1 developmental defects Flashcards
lateral facial cleft
where
associations (x4)
commissure to ear
Treacher Collins, hemifacial microsomia, Nager acrofacial dysostosis, amniotic rupture sequence
oblique facial cleft
where
assoc
upper lip to eye
can be assoc w CP
median cleft of upper lip assoc (x2)
oral-facial-digital syndrome and Ellis van Crevelde
most minimal CP
bifid uvula
submucous palatal cleft where
muscle only; surface mucosa intact
unfused soft palate muscle only; surface mucosa intact
submucous palatal cleft
pierre robin components (x3) and assoc (x2)
CP, mandibular micrognathia, glossoptosis
Stickler and velocardiofacial
Stickler and velocardiofacial what in common
pierre robin sequence
CP, mandibular micrognathia, glossoptosis
pierre robin
van der woude face look and genetics
CP + paramedian lip pits
IRF6 mutation
IRF6 mutation
van der woude
CP + paramedian lip pits
popliteal pterygium syndrome describe
CL+/- CP + paramedian lip pits
popliteal pterygia (webbing behind knee)
genital abnormalities
syngnathia (connection upper and lower ajw)
popliteal pterygia
popliteal pterygium syndrome
webbing behind knee
important bc paramedian lip pits and CL+/- CP
syngnathia
connection upper and lower jaw
popliteal pterygium syndrome
important bc paramedian lip pits and CL+/- CP
Kabuki syndrome describe
CL+/-CP eversion of eyelids mental retardation joint laxity skeletal abnormalities large ears hypodontia
paramedian lip pits
ascher syndrome components
double lip, edema of upper eyelids, non toxic thyroid enlargement
oromandibular-limb hypogenesis syndromes components (x3)
microglossia, hypodactylia (absence of digits) and hypomelia (hypoplasia of limbs)
microglossia, hypodactylia (absence of digits) and hypomelia (hypoplasia of limbs)
oromandibular-limb hypogenesis syndromes
beckwith wiedemann syndrome components (body and face) and genetics
omphalocele visceromegaly visceral tumors gigantism macroglossia
facial: nevus flammeus, earlobe indentations, maxillary hypoplasia
chr 11p15 defect
omphalocele visceromegaly visceral tumors gigantism macroglossia
nevus flammeus, earlobe indentations, maxillary hypoplasia
nevus flammeus, earlobe indentations, maxillary hypoplasia
beckwith wiedemann
nevus flammeus also sturge weber
11p15 defect
beckwith wiedemann
melkerson rosenthal components (3)
fissured tongue, facial paralysis, lip swelling
fissured tongue, facial paralysis, lip swelling
melkerson rosenthal synbdrome
lines of Zahn
layered zones of plts and RBC in thrombosed varix
layered zones of plts and RBC in thrombosed varix
lines of Zahn
dystrophic calcification of thrombus
phlebolith
condylar hyperplasia ddx from hemifacial hyperplasia
hemifacial hyperplasia has soft tissue involvement
congenital condylar hypoplasia assoc (x3)
Treacher Collins
Goldenhar (oculo-auriculo-vertebral syndrome)
hemifacial microsomia
4 types of exostoses
buccal, palatal, solitary, reactive subpontine
reactive subpontine exostosis where
posterior bridge, alveolar bone
extra bone under posterior bridge, alveolar bone
reactive subpontine exostosis
eagle syndrome describe
symptomatic elongation of styloid process or calcification of stylohyoid ligament
eagle syndrome classically after what
tonsillectomy
eagle syndrome dangers
carotid artery syndrome - carotid compressed by process
traumatic - fracture of calcified ligament
symptomatic elongation of styloid process or calcification of stylohyoid ligament
eagle syndrome
types of palatal cysts in newborns
epstein pearls - median palate
bohns nodules - all over palate
palatal cysts all over palate
bohns nodules, newborn
median palate palatal cysts
epstein pearls, newborn
most common non-odontogenic cyst of mouth
nasopalatine duct cyst
nasopalatine duct cyst when only in soft tissue
cyst of incisive papilla
bohns vs epsteins
bohns all over, epstein midline
all on palate
median palatal cyst vs nasopalatine duct cyst
median palatal must show enlargement
otherwise just posteriorly positioned nasoplataine duct cyst
canals of scarpa
foramina within incisive foramen that can carry nasopalatine nerves
foramina within incisive foramen that can carry nasopalatine nerves
canals of scarpa
organ of jacobson
olfactory organ in some animals
epidermal cyst aka
infundibular cyst
infundibular cyst
epidermal cyst
pilar cyst aka
tricholemmal or isthmus-catagen cyst
tricholemmal cyst aja
pilar cyst
oral cyst lined w GI epithelium
heterotopic oral gastrointestinal cyst
sistrunk procedure
removal of thyroglossal duct cyst w hyoid bone and muscle
removal of thyroglossal duct cyst
sistrunk
with hyoid bone and muscle
hemihyperplasia what is and assoc (x6)
risks
asymmetric growth of 1 or more body parts
complex or simplr
neurofibromatosis McCune Albright Mafucci segmental odontomaxillary dysplasia Beckwith-Wiedemann sybdrome Proteus syndrome
increased prevalence of abdominal tumors
hemihyperplasia when it’s just face
hemifacial hyperplasia
atrophy of one side of face – what is and why
progressive hemifacial atrophy (Parry-Romberg syndrome)
assoc w Lyme (Borrelia infx)
rel to localized scleroderma
parry romberg
progressive hemifacial atrophy
consider Lyme and localized scleroderma
becker nevus what is and assoc
hypertrichosis and hyperpigmentation
segmental odontomaxillary dysplasia
Crouzon sybdrome aka and genetics
craniofacial dysostosis FGFR2 mutation (chr 10)
FGFR2 mutation (chr 10)
crouzon and apert
clover leaf skull (kleeblattschadel deformity)
crouzon
crouzon skull
clover leaf
kleeblattschadel deformity)
apert syndrome aka and genetics
acrocephalosyndactyly FGFR2 mutation (chr 10)
treacher collins aka and genetics
mandibulofacial dysostosis
TCOF1
eyelid treacher collins
coloboma
syndromic association frequencies for CL+/-CP and CPO
30% of CL+/-CP
50% of CPO
syndromic
highest prevalence of orofacial clefts ethnically
asian
environmental risks for clefting
mom smiking/drinking, folic acid def, corticoids or antocinvulsants use
genes in pierre robin
SOX9/KCNJ2
digeorge syndrome
CATCH22 - chr 22 abnormality
Cardiac defect Abnormal facies Thymic aplasia --> defective cellular immunity Cleft palate HypoCaemia/hypoparathyroid
chr 22 + immunodefcy
DiGeorge - thymic aplasia
most common cause of syndromic clefting
van der woude - IRF6
everted eyelids, cleft lip, large ears
kabuki
irf 6
van der woude and popliteal pterygium apparetnly
orofacial digital syndrome describe
bifid tongue, multiple hyperplastic frenula
leukoedema locations
cheeks to lips
vagina, larynx, FOM, palatal pharyngeal
white and lacy but disappears when stretched
leukoedema
microglossia can locally cooccur with what
hypoplasia of mandible
lower incisors may be missing
microglossia, hypodactylia, hypomelia
oromandibular limb hypogenesis syndromes
beckwith wiedemann chromosome
11
omphalocele and portwine stain
beckwith wiedemann – also macroglossia
most common location for ectopic thyroid
foramen cecum of tongue – 90%
sex predilection for lingual thyroid
4-7x F
considerations for removal of lingual thyroid
for 70% it’s their only thyroid tissue
30% have hypothyroidism (compensatory?)
how to dx lingual thyroid
scan – avoid bx
hemorrhage + may be their only thyroid tissue
risks of lingual thyroid
removal – hypothyroidism and bleeding
by itself –> 1% malignancy, more common in M
syndromic fordyce granules
50-90x increase in Lynch syndrome
hereditary nonpolyposis colorectal cancer dyndrome
melkerson rosenthal
fissured tongue, facial paralysis, lip swelling
hairy tongue what is and causes
keratin accumulation on filiform papillae
tobacci, poor OHI, debilitation, abx, radiotx
coated tongue vs hairy tongue
accumulation of bacteria and epithelial cells
2/o hairlike filiform projections
most common varicosity
sublingual varix
when are isolated varices commonly noticed and where
lips and buccal mucosa
typically noticed after thrombosis
layered zones of plts and RBCs in thrombosed varix
lines of Zahn
lines of Zahn
layered zones of plts and RBC in thrombosed varix
caliber persistent artery what happens
main arterial branch extends up w/o reducing diameter
loss of tone
looks like papule on lip, w pulsation
lateral soft palate fistula what is, where, when
bilateral on anterior tonsillar pillar
can appear following infection, surgery, or developmental defect
eg absence of tonsil, hearing loss, preauricular fistulas
coronoid hyperplasia where, who, manifests
usually bilateral
5x more in M
unilateral – have to ddzx from osteoma or osteochondroma
mouth opening limitation or deviation of MD (unilateral) – towards defect bc gets stuck ; opening limitation if bilateral
condylar hyperplasia leads to
ddx from
facial asymmetry, prognathism, open/cross bite
ddx from hemifacial hyperplasia (soft tissue and teeth involved in latter)
congenital condylar hypoplasia when
treacher collins, goldenhar syndrome (oculo-auriculo-vertebral syndrome), hemifacial microsomia
can have complete apasia
acuired condylar hypoplasia
usually trauma
also infx, radiation, arthritis
condylar hypoplasia xray
short condylar process, shallow sigmoid notch, small condyle head
goldenhar syndrome aka and components
oculo-auriculo-vertebral syndrome
incomplete development of ear, nose, soft palate, lip, mandible
limbal dermoids, preauricular skin tags, strabismus
bifid condyle why?
trauma, abnormal mm attachment, teratogenic agents, persistence of fibrous tissue within condylar cartilage
4 types of exostoses
buccal (facial MD or MX); palatal tubercle (lingual MX tuberosity); solitary (2/2 irritation, eg graft placement); reactive subpontine (under posterior bridge)
extra bone under posterior bridge in alveolar bone
reactive subpontine exostosis
palatal tori morphologic classification
flat, spindle, nodular, lobular
mandibular tori laterality
90% bilateral
correlates with bruxism and # of remaining teeth
types of eagle syndrome
classic (after tonsilletcomy)
carotid artery/stylohyoid syndome (carotid compressed by process)
traumatic (fracture of calcified ligament)
stafne defect most common location
RL in angle of MD below canal between molars
cause of stafne
focal concavity of lingual mandible, usually contains sub-MD gland tissue
other rare locations for stafne
anterior MD (sublingual gland) and upper ramus (parotid gland)
sex for stafne
80-90% M
epstein vs bohn
epstein pearls - median palatal raphe - palatal cysts of newborn; from epithelium entrapment when shelves fuse
bohn’s nodules – scattered all over palate; palatal cysts of newborn; epithelial remnants of minor salivary glands
nasolabial cyst aka and origin
Klestadt’s cyst
poss nasolacrimal duct?
nasolabial cyst look
swelling of upper lip lateral to midline
elevation of nose ala
obliteration of mucolabial fold
histo of nasolabial cyst
pseudostratified columnar epithelium, can have cilia amd goblet cells and apocrine lining
most common non-odontogenic cyst of mouth
nasopalatine duct cyts – remnants of nasopalatine duct
foramina in incisive foramen - what and what do
canals of scarpa
carry nasopalatine nerves
canals of scarpa
foramina in incisive foramen
carry nasopalatine nerves
preauricular pits 2 assoc
commissural lip pits and lateral soft palate fistulas
accessory olfactory organ in some animals name and what related to in OP terms
organ of jacobson
nasopalatine duct cyst
organ of jacobson
accessory olfactory organ in some animals
related to nasopalatine duct cyst maybe
incisive canal vs cyst
if >6mm, consider a cyst (unless other symptoms are present)
cyst of incisive papilla
soft tissue nasopalatine duct cyst
soft tissue nasopalatine duct cyst
cyst of incisive papilla
nasopalatine duct cyst xray
inverted pear between maxillary incisors
inverted pear between maxillary incisors on xray
nasopalatine duct syt
types of lining and histo features in nasopalatine duct cyst
85% squamous
can be columnar, cuboidal, mixed
+ canal contents (nerves and arteries)
diagnostic criteria (x7) for median palatal cyst and why relevant
poss posterioarly positioned nasopalatine duct cyst
criteria: critical enlargement, midline location, posterior to palatine papilla, ovoid or round, teeth are vital, no communication w incisive canal, no nerves, vessels, cartilage, or MSG in walll
most common follicular cyst of skin
epidermal (80%)
epidermal cyst syndromic
Gardner
epidermal inclusion cyst what’s up
traumatic implanttion of epithelium
epidermal vs pilar cyst
epidermal 80% pilar 15%
pilar – no granular layer, compact keratin
pilar cyst aka
tricholemmal or isthmus-catagen cyst
dermoid cyst is a form of
benign cystic form of teratoma
complex teratoma criteria and locations
complex – all 3 layers
more in ovaries and testes
can be benign or malignant
immature teratoma features
immature = malignant
contains primitive neuroepithelium
teratoma with primitive neuroepithelium
immature/malignant
oral teratoma aka and location
epignathus
usually congenital
extend through cleft palate from pituitary via rathke’s piouch
high mortality 2/2 airway obstruction
heterotopic oral gastrointestinal cyst aka and location
aka enterocystoma
oral cyst lined w GI epithelium
most in FOM and tongue
considered choritstoma – normal tissue in abnormal location
dermoid cyst vs epidermoid cyst
dermoid has dermal appendages in wall
thyroglossal duct cyst: location, clinical diagnostic aid, age
midline neck
60-80% below hyoid bone (often attached)
vertical movement during swallowing
usually children and young adults
removal of thyroglossal duct cyst
sistrunk
with hyoid bone and muscle
risks of thyroglossal duct cyst
1% –> papillary thyroid carcinoma
branchial cleft cyst aka, location, most common origin, and ddx
upper lateral neck anterior to SCM
95% from 2nd branchial arch
if older pt, check lining if malignant to rule out cystic metastatic SCC
oral lymphoepithelial cyst location and origin
FOM most common
waldeyer’s ring: palatine tonsils, lingual tonsils, pharyngeal adenoids
hemihyperplasia aka and what is
hemihypertrophy
asymmetric growth of 1 or more body parts
complex vs simple hemihyperplasua
complex entire side of body
simple single limb
hemihyperplasia more common isolated or syndromic
which syndromes (x6)
isolated more common
syndromes: NF, McCune-Albright, Maffucci, segmental odontomaxillary dysplasia, Beckwith-Wiedemann, Proteus
skin and viscera in hemihyperplasia
skin: increased pigmentation, hypertrichosis, telangiectasias, nevus flammeus
increased prevalence of abdominal tumors: Wilms, adrenal Ca, hepatoblastoma
hemifacial hyperplasia
hemihyperplasia of just on side of face
premature eruption
progressive hemifacial atrophy aka, manifests, triggers
aka Parry-Romberg syndrome
atrophy of one side of face
pigmentation, enophthalmos, delayed eruption of teeth
assoc w trauma and Lyme dz (Borrelia infection)
progressive hemifacial atrophy progression and ddx
starts on skin )pigmentation), then nerves and bones
related to localized(linear) scleroderma - also has coupe de sabre scar on forehead
coup de sabre
localized scleroderma and progressive hemifacial atrophy
atrophy of one side of face
pigmentation, enophthalmos, delayed eruption of teeth
progressive hemifacial atrophy
segmental odontomaxillary dysplasia aka and oral manifestations
hemimaxillofacial dysplasia
painless unilateral enlargement of mx + fibrous hyperplasia of overlying gingiva
absence of 1+ mx PM, hypoplastic primary teeth
segmental odontomaxillary dysplasia xray
vertically oriented and thickened bony trabeculae (granular appearance)
hypertrichosis and rough erythema
becker nevus –> segmental odontomaxillary dysplasia
absence of 1+ mx PM, hypoplastic primary teeth, vertical trabeculae
segmental odontomaxillary dysplasia
histo segmental odontomaxillary dysplasia
soft tissue - fibrosis
bone – irregular trabeculae w woven appearance and reversal lines
crouzon syndrome aka and genetics
craniofacial dysostosis
FGFR2 mutation
related to increased paternal age
crouzon skull
craniosynostosis - premature closing of cranial sutures
brachy, scapho, trigonocephaly or clover lead (Kleeblattschadel deformity(
xray: beaten metal/digital markings
crouzon face look
midfacial hypoplasia, ocular proprosis, teeth crowding, midline maxillary pseudocleft
visual and hearing loss
no mental retardation
midline maxillary pseudocleft
crouzon and paert (hyaluronic acid deposition)
enophthalmos
progressive hemifacial atrophy
apert syndrome aka and genetics
acrocephalosyndactyly
AD, FGFR2, increased paternal age
craniofacial dysostosis aka
crouzon
acrocephalosyndactyly aka
apert syndrome
FGFR2 mutation
crouzon and apert
increased paternal age and developmental abnormalities
crouzon, apert, treacher collin
apert skull
acrobrachycephaly (tower skull), tall forehead, clover leaf skull, visual loss
beaten metal on xray
clover leaf skull
crouzon and apert
kleeblattschadel
apert vs other craniosynostoses
syndactyly of hands and feet in apert
apert oral
open mouth appearance, trapezoid lips,
cleft soft palate/bifid ucula
lateral hard palate swelling with pseudocleft (hyaluronic acid deposition)
shovel incisors
shovel incisors and trapezoid lips
apert
beaten metal
copper - hypophosphatasia
metal - apert and crouzon
treacher collins aka and genetics
mandibulofacial dysostosis
TCOF1 (treacle) on chr 5
increased paternal age
TCOF1 aka, chromosome, result
treacle
5
treacher collins syndrome
treacle aka, chromosome, result
TCOF1
5
treacher collins syndrome
treacher collins face
hypoplastic zygoma, narrow face, depressed cheeks, downward palpebral fissure
coloboma - notch in outer lower eyelid )no eyelashes medial to it
hypoplastic zygoma, narrow face, depressed cheeks, downward palpebral fissure
treacher collins
notch in outer lower eyelid with no eyelashes medial to it
coloboma
eg treacher collins
goltz-gorlin syndrome - coloboma of iris
coloboma of iris
goltz-gorlin syndrome -
development of central face when
4 wks
development of upper lip when
6-7 wks
primary palate merger of what
medial nasal processes –> premaxilla (the 4 incisors)
premaxilla where and origin
4 incisors - premaxilla
from medial nasal processes, primary palte
secondary palate origin and result
90% of hard and soft palate
from maxillary process of 1st branchial arch
cleft lip why
defect in fusion of medial nasal process + maxillary process
cleft palate why
failure of the palatal shelves to fuse
minimal cleft palate
bifid uvula
CL+CP - CL only - CP only %%
CL + CP = 45 %
CPO = 30%
Isolated CL=25%
lateral facial cleft why
4 syndromes
failure of fusion between maxillary + mandibular process (extends to ear)
Usually occurs with other syndromes Mandibular dysostosis Oculo-auriculo-vertebral spectrum (hemifacial macrosomia) Nager acrofacial dysostosis Amniotic rupture sequence
failure of fusion between maxillary + mandibular process
lateral facial cleft
oblique facial cleft why
Failure of fusion between lateral nasal + maxillary process
extends from lip to eye
nearly always associated with CP
Failure of fusion between lateral nasal + maxillary process
oblique facial cleft
extends from lip to eye
nearly always associated with CP
median cleft of upper lip why and syndromes
failure of fusion of the medial nasal process. Associated with a number of syndromes
oral-facial-digital syndrome
Ellis Van Crevald Syndrome
Holoprosencephaly
commissural lip pits
origin
location
genetics
congenital but develop later in life / corner of mouth / AD / failure of max
+ mandibular process to fuse
pierre robin sequence triad and syndromes
CP / mandibular micrognathia / glossoptosis (airway obstruction from posterior
displacement of tongue
Associated with Stickler Syndrome
Associated with velocardiofacial syndrome = DiGeorge Syndrome ( Catch 22)
digeorge components
CATCH 22 Cardiac defect Abnormal facial features Thymus deficiency Cleft palate Hypocalcemia #22q11.2
Thymus deficiency
Cleft palate
digeorge
other name for digeorge
velocardiofacial syndrome
CATCH 22
digeorge
paramedian lip pits aka, inheritance, origin, and syndromes
AD
assoc w orofacial clefts
invagination of lower lip / lateral sulci of mandibular Arch
van der woude, kabuki, popliteal pterygium
most common cause of syndromic clefting
van der woude
Oro-mandibular-limb hypogenesis syndrome three key components
Hypodactylia: absence of digits
Hypoamelia: absence of limbs
Microglossia
lateral soft palatal fistula preferred location
bilateral>unilateral
anterior tonsillar pillae
melkersson rosenthal components
fissured tongue
facial paralysis
orofacial granulomatosis
coronoid hyperplasia sex and laterality
M>F
bi> uni
impinges on zygoma and restricts opening
syndromes w condylar hypoplasia
Mandibulofacial dysostosis ( Treacher Collins syndrome)
Oculoauriculovertebral syndrome (Goldenhar Syndrome)
Hemifacial microsomia
treacher collins embryonic origin
inheritance
genetics
face look
1st and 2nd branchial arches AD/ 5q32 (TCOF1) Hypoplasic mandible Coloboma Ear deformity Cleft palate SG hypoplasia
Pain when turning head, otalgia, headache, dizziness, syncope, dysphagia, dysphonia eval for what
eagle
non-tonsillectomy eagle
carotid artery syndrome
soft counterpart of nasopalatine
cyst of incisive papilla
epidermoid cysts syndromc
gardner
dermoid cyst look and approach depending on location
above geniohyoid = sublingual swelling; likes midline FOM – intraoral
below geniohyoid = submental swelling double chin – extraoral
dermoid cyst on palpation
doughy; retains pitting after pressure
pilar cyst aka and ddx from epidermoid
Trichilemmal cyst ; Isthmus-Catagen cyst
no granular layer and packed keratin/abrupt from big keratinocytes into keratin
thyroglossal duct cyst
when develop and where can be
development at 3 wks in utero
anywhere from tongue to suprasternal notch
60-80% below hyoid bone
age for thyroglossal duct cyst
<20 for 50%
thyroglossal duct cyst embryo
tuberculum impar + copula of tongue = foramen cecum
risks of thyroglossal
10% recurrence
1-2 % carcinoma
surgical procedure for thyroglossal duct cyst
sistrunk (w hyoid)
asymmetrical growth of one or more body parts
hemihyperplasia
complex vs simple hemihyperplasia
complex - entire side of body
simple - one limb
skin in hemihyperplasia
thick, increased pigmentation, hypertrichosis, telangiectasia, nevus flammeus
malignancy in hemihyperplasia
abdominal tumors
Wilms, adrenal cortical carcinoma, hepatoblastoma
hemihyperplasia but only face
hemifacial hyperplasia
progressive hemifacial atrophy aka, sex, duration
parry romberg and romberg; F>M, slows down after 20 years
face and mouth and parry romberg
similar features to scleroderma coup de sabre a sharp line of demarcation resembling a large linear scar local alopecia enophthalmos brown pigmentation trigeminal neuralgia / epilepsy/ headache delayed eruption atrophy of tongue posterior open bite
hemihyperplasia sex and side
F, right
segmental odontomaxillary dysplasia aka and sex
hemimaxillofacial dysplasia, M
mouth in segmental odontomaxillary dysplasia
unilateral enlargement, missing PMs, gingival hyperplasia
skin in segmental odontomaxillary dysplasia
becker nevus - ipsilateral hypertrichosis and hyperpigmentation of shoulder and trunk
hypertrichosis and hyperpigmentation of shoulder and trunk
becker nevus
segmental odontomaxillary dysplasia
classic ddx for segmental odontomaxillary dysplasis
fibrous dysplasia, hemifacial dysplasia
crouzon syndrome aka, genetics, mechanism
craniofacial dysostosis
Early closure of sutures / 10q26 (FGFR-2)
4 heads of crouzon
Brachycephaly: short head
Scaphocephaly: boat shaped
Trigoncephaly: triangle shaped
Kleeblasttshadel deformity (clover leaf )
mouth of crouzon
Underdevelopment of maxilla
Crowding of teeth
Congenital missing teeth
head and face of crouzon
xray?
Ocular proptosis
Blindness/ hearing loss
Radiograph: Beaten metal
beaten metal skull
Apert
Crouzon
Hypophosphatasia
apert syndrome aka, genetics
Acrocephalosyndactyly
10q26 (FGFR-2)
2 heads of apert
Acrobrachycephaly: tower head
Kleeblasttshadel deformity (clover leaf
mouth of apert
Trapezoid lips Missin lateral or PM Mouth breather CP-bifid uvula V-shaped maxilla Class III malocclusion Open bite Post.crossbie Pseudocleft due To GAG
pierre robin sequence
components and syndromes
Cleft palate (CP) Mand.micrognathia Glossoptosis causing airway obstruction Isolated vs with syndromes Stickler syndrome Velocardiofacial
stickler syndrome aka and clinical look
AKA:Hereditary progressive
artho-ophthalmopathy
Facial abnormalities Flat cheeks Flat nasal bridge Small jaws Pronounced lips CP Ocular (myopia) Hearing loss Joint problems
popliteal pterygium syndrome inheritance/gene and clinical
AD, IRF6? Skin: webs impair mobility Face: CL /CP Hypodontia Genitals
paramedian lip pits and genital troubles
popliteal pterygium
paramedian lip pits and skeletal problems
kabuki
kabuki inheritance and clinial
AD
Heart defect
Eversion of lower lat. Eyelids Large ears, hearing prob CL/CP Hypodontia Joint laxity Skeletal problems
van der woude inheritance/genetics and clinical
AD; IRF6 on chr 1q32-q41
Most common form of syndromic clefting
CP/CL + paramedian lip pits
Hypodontia
ascher syndrome components
Double lip; upper> lower
Nontoxic thyroid goiter
Brepharochalasis (edema of upper eyelids)
Oro-mandibular-limb
hypogenesis syndrome components
Hypodactylia Hypomelia CP Hypoplasia of mand Low incisors missing MICROGLOSSIA
beckwith wiedemann inheritance/genetics and components
AD; 11p15
MACROGLOSSIA Omphalocele Neonatal hypoglycemia Gigantism Visceromegaly HIGH RISK FOR 1- Wilms tumor 2- Neuroblastoma 3- Rhabdomyosarcoma 4- Hepatoblastoma
eagle syndrome: why classic? population manifestation nerves affected mechanic cause
classic after tonsillectomy
carotid artery not
Adults Pain during swallowing Pain when turning head Cranial nerves V, VII, IX, X Elongation of stylohyoid process and/or Mineralization of Stylohyoid ligament
Pain during swallowing
Pain when turning head
suspect eagle
etiology of progressive hemifacial atrophy
Maybe due to
Lyme disease
(Borrelia) or
Trauma
progressive hemifacial atrophy aka and similar to what
Progressive facial hemiatrophy
Romberg Syndrome
Parry Romberg Syndrome
Similar to loc. scleroderma (coup de sabre)
population/face of hemifacial atrophy
F > M )starts early) Enophthalmos / Local alopecia Atrophy of lip and tongue Post. open bite Mouth deviated to affected side
segmental odontomaxillary dysplasia ddx
fibrous dysplasia and hemifacial hyperplasia
mouth and skin in segmental odontomaxillary dysplasia
Uni. Enlargement of maxilla Fibrous hyperplasia Some teeth missing Primary teeth hypolastic Sinus smaller on affected side Becker’s Nevus
FGFR2 location, inheritance, and syndromes
Chr # 10q26
AD
crouzon and apert
kleeblattschadel deformity
severe crouzon and apert (cloverleaf skull)
skull of crouzon vs apert
both when extreme cloverleaf
both beaten metal on xray
crouzon: trigono, scapho, brachy
apert: acrobrachy (tower)
mouth of apert
CP + pseudocleft Bifid uvula V shaped arch Class 3 Trapezoid lips; mouth breathing
intellectual disability apert vs crouzon
more severe in apert?
apert vs crouzon
syndactyly in apert: 2-3-4 hands and feet
treacher collins aka (2)
Mandibulofacial Dysostosis
Franceschetti-Zwahlen-Klein
treacher collins genetics and inheritance
AD
TCOF1
5q32-q33.1
treacher collins what’s defective
face and mouth
Defect in 1st + 2nd brachial arch
Hypoplastic zygoma causing depressed cheek
1/3 CP
Hypoplastic SG/ Pharynx/ Condyle /Coronoid
Coloboma: Notch along outside of eye (lower lid)
Mandible underdeveloped
Notch along outside of eye (lower lid)
coloboma in treacher collins
hypoplastic zygoma
treacher collins
defect in 1-2 branchial arch
treacher collins
digeorge what’s defective
3-4 pharyngeal pouches
3-4 pharyngeal pouches
digeorge