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Sakamoto Y, Miwa T. Pitfall of Monobloc Advancement in Beare-Stevenson Syndrome. J Craniofac Surg 2024:00001665-990000000-01394. [PMID: 38445861 DOI: 10.1097/scs.0000000000010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/14/2024] [Indexed: 03/07/2024] Open
Abstract
Beare-Stevenson syndrome (BSS) is an extremely rare form of craniosynostosis. Half of patients with BSS died within the first year of life due to cardiorespiratory arrest or unexpected sudden death. In addition, there have only been fewer than 30 cases, which limits prognostication for clinicians. We currently have an 8-year-old patient who is being followed up. She underwent tracheostomy, cranioplasty, and shunting. After waiting for growth, for improvement of ocular herniation, monobloc advancement was performed at the age of 5 years. The temporal fossa was quite narrow due to severe midface hypoplasia. In addition, even though midface advancement, it was difficult to remove tracheostomy. This was because midfacial hypoplasia was so severe that it was hard to notice, but there was also micrognathia. We report our experience with this midface treatment.
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Affiliation(s)
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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2
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Ornitz DM, Itoh N. New developments in the biology of fibroblast growth factors. WIREs Mech Dis 2022; 14:e1549. [PMID: 35142107 PMCID: PMC10115509 DOI: 10.1002/wsbm.1549] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/28/2023]
Abstract
The fibroblast growth factor (FGF) family is composed of 18 secreted signaling proteins consisting of canonical FGFs and endocrine FGFs that activate four receptor tyrosine kinases (FGFRs 1-4) and four intracellular proteins (intracellular FGFs or iFGFs) that primarily function to regulate the activity of voltage-gated sodium channels and other molecules. The canonical FGFs, endocrine FGFs, and iFGFs have been reviewed extensively by us and others. In this review, we briefly summarize past reviews and then focus on new developments in the FGF field since our last review in 2015. Some of the highlights in the past 6 years include the use of optogenetic tools, viral vectors, and inducible transgenes to experimentally modulate FGF signaling, the clinical use of small molecule FGFR inhibitors, an expanded understanding of endocrine FGF signaling, functions for FGF signaling in stem cell pluripotency and differentiation, roles for FGF signaling in tissue homeostasis and regeneration, a continuing elaboration of mechanisms of FGF signaling in development, and an expanding appreciation of roles for FGF signaling in neuropsychiatric diseases. This article is categorized under: Cardiovascular Diseases > Molecular and Cellular Physiology Neurological Diseases > Molecular and Cellular Physiology Congenital Diseases > Stem Cells and Development Cancer > Stem Cells and Development.
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Affiliation(s)
- David M Ornitz
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nobuyuki Itoh
- Kyoto University Graduate School of Pharmaceutical Sciences, Sakyo, Kyoto, Japan
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3
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Katsuragi SY, Hirose E, Arai Y, Otsuki Y, Ohki S, Kobayashi H. Autopsy Case of Pfeiffer Syndrome Type 2, a Phenotype of Fibroblast Growth Factor Receptor-Associated Craniosynostosis Syndromes, with Tracheal Cartilage Sleeve and Abnormal Hyperplasia of Bronchial Cartilages. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932450. [PMID: 34366428 PMCID: PMC8363655 DOI: 10.12659/ajcr.932450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pfeiffer syndrome (PS) is a fibroblast growth factor receptor (FGFR)-associated craniosynostosis syndrome, characterized by abnormally broad and medially deviated thumbs and great toes. Tracheal cartilage sleeve (TCS) is associated with several FGFR-associated craniosynostosis syndromes, including PS. TCS is an airway malformation in which the tracheal cartilage rings fuse with each other to form a sleeve of cartilage. CASE REPORT The patient was a 4-year-old girl with PS, TCS, and abnormal hyperplasia of non-fused intrapulmonary cartilages. The patient showed cranial dysplasia on prenatal ultrasonography. At birth, a cloverleaf skull in association with hydrocephalus and digital malformations was apparent. These findings were consistent with PS type 2. The diagnosis of PS type 2 was confirmed from a genetic test detecting a FGFR2 mutation (Y340C). During the clinical course, she underwent several surgeries, including ventriculoperitoneal shunts, sequential cranioplasty surgeries, and tracheotomy due to upper airway abnormalities. At 4 years old, she died of multiple organ failure following aspiration pneumonia. The autopsy revealed that the tracheal cartilages had fused with each other, resulting in a condition called TCS, in which the cartilage rings and tracheal ligaments were absent. The lungs were poorly aerated, and the dilated bronchi had thickened walls surrounded by many cartilage fragments, mainly at the hilum. These cartilages tended to overlap at both ends, did not fuse, and were greatly altered in size and shape. CONCLUSIONS We report the results of autopsy for PS with the first histopathological findings for the lungs and other visceral organs.
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Affiliation(s)
- Shin-Ya Katsuragi
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Etsuko Hirose
- Department of Neonatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Shigeru Ohki
- Department of Neonatology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroshi Kobayashi
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.,Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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4
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Noble AR, Cunningham ML, Lam A, Wenger TL, Sie KC, Perkins JA, Dahl JP. Complex Airway Management in Patients with Tracheal Cartilaginous Sleeves. Laryngoscope 2021; 132:215-221. [PMID: 34133757 DOI: 10.1002/lary.29692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS A tracheal cartilaginous sleeve (TCS) is a rare anomaly characterized by anterior fusion of tracheal cartilages. TCS is associated with syndromic craniosynostoses including Apert, Crouzon and Pfeiffer syndromes and FGFR2, FGFR3, and TWIST1 variants. This study presents a 30-year review of patients with syndromic craniosynostosis and TCS and describes diagnostic methods, genetic variants, surgical interventions, and long-term outcomes. STUDY DESIGN Retrospective, single-institution review. METHODS This review included patients with syndromic craniosynostosis and TCS treated at Seattle Children's Hospital from 1990 to 2020. Tracheostomy, genetic variants, and additional surgery were primary measures. Fisher's exact test compared need for tracheostomy in patients with proposed high-risk (FGFR2 p.W290 or FGFR2 p.C342) versus low-risk genetic variants. RESULTS Thirty patients with TCS were identified. Average age at diagnosis was 12 months (range 2-weeks to 7.9-years; standard deviation 19.8 months). Syndromes included Pfeiffer (37%), Apert (37%), and Crouzon (26%). Severe obstructive sleep apnea was present in 76% of patients. Tracheostomy was performed in 17 patients (57%); five were successfully decannulated. Additional interventions included adenotonsillectomy (57%), nasal (20%), laryngeal (17%), and craniofacial skeletal surgery (87%). All patients with Pfeiffer syndrome and FGFR2 p.W290C variants and 83% of patients with FGFR2 p.C342 variants required tracheostomy, differing from other variants (P = .02, odds ratio 33, 95% confidence interval 1.56-697.96). One patient (3%) died. CONCLUSION TCS contributes to multilevel airway obstruction in patients with syndromic craniosynostosis. Genetic testing in patients with FGFR2-related syndromic craniosynostoses may identify those at risk of TCS and facilitate early intervention. A better understanding of this patient population may foster individualized airway management strategies and improve outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Anisha R Noble
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Michael L Cunningham
- Department of Pediatrics, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Pediatrics, Division of Craniofacial Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Seattle Children's Research Division, Seattle Children's Research Institute, Seattle, Washington, U.S.A
| | - Austin Lam
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Tara L Wenger
- Division of Genetic Medicine, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Kathleen C Sie
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Pediatrics, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Seattle Children's Research Division, Seattle Children's Research Institute, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Jonathan A Perkins
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Pediatrics, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Seattle Children's Research Division, Seattle Children's Research Institute, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Pediatrics, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Seattle Children's Research Division, Seattle Children's Research Institute, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
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5
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Kim BS, Shin HR, Kim HJ, Yoon H, Cho YD, Choi KY, Choi JY, Kim WJ, Ryoo HM. Septal chondrocyte hypertrophy contributes to midface deformity in a mouse model of Apert syndrome. Sci Rep 2021; 11:7979. [PMID: 33846505 PMCID: PMC8041873 DOI: 10.1038/s41598-021-87260-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Midface hypoplasia is a major manifestation of Apert syndrome. However, the tissue component responsible for midface hypoplasia has not been elucidated. We studied mice with a chondrocyte-specific Fgfr2S252W mutation (Col2a1-cre; Fgfr2S252W/+) to investigate the effect of cartilaginous components in midface hypoplasia of Apert syndrome. In Col2a1-cre; Fgfr2S252W/+ mice, skull shape was normal at birth, but hypoplastic phenotypes became evident with age. General dimensional changes of mutant mice were comparable with those of mice with mutations in EIIa-cre; Fgfr2S252W/+, a classic model of Apert syndrome in mice. Col2a1-cre; Fgfr2S252W/+ mice showed some unique facial phenotypes, such as elevated nasion, abnormal fusion of the suture between the premaxilla and the vomer, and decreased perpendicular plate of the ethmoid bone volume, which are related to the development of the nasal septal cartilage. Morphological and histological examination revealed that the presence of increased septal chondrocyte hypertrophy and abnormal thickening of nasal septum is causally related to midface deformities in nasal septum-associated structures. Our results suggest that careful examination and surgical correction of the nasal septal cartilage may improve the prognosis in the surgical treatment of midface hypoplasia and respiratory problems in patients with Apert syndrome.
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Affiliation(s)
- Bong-Soo Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hye-Rim Shin
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hyun-Jung Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Heein Yoon
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Kang-Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Je-Yong Choi
- Department of Biochemistry and Cell Biology, Cell and Matrix Research Institute, Skeletal Disease Analysis Center, Korea Mouse Phenotyping Center (KMPC), School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo-Jin Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.
| | - Hyun-Mo Ryoo
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.
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6
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Loy KA, Lam AS, Otjen JP, Dahl JP. Tracheal cartilaginous sleeve diagnosed on ultrasound in a child with Pfeiffer syndrome. Int J Pediatr Otorhinolaryngol 2020; 138:110321. [PMID: 32877875 PMCID: PMC8007212 DOI: 10.1016/j.ijporl.2020.110321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
The tracheal cartilaginous sleeve (TCS) is a rare, difficult to diagnose airway malformation in which segmented tracheal rings are replaced by a solid sheath of cartilage. TCS is a significant cause of morbidity and mortality in patients with syndromic craniosynostosis, and early diagnosis is essential. We report a case in which ultrasound (US) was used to diagnose TCS in a patient with Pfeiffer syndrome. This is the first case demonstrating the use of US as the initial tool to diagnose TCS. The case supports ongoing research investigating the use of US as a screening and diagnostic imaging modality for TCS.
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Affiliation(s)
- Kelsey A. Loy
- Department of Otolaryngology – Head and Neck Surgery, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA,Department of Surgery, Division of Pediatric Otolaryngology – Head & Neck Surgery, Seattle Children’s Hospital, Seattle, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Austin S. Lam
- Department of Otolaryngology – Head and Neck Surgery, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA,Department of Surgery, Division of Pediatric Otolaryngology – Head & Neck Surgery, Seattle Children’s Hospital, Seattle, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Jeffrey P. Otjen
- Department of Radiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA,Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - John P. Dahl
- Department of Otolaryngology – Head and Neck Surgery, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA,Department of Surgery, Division of Pediatric Otolaryngology – Head & Neck Surgery, Seattle Children’s Hospital, Seattle, 4800 Sand Point Way NE, Seattle, WA, 98105, USA,Corresponding author. 4800 Sand Point Way NE, Seattle, WA, 98105, USA. (J.P. Dahl)
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7
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Feeding, Communication, Hydrocephalus, and Intracranial Hypertension in Patients With Severe FGFR2-Associated Pfeiffer Syndrome. J Craniofac Surg 2020; 32:134-140. [DOI: 10.1097/scs.0000000000007153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Lam AS, Liu CC, Deutsch GH, Rivera J, Perkins JA, Holmes G, Jabs EW, Cunningham ML, Dahl JP. Genotype-Phenotype Correlation of Tracheal Cartilaginous Sleeves and Fgfr2 Mutations in Mice. Laryngoscope 2020; 131:E1349-E1356. [PMID: 32886384 DOI: 10.1002/lary.29060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To characterize tracheal cartilage morphology in mouse models of fibroblast growth factor receptor (Fgfr2)-related craniosynostosis syndromes. To establish relationships between specific Fgfr2 mutations and tracheal cartilaginous sleeve (TCS) phenotypes in these mouse models. METHODS Postnatal day 0 knock-in mouse lines with disease-specific genetic variations in the Fgfr2 gene (Fgfr2C342Y/C342Y , Fgfr2C342Y/+ , Fgfr2+/Y394C , Fgfr2+/S252W , and Fgfr2+/P253R ) as well as line-specific controls were utilized. Tracheal cartilage morphology as measured by gross analyses, microcomputed tomography (μCT), and histopathology were compared using Chi-squared and single-factor analysis of variance statistical tests. RESULTS A greater proportion of rings per trachea were abnormal in Fgfr2C342Y/+ tracheas (63%) than Fgfr2+/S252W (17%), Fgfr2+/P253R (17%), Fgfr2+/Y394C (12%), and controls (10%) (P < .001 for each vs. Fgfr2C342Y/+ ). TCS segments were found only in Fgfr2C342Y/C342Y (100%) and Fgfr2C342Y/+ (72%) tracheas. Cricoid and first-tracheal ring fusion was noted in all Fgfr2C342Y/C342Y and 94% of Fgfr2C342Y/+ samples. The Fgfr2C342Y/C342Y and Fgfr2C342Y/+ groups were found to have greater areas and volumes of cartilage than other lines on gross analysis and μCT. Histologic analyses confirmed TCS among the Fgfr2C342Y/C342Y and Fgfr2C342Y/+ groups, without appreciable differences in cartilage morphology, cell size, or density; no histologic differences were observed among other Fgfr2 lines compared to controls. CONCLUSION This study found TCS phenotypes only in the Fgfr2C342Y mouse lines. These lines also had increased tracheal cartilage compared to other mutant lines and controls. These data support further study of the Fgfr2 mouse lines and the investigation of other Fgfr2 variants to better understand their role in tracheal development and TCS formation. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1349-E1356, 2021.
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Affiliation(s)
- Austin S Lam
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Seattle Children's Research Institute, Center for Developmental Biology and Regenerative Medicine, Seattle, Washington, U.S.A
| | - Carrie C Liu
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Current address: Divisions of Otolaryngology - Head and Neck Surgery, and Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Gail H Deutsch
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Department of Pathology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Joshua Rivera
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A.,Current address: Center for Personalized Cancer Therapy, University of Massachusetts, Boston, Massachusetts, U.S.A
| | - Jonathan A Perkins
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Greg Holmes
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Ethylin W Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Michael L Cunningham
- Seattle Children's Research Institute, Center for Developmental Biology and Regenerative Medicine, Seattle, Washington, U.S.A.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Otolaryngology - Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology - Head & Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.,Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, U.S.A
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9
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Amiji I, Kalezi ZE, Abdulshakoor A, Tarimo JF, Leiya R, Zuechner A, Naburi HE, Massawe A, Manji KP. Pfeiffer Syndrome type 2; A case report of cranio-orbitofaciostenosis with bilateral choanal atresia at Muhimbili National Hospital, Tanzania. Clin Case Rep 2020; 8:1613-1617. [PMID: 32983461 PMCID: PMC7495869 DOI: 10.1002/ccr3.2959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022] Open
Abstract
Pfeiffer syndrome is a rare genetic disorder with heterogenous phenotype and prognosis. Due to its diverse clinical presentation, it can easily be misdiagnosed. Where genetic testing still remains a challenge, antenatal sonogram can aid in early diagnosis. The cranioorbito-faciostenosis demands aggressive management to permit survival instead of uniform early demise.
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Affiliation(s)
- Insiyah Amiji
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Zawadi E. Kalezi
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Ashfaq Abdulshakoor
- Department of OtorhinolaryngologySchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Janet F. Tarimo
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Raymond Leiya
- Department of OtorhinolaryngologySchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Antke Zuechner
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Helga E. Naburi
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Augustine Massawe
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Karim P. Manji
- Department of Paediatric and Child HealthSchool of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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10
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Seki E, Enomoto K, Tanoue K, Tanaka M, Kurosawa K. Tracheal cartilaginous sleeve in patients with Beare-Stevenson syndrome. Congenit Anom (Kyoto) 2020; 60:97-99. [PMID: 31373082 DOI: 10.1111/cga.12352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/22/2019] [Accepted: 07/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Eijun Seki
- Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan.,Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Keisuke Enomoto
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Koji Tanoue
- Department of General Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Mio Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
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11
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Zenner K, Bonilla-Velez J, Johnson K, Bly RA. Slide Tracheoplasty to Repair Stenotic Tracheal Cartilaginous Sleeve with Advanced Surgical Planning. Otolaryngol Head Neck Surg 2020; 163:391-393. [PMID: 32284001 DOI: 10.1177/0194599820915469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kaitlyn Zenner
- Department of Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Juliana Bonilla-Velez
- Department of Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Kaalan Johnson
- Department of Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Randall A Bly
- Department of Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Washington, Seattle, Washington, USA
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12
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Ferreira LC, Dantas Junior JH. Report of a Father With Congenital Bilateral Absence of the Vas Deferens Fathering a Child With Beare–Stevenson Syndrome. Front Genet 2020; 11:104. [PMID: 32158469 PMCID: PMC7052335 DOI: 10.3389/fgene.2020.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leonardo C. Ferreira
- Department of Biochemistry, Federal University of Rio Grande do Norte, Natal, Brazil
- Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Leonardo C. Ferreira,
| | - José H. Dantas Junior
- University Hospital Onofre Lopes, Urologic Unit, Federal University of Rio Grande do Norte, Natal, Brazil
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13
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Mathews F, Shaffer AD, Georg MW, Ford MD, Goldstein JA, Jabbour N, Simons JP. Airway anomalies in patients with craniosynostosis. Laryngoscope 2018; 129:2594-2602. [DOI: 10.1002/lary.27589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Fasil Mathews
- Department of OtolaryngologyUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | | | | | - Matthew D. Ford
- Department of Pediatric Plastic SurgeryChildren's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania U.S.A
| | | | - Noel Jabbour
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
| | - Jeffrey P. Simons
- Department of OtolaryngologyChildren's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania U.S.A
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Wanner MR, Marine MB, Dahl JP. Ultrasound diagnosis of tracheal cartilaginous sleeve in a patient with Pfeiffer syndrome. Pediatr Radiol 2018; 48:1814-1816. [PMID: 30022259 DOI: 10.1007/s00247-018-4207-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/06/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
There is an association between tracheal cartilaginous sleeve and syndromic craniosynostosis. We present a case of tracheal cartilaginous sleeve diagnosed by ultrasound (US) in a patient with Pfeiffer syndrome. The patient developed respiratory failure and was suspected at bronchoscopy to have tracheal cartilaginous sleeve. US performed before tracheostomy placement demonstrated continuous hypoechoic cartilage along the anterior surface of the trachea, confirming the diagnosis. Our report shows that US can make a definitive diagnosis of tracheal cartilaginous sleeve and raises the possibility of using US to screen for the condition in patients with syndromic craniosynostosis without the need for anesthesia or ionizing radiation.
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Affiliation(s)
- Matthew R Wanner
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Rm. 1053, Indianapolis, IN, 46202, USA.
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Rm. 1053, Indianapolis, IN, 46202, USA
| | - John P Dahl
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
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15
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Holmes G, O'Rourke C, Motch Perrine SM, Lu N, van Bakel H, Richtsmeier JT, Jabs EW. Midface and upper airway dysgenesis in FGFR2-related craniosynostosis involves multiple tissue-specific and cell cycle effects. Development 2018; 145:dev.166488. [PMID: 30228104 DOI: 10.1242/dev.166488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022]
Abstract
Midface dysgenesis is a feature of more than 200 genetic conditions in which upper airway anomalies frequently cause respiratory distress, but its etiology is poorly understood. Mouse models of Apert and Crouzon craniosynostosis syndromes exhibit midface dysgenesis similar to the human conditions. They carry activating mutations of Fgfr2, which is expressed in multiple craniofacial tissues during development. Magnetic resonance microscopy of three mouse models of Apert and Crouzon syndromes revealed decreased nasal passage volume in all models at birth. Histological analysis suggested overgrowth of the nasal cartilage in the two Apert syndrome mouse models. We used tissue-specific gene expression and transcriptome analysis to further dissect the structural, cellular and molecular alterations underlying midface and upper airway dysgenesis in Apert Fgfr2+/S252W mutants. Cartilage thickened progressively during embryogenesis because of increased chondrocyte proliferation in the presence of Fgf2 Oral epithelium expression of mutant Fgfr2, which resulted in a distinctive nasal septal fusion defect, and premature facial suture fusion contributed to the overall dysmorphology. Midface dysgenesis in Fgfr2-related craniosynostosis is a complex phenotype arising from the combined effects of aberrant signaling in multiple craniofacial tissues.
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Affiliation(s)
- Greg Holmes
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Courtney O'Rourke
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Susan M Motch Perrine
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA
| | - Na Lu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joan T Richtsmeier
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA
| | - Ethylin Wang Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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16
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A genotype-specific surgical approach for patients with Pfeiffer syndrome due to W290C pathogenic variant in FGFR2 is associated with improved developmental outcomes and reduced mortality. Genet Med 2018; 21:471-476. [DOI: 10.1038/s41436-018-0073-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
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17
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Saliba S, Morel B, Gonzales M, Sénat MV, Guilbaud L, Jouannic JM, Cassart M, Garel C, Blondiaux E. Variable prenatal presentation of Pfeiffer syndrome: Suggested aids to prenatal sonographic diagnosis. Prenat Diagn 2018; 38:349-356. [DOI: 10.1002/pd.5231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Souha Saliba
- Service d'imagerie, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Baptiste Morel
- Service d'imagerie, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Marie Gonzales
- Service de médecine fœtale, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Marie-Victoire Sénat
- Service de médecine fœtale, APHP, Hôpital du Kremlin Bicêtre; Le Kremlin Bicêtre France
| | - Lucie Guilbaud
- Service de médecine fœtale, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Jean-Marie Jouannic
- Service de médecine fœtale, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Marie Cassart
- Services de radiologie et médecine fœtale; Hôpitaux Iris Sud et CHU St Pierre; Bruxelles Belgium
| | - Catherine Garel
- Service d'imagerie, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
| | - Eléonore Blondiaux
- Service d'imagerie, HUEP-APHP, Hôpital Armand-Trousseau, Faculté de Médecine Pierre et Marie Curie, Sorbonne Universités, UPMC, Paris VI; Paris France
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18
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Abstract
PURPOSE OF REVIEW When providing accurate clinical diagnosis and genetic counseling in craniosynostosis, the challenge is heightened by knowledge that etiology in any individual case may be entirely genetic, entirely environmental, or anything in between. This review will scope out how recent genetic discoveries from next-generation sequencing have impacted on the clinical genetic evaluation of craniosynostosis. RECENT FINDINGS Survey of a 13-year birth cohort of patients treated at a single craniofacial unit demonstrates that a genetic cause of craniosynostosis can be identified in one quarter of cases. The substantial contributions of mutations in two genes, TCF12 and ERF, is confirmed. Important recent discoveries are mutations of CDC45 and SMO in specific craniosynostosis syndromes, and of SMAD6 in nonsyndromic midline synostosis. The added value of exome or whole genome sequencing in the diagnosis of difficult cases is highlighted. SUMMARY Strategies to optimize clinical genetic diagnostic pathways by combining both targeted and next-generation sequencing are discussed. In addition to improved genetic counseling, recent discoveries spotlight the important roles of signaling through the bone morphogenetic protein and hedgehog pathways in cranial suture biogenesis, as well as a key requirement for adequate cell division in suture maintenance.
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Affiliation(s)
- Andrew O M Wilkie
- aClinical Genetics Group, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital bOxford Centre for Genomic Medicine, Nuffield Orthopaedic Centre cCraniofacial Unit, John Radcliffe Hospital, Headington, Oxford, UK
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19
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Azoury SC, Reddy S, Shukla V, Deng CX. Fibroblast Growth Factor Receptor 2 ( FGFR2) Mutation Related Syndromic Craniosynostosis. Int J Biol Sci 2017; 13:1479-1488. [PMID: 29230096 PMCID: PMC5723914 DOI: 10.7150/ijbs.22373] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/01/2017] [Indexed: 12/30/2022] Open
Abstract
Craniosynostosis results from the premature fusion of cranial sutures, with an incidence of 1 in 2,100-2,500 live births. The majority of cases are non-syndromic and involve single suture fusion, whereas syndromic cases often involve complex multiple suture fusion. The fibroblast growth factor receptor 2 (FGFR2) gene is perhaps the most extensively studied gene that is mutated in various craniosynostotic syndromes including Crouzon, Apert, Pfeiffer, Antley-Bixler, Beare-Stevenson cutis gyrata, Jackson-Weiss, Bent Bone Dysplasia, and Seathre-Chotzen-like syndromes. The majority of these mutations are missense mutations that result in constitutive activation of the receptor and downstream molecular pathways. Treatment involves a multidisciplinary approach with ultimate surgical fixation of the cranial deformity to prevent further sequelae. Understanding the molecular mechanisms has allowed for the investigation of different therapeutic agents that can potentially be used to prevent the disorders. Further research efforts are need to better understand screening and effective methods of early intervention and prevention. Herein, the authors provide a comprehensive update on FGFR2-related syndromic craniosynostosis.
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Affiliation(s)
- Saïd C. Azoury
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sashank Reddy
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vivek Shukla
- TGIB, NCI, National Institutes of Health, Bethesda, MD, USA
| | - Chu-Xia Deng
- Faculty of Health Sciences, University of Macau, Macau SAR, China
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20
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Peskett E, Kumar S, Baird W, Jaiswal J, Li M, Patel P, Britto JA, Pauws E. Analysis of the Fgfr2C342Y mouse model shows condensation defects due to misregulation of Sox9 expression in prechondrocytic mesenchyme. Biol Open 2017; 6:223-231. [PMID: 28069589 PMCID: PMC5312100 DOI: 10.1242/bio.022178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Syndromic craniosynostosis caused by mutations in FGFR2 is characterised by developmental pathology in both endochondral and membranous skeletogenesis. Detailed phenotypic characterisation of features in the membranous calvarium, the endochondral cranial base and other structures in the axial and appendicular skeleton has not been performed at embryonic stages. We investigated bone development in the Crouzon mouse model (Fgfr2C342Y) at pre- and post-ossification stages to improve understanding of the underlying pathogenesis. Phenotypic analysis was performed by whole-mount skeletal staining (Alcian Blue/Alizarin Red) and histological staining of sections of CD1 wild-type (WT), Fgfr2C342Y/+ heterozygous (HET) and Fgfr2C342Y/C342Y homozygous (HOM) mouse embryos from embryonic day (E)12.5-E17.5 stages. Gene expression (Sox9, Shh, Fgf10 and Runx2) was studied by in situ hybridisation and protein expression (COL2A1) by immunohistochemistry. Our analysis has identified severely decreased osteogenesis in parts of the craniofacial skeleton together with increased chondrogenesis in parts of the endochondral and cartilaginous skeleton in HOM embryos. The Sox9 expression domain in tracheal and basi-cranial chondrocytic precursors at E13.5 in HOM embryos is increased and expanded, correlating with the phenotypic observations which suggest FGFR2 signalling regulates Sox9 expression. Combined with abnormal staining of type II collagen in pre-chondrocytic mesenchyme, this is indicative of a mesenchymal condensation defect. An expanded spectrum of phenotypic features observed in the Fgfr2C342Y/C342Y mouse embryo paves the way towards better understanding the clinical attributes of human Crouzon-Pfeiffer syndrome. FGFR2 mutation results in impaired skeletogenesis; however, our findings suggest that many phenotypic aberrations stem from a primary failure of pre-chondrogenic/osteogenic mesenchymal condensation and link FGFR2 to SOX9, a principal regulator of skeletogenesis.
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Affiliation(s)
- Emma Peskett
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Samin Kumar
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - William Baird
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Janhvi Jaiswal
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Ming Li
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Priyanca Patel
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Jonathan A Britto
- Craniofacial Unit, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Erwin Pauws
- UCL Great Ormond Street, Institute of Child Health, University College London, London, WC1N 1EH, UK
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