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      Prenatal Diagnosis of Isolated Agnathia-Otocephaly: A Case Report and Review of the Literature

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          Abstract

          Agnathia is a rare disease characterized by the absence of a mandible. Few cases of prenatally diagnosed isolated agnathia have been reported. We present a case report and review of the literature of prenatally diagnosed agnathia. A 38-year-old woman (gravida 0, para 0) was referred to our hospital at 28 weeks and 3 days of gestation for fetal evaluation because of polyhydramnios and suspected facial anomalies. Three-dimensional ultrasonography and MRI indicated agnathia. Premature rupture of the membranes occurred before the parents could reach a decision on the postnatal treatment. We performed emergency cesarean section on the second day of the 33rd week of gestation. The neonate was deemed nonresuscitable and he died of airway obstruction shortly after birth. Because agnathia is associated with very poor prognosis, accurate prenatal diagnosis and detailed counseling should be promptly provided before unexpected delivery to the parents for the determination of postnatal treatment.

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          Most cited references46

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          The Teratogenic Effects of Prenatal Ethanol Exposure Are Exacerbated by Sonic Hedgehog or Gli2 Haploinsufficiency in the Mouse

          Disruption of the Hedgehog signaling pathway has been implicated as an important molecular mechanism in the pathogenesis of fetal alcohol syndrome. In severe cases, the abnormalities of the face and brain that result from prenatal ethanol exposure fall within the spectrum of holoprosencephaly. Single allele mutations in the Hh pathway genes Sonic Hedgehog (SHH) and GLI2 cause holoprosencephaly with extremely variable phenotypic penetrance in humans. Here, we tested whether mutations in these genes alter the frequency or severity of ethanol-induced dysmorphology in a mouse model. Timed pregnancies were established by mating Shh+/− or Gli2+/− male mice backcrossed to C57BL/6J strain, with wildtype females. On gestational day 7, dams were treated with two ip doses of 2.9 g/kg ethanol (or vehicle alone), administered four hrs apart. Fetuses were then genotyped and imaged, and the severity of facial dysmorphology was assessed. Following ethanol exposure, mean dysmorphology scores were increased by 3.2- and 6.6-fold in Shh+/− and Gli2+/− groups, respectively, relative to their wildtype littermates. Importantly, a cohort of heterozygous fetuses exhibited phenotypes not typically produced in this model but associated with severe holoprosencephaly, including exencephaly, median cleft lip, otocephaly, and proboscis. As expected, a correlation between the severity of facial dysmorphology and medial forebrain deficiency was observed in affected animals. While Shh+/− and Gli2+/− mice have been described as phenotypically normal, these results illustrate a functional haploinsufficiency of both genes in combination with ethanol exposure. By demonstrating an interaction between specific genetic and environmental risk factors, this study provides important insights into the multifactorial etiology and complex pathogenesis of fetal alcohol syndrome and holoprosencephaly.
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            Objective diagnosis of micrognathia in the fetus: the jaw index.

            To provide an objective and accurate tool to diagnose micrognathia in the fetus. The anteroposterior and laterolateral diameter of the mandible were measured in 262 normal fetuses between 12 and 37 weeks' gestation and plotted against gestational age and biparietal diameter (BPD). The jaw index (anteroposterior mandibular diameter/BPD x 100) was then tested against the usual subjective method for diagnosing micrognathia, consisting of the evaluation of the facial profile, in a population of 198 malformed fetuses, 11 of which had micrognathia at necropsy or birth. The mandibular growth was linearly correlated with gestational age and BPD. Using a cutoff level of less than 23, the jaw index had a 100% sensitivity and 98.1% specificity in diagnosing micrognathia, in comparison with 72.7% and 99.2% shown by the subjective evaluation of the fetal profile. With a cutoff of 21, it yielded a positive predictive value of 100%. We demonstrated the linear relationship between mandibular growth and gestational age or BPD. In addition, we validated the jaw index as an objective tool for diagnosis of micrognathia in the fetus.
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              Current perspectives on the etiology of agnathia-otocephaly

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                Author and article information

                Journal
                Case Rep Obstet Gynecol
                Case Rep Obstet Gynecol
                CRIOG
                Case Reports in Obstetrics and Gynecology
                Hindawi Publishing Corporation
                2090-6684
                2090-6692
                2016
                4 August 2016
                : 2016
                : 8512351
                Affiliations
                1The Jikei University School of Medicine, Nishishimbashi 25-83-3, Minato-ku, Tokyo 105-8461, Japan
                2National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
                Author notes

                Academic Editor: Giovanni Monni

                Author information
                http://orcid.org/0000-0003-4358-8791
                Article
                10.1155/2016/8512351
                4989077
                29094f56-08cf-42a1-b191-c5b5deb6ed01
                Copyright © 2016 Kazuhiro Kajiwara et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 May 2016
                : 7 July 2016
                : 11 July 2016
                Categories
                Case Report

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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