Further Outpatient Care
See the list below:
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Carefully monitor postoperative complications.
Further Inpatient Care
See the list below:
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Admit patients with Apert syndrome for surgical intervention.
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Tracheostomy may be necessary for airway management.
Transfer
See the list below:
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Transfer may be indicated for further diagnostic evaluation and surgical intervention.
Complications
See the list below:
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Potential eye or brain injury
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Wound infections
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Leakage of cerebrospinal fluid or meningocele formation
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Increased intracranial pressure and hydrocephalus
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Airway obstruction, respiratory insufficiency, and sleep apnea
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Treatment goals focused on preventing avoidable developmental delays (from raised intracranial pressure and sleep apnea) and reducing operative interventions may potentially improve developmental outcomes. [35]
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A significant proportion of children have obstructive sleep apnea and may develop supraglottic airway obstruction on induction and emergence from anesthesia, due to the midface anatomical abnormalities associated with Apert syndrome. [36]
Prognosis
See the list below:
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Prognosis largely depends on the age at operation. Craniosynostosis can result in brain compression and mental retardation unless relieved by early craniectomy. Innovations in craniofacial surgery have enabled children with Apert syndrome to achieve their full potential by maximizing their opportunities for intellectual growth, physical competence, and social acceptance; however, early surgical treatment of craniosynostosis may not alter intellectual outcome.
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Prognosis depends on associated brain malformations. Malformations of the corpus callosum and size of the ventricles appear to play no role in the final intelligence quotient (IQ) score, though malformations of septum pellucidum have a significant effect.
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Quality of the family environment is another factor involved in intellectual achievement. Only 12.5% of children with Apert syndrome who are institutionalized reach a normal IQ score, compared with 39.3% of children from a healthy family background.
Patient Education
See the list below:
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55 Kenosia Avenue
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PO Box 1968
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Danbury, CT 06813-1968
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Phone: 800-999-6673
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Fax: 203-798-2291
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email: orphan@rarediseases.org
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Apert Syndrome Support Group
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8708 Kathy
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St. Louis, MO 63126
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Phone: 314-965-3356
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PO Box 11082
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Chattanooga, TN 37401
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Phone: 800-332-2373 or 423-266-1632
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email: faces@faces-cranio.org
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Apert Support and Information Network
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PO Box 1184
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Fir Oaks, CA 95628
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Phone: 916-961-1092
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email: apernet@ix.netcom.com
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PO Box 2571
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Columbia, SC 29202
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Phone: 803-732-2372
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email: catndon@apert.org
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13140 Coit Road
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Suite 307
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Dallas, TX 75240
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Phone: 800-535-3643
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An infant with Apert syndrome is shown. Note the characteristic ocular hypertelorism, down-slanting palpebral fissures, proptotic eyes, horizontal groove above the supraorbital ridge, break of the eyebrows' continuity, depressed nasal bridge, and short, wide nose with bulbous tip.
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Note the mitten appearance of the hands with syndactyly involving the second, third, fourth, and fifth fingers. This patient also has characteristic concave palms, hitchhiker posture (radial deviation) of the short broad thumbs, and contiguous nail beds (synonychia).
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Note the socklike appearance of the feet with syndactyly involving the second, third, fourth, and fifth toes. The patient also has contiguous nail beds (synonychia).
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In this profile photo, turribrachycephaly (high prominent forehead), proptosis, a depressed nasal bridge, a short nose, and low-set ears are prominent.
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This radiograph demonstrates turribrachycephaly, shallow orbits, ocular hypertelorism, and a hypoplastic maxilla.
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Note the osseous syndactyly involving the second, third, fourth, and fifth fingers; multiple synostosis involving the distal phalanges and proximal fourth and fifth metacarpals; symphalangism of the interphalangeal joints; shortening and radial deviation of the distal phalanx; and the delta-shaped deformity of proximal phalanx of the thumbs.
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Note the osseous syndactyly, fusion of the interphalangeal joints, synostosis involving the proximal first and second metatarsals, and the partially duplicated and delta-shaped proximal phalanx of the great toes.
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A 9-month-old girl was seen because of syndactyly of the hands and feet as well as associated with craniofacial anomalies. The family and pregnancy histories were noncontributory. The child had broad thumbs with 2-5 digits with cutaneous syndactyly (only the right hand is shown here). The feet were characterized by brachydactyly and syndactyly of 2-5 toes. Genomic DNA analysis showed a heterozygous C-to-G mutation at nucleotide 755 of the fibroblast growth factor receptor 2 (FGFR2) gene (c.755C>G) that changes a codon for serine (TCG) to that for tryptophan (TGG) at amino acid position 252 (p.Ser252Trp). This mutation is diagnostic for Apert syndrome.
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The right hand radiograph for the same patient in the previous image, at age 15 months (left image), showed soft-tissue fusion between the second through fourth digits as well as fusion of the proximal soft tissues between the fourth and fifth digits. Hypoplastic, deformed phalanges were present with fusion of the proximal and middle phalanges of the second through fourth digits. Bony fusion was also seen at the bases of the fourth and fifth metacarpals along with fusion of the capitate and hamate. The thumb pointed laterally with a sharp angulation at the first metacarpophalangeal joint. A right hand radiograph from the child at age 1 month (right image) is provided for comparison. Similar abnormalities were also seen in the left hand (not shown).
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Radiographs of both feet in the same child as in the previous images, at age 1 month, showed foreshortening of the bilateral second metatarsals, the right third proximal phalanx and left fourth phalanx, and the distal phalanges of the left second, third, fourth, and fifth digits. Both great toes are bulbous and foreshortened, with deformed phalanges and partially duplicated metatarsals. Soft-tissue fusion was present in the second through fifth digits of both feet.
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Magnetic resonance images of the brain obtained at in the same patient as in the previous images, at age 16 months, showed hypoplasia of the parieto-occipital white matter, with undulating bilateral lateral ventricle occipital horns (arrow; left image). Shallow orbits can be appreciated bilaterally with ocular hypertelorism (right image).
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A 17-month-old boy with Apert syndrome. Three-dimensional (3-D) CT imaging of the head showed craniosynostosis of the coronal suture and a hypoplastic midface.
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Axial facial CT scans in the same patient as in the previous image showed bilateral shallowed orbits with proptosis and mild hypertelorism. Crowding of the teeth was present.
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Radiograph of bilateral hands in the same patient as in the previous images, at age 18 months, showed bilateral syndactyly involving the second through fifth digits, with absent distal phalanges. Bilateral shortened hypoplastic middle phalanges are present, with bony fusion at the third and fourth middle phalanges, along with deformities of the proximal phalanges and shortened metacarpals.
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Radiograph of bilateral feet in the same patient as in the previous images, at age 7 years, showed syndactyly with diffuse deformities and multiple midfoot and hindfoot tarsal coalitions.
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Three-dimensional facial CT scans in the same child as in the previous images, at age 9 years, showed hypoplastic midfacial bones.
