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Carpenter Syndrome

Carpenter syndrome is an extremely rare genetic condition. In these patients, the bones that make up the skull fuse together too early. New-born infants and children normally have soft spaces between the main bones of the head. These initially allow the baby’s head to fit through the mother’s birth canal during birth. After birth, they allow the child’s brain to grow properly. This is one of the reasons a baby’s head circumference is routinely measured during doctors’ appointments.

Normally, the soft bones will harden and fuse together during the first 18 months of life. In children with Carpenter syndrome, the soft spaces between the bones fuse together before the child is born. The fusion can occur in only one or in several of the spaces of the head.

Carpenter Syndrome is extremely rare and only about 70 cases are known. Because of this, it is difficult to study.

There are two subtypes based on the location of the faulty gene causing the syndrome:

  • Carpenter syndrome type 1
  • Carpenter syndrome type 2

Symptoms

The early fusing of a child’s head can cause the child’s skull and face to appear pointed or misshapen. Some other associated symptoms include:

  • Widely spaced eyes
  • Unusually shaped eyes
  • Webbed feet
  • Extra fingers or toes
  • Fingers or toes joined together
  • Learning disabilities
  • Heart problems
  • Shorter than average height
  • Obesity
  • Undescended testes in males
  • Hearing loss
  • Vision problems
  • Dental problems

The severity of these symptoms varies from patient to patient and even between affected members of the same family. Not all patients will show all symptoms.

Causes

Carpenter syndrome is caused by a faulty gene on either chromosome 6 or chromosome 19. Carpenter syndrome type 1 is associated with the gene on chromosome 6. Carpenter syndrome type 2 is associated with the gene on chromosome 19.

Every person inherits two sets of 23 chromosomes from each parent. To get Carpenter syndrome, a person must inherit the faulty gene from both parents. It appears that males and females are affected equally.

Diagnosis

Most children are diagnosed at birth or shortly afterward. Doctors may request routine blood tests or imaging to determine what is causing the baby’s symptoms. Because the symptoms of Carpenter syndrome are like those of other diseases, it can take some time to make the diagnosis.

Genetic testing that shows the typical faulty genes is the final diagnostic tool. This is usually a blood test. As with all genetic testing, the patient and family members should speak with a genetic counsellor prior to having the test.

Treatment

Unfortunately, there is no cure for Carpenter syndrome. Treatment aims to correct a patient’s symptoms. Potential options include:

  • Surgery to relieve pressure on the growing brain
  • Surgery to correct the premature fusion of skull bones
  • Surgery to correct finger and toe abnormalities
  • Surgery to correct any heart problems

Patients with Carpenter syndrome usually require a team-based approach to treatment. Team members may include:

  • Paediatrician
  • Specialist surgeons of the skull and face
  • Neurosurgeon (in case of brain surgery)
  • Cardiologist (heart doctor)
  • Audiologist (to assess for hearing)
  • Ophthalmologist (eye doctor)
  • Speech, occupational, and physical therapists to help with everyday life
  • Educational support
  • Psychological support

Complications

Complications of Carpenter syndrome vary from patient to patient because of the differences in disease severity. Some patients become independent adults. Others require support throughout their lives. Associated heart disease can shorten the lifespan.

Prevention

If a person knows they are a carrier of the gene for Carpenter syndrome, they and their partner should consider genetic testing prior to attempting to conceive.

 
 
 

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