Craniofacial Disorders Flashcards

1
Q

Out of isolated cleft lip, isolated cleft palate, and cleft lip and palate, which is the most common?

A

Most to least common
both > palate alone > lip alone

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2
Q

What is a good indication to check for cleft palate?

A

bifid uvula

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3
Q

What is the incidence of isolated cleft palate?

A

incidence of isolated cleft
palate: 1/2,000 live births

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4
Q

What is the incidence of cleft lip and palate?

A

Incidence of cleft lip and
palate: 1/600-1/800 live births

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5
Q

Which clefts are more common in boys vs girls?

A

Cleft Lip/Palate more common in males
Isolated cleft palate more common in females

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6
Q

Are unilateral or bilateral clefts more common?

A

Unilateral more common than bilateral (4:1)
- 70% left sided

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7
Q

What are the recurrence risks for clefts?

A
  • Unaffected parents, one child with cleft: 2.5-
    4%
  • Parent with cleft: 3-6%
  • One parent and one child with cleft: 15-16%
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8
Q

Are clefts associated with advanced maternal or paternal age?

A

paternal

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9
Q

What are medications that can cause clefts?

A
  • Antiepileptics (valproate, carbamazepine)
  • Ondansetron (hyperemesis gravida)
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10
Q

Describe Pierre Robin sequence

A
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11
Q

What is one cause otitis media (nfection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum)

A

Cleft Lip/Cleft Palate

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12
Q

What is the timeline for cleft lip repair?

A

3-6 months old

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13
Q

What is the timeline for cleft palate repair?

A

9-18 months old

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14
Q

What is Nasoalveolar Molding (NAM) Procedure?

A
  • Non-surgical intervention for first few weeks
  • Reshapes gums/lip/nostrils prior to cleft repair
  • In hopes of reducing surgeries in the future
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15
Q

What is the inheritence pattern of Stickler Syndrome?

A

AR or AD depending on COL_A Gene

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16
Q

What type of disorder is Stickler Syndrome?

A

collagen type II disorder

17
Q

What are key features of Stickler Syndrome?

A

single gene cause of clefting
Pierre Robin sequence, cleft palate, cataracts, severe myopia, arthritis, scoliosis, sensorineural hearing loss
High risk of retinal detachment

18
Q

Why is it important to identify Stickler Syndrome early?

A

High risk of retinal detachment → laser prophylactic treatment available

19
Q

Genetics & Key features of Van der Woude

A

IRF6, GRHL3
Autosomal Dominant
Cleft lip and/or palate
Lip pits

IRF6 is also for Popliteal Pterygium Syndrome (PPS)

20
Q

Genetics & Key features of Popliteal Pterygium Syndrome (PPS)

A

Autosomal dominant IRF6
Webbing of skin on the back of legs pathognomonic skin folding around nails

same gene as Van der Woude

21
Q

Smith-Lemli-Opitz (SLO) Syndrome

A

DHCR7 Autosomal recessive
Metabolic condition, 7-dehydrocholesterol reductase enzyme deficiency
Causes cholesterol deficiency
Feeding difficulties, 2,3-syndactyly on feet, microcephaly, low set ears, cleft palate
Autism and/or ID, cataracts, recurrent infections, polydactyly

22
Q

Genetics & Key features of Kabuki Syndrome

A

KMT2D - AD, KDM6A - X-linked
Infantile hypotonia, developmental delay, retained fetal fingertip pads, increased risk for infections, cleft lip/palate, high arched palate, congenital heart defects, hearing loss
Appearance: long palpebral fissures, broad arched eyebrows, prominent ears

both genes strt with K

23
Q

What are something things to look fo rto be suspicious of a clefting syndrome/ single gene cause of clefting? (We may not be looking at a multifactorial cause for cleft, and should consider a genetic cause)

A
  • More than one affected family member
  • Additional features associated with common clefting syndromes
    Lip pits (Van der Woude)
    Developmental delays
    Congenital heart defect
  • Significant family history related to common clefting syndromes
    Father with retinal detachment (Stickler Syndrome)
24
Q

Genetics & Key features of DiGeorge Syndrome

A

22q11.2 Deletion
90% de novo, common deletion is around 2.5 Mb
1:3800-1:6000 prevalence
Developmental delay, submucosal cleft palate, congenital heart defects, autism, schizophrenia possible, scoliosis, feeding difficulties, short stature and obesity
Asymmetric crying facies, prominent nasal bridge, craniosynostosis, micrognathia