Psaume Syndrome

A congenital X-linked syndrome lethal for males. It is characterized by orofacial and digital defects associated with renal failure.

Gorlin-Psaume Syndrome; Papillon-Léage Syndrome; Digito-Orofacial Syndrome I; Orofaciodigital Syndrome I; Gorlin Syndrome I; Papillon-Léage-Psaume Syndrome.

Genetic disorder that was first described by Psaume (1962) and known worldwide because of Gorlin's works. First described in 1954 by E. Papillon-Léage, a French dentist, and J. Psaume, also a French dentist. R. J. Gorlin, an American oral pathologist and geneticist, made this condition internationally known.

1:250,000 live births.

X-linked dominant.

Caused by mutations in the CXORF5 gene mapped on Xp22.3-p22.2. One hypothesis is that the OFD1 protein may have widespread influence on organogenesis and be essential for fetal survival.

Clinically evocated in females with characteristic facies, multiple digits anomalies, and renal failure.

Features involve head and neck (microcephaly or macrocephaly, micrognathia, frontal bossing, zygomatic hypoplasia, increased cranial base angle, hypertelorism, telecanthus, choroid coloboma, hypoplastic alar cartilage, broad nasal root, short upper lip, median cleft lip, cleft palate, palatal grooves, alveolar notching, hyperplastic oral frenula, lobulated/bifid tongue, tongue hamartomas, missing incisor teeth, supernumerary teeth, periodontal diseases, malocclusion), digits (brachydactyly, clinodactyly, syndactyly), skin (dry scalp, sparse hair, alopecia), central nervous system (hydrocephaly, hydranencephaly, porencephaly, partial agenesis of the corpus callosum, hamartoma of the hypothalamus, gray matter heterotopias, conductive deafness), and kidneys (renal failure, polycystic kidneys). Mild mental retardation and irritability occur in 50% of cases. Seizures, precocious puberty, and short stature can be associated.

Evaluate tracheal intubation (clinical, radiographs), neurological function (clinical, CT/MRI scans, EEG), and renal function (clinical, echography, laboratory).

Tracheal intubation can be difficult and may require adapted anesthetic management. Increase in intracranial pressure is possible and makes spinal anesthesia not recommended.

Consider interaction between antiepileptic treatment and anesthetic drugs. Intraoperative fluid regimen and anesthetic drugs choice should consider renal function.