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Branchiooculofacial Syndrome

Clinical Characteristics

Ocular Features

Microphthalmos, or anophthalmia, and an imperforate nasolacrimal duct are the primary ocular features in this syndrome.  The nasolacrimal ducts may open onto the skin adjacent to the lacrimal sac.  Uveal tract and optic nerve colobomas are present in nearly half of patients. Strabismus is sometimes seen.  Cataracts are present in about 25% of patients as well.  The lid fissures are often slanted upwards.

Systemic Features

A cleft lip and/or palate are common features.  There may be preauricular pits, lip pits, a highly arched palate, and hypodontia.  Some individuals have subcutaneous cysts in the scalp.  Postauricular cervical branchial and supraauricular defects are often present as well.  It is not unusual to see some skin discoloration behind the ears.  The nasal bridge is broad, the top of the nose is flattened, and the philtrum is often short.  The ears are often enlarged or malformed and in 70% of patients there is some hearing loss which is usually conductive in origin but neurosensory deafness has also been documented.  Premature graying of hair is common.  Kidney malformations and dysfunction have been documented.  Mental function is usually normal.  Preaxial polydactyly is an uncommon feature.

Genetics

This is an autosomal dominant disorder resulting from mutations in the TFAP2A gene (6p34.3).  Both deletions and insertions have been identified.  However, 50-60% of patients have de novo mutations.  As in many autosomal dominant disorders there is considerable clinical heterogeneity and few patients have all of the signs.

Treatment Options

Treatment requires a multidisciplinary approach with oculoplastic, ophthalmic, and ENT surgeons.  Physical, speech, hearing, and learning specialists can be helpful.

References

Dumitrescu AV, Milunsky JM, Longmuir SQ, Drack AV. A family with branchio-oculo-facial syndrome with primarily ocular involvement associated with mutation of the TFAP2A gene. Ophthalmic Genet. 2011 Dec 22. [Epub ahead of print].

PubMed ID: 
22191992

Al-Dosari MS, Almazyad M, Al-Ebdi L, Mohamed JY, Al-Dahmash S, Al-Dhibi H, Al-Kahtani E, Al-Turkmani S, Alkuraya H, Hall BD, Alkuraya FS. Ocular manifestations of branchio-oculo-facial syndrome: report of a novel mutation and review of the literature. Mol Vis. 2010 May 8;16:813-8. Review.

PubMed ID: 
20461149

Stoetzel C, Riehm S, Bennouna Greene V, Pelletier V, Vigneron J, Leheup B, Marion V, Hellé S, Danse JM, Thibault C, Moulinier L, Veillon F, Dollfus H. Confirmation of TFAP2A gene involvement in branchio-oculo-facial syndrome (BOFS) and report of temporal bone anomalies. Am J Med Genet A. 2009 Oct;149A(10):2141-6.

PubMed ID: 
19764023

Lin AE, Gorlin RJ, Lurie IW, Brunner HG, van der Burgt I, Naumchik IV, Rumyantseva NV, Stengel-Rutkowski S, Rosenbaum K, Meinecke P, et al. Further delineation of the branchio-oculo-facial syndrome. Am J Med Genet. 1995 Mar 13;56(1):42-59. Review.

PubMed ID: 
7747785