An Anatomical study of Cleft hand in North – East population of Assam

Introduction: Cleft hand or Ectrodactyly or Split Hand is a rare form of congenital hand disorder in which there is deficiancy of one or more central rays of the hand. The hand presents with a V-shaped gap situated in the centre of the palm. The condition may occur alone or maybe associated with anomalies of foot, syndactly, polydactyly, triphalangeal thumb, transverse bones in the hand or maybe part of Ectrodactyly Ectodermal dysplasia Cleft (ECC) Syndrome. Aims and Objectives: To find out the sex ratio and incidence of laterality (unilateral or bilateral) of cleft hand in North East population of Assam. Subjects and Methods: This study included 31 children between age group of 3 years to 8 years with hand deformities who were brought to the Plastic Surgery Department, Gauhati Medical College, Guwahati for aesthetic correction within a time span of 2 years. Only those cases who had central defects of hand were included & those with other syndromic anomalies were excluded. For this detailed clinical and radiological examination was done to evaluate the extent of bone or tissue involvement and to find out any syndromic association of the condition. Results: Out of 31 cases, 10 cases were had Unilateral and 21 cases had Bilateral Cleft Hands. It was seen that out of 31 cases, 22 were males and only 09 were females indicating that male to female ratio of the deformity is 2.44 .Thus, males were more affected than females. Conclusion: Most of the cases presented with absence of the middle finger and central tissue of the affected hand since birth. The embryological basis has been highlighted to throw light into such a catastrophe where both males and females were affected and showed unilateral or bilateral involvement of the hand leading to cosmetic and functional debility. Therefore, the study revealed that males were more affected than females and bilateral involvement of the hands were common than unilateral involvement

Hipoplasia dérmica focal (síndrome de Goltz) / Focal dermal hypoplasia (Goltz syndrome)

Resumen: Introducción: La hipoplasia dérmica focal o síndrome de Goltz es una rara genodermatosis de herencia dominante ligada al X, que afecta al tejido proveniente de las placas del ectodermo y del mesodermo. El cuadro clínico se caracteriza por alteraciones cutáneas, oftálmicas, neurológicas, dentales, ungueales, bucales, de tejidos blandos y esqueléticas. El diagnóstico se realiza por los hallazgos clínicos en un individuo con alteraciones ectodérmicas y malformaciones características en las extremidades. El manejo es multidisciplinario y, al igual que el pronóstico, depende de las alteraciones específicas que presente cada paciente. Caso clínico: Se presenta el caso de un recién nacido de sexo femenino, de 15 días de vida, con zonas de alopecia en piel cabelluda, herniación de tejido celular subcutáneo en varias áreas de todos los segmentos corporales, escotadura en ala nasal, hendidura en encía superior, defecto grave de extremidad superior izquierda con rizomelia (acortamiento de segmento proximal) y aplasia de radio, así como ectrodactilia de miembro pélvico derecho. Todos los hallazgos son compatibles con hipoplasia dérmica focal de acuerdo con los criterios diagnósticos. Conclusiones: Se presenta el caso de una paciente recién nacida con síndrome de Goltz.

Abstract: Background: Focal dermal hypoplasia or Goltz syndrome is a rare X-linked dominant inherited genodermatosis, affecting both the ectodermal and mesodermal tissue. Clinical manifestations include skin abnormalities, defects in eyes, teeth, nails, mouth, soft tissues and skeleton. The diagnosis is based on clinical findings and is suspected in individuals with ectodermal abnormalities and characteristic malformations in the extremities. The management is multidisciplinary and, like the prognosis, depends on the specific alterations that each patient presents. Case report: We report the case of a 15-day-old female newborn with alopecic areas on the scalp, herniation of subcutaneous cellular tissue at the lumbar level, nasal wing notch, severe left superior limb defect with rhizomelia (proximal segment shortening) and radio aplasia, as well as right leg ectrodactyly, areas of atrophy compatible with focal dermal hypoplasia according to diagnostic criteria. Conclusions: We present a case of female newborn patient with Goltz syndrome.

A Case of Ectrodactyly-ectodermal Dysplasia-cleft Syndrome with Bilateral Epiphora

PURPOSE: In the present study, a case of recurrent nasolacrimal duct obstruction as ectrodactyly-ectodermal dysplasia-cleft syndrome is reported. CASE SUMMARY: An 18-year-old male complained of epiphora in both eyes. By the age of 1, he was diagnosed with nasolacrimal duct obstruction and received left side dacryocystotomy, both sides silicone tube insertion and, right side endoscopic dacryocystorhinostomy. The general findings showed microdontia and, bilateral ectrodactyly. An irrigation test showed ‘regurgitation without pus’ and Jones test showed ‘negative’ in both sides. Complete obstruction was observed on dacryocystography and the patient underwent endoscopic conjunctivodacryocystorhinostomy with Jones tube at right side and endoscopic dacryocystorhinostomy at left side. The chromosome test showed normal findings. CONCLUSIONS: Nasolacrimal duct obstruction in ectrodactyly-ectodermal dysplasia-cleft syndrome is usually caused by dysplasia of the nasolacrimal duct and accompanied by dysplasia of lacrimal punctum and canaliculus. Providing proper care for nasolacrimal duct obstruction in ectrodactyly-ectodermal dysplasia-cleft syndrome is important. Furthermore, the high failure rate should be considered.

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly.

Ectrodactyly‑ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.

Medical Mystery: Ectrodactyly A Case Report.

Congenital absence of all or part of one ormore fingers or toes is defined as Ectrodactyly. It is the word derived from Greek ektromameaning “abortion” and dactylymeaning digits. Also called split hand or footmalformation (SHFM), Ectrodactyly is a rare limb malformation with median cleft of hand and foot and aplasia or hypoplasia of the phalanges, metacarpals andmetatarsals. Irregular pattern of inheritance exists for ectrodactyly;may be autosomal dominant, autosomal recessive or X linked. In this condition, themedian cleft of the hand gives the hand, the appearance of lobster claws- so also called ‘Lobster Claw Hand”. Ectrodactylymay be very commonly associated with other anomalies of face, eyes and skeletal system. We report a rare case of unilateral ectrodactyly of right hand .The present case is not associated with any other anomaly as described in various textbooks and reference articles. The details of etiology, diagnosis, genetic causes, association with other anomalies and treatment will be discussed.

EEC syndrome:Report of one case and review of the literature / 实用口腔医学杂志

Ectrodactyly,ectodermal dysplasia and clefting(EEC)syndrome is characterised by ectrodactyly,ectodermal dysplasia and clef-ting.It has been rarely reported till now.To introduce the causes,manifestation,diagnosis and treatment of this disease,we presented a case of EEC syndrome and reviewed the related literature.It may provide some informations for clinical doctors.

Ectrodactilia del pie. Reporte de dos casos / Ectrodactyly of the foot

Antecedentes: La ectrodactilia es una malformación congénita caracterizada por la presencia de hendiduras en los pies acompañada de agenesia e hipoplasia de los metatarsianos y falanges. Es un desorden genético muy poco frecuente, con una incidencia de 1:90,000-100,000 nacimientos vivos y no está ligada al sexo. Su patrón genético es de tipo autosómico dominante con penetrancia genética variable. El diagnóstico es clínico al momento del nacimiento; sin embargo, puede ser prenatal mediante ultrasonografía desde el primer trimestre de gestación. El manejo de la ectrodactilia incluye tanto el tratamiento quirúrgico como el no quirúrgico. Métodos: Se revisó el archivo de historias médicas desde enero 2005 a enero 2010, se incluyeron todos los pacientes con diagnóstico de ectrodactilia. Se encontraron dos pacientes que fueron tratados quirúrgicamente a los cuales se les realizó un seguimiento mínimo de tres años. Resultados: La evolución a largo plazo fue favorable permitiendo el uso de calzado y la marcha. No se evidenciaron recidivas o complicaciones. Los resultados finales fueron buenos de acuerdo a la escala de Tani y colaboradores. Discusión: De acuerdo a nuestros resultados a mediano y largo plazo en el manejo de estos dos casos de ectrodactilia, recomendamos la combinación del tratamiento ortopédico conservador, como preparación para la cirugía, y la resolución definitiva mediante cierre de la hendidura. El tratamiento quirúrgico realizado y el adecuado manejo postoperatorio permitieron el uso de calzado, mejorar la función y apariencia en ambos casos.

Background: Ectrodactyly is a congenital malformation characterized by the presence of clefts in the feet accompanied by aplasia and hypoplasia of the phalanges and metatarsals. It is a rare genetic disorder with an incidence of 1:90,000-100,000 live births and it is not linked to sex. Its genetic pattern is autosomal dominant with a variable genetic penetrance. Clinical diagnosis is made at birth, however it can be prenatal through ultrasound during the first trimester. Management of ectrodactyly includes both surgical and non-surgical treatment. Methods: We reviewed the archive of medical histories from January 2005 to January 2010, we included all patients with an ectrodactyly diagnosis. We found two patients who were treated surgically and were followed-up for three years. Results: The long term evolution was favorable, allowing the patient to wear shoes and walk. There were no recurrences or complications observed. The final results were good according to the Tani et al scale. Discussion: According to our medium and long term results in the management of these two cases of ectrodactyly, we recommend the combination of conservative orthopedic treatment as preparation for surgery and the final resolution with closure of the cleft. The surgical treatment performed and appropriate postoperative management allowed the patient to wear shoes, to improve function and appearance in both cases.

Lobster claw deformity.

Endogenous erythroid colony (EEC) syndrome comprise of three cardinal features, i.e. ectrodactyly, ectodermal dysplasia and cleft lip. EEC itself has three different forms. Ectrodactyly (absence of one or more digits) can be present with clefting in the proximal portion of hand or foot known as split hand foot malformation (SHFM) or lobster claw deformity. SHFM can be of four types depending upon the different responsible chromosomal loci. SHFM-4 can be present as pure limb malformation (non-syndromic form). In this article, describes a rare case report of lobster claw deformity patient.

Split-hand/feet malformation in three tamilian families and review of the reports from India.

Split‑hand/foot malformation (SHFM) is a rare condition which can be either syndromic or nonsyndromic. We report three unrelated pedigrees, one with autosomal dominant (AD) inheritance and the other two with autosomal recessive (AR) pattern. We also briefly review the published reports from India.

Síndrome de ectrodactilia, displasia ectodérmica y fisura de labio/paladar, informe de un caso con expresividad variable / Ectrodactyly, ectodermal dysplasia and cleft lip/palate syndrome, report of a case with variable expressivity

El síndrome ectrodactilia, displasia ectodérmica y fisura de labio/paladar es una entidad poco frecuente, asociada a la mutación de genes que codifican la proteína p63. Presentamos un caso de un paciente con ectrodactilia en el pie derecho asociada a labio y paladar fisurados, sin otras alteraciones evidentes, con antecedente familiar de labio con paladar fisurado y muerte en el período perinatal. El manejo de cada caso de este síndrome debe ser específico y multidisciplinario.

The ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome is a rare entity associated with mutations in the genes that express the protein p63. We present a case of a patient with right foot ectrodactyly associated with cleft lip and palate, without other evident anomalies. The patient has a positive familiar history for cleft lift and palate and mortality during the perinatal period. The management of each case must be specific and multidisciplinary.

Association of generalized aggressive periodontitis and ectrodactyly-ectodermal dysplasia-cleft syndrome.

Ectrodactyly-ectodermal dysplasia-cleft (EEC) syndrome is an autosomal dominant disorder characterized by the triad of ectrodactyly, ectodermal dysplasia, and facial clefting. Even though literature has documented the association of various genetic disorders with aggressive periodontitis, the periodontal manifestations in patients with EEC syndrome have never been addressed. This case report presents the periodontal status of three patients in a family with EEC syndrome. The presence of generalized aggressive periodontitis was noticed in these patients. EEC syndrome could be a new addition to the group of genetic disorders associated with aggressive periodontitis.

Ectrodactyly: A rare anomaly of limbs.

Split-hand/split-foot malformation (SHFM) is a rare congenital malformation of the limbs with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals and metatarsals. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a case of nonsyndromic form of ectrodactyly because of its rarity.

Familial clustering of a rare syndrome.

Ectrodactyly, ectodermal dysplasia and cleft palate syndrome is a rare autosomal dominant multiple congenital anomaly syndrome with variable expressivity and reduced penetration. The cardinal features are cleft palate/lip, lobster hand deformity, sparse hypopigmented hair, dry scaly skin, and lacrimal and urogenital anomalies. A neonate presented to us with typical features, his mother and other two siblings were also affected.

EEC Syndrome: A rare entity

Ectrodactyly, Ectodermal dysplasia and Cleft lip/palate (EEC) syndrome is a rare combination of multiple congenital anomalies. Although the anomalies are diverse, the underlying problem arise from early embryonic ectodermal tissue defects or insults. We report a case of a baby boy who was born at 33 weeks of gestation with EEC syndrome. He died five months later of aspiration pneumonia. The management requires a multidisciplinary approach and proper parental counseling which should include risk of recurrence in future pregnancies. Prenatal diagnosis is possible by antenatal ultrasound scan at 14-16 weeks of gestation.

Ectrodactilia em cão: relato de caso / Ectrodactyly in dog: case report

Descreve-se um caso de ectrodactilia em um cão, sem raça definida e dois meses de idade. No exame clínico e radiográfico, foi verificada a separação óssea e de tecidos moles entre o segundo e o terceiro dígitos, estendendo-se proximalmente até a região distal do rádio e da ulna, e luxação do cotovelo ipsilateral. O animal foi submetido a procedimento cirúrgico para redução da luxação do cotovelo e reaproximação óssea e dos tecidos moles. Após 16 meses da cirurgia, o animal apresentava uso parcial do membro

A case of ectrodactyly is described in a 2-month-old male mixed Terrier dog. The defect was a complete osseous and soft tissue separation extending from between digits 2 and 3 proximally to the level of the radius and ulna. Radiography revealed elbow luxation. Treatment consisted of surgical reduction of elbow luxation and soft tissue reconstruction. Sixteen months after surgery, the dog was intermittent nonweight-bearing lameness

Congenital Anonychia with Ectrodactyly of 5th Finger

PURPOSE: Despite a high frequency of acquired nail disease, congenital absence of the nail, also called as anonychia, is a rare anomaly. It may be seen as an isolated of phalangeal bone(ectrodactyly), nail-patella syndrome, birth trauma, impaired peripheral circulation, alopecia areata, and pemphigus, idiopathic atrophy of the nail, bullous drug eruptions, periodic shedding, lichen planus, Stenvens-Johnson syndrome and so forth. METHODS: We have experienced a rare case of 40-day-old neonate, suffering from intrauterine growth retardation, but without familial history, chromosomal anomalies or any other diseases. RESULTS: There was no nail on left 5th finger and distal phalangeal bone of same finger. So, We diagnosed as Congenital Anonychia with ectrodactyly of 5th Finger. CONCLUSION: We report this case as congenital anonychia of 5th finger which have developed from underlying distal phalangeal ectrodactyly. We also review other reported cased in the literatures.

Diagnóstico prenatal de ectrodactilia, por ecografía, en dos hermanos / Prenatal diagnosis of ectrodactyly in two siblings

La Ectrodactilia una malformación congénita rara caracterizada por la ausencia de dígitos y tiene una amplia variedad de expresión. Esta anomalía puede ser esporádica o asociada a síndromes genéticos y no genéticos, como la Ectrodactilia autosómica dominante y el Síndrome de Ectrodactília y displasia ectodérmica y paladar hendido. En este trabajo presentamos los casos de dos hermanos con el diagnóstico prenatal de ectrodactilía por ecografía del 2° trimestre, en ambos casos. El primer embarazo resultó en un feto muerto con ectrodactilia de ambas manos y ambos pies y estenosis de cordón umbilical. El segundo embarazo, en el nacimiento de un niño de sexo masculino con agenesia de mano izquierda y ectrodactília de mano derecha y ambos pies. Se resalta la importancia de un examen exhaustivo de manos y pies fetales, en la ecografía del segundo trimestre para así realizar más y mayores diagnósticos de malformaciones de manos y pies.

Ectrodactyly is a rare congenital malformation characterized by absence of digits and has a wide variety of expression. This anomaly can be sporadic or associated with various genetic and non­genetic syndromes such as the autosomal dominant Ectrodactyly and the Ectrodactyly and Ectodermal Dysplasia, Cleft Palate Syndrome (EEC). In this report, we present the cases of two brothers with a prenatal diagnosis of ectrodactyly by ultrasound in the second trimester of both pregnancies. The first pregnancy ended in the stillbirth of a male fetus with ectrodactyly of both hands and feet and stenosis of the umbilical cord. The second pregnancy resulted in the delivery of a boy with left hand agenesis and right hand and feet ectrodactyly. We highlight the importance of routine and thorough examination of fetal hands and feet during the second trimester ultrasound to make a better and more frequent diagnosis of hand and foot malformations.

A Case of Ectrodactyly-Ectodermal Dysplasia-Clefting Syndrome

Ectrodactyly (lobster-claw hand or foot), ectodermal dysplasia and cleft lip or palate constitute a rare clinical syndrome of congenital anomalies, commonly called ectrodactyly- ectodermal dysplasia-clefting (EEC) syndrome. Clinical manifestations of EEC syndrome are variable. This disorder is transmitted by autosomal dominant inheritance and thought to be controlled by single gene. This patient is two month old female who has typical ectrodactyly or lobster-claw hand and foot and cleft palate compatible with EEC syndrome. A brief report of a case with review of literature is given.

Ectrodactyly-Ectodermal Dysplasia-Clefting(EEC) Syndrome with Ocular Defects and Nevus Lipomatosus Cutaneous Superficialis

The ectrodactyly-ectodermal dysplasia-clefting(EEC) syndrome is a rare autosomal dominant disease which has multiple congenital anomalies characterized by ectodermal dysplasia, distal limb anomaly, cleft lip and palate, and lacrimal duct anomalies. There is wide variability of clinical expression of this syndrome, and occasional nonpenetrance. We report a 1 year old girl with typical EEC syndrome manifestations, who presented dry skin, light colored sparse hair on scalp, cleft lip and palate, microdontia with oligodontia, partial syndactyly of the hands, total syndactyly of the feet and mild developmental delay, including ocular defects and skin lesions. Ocular MRI showed microphthalmia with cystic mass on both eye globes and atrophy of the optic nerves. Vesicle like skin lesions were consistent with nevus lipomatosus cutaneous superficialis by pathologic study.