Oculodentodigital dysplasia (ODD dysplasia) syndrome may be inherited in an autosomal dominant or autosomal recessive manner. The typical clinical findings in this syndrome depend on the type of inheritance, with multiple organ systems being afflicted, namely the head, eyes, mouth cavity, skin, skeletal, and nervous system [1].

Patients with the autosomal dominant form of ODD dysplasia are usually born with microphthalmia with or without microcephaly. The other common ocular findings include glaucoma, strabismus, iris atrophy, micro cornea, epicanthic folds, a narrow palpebral fissure and atrophy of the eye [2] [3].

The dental problems occurring in patients with ODD dysplasia include small teeth predisposed to caries due to insufficient enamel. Irregular teeth, missing teeth, and early tooth loss are the other findings.

A slender nose with narrow and/or underdeveloped nostrils is another typical finding. Cleft lip or palate may also be observed.

A major sign of ODD dysplasia syndrome is the syndactyly between the fourth and the fifth fingers and/or the fourth and the fifth toes. Apart from being pathologically connected, the fingers and toes may also be unusually bent (camptodactyly).

In some cases, neurologic deficits may be present. Patients may suffer from ataxia, dysarthria, spastic paraplegia, deafness and problems with urination and defecation [4] [5] [6].

Palmoplantar keratoderma has also been reported in some patients. The hair may be fragile, dry, thin and shows extremely slow growth [7].

Signs and symptoms in the autosomal recessive form of ODD dysplasia are typically more severe. The eyes are extremely small and slender, with the interpupillary distance wider than normal. Some patients may even go completely blind. The skeletal changes are more pronounced and the bones of the skull, lower jaw, and the collar bone show an abnormal thickening.

ODD dysplasia must be distinguished from several other conditions presenting with similar symptoms. Foremost among these is the oro-cranio-digital syndrome, an autosomal recessive condition characterized by numerous abnormalities such as microcephaly, cleft lip and/or palate and growth retardation. This disorder is extremely rare and shows a slight female preponderance.

Amelogenesis imperfecta is another rare congenital condition in which defective formation of the tooth enamel results in the teeth being more sensitive to extremes of temperature. Early tooth loss with frequent dental infections are the other common clinical features.

A group of hereditary conditions, termed the ectodermal dysplasias, may also be a cause for defective enamel formation, with missing teeth and hair problems being the usual presenting features. Other organs derived from the ectodermal germ layer, most notably the skin, are also routinely affected.

Saethre-Chotzen syndrome is an autosomal dominant disorder, characterized by various malformations of the head, skeleton, and skin of the fingers and toes that may present with mental retardation.

• Proportionate Short Stature

  We report a case of a 6-year-old male who presented with dysmorphic facial features (short palpebral fissure, thin nose with hypoplastic alae nasi, and flat face), bilateral syndactyly, abnormal dentition, and proportionate short stature with growth hormone [ncbi.nlm.nih.gov]

• Steatorrhea

  Steatorrhea was documented, but the usual methods for investigating this were thwarted by the patient's abnormal gastric anatomy and poor gastric motility. [ncbi.nlm.nih.gov]

• Poor Oral Hygiene

  Combination of odontodysplasia, poor oral hygiene, and parental neglect can lead to extensive destruction of tooth structure and the treatment options become limited. [ncbi.nlm.nih.gov]

• Visual Impairment

  impairment Impaired vision Loss of eyesight Poor vision [ more ] 0000505 5%-29% of people have these symptoms Abnormal diaphysis morphology Abnormal shape of shaft of long bone 0000940 Abnormal form of the vertebral bodies 0003312 Abnormality iris morphology [rarediseases.info.nih.gov]

  Neuro-ophthalmological findings include ptosis, nystagmus, gaze palsies, squint and visual impairment that is probably related to glaucoma or amblyopia. 2 No neuropathological postmortem findings have been reported yet in these patients. 2 Less common [acnr.co.uk]

  impairment Abnormality of the retinal vasculature Narrow nasal bridge Opacification of the corneal stroma Hypoplasia of the iris Irritability Delayed puberty Migraine Sclerocornea Aplasia/Hypoplasia of the cerebellum Ectopia lentis Glioma Abnormality [mendelian.co]

  impairment　(視力障害)　[HP:0000505]　[06011] 　 　 5%-29% 　Abnormal diaphysis morphology　(骨幹形態異常)　[HP:0000940]　[160022] 　Abnormal form of the vertebral bodies　(椎体骨異常)　[HP:0003312]　[1615] 　Abnormality iris morphology　(虹彩形態異常)　[HP:0000525]　[06112] 　Abnormality [syndromefinder.ncchd.go.jp]

• Progressive Loss of Vision

  Described here is the case of a 21-year-old male who presented to the ophthalmology outpatient department with a complaint of bilateral progressive loss of vision since childhood. [ncbi.nlm.nih.gov]

  Case Report A 21-year-old male presented to the ophthalmology outpatient department of our institute with a complaint of bilateral progressive loss of vision since childhood. [ijo.in]

• Small Palpebral Fissures

  The distance between the inner canthi and the medial orbital walls in three patients we studied suggests that previous reports of hypertelorism may have been illusions resulting from microcornea, small palpebral fissures, and variably present epicanthus [ncbi.nlm.nih.gov]

• Deformed Limbs

  Oculodentodigital dysplasia (ODDD) is a multisystem congenital disorder characterized by abnormal facial development, deformed limbs and dentition. [ncbi.nlm.nih.gov]

• Alopecia

  2 Palmoplantar Keratoderma and Congenital Alopecia, Autosomal Dominant Papillon-Lefevre Syndrome Pili Torti and Developmental Delay Pilodental Dysplasia with Refractive Errors Poikiloderma with Neutropenia Polyposis, Skin Pigmentation, Alopecia, and [nfed.org]

  Chronic cheilitis and perléche are common, whereas hair and nail dystrophy, scarring alopecia, dental anomalies and heat intolerance are less frequent. [sajr.org.za]

  SYNDROME Albinism Deafness Syndrome Aldred Syndrome Alice in Wonderland Syndrome Alien Hand Syndrome ALKURAYA-KUCINSKAS SYNDROME Allan-Herndon-Dudley syndrome Allanson Pantzar McLeod Syndrome allergic cutaneous vasculitis Aloi Tomasini Isaia Syndrome Alopecia [rgd.mcw.edu]

  […] bones Persistent pupillary membrane Macrodontia of permanent maxillary central incisor Fifth finger distal phalanx clinodactyly 4-5 finger syndactyly 2-4 toe cutaneous syndactyly Hydrocephalus Abnormality of dental morphology Respiratory insufficiency Alopecia [mendelian.co]

  (Hu et al. 2013) (6) Palmoplantar keratoderma and congenital alopecia 1 (104100) .0023 Palmoplantar keratoderma and congenital alopecia 1 (104100) [GJA1, GLY8VAL] (rs864309644) (RCV000185623) (Wang et al. 2015) (7) Eythrokeratoderma variabilis et progressiva [syndromefinder.ncchd.go.jp]

• Neglect

  Combination of odontodysplasia, poor oral hygiene, and parental neglect can lead to extensive destruction of tooth structure and the treatment options become limited. [ncbi.nlm.nih.gov]

  Second, neurological symptoms can be easily neglected if the diagnosis of ODDD is made by physicians with other specialties, especially when the symptoms are subtle. [e-jmd.org]

• Paresthesia

  Additional findings consisted of gaze palsy and squinting (28), bladder and bowel disturbances (21), visual loss (20) and blindness (4), hearing loss (15), ataxia (11), nystagmus (9), muscle weakness (5) and paresthesias (3). [ncbi.nlm.nih.gov]

• Pyramidal Tract Signs

  We found a novel GJA1 mutation (W25C) as the possible causative gene in this sporadic ODDD patient with neurological features of motor deficits by pyramidal tract signs, and sensory deficits due to peripheral nerve disturbance. [ncbi.nlm.nih.gov]

• Loss of Speech

  Neurological symptoms are not universally seen, but about 30% of the patient population has been diagnosed with neurological problems that include conductive hearing loss, dysarthria (speech articulation problems), neurogenic bladder (voiding problems [ncbi.nlm.nih.gov]

A proper diagnosis rests on the identification of the typical clinical features of ODD dysplasia. However, the symptoms and their severity vary from case to case and hence, the recognition of this disorder based primarily on its clinical manifestations is not always apparent. When ODD dysplasia is suspected, the diagnosis can be confirmed by certain molecular tests. The defective gene is situated on 6q chromosome and genetic mapping studies may help to further elucidate the precise location of the mutation [8] [9] [10].

• White Matter Lesions

  matter lesions (9) and basal ganglia changes (6) on MRI. [doi.org]

  However, white matter lesions and basal ganglia changes have been documented on MRI. [disorders.eyes.arizona.edu]

• Gliosis

  At the microscopic level, epileptic brain regions are characterized by injured neurons, gliosis, axonal sprouting, and the formation of new, aberrant, synaptic connections (reviewed in D'Ambrosio, 2004 ; Dichter, 2009 ; Reid et al., 2009 ). [ncbi.nlm.nih.gov]

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9. Brueton L, Huson S, Farren B, Winter R. Oculodento-digital dysplasia and type III syndactyly: separate genetic entities or disease spectrum? J. Med. Genet. 1990;27:169-175.
10. Temtamy S, McKusick V. The genetics of hand malformations. Birth Defects. 1978;14:309-314.