Mohr syndrome: a rare case and distinction from orofacial digital syndrome 1.
HS Hosalkar, H Shah, P Gujar, A Kulkarni, MG Yagnik
Bai Jerbai Wadi Hospital for Children, Parel, Mumbai, India. , India
H S Hosalkar
Bai Jerbai Wadi Hospital for Children, Parel, Mumbai, India.
In view of the different modes of inheritance and the different prognoses of the two oro-facio-digital syndromes, type 1 and type 2, it is important to establish a correct diagnosis in these patients. A case of type II oro-facio-digital syndrome is being reported and the distinguishing clinicoradiological features with type I are compared.
|How to cite this article:|
Hosalkar H S, Shah H, Gujar P, Kulkarni A, Yagnik M G. Mohr syndrome: a rare case and distinction from orofacial digital syndrome 1. J Postgrad Med 1999;45:123-4
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Hosalkar H S, Shah H, Gujar P, Kulkarni A, Yagnik M G. Mohr syndrome: a rare case and distinction from orofacial digital syndrome 1. J Postgrad Med [serial online] 1999 [cited 2022 Dec 6 ];45:123-4
Available from: https://www.jpgmonline.com/text.asp?1999/45/4/123/332
The Mohr syndrome or oro-facial-digital syndrome type II (OFD-II)] is characterised by a lobulate tongue, midline cleft of lip, high arched or cleft palate, broad nasal root with wide bifid nasal tip, hypertelorism, micrognathia, brachydactyly, syndactyly and polydactyly, bilateral reduplicated hallux, conductive hearing loss and normal intelligence. The bifid great toe, one of the features that distinguishes OFD II3 from OFD I, may not extend to the soft tissue, in which case it will only be seen by radiological examination.
A seven-year-old girl born out of non-consanguineous marriage as the second child of a 36-year-old mother and 42-year-old father. The earlier sibling had died as a stillbirth. This girl was born at full term, uneventful pregnancy, no prenatal and perinatal complications, weighed 4400 gms.
On clinical examination, child had mental retardation with mandibular hypoplasia, lobulated tongue, low set ears [Figure:1]. Patient had polydactyly of both hands and feet, preaxial in feet and postaxial in hands [Figure:2]. On further clinico-radiological examination, cardiac anomaly in the form of atrial septal defect (ASD) and bilateral conductive deafness was present.
In 1941 Mohr described a family in which male proband had OFD malformation including a high arched palate, lobulate tongue with papilliform outgrowths, a broad root of nose and "ocular hypertelorism". Syndactyly, brachydactyly and polydactyly of hands and feet were also present. Most characteristic feature was polysyndactyly of the great toes. This child had three brothers who had more limited malformations of oral cavity and digits. Mohr concluded that this syndrome was due to a sex linked recessive sublethal gene.
These patients apparently have normal intelligence and plastic surgery is indicated for cleft lip or palate, hypertrophied frenula and partial reduplication of the hallux. A surgical attempt to reconstruct the auditory ossicles should be made to improve the conduction deafness. Early accurate diagnosis is important from a genetic counselling point of view, since it implies a one in four risk of recurrence.
In conclusion, Mohr syndrome (OFD II) appears to be much rarer than OFD I. It can be easily confused with OFD I. Therefore distinction between these two syndromes has important implications in genetic counselling.
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