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Craniometaphyseal Dysplasia

Synonyms of Craniometaphyseal Dysplasia

  • CMD
  • Jackson type CMD
  • Osteochondroplasia

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Craniometaphyseal dysplasia is an extremely rare genetic disorder characterized by distinctive abnormalities of the head and facial (craniofacial) area, impairment of certain nerves (cranial nerves) that emerge from the brain, and malformations of the long bones of the arms and legs. In infants and children with craniometaphyseal dysplasia, there may be overgrowth and/or abnormal hardening of certain bones of the skull (cranial hyperostosis and/or sclerosis) and overgrowth (hypertrophy) of craniofacial bones, resulting in widely-spaced eyes (ocular hypetelorism), an abnormally wide nasal bridge, an enlarged lower jaw (mandible), and a "leonine" facial appearance (leontiasis ossea). Compression of certain nerves emerging from the brain (cranial nerves) may result in loss of some motor function (paralysis) in the facial area (cranial nerve palsy) and hearing loss (conductive and/or sensorineural hearing impairment). In addition, in individuals with the disorder, the long bones of the arms and legs may develop abnormally, resulting in unusual "club-like" flaring or broadening of the end portions (metaphyses) of the bones (metaphyseal dysplasia). In some cases, craniometaphyseal dysplasia may be inherited as an autosomal dominant genetic trait; in other cases, the disorder may have an autosomal recessive mode of inheritance.

Symptoms

Craniometaphyseal dysplasia is a genetic disorder that is usually evident at birth. This disorder is characterized by the abnormal growth (hyperostosis) or hardening of the bones of the forehead and back of the head. The facial bones may show thickening, especially at the bridge area of the nose and lower jaw bone (mandible). The nasal passages may be abnormally narrow, and affected individuals may experience inflammation of the mucous membranes (rhinitis). The eyes are widely spaced and bulging (proptosis). If cranial pressure is not relieved there may be facial paralysis, deafness and loss of vision due to compression of the brain and cranial nerves. The limbs may be affected by a hardening (sclerosis) or broadening of the shaft of the long bones close to the growth center (metaphyseal splaying). Intelligence is usually normal.

Causes

Craniometaphyseal dysplasia may be inherited either as an autosomal dominant trait, in which case the mutant gene has been tracked to the short arm of chromosome 5 (5p15.2-p14.1), or it may be inherited as an autosomal recessive trait, in which case the mutant gene has been tracked to the long arm of chromosome 6 (6q21-q22). The recessive form is the more rare of the two, and tends to have a more severe impact on those affected. People with the dominant form have milder symptoms.

The gene on chromosome 5 controls the production of a protein involved in the transport of pyrophosphate into the bone matrix. The concentration of pyrophosphate in the bone matrix is key to regulating the mineralization of the bone. The gene located at chromosome 6q21-q22 deals with an entirely different process in the development of bone.

Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated "p" and a long arm designated "q". Chromosomes are further sub-divided into many bands that are numbered. For example, "chromosome 5p15.2-p14.1" refers to a region between bands 15.2 and 14.1 on the short arm of chromosome 5. In a like manner the term "chromosome 6q21-q22" refers to a region between bands 21 and 22 on the long arm of chromosome 6. The numbered bands specify the location of the thousands of genes that are present on each chromosome.

Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.

All individuals carry a few abnormal genes. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.

Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy regardless of the sex of the resulting child.

Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%. The risk is the same for males and females.

Affected Populations

Craniometaphyseal dysplasia is a very rare disorder that affects males and females in equal numbers. Little is known about the incidence or prevalence of this disorder.

Related Disorders

Symptoms of the following disorders can be similar to those of Craniometaphyseal Dysplasia. Comparisons may be useful for a differential diagnosis:

Pyle's Disease is often confused with Craniometaphyseal Dysplasia. It is a rare genetic disorder characterized by head and facial abnormalities, and multiple skeletal deformities. Occasionally there may be muscle weakness, joint pain, fractures, an elongated big toe, curvature of the spine (scoliosis) and misplaced teeth.

Osteopetrosis is a rare genetic bone disorder. It can be inherited as either a dominant or recessive trait. Initial symptoms of the dominant form of Osteopetrosis may include bone fragility leading to easy fractures and unusual dental problems. Bone pain may occur in the spine, and cranial nerves may be affected. Some vision defects or facial palsy may also be symptomatic of the dominant form of Osteopetrosis. Severe anemia may occur due to obliteration of the bone marrow.

A more serious recessive form of Osteopetrosis is present at birth and can be diagnosed by skeletal x-rays. Symptoms may include retardation of growth, enlargement of the head, a deformity of the base of the skull and delayed closure of the soft spot on the skull of infants with this disorder. Vision failure, cataracts, deafness, dental decay, chest deformity and brain damage are also symptomatic of the more severe form of Osteopetrosis. (For more on this disorder, choose "Osteopetrosis" as your search term in the Rare Disease Database.)

Frontometaphyseal Dysplasia is a rare genetic disorder characterized by coarse facial features that include a wide nasal bridge, widely spaced eyes, overgrowth of the bone over the eyes (supraorbital bossing), small jawbone (mandible) and an incomplete development of the sinuses. There may also be multiple deformities of the teeth and bones. Occasionally mental retardation may occur.

Standard Therapies

Early surgical treatment of Craniometaphyseal Dysplasia to relieve cranial pressure and correct the facial deformities may help eliminate the sight and hearing complications associated with this disorder. Genetic counseling may be of benefit for patients and their families. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Craniometaphyseal Dysplasia

References

TEXTBOOKS
Reichenberger E, Mulliken JB. Craniometaphyseal Dysplasia. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:184.

Gorlin RJ, Cohen MMJr, Levin LS. eds. Syndromes of the Head and Neck. 3rd ed. Oxford University Press, London, UK; 1990:229.

Jones KL., ed. Smith's Recognizable Patterns of Human Malformation. 5th ed. W. B. Saunders Co., Philadelphia, PA; 1997:395.

JOURNAL ARTICLES
Puri P, Chan J. Craniometaphyseal dysplasia: ophthalmic features and management. J Pediatr Ophthalmol Strabismus. 2003;40:228-31.

Sheppard WM, Shprintzen RJ, Tatum SA, et al. Craniometaphyseal dysplasia: a case report and review of medical and surgical management. Int J Pediatr Otorhinolaryngol. 2003;67:687-93.

Reichenberger E, Tiziani V, Watanabe S, et al. Autosomal dominant craniometaphyseal dysplasia is caused by mutations in the transmembrane transport protein ANK. Am J Hum Genet. 2001;68:1321-26.

Iughetti P, Alonso LG, Wilcox W, et al. Mapping of the autosomal recessive (AR) craniometa-physeal dysplasia locus to chromosome region ^q21-22 and confirmation of genetic heterogeneity for mild AR spondylocostal dysplasia. Am J Med Genet. 2000;95:482-91.

Feingold M. 28-year follow-up of the craniofacial findings in a patient with craniometaphyseal dysplasia. Am J Med Genet. 1999;86:501-02.

Tinschert S, Braun HS. Craniometaphyseal dysplasia in six generations of a German kindred. Am J Med Genet. 1998;77:175-81.

FROM THE INTERNET
McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Craniometaphyseal Dysplasia, Autosomal Dominant; CMDD. Entry Number; 123000: Last Edit Date; 7/2/2001.

McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Craniometaphyseal Dysplasia, Autosomal Recessive; CMDR. Entry Number; 218400: Last Edit Date; 3/18/2004.

Skeletal Dysplasias. Orthoteers. Updated on: 27 January 2001. 5pp.
www.orthoteers.co.uk/Nrujp~ij33lm/Orthdysplasias.htm

The Osteopetroses (Marble Bones). The Merck Manual. 2004.
www.merck.com/mrkshared/mmanual/section19/chapter270/270f.jsp

Craniometaphyseal dysplasia. Encyclopedia of Medical Imaging III:1. Amersham Health. nd. 1p.
www.medcyclopedia.com

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/04/11 00:00:00 GMT+0

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