Palpebral Fissures: A New Dysmorphic Syndrome
Aamir Jalal Al Mosawi Abstract-A dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat mid-face), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay.
The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and thin non-slanting lateral parts) with downward slanting palpebral fissures, bilateral convergent squint, hypertelorism with flat mid-face, epicanthic folds, large ears, developmental delay, and infantile hypotonia mostly attributed to congenital myopathy.
dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat midface), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay [1,2,3,4].
The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and
Nerve conduction study (Table -
No spontaneous activity.
No myotonic discharges.
Right deltoid= 5.1 msec (n=8.3 msec). Right biceps = 4.8 msec (n=8.1 msec). Right vastus medialis = 4.1 msec (n=8.3 msec). Right tibialis anterior = 5.3 msec (n= 10.2 msec). Left tibialis anterior = 5.2 msec (n= 12.5 msec). 30-40% polyphasia of short duration low amplitude was observed.
EMG and nerve conduction studies suggested chronic diffuse non dystrophic myopathic of moderate severity mostly resulting from congenital myopathy.
The proximal lower limb muscles were more severely involved.
thin non-slanting lateral parts) with downward slanting |
palpebral fissures, bilateral convergent squint, |
hypertelorism with flat mid-face, epicanthic folds, large |
ears, developmental delay, and infantile hypotonia |
mostly attributed to congenital myopathy. |
II. Case Report |
1. Highly specific unique eyebrows abnormalities |
consisting of splitting with a relatively thick upward |
slanting medial parts and thin non-slanting lateral |
parts. |
2. Downward slanting palpebral fissures. |
3. Epicanthic folds. |
4. Hypertelorism. |
5. Depressed nasal bridge. |
6. Large ears. |
7. Convergent squints of both eyes. |
Brain MRI was performed at the age of one |
month showed normal findings. |
Screening for several inborn errors of |
metabolisms has already revealed no abnormality. |
Sporadic occurrence |
Non consanguineous parents |
Splitting of eyebrows with a relatively thick upward slanting medial parts and thin non-slanting |
lateral parts |
Downward slanting palpebral fissures |
Epicanthic folds |
Hypertelorism |
Depressed nasal bridge |
Large ears |
Convergent squints of both eyes. |
Infantile hypotonia attributed to congenital myopathy |
Sensory | Motor | ||||||
Nerve | Latency msec/cm | Amplitude ?V | SNCV m/sec | Muscle | DML Msec /cm | MNCV msec /cm | F-wave Latency |
Right median | 2.1 | 26.6 | 56.2 | ABP | 3.1 | 50.2 | 16.5 |
Right ulnar | 1.9 | 27.3 | 56.6 | ADM | 2.9 | 51.2 | 17.2 |
Right common peroneal | Tibialis Ant. EDB | 3.3 4.2 | 40.2 | 35.3 | |||
Left common peroneal | Tibialis Ant. EDB | 3 4.1 | 40.3 | 36.3 | |||
Left sural | 2 | 15.3 | 44.6 |
The author would to express his gratitude for the parents of the patients who accepted publishing his photos.