Presentation
The present patient had typical findings of Nager syndrome and Pierre Robin sequence. He progressed to severe respiratory distress, requiring mechanical ventilation and tracheostomy. [ncbi.nlm.nih.gov]
Entire Body System
- Dysostosis
[…] malformations plus mandibulofacial dysostosis. [ncbi.nlm.nih.gov]
Harley: Mandibulofacial dysostosis with limb malformations (Nager's acrofacial dysostosis). Birth Defects, 1974, 10(5): 109-115 A. S. [whonamedit.com]
[…] involving either the upper limbs or craniofacial defects in the form of mandibulofacial dysostosis. [medical-dictionary.thefreedictionary.com]
[…] the AFD Rodriquez type as well as mandibulofacial dysostosis with microcephaly (see these terms). [orpha.net]
- Short Stature
stature IMPORTANT NOTE: NIH does not independently verify information submitted to the GTR; it relies on submitters to provide information that is accurate and not misleading. [ncbi.nlm.nih.gov]
Short stature, aplasia /hypoplasia of the radius Homozygous or compound heterozygous mutation in the RECQL4 Cornelia de Lange syndrome (OMIM# 122470) Facial defects, growth restriction and mental retardation, upper limb anomalies Defects in chromosome [gynecology-obstetrics.imedpub.com]
stature Decreased body height Small stature [ more ] 0004322 Short toe Short toes Stubby toes [ more ] 0001831 Talipes equinovarus Club feet Club foot Clubfeet Clubfoot [ more ] 0001762 Tetralogy of Fallot 0001636 Toe syndactyly Fused toes Webbed toes [rarediseases.info.nih.gov]
Upper limb deformities include thumb anomalies, radial defect and radioulnar synostosis and axial skeletal anomalies with short stature [3]. [symbiosisonlinepublishing.com]
- Anemia
A CELLULE FALCIFORMI BLACKFAN-DIAMOND, ANEMIA DI ANEMIA CONGENITA IPOPLASTICA FANCONI, ANEMIA DI PANCITOPENIA DI FANCONI ANEMIE SIDEROBLASTICHE METAEMOGLOBINEMIA DA DEFICIT DI METAEMOGLOBINAREDUTTASI METAEMOGLOBINEMIA CONGENITA EREDITARIA RD0010 SINDROME [retemalattierare.it]
[…] radius Homozygous or compound heterozygous mutation in the RECQL4 Cornelia de Lange syndrome (OMIM# 122470) Facial defects, growth restriction and mental retardation, upper limb anomalies Defects in chromosome 5,10,X NIPBL, SMC1A, MC3 genes Fanconi anemia [gynecology-obstetrics.imedpub.com]
Aygun B, Mortier NA, Smeltzer MP, Hankins JS, Ware RE: Glomerular hyperfiltration and albuminuria in children with sickle cell anemia. Pediatr Nephrol. 2011;26:1285–1290. 71. Wickman C, Kramer H: Obesity and kidney disease: Potential mechanisms. [dovepress.com]
Sickle cell anemia, Asthma, Epilepsy, Diabetes, End stage renal disease ESRD) were excluded from the study. [bmcnephrol.biomedcentral.com]
Jaw & Teeth
- Dental Caries
The findings in this study contrasts previous studies that reported a reduced rate of dental caries in individuals with Down syndrome [16,17]. [library.down-syndrome.org]
Eyes
- Antimongoloid Slant
slant lower lid ptosis microtia micrognathia mandibular hypoplasia hearing loss auricular tags cleft lip + / - palate other skeletal: radial hypoplasia or radial aplasia fibular hypoplasia or fibular aplasia radio-ulnar synostosis thumb anomalies hypoplastic [radiopaedia.org]
Ocular findings in Nager syndrome may include downward slanting eyes, absent eyelashes, and lower eyelid coloboma. [4] Maxillofacial dysostosis: Findings in Maxillofacial dysostosis include a hypoplastic maxilla, downward slanting palpebral fissures, [eyewiki.aao.org]
slant of the eyes, coloboma in the lower eye lid, micrognathia, microtia and other deformity of the ears, hypoplastic zygomatic arches, macrostomia, cleft palate TCOF1 on chromosome 5q32 POLR1D on chromosome 3q12.2 POLR1C on Chromosome 6 Goldenhar syndrome [gynecology-obstetrics.imedpub.com]
Upper eyelid ptosis with an antimongoloid slant may be seen. Blindness may be present. Overall, the deformity is worse than that of Crouzon syndrome. See the image below. [emedicine.medscape.com]
Ears
- Hearing Impairment
He will likely have a hearing impairment because of his underdeveloped ears. The hearing impairment could also lead to speech delays. He will have trouble playing sports because of his arm motion will be limited. [myriverside.sd43.bc.ca]
impairment Low-set ears Posteriorly rotated ears Growth abnormality Short stature IMPORTANT NOTE: NIH does not independently verify information submitted to the GTR; it relies on submitters to provide information that is accurate and not misleading. [ncbi.nlm.nih.gov]
[…] more ] 0000750 Downslanted palpebral fissures Downward slanting of the opening between the eyelids 0000494 Hearing impairment Deafness Hearing defect [ more ] 0000365 Hypoplasia of the maxilla Decreased size of maxilla Decreased size of upper jaw Maxillary [rarediseases.info.nih.gov]
The inner ear bones often will be poorly formed, causing hearing impairment or loss, which may or may not be correctable with surgery or a hearing aid. [houstoncraniofacial.com]
Conclusion: Regular ear check-up in people with DS is essential for the detection and treatment of ear wax, OME and hearing impairment which is highly prevalent in them. Pneumatic otoscopy is recommended for the detection of OME in all age groups. [nigerianmedjournal.org]
Musculoskeletal
- Hip Dislocation
dislocation Hypoplasia of first ribs Malar flattening Microcephaly Micrognathia Radioulnar synostosis Retrognathia Scoliosis Temporomandibular joint ankylosis Trismus Abnormality of the nervous system Aganglionic megacolon Aqueductal stenosis Delayed [ncbi.nlm.nih.gov]
dislocation Dislocated hips Dislocation of hip [ more ] 0002827 Hydrocephalus Too much cerebrospinal fluid in the brain 0000238 Hypoplasia of first ribs Small first rib Underdeveloped first rib [ more ] 0006657 Hypoplasia of the epiglottis 0005349 Laryngeal [rarediseases.info.nih.gov]
Other limb anomalies may include hypoplasia or aplasia of the radius, radioulnar synostosis, hip dislocation, and limitations of elbow extension. Legs and toes may also be affected. Some internal anomalies exist including stomach or kidney reflux. [whonamedit.com]
[…] de Lange syndrome (OMIM# 122470) Facial defects, growth restriction and mental retardation, upper limb anomalies Defects in chromosome 5,10,X NIPBL, SMC1A, MC3 genes Fanconi anemia (OMIM# 613390 RAD51C) Absent thumbs, radial ray defects, congenital hip [gynecology-obstetrics.imedpub.com]
Those reported so far include hip dislocation in three previous cases, [19], [21], [22] complete aplasia of lower limbs with feet attached directly to the femora or trunk which was reported in a particularly severe form of Nager AFD, [23] equinovarus [jofs.in]
- Hand Deformity
Upton’s practice is one of the world’s largest specializing in congenital hand deformities, vascular anomalies, and pediatric and adult microsurgery. [books.google.com]
Jump to navigation Jump to search Nager Syndrome Also known as [ edit ] Acrofacial Dysostosis, Nager Type AFD Nager Acrofacial Dysostosis Syndrome Split Hand Deformity-Mandibulofacial Dysostosis Exact cause unknown [ edit ] Inheritance [ edit ] Unknown [en.wikibooks.org]
Severe micrognathia and malar hypoplasia ( Figure 1) and the club hand deformity together with hypoplastic/absent thumbs and fixed elbows and wrists were also present ( Figure 2 ). [gynecology-obstetrics.imedpub.com]
- Extension of Elbows Limited
elbow extension Decreased elbow extension Elbow limited extension Limitation of elbow extension Limited extension at elbows Limited forearm extension Restricted elbow extension [ more ] 0001377 Low-set ears Low set ears Lowset ears [ more ] 0000369 Malar [rarediseases.info.nih.gov]
- Absent or Hypoplastic Thumbs
Preaxial limb malformations include absent or hypoplastic thumbs, hypoplasia of the radius and shortened humeral bones. [ncbi.nlm.nih.gov]
Face, Head & Neck
- Pierre Robin Syndrome
PIERRE ROBIN ANOMALAD / SYNDROME Robin sequence previously known as Pierre Robin syndrome and Pierre Robin anomalad consists of three essential components: Micrognathia or retrognathia Cleft palate (usually U-shaped, but V-shape also occurs) Glossoptosis [fetalultrasound.com]
Doctors told Emi and Andrew that she may have Pierre Robin syndrome, where a smaller than normal lower jaw causes breathing problems. "We were so shocked and worried," says Andrew. [gosh.nhs.uk]
In Holt Oram and Fanconi syndrome, there is no mandibular and malar hypoplasia. Diagnostically relevant are: Goldenhar syndrome, Pierre-Robin syndrome and Vater associations with the absence of radial and thumb aplasia in all. [gynecology-obstetrics.imedpub.com]
Synonyms: Pierre Robin syndrome (PRS), Pierre Robin anomaly/anomalad, Pierre Robin malformation (PRM) complex, Robin sequence, Robin complex Related conditions - these may display features of the malformation: Stickler's syndrome, velocardiofacial syndrome [patient.info]
Pierre Robin syndrome. Preoperative appearance. Pierre Robin syndrome. Preoperative appearance. Mild cases are treated by placing the baby on its side or face down with the foot of the cot raised. [emedicine.medscape.com]
Workup
Clinical Testing and Workup Specialized x-ray studies will confirm the presence and/or extent of certain observed craniofacial abnormalities. [rarediseases.org]
Treatment
Treatment was safe and successful in this case. [ncbi.nlm.nih.gov]
Treatment planning requires a craniofacial team to sequence the ear reconstruction, jaw reconstruction and soft tissue reconstruction. [rchsd.org]
Management and treatment Management must focus on neonatal respiratory distress (tracheostomy) and feeding difficulties (gastrostomy). [orpha.net]
Prognosis
Distinguishing this condition from similar syndromes is critical for care and prognosis. [ncbi.nlm.nih.gov]
Prognosis After infancy, most patients are healthy and are presumed to have a normal lifespan. [orpha.net]
1 answer Nager Syndrome and depression What is Nager Syndrome Nager Syndrome synonyms Nager Syndrome prognosis Which advice would you give to someone who has just been diagnosed with Nager Syndrome? 1 answer [diseasemaps.org]
Etiology
Nager acrofacial dysostosis is a rare syndrome of unknown etiology combining mandibular and thumb/radial hypoplasia. [ncbi.nlm.nih.gov]
Etiology In approximately 50% of patients, NAFD has been associated with heterozygous mutations in the SF3B4 gene (1q21.2), coding for a component of the splicing machinery. [orpha.net]
“These studies,” says Professor Saint-Jeannet, will identify genes important for neural crest and craniofacial development, and will provide novel insights into the etiology and pathogenesis of Nager syndrome. [nyu.edu]
Epidemiology
The scientific developments have fast-tracked our insights SARS-CoV-2 epidemiology, likewise vaccinology relevant for developing drugs for viral infections treatment. [ijtmgh.com]
Summary Epidemiology The prevalence is unknown; more than 100 cases of NAFD have been published. [orpha.net]
Pathophysiology
The mechanisms that link the metabolic abnormalities of MS with the pathophysiology of clinical diseases associated with MS are numerous and poorly understood (Rahamon et al., 2014). [new.ejpsy.eg.net]
[…] facilitating pre-synaptic release and blocking post-synaptic reuptake of dopamine.34,35 Based on evidence from epidemiological and basic science studies, head injury is considered a susceptibility factor for Parkinson disease, which is thought to share pathophysiological [ncbi.nlm.nih.gov]
It is therefore possible that the extrinsic pathway is unaffected by the pathophysiologic changes that occur in nephrotic syndrome. About 90% of children with nephrotic syndrome had INR within reference range. [bmcnephrol.biomedcentral.com]
Nephrotic syndrome in infants and children: pathophysiology and management. Paediatr Int Child Health. 2017;37(4):248–258. 11. [dovepress.com]
Prevention
One other study raised the concept of unloading the condyles during the mandibular distraction to prevent subsequent ankylosis. [ncbi.nlm.nih.gov]
Prevention and control of sick building syndrome (SBS). Part 1: Identification of risk factors. Int J Sanit Eng Res. 2014;8:16-40. [oamjms.eu]
The authors would advocate early pollicization in patients with thumb anomalies to prevent any impairment in manual dexterity. * Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, SA, Australia † Team for Congenital Hand and Upper [journals.lww.com]
Diagnosis, therapy, and prevention of the cracked tooth syndrome. Quintessence Int. 2003; 34: 409-417 Hiatt W.H. Incomplete crown-root fracture in pulpal-periodontal disease. J Periodontol. 1973; 44: 369-379 Ehrmann E.H. Tyas M.J. [jendodon.com]
Centers for Disease Control and Prevention Intersex (Medical Encyclopedia) [ Read More ] [icdlist.com]