract
We report an 8-month-old boy with Emanuel syndrome who also had the clinical features of Goldenhar syndrome. At birth, he was observed to have bilateral microtia with multiple auricular pits, retrognathia, and a unilateral lipodermoid. Further testing revealed cardiac defects. The finding of a lipodermoid in Emanuel syndrome demonstrates phenotypic overlap between Goldenhar and Emanuel syndromes and suggests a role for genetic analysis in all patients with clinical features that include ear anomalies and lipodermoids. Correct identification of patients with Emanuel syndrome is important for determining whether there is risk of long-term neurodevelopmental disability, and genetic testing can determine parental carrier status to aid in family planning.
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Affiliation(s)
- Tanya S Glaser
- Department of Ophthalmology, University of California-San Francisco, San Francisco, California, USA
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Seymenoğlu G, Başer E, Tansuğ N, Demireli P. An unusual association of Goldenhar syndrome. Int Ophthalmol 2012; 33:91-4. [PMID: 23053767 DOI: 10.1007/s10792-012-9631-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/10/2012] [Indexed: 11/30/2022]
Abstract
Goldenhar syndrome is well known for its classical triad of epibulbar dermoids or lipodermoids, auricular appendages and pretragal fistulas. Here we report a case of Goldenhar syndrome with an unusual association of a fibroepithelial polyp attached to a limbal dermoid. A case of Goldenhar syndrome in a 5-month-old male infant presented with the features of a fibroepithelial polyp attached to a limbal dermoid, right-sided polydactylia with hypoplastic thumb, and accessory preauricular appendages on the left side. The association of a fibroepithelial polyp attached to a limbal dermoid with Goldenhar syndrome is a rare report in the literature. In these cases, regular follow-up with an ophthalmologist is important to monitor the visual development of the patient. Ideally, a multidisciplinary approach is required to manage the other associated anomalies.
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Affiliation(s)
- Göktuğ Seymenoğlu
- Department of Ophthalmology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
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Herwig MC, Gembruch U, Born M, Gevensleben H, Loeffler KU, Müller AM. Preterm diagnosis of choristoma and choroidal coloboma in Goldenhar's syndrome. Pediatr Dev Pathol 2011; 14:322-6. [PMID: 21345085 DOI: 10.2350/10-07-0874-cr.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In addition to general pathological findings characteristic of Goldenhar's syndrome, we report ocular findings in a 22-week-old fetus with hemifacial microsomia, endorsing this diagnosis. After abortion the fetus was examined via a standard paidopathological autopsy including ophthalmopathologic macroscopic and microscopic examination of both eyes. Postmortem findings included left hemifacial microsomia with ipsilateral microtia, atresia of the acoustic meatus, microphthalmia, a ventricular septal defect, and abnormalities of the ribs. Ophthalmopathological examination of the affected microphthalmic eye revealed a scleral choristoma (cartilage), choroidal/retinal pigment epithelium coloboma, and staphyloma. General pathology findings plus the ocular findings allowed the diagnosis of Goldenhar's syndrome. The cartilaginous choristoma present in the patient has previously not been reported in association with this syndrome. A discussion of differential diagnoses is provided, confirming that the ophthalmopathological investigation of fetal eyes can be of great value for classifying syndromes associated with microphthalmia.
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Affiliation(s)
- Martina C Herwig
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
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26
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Skeletal and Connective Tissue Disorders with Anterior Segment Manifestations. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pachajoa H, Rodríguez CA, Isaza C. [Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in Pre-Hispanic Tumaco-La Tolita ceramic culture (300 b.C. to 600 a.C.)]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2010; 85:154-155. [PMID: 20858405 DOI: 10.1016/s0365-6691(10)70041-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- H Pachajoa
- Facultad de Salud Universidad del Valle, Cali, Valle del Cauca, Colombia.
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Non-syndromic supernumerary caruncles causing ocular irritation after cataract surgery: a critical review of caruncular dysgeneses. Am J Ophthalmol 2010; 149:398-404.e1-2. [PMID: 20172067 DOI: 10.1016/j.ajo.2009.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 09/30/2009] [Accepted: 09/30/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe a patient with 2 ipsilateral supernumerary caruncles and to determine if they are predictive of associated abnormalities. DESIGN Retrospective and interventional clinicopathologic study with a critical review of the literature over the past 100 years. METHODS Assessment of clinical features and histopathologic findings in paraffin-embedded tissue sections stained with hematoxylin and eosin, Masson trichrome, periodic acid-Schiff (PAS) reaction with and without diastase, and Ziehl-Neelsen method. RESULTS Two placoid lesions causing ocular irritation after routine phacoemulsification were discovered in the inferomedial palpebral conjunctiva. They were totally separate from a normal caruncle. Their surface was studded with yellowish micronodules with projecting white vellus hairs. There were no associated local ophthalmic or systemic abnormalities. Microscopically, they were covered by a goblet cell-rich, nonkeratinizing squamous epithelium with subadjacent pilosebaceous units, the hairs of which were highlighted by the Masson trichrome and Ziehl-Neelsen stains, and small lobules of lacrimal gland tissue. The ocular irritation has not returned after surgery. CONCLUSIONS A literature review confirms that supernumerary (extra) caruncles coexisting with a normal caruncle are always unilateral and unassociated with any other ocular anomalies, as in the current case. They may, however, cause ocular irritation. They must be distinguished from ectopic (topographically displaced) or dysplastic caruncles that are generally bilateral and often associated with ocular adnexal abnormalities or Goldenhar syndrome. Ectopic or dysplastic caruncles, but not supernumerary ones, are characteristically accompanied by plical abnormalities or its absence. Well-documented supernumerary and ectopic caruncles have always been located in the inferior palpebral conjunctiva.
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Jakobiec FA, Pineda R, Rivera R, Hsu-Winges C, Cherwek D. Epicorneal polypoidal lipodermoid: lack of association of central corneal lesions with goldenhar syndrome verified with a review of the literature. Surv Ophthalmol 2010; 55:78-84. [PMID: 19783022 DOI: 10.1016/j.survophthal.2009.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 05/01/2009] [Indexed: 11/24/2022]
Abstract
It is remarkable to uncover a new aspect of congenital epibulbar solid dermoids and lipodermoids. We describe a dramatic central epicorneal polypoidal lipodermoid coloboma accompanied by an upper eyelid coloboma that was not associated with Goldenhar syndrome. Histopathologically the excised lesion displayed superficial layers of epidermis and a thin dermis with eccrine glands, vestigial hair structures, and bundles of arrector pili smooth muscle that extended from the undersurface of the epidermis to the bulge area of the primitive hairs. This last feature is not present in normal eyelid skin nor in the conjunctiva, and has not been previously documented to occur in epibulbar dermoids and lipodermoids. S-100-positive dendritic melanocytes and CD1a-positive Langerhans cells were both observed intraepidermally, indicating a complete complement of normal cells in this layer. Beneath the dermis was a massive collection of lobules of mature adipose tissue that fused with the corneal stroma. A virtually identical pedunculated limbal tumor has been previously reported that was associated with Goldenhar syndrome. Review of earlier published cases of epibulbar dermoids and lipodermoids establishes that central corneal lesions are not a stigma of Goldenhar syndrome, in contrast to limbal masses. Other epibulbar choristomas that can be confused with lipodermoids are described.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Cloonan YK, Kifle Y, Davis S, Speltz ML, Werler MM, Starr JR. Sleep outcomes in children with hemifacial microsomia and controls: a follow-up study. Pediatrics 2009; 124:e313-21. [PMID: 19651569 PMCID: PMC2739665 DOI: 10.1542/peds.2008-3488] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Children with craniofacial anomalies are at high risk for sleep-disordered breathing (SDB), yet its prevalence among children with craniofacial conditions is not known. Children with hemifacial microsomia (HFM) are likely particularly vulnerable to SDB as a result of underdevelopment of the mandible and oropharynx. Nevertheless, most children with HFM are not referred for sleep studies. We hypothesized that sleep outcomes would be worse in children with HFM versus control subjects. METHODS We conducted a follow-up study among 124 case participants and 349 control subjects who previously participated in a study of HFM risk factors. Parents completed the Pediatric Sleep Questionnaire (PSQ) regarding symptoms of SDB and sleep habits. Regression models were adjusted for region, age, sex, race/ethnicity, and maternal education. RESULTS Snoring was more commonly reported for children with HFM (29%) than for control subjects (17%). Compared with control subjects, children with HFM more often had symptoms consistent with SDB. On average, case participants' parents reported 1.9 times as many symptoms on the PSQ breathing scale and 1.3 times more symptoms on the PSQ sleepiness scale than did control subjects' parents, with little difference on the PSQ behavior scale. Parents of children with HFM reported 1.4 times more night awakenings than did control subjects' parents. CONCLUSIONS Children with HFM experienced more snoring and other symptoms of SDB than did control subjects. Pediatricians should be aware of the increased vulnerability for SDB among children with mandibular or external ear underdevelopment or asymmetry and should refer to a sleep specialist as needed.
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Affiliation(s)
- Yona K. Cloonan
- Department of Epidemiology, Michigan State University, East Lansing, MI
| | - Yemiserach Kifle
- Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, WA,Department of Pediatrics, University of Washington, Seattle, WA
| | - Scott Davis
- Department of Epidemiology, University of Washington, Seattle, WA,Division of Public Health Sciencies, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew L. Speltz
- Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, WA,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | | | - Jacqueline R. Starr
- Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, WA,Department of Pediatrics, University of Washington, Seattle, WA,Department of Epidemiology, University of Washington, Seattle, WA,Division of Public Health Sciencies, Fred Hutchinson Cancer Research Center, Seattle, WA
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Das A, Ray B, Das D, Das S. A case of Goldenhar-Gorlin syndrome with unusual association of hypoplastic thumb. Indian J Ophthalmol 2009; 56:150-2. [PMID: 18292629 PMCID: PMC2636090 DOI: 10.4103/0301-4738.39123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A case of Goldenhar-Gorlin syndrome in a seven-month-old male
infant presented with the features of epibulbar dermoid, microtia
and hemifacial microsomia associated with thumb defect. The
dermoid was bilateral and microtia was unilateral. Preauricular
appendages and pits were double and single respectively on
both the sides. Hemifacial microsomia was unilateral and was
associated with cleft lip, macrostomia, dental misalignment,
large tongue and high arched palate. The association of
hypoplastic thumb with Goldenhar-Gorlin syndrome has not
been documented in the past.
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Affiliation(s)
- Amitava Das
- Department of Ophthalmology, RG Kar Medical College and Hospital, Kolkata - 700 004, India
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Yoon CK, Kim JH, Kim SJ, Yu YS. The Surgical Outcomes of Simple Keratectomy for Limbal Dermoids. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.6.897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chang Ki Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Seong Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Ottaviano G, Calzolari F, Martini A. Goldenhar syndrome in association with agenesia of the internal carotid artery. Int J Pediatr Otorhinolaryngol 2007; 71:509-12. [PMID: 17161873 DOI: 10.1016/j.ijporl.2006.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 11/01/2006] [Accepted: 11/01/2006] [Indexed: 11/29/2022]
Abstract
The association between Goldenhar syndrome and homolateral internal carotid artery agenesis to our knowledge, has never emerged before. We present a case report in a female child that was examined with tonal audiometry, A.B.R., CT scan, MR, digital-subtraction-angiography and color Doppler. The aim of this report is to present an uncommon pathologic association which also provides a brief review of the embryology of the ear and carotid vessels whilst discussing probable pathogenetic causes.
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MESH Headings
- Angiography, Digital Subtraction
- Audiometry, Pure-Tone/methods
- Carotid Artery Diseases/complications
- Carotid Artery Diseases/diagnosis
- Carotid Artery, Internal/abnormalities
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/pathology
- Female
- Goldenhar Syndrome/complications
- Goldenhar Syndrome/diagnosis
- Hearing Loss, Conductive/complications
- Hearing Loss, Conductive/diagnosis
- Humans
- Infant, Newborn
- Magnetic Resonance Imaging
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Color
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Konaş E, Canter HI, Mavili ME. Goldenhar complex with atypical associated anomalies: is the spectrum still widening? J Craniofac Surg 2007; 17:669-72. [PMID: 16877912 DOI: 10.1097/00001665-200607000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Goldenhar syndrome is a well-known developmental anomaly of maxillofacial skeleton and hemi-facial soft tissue, was later included to a broader classification called oculo-ariculo-vertebral spectrum. Here we report a patient presenting goldenhar syndrome with accessory auricula, defined as polyotia, coloboma and bifid tongue.
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Affiliation(s)
- Ersoy Konaş
- Department of Plastic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Abstract
Congenital corneal anesthesia is a rare clinical entity that poses a diagnostic dilemma, particularly in the pediatric age group. The sensory deficit may be confined to the cornea, or extend to other divisions of the trigeminal nerve. The sensory deficit may occur as an isolated abnormality, as part of a complex neurological syndrome, or it may occur in association with multiple somatic abnormalities and congenital insensitivity to pain. This condition usually presents between the ages of 8 to 12 months. Poor vision, photophobia, conjunctival injection, and corneal ulceration in the absence of pain and distress in a child should alert the clinician to the possibility of anesthetic cornea. In the early stages of presentation, punctuate keratopathy is the main feature, which may progress to non-healing persistent corneal epithelial defects. This stage may progress to acute corneal lysis and perforation. In most patients, conservative approaches such as copious lubrication, prevention of self-harm and cautious use of bandage contact lenses are effective in preventing progressive corneal damage. Tarsorrhapy is effective in promoting epithelial healing and permanent lateral tarsorraphy may prevent further development of epithelial defects. Amniotic membrane graft may be considered in order to improve epithelial healing. Corneal grafts carry a poor prognosis. Accurate initial diagnosis, evaluation, and proper management are paramount to prevent visual loss due to long-term complications of corneal anesthesia. This review of the literature outlines the problems and approaches in diagnosis, evaluation, and management of this rare condition.
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Affiliation(s)
- K Ramaesh
- Tennent Institute of Ophthalmology, Gartnaval General Hospital, Glasgow, United Kingdom
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Lee WK, Kim EJ, Lee JH, Lee SG, Ban JS, Min BW. Airway Management in a Patient with Goldenhar's Syndrome - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.4.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Won Kook Lee
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Eun Ju Kim
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Ji Hyang Lee
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Sang Gon Lee
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Jong Suk Ban
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
| | - Byung Woo Min
- Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea
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Tasse C, Majewski F, Böhringer S, Fischer S, Lüdecke HJ, Gillessen-Kaesbach G, Wieczorek D. A family with autosomal dominant oculo-auriculo-vertebral spectrum. Clin Dysmorphol 2007; 16:1-7. [PMID: 17159507 DOI: 10.1097/mcd.0b013e328010d313] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Oculo-auriculo-vertebral spectrum (MIM 164210) is a term suggested by Gorlin to summarize the different phenotypic expressions of a continuum that has been known as hemifacial microsomia, Goldenhar syndrome, or first and second branchial arch anomalies. The different terms indicate the extremely variable clinical findings, including especially defects of aural, oral and mandibular development. Additionally, cardiac, renal, skeletal and other anomalies occur. The majority of oculo-auriculo-vertebral spectrum cases are sporadic; nevertheless, several families have been reported with proof of both autosomal dominant and autosomal recessive inheritance. We describe a family with transmission of oculo-auriculo-vertebral spectrum from a mother to her two daughters indicating an autosomal dominant mode of inheritance. Our literature review reveals that patients with autosomal dominant inheritance of oculo-auriculo-vertebral spectrum are more often bilaterally affected than patients with sporadic occurrence of oculo-auriculo-vertebral spectrum. In addition, hearing loss, absent or narrow external auditory canal, anomalies of the mouth and epibulbar dermoids seem to occur less frequently in patients with autosomal dominant oculo-auriculo-vertebral spectrum compared with sporadic oculo-auriculo-vertebral spectrum.
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Affiliation(s)
- Christiane Tasse
- Institute of Human Genetics, University Clinic Essen, Essen Institute of Human Genetics and Anthropology, University of Düsseldorf, Düsseldorf Institute of Human Genetics, University Clinic Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Abstract
We describe two boys with Goldenhar syndrome. The 8-year-old boy had an epibulbar dermoid in his left eye, type 1 Duane syndrome, bilateral preauricular appendages, and an interauricular septal defect. The 10-year-old boy had an epibulbar dermoid in his right eye, appendages in the right preauricular region, and sensorineural hearing loss.
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Affiliation(s)
- Ihsan Caca
- Department of Ophthalmology Dicle University Faculty ofMedicine, Diyarbakir, Turkey
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Terhal P, Rösler B, Kohlhase J. A family with features overlapping Okihiro syndrome, hemifacial microsomia and isolated Duane anomaly caused by a novelSALL4 mutation. Am J Med Genet A 2006; 140:222-6. [PMID: 16411190 DOI: 10.1002/ajmg.a.31060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The SALL4 gene encodes a putative zinc finger transcription factor and is located on chromosome 20q13.13-13.2. Mutations in SALL4 have been identified in patients with Okihiro syndrome, which is characterized by radial ray anomalies associated with a Duane anomaly. Here, we report an unusual family in which affected persons show an extremely variable phenotype consistent with either Okihiro syndrome, hemifacial microsomia, or isolated Duane anomaly. A novel nonsense mutation in the SALL4 gene was detected in all affected family members and obligate carriers. This mutation is located in exon 3, only 29 bp 5' of the most 3' intron, and would therefore be expected to escape the nonsense mediated mRNA decay pathway, which might explain the phenotypic variability and mild degree of limb involvement.
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Affiliation(s)
- Paulien Terhal
- Department of Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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Tasse C, Böhringer S, Fischer S, Lüdecke HJ, Albrecht B, Horn D, Janecke A, Kling R, König R, Lorenz B, Majewski F, Maeyens E, Meinecke P, Mitulla B, Mohr C, Preischl M, Umstadt H, Kohlhase J, Gillessen-Kaesbach G, Wieczorek D. Oculo-auriculo-vertebral spectrum (OAVS): clinical evaluation and severity scoring of 53 patients and proposal for a new classification. Eur J Med Genet 2005; 48:397-411. [PMID: 16378924 DOI: 10.1016/j.ejmg.2005.04.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 04/22/2005] [Indexed: 01/20/2023]
Abstract
Oculo-auriculo-vertebral spectrum (OMIM164210) is a phenotypically and probably also a genetically heterogeneous disorder, characterized by anomalies of the ear (mostly microtia), hemifacial microsomia, and defects of the vertebral column. Associated clinical findings include anomalies of the eye and brain, and developmental delay. We have evaluated the clinical data and photographs of 53 unrelated patients with OAVS, all presenting with either isolated microtia or preauricular tags in association with hemifacial microsomia as minimal diagnostic criteria; five had a positive family history for OAVS. Based on the main clinical findings and unilateral or bilateral involvement, we have developed a new classification system for OAVS, consisting of six subgroups. There is a statistically significant correlation between the subgroup and number of associated clinical findings, and a statistically significant difference regarding prognosis in uni- and bilaterally affected patients, suggesting that this classification is clinically relevant to the categorization of patients with OAVS. The newly developed scoring system (two points for each main clinical finding and one for each associated clinical finding) presented here, also aids prognosis, especially for delay of motor development and brain anomalies, and statistical analysis revealed significant clustering between different clinical findings of OAVS confirming the clinical impression previously published by several authors.
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Affiliation(s)
- Christiane Tasse
- Institut für Humangenetik, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen, Germany
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Beck AE, Hudgins L, Hoyme HE. Autosomal dominant microtia and ocular coloboma: New syndrome or an extension of the oculo-auriculo-vertebral spectrum? Am J Med Genet A 2005; 134:359-62. [PMID: 15800906 DOI: 10.1002/ajmg.a.30638] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The oculo-auriculo-vertebral (OAV) spectrum is an etiologically heterogeneous condition classically consisting of microtia, hemifacial microsomia, epibulbar dermoids, and vertebral anomalies. Other eye findings described in OAV include upper eyelid colobomas, ptosis, and varying degrees of microphthalmia or even anophthalmia. Iris and/or retinal colobomas have rarely been reported. We describe two familial cases of apparent OAV with ocular colobomas. We postulate that iris and/or retinal colobomas associated with OAV may represent a subgroup within the OAV spectrum with autosomal dominant inheritance, as in the families described herein. Since microtia can result from aberrant migration of neural crest cells into the first and second branchial arches during early embryonic development, and concomitant deficient neural crest migration into the developing eye can lead to ocular coloboma and or iris heterochromia, it may be that the altered gene or genes in our familial cases are involved with regulation of neural crest development.
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Affiliation(s)
- Anita E Beck
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305-5323, USA.
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Miller TD, Metry D. Multiple accessory tragi as a clue to the diagnosis of the oculo-auriculo-vertebral (Goldenhar) syndrome. J Am Acad Dermatol 2004; 50:S11-3. [PMID: 14726857 DOI: 10.1016/s0190-9622(03)00479-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a newborn with multiple features of the oculo-auriculo-vertebral spectrum (OAVS), or Goldenhar's syndrome. Although not reported previously, aplasia cutis congenita might be within the spectrum of anomalies seen in the syndrome. Of particular importance to the dermatologist is the finding of multiple accessory tragi in a linear distribution from the preauricular skin, along the mandible, to the lateral neck, which might be a clue to the diagnosis of OAVS. This syndrome is associated with additional systemic anomalies that can often be found by simple screening techniques.
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Affiliation(s)
- Tara D Miller
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Nijhawan N, Morad Y, Seigel-Bartelt J, Levin AV. Caruncle abnormalities in the oculo-auriculo-vertebral spectrum. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 113:320-5. [PMID: 12457402 DOI: 10.1002/ajmg.b.10715] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Goldenhar syndrome (GS) is a congenital disorder believed to be caused by the defective development of the first and second brachial arches and the first brachial clefts during the fourth through eighth weeks of embryologic development. It is characterized by epibulbar dermoids and/or lipodermoids, preauricular tags, pretragal fistulas, hemifacial microsomia, and vertebral anomalies. Other ocular and nonocular symptoms have also been described. To our knowledge there are only three previous reports of abnormal caruncles in GS. We have reviewed our experience with a consecutive series of seven GS patients with caruncular malformations. Caruncular abnormalities included dysplatic and/or bilobed caruncles (two cases), ectopic caruncles (three bilateral cases and one unilateral case), and ectopic plus dysplastic caruncles (one case). Our experience suggests that the incidence of caruncular malformations in GS anomalies is higher than previously reported. This may be clinically important in differentiating GS from other first- and second-arch syndromes. Additionally, linking abnormalities in the first and second months of gestation that cause the typical stigmata of GS with malformation of the caruncles, which normally develop in the third month of gestation, could provide clues to the pathogenesis of GS.
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Affiliation(s)
- Navdeep Nijhawan
- Department of Ophthalmology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Milani D, Selicorni A. Right pulmonary agenesis with ipsilateral microtia: a new laterality association or part of the oculoauriculovertebral spectrum? Prenat Diagn 2002; 22:1053-4; author reply 1054-5. [PMID: 12424776 DOI: 10.1002/pd.446] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE We report on the surgical management, complications, postoperative visual acuity, and astigmatism of limbal dermoids in children. METHODS This was a retrospective study of 49 children (51 eyes) treated between 1990 and 2000. Demographic data, age at surgery, details of the surgical procedure, the preoperative and postoperative visual acuity and astigmatism, the complications of surgery, and the ocular and systemic associations were recorded. Age at surgery was regressed against the size of the corneal graft, the visual outcome, and astigmatism. The size of the corneal graft was regressed against the visual outcome and astigmatism. A test for a difference in proportions of the preoperative and postoperative astigmatism was conducted. Postoperatively children were followed up until suture removal if necessary at 4 weeks. Children living locally continued follow-up at The Hospital for Sick Children, Toronto, Ontario, Canada; the rest were referred to their referring ophthalmologist. RESULTS The mean age of the patients at surgery was 4.4 +/- 3.8 years (range, 1 month to 15 years). Excision of the dermoid and lamellar keratoplasty was performed in 48 eyes, simple excision was performed in 2 eyes, and a penetrating graft was performed in 1 eye. The mean graft size (6.6 +/- 1.2 mm; range, 3.5-10 mm) was inversely related to the age of the patient (P =.04). Three eyes had microperforations during excision of the dermoid. Opacification of part of the graft was seen in 10.2% of eyes (5/49) with a mild haze in 3 eyes. Postoperatively 96.7% of eyes (29/30) had a visual acuity greater than or equal to 6/24, with 86.7% (26/30) greater than or equal to 6/12; one eye had a visual acuity of 6/120. The size of the graft correlated inversely with the visual acuity (P =.03). Preoperative and postoperative refraction was recorded in 23 patients. Astigmatism greater than 1 D was present in 43.4% preoperatively and in 60% postoperatively (P =.6). There was no association between age at surgery (P =.6) and the size of the graft (P =.2) and the presence of postoperative astigmatism. CONCLUSION Excellent visual results were achieved in the majority of patients. Younger children were operated on for visual reasons with larger grafts and a tendency for a lower visual acuity. Although astigmatism was noted to decrease in a few children after excision, a significant number had an increase in astigmatism postoperatively, which warrants a close follow-up in children operated during the amblyogenic age.
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Affiliation(s)
- Patrick Watts
- Department of Ophthalmology, The Hospital For Sick Children, Toronto, Ontario, Canada
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Cruz AAV, Schirmbeck T, Pina-Neto JM, Funayama CAR. Cicatricial upper eyelid retraction in encephalocraniocutaneous lipomatosis: a report of two cases and review of literature. Ophthalmic Plast Reconstr Surg 2002; 18:151-5. [PMID: 11897958 DOI: 10.1097/00002341-200203000-00012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe two patients with encephalocraniocutaneous lipomatosis (ECCL) and to review the literature on this disorder. METHODS Brain and orbit CT scans were performed on two patients with ECCL. Both patients were examined by the same ophthalmologist and neurologist during at least a 2-year follow-up period. RESULTS Unilateral skull hamartomas, intracranial abnormalities, epibulbar choristomas, and ocular adnexal changes including a specific form of cicatricial upper eyelid retraction were present in both patients. CONCLUSIONS ECCL is a special form of oculocerebrocutaneous disease that has significant adnexal findings that are essential for the diagnosis of this rare disorder.
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Affiliation(s)
- Antonio A V Cruz
- Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Abstract
PURPOSE To evaluate results of lamellar keratoplasty in limbal dermoid. METHODS The ocular records were reviewed of 155 consecutive eyes with solid epibulbar dermoids that underwent lamellar keratoplasty at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences from 1977 to 1998. According to the size and location, the dermoids were managed surgically either by sectoral, annular, or central lamellar keratoplasty. RESULTS All but 16 eyes improved cosmetically; while all the patients showed reduction in astigmatism, 116 eyes improved functionally. CONCLUSION Excision with lamellar keratoplasty appears to be an effective means of management for extensive limbal dermoid. To avoid development of amblyopia, surgery at an early age is preferred.
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Affiliation(s)
- Anita Panda
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
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Shea CJ, Westfall KC, MacKenzie T, Bateman JB. Comparison of measured astigmatic retinoscopies from different lid specula. J AAPOS 2001; 5:357-60. [PMID: 11753255 DOI: 10.1067/mpa.2001.119244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We wanted to study the effects of different lid specula on retinoscopy readings in the pediatric population. METHODS We prospectively enrolled 29 patients from the Eye Clinic at The Children's Hospital of Denver who were being examined under anesthesia and met the inclusion criteria for the study. Any patient with ocular pathology that could affect the pliability of the sclera of both eyes was excluded. Patients with preexisting lid abnormalities or adnexal masses were also excluded. Cycloplegic retinoscopies were performed under anesthesia with the Barraquer wire and the Lancaster solid-blade specula. The amounts and the axes of the astigmatism were tabulated and statistically analyzed with the paired t test. RESULTS A statistically significant difference occurred in the retinoscopies obtained from the 2 lid specula. The Barraquer lid speculum seemed to induce the least amount of astigmatism (P =.0001). CONCLUSIONS There was a statistically significant difference in the amount of astigmatism found with each lid speculum. The choice of lid speculum in performing retinoscopies on the pediatric population can influence the final refraction and may have implications for visual outcome.
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Affiliation(s)
- C J Shea
- Department of Ophthalmology, The Children's Hospital, University of Colorado School of Medicine, Denver, Colorado, USA.
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