Crouzon syndrome: features of clinical manifestations, management and outcomes in children

   Syndromic craniosynostosis is a special group of hereditary pathologies. One of the syndromic craniosynostoses is Crouzon syndrome, an autosomal dominant pathology of the primary violation of the fusion of cranial sutures. It occurs with a frequency of 1:60,000 newborns. The disease leads to a number of secondary complications, such as exophthalmos, orthognathic problems, impaired vision, hearing, breathing, lag in neuropsychic development. The development of Crouzon syndrome is associated with a missense mutation in the fibroblast growth factor receptor-2 (FGFR2) gene. In modern medicine, a variant of Crouzon syndrome with black acanthosis is also known, the development of which is associated with a mutation in the FGFR3 gene. The similarity of clinical manifestations as with others syndromic craniosynostoses, also between 2 variants of Crouzon syndrome, leads to difficulties in differential diagnostic search. Knowledge and awareness of the full clinical presentation of this syndrome makes it possible to timely diagnose and treat, prevent possible severe complications and improve the quality of life of patients with Crouzon syndrome. This article describes 2 clinical cases with mutations in the FGFR2 and FGFR3 genes.

1. Sawh-Martinez R., Steinbacher D.M. Syndromic Craniosynostosis. Clin Plast Surg 2019; 46(2): 141–155. DOI: 10.1016/j.cps.2018.11.009

2. Conrady C.D., Patel B.C. Crouzon Syndrome. StatPearls Publishing; 2023 Aug; PMID: 30085540. https://www.ncbi.nlm.nih.gov/books/NBK518998 / Link active as of 12/12/2023.

3. Kulakov A.A. Maxillofacial surgery. Ed. A.A. Kulakov. Moscow: GEOTAR-Media, 2019; 692 p. (in Russ.)

4. Cunningham M.L., Seto M.L., Ratisoontorn C., Heike C.L., Hing A.V. Syndromic craniosynostosis: from history to hydrogen bonds. Orthod Craniofac Res 2007; 10(2): 67–81. DOI: 10.1111/j.1601–6343.2007.00389.x

5. Pal U.S., Gupta C., Chellappa A.A. Crouzon syndrome with primary optic nerve atrophy and normal brain functions : A case report. J Oral Biol Craniofac Res 2012; 2(2): 116–118. DOI: 10.1016/j.jobcr.2012.03.011

6. Reardon W., Winter R.M., Rutland P., Pulleyn L.J., Jones B.M., Malcolm S. Mutations in the fibroblast growth factor receptor 2 gene cause Crouzon syndrome. Nat Genet 1994; 8(1): 98–103.

7. Di Rocco F., Collet C., Legeai-Mallet L., Arnaud E., Le Merrer M., Hadj-Rabia S., Renier D. Crouzon syndrome with acanthosis nigricans: a case-based update. Childs Nerv Syst 2011; 27(3): 349–354. DOI: 10.1007/s00381–010–1347-z

8. Mathijssen I.M. Guideline for Care of Patients With the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis. J Craniofac Surg 2015; 26(6): 1735–1807. URL: https://www.researchgate.net/publication/281682735_Guideline_for_Care_of_Patients_With_the_Diagnoses_of_Craniosynostosis_Working_Group_on_Craniosynostosis

9. Kim H.J., Roh H.G., Lee I.W. Craniosynostosis: Updates in Radiologic Diagnosis. J Korean Neurosurg Soc 2016; 59(3): 219–226. DOI: 10.3340/jkns.2016.59.3.219

10. Ciurea AV, Toader C. Genetics of craniosynostosis : review of the literature. J Med Life 2009; 2(1): 5–17.

11. Vargervik K., Rubin M.S., Grayson B.H., Figueroa A.A., Kreiborg S., Shirley J.C. et al. Parameters of care for craniosynostosis: dental and orthodontic perspectives. Am J Orthod Dentofacial Orthop 2012; 141(4 Suppl): S68–73. DOI: 10.1016/j.ajodo.2011.12.013

12. Raybaud C., Di Rocco C. Brain malformation in syndromic craniosynostoses, a primary disorder of white matter : a review. Childs Nerv Syst 2007; 23(12): 1379–1388. DOI: 10.1007/s00381–007–0474–7

13. Conrady C.D., Patel B.C., Sharma S. Apert Syndrome. Stat-Pearls Publishing; 2023 Jan; PMID: 30085535. https://pubmed.ncbi.nlm.nih.gov/30085535 / Link is active on 12/12/2023.

14. Wilkie A.O., Slaney S.F., Oldridge M., Poole M.D., Ashworth G.J., Hockley A.D. et al. Apert syndrome results from localized mutations of FGFR2 and is allelic with Crouzon syndrome. Nat Genet 1995; 9(2): 165–172.

15. Fearon J.A. Treatment of the hands and feet in Apert syndrome: an evolution in management. Plast Reconstr Surg 2003; 112(1): 1–12. URL: https://www.researchgate.net/publication/10685177_Treatment_of_the_Hands_and_Feet_in_Apert_Syndrome_An_Evolution_in_Management

16. Betances E.M., Mendez M.D., Das J. Craniosynostosis. Stat-Pearls Publishing 2023; PMID: 31335086. https://pubmed.ncbi.nlm.nih.gov/31335086 / Ссылка активна на 12.12.2023.

17. Kalathia M.B., Parikh Y.N., Dhami M.D., Hapani P.T. Pfeiffer syndrome. J Pediatr Neurosci 2014; 9(1): 85–86. URL: https://www.researchgate.net/publication/262816749_Pfeiffer_syndrome

18. Clinical guidelines «Diagnostics and treatment of Pfeiffer syndrome» — Association of Genetics and Neurologists 2017. (in Russ.) https://med-gen.ru/docs/pfayfer.pdf / Link active as of 12/12/2023.

19. Taylor J.A., Bartlett S.P. What’s New in Syndromic Craniosynostosis Surgery? Plast Reconstr Surg 2017; 140(1): 82e–93e. URL: https://www.researchgate.net/publication/318163206_What's_New_in_Syndromic_Craniosynostosis_Surgery

20. Azoury S.C., Reddy S., Shukla V., Deng C.X. Fibroblast Growth Factor Receptor 2 (FGFR2) Mutation Related Syndromic Craniosynostosis. Int J Biol Sci 2017; 13(12): 1479–1488. DOI: 10.7150/ijbs.22373

21. Graul-Neumann L.M., Klopocki E., Adolphs N., Mensah M.A., Kress W. Mutation c.943G>T (p.Ala315Ser) in FGFR2 Causing a Mild Phenotype of Crouzon Craniofacial Dysostosis in a Three-Generation Family. Mol Syndromol 2017; 8(2): 93–97. DOI: 10.1159/000455028

22. Kutkowska-Kaźmierczak A., Gos M., Obersztyn E. Craniosynostosis as a clinical and diagnostic problem: molecular pathology and genetic counseling. J Appl Genet 2018; 59(2) :133–147. DOI: 10.1007/s13353–017–0423–4

23. Snyder-Warwick A.K., Perlyn C.A., Pan J., Yu K., Zhang L., Ornitz D.M. Analysis of a gain-of-function FGFR2 Crouzon mutation provides evidence of loss of function activity in the etiology of cleft palate. Proc Natl Acad Sci USA 2010; 107(6): 2515–20. DOI: 10.1073/pnas.0913985107

24. Carter E.P., Fearon A.E., Grose R.P. Careless talk costs lives: fibroblast growth factor receptor signalling and the consequences of pathway malfunction. Trends Cell Biol 2015; 25(4): 221–233. DOI: 10.1016/j.tcb.2014.11.003

25. Kapp-Simon K.A., Speltz M.L., Cunningham M.L., Patel P.K., Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007; 23(3): 269–281. DOI: 10.1007/s00381–006–0251-z