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Craniometaphyseal and craniodiaphyseal dysplasia, head and neck manifestations and management

Published online by Cambridge University Press:  29 June 2007

Aurelia Richards ,
Caroline Brain ,
M. J. Dillon  and
C. M. Bailey
Aurelia Richards*
Affiliation:
Department of Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK
Caroline Brain
Affiliation:
Department of Medicine, Great Ormond Street Hospital for Children NHS Trust, London, UK
M. J. Dillon
Affiliation:
Department of Medicine, Great Ormond Street Hospital for Children NHS Trust, London, UK
C. M. Bailey
Affiliation:
Department of Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK
*
Address for correspondence: Miss Aurelia Richards, F.R.C.S., Department of Otolaryngology, Guy's Hospital, St Thomas' Street, London SE1 9RT. Tax: 0171-955-8878
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Abstract

Craniometaphyseal and craniodiaphyseal dysplasia are rare genetic disorders of bone due to modelling errors of long bones and skull bones. These syndromes present with multiple ENT symptomatology from an early age. The diagnostic distinction can now be made radiologically by serial skeletal survey which is important for prognosis. We review the clinical, radiological, computed tomography (CT) scan, otological, audiological and histopathological findings in two cases with craniodiaphyseal, and two cases with craniometaphyseal dysplasia, and report our experiences of medical and surgical treatment to date.

In the craniodiaphyseal dysplasia, the hearing abnormality progressed from an initial conductive to a mixed loss on serial audiometric follow up. Temporal bone CT scans showed narrowing of the middle ear cavity, internal auditory meatus, and facial nerve canal at the geniculate ganglion. Benefits from choanal stenosis surgery, craniofacial remodelling and dacrocystorhinostomy were shortlived. Calcitriol therapy with a low calcium diet did not alter the clinical course of progression in our cases. The underlying defect, causing net bone formation in these phenotypically similar syndromes, appears to be different when based on the differing biochemical responses to calcitriol and bone biopsy findings. Increased numbers of osteoblasts were found in bone biopsies from both cases with craniodiaphyseal dysplasia.

Early recognition is crucial in these conditions as therapy directed at the underlying bony defect has the best chance of success if initiated in infancy (Cole et al., 1988; Fanconi et al., 1988; Key et al., 1988).

Keywords

Craniometaphyseal dysplasiaCraniodiaphyseal dysplasiaDeafnessChoanal atresiaNasal obstructionFacial palsyOsteoblastCalcitriol
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 110 , Issue 4 , April 1996 , pp. 328 - 338
Copyright
Copyright © JLO (1984) Limited 1996

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Footnotes

Presented at the British Association of Paediatric Otolaryngologists meeting. October 1994, London.

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