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Popat A, Yadav S. Air Embolism-Induced Ischemic Stroke Following Orthognathic Surgery in a Patient With Goldenhar Syndrome. Clin Med Res 2024; 22:44-48. [PMID: 38609140 DOI: 10.3121/cmr.2024.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 04/14/2024]
Abstract
Goldenhar syndrome, a rare congenital anomaly, manifests as craniofacial malformations often necessitating intricate surgical interventions. These procedures, though crucial, can expose patients to diverse postoperative complications, including hemorrhage or infection. A noteworthy complication is stroke, potentially linked to air embolism or local surgical trauma. We highlight a case of a male patient, aged 20 years, who experienced a significant postoperative complication of an ischemic stroke, theorized to be due to an air embolism, after undergoing orthognathic procedures for Goldenhar syndrome. The patient was subjected to LeFort I maxillary osteotomy, bilateral sagittal split ramus osteotomy of the mandible, and anterior iliac crest bone grafting to the right maxilla. He suffered an acute ischemic stroke in the left thalamus post-surgery, theorized to stem from an air embolism. Advanced imaging demonstrated air pockets within the cavernous sinus, a rare and concerning finding suggestive of potential air embolism. This case underscores the intricate challenges in treating Goldenhar syndrome patients and the rare but significant risk of stroke due to air embolism or surgical trauma. Limited literature on managing air embolism complications specific to Goldenhar syndrome surgeries exists. Generally, management includes immediate recognition, positional adjustments, air aspiration via central venous catheters, hyperbaric oxygen therapy, hemodynamic support, and high-flow oxygen administration to expedite air resorption. Our patient was conservatively managed post-surgery, and at a 3-month neurology follow-up, he showed significant improvement with only residual right arm weakness. It emphasizes the imperative of a comprehensive, multidisciplinary approach.
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Affiliation(s)
- Apurva Popat
- Marshfield Clinic Health System, Internal Medicine, Marshfield, Wisconsin, USA
| | - Sweta Yadav
- GMERS Medical College, Internal Medicine, Ahmedabad, Ahmedabad, India
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Della Bella G, Castelli E, Vigevano F. Long-term efficacy of glycopyrrolate on sialorrhea in Goldenhar syndrome: a case report. Ital J Pediatr 2022; 48:166. [PMID: 36068575 PMCID: PMC9450236 DOI: 10.1186/s13052-022-01320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Goldenhar syndrome (GS) is a rare congenital disease characterized by impaired development of different facial structures and deformations of the teeth structures. Sialorrhea, which can cause difficulties in breathing and language impairment, is very common in GS and often difficult to treat. This case report highlights the short- and long-term importance of the therapeutic choice – glycopyrronium in oral solution - for the treatment of sialorrhea in children with poly-malformative syndrome, complicated by outcomes of post-hemorrhagic hydrocephalus. Case presentation We report the case of a 6-year-old child with GS, carrying a percutaneous endoscopic gastrostomy after tracheostomy. The child also presented developmental dysfunction of oral motor skills of feeding, complicated by severe sialorrhea, related to the maxillo-facial dysmorphism. Sialorrhea caused several respiratory tract infections and led to an increase in the care burden. Both the inoculations of botulinum toxin and the treatment with scopolamine transdermal patch have shown mild and transient efficacy. The therapeutic choice of glycopyrronium in oral solution was the most suitable for this patient, leading to long-term sialorrhea control. Conclusions This clinical experience represents the first long-term efficacy and tolerability evaluation in using glycopyrrolate oral solution in treating drooling in children with GS. The reduction of drooling over time and the lack of clinically relevant adverse events have contributed to the decrease of respiratory tract infections, the development of oral motor skills, and determining a positive psycho-social impact on the patient's quality of life and her family.
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Affiliation(s)
- Gessica Della Bella
- Intensive Neurorehabilitation and Robotics Department - Bambino Gesù Paediatric Hospital, Via Torre di Palidoro, 00054 Passoscuro-, Fiumicino, Italy
| | - Enrico Castelli
- Intensive Neurorehabilitation and Robotics Department - Bambino Gesù Paediatric Hospital, Via Torre di Palidoro, 00054 Passoscuro-, Fiumicino, Italy
| | - Federico Vigevano
- Neurosciences Department, Bambino Gesù Paediatric Hospital, Piazza di Sant'Onofrio 4, 00165, Rome, Italy.
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Rengasamy Venugopalan S, Farrow E, Sanchez-Lara PA, Yen S, Lypka M, Jiang S, Allareddy V. A novel nonsense substitution identified in the AMIGO2 gene in an Occulo-Auriculo-Vertebral spectrum patient. Orthod Craniofac Res 2019; 22 Suppl 1:163-167. [PMID: 31074142 DOI: 10.1111/ocr.12259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/19/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Craniofacial microsmia is the second most common congenital disorder with mostly unilateral defects of ear, temporomandibular joint, mandible, and muscles of facial expression and mastication. The objective of this study was to identify, if there were any, de novo germline or somatic variants in a patient with Occulo-Auriculo-Vertebral Spectrum (OAVS) using whole-exome sequencing. SETTINGS AND SAMPLE POPULATION Trio/Family-based study of an OAVS proband. MATERIALS AND METHODS Children's Mercy Hospital Institutional Review Board approved this study and a request-to-rely was procured from the University of Missouri Kansas City IRB. Informed assent/consent was obtained for all family members prior to any research activities. The peripheral blood/affected side tissues from corrective surgery of the proband and peripheral blood samples from unaffected parents were collected. The isolated genomic DNA were enriched for exomes and sequenced on an Illlumina HiSeq 2500 instrument yielding paired-end 125 nucleotide reads (84X coverage). Gapped alignment to reference sequences (GRCh37.p5) was performed with BWA and the GATK and analysis completed using custom-developed software. RESULTS Analyses revealed that the proband carried a de novo germ line nonsense substitution (c.901C>T) in AMIGO2 gene, and missense substitutions in ZCCHC14 (c.1198C>T), and in SZT2 genes (c.2951C>T). CONCLUSIONS The nonsense substitution in AMIGO2 gene introduces a premature stop codon possibly rendering the gene non-functional via nonsense-mediated pathway decay-therefore considered a stronger candidate. Further functional studies are required to confirm whether loss-of-function variants in AMIGO2 can cause OAVS.
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Affiliation(s)
| | - Emily Farrow
- Children's Mercy Hospitals, Kansas City, Missouri
| | - Pedro A Sanchez-Lara
- Cedars-Sinai Medical Center, Los Angeles, California.,Children's Hospital Los Angeles, Los Angeles, California
| | - Stephen Yen
- Children's Hospital Los Angeles, Los Angeles, California
| | | | - Shao Jiang
- Children's Mercy Hospitals, Kansas City, Missouri
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Bragagnolo S, Colovati MES, Souza MZ, Dantas AG, F de Soares MF, Melaragno MI, Perez AB. Clinical and cytogenomic findings in OAV spectrum. Am J Med Genet A 2018; 176:638-648. [PMID: 29368383 DOI: 10.1002/ajmg.a.38576] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/10/2017] [Accepted: 11/16/2017] [Indexed: 11/06/2022]
Abstract
The oculoauriculovertebral spectrum (OAVS) is characterized by anomalies involving the development of the first and second pharyngeal arches during the embryonic period. The phenotype is highly heterogeneous, involving ears, eyes, face, neck, and other systems and organs. There is no agreement in the literature for the minimum phenotypic inclusion criteria, but the primary phenotype involves hemifacial microsomia with facial asymmetry and microtia. Most cases are sporadic and the etiology of this syndrome is not well known. Environmental factors, family cases that demonstrate Mendelian inheritance, such as preauricular appendages, microtia, mandibular hypoplasia, and facial asymmetry; chromosomal abnormalities and some candidate genes suggest a multifactorial inheritance model. We evaluated clinical, cytogenomic and molecularly 72 patients with OAVS, and compared our findings with patients from the literature. We found 15 CNVs (copy number variations) considered pathogenic or possibly pathogenic in 13 out of 72 patients. Our results did not indicated a single candidate genomic region, but recurrent chromosomal imbalances were observed in chromosome 4 and 22, in regions containing genes relevant to the OAVS phenotype or related to known OMIM diseases suggesting different pathogenic mechanisms involved in this genetically and phenotypic heterogeneous spectrum.
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Affiliation(s)
- Silvia Bragagnolo
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Mileny E S Colovati
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Malu Z Souza
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Anelise G Dantas
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Maria I Melaragno
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Ana B Perez
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
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Spineli-Silva S, Bispo LM, Gil-da-Silva-Lopes VL, Vieira TP. Distal deletion at 22q11.2 as differential diagnosis in Craniofacial Microsomia: Case report and literature review. Eur J Med Genet 2018; 61:262-8. [PMID: 29288792 DOI: 10.1016/j.ejmg.2017.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/17/2017] [Accepted: 12/23/2017] [Indexed: 01/23/2023]
Abstract
Craniofacial Microsomia (CFM) also known as Oculo-auriculo-vertebral Spectrum (OAVS) or Goldenhar Syndrome, presents wide phenotypic and etiological heterogeneity. It affects mainly the structures originated from the first and second pharyngeal arches. In addition, other major anomalies may also be found, including congenital heart diseases. In this study, we report a patient with distal deletion in the 22q11.2 region and a phenotype which resembles CFM. The proband is a girl, who presented bilateral preauricular tags, left auditory canal stenosis, malar hypoplasia, cleft lip and palate, mild asymmetry of soft tissue in face, congenital heart disease, intestinal atresia, annular pancreas and hydronephrosis. The genomic imbalances investigation by Multiplex Ligation-dependent Probe Amplification (MLPA) and Chromosomal Microarray Analysis (CMA) revealed a distal deletion of 1,048 kb at 22q11.2 encompassing the region from Low Copy Repeats (LCRs) D to E. We did review of the literature and genotype-phenotype correlation. This is the sixth case of distal 22q11.2 deletion resembling CFM and the second encompassing the region between LCRs D to E. All cases share some phenotypic signs, such as preauricular tags, facial asymmetry, cleft lip and palate, and congenital heart diseases. Candidate genes in this region have been studied by having an important role in pharyngeal arches developmental and in congenital heart diseases, such as HIC2, YPEL1and MAPK1/ERK2. This case corroborates the phenotypic similarity between 22q11.2 distal deletion and CFM/OAVS. It also contributes to genotype-phenotype correlation and reinforces that candidate genes for CFM, in the 22q11.2 region, might be located between LCRs D and E.
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Abstract
Ocular lipodermoid cysts and solid dermoid tumors are choristomas which are described as normal tissue growth in an abnormal location. Congenital epibulbar lipodermoid comprises adipose tissue that is covered by connective tissue. They are usually located superotemporally, and basically tend not to involve the peripheral cornea. If the dermoid or lipodermoid is accompanied by other systemic conditions or ocular anomalies in young children, a consultation with an Internist or pediatrician is required to rule out Goldenhar syndrome which is a oculoauriculovertebral dysplasia. This paper reports a unilateral lipodermoid cyst which is remarkable regarding its caruncular origin, in an otherwise healthy adult female.
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Affiliation(s)
- Mohammad Taher Rajabi
- Department of Ophthalmic Plastic and Reconstructive Surgery, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Koosha Ramezani
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA
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Baugh AD, Wooten W, Chapman B, Drake AF, Vaughn BV. Sleep characteristics in Goldenhar Syndrome. Int J Pediatr Otorhinolaryngol 2015; 79:356-8. [PMID: 25636665 DOI: 10.1016/j.ijporl.2014.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the characteristics of sleep in patients with Goldenhar Syndrome. DESIGN Retrospective review of all polysomnography studies conducted at the University of North Carolina Hospitals between 2003 and 2013 on patients carrying the diagnosis of Goldenhar's Syndrome. RESULTS A preponderance of patients demonstrated severe obstructive sleep apnea and hypercapnia. CONCLUSIONS Patients with Goldenhar Syndrome should be screened for sleep apnea and hypercapnia.
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Affiliation(s)
- A D Baugh
- Department of Surgery, Michigan State University, United States
| | - W Wooten
- Pediatric Specialty Care, East Carolina University, United States
| | - B Chapman
- Department of Neurology, The Ohio State University, United States
| | - A F Drake
- Department of Otolaryngology Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - B V Vaughn
- Division of Sleep and Epilepsy, Department of Neurology, University of North Carolina School of Medicine, United States
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SACCOMANNO S, GRECO F, D'ALATRI L, DE CORSO E, PANDOLFINI M, SERGI B, PIRRONTI T, DELI R. Role of 3D-CT for orthodontic and ENT evaluation in Goldenhar syndrome. Acta Otorhinolaryngol Ital 2014; 34:283-7. [PMID: 25210224 PMCID: PMC4157534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/15/2011] [Indexed: 11/17/2022]
Abstract
Goldenhar syndrome is a congenital condition that includes anomalies of the derivatives of the first and second brachial arches, vertebral defects and ocular abnormalities. It is also known as oculo-auriculo-vertebrale syndrome (OAVS), hemifacial microsomia, or first or second brachial arch syndrome. It was first described by Van Duyse in 1882 and better studied by M. Goldenhar in 1952. Its treatment requires a multidisciplinary approach. Herein, we describe the value of 3D-CT evaluation in a patient with Goldenhar syndrome, with particular regard to planning diagnostic and therapeutic approach. A 7-year-old boy with Goldenhar syndrome with definite post-natal genetic diagnosis was referred to our Department of Radiology for neuroimaging of the temporal bone. By 3D-CT evaluation of this young patient we observed the asymmetry of the condyles with the right one dysmorphic, short and wide; the auricle of the right ear was replaced by a dysmorphic rough; the right middle ear had a hypoplastic tympanic cavity and the internal auditory canal of right ear was atresic. In our experience, 3D-CT is a powerful diagnostic instrument and offers many advantages: volumetric reproduction of cranium and soft tissues, no overlap of anatomic parts that limits the visibility of various structures, high precision and assurance of images, and a constant and easily reproducible reference system. In our case, 3D-CT offered a very complete evaluation of all malformations of mandibular and temporal bone that characterize this syndrome and representing an important step for ENT and orthodontic therapeutic approaches.
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Affiliation(s)
- S. SACCOMANNO
- Address for correspondence: Sabina Saccomanno, Department of Head and Neck Surgery, Institute of Orthodontics, Catholic University of Medicine and Surgery, Largo A. Gemelli 8, 00168 Roma. E-mail:
| | | | | | | | | | | | - T. PIRRONTI
- Department of radiology, Catholic University A.Gemelli Roma, Italy
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Affiliation(s)
- Zouheir Hafidi
- Université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
| | - Rajae Daoudi
- Université Mohammed V Souissi, service d'ophtalmologie A de l'hôpital des spécialités, Centre hospitalier universitaire, Rabat, Maroc
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Gharehbaghi MM, Ghaemi MR. Goldenhar syndrome in an infant of diabetic mother. Iran J Pediatr 2010; 20:131-4. [PMID: 23056696 PMCID: PMC3445997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 05/25/2009] [Accepted: 07/06/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Goldenhar syndrome (oculoauriculovertebral dysplasia) is a rare congenital anomaly with unknown etiology and consists of non accidental association of hemifacial microsomia, auricular anomalies, epibulbar dermoid and vertebral anomalies. Although some malformations are more frequent in infants of diabetic mothers, developmental defects of first and second branchial arch is not a common finding in these patients. CASE PRESENTATION We report a female case of Goldenhar syndrome in a newborn infant of a diabetic mother (IDM). Follow up of this patient after 6 months showed normal neurodevelopment and no evidence of hearing loss. She had developed epibulbar dermoid tumor in her right eye. CONCLUSION It is necessary to evaluate IDM for presence of anomalies implying oculoauriculo-vertebral dysplasia.
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