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Abstract
We present a 4-year-old girl with persistent anterior fontanelle and narrow sloping shoulders. The X-ray imaging revealed widely open anterior fontanelle, supernumerary teeth, and absence of clavicles. Therefore, the diagnosis was cleidocranial dysplasia, which is a rare autosomal dominant skeletal disease, caused by the mutation in the gene on 6p21 encoding transcription factor CBFA1 (runt-related transcription factor 2-RUNX2). The girl remains under close surveilance, her anterior fontanelle closed spontaneously at the age of 9 years.
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Affiliation(s)
- Stepan Kutilek
- Department of Pediatrics, Klatovy Hospital, Klatovy, Czech Republic.,Department of Pediatrics, Pardubice Hospital, Pardubice, Czech Republic
| | - Roman Machytka
- General Pediatrician-Practitioner, Holice, Czech Republic
| | - Petr Munzar
- Department of Pediatrics, Pardubice Hospital, Pardubice, Czech Republic
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2
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Shekhawat V, Gulati Y. Cleidocranial dysplasia – A case report discussing the clinical and radiological manifestations. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_59_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Çamtosun E, Akıncı A, Demiral E, Tekedereli İ, Sığırcı A. A Case of Cleidocranial Dysplasia with a Novel Mutation and Growth Velocity Gain with Growth Hormone Treatment. J Clin Res Pediatr Endocrinol 2019; 11:301-305. [PMID: 30468148 PMCID: PMC6745455 DOI: 10.4274/jcrpe.galenos.2018.2018.0211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder that is characterized by hypoplasia or aplasia of clavicles, failure of cranial suture closure, dental anomalies, short stature and other changes in skeletal patterning and growth. The gene responsible for pathogenesis has been mapped to the short arm of chromosome 6p21, core binding factor alpha-1 (CBFA1) or runt related transcription factor-2 (RUNX2). Here we describe a CCD patient with a novel mutation in the RUNX2 gene. A five-and-a-half year old girl presented with severe short stature, dysmorphic facial appearance (hypertelorism, prominent forehead, high palate, midfacial hypoplasia), macrocephaly, large anterior fontanelle, increased anteroposterior chest diameter. Her shoulders were close to each other and her bilateral clavicles appeared short on physical examination. Bilateral hypoplastic clavicles, coxa valga, hypoplasia of iliac bones, wide symphysis pubis and phalangeal dysplastic features were detected on her skeletal X-ray examination. She was diagnosed as having CCD. Molecular analysis detected a novel heterozygous mutation ‘NM_001024630.3p.T155P(c.463A>C)’ in the RUNX2 gene. At age seven years and two months old, because of her severe short stature, growth hormone (GH) treatment was started and she responded well to GH therapy with no adverse effects. In conclusion, hypoplasia or aplasia of the clavicles, failure of cranial suture closure, dental anomalies and short stature should bring CCD to mind. We present a novel mutation in the RUNX2 gene for CCD. We obtained growth velocity gain with GH treatment in our patient.
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Affiliation(s)
- Emine Çamtosun
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey,* Address for Correspondence: İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey Phone: +90 422 341 06 60-5377 E-mail:
| | - Ayşehan Akıncı
- İnönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Emine Demiral
- İnönü University Faculty of Medicine, Department of Medical Biology and Genetics, Malatya, Turkey
| | - İbrahim Tekedereli
- İnönü University Faculty of Medicine, Department of Medical Biology and Genetics, Malatya, Turkey
| | - Ahmet Sığırcı
- İnönü University Faculty of Medicine, Department of Radiology, Malatya, Turkey
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The Treatment Strategy of Cleidocranial Dysplasia: Combined Orthodontic and Orthognathic Treatment. J Craniofac Surg 2019; 30:1767-1771. [PMID: 30950953 DOI: 10.1097/scs.0000000000005372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cleidocranial dysplasia is a rare autosomal-dominant condition that affects ossification. The main symptoms of this cleidocranial dysplasia patient include craniofacial abnormalities, hypoplasia of clavicles, narrow thorax, retarded exfoliation of deciduous teeth, retarded eruption of permanent teeth, and multiple impacted supernumerary teeth. The aim of this treatment was to correct the craniofacial abnormalities and provide an adequate functional reconstruction of the occlusion. The patient was treated with a multidisciplinary therapeutic protocol including removal of supernumerary teeth, surgical exposure of impacted teeth, orthodontic, and orthognathic surgery. After 6 years' follow-up, the treatment objectives of acceptable occlusion, normal function, and acceptable profile were achieved.
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Xu L, Fu Y, Zhu W, Xu R, Zhang J, Zhang P, Cheng J, Jiang H. microRNA-31 inhibition partially ameliorates the deficiency of bone marrow stromal cells from cleidocranial dysplasia. J Cell Biochem 2018; 120:9472-9486. [PMID: 30506733 DOI: 10.1002/jcb.28223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/15/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cleidocranial dysplasia (CCD) in humans is an autosomal-dominant skeletal dysplasia caused by heterozygous mutations of the runt-related transcription factor 2 (RUNX2) and significantly increases the risk of osteoporosis. Increasing evidence demonstrates that the dysfunction of bone marrow stromal cells from CCD patients (BMSCs-CCD) contributes to the bone deficiency, but the characteristics of BMSCs-CCD and the mechanisms that underlie their properties remain undefined. METHODS The clinical manifestations of three CCD patients were collected and the mutations of RUNX2 were analyzed. The properties of proliferation, osteogenesis, stemness, and senescence of BMSCs-CCD were compared with that of BMSCs from healthy donors. The expression of microRNA-31 ( miR-31) between BMSCs-CCD and BMSCs was measured and lentivirus-carried miR-31 inhibitor was used to determine the role of miR-31 in BMSCs-CCD both in vitro and in vivo. The molecular mechanisms underlying RUNX2-miR31 and miR-31 targeting stemness and senescence of BMSCs-CCD were also explored. RESULTS We identified two mutation sites of RUNX2 via exome sequencing from 2 of 3 Chinese CCD patients with typical clinical presentations. Compared with BMSCs from healthy donors, BMSCs-CCD displayed significantly attenuated proliferation, osteogenesis and stemness, and enhanced senescence. Meanwhile, miR-31 knockdown could ameliorate these deficiency phenotypes of BMSCs-CCD by regulating SATB2, BMI1, CDKN, and SP7. Mechanistically, RUNX2 directly repressed miR-31 expression, and therefore RUNX2 haploinsufficiency in CCD leading to miR-31 upregulation contributed to the deficiency of BMSCs-CCD. miR-31 inhibition in BMSCs-CCD showed enhanced osteogenesis through heterotopic subcutaneous implantation in the nude mice. CONCLUSIONS Our results show the functional deficiencies of BMSCs-CCD and a potential role of miR-31 in BMSCs-CCD deficiencies. The application of miR-31 inhibitor in BMSCs-CCD might lend hope for developing BMSC-based therapeutic approaches against CCD-associated skeletal diseases.
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Affiliation(s)
- Ling Xu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Weiwen Zhu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Rongyao Xu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Juan Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
| | - Ping Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hongbing Jiang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
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Kreiborg S, Jensen BL. Tooth formation and eruption – lessons learnt from cleidocranial dysplasia. Eur J Oral Sci 2018; 126 Suppl 1:72-80. [DOI: 10.1111/eos.12418] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Sven Kreiborg
- Section of Pediatric Dentistry and Clinical Genetics Department of Odontology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - B. L. Jensen
- Section of Pediatric Dentistry and Clinical Genetics Department of Odontology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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The Treatment of Cleidocranial Dysostosis (Scheuthauer-Marie-Sainton Syndrome), a Rare Form of Skeletal Dysplasia, Accompanied by Spinal Deformities: A Review of the Literature and Two Case Reports. Case Rep Orthop 2018; 2018:4635761. [PMID: 30123598 PMCID: PMC6079611 DOI: 10.1155/2018/4635761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 11/23/2022] Open
Abstract
Cleidocranial dysostosis is a skeletal dysplasia inherited in an autosomal dominant manner and may lead to complications such as scoliosis and kyphosis, concurrent with various orthopedic involvements. Since concurrent spinal deformities are of progressive nature, surgical treatment may be necessary. In addition to other orthopedic problems, possible accompanying complications such as atlanto-axial subluxation, myelopathy, syringomyelia, congenital spine deformities, spondylosis, and spondylolisthesis should be kept in mind while planning for the treatment of scoliosis and kyphosis. Lengthening the use of growth-friendly systems (growing rod) in patients, like ours, with an early onset of symptoms, and performing posterior instrumentation and fusion once the spinal growth is complete will yield successful results with no complications in the middle and the long term. Further multicenter studies with more comprehensive assessments are required to find solutions to spinal problems related to this rare skeletal dysplasia.
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Delayed Eruption of Permanent Dentition and Maxillary Contraction in Patients with Cleidocranial Dysplasia: Review and Report of a Family. Int J Dent 2018; 2018:6591414. [PMID: 30123273 PMCID: PMC6079435 DOI: 10.1155/2018/6591414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/20/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Cleidocranial dysplasia (CCD) is an inherited disease caused by mutations in the RUNX2 gene on chromosome 6p21. This pathology, autosomal dominant or caused by a spontaneous genetic mutation, is present in one in one million individuals, with complete penetrance and widely variable expressivity. Aim To identify the incidence of these clinical findings in the report of the literature by means of PubMed interface from 2002 to 2015, with the related keywords. The report of local patients presents a clinical example, related to the therapeutic approach. Results and Discussions The PubMed research resulted in 122 articles. All the typical signs were reported in all presented cases. The maxilla was hypoplastic in 94% of the patients. Missing of permanent teeth was found in two cases: one case presented a class II jaw relationship, instead of class III malocclusion. Similar findings were present in our cohort. Conclusion CCD is challenging for both the dental team and the patient. The treatment requires a multidisciplinary approach. Further studies are required to better understand the cause of this disease. According to this review, a multistep approach enhances the possibilities to achieve the recovery of the most possible number of teeth, as such to obtain a good occlusion and a better aesthetic.
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Ha SW, Jung YJ, Bae HS, Ryoo HM, Cho IS, Baek SH. Characterization of dental phenotype in patients with cleidocranial dysplasia using longitudinal data. Angle Orthod 2018; 88:416-424. [PMID: 29664332 DOI: 10.2319/092617-647.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the characteristics of the dental phenotype in patients with cleidocranial dysplasia (CCD) using longitudinal data. MATERIALS AND METHODS Twelve unrelated Korean CCD patients were observed using a longitudinal series of radiographs and clinical photographs. Statistical analysis was performed on the dental phenotypic data. RESULTS Although dysplasia of the clavicles, open fontanelle, and wormian bone were observed in all 12 patients, delayed fusion of the mandibular symphysis was found in four patients. One patient did not have a supernumerary tooth (ST). However, 62 STs were found in 11 patients (mean, 5.6 per patient; range of ST emergence, 5 years 6 months-14 years 8 months; developing position, occlusal to the permanent incisors, canines, and premolars and distal and apical to the permanent molars). The mandibular premolar region was the most frequent area of ST development (50.0%, P < .001). All 12 patients showed impacted permanent teeth (IPT), including one patient without ST (mean, 17.8 per patient). Impaction occurred most frequently in the mandibular premolar region and least frequently in the maxillary molar region (93.8% vs 39.6%, P < .01). The ratio of spontaneous eruption of IPT after removal of retained deciduous teeth and/or ST was highest for the maxillary and mandibular incisors (all 54.6%) and lowest for the mandibular canines and premolars (26.7% and 28.9%, respectively); however, the difference was not significant. CONCLUSIONS The emergence time and development position of ST and the root development of IPT should be considered to determine the timing for the removal of ST and forced eruption of IPT.
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Anaesthetic management of an obstetric patient with cleidocranial dysplasia. Int J Obstet Anesth 2017; 33:94-96. [PMID: 28801164 DOI: 10.1016/j.ijoa.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022]
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Singh A, Goswami M, Pradhan G, Han MS, Choi JY, Kapoor S. Cleidocranial Dysplasia with Normal Clavicles: A Report of a Novel Genotype and a Review of Seven Previous Cases. Mol Syndromol 2015; 6:83-6. [PMID: 26279653 PMCID: PMC4521062 DOI: 10.1159/000375354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/19/2022] Open
Abstract
We report an unusual combination of features comprising delayed tooth eruption and closure of the anterior fontanel as the sole presenting features in a child with cleidocranial dysplasia (CCD). Radiological survey revealed the presence of wormian bones in the skull, pseudoepiphysis at the base of the bilateral second metacarpal, and midline ossification defects at pubic symphysis in the presence of essentially normal clavicles. DNA sequencing of the RUNX2 gene detected a novel nonsense mutation in exon1 (c.166C>T; p.Q56X) in its glutamine-alanine (Q/A) repeat domain. The genotypes of all published cases of CCD with normal clavicles were reviewed. Additional dental and otolaryngological features were enlisted. Three cases with a milder dental phenotype and normal clavicles were associated with a mutation in the Q/A domain. Collectively, we found a novel CCD-causing nonsense mutation p.Q56X in the Q/A domain of the RUNX2 gene.
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Affiliation(s)
- Ankur Singh
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, New Delhi, India
| | - Mridula Goswami
- Department of Pediatric Dentistry, Maulana Azad Institute of Dental Sciences, Daegu, Republic of Korea
| | | | - Min-Su Han
- Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Je-Yong Choi
- Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seema Kapoor
- Division of Genetics and Metabolism, Department of Pediatrics, MAMC Associated Lok Nayak Hospital, New Delhi, India
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Al Kaissi A, Ben Chehida F, Kenis V, Ganger R, Radler C, Hofstaetter JG, Klaushofer K, Grill F. Broad spectrum of skeletal malformation complex in patients with cleidocranial dysplasia syndrome: radiographic and tomographic study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2013; 6:45-55. [PMID: 24023524 PMCID: PMC3762605 DOI: 10.4137/cmamd.s11933] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE Cleidocranial dysplasia is an autosomal dominant disorder characterized by defective ossification of the intramembraneous ossification (primarily the clavicles, cranium, and pelvis), and it is caused by mutations in the RUNX2 gene that is responsible for osteoblast differentiation. Spine deformities were of progressive nature and considered to be the major orthopedic abnormalities encountered in our practice in patients with cleidocranial dysplasia. We aimed to further delineate the underlying spine pathology and its etiological understanding. Extraspinal deformities were dealt with respectively. MATERIAL AND METHODS In this paper, we describe 7 patients who were consistent with the phenotypic and the genotypic characterization of cleidocranial dysplasia. Reformatted computed tomography (CT) scans have been applied in several instances to further understand the underlying pathology of progressive spine tilting. Radiographs were sufficient to illustrate other skeletal malformations. RESULTS Anatomical survey demonstrates that a broad spectrum of frequently unrecognized orthopedic aberrations were encountered. We believe that torticollis has evolved in connection with the persistence of synchondrosis of the skull base and the upper cervical spine and these are strongly correlated to the well-known pathology of posterior occipital synchondrosis. Similarly, scoliosis and kyphoscoliosis resulted from the pathologic aberration of the cartilaginous stage of disrupted embryological development. All our results are discussed for the first time. Coxa vara, patellar dysplasia, and genu valgum were observed as extraspinal deformities. CONCLUSION This paper includes for the first time the anatomical analysis of the malformation complex of the craniocervical and the entire spine in patients with cleidocranial dysplasia. Reformatted CT scan was the modality of choice. We were able to illustrate that the persistence of skull base and the cervical spine synchondrosis were correlated with the pathological mechanism of the posterior occipital synchondrosis. Therefore, injuries to the craniocervical region in these patients might lead to a wide range of dreadful complications, ranging from complete atlanto-occipital or atlanto-axial dislocation to nondisplaced occipital condyle avulsion fractures with the possibility of morbid and or mortal outcome. On the other hand, the persistence of a cartilaginous spine was the reason behind the progressive spine tilting. This pathological form can be considered as a notoriously unpredictable malformation complex. The value of presenting these patients is to demonsterate that the genotype is not a precise index to assess the severity and the natural history of the phenotype.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Center Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria. ; Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
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Ramadoss T, Pravda C. Cleidocranial Dysplasia – Report of a rare case. Indian J Dent 2013. [DOI: 10.1016/j.ijd.2012.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roberts T, Stephen L, Beighton P. Cleidocranial dysplasia: a review of the dental, historical, and practical implications with an overview of the South African experience. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:46-55. [PMID: 23102800 DOI: 10.1016/j.oooo.2012.07.435] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 05/26/2012] [Accepted: 07/09/2012] [Indexed: 01/10/2023]
Abstract
Cleidocranial dysplasia (CCD) is an uncommon but well-known genetic skeletal condition. Several hundred affected persons are members of a large extended family in the Cape Town Mixed Ancestry community of South Africa. The clinical manifestations are often innocuous, but hyperdontia and other developmental abnormalities of the teeth are a major feature and may require special dental management. Over the past 40 years, the authors have encountered more than 100 affected persons in Cape Town. Emphasis has been on dental management, but medical, genetic, and social problems have also been addressed. In this article, we have reviewed the manifestations of the disorder in the light of our own experience, and performed a literature search with emphasis on the various approaches to dental management and treatment options in CCD. Advances in the understanding of the biomolecular pathogenesis of CCD are outlined and the international and local history of the disorder is documented.
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Affiliation(s)
- Tina Roberts
- Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
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Bhat MA, Laway BA, Mantoo S, Choudry K, Kotwal S, Mir SA. Cleidocranial dysplasia: a rare cause of disproportionate severe short stature. Oman Med J 2012; 27:408-10. [PMID: 23074552 DOI: 10.5001/omj.2012.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/20/2012] [Indexed: 12/25/2022] Open
Abstract
Skeletal dysplasia is an uncommon cause of short stature in children. An 11-year-old girl was evaluated for severe short stature in a tertiary care hospital. Clinical examination revealed severe disproportionate short stature and classical triad of multiple supernumerary teeth, and complete absence of clavicles and open sagittal sutures and fontanelles. Skeletal survey confirmed these findings, in addition to other features associated with the syndrome.
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Marchisella C, Rolando F, Muscarella LA, Zelante L, Bracco P, Piemontese MR. Identification of a novel RUNX2 gene mutation in an Italian family with cleidocranial dysplasia. Eur J Orthod 2010; 33:498-502. [DOI: 10.1093/ejo/cjq107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Li X, Tan L, Liu X, Lei S, Yang T, Chen X, Zhang F, Fang Y, Guo Y, Zhang L, Yan H, Pan F, Zhang Z, Peng Y, Zhou Q, He L, Zhu X, Cheng J, Zhang L, Liu Y, Tian Q, Deng H. A genome wide association study between copy number variation (CNV) and human height in Chinese population. J Genet Genomics 2010; 37:779-85. [DOI: 10.1016/s1673-8527(09)60095-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 10/27/2010] [Accepted: 10/29/2010] [Indexed: 12/24/2022]
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Ioscovich A, Barth D, Samueloff A, Grisaru-Granovsky S, Halpern S. Anesthetic management of a patient with cleidocranial dysplasia undergoing various obstetric procedures. Int J Obstet Anesth 2010; 19:106-8. [DOI: 10.1016/j.ijoa.2009.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 03/21/2009] [Accepted: 07/08/2009] [Indexed: 11/29/2022]
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Abstract
Cleidocranial dysplasia is a well-documented rare congenital disorder of the bone characterized by abnormalities of the skull, clavicle, and dentition. Despite numerous observations, there are still comparatively few reports regarding patients with cleidocranial dysplasia that focus on the impact of reconstruction of these defects on facial aesthetics. We report a 19-year-old woman with opened metopic and sagittal sutures and delayed closure of the anterior fontanelle. Through bicoronal incision and pericranial elevation, the defect was fully exposed. BoneSource was used to fill the cranial defect and was contoured to the desired cosmetic outcome. During a 24-month follow-up period, no absorption or recurrence was seen, and the patient was satisfied.
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Mata Zubillaga D, Lapeña López de Armentia S. Disostosis cleidocraneal. Revisión de once casos en cinco generaciones. An Pediatr (Barc) 2008; 69:162-6. [DOI: 10.1157/13124897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kisiel BM, Kostrzewa G, Wlasienko P, Kruczek A, Gajdulewicz M, Maciejak D, Wisniewska M, Ploski R, Korniszewski L. Cleidocranial dysplasia in a Polish population: high frequency of the R193X mutation. Clin Genet 2006; 70:167-9. [PMID: 16879201 DOI: 10.1111/j.1399-0004.2006.00648.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu YZ, Guo YF, Xiao P, Xiong DH, Zhao LJ, Shen H, Liu YJ, Dvornyk V, Long JR, Deng HY, Li JL, Deng HW. Epistasis between loci on chromosomes 2 and 6 influences human height. J Clin Endocrinol Metab 2006; 91:3821-5. [PMID: 16849413 DOI: 10.1210/jc.2006-0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Human height is a typical and important complex trait, which is determined by both actions and interactions of multiple genes. Although an increasing number of genes or genomic regions have been discovered for their independent effects on height variation, no study has been performed to identify genes or loci that interact to control the trait. OBJECTIVE This study aimed to search for potential genomic regions that harbor interactive genes underlying human height. METHODS Here with a sample containing 3726 Caucasians, the largest one ever obtained from a single population of the same ethnicity among genetic linkage studies of human complex traits, we performed variance component linkage analyses of height based on a two-locus epistatic model. We examined pairwise genetic interaction among three regions, 9q22, 6p21, and 2q21, which achieved significant or suggestive linkage signals for height in our recent whole genome scan. RESULTS Significant genetic interaction between 6p21 and 2q21 was detected, with 2q21 achieving a maximum LOD score of 3.21 (P = 0.0035) under the epistatic model, compared with a maximum LOD score of 1.63 under a two-locus additive model. Interestingly, 6p21 contains a cluster of candidate genes for skeletal growth, suggesting a mechanism whereby 2q21 regulates height through 6p21. CONCLUSION By providing the first evidence for genetic interaction underlying human height variation, this study further delineated the genetic architecture of human height and contributed to the genetic dissection of human complex traits in general.
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Affiliation(s)
- Yao-Zhong Liu
- Osteoporosis Research Center, Creighton University Medical Center, 601 North 30th Street, Suite 6787, Omaha, NE 68131, USA
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Abstract
The Runx2 gene is a master transcription factor of bone and plays a role in all stages of bone formation. It is essential for the initial commitment of mesenchymal cells to the osteoblastic lineage and also controls the proliferation, differentiation, and maintenance of these cells. Control is complex, with involvement of a multitude of factors, thereby regulating the expression and activity of this gene both temporally and spatially. The use of multiple promoters and alternative splicing of exons further extends its diversity of actions. RUNX2 is also essential for the later stages of tooth formation, is intimately involved in the development of calcified tooth tissue, and exerts an influence on proliferation of the dental lamina. Furthermore, RUNX2 regulates the alveolar remodelling process essential for tooth eruption and may play a role in the maintenance of the periodontal ligament. In this article, the structure of Runx2 is described. The control and function of the gene and its product are discussed, with special reference to developing tooth tissues, in an attempt to elucidate the role of this gene in the development of the teeth and supporting structures.
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Affiliation(s)
- Simon Camilleri
- Department of Orthodontics, Dental Institute of Kings College London, London, UK.
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24
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McBrien H, Turk J, Letch N. The management of ADHD and associated problems in a young person with cleidocranial dysostosis (CCD) and mild intellectual disability. Clin Child Psychol Psychiatry 2006; 11:445-56. [PMID: 17080780 DOI: 10.1177/1359104506059127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is increasingly recognized that comorbidity is common in all fields of psychiatry, and furthermore, it is acknowledged that a large number of individuals with genetically determined conditions have associated behavioural phenotypes, and are more susceptible to particular psychiatric and psychological comorbidities than others. It is also recognized that the identification of such phenotypes enables clinicians to be more aware of the potential difficulties an individual may experience, and hence, facilitate early diagnosis, effective management and prevention, appropriate allocation of resources and psychoeducation for the individual and their family. We describe the case report of a girl with cleidocranial dysostosis (CCD), and comorbid intellectual disability and attention deficit hyperactivity disorder (ADHD), and suggest the possible existence of a behavioural phenotype. We also highlight the lack of an evidence base for the management of ADHD within the learning-disability population, and describe successful management utilizing the current evidence base, which exists for those of average intellectual ability.
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González López BS, Ortiz Solalinde C, Kubodera Ito T, Lara Carrillo E, Ortiz Solalinde E. Cleido cranial dysplasia: report of a family. J Oral Sci 2005; 46:259-66. [PMID: 15901072 DOI: 10.2334/josnusd.46.259] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A family case of Cleidocranial Dysplasia is presented. A mother and two adolescent girls were examined. In all three cases, a radiological series was performed over the entire body. Generalized dysplasia in bones, prolonged retention of primary teeth, and delayed eruption of permanent, as well as supernumerary teeth was diagnosed. The citogenetic study with GTG band showed normal 46, XX. Bilateral audiometry in the mother demonstrated a mild to moderate hypoacustic condition. Radiological findings are presented and the importance of early diagnosis is discussed.
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26
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Yoshida T, Kanegane H, Osato M, Yanagida M, Miyawaki T, Ito Y, Shigesada K. Functional analysis of RUNX2 mutations in Japanese patients with cleidocranial dysplasia demonstrates novel genotype-phenotype correlations. Am J Hum Genet 2002; 71:724-38. [PMID: 12196916 PMCID: PMC378531 DOI: 10.1086/342717] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2002] [Accepted: 06/25/2002] [Indexed: 12/18/2022] Open
Abstract
Cleidocranial dysplasia (CCD) is an autosomal dominant heritable skeletal disease caused by heterozygous mutations in the osteoblast-specific transcription factor RUNX2. We have performed mutational analysis of RUNX2 on 24 unrelated patients with CCD. In 17 patients, 16 distinct mutations were detected in the coding region of RUNX2: 4 frameshift, 3 nonsense, 6 missense, and 2 splicing mutations, in addition to 1 polymorphism. The missense mutations were all clustered within the Runt domain, and their protein products were severely impaired in DNA binding and transactivation. In contrast, two RUNX2 mutants had the Runt domain intact and remained partially competent for transactivation. One criterion of CCD, short stature, was much milder in the patients with the intact Runt domain than in those without. Furthermore, a significant correlation was found between short stature and the number of supernumerary teeth. On the one hand, these genotype-phenotype correlations highlight a general, quantitative dependency, by skeleto-dental developments, on the gene dosage of RUNX2, which has hitherto been obscured by extreme clinical diversities of CCD; this gene-dosage effect is presumed to manifest on small reductions in the total RUNX2 activity, by approximately one-fourth of the normal level at minimum. On the other hand, the classic CCD phenotype, hypoplastic clavicles or open fontanelles, was invariably observed in all patients, including those with normal height. Thus, the cleidocranial bone formation, as mediated by intramembranous ossification, may require a higher level of RUNX2 than does skeletogenesis (mediated by endochondral ossification), as well as odontogenesis (involving still different complex processes). Overall, these results suggest that CCD could result from much smaller losses in the RUNX2 function than has been envisioned on the basis of the conventional haploinsufficiency model.
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Affiliation(s)
- Taketoshi Yoshida
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Hirokazu Kanegane
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Motomi Osato
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Masatoshi Yanagida
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Toshio Miyawaki
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Yoshiaki Ito
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
| | - Katsuya Shigesada
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan; and Departments of Genetics and Molecular Biology and Viral Oncology, Institute for Virus Research, Kyoto University, Kyoto
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27
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Affiliation(s)
- M M Cohen
- Department of Oral and Maxillofacial Sciences, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5.
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Cooper SC, Flaitz CM, Johnston DA, Lee B, Hecht JT. A natural history of cleidocranial dysplasia. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 104:1-6. [PMID: 11746020 DOI: 10.1002/ajmg.10024] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia associated with clavicle hypoplasia and dental abnormalities. The condition is caused by mutations in the CBFA1 gene, a transcription factor that activates osteoblast differentiation. Clinical characteristics associated with CCD have previously been described in case reports and small case series. This study was undertaken to gain a more complete delineation of clinical complications associated with CCD. The study population was composed of 90 CCD individuals and 56 relative controls ascertained from genetic and dental practices in the United States, Canada, Europe, and Australia. A number of previously unrecognized complications were significantly increased including: genua valga, scoliosis, pes planus, sinus infections, upper respiratory complications, recurrent otitis media, and hearing loss. Primary Cesarean section rate was significantly increased compared to relative controls and the general population rate. Finally, dental abnormalities, including supernumerary teeth, failure of exfoliation of the primary dentition, and malocclusion, are serious and complex problems that require intervention. Clinical recommendations based on the results of this study are included.
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Affiliation(s)
- S C Cooper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Houston Medical School, 6431 Fannin, Houston, TX 77030, USA
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Oyer CE, Tatevosyants NG, Cortez SC, Hornstein A, Wallach M. Cleidocranial dysplasia with neonatal death due to central nervous system injury in utero: case report and literature review. Pediatr Dev Pathol 1998; 1:314-8. [PMID: 10463294 DOI: 10.1007/s100249900045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cleidocranial dysplasia (CCD), an uncommon disorder involving membranous bones, is rarely lethal in early life. The calvaria is defective and wormian bones are present. Abnormalities of the clavicles vary in severity from a minor unilateral defect to bilateral absence. This report concerns pre- and postmortem anatomical and radiological findings in a 15-day-old female neonate with CCD. Her postnatal course was characterized by seizures and recognition of hydrocephalus during the first day of life. The calvaria was hypoplastic with numerous wormian bones. A pseudofracture of the right clavicle was present. Hydrocephalus was present in the brachycephalic brain which had a severely thinned cerebral cortex. Hemosiderin in the ventricular lining and marked subependymal gliosis were interpreted as evidence of old intraventricular hemorrhage that had occurred in utero. A CCD-related condition, Yunis-Varon syndrome (YVS), is noted for early lethality and for developmental and secondary abnormalities of the central nervous system. The present case only partially matches the phenotype of YVS and might represent a part of a spectrum of phenotypic variants ranging from viable CCD to lethal YVS.
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Affiliation(s)
- C E Oyer
- Department of Pathology, Brown University School of Medicine, Rhode Island Hospital, Women and Infants' Hospital, Providence 02905, USA
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30
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Affiliation(s)
- G A Rodan
- Department of Bone Biology and Osteoporosis Research, Merck Research Laboratories, West Point, Pennsylvania 19486, USA
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31
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Zackai EH, Robin NH, McDonald-McGinn DM. Sibs with cleidocranial dysplasia born to normal parents: germ line mosaicism? AMERICAN JOURNAL OF MEDICAL GENETICS 1997; 69:348-51. [PMID: 9098480 DOI: 10.1002/(sici)1096-8628(19970414)69:4<348::aid-ajmg2>3.0.co;2-h] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cleidocranial dysplasia (CCD) is classically an autosomal dominant disorder. However, the possibility of an autosomal recessive form of CCD has been suggested based on a report of 2 consanguineous families, one with a single affected child, the second with affected sibs, born to normal parents. We present a family with sibs with CCD born to normal parents, and suggest germ line mosaicism as the more likely mechanism for this occurrence.
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Affiliation(s)
- E H Zackai
- Chidren's Hospital of Philadelphia, Division of Human Genetics and Molecular Biology, Pennsylvania 19104, USA
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32
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Abstract
A 29-year-old Caucasian woman who presented with short stature and multiple unerupted supernumerary teeth is described. Radiological investigations of her cranial and skeletal abnormalities revealed cleidocranial dysplasia. Because of the advanced age of the patient and contraindication for orthodontic treatment, only surgical and prosthetic treatment were performed. The characteristics and treatments of this rare autosomal dominant disorder are discussed.
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Affiliation(s)
- F Taşar
- Department of Oral Surgery, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
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Beighton P, Giedion ZA, Gorlin R, Hall J, Horton B, Kozlowski K, Lachman R, Langer LO, Maroteaux P, Poznanski A. International classification of osteochondrodysplasias. ACTA ACUST UNITED AC 1992; 44:223-9. [PMID: 1360767 DOI: 10.1002/ajmg.1320440220] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P Beighton
- Universitätskinderklinik, Mainz, Germany
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34
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Affiliation(s)
- L Mehta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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35
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Spranger J. International classification of osteochondrodysplasias. The International Working Group on Constitutional Diseases of Bone. Eur J Pediatr 1992; 151:407-15. [PMID: 1628667 DOI: 10.1007/bf01959352] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Spranger
- Universitätskinderklinik, Mainz, Federal Republic of Germany
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36
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Chitayat D, Hodgkinson KA, Azouz EM. Intrafamilial variability in cleidocranial dysplasia: a three generation family. AMERICAN JOURNAL OF MEDICAL GENETICS 1992; 42:298-303. [PMID: 1536165 DOI: 10.1002/ajmg.1320420307] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We present a 3-generation family, ascertained after the birth of a child with cleidocranial dysplasia (CCD). The propositus presented with respiratory distress (due to a narrow thorax) and hypoplasia and discontinuity of both clavicles. The mother, aunt, and grandmother had varied features of the condition. This intrafamilial variation illustrates the need for clinical assessment of family members following the birth of an apparent sporadic case of CCD.
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Affiliation(s)
- D Chitayat
- Department of Pediatrics, Montreal Children's Hospital, Quebec, Canada
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