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A novel heterozygous deletion in the EVC2 gene causes Weyers acrofacial dysostosis.

Weyers acrofacial dysostosis (MIM 193530) is an autosomal dominant disorder clinically characterized by mild short stature, postaxial polydactyly, nail dystrophy and dysplastic teeth. Ellis-van Creveld syndrome (EvC, MIM 225500) is an autosomal recessive disorder with a similar, but more severe phenotype. Mutations in the EVC have been identified in both syndromes. However, the EVC mutations only occur in a small proportion of EvC patients. Recently, mutations in a new gene, EVC2, were found to be associated with other EvC cases. The EVC and EVC2 are located close to each other in a head-to-head configuration and may be functionally related. In this study, we report identification of a novel heterozygous deletion in the EVC2 that is responsible for autosomal dominant Weyers acrofacial dysostosis in a large Chinese family. This constitutes the first report of Weyers acrofacial dysostosis caused by this gene. Hence, the spectrum of malformation syndromes due to EVC2 mutations is further extended. Our data provides conclusive evidence that Weyers acrofacial dysostosis and EvC syndrome are allelic and genetically heterogeneous conditions.

Abnormalities, Multiple↗

Oto-mandibulo-facial dysostosis: a case report.

The case presented here is a 6 year old male child with oto-mandibulo-facial dysostosis syndrome. Oto-mandibulo-facial dysostosis is a term used for a unilateral congenital birth defect in which abnormalities can range from minor unilateral ear anomalies or preauricular tags to severe ones involving anotia and mandibular hypoplasia.

Child↗

Flexor digitorum longus accessorius in the club foot of an infant with Nager syndrome.

The case of a male infant is reported who had club foot on the right side and pes adductus on the left side in combination with acrofacial dysostosis; he also demonstrated preaxial anomalies of the upper limbs indicative of Nager syndrome. In addition, an unusual aberrant muscle was discovered during surgical correction of the right club foot.

Abnormalities, Multiple↗

Bilateral choanal atresia in two members of one family.

Two children are presented with bilateral choanal atresia: a girl with the typical features of the Treacher Collins syndrome, and a boy, a third cousin of the girl, without mandibulo-facial dysostosis. Simultaneous occurrence of choanal atresia and the Treacher Collins syndrome may be based on a defective ossification of the mesenchyme of the first visceral arch. Choanal atresia may be due to nonabsorption of the bucconasal membrane and/or extension of the sphenoid or palate bone.

Female↗

Nager syndrome. Problems and possibilities of therapy.

The congenital Nager acrofacial dysostosis syndrome is presented, and possibilities and problems in the treatment of these patients are described. A case study of a patient who has been followed from birth to adulthood illustrates the surgical/orthodontic course of treatment and its limits.

Abnormalities, Multiple↗

Nager syndrome (preaxial acrofacial dysostosis): a case report.

The Nager syndrome is a rare condition associated with craniofacial malformations such as micrognathia, zygomatic hypoplasia, cleft palate, and preaxial limb deformities. This report features a case of the Nager syndrome occurring in a 4-year-old boy showing microdontia, thumb duplication and radioulnar synostosis, and ventricular septum defect, characteristics not usually encountered in the published cases.

Child, Preschool↗

Radiology of the ear in mandibulo-facial dysostosis--Treacher Collins syndrome.

Deformities of the external and middle ear with conductive deafness are common in mandibulo-facial dysostosis but cochlear function is nearly always normal. Twelve patients with the typical appearance and characteristics of the lesion are described. All had some degree of atresia of attic and antrum with absent or deformed ossicles but 4 had external auditory meatuses of normal calibre. The characteristic tomographic appearances of the ear are described.

Ear, External↗

Maxillofacial dysostosis.

Four individuals in a single family affected with maxillofacial dysostosis are reported. Maxillary hypoplasia, delayed onset of speech, and poor development of language skills without associated hearing loss are the main characteristics of the syndrome which is transmitted as an autosomal dominant. Cephalometric analysis and speech and hearing evaluation of our patients confirmed the above findings.

Adolescent↗

The relationship between soft tissue anomalies around the orbit and globe and astigmatic refractive errors: a preliminary report.

Corneoscleral limbal masses were created in ten rabbit eyes and upper eyelid colobomas were produced in an additional ten eyes. The resultant changes in corneal curvature were recorded over a one-month period using streak retinoscopy and photokeratometry. By these methods, we have determined that forces at or near the corneoscleral limbus can produce changes in the corneal curvature that lead to refractive errors primarily of the astigmatic variety. There is a shift of the axis of astigmatism towards the meridian 90 degrees away from the external force or an increase of astigmatism along the meridian where the force was exerted. In this study, corneal curvature changed significantly in the coloboma and epibulbar mass groups when compared to the control group. This study supported a causal relationship between soft tissue anomalies and astigmatic refractive errors seen clinically in certain syndromes, such as Goldenhar and mandibulo-facial dysostosis. These findings suggest that patients observed with periorbital soft tissue defects may be at risk for the development of unilateral anisometropic refractive errors and secondary amblyopia. Recognition of this entity is essential in order that adequate therapy can be instituted at an early age.

Animals↗

Newly recognized autosomal recessive acrofacial dysostosis syndrome resembling Nager syndrome.

We report on two patients with a unique constellation of anomalies resembling the Nager acrofacial dysostosis syndrome. Clinical manifestations which differentiate their condition from Nager syndrome include: microcephaly, cleft lip and palate, a peculiar beaked nose, blepharophimosis, microtia, symmetrical involvement of the thumbs, and great toes and developmental delay. We postulate that the inheritance is autosomal recessive on the basis of similarly affected male and female sibs.

Abnormalities, Multiple↗

Severe postaxial acrofacial dysostosis: an anatomic and angiographic study.

We describe a severe case of postaxial acrofacial dysostosis syndrome [POADS] or Genée-Wiedemann syndrome in a stillborn female. The report includes an arteriographic and anatomic study of the limbs. Previously unreported findings such as hypoplasia of the femora, ossification defect of the ischium and pubis, bilobed tongue, and lung hypoplasia were noted. This case documents further variability in the POADS or Genée-Wiedemann syndrome.

Angiography↗

[Diagnostic and therapeutic problems in a clinical case of oculoauricular dysplasia associated with mandibule-facial dysostosis (Franceschetti-Goldenhar syndrome)].

The authors present a case of oculo-auricular dysplasia (type Goldenhar) associated with France-schetti's syndrome (mandibulo-facial dysostosis) and complicated by paralytic strabismus and genital malformations. Complete investigation failed to establish a precise aetiology; one suggests an external disturbance in the course of the organogenesis of the branchial arches. Aesthetic improvement was undertaken--removal of epibulbar dermoids, correction of the squint, and ablation of the preauricular appendages; functional orthodontic treatment continues.

Adult↗

Mandibulo-facial dysostosis. Analysis; principles of surgery.

Before regarding the treatment of facial deformities in mandibulo-facial dysostosis, the clinical, radiological and anatomical findings are reviewed. The plastic surgical correction of the main deformities are then considered. The aims of the treatment are: close the palpebral coloboma, build the zygomatic bones and zygomatic arches, correct the malformation of the auricles and the macrostomia, re-establish normal dental occlusion if necessary and harmonize the profile by reducing the nose and excessive vertical dimension of the mental symphysis.

Adolescent↗

Human PRRX1 and PRRX2 genes: cloning, expression, genomic localization, and exclusion as disease genes for Nager syndrome.

In this study, we extend our examination of the function of the Prrx1 (a.k.a Mhox, Prx1, K-2, and Pmx1) as well as Prrx2 (a.k.a. S8 and Prx2) genes by characterizing the expression of the human orthologs and their potential for causing specific human malformations. The expression pattern of PRRX2 and its close relative, PRRX1, were analyzed in human tissue by RT-PCR. Although the expression of these human genes is similar to their mouse orthologs, there are notable differences in expression. PRRX2 was detected in the human kidney and lung, whereas in mice and chickens neither of these tissues has been reported to express Prrx2. For PRRX1 the expression pattern was quite similar to other vertebrates, but the ratio of the two isoforms was reversed. To begin the search for the gene-disease connection, both genes were mapped to human chromosomes by FISH. The PRRX1 locus maps to 1q23, whereas the PRRX2 locus maps to 9q34.1. This localization, along with the recently described phenotypes of the gene-targeted Prrx1, Prrx2 and double mutant mice, enabled us to search the human disease databases for similar malformations. This examination suggested that mutations at the PRRX1 and/or PRRX2 loci could result in Nager Acrofacial Dysostosis (NAFD) syndrome. We obtained DNA samples from eight patients with NAFD, as well as two patients with Miller syndrome, and analyzed them for mutations in the PRRX1 and PRRX2 genes. The data excludes mutations in the presumed coding sequences of these genes from causing NAFD.

Abnormalities, Multiple↗

Prenatal ultrasound diagnosis of Nager syndrome.

Nager syndrome, or acrofacial dysostosis, is a rare malformation complex characterized by facial anomalies (external ear abnormalities and micrognathia) and limb defects (radial hypoplasia and absence of the thumb and/or other digits). Since its first description in 1948, more than 80 cases have been reported in the pediatric literature. However, there is only one previous report on the prenatal recognition of the syndrome, which was at 30 weeks of gestation. We report here a further case of Nager syndrome, prospectively diagnosed at 23 weeks of gestation.

Abortion, Induced↗

Mandibulo-facial dysostosis--the eye signs of a case study.

The mandibulo-facial dysostosis syndrome (Treacher-Collins syndrome) was first described in 1889. It is a syndrome with multiple presentations, the classification for which was devised by Franceschetti and Zwahlen in 1944. The eye signs are an important part of this syndrome. In addition to the main ocular features of colobomata of the lower eyelids and an anti-mongoloid slant, many other eye signs have been reported. An 18-year-old Indian male was found to have features not previously described. These are high myopia, dermolipoma, lens subluxation and secondary glaucoma.

Adolescent↗

Treacher-Collins syndrome. Management of major and minor anomalies of the ear.

12 patients suffering from a Treacher-Collins syndrome, or mandibulo-facial dysostosis, were operated on in the Nijmegen University Hospital between 1960 and 1990. An early diagnosis is generally reached when there is a congenital atresia of the auditory canal. Auditory rehabilitation with a conventional prosthesis of the bone or a BAHA is preferable to surgical reconstruction. In minor cases, deafness must be screened as early as possible, with a bone hearing aid prosthesis. Surgical exploration can be performed at best as the age of 10, but the chances of success are less than those of other functional reconstructions because of the associated malformation.

Ear↗