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Oral-facial-digital syndromes, 1992.

In 1988, there were seven conditions which could be considered distinct oral-facial-digital syndromes (OFDS). Currently there are at least nine, as well as different classification systems in use. This paper provides an update on recently described OFDS, and discusses alternative classification systems.

Abnormalities, Multiple↗

Cebo-anancephaly.

A case of cebocephaly associated with anencephaly, preauricular appendages and single umbilical artery in a stillborn full term female fetus is described. The changing nomenclature of the median faciocerebral defects, which has led to an apparent confusion, is discussed. It is felt that paucity of literature on cebocephaly is partly due to missed diagnosis of these cases in the absence of a competent teratologist.

Abnormalities, Multiple↗

Intrafamilial variation in Cohen syndrome.

Three sibs with Cohen syndrome are presented. Abnormalities present in all three children include mental retardation, hypotonia, and short philtrum with open mouth and prominent lips. The older two sibs have a similar facies and an engaging personality. The youngest child shows a different facial appearance and marked behavioural problems, thereby illustrating the intrafamilial variability which may occur in this disorder.

Adolescent↗

Popliteal pterygium syndrome with syngnathia.

We report a case of perioperative management of a neonate with popliteal pterygium syndrome complicated by interalveolar syngnathia. Syngnathia were excised in the operating room without a major anaesthetic. We discuss our management of this case, as well as other possible strategies to secure the airway in neonates with syngnathia. We also reviewed the literature regarding airway management in presence of syngnathia in similar situations.

Abnormalities, Multiple↗

Multiple periorbital dermoid cysts, clefting and mental retardation: a new malformation syndrome?

We report a child with multiple anomalies that was born to healthy nonconsanguineous parents after an unremarkable pregnancy. The female infant had bilateral cleft lip and palate, bilateral toe syndactyly (second and third with no bony fusion), multiple bilateral periorbital tumors, ectropion, lagophthalmos, strabismus and prominent eyes. High frontal hairline and everted lower lip were also noted. Soon after delivery, she was referred to the 'Cleft Clinic' where she underwent cleft lip and palate repair. Seven dermoid cysts were also removed from both periorbital areas. Follow-up documented moderate developmental retardation, hypothyroidism and hydronephrosis. Although some features of our patient overlap with those described in ectrodactyly, ectodermal dysplasia and cleft lip/palate, Martinez, Zlotogora-Ogur, Filippi, Freihofer and Blepharocheilodontic syndromes, our patient has a combination of features not previously reported.

Abnormalities, Multiple↗

Congenital malformations and maternal occupation in Finland: multivariate analysis.

The Finnish Register of Congenital Malformations was used in a multivariate analysis to explore the associations between maternal occupation in industry and children born with central nervous system (CNS) or musculoskeletal or oral cleft malformations. Possible confounding factors were selected in preliminary screening of risk indicators for malformations. These factors included characteristics of the mother, the child, and the family; maternal illnesses; an maternal medication at the time of pregnancy. Tobacco smoking was a confounding factor for all type of malformations; number of children born to the mother, maternal age, malformations in the family, number of rooms occupied by the family, sex of the child, threatened abortion, and continuous medication of the mother during the first trimester confounded the association for certain type of malformations. After adjusting for confounding factors, maternal occupation in industrial trades significantly correlated with CNS, oral cleft, and musculoskeletal malformation in the offspring. Maternal occupation in industry and construction only was significantly associated with CNS malformations in the offspring but the associations with oral cleft and musculoskeletal malformations were not significant.

Adult↗

Natural history of Wolf-Hirschhorn syndrome: experience with 15 cases.

Wolf-Hirschhorn syndrome (WHS) is a well-known chromosomal disorder attributable to partial deletion of the short arm of chromosome 4 (4p-). Although about 120 cases have been reported so far, there is still very little data on its natural history. Information given to parents at the time of diagnosis tends to be skewed to the extreme negative. To help delineate more thoroughly the natural history of WHS, and to obtain better information to answer parents' questions in a clinical setting, we evaluated 15 patients (12 females, 3 males) in three centers with the 4p- syndrome. Four of the cases had a follow-up spanning 16 years. Thirteen cases were detected by standard cytogenetics (regular G-banding 10, high-resolution banding 3), while the remaining 2 required fluorescence in situ hybridization. A total of 5/15 (33.3%) had heart lesions; 7/15 (46. 6%) had oral facial clefts; 13/15 (86.6%) had a seizure disorder, that tended to disappear with age; and 100% had severe/profound developmental retardation. One Italian patient had sensorineural deafness and 1 Utah patient had a right split hand defect. Of note, 2 Utah patients were able to walk with support (at 4 and 12 years of age, respectively), whereas 3 Italian patients and 1 Utah patient were able to walk unassisted (at 4, 5, 5 years 9 months, and 7 years of age, respectively). Two of the 3 Italian patients also achieved sphincter control (by day). The 8 patients receiving serial electroencephalogram studies showed fairly distinctive abnormalities, usually outlasting seizures. A slow, but constant progress in development was observed in all cases, during the follow-up period. In conclusion, the combined cases of the three centers represent considerable experience, providing new information on several aspects of this important deletion syndrome.

Adolescent↗