Clinical analysis of 113 patients with Poland syndrome

Surgical Treatment of Chest Deformity in a Patient with Poland Syndrome. Clinical Case Report

Introduction

Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of the hand and deformation of the chest. Often the patients has abnormalities of the nipple-areolar complex. Here, we present a case of surgical treatment of local chest deformity with patient with Poland syndrome.

Case Presentation

We observed a patient, an 18-year-old man. The parents noticed the deformation of the chest from birth. The patient did not receive any treatment until adulthood. The patient contacted our clinical research center to correct chest deformity. After clinical and diagnostic procedures, the patient underwent surgical operation: open thoracoplasty with installation of a wire-frame construction. The early postoperative period was uneventful. Early postoperative outcome was assessed 6 months after surgery.

Conclusion

Our experience shows that thoracoplasty using a wire-frame construction is a good method for correcting local chest deformities in patients with Poland syndrome.

Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients

Background

Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population.

Methods

We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed.

Results

Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction.

Conclusions

Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.

Transient Ischemic Attack in a Patient With Poland Syndrome With Dextrocardia

This report discusses the case of a patient with a past medical history of Poland syndrome and dextrocardia who was admitted for a transient ischemic attack. Poland syndrome is a rare genetic condition characterized by underdevelopment of chest wall musculature that presents with a variety of associations that may or may not be present in each case. This case report intends to discuss a unique presentation of Poland syndrome with dextrocardia, one of the rare conditions associated with Poland syndrome, as well as the treatment of Poland syndrome as a whole and possible associated complications.

Untrapped: bilateral hypoplasia of the trapezius muscle

Agenesis or congenital hypoplasia of skeletal muscles occurs infrequently but may occur with specific conditions such as Poland syndrome. The trapezius muscle can vary in the extent of its bony attachments or may have additional slips, however congenital absence or hypoplasia is extremely rare. There are only a few reports of partial or complete absence of the trapezius muscle. Two cases of bilateral absence of the trapezius were both in males and were accompanied by the absence of additional muscle in the pectoral girdle. Herein, we describe a case of a 56-year-old male cadaver with bilateral hypoplasia of the trapezius. The muscle was largely represented by atrophied muscle fibers with an abundance of fibrotic or fatty connective tissue. This subject had very minor hypoplasia of the left pectoralis major muscle, but the remaining muscles of the pectoral girdle were normal. The spinal accessory nerve terminated in the sternocleidomastoid muscle on both sides, failing to reach the trapezius. We interpret these findings to be consistent with a minor variant of Poland syndrome.

Upper-Limb Disturbances in Female Patients with Poland Syndrome, including the Digit Ratio (2D:4D)

BACKGROUND

Poland syndrome (PS) is a rare congenital anomaly characterized by a variable clinical picture. Classic deformity consists of the unilateral hypoplasia or aplasia of the pectoralis major muscle and ipsilateral hand malformations. The aim of this study is to present disturbances in the development of upper limb in women with Poland syndrome (including digit ratio 2D:4D) in comparison to the healthy controls.

METHODS

The group of patients with Poland syndrome consisted of 36 women, while the control group consisted of 50 heathy women. Both upper limbs were measured anthropometrically. The length of all fingers and forearms were measured, and the digit ratio was calculated.

RESULTS

In women with Poland syndrome, the length of digits 2 and 4 and the forearm were significantly higher on the nonaffected side than on the affected side. In addition, there were significant differences between the length of digits 2 and 4 and the forearm between patients and controls.

CONCLUSIONS

In patients with Poland syndrome, the upper limb at the affected side is significantly different from the upper limb on the healthy side, mainly in the length of the forearm and digits. While examining the patient with Poland syndrome, we think it is essential to pay attention not only to hand anomalies but also to the development of whole upper limb. It may prove to be helpful in estimating the complete picture of Poland syndrome.

Natural History of Poland Syndrome: A Long-term Study of Functional and Psychosocial Outcomes

BACKGROUND

Poland syndrome (PS) is a congenital condition characterized by pectoralis hypoplasia and an ipsilateral hand anomaly that frequently necessitates surgery in childhood. This study aimed to determine long-term functional and psychosocial implications of PS.

METHODS

Patients underwent strength testing of their affected limb by comparing with their contralateral arm. They completed Disabilities of the Arm, Shoulder, and Hand (DASH), 36-item Short-Form Health Survey (SF-36), and several Patient-Reported Outcome Measurement Information System (PROMIS) surveys. Aggregate scores were compared with population norms.

RESULTS

Twenty-eight patients were enrolled, and 16 returned for strength testing. The average age was 42 years (range, 18-65 years), and the average follow-up was 25 years (range, 1-52 years). Dynamometer testing showed decreased strength in shoulder internal rotation and abduction/adduction, hand grip, and key pinch/tip pinch. Average DASH and SF-36 scores were comparable with population norms. The PROMIS Upper Extremity score (46.2) was significantly lower than the average 50 (SD, 10.0); the Social Roles score (57.3) indicated significantly less disability than the general population. Seventy-nine percent reported higher than average satisfaction with life, 82% had normal self-esteem, and 21% and 4% met screening criteria for depression and anxiety, respectively. The Derriford Appearance Scale revealed that 68% of patients identified PS as their most self-conscious feature, with 36% reporting subsequent life adjustments.

CONCLUSIONS

This cohort of PS patients self-reported more favorable functional, psychological, and emotional outcomes than expected based on significant shoulder and hand strength deficits. Despite these deficits, patients make adaptations, allowing fulfilling lives with psychosocial functioning similar to their peers.

A de novo SFMBT1 pathogenic variant identified in a boy with Poland syndrome

Poland syndrome is a rare developmental disorder characterized by unilateral, complete or partial, absence of the pectoralis major (and often minor) muscle, accompanied with ipsilateral hand malformations. To date, no clear genetic cause has been associated with Poland syndrome, although familial cases have been reported. We report the employment of trio exome investigation and the identification of a heterozygous de novo pathogenic variant in the SFMBT1 gene, a transcription factor associated with transcriptional repression during development, in a 14-yr-old boy with Poland syndrome. We further demonstrate by means of cDNA sequencing and western blot analysis that this variant results in SFMBT1 exon 10 skipping and a lower concentration of the SFMBT1 wild-type protein. To our knowledge, the heterozygous pathogenic SFMBT1 variant identified in association with this condition is novel as it has not been elsewhere described in the literature and it can be incorporated to the limited reported cases published.

A narrative review of Poland's syndrome: theories of its genesis, evolution and its diagnosis and treatment

Poland's syndrome (PS) is a rare musculoskeletal congenital anomaly with a wide spectrum of presentations. It is typically characterized by hypoplasia or aplasia of pectoral muscles, mammary hypoplasia and variably associated ipsilateral limb anomalies. Limb defects can vary in severity, ranging from syndactyly to phocomelia. Most cases are sporadic but familial cases with intrafamilial variability have been reported. Several theories have been proposed regarding the genesis of PS. Vascular disruption theory, "the subclavian artery supply disruption sequence" (SASDS) remains the most accepted pathogenic mechanism. Clinical presentations can vary in severity from syndactyly to phocomelia in the limbs and in the thorax, rib defects to severe chest wall anomalies with impaired lung function. Most patients have subtle presentation at birth and milder forms in childhood. Functional limitations due to PS are usually minimal. Surgical treatment aims to improve pulmonary functions arising from severe thoracic deformities but is more often done to enhance the cosmesis. The use of adipose-derived mesenchymal stem cells and fat transfer have shown promising results in recent times for correction of chest defects and breast augmentation. Gaining deeper insights into the etiopathogenesis and clinical presentation of PS will improve the clinical recognition and management of this rare condition. In this review article, we aim to outline the details of this syndrome including its etiopathogenesis, evolution, spectrum of clinical manifestations, other systemic associations, diagnostic modalities, and recent advances in treatment.

Reinforcing the vascular disruption theory of the genesis of Poland's syndrome: a rare association of diaphragmatic eventration in a preterm infant with severe musculoskeletal defects

A preterm female infant was admitted at birth with respiratory distress. On examination, she had an asymmetric right chest wall and ipsilateral small hand. Air entry was reduced over the right chest. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the right pectoral muscles, absent nipple, deformed ribs and symbrachydactyly of the ipsilateral hand. Chest X-ray suggested and ultrasound confirmed eventration of the right hemidiaphragm. 'Subclavian artery supply disruption sequence' (SASDS) theory by Bavnick and Weaver remains the most accepted pathogenic mechanism in Poland's syndrome. This case reinforces SASDS theory associated with the genesis of Poland's syndrome that relates to the pathogenicity of vascular disruption of subclavian artery, characteristics of which are unilateral pectoral defects, symbrachydactyly and eventration of the diaphragm. At 2 months, she underwent diaphragm plication. She is under review by our multidisciplinary surgical team for reconstruction of the chest deformity.

Poland Syndrome with Atypical Malformations Associated to a de novo 1.5 Mb Xp22.31 Duplication

Poland's syndrome (PS; OMIM 173800) is a rare congenital syndrome which consists of absence or hypoplasia of the pectoralis muscle. Other features can be variably associated, including rib defects. On the affected side other features (such as of breast and nipple anomalies, lack of subcutaneous tissue and skin annexes, hand anomalies, visceral, and vertebral malformation) have been variably documented. To date, association of PS with central nervous system malformation has been rarely reported remaining poorly understood and characterized. We report a left-sided PS patient carrying a de novo 1.5 Mb Xp22.31 duplication diagnosed in addiction to strabismus, optic nerves and chiasm hypoplasia, corpus callosum abnormalities, ectopic neurohypophysis, pyelic ectasia, and neurodevelopmental delay. Since, to our knowledge, this features' association has not been previously reported, we argue that this case may contribute to further widening of the variability of PS phenotype.

Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

Background

Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals.

Main body

The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus.

Conclusion

Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts.

Pedicled Supraclavicular Flap for Neck Defect Reconstruction in Poland Syndrome

Introduction

The most accepted pathogenesis for Poland syndrome is the subclavian artery supply disruption sequence during embryonic growth. The result is associated with a constellation of abnormalities of structures supplied by the subclavian artery. We present a case of a neck defect reconstructed with a fasciocutaneous supraclavicular flap in a patient with Poland syndrome with the absence of a pectoralis major muscle. To the best of our knowledge, this is the first report of the use of the supraclavicular flap in patients with Poland syndrome.

Methods

An 80-year-old patient with a 14-mm-Breslow-thickness melanoma had undergone a 3-cm-wide local excision of the scar on his right neck and reconstruction with a pedicled supraclavicular flap despite him having Poland syndrome on the same side.

Results

The flap was well perfused, and the patient was discharged at postoperative day 5. Complete healing of the flap was observed without any flap loss.

Conclusion

The supraclavicular fasciocutaneous flap is a versatile and useful pedicled flap reconstruction for head and neck defects. It is possible in patients with Poland syndrome as shown, and the pedicle should be checked with preoperative Doppler and an exploratory incision before completely raising it.

Poland Sequence: Retrospective Analysis of 66 Cases

INTRODUCTION AND OBJECTIVES

The literature reports many variations of Poland syndrome, which is a congenital disorder and a rare condition. The associated features are extremely variable, including alterations in the ipsilateral thorax and upper extremity and other malformations. This is used to designate the condition as Poland sequence (PS) because a sequence is a primary defect with a secondary cascade of structural changes. It is generally accepted that it is characterized as pathognomonic by absence/aplasia of the sternocostal aspect of the pectoralis major muscle of one side. Because it is considered a rare disease, and the incidence is low, we aimed to determine the features in all patients diagnosed at our institution to analyze the patterns and outcomes. We also revised the diagnosis according to the new classification proposed by Romanini et al to facilitate future treatments as well as to propose an improvement in the assessment and initial behavior when PS is suspected.

METHODS

We performed a retrospective study using our database from 1988. We identified 66 patients with a clinical diagnosis of PS in the Pediatric Plastic Surgery Unit of Hospital Sant Joan de Deu, Barcelona. We analyzed the medical charts, records, photographs, and imaging information to gather all the epidemiological information and clinical history, as well as the treatments received to analyze our experience with these patients. We used the TBN classification of Romanini et al, adding an S if there was upper extremity involvement (TBNS).We also conducted a systematic review consulting the following databases: PubMed, Cochrane Plus, Scopus, Web of Science, and Europe PMC.

RESULTS

Among the 66 patients, 27 were men, and 39 were women. The right side was affected in 51 patients (77.3%) (19 men and 32 women). In a total of 37 patients (56.1%; 16 men and 21 women), there was no upper extremity involvement. We found 40 cases with other associations, with scoliosis being the most common. Before 2007, the team performed surgery in 1 male patient and 4 female patients; after 2007, the actual team has performed reconstruction in 8 male patients and 16 female patients. In the female patients, the average volume of breast implants was 252.5 cc, and the average volume for fat grafting was 103.5 cc on the side affected with PS. There is a wide range of chest-breast clinical involvement, which was why we decided to readdress all the imaging and clinical history to classify the patients using a new classification system to learn how to optimally treat these cases in the future. In female patients, we used Romanini's TBN classification and added an S for upper extremity involvement; the T1B1N1S0 was the most frequently observed classification. Owing to the sample size and the disparity in sex distribution, we also reassessed publications in PubMed, Cochrane Plus, Scopus, Web of Science, and Europe PMC with more than 5 cases; we found that there were a total of 1600 patients with PS in the literature and that the distribution was almost 50% for men and women, including the patients in our study (611 women, 561 men).

CONCLUSIONS

We propose to include the presence of upper extremity involvement in Romanini's TBN classification (TBNS) for optimal management of these patients and use a standard number and profile for image documentation presurgery and postsurgery. We found that in the literature the ratio of men and women with PS was not 2 to 3:1, but 1:1. The most frequent phenotype of PS was T1B1N1S0 (hypoplasia or aplasia of the pectoralis muscles and soft tissue/breast hypoplasia/nipple-areolar complex with dislocation of <2 cm / absence of upper extremity involvement). There was no relationship between the side involved and patients' sex for the severity of the deformity and between the severity of the thoracic involvement and ipsilateral upper extremity association. In the literature, there are several plastic reconstruction methods available ranging from standard implants to microsurgery techniques. The selected procedure depends on the phenotype, patients' needs and expectations, availability of surgery in the hospital, and surgeons' criteria; thus, surgery has to be personalized while providing a match related to the risk/benefit, taking into account the degree of functional impairment. Since the author started her practice in the hospital in 2007, the timing for procedures has been proposed at the end of adolescence with 2 consecutive appointments without changes in the breast-thorax measures. The procedure performed has included implant use with lipofilling, yielding no major complications and a high rate of satisfaction during a maximum of 10 years of follow-up.

Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision

BACKGROUND

Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness.

METHODS

A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities.

RESULTS

Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0.

CONCLUSIONS

Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Correcting Poland Syndrome with a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction

BACKGROUND

Poland syndrome is historically associated with hypoplasia of the pectoral major muscle and abnormalities of the upper limbs. The authors propose an innovative procedure for correcting Poland syndrome thoracic malformations using three-dimensional modeling. Moreover, the authors evaluated aesthetic improvement, satisfaction, and quality of life after reconstruction with computer-aided design customized silicone implants.

METHODS

Since 1993, the authors have treated 129 patients for Poland syndrome. Before 2007, the implants were made from plaster molds; since 2007, they have been made using three-dimensional computer-aided design. Patient satisfaction was assessed using a standardized questionnaire, and quality of life was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS

Lipofilling was performed in combination with computer-aided design in one-third of cases, and breast prostheses were required in 24 percent of cases. We found three exposed prostheses and two infections. Cosmetic results were excellent in more than 90 percent of cases, and more than 80 percent of patients were very satisfied or satisfied, with no significant difference between men and women (p = 0.382). The Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements in role emotional (p < 0.05), emotional well-being (p < 0.001), and social functioning (p < 0.001).

CONCLUSIONS

Correcting Poland syndrome using a computer-aided design silicone implant fulfilled aesthetic and psychological demands, and significant improvements were seen in quality of life. The technique is simple and reliable and yields high-quality results, and three-dimensional computer-aided design has optimized the authors' reconstructions. Nevertheless, associated procedures and secondary corrections remain necessary to obtain optimal results.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

The value of full-body skin examination: Poland syndrome diagnosed as an incidental finding

Poland syndrome is a rare congenital disorder characterized by agenesis of the pectoralis major muscle. It is generally unilateral, right-sided, and can be associated with a myriad of thoracic and upper limb defects. Knowledge of this disorder can lead the astute clinician to prompt diagnosis and referral to surgical specialists for further workup. Surgery is often performed for either esthetic or functional concerns.

Management of the Lateral Breast

Breast asymmetry is a common finding in developing adolescents. In select cases, there is maldevelopment of 1 or both breasts, which persists into adulthood and causes significant negative impact on life. Various surgical techniques (eg, breast augmentation/reduction) and nonsurgical techniques (eg, bras/gel inserts) are currently in practice to achieve breast symmetry. We describe a unique case of a young lady with Poland’s syndrome, who presented with a lateralized right breast. We have used a V-Y advancement flap, along with a breast implant, to medialize the breast and achieve symmetry in contour and volume, followed by medialization of the nipple areolar complex. Using this technique produced an excellent result on our patient. We, therefore, feel that using the V-Y advancement flap is a novel and good option for dealing with difficult cases of lateralized breast.

Anaesthesia for chest wall reconstruction in a patient with Poland syndrome: CARE-compliant case report and literature review

BACKGROUND

Poland syndrome is a rare congenital disease, characterized by agenesis/hypoplasia of the pectoralis major muscle, usually associated with variable thoracic anomalies that needed chest wall reconstruction under general anesthesia. Anaesthetic management in Poland syndrome has scarcely been described.

CASE PRESENTATION

Here, we present our anaesthetic management of Nuss procedure for chest wall correction in a 5 years old patient with Poland syndrome. We also reviewed the reports of anaesthetic management of Poland syndrome by searching Pubmed, and summarize the perioperative procedures that may warrant a safe surgery.

CONCLUSIONS

Examinations before surgery, intraoperative monitoring, choice of general anesthetics and pain management after surgery should all be contemplated.

Controversies in Poland Syndrome: Alternative Diagnoses in Patients With Congenital Pectoral Muscle Deficiency

PURPOSE

Poland syndrome was first described as a deficiency of the pectoral muscle with ipsilateral symbrachydactyly. Currently, numerous case reports describe variations of Poland syndrome in which pectoral muscle deficiency is often used as the only defining criterion. However, more syndromes can present with pectoral muscle deficiency. The aim of this review is to illustrate the diversity of the phenotypic spectrum of Poland syndrome and to create more awareness for alternative diagnoses in pectoral muscle deficiency.

METHODS

A systematic literature search was performed. Articles containing phenotypical descriptions of Poland syndrome were included. Data extraction included number of patients, sex, familial occurrence, and the definition of Poland syndrome used. In addition, hand deformities, thoracic deformities, and other deformities in each patient were recorded. Alternative syndrome diagnoses were identified in patients with a combination of hand, thorax, and other deformities.

RESULTS

One hundred-and-thirty-six articles were included, describing 627 patients. Ten different definitions of Poland syndrome were utilized. In 58% of the cases, an upper extremity deformity was found and 43% of the cases had an associated deformity. Classic Poland syndrome was seen in 29%. Fifty-seven percent of the patients with a pectoral malformation, a hand malformation, and another deformity had at least 1feature that matched an alternative syndrome.

CONCLUSIONS

Pectoral muscle hypoplasia is not distinctive for Poland syndrome alone but is also present in syndromes with other associated anomalies with a recognized genetic cause. Therefore, in patients with an atypical phenotype, we recommend considering other diagnoses and/or syndromes before diagnosing a patient with Poland syndrome. This can prevent diagnostic and prognostic errors.

CLINICAL RELEVANCE

Differentiating Poland syndrome from the alternative diagnoses has serious consequences for the patient and their family in terms of inheritance and possible related anomalies.

Dorsoscapularis triangularis: embryological and phylogenetic characterization of a rare variation of trapezius

The muscle trapezius shows considerable morphological diversity. Variations include an anomalous origin and complete or partial absence of the muscle. The present study reported, a hitherto undocumented complete bilateral absence of the cervical part of trapezius. Based on its peculiar origin and insertion, it was named dorsoscapularis triangularis. The embryological, phylogenetic and molecular basis of the anomaly was elucidated. Failure of cranial migration of the trapezius component of the branchial musculature anlage to gain attachment on the occipital bone, cervical spinous processes, ligamentum nuchae between 11 mm and 16 mm stage of the embryo, resulted in this anomaly. A surgeon operating on the head and neck region or a radiologist analyzing a magnetic resonance imaging of the cervical region would find the knowledge of this morphological variation of trapezius useful in making clinical decisions.

Sprengel anomaly in deletion 22q11.2 (DiGeorge/Velo-Cardio-Facial) syndrome

Sprengel anomaly (SA) is a rare skeletal defect characterized by uni- or bi-lateral elevation of the scapula. This anomaly is often isolated, although it can occur in association with other defects, including cervical spine malformations, cleft palate, and facial anomalies. Neural crest migration anomalies have been involved in the etiology of SA. Since the same embryological pathway accounts for some of the clinical features of deletion 22q11.2 syndrome (del22q11.2; DiGeorge/Velo-Cardio-Facial syndrome), we investigated the occurrence of SA in a consecutive series of 235 del22q11.2 patients aged more than 2 years, undergoing a complete clinical and orthopedic assessment of the dorsal and thoracic skeleton. In the present series, two patients were diagnosed with true SA. Present results and published reports suggest that scapular involvement including SA occurs in 1-2% of del22q11.2 individuals. Accordingly, this anomaly should be investigated as one of the possible skeletal findings of del22q11.2 syndrome, while this diagnosis should be excluded in patients presenting with SA associated with other defects.