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LETTER TO EDITOR
Year : 2009  |  Volume : 4  |  Issue : 1  |  Page : 53-55
 

Delleman syndrome with Goldenhar overlap


Department of Neurological Sciences, Christian Medical College, Vellore 632 004, Tamil Nadu, India

Correspondence Address:
Vedantam Rajshekhar
Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamilnadu-632 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.49115

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How to cite this article:
Sujit Kumar G S, Haran R P, Rajshekhar V. Delleman syndrome with Goldenhar overlap. J Pediatr Neurosci 2009;4:53-5

How to cite this URL:
Sujit Kumar G S, Haran R P, Rajshekhar V. Delleman syndrome with Goldenhar overlap. J Pediatr Neurosci [serial online] 2009 [cited 2019 Apr 26];4:53-5. Available from: http://www.pediatricneurosciences.com/text.asp?2009/4/1/53/49115


Sir,

We report here an interesting case of a two and a half year-old boy who presented with features of Delleman syndrome with Goldenhar overlap. Delleman syndrome includes orbital cysts or microopthalmia, focal skin defects and central nervous system cysts, and/or hydrocephalus (oculocerebrocutaneous syndrome) [1] whereas Goldenhar syndrome includes a triad of epibulbar dermoid, accessory auricular appendages, and preauricular fistulae. [2] Various CNS, cardiac, vertebral, pulmonary, GIT, and facial defects have been later added to Goldenhar syndrome. [3]

This two and a half year-old boy presented with complaints of a large head, absent right eye, right ear, and right facial hemiatrophy. Examination revealed his head circumference to be 49 cm; the anterior and posterior fontanelles were open and tense. He had a 2 cm soft, nontender, nonpulsatile, transilluminant swelling with a cough impulse in the scalp, over the right medial parietal region. He had an absent right eye with partially formed eyelids but a normal left eye [Figure 1]. The right ear pinna was absent with no visible external auditory meatus. There was a skin tag in the region of the right ear whereas the left ear was low set and the pinna malformed with an abnormal preauricular skin tag. He had right facial hemiatrophy [Figure 2] and the palate was high-arched. He had a dimple in the midline lumbar region superior to the natal cleft with no skin tethering, hair tuft, lipoma, sinus, hyperpigmented patch, or spina bifida. There were no other anomalies or neurocutaneous markers. The fundus was normal in the left eye and there were no focal neurological deficits.

CT of the brain [Figure 3a] and [Figure 3b] showed obstructive hydrocephalus with dilated lateral and third ventricles but a normal fourth ventricle. The bony orbit was present on the right side although there was no globe seen within. The bony part of the right external auditory canal was not visualized. The patient underwent a medium-pressure, right, ventriculoperitoneal shunt. Postoperatively, the fontanelles became lax and the parietal scalp swelling also decreased in size. The child was asymptomatic at one year follow-up.

Oculocerebrocutaneous syndrome or Delleman syndrome is a multiple congenital anomaly syndrome characterized by orbital cysts, cerebral anomalies, and focal dermal hypoplasia. [1] A more severe form of oculocerebrocutaneous syndrome can have anophthalmia, congenital hydrocephalus, as well as cleft lip and palate. This is a rare and sporadic disorder and possible etiological hypotheses include the survival of a lethal mutation by mosaicism and external causal factors. [4] Disruption of the anterior neuroectodermal plate seems to be the most probable pathogenic mechanism. A primarily unilateral involvement of this syndrome has been emphasized. [4] A postzygotic or somatic mutation resulting in a mosaic state might account for the primarily ectodermal involvement, unilateral predominance, and the sporadic nature of this syndrome. [4] One report from India has been that of a 4 year-old male child who presented with oculocerebrocutaneous syndrome featuring focal alopecia on the left side of the scalp, left periorbital skin appendages, a left-sided orbital dermoid, a large left-sided intracranial cyst, and optic atrophy. [5] Cases of Delleman syndrome need to be differentiated from encephalo-cranio-cutaneous lipomatosis. [5]

Goldenhar syndrome, first described by Von Arct and later by Goldenhar, represent morphological abnormalities involving the first and the second branchial arches. Due to the anomalies of the eye, ear, and vertebral column, Goldenhar syndrome is also known as oculoauriculovertebral syndrome. [6] Goldenhar syndrome have also been reported with rare associations. [7] Definitive etiology has not been described-the proposed factors are abnormal mezoblastic development and abnormal embryonic vascular supply of the first arch. [8] Although most cases are sporadic, autosomal dominant and autosomal recessive modes of inheritance have been described. Trisomy of 7, 22 have been described in association with Goldenhar syndrome. [9] The syndrome usually has a male predominance and the right side is preferentially involved. Goldenhar syndrome needs to be differentiated from Treacher Collins and Pierre-Robin syndromes. [10]

In our case, the possibility of Dellemans syndrome with Goldenhar overlap was considered because of the absent right eye and hydrocephalus (features of Dellemans syndrome) and absent right ear, preauricular skin tags, and right facial hemiatrophy (features of Goldenhar syndrome). Multiple variants of these syndromes have been described, but, to the best of our knowledge, the combination of features described in our case has not been reported to date. A detailed clinical examination is required in these cases to document all the abnormalities and a multidisciplinary approach is usually required in the appropriate management and rehabilitation of these cases.

 
   References Top

1.Delleman JW, Oorthuys JW. Orbital cyst in addition to congenital cerebral and focal dermal malformations: A new entity. Clin Genet 1981;19:191-8.  Back to cited text no. 1  [PUBMED]  
2.Goldenhar M. Associations malformatives do I'oeil et de I' oreille, en partiaulier le syndrome dermoide epibulbaue - appendices auricularies-fistula auris congenita et ses relations avec la dystostose mandibulo-faciale. J Genet Hum 1952;1:243-82.  Back to cited text no. 2    
3.Jones KL. Oculo-auriculo-vertebral spectrum. In: Jones KL, editor. Smith's recognizable patterns of human Malformation. Philadelphia: WB Saunders Company; 1997. p. 642-5.  Back to cited text no. 3    
4.Hoo JJ, Kapp-Simon K, Rollnick B, Chao M. Oculocerebrocutaneous (Delleman) syndrome: A pleiotropic disorder affecting ectodermal tissues with unilateral predominance. Am J Med Genet 1991;140:290-3.   Back to cited text no. 4    
5.Tambe KA, Ambekar SV, Bafna PN. Delleman (oculocerebrocutaneous syndrome): Few variations in a classical case. Eur J Paediatr Neurol 2003;7:77-80.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Gorlin RJ, Jue KL, Jacobsen U, Goldshmidt E. Oculoauriculovertebral dysplasia. J Pediatr 1963;63:991-9.   Back to cited text no. 6    
7.Kumar R, Balani B, Patwari AK. Goldenhar syndrome with rare associations. Indian J Pediatr 2000;67:231-3.  Back to cited text no. 7    
8.McCandless SE, Robin NH. Severe Oculocerebrocutaneous (Delleman) syndrome: Overlap with Goldenhar anomaly. Am J Med Genet 1998;78:282-5.   Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Kobrynski L, Chitayat D, Zahed L, McGregor D, Rochon L, Brownstein S, et al. Trisomy 22 and facioauriculovertebral (Goldenhar) sequence. Am J Med Genet 1993;46:68-71.  Back to cited text no. 9  [PUBMED]  
10.Hunt JA, Hobar PC. Common craniofacial anomalies: The facial dysostoses. Plast Reconstr Surg 2002;110:1714-25.   Back to cited text no. 10  [PUBMED]  [FULLTEXT]


    Figures

  [Figure 1], [Figure 2], [Figure 3a], [Figure 3b]



 

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