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Cong NV, Minh LHN, Hoang LH, Do U, Dung NTM. Bosma Arhinia Microphthalmia Syndrome (BAMS): First Report from Vietnam. Cureus 2023; 15:e35222. [PMID: 36968924 PMCID: PMC10032420 DOI: 10.7759/cureus.35222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Bosma arhinia microphthalmia syndrome (BAMS) is a rare condition, with about 100 cases identified worldwide. It is characterized by nasal and ophthalmic abnormalities, as well as disturbances in puberty and sexual development. The cardinal sign is arhinia, though some cases have partial aplasia of the external nose. In addition, several reports have revealed abnormal brain structure, including changes to the olfactory bulbs. This case describes a 29-year-old female who has suffered from BAMS since birth. On presentation, she was noted to have congenital arhinia, bilateral microphthalmia, vision loss, mouth-breathing, an unclear speaking voice, a high arched or cleft palate, and a hypoplastic maxilla. Her paranasal sinuses were ossified and underdeveloped. This syndrome occurs rarely, both within Vietnam and worldwide. It is characterized by four major features: arrhinia, complete absence of the paranasal sinuses, eye defects, and absent sexual maturation. This case report describes the presentation of the disorder to improve otolaryngologists' understanding of BAMS. Criteria for diagnosis consist of arhinia, midface hypoplasia (with a hypoplastic maxilla), hypogonadotropic hypogonadism, and normal intellectual abilities. Additional important findings are microphthalmia with or without coloboma, anosmia, maxillary hypoplasia, a high-arched palate, and absence of paranasal sinuses and olfactory bulbs.
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Zemtsov GE, Swartz AE, Kuller JA. Prenatal Diagnosis of Arhinia. AJP Rep 2022; 12:e127-e130. [PMID: 35941965 PMCID: PMC9356769 DOI: 10.1055/s-0042-1748521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Arhinia is a rare congenital anomaly that is not typically associated with known genetic mutations and is usually discovered after an affected infant is born. Prenatal diagnosis is important because neonates with arhinia often require specialized respiratory support with creation of an artificial airway. We present a case of isolated arhinia diagnosed on second-trimester ultrasound. A patient presented for routine ultrasound at 18 weeks gestation, and nasal tissues were absent in an otherwise morphologically normal appearing fetus. Cell free fetal DNA was unremarkable. The patient elected to undergo termination of pregnancy by dilation and evacuation. Subsequent genetic analysis confirmed a normal fetal karyotype and microarray, and no examination of fetal structural anatomy was possible. Antenatal diagnosis of arhinia is important to guide maternal-fetal care decisions and requires methodical sonographic evaluation to identify this malformation prior to delivery.
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Affiliation(s)
- Gregory E Zemtsov
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Anthony E Swartz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey A Kuller
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Harrison LM, Anderson SR, Spiller KE, Pak KY, Schmidt SP, Mancho SN. Reconstruction of Congenital Arhinia With Stereolithographic Modeling: Case Correlate and Literature Review. Cleft Palate Craniofac J 2021; 59:530-537. [PMID: 34291675 DOI: 10.1177/10556656211012859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and airway. We report our novel multistaged reconstructive approach and literature review. Nasal methyl methacrylate prosthesis was created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 with cannulization was utilized for midface advancement and airway formation. External framework was reconstructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. Patient was pleased with the aesthetics and had safe decannulation with the ability to breathe through the nose and airway.
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Affiliation(s)
- Lucas M Harrison
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Spencer R Anderson
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Kelly E Spiller
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Kaitlynne Y Pak
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Steven P Schmidt
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Salim N Mancho
- Department of Orthopeadic & Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Stromiedel H, Van Quekelberghe C, Yigit G, Naimi AA, Bahlmann F, Sader R, Guchlerner M, Lüchtenberg M, Latta K, Cho CH, Wollnik B, Kunzmann S. [A Newborn Suffering from Arhinia: Neonatologic Challenges During Primary Care of the Newborn With Bosma Arhinia Microphthalmia Syndrome (BAMS)]. Z Geburtshilfe Neonatol 2020; 224:377-380. [PMID: 32882744 DOI: 10.1055/a-1224-4465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungAnhand eines weiblichen Neugeborenen soll das seltene Krankheitsbild der
konnatalen Nasenagenesie vorgestellt werden. In der Schwangerschaft fielen
eine intrauterine Wachstumsrestriktion mit Polyhydramnion und eine
Mittelgesichtshypoplasie auf. Das Atemwegsmanagement nach primärer
Sectio in der 38+4 SSW gelang mittels Schienung durch einen
Güdel- bzw. im Verlauf Rachentubus ohne Zeichen einer
respiratorischen Insuffizienz. Neben der vollständigen Nasenagenesie
zeigten sich bei unauffälligen zerebralen Strukturen ein
Hypertelorismus, ein gotischer Gaumen, ein beidseitiger Mikrophthalmus und
Iriskolobom. Die Nahrungsaufnahme wurde mit einer orogastralen Sonde
sichergestellt, durch Trinktraining und einen speziellen Schnuller konnten
eine bessere Koordination und Trinkleistung erzielt werden. Der sich bei
assoziierten Fehlbildungen ergebende Verdacht auf ein
Bosma-Arhinie-Mikrophthalmie-Syndrom (BAMS) wurde humangenetisch durch den
Nachweis einer heterozygoten de novo Mutation im SMCHD1-Gen, welches eine
Schlüsselfunktion in der Embryogenese der menschlichen Nase spielt,
bestätigt (c.1043A>G; pHis348Arg). Aus neonatologischer
Sicht ist oftmals die initiale Kreißsaal-Versorgung eine
Herausforderung: Patienten mit Nasenagenesie werden häufig
postpartal intubiert und elektiv tracheotomiert. Bei fehlender
respiratorischer Problematik und Nahrungsaufnahme mit perzentilengerechtem
Wachstum besteht jedoch keine dringliche Indikation zur frühzeitigen
plastisch-chirurgischen Versorgung, insbesondere da diese mit Gefahren wie
Sepsis und Wachstumsstörungen im Mittelgesicht behaftet ist.
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Affiliation(s)
- Helen Stromiedel
- Klinik für Neonatologie und pädiatrische Intensivmedizin, Bürgerhospital Frankfurt, Frankfurt am Main
| | - Chantal Van Quekelberghe
- Klinik für Kinder- und Jugendmedizin, Bürgerhospital und Clementine Kinderhospital gemeinnützige GmbH, Frankfurt am Main
| | - Gökhan Yigit
- Institut für Humangenetik, Georg-August-Universität Göttingen Universitätsmedizin, Göttingen
| | - Ammar Al Naimi
- Klinik für Geburtshilfe, Bürgerhospital Frankfurt, Frankfurt am Main
| | - Franz Bahlmann
- Klinik für Geburtshilfe, Bürgerhospital Frankfurt, Frankfurt am Main
| | - Robert Sader
- Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - Marina Guchlerner
- Klinik für Kinderaugenheilkunde, Schielbehandlung und plastisch-rekonstruktive Lidchirurgie, Bürgerhospital Frankfurt, Frankfurt am Main
| | - Marc Lüchtenberg
- Klinik für Kinderaugenheilkunde, Schielbehandlung und plastisch-rekonstruktive Lidchirurgie, Bürgerhospital Frankfurt, Frankfurt am Main
| | - Kay Latta
- Klinik für Kinder- und Jugendmedizin, Bürgerhospital und Clementine Kinderhospital gemeinnützige GmbH, Frankfurt am Main
| | - Chie Hee Cho
- Institut für diagnostische Radiologie, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin
| | - Bernd Wollnik
- Institut für Humangenetik, Georg-August-Universität Göttingen Universitätsmedizin, Göttingen
| | - Steffen Kunzmann
- Klinik für Neonatologie und pädiatrische Intensivmedizin, Bürgerhospital Frankfurt, Frankfurt am Main
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Fuller AK, McCrary HC, Graham ME, Skirko JR. The Case of the Missing Nose: Congenital Arhinia Case Presentation and Management Recommendations. Ann Otol Rhinol Laryngol 2020; 129:645-648. [PMID: 32100546 DOI: 10.1177/0003489420909415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To discuss the presentation and management of infants with arhinia or congenital absence of the nose. METHODS This case report describes an infant with arhinia that was diagnosed prenatally. In addition to a discussion of the case, a review of the literature was completed to define appropriate postnatal work-up and management. RESULTS The patient is a term male infant, diagnosed with arhinia on ultrasound and magnetic resonance imaging (MRI) performed at 21-weeks gestational age. Upon birth, the patient was subsequently intubated, followed by tracheostomy due to complete nasal obstruction. Through a genetics evaluation, the patient was found to be heterozygous for the SMCHD1 gene, with hypomethylation at the D4Z4 locus. Plans for reconstruction will be based on future imaging and the development of any nasal patency, however, the patient's family plans to utilize a prosthetic nose until the patient is older. CONCLUSION Arhinia is a rare condition causing respiratory distress in the neonatal period. While stabilization of the airway is the first priority, further management is not clearly defined given the rarity of the malformation. This case discusses stabilization of the airway with a review of treatment and reconstructive options.
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Affiliation(s)
- Andrew K Fuller
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hilary C McCrary
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - M Elise Graham
- Department of Otolaryngology, Western University, London, ON, Canada
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
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Jung JW, Ha DH, Kim BY, Seo BF, Han HH, Kim DH, Rhie JW, Kim SW, Cho DW. Nasal Reconstruction Using a Customized Three-Dimensional-Printed Stent for Congenital Arhinia: Three-Year Follow-up. Laryngoscope 2018; 129:582-585. [PMID: 30247752 DOI: 10.1002/lary.27335] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/08/2022]
Abstract
A male Mongolian child with a complete congenital absence of both nose and nasal passage had a poor survival prognosis due to respiratory distress. To enable his survival, a new nose capable of conferring respiratory function was constructed. Following reconstructive surgery, an absence of mucoepithelium in the nasal passage can lead to rhinostenosis. To avoid this complication, a custom-made nasal silicone stent was created using three-dimensional (3D) printing technology in conjunction with the patient's computed tomography data. The stent was implanted for 2 months to maintain the shape and size of the nasal passage. At 2 months after stent implantation, the mucoepithelium tissue in the passage had successfully regenerated with no immune reaction. Three years after stent removal, respiratory function, nasal passage structure, and external nose shape were maintained without additional medical care. These results indicate the successful nasal reconstruction in an arhinia patient using a customized, 3D-printed nasal stent. Laryngoscope, 129:582-585, 2019.
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Affiliation(s)
- Jin Woo Jung
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Dong-Heon Ha
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Boo Young Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul, South Korea
| | - Bommie F Seo
- Department of Plastic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Hyun Ho Han
- Department of Plastic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul, South Korea
| | - Jong-Won Rhie
- Department of Plastic Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul, South Korea
| | - Dong-Woo Cho
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
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Hunter JD, Davis MA, Law JR. Hypogonadotropic hypogonadism in a female patient with congenital arhinia. J Pediatr Endocrinol Metab 2017; 30:101-104. [PMID: 27941181 DOI: 10.1515/jpem-2016-0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2022]
Abstract
The association of anosmia and congenital hypogonadotropic hypogonadism (CHH) is well described; however, congenital arhinia is a malformation associated with CHH that occurs much more rarely. There have been three reports of male patients with hypogonadism and congenital arhinia in the literature to date. We present the first case of arhinia associated with CHH in a female patient. A 14 years and 8 months female with congenital arhinia presented with delayed puberty. Physical examination and laboratory evaluation were consistent with hypogonadotropic hypogonadism. She had no other hormone deficiencies and brain magnetic resonance imaging demonstrated a normal pituitary gland. Abdominal ultrasound showed a prepubertal uterus and ovaries. She was subsequently started on sex steroid treatment to induce secondary sexual characteristics. This case demonstrates that abnormalities of nasal development may provide an early diagnostic clue to hypogonadotropic hypogonadism, particularly in female patients who would not manifest classic signs of CHH in infancy (micropenis and cryptorchidism). Early diagnosis of CHH and timely initiation of sex steroid therapy is important to prevent comorbidities related to pubertal delay.
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Mondal U, Prasad R. Congenital Arhinia: A Rare Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2016; 68:537-539. [PMID: 27833885 DOI: 10.1007/s12070-016-1009-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/05/2016] [Indexed: 11/25/2022] Open
Abstract
Congenital absence of nose (Arhinia) is extremely rare. A male baby was born at term via uncomplicated vaginal delivery and presented with complete arhinia, bilateral microphthalmia, lower eyelid coloboma and feeding difficulty. Reconstructive surgery was postponed until preschool age. On follow up at 1 year of age baby is feeding liquid and semisolid food and growing well.
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Affiliation(s)
- Uttam Mondal
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, 700020 India
| | - Rameshwar Prasad
- Department of Neonatology, IPGME&R and SSKM Hospital, Kolkata, 700020 India
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Nasal reconstruction of a patient with complete congenital arhinia: A clinical report. J Prosthet Dent 2016; 116:924-927. [PMID: 27318501 DOI: 10.1016/j.prosdent.2016.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022]
Abstract
Complete congenital arhinia is a rare embryonic disorder of unknown etiology. This is a clinical report of the prosthetic nasal rehabilitations done in the early childhood and adolescent stages of a patient with complete congenital arhinia. Additive manufacturing techniques for creating presurgical planning models to assist in the creation of new nasal passages are also described. These rare disorders can be successfully rehabilitated if patients are sufficiently motivated and there is meticulous planning and collaboration from a multidisciplinary team.
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