5 - Paediatrics Flashcards

1
Q

Velocardiofacial Syndrome

A
  • Epidemiology
    • 1:4000 -7000
    • No racial or gender predilection
  • Genetics
    • Deletion on Chromosome 22q11.2
      • 90% new mutation
      • 10% inherited
        • Autosomal dominant
  • Presentation
    • Varied presentation
      Affect branchial arches from I - IV
    • Arch I
      • Hypertelorism
      • Midface hypoplasia
        • Short philtrum
        • Velopharyngeal insufficiency
      • Micrognathia & Retrognathia
      • Cleft palate
      • Low set, malformed or absent ears
        • Hearing loss
    • Arch II
    • Arch III
      • Parathyroid problems - Hypocalcemia
      • Cardiac & Great vessel anomalies
        • Tetralogy of Fallot
          • VSD
          • Pulmonary valve stenosis
          • Overriding aorta
          • RV hypertrophy
        • Aortic arch defects
        • Pulmonary artery atresia
      • Thymus
        • Impaired T cell maturation
        • Increased likelihood of Autoimmune conditions
    • Arch IV
      • Cardiac & Great vessel anomalies
        • Tetralogy of Fallot
          • VSD
          • Pulmonary valve stenosis
          • Overriding aorta
          • RV hypertrophy
        • Aortic arch defects
        • Pulmonary artery atresia
    • Neurological
      • Developmentally delayed
      • ADHD, Bipolar, Schizophrenia
      • Seizures
    • Extra-cranial
      • Genitourinary
      • Renal
      • Respiratory
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2
Q

Suture and Fontanelle Closure Time

A
  • Posterior Fontanelle: 3-6 months
  • Anterior Fontanelle: 9-12 months​
  • Sphenoid Fontanelle: 6 months
  • Mastoid Fontanelle: 6 - 18 months
  • Metopic Suture: 3 - 9 months
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3
Q

Craniosynostosis

A

Craniosynostosis - premature fusion of sutures
Craniofacial dysostosis - Describes the syndromic forms of craniofacial synostosis
Involves not only cranial vault but also skull base and midface skeletons

Craniosynostosis - 1:2000 -4000
Sagittal most common, Lambdoid is rarest
Fontanelle closure - Posterior 3-6 months, Anterior 9-12 months

Virchow’s Law

  • Growth parallel to the fused suture
  • Sagittal Craniosynostosis
    • Most common non syndromic single suture craniosynostosis - 50%
    • Scaphocephaly
    • Presentation
      • Frontal bossing
      • AP elongation, Transverse narrowing
    • Rarely associated with raised intracranial pressure
  • Unicoronal Craniosynostosis
    • Second most common non syndromic craniosynostosis - 20%
    • Anterior plagiocephaly
    • Presentation
      • Ipsilateral flattening of the forehead
      • Elevation of supraorbital rim (Harlequin deformity)
      • Shallow orbit and globe can be proptotic
      • Ipsilateral deviation of nasal bridge
  • Bicoronal Craniosynostosis
    • Most common syndromic craniosynostosis - 20%
      Third most common non syndromic craniosynostosis - 10%
    • Brachycephaly
    • Presentation
      • High cranial vault
      • Recession of supraorbital ridges
      • Forehead bulge
  • Metopic Craniosynostosis
    • Accounts for 10% of non syndromic craniosynostosis
    • Trigonocephaly
    • Presentation
      • Narrowing of the forehead
      • Narrowing bitemporal region
      • Bulging biparietal regiong
      • Recessed lateral orbital rim and elevation of medial superior orbital rim
  • Lambdoid Craniosynostosis
    • 1:30 000
    • Difficult to distinguish from deformational plagiocephaly
    • Posterior plagiocephaly (Rhomboid)
    • Presentation
      • Head shape rhomboid
      • Ear is inferiorly displaced
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4
Q

Craniofacial Dysostosis

A

Craniofacial dysostosis - Describes the syndromic forms of craniofacial synostosis
Involves not only cranial vault but also skull base and midface skeletons

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5
Q

Craniofacial Treatment Protocol

A
  • 0-9 months
    • Airway
      • CPAP
      • Surgical
        • Lip tongue adhesion
        • Distraction osteogenesis
        • Tracheostomy
    • Feeding
      • NG feeds
      • Specialised bottles
    • Vision
      • Lubricating eye drops
      • Eyelid taping
  • 9-12 months
    • ICP and brain development
      • Fronto-orbital advancement and remodelling
        • Cranial expansion
        • Orbital expansion
      • Posterior vault distraction
      • “Melbourne technique”
      • Strip craniectomies
  • 1-6 years
    • Repeat vault expansion as required
    • Hearing
      • EAC atresia or otitis media
      • Tympanostomy tubes
    • OSA
      • CPAP
      • Tonsils and Adenoids
      • Tracheostomy
  • 6-12 years
    • OSA
      • Usually - LeFort III or distraction
      • Other techniques
        • Monobloc
        • Facial bipartisan
        • Box osteotomy
    • Vision
      • Strabismus surgery
      • Corneal grafting
      • Tarsorrhaphy
  • 14 years
    • Dentofacial deformity
      • LeFort I or Bimax
      • Distraction
    • Cranioplasty and recontouring
    • Rhinoplasty
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6
Q

Pierre Robin Sequence

A
  • Micrognathia
  • Glossoptosis
  • Cleft palate
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7
Q

Branchial Arch Syndromes

A
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8
Q

Craniofacial Dysostosis Syndromes

A

Craniofacial Dysostosis

Syndrome

Epidemiology & Genetics

Classification

Clinical signs

OMS Considerations

Other specialty considerations

Crouzon

Acrocephalosyndactyly

1:50 000

FGF2
Chromosome 10

Autosomal dominant

Bicoronal synostosis

Brachycephaly

Can involve other sutures

Hypoplastic orbits

Exorbitism

Hypertelorism

Frontal bossing

Midface hypoplasia

10% hydrocephalus

No limb abnormalities

Normal intellect

Hypoplastic orbit

Midface hypoplasia

Class III AOB DFD

Ophthal

Craniofacial

Neurosurg

Aperts

Acrocephalosyndactyly

Crouzons + Hands

1:100 000

FGF2

Chromosome 10

Autosomal dominant

Bicoronal synostosis

with other sutures

Acrobrachycephaly

Hypoplastic orbits

Exorbitism

Hypertelorism

Frontal bossing

Midface hypoplasia

30% cleft palate

2% hydrocephalus

Limb abnormalities

Some internal organ anomalies

Developmental delay

Hand deformity
Type I - Spade

Type II - Mitten

Type III - Rosebud

Hypoplastic orbit

Midface hypoplasia

Class III AOB DFD

Ophthal

Craniofacial

Neurosurg

Plastics

Orthopaedics

Pfeiffer

Acrocephalosyndactyly

1:100 000

FGF1 & 2 - Type I & II

FGF2 - Type II

Autosomal dominant

Bicoronal synostosis

with other sutures

Type I - Turribrachycephaly

Type II - Cloverleaf

Early infant death

Type III - Skull base

Early infant death

Hypoplastic orbits

Exorbitism

Hypertelorism

Frontal bossing

Midface hypoplasia

Limb abnormalities

Thumb and tongue

Some internal organ anomalies

Developmental delay

Hypoplastic orbit

Midface hypoplasia

Class III AOB DFD

Ophthal

Craniofacial

Neurosurg

Plastics

Orthopaedics

Saethre-Chotzen

Acrocephalosyndactyly

1:25 000 to 50 000

TWIST1

Chromosome 7

Autosomal dominant

Uni or Bicoronal synostosis

Low set hairline

S shaped ptosis of upper lids

Brachydactyly or partial syndactyly

Low set ears

Normal intelligence

Muenke

1:30 000

FGFR3

Autosomal dominant

Uni or Bicoronal synostosis

Hypertelorism

Strabismus

Hearing loss

Developmental delay

Seizures

Limb abnormalities (mild)

Carpenter

1:

RAB23

Chromosome 6

Autosomal recessive

Short stature

Congenital heart defects

Obesity

Poly or syndactyly

Developmental delay

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9
Q

Cleft - Classification

A
  • Veau
    • 1 - Soft palate
    • 2 - Soft and Hard palate
    • 3 - Soft, Hard palate and Alveolus
    • 4 - Bilateral lip, alveolus, hard and soft palate
  • Millards (Modified Striped Y Classification)
    ​Kernahan and Stark
    • 1 and 4 - Lip
    • 2 and 5 - Alveolus
    • 3 and 6 - Primary palate
    • 7 and 8 - Hard palate
    • 9 - Soft palate
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