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Clinical and Genetic Studies of the First Monozygotic Twins with Pfeiffer Syndrome. Genes (Basel) 2022; 13:genes13101850. [PMID: 36292735 PMCID: PMC9601734 DOI: 10.3390/genes13101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To report the clinical and radiographic findings and molecular etiology of the first monozygotic twins affected with Pfeiffer syndrome. Methods: Clinical and radiographic examination and whole exome sequencing were performed on two monozygotic twins with Pfeiffer syndrome. Results: An acceptor splice site mutation in FGFR2 (c.940-2A>G) was detected in both twins. The father and both twins shared the same haplotype, indicating that the mutant allele was from their father’s chromosome who suffered severe upper airway obstruction and subsequent obstructive sleep apnea. Hypertrophy of nasal turbinates appears to be a newly recognized finding of Pfeiffer syndrome. Increased intracranial pressure in both twins were corrected early by fronto-orbital advancement with skull expansion and open osteotomy, in order to prevent the more severe consequences of increased intracranial pressure, including hydrocephalus, the bulging of the anterior fontanelle, and the diastasis of suture. Conclusions: Both twins carried a FGFR2 mutation and were discordant for lambdoid synostosis. Midface hypoplasia, narrow nasal cavities, and hypertrophic nasal turbinates resulted in severe upper airway obstruction and subsequent obstructive sleep apnea in both twins. Hypertrophy of the nasal turbinates appears to be a newly recognized finding of Pfeiffer syndrome. Fronto-orbital advancement with skull expansion and open osteotomy was performed to treat increased intracranial pressure in both twins. This is the first report of monozygotic twins with Pfeiffer syndrome.
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Srikanthan A, Scott S, Desai V, Reichert L. Neonatal Airway Abnormalities. CHILDREN 2022; 9:children9070944. [PMID: 35883928 PMCID: PMC9322467 DOI: 10.3390/children9070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.
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Affiliation(s)
| | - Samantha Scott
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
| | - Vilok Desai
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
| | - Lara Reichert
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
- Correspondence:
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Setiawan D, Adibrata ASP, Sari PP, Kuntara A, Yogaswara GP. Imaging of Pfeiffer Syndrome: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Pfeiffer syndrome (PS) is a rare case in the Asian population, and only a few have been reported in Indonesia. This case report aims to spotlight the identification of PS with its correlated radiological imaging and distinguish it from other syndromes.
CASE REPORTS: The authors report a case of a 5-year-old girl with PS, manifested by brachyturricephally, broad thumbs and big toes, and medially deviated big toes. The patient also had proptosis, midface hypoplasia, and bilateral Syndactyly of the fingers and toes. This report confirms the thorough examination procedures and indexes to identify PS as a literature reference for the research of reported PS in Southeast Asian race patients and as one comprehensive source for identification using index figures.
CONCLUSION: This report provides a detailed radiology interpretation of PS on Southeast Asian race patients. Radiological findings can help in diagnosing and determining adequate treatment as needed.
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Stanton E, Urata M, Chen JF, Chai Y. The clinical manifestations, molecular mechanisms and treatment of craniosynostosis. Dis Model Mech 2022; 15:dmm049390. [PMID: 35451466 PMCID: PMC9044212 DOI: 10.1242/dmm.049390] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Craniosynostosis is a major congenital craniofacial disorder characterized by the premature fusion of cranial suture(s). Patients with severe craniosynostosis often have impairments in hearing, vision, intracranial pressure and/or neurocognitive functions. Craniosynostosis can result from mutations, chromosomal abnormalities or adverse environmental effects, and can occur in isolation or in association with numerous syndromes. To date, surgical correction remains the primary treatment for craniosynostosis, but it is associated with complications and with the potential for re-synostosis. There is, therefore, a strong unmet need for new therapies. Here, we provide a comprehensive review of our current understanding of craniosynostosis, including typical craniosynostosis types, their clinical manifestations, cranial suture development, and genetic and environmental causes. Based on studies from animal models, we present a framework for understanding the pathogenesis of craniosynostosis, with an emphasis on the loss of postnatal suture mesenchymal stem cells as an emerging disease-driving mechanism. We evaluate emerging treatment options and highlight the potential of mesenchymal stem cell-based suture regeneration as a therapeutic approach for craniosynostosis.
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Affiliation(s)
- Eloise Stanton
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mark Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90033, USA
| | - Jian-Fu Chen
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
| | - Yang Chai
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
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Thomas A, Flanary V, Friedland DR, Adams JA, Tong L, Osinski K, Luo J. The impact of social determinants of health and clinical comorbidities on post-tympanotomy tube otorrhea. Int J Pediatr Otorhinolaryngol 2022; 152:110986. [PMID: 34839989 DOI: 10.1016/j.ijporl.2021.110986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To measure the impact of social determinants of health and clinical comorbidities on the incidence of post-tympanotomy tube otorrhea (PTTO). METHODS Retrospective observational cohort study. All children between the ages of 0 and 17 having tympanotomy tube placement between 2009 and 2019. Between group comparisons entailed the calculation of odds ratios (OR) with 95% confidence intervals and associated p-values. RESULTS Among 12,757 patients who underwent myringotomy and tube placement, 2217 (17.4%) presented with PTTO within 1 year. Race and sex did not correlate with the development of PTTO. Non-Hispanic ethnicity had a negative association with PTTO (OR: 0.80 (0.70-0.91), p < .0001). Insurance status correlated with incidence of PTTO with a higher rate noted among those with public insurance (OR: 1.12 (1.02-1.23), p = .02) and a lower rate among those with private insurance (OR: 0.84 (0.77-0.92), p < .0001). Craniofacial abnormalities had the strongest positive correlation with PTTO, particularly, cleft lip and/or cleft palate (OR>2.24, p < .0001). Immunodeficiency had similar impact on PTTO (OR: 2.38 (1.46-3.91), p < .0001). Asthma and prematurity did not significantly correlate with occurrence of PTTO. CONCLUSION Higher rates of PTTO correlated strongest with clinical factors; particularly craniofacial abnormalities and immunodeficiency. Social determinants, including private insurance and non-Hispanic ethnicity, were associated with lower rates of PTTO. Race and sex did not show significant correlations.
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Affiliation(s)
- Abigail Thomas
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, United States.
| | - Valerie Flanary
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, United States.
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, United States.
| | - Jazzmyne A Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, United States.
| | - Ling Tong
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Northwest Quadrant B 6469, Milwaukee, WI, 53211, United States.
| | - Kristen Osinski
- Clinical and Translational Science Institute, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, United States.
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Northwest Quadrant B 6469, Milwaukee, WI, 53211, United States.
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Paternoster G, Haber SE, Khonsari RH, James S, Arnaud E. Craniosynostosis: Monobloc Distraction with Internal Device and Its Variant for Infants with Severe Syndromic Craniosynostosis. Clin Plast Surg 2021; 48:497-506. [PMID: 34051901 DOI: 10.1016/j.cps.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of distraction osteogenesis to frontofacial monobloc advancement has increased the safety of the procedure. One hundred forty-seven patients with syndromic craniosynostosis underwent frontofacial monobloc advancement using 4 internal distractors. Twenty-five were aged 18 months or less. Ten patients presented with a tracheostomy, 5 (50%) were decannulated after surgery, and 3 others (30%) required an additional intervention before decannulation. Six patients required the addition of a transfacial pin and external traction. Very early frontofacial monobloc with 4 internal distractors is a safe and effective treatment to protect the ophthalmic, neurologic, and respiratory functions in infants with severe syndromic craniosynostosis.
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Affiliation(s)
- Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France
| | - Samer Elie Haber
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France
| | - Roman Hossein Khonsari
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université de Paris, Université Paris Descartes, 149 rue de Sèvres, 75015, Paris, France
| | - Syril James
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Clinique Marcel Sembat, Ramsay Générale de Santé, 105 boulevard Victor Hugo, 92100 Boulogne, France
| | - Eric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST, Filière Maladies Rares TeteCou, Université Paris Descartes, ERN Cranio, 149 rue de Sèvres, 75015, Paris, France; Clinique Marcel Sembat, Ramsay Générale de Santé, 105 boulevard Victor Hugo, 92100 Boulogne, France.
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Ungkanont K, Tabthong A, Komoltri C, Vathanophas V, Tanphaichitr A, Keskool P. Association of cleft palate and craniofacial syndromic anomalies with the outcome of tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100036] [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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