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Park J, Yang IH, Choi JY, Chung JH, Kim S, Baek SH. Distribution and Phenotype of Goldenhar Syndrome and Its Association With Other Anomalies. J Craniofac Surg 2023; 34:e664-e669. [PMID: 37417749 DOI: 10.1097/scs.0000000000009529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 05/19/2023] [Indexed: 07/08/2023] Open
Abstract
The purpose of this study was to investigate the distribution and phenotype of Goldenhar syndrome (GS) and its association with other anomalies. The samples consisted of 18 GS patients (6 males and 12 females; mean age at investigation, 7.4 ± 4.8 y) who were treated or followed up at the Department of Orthodontics, Seoul National University Dental Hospital between 1999 and 2021. The prevalence of side involvement and degree of mandibular deformity (MD), midface anomalies, and association with other anomalies were evaluated using statistical analysis. The prevalence of unilateral and bilateral MD did not differ (55.6% versus 44.4%). In unilateral MD cases, there was a tendency for higher prevalence of more severe Pruzansky-Kaban types than mild ones (type I, 10%; type IIa, 10%; type IIb, 50%; type III, 30%). Despite hypoplasia of the condyle/ramus complex, compensatory mandibular body growth occurred in 33.3% of GS patients (more severe side in bilateral MD cases, 37.5%, and ipsilateral side in unilateral MD cases, 30%). Class II molar relation was more prevalent than class I and class III molar relations (72.2% versus 11.1% versus 16.7%, P <0.01). Al total of 38.9% of patients had congenitally missing tooth. #7 facial cleft was found in 44.4% of patients. In midface anomalies, ear problem was the most common anomaly, followed by hypoplasia/absence of zygomatic arch and eye problem (88.9% versus 64.3% versus 61.1%, P <0.01). Association with the midface, spine, cardiovascular, and limb anomalies did not differ between unilateral and bilateral MD cases. These results might provide a basic guideline for diagnosis and treatment planning for GS patients.
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Affiliation(s)
- Juhwan Park
- Department of Orthodontics, School of Dentistry, Seoul National University
| | - Il-Hyung Yang
- Department of Orthodontics, School of Dentistry, Seoul National University
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Children Hospital, Seoul
| | - Sukwha Kim
- Department of Plastic Surgery, CHA Bundang Medical Center, Seong-nam, Gyeonggi-do
| | - Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Three-Dimensional Morphology and Configuration Analyses of the Craniovertebral Junction in Children with Hemifacial Microsomia. Spine (Phila Pa 1976) 2022; 47:817-824. [PMID: 35193998 DOI: 10.1097/brs.0000000000004346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational and morphological study with three-dimensional (3D) computed tomography (CT) analysis. OBJECTIVE To discover the morphology and configuration deformities of craniovertebral junction (CVJ) and upper cervical spine in children with unilateral hemifacial microsomia (HFM). To determine whether there are specific HFM patients who are at higher risk of certain cervical vertebral anomaly. SUMMARY OF BACKGROUND DATA The evaluation for cervical vertebrae anomaly in HFM children, especially in CVJ region, is underreported. METHODS Eighty-eight unilateral HFM children (64 males, 24 females) with four Pruzansky-Kaban types (I, Ila, Ilb, and III) underwent cranial and cervical CT scanning from skull to C5 in neutral position. The 3D morphology and configuration of the occipital condyle, atlas, and axis, etc. were evaluated on the presence of deformed detailed structures of CVJ region. RESULTS No C1 deformation was found in type I group. Six (14.3%) type Ila cases, seven (33.3%) type IIb cases, and six (37.5%) type Ill cases had lateral masses asymmetry of C1 (P < 0.05). Five (55.6%) type I cases, 17 (40.5%) type Ila cases, 12 (57.1%) type Ilb cases, and 10 (62.5%) type Ill cases had C2 anomaly (P > 0.05). The incidence rate of C1-C2 instability for four groups were 33.3% (type I), 33.3% (type IIa), 33.3% (type IIb), and 31.3% (type Ill), respectively (P > 0.05). CONCLUSION For HFM children, the incidence of C1 deformation increased from type I to type Ill. The probability of C2 anomaly and C1-C2 instability in children with different types of HFM is nearly the same. The craniovertebral junction of every HFM child must be monitored carefully for C1-C2 instability before any surgical procedure to avoid atlantoaxial dislocation and spinal cord injury.Level of Evidence: N/A.
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A new lumbar vertebral anomaly in Goldenhar syndrome: A case report. Radiol Case Rep 2022; 17:2175-2180. [PMID: 35469301 PMCID: PMC9034019 DOI: 10.1016/j.radcr.2022.03.076] [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: 03/04/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022] Open
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Xing W, Qian J, Wang B, Wang Y, Hu J, Zhang Q. Auricular reconstruction with modified expanded two-flap method in Goldenhar Syndrome: 7-Year experiences. Int J Pediatr Otorhinolaryngol 2020; 139:110228. [PMID: 33022554 DOI: 10.1016/j.ijporl.2020.110228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Goldenhar Syndrome (GS) is a systematic polymalformational disease characterized by microtia, hemifacial microsomy, ocular anomalies, abnormal vertebra and other deformities. These congenital malformations brought severe physical and mental stress to the patients. Auricular reconstruction has always been the primary appeal of the patients and their families to achieve a better facial balance and harmony. However, multiple deformities made it a great challenge to perform this technique. In this study, we reported a modified expanded two-flap method of auricular reconstruction, which is more applicable for patients with Goldenhar Syndrome. METHODS Between January of 2012 and September of 2019, 69 cases of Goldenhar Syndrome underwent auricular reconstruction with the modified expanded two-flap technique. Auricular reconstruction was performed in three surgical stages. In the first stage, a 50 ml kidney-shaped tissue expander was embedded in mastoid region and the retroauricular skin expanded. In the second stage, the autologous rib cartilage was harvested and the ear framework fabricated. The expander was further removed, and then enveloped by the expanded flap, retroauricular fascial flap and a free skin graft. In the third stage, the reconstructed ear was further trimmed, including lobule transposition and tragus reconstruction. RESULTS The patients were followed for 6 months to 7 years. There were 63 cases (91.3%) responded satisfied outcomes in size, shape, position and bilateral symmetry. One case suffered expander leakage and tissue expansion accomplished after the expander was replaced. Hematoma was occurred in four cases and removed to complete the reconstruction. Complications of cartilage exposure were observed in one case. CONCLUSION Modified expanded two-flap method is effective and safe in auricular reconstruction for patients of Goldenhar syndrome with long term satisfying results. Level of Evidence IV.
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Affiliation(s)
- Wenshan Xing
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Jin Qian
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Bingqing Wang
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Yue Wang
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Jintian Hu
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Qingguo Zhang
- Auricular Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
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Hemifacial Microsomia Review: Recent Advancements in Understanding the Disease. J Craniofac Surg 2020; 31:2123-2127. [PMID: 33136839 DOI: 10.1097/scs.0000000000006616] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hemifacial microsomia (HFM) is the second most common congenital disability of the face, with a prevalence of 1 in 3000 to 5600 live births. Although etiology is still not fully understood, including both genetics and environmental factors, the latest reports indicate the prominence of premature loss of the neural crest cells. What is more, a deficit of muscles of mastication, except the masseter, correlates in the pathomechanism of mandibular underdevelopment. Due to the significant phenotypic diversification, the typical picture of HFM cannot be determined. It may present as an esthetic concern-minor asymmetry with deformed auricle, and on the contrary, as microtia/anotia with conductive type hearing loss, hypoplastic mandible, and microphthalmia, impairing patient's daily activities. Referring to psychosocial problems, it has been proved that in population with HFM, there is a modestly elevated risk for behavior problems, social competence, and less acceptance. Over the years, more comprehensive methods of assessing the extent and severity of the HFM as the OMENS (+) classification have emerged. The authors like to summarize and present for plastic surgery resident and plastic surgeons the critical features of HFM, including the epidemiology, clinical presentation, pathogenesis, and innovative management reported in the current literature.
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Oculo-Auriculo-Vertebral Dysplasia With Craniocervical Instability and Occult Tethered Cord Syndrome. An Addition to the Spectrum? First Case Report and Review of the Literature. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e805. [PMID: 31579884 PMCID: PMC6743983 DOI: 10.5435/jaaosglobal-d-17-00085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Oculo-auriculo-vertebral spectrum (OAVS) is an uncommon congenital disorder of abnormal development of the first and second pharyngeal arches. This spectrum is characterized by craniofacial microsomia, epibulbar dermoids, ear abnormalities, renal and cardiac defects, and a wide range of vertebral segmentation and formation disorders. Frequently, the cervicothoracic spine is involved. Only recently, the morbidity attributed to the spinal abnormalities has gained attention. Strategy and timing of spine surgery has become increasingly important in patients with OAVS. Here, we report a case of OAVS with characteristic vertebral cervical and thoracic involvement and its sequelae requiring multiple spinal procedures, further complexed by an unprecedented occult tethered cord syndrome, which was successfully treated by surgical detethering. In this context, the recent literature on spinal anomalies is reviewed.
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Abstract
STUDY DESIGN Systematic review (Level 4). OBJECTIVE To summarize the demographics, clinical presentations, and conditions associated with butterfly vertebrae. METHODS A systematic search was performed of multiple databases. A total of 279 articles were identified for screening. Case series or case reports of butterfly vertebrae with adequate clinical detail were complied. RESULTS Eighty-two total articles (109 patients) were selected for final inclusion. Sixty-one percent of patients presented with a single butterfly vertebra, while 39% were multiple. The most common location for butterfly vertebrae was T1. Fifty-six percent of cases were associated with a syndrome, the most common being spondylocostal dysostosis. The presence of multiple butterfly vertebra was strongly associated with a syndrome or additional anomalies (P < .001). Overall, the most common presenting complaint was low back pain. Seventy percent of patients had associated spinal disease. Other organ systems affected included musculoskeletal (43%), craniofacial (30%), neurologic (27%), cardiovascular (24%), genitourinary (23%), gastrointestinal (22%), laboratory abnormality (16%), and endocrine (9%). CONCLUSIONS This study is the largest collection of butterfly vertebrae cases to date. Butterfly vertebrae are associated with spinal deformity and multiple butterfly vertebrae may indicate a syndromic illness. Low back pain or disc herniation may occur with lumbar butterfly vertebrae however the etiology of this phenomena has not been rigorously explained. Many diseases and syndromes are associated with butterfly vertebrae.
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Affiliation(s)
- Yoshihiro Katsuura
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN,
USA,Yoshihiro Katsuura, 975 East Third Street, Hospital
Box 260, Chattanooga, TN 37403, USA.
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA,New York–Presbyterian Hospital, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
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Connell B, Oore JJ, Pahys JM, Thompson GH, St Hilaire T, Flynn T, El-Hawary R. Growth-Friendly Surgery Is Effective at Treating Early-Onset Scoliosis Associated With Goldenhar Syndrome. Spine Deform 2019; 6:327-333. [PMID: 29735145 DOI: 10.1016/j.jspd.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the radiographic results and complications of growth-friendly (GF) surgery in the treatment of early-onset scoliosis (EOS) associated with Goldenhar syndrome. BACKGROUND Goldenhar syndrome has been associated with spinal deformity, which may be progressive. Efficacy and complication rate of GF treatment has not been reported for this population of patients with EOS. METHODS Patients with Goldenhar syndrome and EOS with two years' follow-up were identified from two international multicenter EOS databases. Scoliosis, kyphosis, spine height, and hemithoracic height/width were determined preimplant, immediately postoperative, and at the two-year follow-up. Severity of complications (SV) was recorded (Smith et al. JPO 2015). RESULTS Ten patients met inclusion criteria and had a mean age of 4.6 ± 2.5 years at GF implantation (one spine and nine rib-based). Mean preoperative scoliosis was 64°, postimplant 52°, and at mean follow up of 2.4 ± 0.5 years was 50° (p = .09). Preoperative kyphosis was 36°, postimplant 38°, and final 42° (p = .08). Preoperative T1-S1 height was 23.5 cm, postimplant 23.6 cm, and final 27.3 cm (p = .06). Preoperative convex hemithoracic height was 10.4 cm, postimplant 7.9 cm, and final 12.8 cm (p < .05). Preoperative concave hemithoracic height was 8.4 cm, postimplant 8.8 cm, and final 9.9 cm (p = .30). Preoperative right hemithoracic width was 8.02 cm, postimplant 7.22 cm, and final 7.86 cm (p = .07). Preoperative left hemithoracic width was 7.18 cm, postimplant 7.86 cm, and final 8.60 cm (p = .43). Eight patients had ≥1 complication with SV I (n = 7), SV II (n = 2), and SV IIA (n = 7). These included infection (n = 4), migration (n = 3), pneumonia (n = 2), and instrumentation failure (n = 2). CONCLUSION At minimum two-year follow-up, GF surgical intervention for the treatment of EOS associated with Goldenhar syndrome trended toward improvements in scoliosis and spine height, but had a significant improvement in convex hemithoracic height; however, the majority of patients experienced severity grade I or II complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Braydon Connell
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
| | - Jonathan J Oore
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Joshua M Pahys
- Shriner's Hospital, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - George H Thompson
- Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Tricia St Hilaire
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Tara Flynn
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Ron El-Hawary
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
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Renkema R, Caron C, Wolvius E, Rooijers W, Schipper J, Dunaway D, Forrest C, Koudstaal M, Padwa B. Vertebral anomalies in craniofacial microsomia: a retrospective analysis of 991 patients. Int J Oral Maxillofac Surg 2018; 47:1365-1372. [DOI: 10.1016/j.ijom.2018.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
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10
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Ding X, Wang X, Cao Y, Zhang J, Lin M, Fan X, Li J. Goldenhar syndrome with blepharophimosis and limb deformities: a case report. BMC Ophthalmol 2018; 18:206. [PMID: 30134872 PMCID: PMC6106733 DOI: 10.1186/s12886-018-0872-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Goldenhar syndrome has variable presentations and can affect multiple regions of the body. Diagnoses are based on clinical manifestations. The association of Goldenhar syndrome with blepharophimosis and limb deformities has not previously been reported. Here, we describe a patient who was diagnosed with Goldenhar syndrome in association with blepharophimosis, ocular hypertelorism, hearing loss and limb deformities. Case presentation A 10-year-old male was first referred to our ophthalmology clinic on 2009–2-11 for ocular hypertelorism and microphthalmia when he had chin-up position. In the first ophthalmic examination, his palpebral fissure length was 19 mm on the right and 20 mm on the left, both palpebral fissure height was 4 mm, the inner intercanthal distance was 63 mm, both upper margin reflex distances were − 1 mm, the myodynamia of the levator palpebrae muscle was 2 mm on the right and 3 mm on the left, and his visual acuity was 20/40 on the right and 20/32 on the left. A physical examination revealed the patient had developed limb deformities in his hands, wrists, elbows and shoulders along with hearing loss. The patient was diagnosed with Goldenhar syndrome because his clinical presentations included ocular hypertelorism, hearing loss, and multiple acral joint deformities. He underwent a first operation in 2009 and a second in 2015. The second operation achieved a satisfactory result in which the horizontal fissure length was 28 mm on both sides, both palpebral fissure height was 10 mm, the inner intercanthal distance was 30 mm, and both of the upper margin reflex distances were 4 mm. He continued to wear hearing aids as usual. His hearing loss and joint deformities were slated for long-term follow-up at his parents’ request. Conclusion The patient, diagnosed with Goldenhar syndrome in association with blepharophimosis, ocular hypertelorism, hearing loss and limb deformities, underwent two operations and achieved a satisfactory result. The patient was submitted to long-term follow-up observations and symptomatic treatments that vary with age and systemic associations, as needed. When treating patients with Goldenhar syndrome, ophthalmology specialists should cooperate with a multi-disciplinary team of clinicians and reach agreement regarding the appropriate systemic and comprehensive treatments.
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Affiliation(s)
- Xia Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xi Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuan Cao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiaying Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ming Lin
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Jin Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 ZhizaojuRoad, Shanghai, 200025, People's Republic of China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Xue X, Zhao S. Severe Kyphoscoliosis in a Patient with Goldenhar Syndrome: A Case Report. CASE REPORTS IN ORTHOPEDIC RESEARCH 2018. [DOI: 10.1159/000490066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Goldenhar syndrome includes a wide spectrum of congenital anomalies involving structures arising from the first and second branchial arches. It is characterized by impaired development of structures such as eyes, ears (with or without hearing loss), lip, tongue, palate, mandible, maxilla, and deformations of vertebrae. The etiology of this syndrome is unclear since it varies genetically and is linked to a plethora of reasons. Case Report: A 13-year-old male presented to the Orthopedic Department with complaints of back bulge with bilateral microtia since birth. X-ray and computed tomography revealed severe congenital kyphoscoliosis. Posterior vertebral column resection surgery with instrumentation and anterior cage support with bone graft fusion were performed. A postoperative plain X-ray film demonstrated a good correction rate. His follow-up was asymptomatic and well balanced in the sagittal and coronal planes at 6 months following operation. Systemic involvement was clinically and radiographically assessed. Conclusion: Patients with Goldenhar syndrome due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitates an individual approach to each single patient and involvement of a team of specialists in treatment planning. Although complex scoliosis surgery could be achieved safely in Goldenhar syndrome patients, careful preoperative management is required.
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Nardi C, De Falco L, Selvi V, Lorini C, Calistri L, Colagrande S. Role of cone-beam computed tomography with a large field of view in Goldenhar syndrome. Am J Orthod Dentofacial Orthop 2018; 153:269-277. [DOI: 10.1016/j.ajodo.2017.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 01/21/2023]
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Abstract
BACKGROUND Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques. DATA SOURCES Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia. RESULTS The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed. CONCLUSIONS Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
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Renkema R, Caron C, Mathijssen I, Wolvius E, Dunaway D, Forrest C, Padwa B, Koudstaal M. Vertebral anomalies in craniofacial microsomia: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1319-1329. [DOI: 10.1016/j.ijom.2017.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
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A Constellation of Rare Findings in a Case of Goldenhar Syndrome. Case Rep Pediatr 2017; 2017:3529093. [PMID: 28607792 PMCID: PMC5457769 DOI: 10.1155/2017/3529093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/19/2017] [Accepted: 04/20/2017] [Indexed: 11/24/2022] Open
Abstract
An 18-month-old child presented with right macrostomia, bilateral preauricular skin tags, bilateral CTEV, squint in bilateral eyes, thoracic vertebral anomalies, right sided aortic arch, and associated left pulmonary agenesis. The patient did not have any associated respiratory symptoms. Ipsilateral pulmonary agenesis is considered as a rare association with Goldenhar syndrome and a case of contralateral pulmonary aplasia has been described as an even rarer association.
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Complete occipitalization of the atlas with bilateral external auditory canal atresia. Surg Radiol Anat 2017; 39:1053-1059. [PMID: 28214971 DOI: 10.1007/s00276-017-1826-y] [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: 09/01/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
Fusion of the atlas with the occipital bone is a rare congenital dysplasia known as occipitalization of the atlas, occipitocervical synostosis, assimilation of the atlas, or atlanto-occipital fusion. It is a component of the paraxial mesodermal maldevelopment and commonly associated with other dysplasias of the craniovertebral junction. External auditory canal atresia or external aural atresia is a rare congenital absence of the external auditory canal. It occurs as the consequence of the maldevelopment of the first pharyngeal cleft due to defects of cranial neural crest cells migration and/or differentiation. It is commonly associated with the dysplasias of the structures derived from the first and second pharyngeal arches including microtia. We present the coexistence of the occipitalization of the atlas and congenital aural atresia, an uncommon combination of the paraxial mesodermal maldevelopment, and defects of cranial neural crest cells. The association is most probably syndromic as minimal diagnostic criteria for the oculoariculovertebral spectrum are fulfilled. From the clinical point of view, it is important to be aware that patients with microtia must obtain also appropriate diagnostic imaging studies of the craniovetebral junction due to eventual concomitant occipitalization of the atlas and frequently associated C1-C2 instability.
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Tripathy K, Sharma YR, Chawla R, Basu K, Vohra R, Venkatesh P. Triads in Ophthalmology: A Comprehensive Review. Semin Ophthalmol 2015; 32:237-250. [DOI: 10.3109/08820538.2015.1045150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Koushik Tripathy
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Yog Raj Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Basu
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Arumugam SV, Paramasivan VK, Murali S, Natarajan K, Sudhamaheswari, Kameswaran M. Syndromic deafness-prevalence, distribution and hearing management protocol in Indian scenario. Ann Med Surg (Lond) 2015; 4:143-50. [PMID: 26005567 PMCID: PMC4434209 DOI: 10.1016/j.amsu.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The estimated prevalence of Sensory Neural Hearing Loss (SNHL) in patients less than 18 years of age is 6 per 1000. Roughly 50% of cases of congenital SNHL can be linked to a genetic cause, with approximately 30% being syndromic and the remaining 70% being non-syndromic. The term "syndromic" implies the presence of other distinctive clinical features in addition to hearing loss. The aim of our study was to find the distribution of various Syndromic associations in patients with profound deafness, presented at Madras ENT Research foundation, Chennai and to formulate a management protocol for these patients and to discuss in detail about the clinical features of commonly encountered syndromic deafness. MATERIALS AND METHODS Our retrospective study was aimed at describing the various Syndromic associations seen in patients with congenital profound deafness. Information was collected from the medical records. At our centre all patients undergo a comprehensive evaluation. The distribution, etiological factors and management protocol for various syndromes are here presented. RESULTS Out of 700 patients with congenital profound deafness all patients with Syndromic associations (n = 35) were studied. 5% of profoundly deaf candidates were found to be syndromic. Most common syndrome in our series was found to be congenital rubella syndrome followed by Jervell and Lange-Nielsen syndrome. CONCLUSION Congenital deafness is an associated feature of many syndromes. Detailed history taking with comprehensive evaluation is mandatory to rule out the associated syndromes. Diagnosis must be confirm by a genetic study. Multidisciplinary approach is essential for appropriate diagnosis and management.
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Al Kaissi A, Ben Chehida F, Ganger R, Klaushofer K, Grill F. Distinctive spine abnormalities in patients with Goldenhar syndrome: tomographic assessment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:594-9. [PMID: 24504787 DOI: 10.1007/s00586-014-3204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE Goldenhar syndrome consists of a combination of unilateral auricular appendages, auricular fistulas, and ocular epibulbar dermoids combined with a unilateral underdevelopment of the craniofacial structures and vertebral abnormalities. We aimed to elicit the underlying spine pathology in a group of patients via tomographic assessment. MATERIALS AND METHODS Hemifacial microsomia, cranial asymmetry, multiple ear tags, skin tags around the mouth and microtia were the most prominent facial features encountered in six patients with Goldenhar syndrome. Torticollis and cervico-thoracic scoliosis were the major deformities encountered in all patients. Thoraco-lumbar scoliosis and kyphoscoliosis were of lesser occurrence. Tomographic studies have been applied to all patients to delineate the underlying pathology. RESULTS Diverse spectrum of distinctive spine anomalies has been identified. Malsegmentation of the skull base associated with diffuse fusion with the upper cervical vertebrae was the most common spine pathology. Bilateral failure of segmentation, unilateral unsegmented bar and failure of vertebral formation were of lesser occurrence. Strikingly, we observed that the side of the hemifacial microsomia is strongly correlated with that of the craniocervical and the cervical vertebral abnormalities. CONCLUSION The importance of this paper is threefold; first, little information is available in the literature regarding the magnitude and the diversity of spine pathology in patients with Goldenhar syndrome. Second, is to alert spine specialists that conventional radiographic assessment of the craniocervical area is an insufficient modality to assess children with syndromic associations. Third, a rotation and flexion deformity of the neck associated with facial asymmetry and/or plagiocephaly should be considered as a syndromic entity rather than a simple physiological deformation.
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Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, The Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Heinrich Collin Str. 30 A, 1140, Vienna, Austria,
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20
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Machnowska M, Raybaud C. Imaging of the craniovertebral junction anomalies in children. Adv Tech Stand Neurosurg 2014; 40:141-170. [PMID: 24265045 DOI: 10.1007/978-3-319-01065-6_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The craniovertebral junction (CVJ) is interposed between the unsegmented skull and the segmented spine; it is functionally unique as it allows the complex motion of the head. Because of its unique anatomy, numerous craniometric indices have been devised. Because of its complex embryology, different from that of the adjacent skull and spine, it is commonly the seat of malformations. Because of the mobility of the head, and its relative weight, the craniovertebral junction is vulnerable to trauma. Like the rest of the axial skeleton, it may be affected by many varieties of dysplasia. In addition, the bony craniovertebral junction contains the neural craniovertebral junction and its surrounding CSF: any bony instability or loss of the normal anatomic relationships may therefore compromise the neural axis. In addition, the obstruction of the meningeal spaces at this level can compromise the normal dynamics of the CSF and result in hydrocephalus and/or syringohydromyelia. To image the CVJ, plain X-rays are essentially useless. MR is optimal in depicting the soft tissues (including the neural axis) and the joints, as well as the bone itself. CT still may be important to better demonstrate the bony abnormalities.
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Affiliation(s)
- Matylda Machnowska
- Division of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada,
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Swibel Rosenthal LH, Caballero N, Drake AF. Otolaryngologic manifestations of craniofacial syndromes. Otolaryngol Clin North Am 2012; 45:557-77, vii. [PMID: 22588037 DOI: 10.1016/j.otc.2012.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review describes important aspects of the most commonly encountered craniofacial syndromes. The goal is to provide otolaryngologists and other health care providers with critical information necessary to manage these patients appropriately. The algorithm provided in this article should be helpful in guiding the treatment of craniofacial patients based on their unique otolaryngologic characteristics. The principles highlighted in the algorithm can be applied to other craniofacial syndromes not addressed here, including Pierre Robin sequence and Down syndrome.
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Affiliation(s)
- Laura H Swibel Rosenthal
- Division of Neurosciences, Department of Otolaryngology - Head and Neck Surgery, Stritch School of Medicine, Loyola University Hospital, 2160 South First Avenue, Maywood, IL 60153-5500, USA.
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Abstract
STUDY DESIGN Focused review of the literature. OBJECTIVE Assist spine specialists in diagnosis and treatment of cervical spine anomalies found in selected genetic syndromes. SUMMARY OF BACKGROUND DATA Cervical spine instability and/or stenosis are potentially debilitating problems in many genetic syndromes. These problems can be overlooked among the other systemic issues more familiar to clinicians and radiologists evaluating these syndromes. It is imperative that spine specialists understand the relevant issues associated with these particular syndromes. METHODS The literature was reviewed for cervical spine issues in 10 specific syndromes. The information is presented in the following order: First, the identification and treatment of midcervical kyphosis in Larsen syndrome and diastrophic dysplasia (DD). Next, the upper cervical abnormalities seen in Down syndrome, 22q11.2 Deletion syndrome, pseudoachondroplasia, Morquio syndrome, Goldenhar syndrome, spondyloepiphyseal dysplasia congenita, and Kniest dysplasia. Finally, the chin-on-chest deformity of fibrodysplasia ossificans progressiva. RESULTS Midcervical kyphosis in patients with Larsen syndrome and DD needs to be evaluated and imaged often to track deformity progression. Upper cervical spine instability in Down syndrome is most commonly caused by ligamentous laxity at C1 to C2 and occiput-C1 levels. Nearly 100% of patients with 22q11.2 deletion syndrome have cervical spine abnormalities, but few are symptomatic. Patients with pseudoachondroplasia and Morquio syndrome have C1 to C2 instability related to odontoid dysplasia (hypoplasia and os odontoideum). Morquio patients also have soft tissue glycosaminoglycan deposits, which cause stenosis and lead to myelopathy. Severely affected patients with spondyloepiphyseal dysplasia congenita are at high risk of myelopathy because of atlantoaxial instability in addition to underlying stenosis. Kniest syndrome is associated with atlantoaxial instability. Cervical spine anomalies in Goldenhar syndrome are varied and can be severe. Fibrodysplasia ossificans progressiva features severe, deforming heterotopic ossification that can become life-threatening. CONCLUSION It is important to be vigilant in the diagnosis and treatment of cervical spine anomalies in patients with genetic syndromes.
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Martelli H, Miranda RTD, Fernandes CM, Bonan PRF, Paranaíba LMR, Graner E, Coletta RD. Goldenhar syndrome: clinical features with orofacial emphasis. J Appl Oral Sci 2011; 18:646-9. [PMID: 21308299 PMCID: PMC3881767 DOI: 10.1590/s1678-77572010000600019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 08/07/2009] [Indexed: 11/22/2022] Open
Abstract
Objectives Goldenhar syndrome (GS) is a relatively common developmental disorder
characterized by craniofacial anomalies in association with vertebral, cardiac,
renal, and central nervous system defects. This paper describes GS features with
special emphasis on oral characteristics. Material and methods The clinical features of 6 patients with GS aged 3 months to 12 years are
described, and a brief review of the literature about this genetic disorder is
presented. Results All patients demonstrated the classical triad of GS, including mandibular
hypoplasia resulting in facial asymmetry, ear and/or eye malformation, and
vertebral anomalies. In addition, renal and gastrointestinal abnormalities were
observed in 2 patients. Regarding the oral involvement, 2 patients presented cleft
lip and palate, and 1 patient had temporomandibular joint malformation.
Malocclusion was found in all patients. Conclusion Our orofacial findings correlate with the reported cases in the literature, and
point out that after diagnosis GS patients need to be examined for systemic
abnormalities.
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Affiliation(s)
- Hercílio Martelli
- Stomatology Clinic, Dental School, State University of Montes Claros, MG, Brazil
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Cui G, Watanabe K, Ishii K, Toyama Y, Chiba K, Matsumoto M. Interpedicular graft using a titanium mesh cage in a patient with lumbar scoliosis associated with a congenital butterfly vertebra. J Neurosurg Spine 2011; 14:215-8. [PMID: 21214313 DOI: 10.3171/2010.10.spine10191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A butterfly vertebra is a congenital anomaly often associated with a series of syndromic diseases and is often recognized incidentally without any presenting symptoms. The authors report the case of a 13-year-old girl with lumbar scoliosis and mild spondylolisthesis associated with a butterfly vertebra at L-6 causing radiculopathy. The L-5 and L-6 nerve roots were entrapped at the intervertebral foramina between L-5 and the butterfly vertebra (L-6) and between L-6 and S-1 in the concave side. To decompress and preserve the two nerve roots, correct the deformity, and obtain a solid bone fusion, surgery involving the thorough removal of the facet joints between L-5 and L-6 and between L-6 and S-1 in the concave side was performed, with a partial resection of the butterfly vertebra and the placement of a titanium mesh cage between the L-5 and S-1 pedicles dorsal to the nerve roots. Complete pain relief and correction of the deformity with solid bone fusion was obtained after a 2-year follow-up period.
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Affiliation(s)
- Guanyu Cui
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, People's Republic of China
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Skarzyński H, Porowski M, Podskarbi-Fayette R. Treatment of otological features of the oculoauriculovertebral dysplasia (Goldenhar syndrome). Int J Pediatr Otorhinolaryngol 2009; 73:915-21. [PMID: 19203801 DOI: 10.1016/j.ijporl.2009.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 01/12/2009] [Accepted: 01/13/2009] [Indexed: 10/21/2022]
Abstract
The oculoauriculovertebral dysplasia is a rare congenital malformation that is characterized by a hemifacial microsomia with ocular abnormalities and coexisting disorders in the spinal column and other organs. Characteristic features of the disease were first described by Maurice Goldenhar in 1952. A broad spectrum of hearing impairment is a result of complex malformations of the external ear, the middle ear and in some cases-the inner ear. The degree of hearing loss can range from mild to moderate conductive type in cases of chronic otitis media with effusion and severe to profound sensorineural hearing impairment with malformations of the inner ear in various forms of cochlear hypoplasia. This study focuses on surgical methods of hearing improvement in patients with the oculoauriculovertebral dysplasia (OAVD). We present 11 patients diagnosed with OAVD who are under supervision of the Institute of Physiology and Pathology of Hearing in Warsaw. It is, to our knowledge, one of the largest groups of patients reported by a single ORL medical center. The degree of hearing impairment was thoroughly described in all patients and individual treatment was introduced. The aim of this report was to present algorithm for diagnostics and treatment of symptoms of Goldenhar syndrome (GS) based upon methodology used in modern otosurgery.
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Affiliation(s)
- Henryk Skarzyński
- International Center of Hearing and Speech of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany, Poland
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Affiliation(s)
- Joseph Lam
- Rady Children's Hospital, University of California, San Diego School of Medicine, San Diego, California, USA
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