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Associated Malformations in Children with Orofacial Clefts in Portugal: A 31-Year Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1635. [PMID: 29616161 PMCID: PMC5865923 DOI: 10.1097/gox.0000000000001635] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/17/2017] [Indexed: 12/03/2022]
Abstract
Background: Orofacial clefts are among the most common congenital craniofacial malformations and may be associated with other birth defects. However, the proportion and type of additional anomalies vary greatly between studies. This study assessed the prevalence and type of associated congenital malformations in children with orofacial clefts, who attended the largest cleft lip and palate tertiary referral center in Portugal. Methods: Consecutive children with orofacial clefts who attended at least 1 consultation in our Clefts Unit between 1981 and 2012 were studied. Demographic and clinical data regarding the number and type of associated malformations were retrospectively collected and analyzed. Results: Of the 701 patients studied, 219 (31.2%) had associated congenital malformations. These malformations were more frequent in children with cleft palate (43.4%) than in children with cleft lip and palate (27.5%) or with cleft lip only (19.4%). Within the group with associated anomalies, 73 cases (33.3%) had conditions related with known chromosomal defects, monogenic syndromes or sequences, and 146 cases (66.7%) had multiple congenital anomalies of unknown origin. From those, head and neck malformations were the most common (60.3%), followed by malformations in the cardiovascular (28.3%) and musculoskeletal systems (26%). Conclusions: The overall prevalence of associated malformations of nearly 1 in 3 children with orofacial clefts stressed the need for a comprehensive evaluation of these patients by a multidisciplinary cleft team. Moreover, one-third of the children had multiple congenital anomalies of known origins. Thus, early routine screening for other malformations and genetic counseling might be valuable for orofacial clefts management.
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Leite GC, Ururahy MA, Bezerra JF, Lima VM, Costa MI, Freire SS, Luchessi AD, Maia JM, Brito ME, Gil-da-Silva-Lopes VL, Rezende AA. Cardiovascular abnormalities in patients with oral cleft: a clinical-electrocardiographic-echocardiographic study. Clinics (Sao Paulo) 2018; 73:e108. [PMID: 29694606 PMCID: PMC5890169 DOI: 10.6061/clinics/2018/e108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The present study aims to describe the clinical, electrocardiographic, and echocardiographic cardiological findings in a group of patients with oral clefts. METHODS This is a prospective cross-sectional study on 70 children (age range from 13 days to 19 years) with oral clefts who attended the multidisciplinary program of a university hospital from March 2013 to September 2014. The patients were evaluated by a pediatric cardiologist and underwent detailed anamnesis, physical examination, electrocardiogram, and echocardiogram. RESULTS Sixty percent of the patients were male; 55.7% presented with cleft lip and palate, and 40.0% presented with health complaints. Comorbidities were found in 44.3%. Relevant pregnancy, neonatal, family and personal antecedents were present in 55.7%, 27.1%, 67.2%, and 24.3% of the patients, respectively. Regarding the antecedents, 15.2% of the patients presented with a cardiac murmur, 49.0% with a familial risk of developing plurimetabolic syndrome, and 6% with family antecedents of rheumatic fever. Electrocardiographic evaluation showed one case of atrioventricular block. Echocardiograms were abnormal in 35.7% of the exams, including 5 cases of mitral valve prolapse - one of which was diagnosed with rheumatic heart disease. CONCLUSION The finding of a family risk of developing plurimetabolic syndrome and a diagnosis of rheumatic heart disease indicates that patients with oral clefts may be more prone to developing acquired heart disease. Thus, our findings highlight the importance of anamnesis and methodological triangulation (clinical-electrocardiographic-echocardiographic) in the investigation of patients with oral clefts and emphasize that cardiological follow-up to evaluate acquired and/or rhythm heart diseases is necessary. This strategy permits comorbidity prevention and individualized planned treatment.
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Affiliation(s)
- Gisele C.P. Leite
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Marcela A.G. Ururahy
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - João F. Bezerra
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Valéria M.G.D.M. Lima
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria I.F. Costa
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Sandra S.C. Freire
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - André D. Luchessi
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Jussara M.C. Maia
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | - Maria E.F. Brito
- Departamento de Pediatria, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
| | | | - Adriana A. Rezende
- Departamento de Analises Clinicas e Toxicologicas, Universidade Federal do Rio Grande do Norte, Natal, RN, BR
- Corresponding author. E-mail:
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Muggenthaler MMA, Chowdhury B, Hasan SN, Cross HE, Mark B, Harlalka GV, Patton MA, Ishida M, Behr ER, Sharma S, Zahka K, Faqeih E, Blakley B, Jackson M, Lees M, Dolinsky V, Cross L, Stanier P, Salter C, Baple EL, Alkuraya FS, Crosby AH, Triggs-Raine B, Chioza BA. Mutations in HYAL2, Encoding Hyaluronidase 2, Cause a Syndrome of Orofacial Clefting and Cor Triatriatum Sinister in Humans and Mice. PLoS Genet 2017; 13:e1006470. [PMID: 28081210 PMCID: PMC5230738 DOI: 10.1371/journal.pgen.1006470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/08/2016] [Indexed: 01/25/2023] Open
Abstract
Orofacial clefting is amongst the most common of birth defects, with both genetic and environmental components. Although numerous studies have been undertaken to investigate the complexities of the genetic etiology of this heterogeneous condition, this factor remains incompletely understood. Here, we describe mutations in the HYAL2 gene as a cause of syndromic orofacial clefting. HYAL2, encoding hyaluronidase 2, degrades extracellular hyaluronan, a critical component of the developing heart and palatal shelf matrix. Transfection assays demonstrated that the gene mutations destabilize the molecule, dramatically reducing HYAL2 protein levels. Consistent with the clinical presentation in affected individuals, investigations of Hyal2-/- mice revealed craniofacial abnormalities, including submucosal cleft palate. In addition, cor triatriatum sinister and hearing loss, identified in a proportion of Hyal2-/- mice, were also found as incompletely penetrant features in affected humans. Taken together our findings identify a new genetic cause of orofacial clefting in humans and mice, and define the first molecular cause of human cor triatriatum sinister, illustrating the fundamental importance of HYAL2 and hyaluronan turnover for normal human and mouse development.
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Affiliation(s)
| | - Biswajit Chowdhury
- Department of Biochemistry & Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. Naimul Hasan
- Department of Biochemistry & Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harold E. Cross
- Department of Ophthalmology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Brian Mark
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gaurav V. Harlalka
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Exeter, United Kingdom
| | - Michael A. Patton
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Exeter, United Kingdom
- Genetics Research Centre, St George’s University London, London, United Kingdom
| | - Miho Ishida
- Genetics and Genomic Medicine, UCL Institute of Child Health, London, United Kingdom
| | - Elijah R. Behr
- Cardiovascular Sciences Research Centre, St George's University of London, London, United Kingdom
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, St George's University of London, London, United Kingdom
| | - Kenneth Zahka
- Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Eissa Faqeih
- Department of Pediatric Subspecialties, Children’s Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Brian Blakley
- Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mike Jackson
- Department of Small Animal and Materials Imaging Facility, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Lees
- Department of Clinical Genetics, Great Ormond Street Hospital, London, United Kingdom
| | - Vernon Dolinsky
- Pharmacology & Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leroy Cross
- Windows of Hope Genetic Information Centre, Holmes County, Ohio, United States of America
| | - Philip Stanier
- Genetics and Genomic Medicine, UCL Institute of Child Health, London, United Kingdom
| | - Claire Salter
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Emma L. Baple
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Exeter, United Kingdom
| | - Fowzan S. Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Andrew H. Crosby
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Exeter, United Kingdom
- * E-mail: (AHC); (BTR)
| | - Barbara Triggs-Raine
- Department of Biochemistry & Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics & Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
- * E-mail: (AHC); (BTR)
| | - Barry A. Chioza
- RILD Wellcome Wolfson Centre, University of Exeter Medical School, Exeter, United Kingdom
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Sasaki Y, Tanaka S, Hamachi T, Taya Y. Deficient Cell Proliferation in Palatal Shelf Mesenchyme of CL/Fr Mouse Embryos. J Dent Res 2016; 83:797-801. [PMID: 15381722 DOI: 10.1177/154405910408301012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
How secondary palate formation is affected in the cleft lip genotype remains poorly understood. The purpose of this study was to analyze regional patterns of cell proliferation in CL/Fr mouse embryos with or without cleft lip. Pairs of palatal shelves were dissected at E13.5 from CL/Fr normal embryos (CL/Fr-N), CL/Fr embryos with bilateral cleft lip (CL/Fr-BCL), and a control strain of C57BL embryos (C57BL). The explants were examined histologically after 48 hrs of organ culture. Cell kinetics for proliferation in the palatal shelves was examined at E13.5 by the bromodeoxyuridine method in vivo. The CL/Fr-BCL palates fused as well as the CL/Fr-N palates in vitro. There were inter-group differences in the absolute number of BrdU-positive cells and the ratio of positive/(positive+negative) cells in the palate’s mesenchyme (C57BL > CL/Fr-N > CL/Fr-BCL) and epithelium (C57BL > CL/Fr-N = CL/Fr-BCL). These findings indicate that a cleft palate follows reduced cell proliferation of secondary palatal mesenchyme in CL/Fr mice.
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Affiliation(s)
- Y Sasaki
- Department of Pathology, Nippon Dental University, Fukuoka, Japan.
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5
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Prevalence of orofacial clefts in Korean live births. Obstet Gynecol Sci 2015; 58:196-202. [PMID: 26023668 PMCID: PMC4444515 DOI: 10.5468/ogs.2015.58.3.196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/12/2014] [Accepted: 10/16/2014] [Indexed: 11/08/2022] Open
Abstract
Objective The aim of this study was to investigate the prevalence of orofacial clefts and identify the characteristics of other birth defects associated with orofacial clefts in Korea. Methods This study used data from the Congenital Anomaly Survey conducted by the Korea Institute for Health and Social Affairs. The survey was conducted on birth defects documented during 2005 to 2006 in 2,348 medical institutes in Korea. This study was performed using data from medical insurance claims of the National Health Insurance Corporation. The prevalence of orofacial clefts was defined as the number of cases per 10,000 live births. Results Among the 883,184 live births, 25,335 infants had birth defects, which included 980 infants with orofacial clefts. The prevalence of total orofacial clefts in the total live births was 11.09 per 10,000, accounting for 3.9% of all birth defects. The most common orofacial cleft was cleft palate only (n=492), followed by cleft lip only (n=245) and cleft lip with cleft palate (n=243), with prevalence rates of 5.57, 2.77, 2.75 per 10,000 live births, respectively. While malformations of the circulatory system; digestive system; eyes, ears, face, and neck; and musculoskeletal system were most frequently encountered among infants with a cleft lip with or without a cleft palate, anomalies of most organ systems were notably observed among infants with cleft palate only. Conclusion The prevalence of orofacial clefts in Korea was similar or slightly lower than that of other countries. This study informs present status of orofacial clefts and gives baseline data to lay the foundation stone for Korea's registry system of orofacial clefts.
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Cranial neural crest deletion of VEGFa causes cleft palate with aberrant vascular and bone development. Cell Tissue Res 2015; 361:711-22. [DOI: 10.1007/s00441-015-2150-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
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7
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Genetics of cleft lip and/or cleft palate: Association with other common anomalies. Eur J Med Genet 2014; 57:381-93. [DOI: 10.1016/j.ejmg.2014.04.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/03/2014] [Indexed: 12/16/2022]
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8
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Rawashdeh MA, Jawdat Abu-Hawas B. Congenital Associated Malformations in a Sample of Jordanian Patients With Cleft Lip and Palate. J Oral Maxillofac Surg 2008; 66:2035-41. [DOI: 10.1016/j.joms.2008.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 10/15/2007] [Accepted: 01/01/2008] [Indexed: 10/21/2022]
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9
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Shaw GM, Carmichael SL, Yang W, Harris JA, Lammer EJ. Congenital malformations in births with orofacial clefts among 3.6 million California births, 1983-1997. ACTA ACUST UNITED AC 2004; 125A:250-6. [PMID: 14994232 DOI: 10.1002/ajmg.a.20508] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few population-based epidemiologic data are available on malformation phenotypes that co-occur with orofacial clefts. We explored the occurrence of structural congenital malformations in offspring with cleft palate (CP) and in offspring with cleft lip with or without CP (CLP), using data from a population-based active surveillance system. Ascertainment was performed among 3548991 liveborn and 23239 stillborn offspring of California women who delivered in nonmilitary hospitals during the period, 1983-1997. Structural congenital malformations were found in 91888 births. Among them, 2343 had CP and 4072 had CLP. Malformations were grouped according to 3- and 4-digit codes of the British Pediatric Association (BPA). Prevalences of each malformation grouping, defined by these codes, were calculated among: (1). all births with CP; (2). all births with CLP; (3). all births without CP or CLP but with another structural malformation; and (4). all births in the population at risk. These various prevalence measures were the basis of estimating relative risks. Observed relative risks indicated that some phenotypes were more likely and some were less likely to co-occur with either CP or CLP, with relative risks ranging from 0.5 to 2.4. For both CP and CLP, estimated relative risks were highest for malformations involving the respiratory system and lowest for spina bifida. The exclusion of all births (n = 10702) with chromosomal anomalies from comparisons did not materially alter observed relative risk estimates. Computations extended to 4-digit level BPA codes revealed elevated risks for a number of more specific diagnoses seen within the larger (3-digit level) groupings defined as eye, ear, respiratory, upper alimentary tract, and other musculoskeletal anomalies. In this large population-based cohort of infants and fetuses with CLP or CP, we observed several noncleft malformation groupings to be more common and others to be less common in their co-occurrence with orofacial clefts relative to their co-occurrence with any other malformation. These observed patterns tended to be similar for CP and for CLP.
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Affiliation(s)
- Gary M Shaw
- March of Dimes Birth Defects Foundation, California Birth Defects Monitoring Program, Oakland, California 94710, USA.
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10
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Shafi T, Khan MR, Atiq M. Congenital heart disease and associated malformations in children with cleft lip and palate in Pakistan. BRITISH JOURNAL OF PLASTIC SURGERY 2003; 56:106-9. [PMID: 12791351 DOI: 10.1016/s0007-1226(03)00044-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children with cleft lip and palate often have other associated malformations. The reported incidence and types of associated malformations vary between different studies. There is a great paucity of literature on the subject from the region in general and none from Pakistan at all. The purpose of this study was to assess the frequency of associated malformations, particularly congenital heart disease, in children with cleft lip and palate presenting to the Aga Khan University (AKU) and Murshid Hospital (MH). From 1st October 1999 to 31st March 2002, all children with cleft lip and palate who presented to AKU and MH were prospectively enrolled in the study group. Socio-demographic characteristics and a number of other variables were documented. All children underwent a thorough clinical examination and an echocardiogram as part of the study protocol. 123 children formed the study group. Thirty-five (29%) of these children were found to have associated malformations. The most common of these was congenital heart disease, which accounted for 51% of all associated malformations. Thirty percent of cleft palate children had associated anomalies while 27% of cleft lip, with or without cleft palate, children had associated anomalies. There was a significant association between children born of a consanguineous marriage and the risk of associated malformations (p-value: 0.001). Consanguinity was present in 74% of children with associated anomalies as compared to 40% of children with no associated anomaly. Dysmorphic features and the presence of associated anomalies were also significantly associated (p-value: 0.009). Dysmorphic features were present in 46% of children with anomalies as compared to 21% of children with no associated anomaly. Fifty percent of children with associated anomalies had a low birth weight compared to 34% of children with no anomalies, but the difference was not statistically significant. The presence of consanguinity in a child with dysmorphic features should raise the suspicion of an associated anomaly. The likelihood of this being a cardiac defect is high and should be ruled out with a thorough clinical examination, supplemented with an echocardiogram in certain cases.
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Affiliation(s)
- T Shafi
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
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12
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Abstract
Illustrative cases are presented showing a variety of interrelationships between the adenoids and the activity of the velopharyngeal valve in speech. The cases presented were selected from a group of 1000 patients referred because of suspected velopharyngeal diseases. When appropriate, complete velopharyngeal assessment was made including otolaryngological speech and hearing examination, polysomnography, nasendoscopy, multiview videofluoroscopy and cephalometry. New observations are described which further elucidate the mechanism by which the adenoids may change the mechanism of velopharyngeal valving and consequently speech patterns. In conclusion, procedures involving the adenoids and tonsils and surgical correction of velopharyngeal valve abnormalities to improve respiratory function must be performed in a manner which ensures preservation of normal speech activity. Similarly, surgical correction of velopharyngeal valve abnormalities to improve speech activity must preserve its respiratory function. The velopharyngeal valve and the adeno-tonsils must be considered together whenever diagnosis and a therapeutic intervention of either of them is considered. A clinical method for patient evaluation, patient management and the development of a rational therapeutic approach is presented.
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Affiliation(s)
- Y Finkelstein
- Department of Otolaryngology, Head and Neck Surgery, Meir Hospital, Kfar Saba, Israel
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Lipson AH, Yuille D, Angel M, Thompson PG, Vandervoord JG, Beckenham EJ. Velocardiofacial (Shprintzen) syndrome: an important syndrome for the dysmorphologist to recognise. J Med Genet 1991; 28:596-604. [PMID: 1956057 PMCID: PMC1015789 DOI: 10.1136/jmg.28.9.596] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report the dysmorphological, genetic, and speech therapy aspects of 38 cases of velocardiofacial syndrome presenting to a craniofacial clinic and a specialised children's hospital, to indicate a relatively low incidence of clefting, good response to pharyngoplasty, considerable variability of the syndrome, and two further familial cases. We emphasise the low index of suspicion by paediatricians and paediatric subspecialists which resulted in delayed diagnosis and delayed treatment for the hypernasal speech and velopharyngeal insufficiency for periods of four months to seven years.
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Affiliation(s)
- A H Lipson
- Cleft Palate Clinic, Children's Hospital, Sydney, NSW, Australia
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