Syndrome characterized by microcephalia,
mental retardation, dwarfism, and urogenital and skeleton anomalies.
Ruvalcaba-Reichert-Smith Syndrome; Osseous Dysplasia with
Mental Retardation Ruvalcaba type.
First described in 1971 by Rogelio H.A. Ruvalcaba, David
Weyhe Smith, American pediatricians and A. Reichert, American physician.
Uncertain; autosomal dominant; semidominant
X-linked inheritance has also been suggested.
Based on typical clinical findings and the familial
nature of the syndrome. No specific genetic or biochemical investigation has
Features involve head (microcephalia; small,
narrow, beak-shaped nose; thin lips and down-slanting palpebral fissures;
hypoplastic maxilla; and pointed mandible), musculoskeletal system (short stature; clinodactyly;
osteochondritis of the vertebral column
and Scheuermann disease [anterior fragmentation of the vertebrae]; narrow trunk; pectus
carinatum; kyphosis or scoliosis; short extremities with widening of the epiphyses;
limitation of joint extension), urogenital (delayed puberty, hypoplastic testicles,
cryptorchism, malrotation, megaureter, and hydronephrosis), and
skin (typical hypoplastic “onion skin”). Varying degrees of mental
One must obtain a complete history
particularly related to neurological development. The presence of renal anomalies must be
excluded. The association of congenital hydrocephalus and Dandy-Walker
anomaly must be eliminated.
Mental retardation may affect
cooperation during induction of anesthesia and premedication may be necessary. No
anesthetic experience has been reported but the possibility of a difficult tracheal
intubation must be considered in the presence of a hypoplastic maxilla and narrow arch.
Careful intraoperative positioning is necessary because of skeletal deformation.
Possible association with raised intracranial pressure.
Muscle relaxants should be avoided
until airway is secured.
Hunter-McAlpine Craniosynostosis Syndrome: Inherited
as an autosomal dominant disorder and characterized by craniosynostosis,
mental deficiency, microcephaly, almond-shaped palpebral fissures,
oval-shaped face, blunt nose, downturned mouth or small mouth, mild
acral-skeletal anomalies, unusually small hands and dwarfism.
Tricho-Rhino-Phalangeal Syndrome Type III (TRPS III;
Characterized by the presence of sparse hair,
beaked nose, long upper lip, and severe metacarpophalangeal shortening.
Although it was suggested to be an example of Ruvalcaba Syndrome, it is
differentiated by the absence of mental retardation and microcephaly. The
abnormalities of the hands and feet are more severe. The sparse hair,
“pear-shaped nose” and radiological cone-shaped epiphyses are also present as features
of TRPS types I and II. However, the presence of severe generalized shortening of
all phalanges and metacarpals (brachydactyly) differentiated the condition
from TRPSI and the absence of mental deficiency and exostoses from TRPSII.
Bianchi E, Livieri C, Arico M, et al: Ruvalcaba syndrome: A case report.
Eur J Pediatr
Ruvalcaba RHA, Reichert A, Smith DW: A new familial syndrome with osseus
dysplasia and mental deficiency. J Pediatr
Sugio Y, Kajii T: Ruvalcaba syndrome: Autosomal dominant inheritance. Am J Med Genet