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CONCISE COMMUNICATION
Year : 2019  |  Volume : 10  |  Issue : 6  |  Page : 719-720  

Goldenhar syndrome: A report of two cases


Department of Dermatology, Venereology and Leprosy, GMC, Kota, Rajasthan, India

Date of Web Publication1-Nov-2019

Correspondence Address:
Suresh Kumar Jain
Dr. Suresh Kumar Jain, GMC, Kota – 324 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_491_18

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How to cite this article:
Kushwaha RK, Singh A, Mohta A, Jain SK. Goldenhar syndrome: A report of two cases. Indian Dermatol Online J 2019;10:719-20

How to cite this URL:
Kushwaha RK, Singh A, Mohta A, Jain SK. Goldenhar syndrome: A report of two cases. Indian Dermatol Online J [serial online] 2019 [cited 2019 Nov 17];10:719-20. Available from: http://www.idoj.in/text.asp?2019/10/6/719/268761



Sir,

Goldenhar syndrome is a rare, inherited disorder of disturbed blastogenesis having multifactorial etiopathogenesis. It is characterized by multiple anomalies including auricular appendices, malformed ears, and dermal epibulbar cysts. Keeping in view its systemic implications, an early diagnosis along with musculoskeletal and cardiovascular systemic examination is essential. Here, we report two cases of Goldenhar syndrome in whom multiple accessory tragi, unilateral ocular and auricular changes, and maxillary and mandibular hypoplasia with growth retardation and developmental delay were observed.

The first case was of a 6-year-old boy, born of nonconsanguineous marriage, who presented to our skin department with multiple accessory tragi, left bulbar dermoids, abnormal growth, and development since birth. On cutaneous examination, the patient had multiple bilateral skin-colored papules in the preauricular area along the line joining the tragus and angle of mouth, identified as accessory tragi [Figure 1]a. On ocular examination, soft, yellowish-brown nodules on the left bulbar conjunctiva and the limbus on the temporal aspect of the left eye were present, identified as dermoids [Figure 1]b. The patient also had kyphosis.
Figure 1: (a) Bilateral accessory tragic. (b) Dermoid and accessory tragi

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The second case was a 1-year-old boy who presented with multiple accessory tragi, left bulbar dermoids, left coloboma, and maxillary and mandibular hypoplasia [Figure 2]a and [Figure 2]b.
Figure 2: (a) Left bulbar dermoid maxillary and mandibular hypoplasia. (b) Accessory tragus

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Goldenhar syndrome is an autosomal dominant condition described by Maurice Goldenhar, a French ophthalmologist, in 1952.[1] Gorlin et al. named this syndrome as oculo-auriculo-vertebral dysplasia due to the presence of vertebral anomalies.[2]

The classic features of this syndrome include ocular changes such as microphthalmia, epibulbar dermoids, coloboma, and lipodermoids; aural features such as preauricular tragi, hearing loss, and microtia; and vertebral anomalies such as scoliosis, cervical fusion, and hemivertebrae.[3],[4] About 85% of cases have unilateral abnormalities and 10%–33% are bilateral.[5] Ocular anomalies especially bilateral dermoids are seen in about 60% of cases, vertebral anomalies in 40% of the cases, and ear anomalies also in 40% of cases.[4] Other unusual features are macrophthalmia and hypertelorism associated with trisomy 22.[6] There is poor development of nostrils resulting in a “parrot-like” appearance.

The most common associated cardiovascular anomalies are Tetralogy of Fallot and ventricular septal defects.[3] Other associated findings are cleft lip and palate, macrostomia, micrognathia, webbing of the neck, short neck, tracheoesophageal fistula, abnormalities of sternocleidomastoid muscle, umbilical hernia, inguinal hernia, urologic anomalies, hypoplastic vagina, and anal anomalies.[7]

Successful treatment usually requires a multidisciplinary approach. Uncomplicated cases require cosmetic reconstruction surgeries of the external ear which can be done at the age of 6–8 years. Jaw reconstruction surgeries are done in early teens. Epibulbar dermoids are surgically resected.[4] In uncomplicated cases, without any systemic associations, prognosis is good.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Goldenhar M. Associated malformations of eye and ear, particularly dermoid syndrome epibulbar-appendices, congenital auricular fistulas and its relations with manibulofacial dysostosis. J Genet Hum 1952;1:243-82.  Back to cited text no. 1
    
2.
Nakajima H, Goto G, Tanaka N, Ashiya H, Ibukiyama C. Goldenhar syndrome associated with various cardiovascular malformations. Jpn Circ J 1998;62:617-20.  Back to cited text no. 2
    
3.
Riyaz A, Riyaz N. Goldenhar syndrome with unusual features. Indian J Dermatol Venereol Leprol 1999;65:143-4.  Back to cited text no. 3
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4.
Kulkarni V, Shah MD, Parikh A. Goldenhar syndrome: A case report. J Postgrad Med 1985;31:177-9.  Back to cited text no. 4
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5.
Bielicka B, Necka A, Andrych M. Interdisciplinary treatment of patients with Goldenhar syndrome – Clinical reports. Dent Med Probl 2006;43:458-62.  Back to cited text no. 5
    
6.
Bowen DI, Collum LM, Rees DO. Clinical aspects of oculo-auriculo-vertebral dysplasia. Br J Ophthalmol 1971;55:145-54. doi: 10.1136/bjo. 55.3.145.  Back to cited text no. 6
    
7.
Kapur R, Kapur R, Sheikh S, Jindal S, Kulkarni S. Hemifacial microsomia: A case report. J Indian Soc Pedod Prev Dent 2008;26:34-40.  Back to cited text no. 7
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