The authors report on the first case of OAVS (Oculo-AuriculoVertebral-Spectrum), with hemifacial microsomy, hydrocephalus, pubertas precox, thelarche at 4 years of age, vaginal bleeding at 5 years, and left ovary of adult type on echography (right ovary initially not visualized). FISH and CGH-ARRAYS methods were negative. By GnRH therapy the delay of onset puberty was obtained. The authors ascribe facial and ovary asymmetry to a derangement of blastogenesis, during which axial right-left structures begin the develop with consequent migration or interation with surrounding tissues of neural crest cells and alteration of diencephalic pituitary systems.
RiassuntoGli autori riportano il primo caso della letteratura di OAVS (OculoAuriculo-Vertebral-Spectrum) con asimmetria facciale, idrocefalo e pubertà precoce, con telarca insorto a 4 anni, perdite ematiche vaginali a 5 anni ed ovaio sn di tipo adulto, mentre il destro non era inizialmente visualizzato e negativi erano FISH e ARRAYS -CGH. Attribuiscono l'asimmetria facciale ed ovarica nella bambina ad un disturbo nella blastogenesi, epoca in cui si determinano gli assi corporei destro-sinistro, con successiva anomalia nella migrazione ed interazione delle cellule delle creste neurali con i tessuti ed in particolare con l'ipofisi ed il diencefalo.Segnalano i risultati positivi ottenuti sul rallentamento della pubertà mediante preparati a base di Gn RH.Oculo-auriculo-vertebral spectrum (OAVS) is relatively common condition, involving the structures derived from the branchial arches, but also other organs 1 We report on the first case of OAVS with precocious puberty. Family history of the patient, a female, included an aunt of her grandmother with right eye proptosis and microphthalmia, her mother with hearing loss, a brother with right hemifacial microsomia and right eye slight than left. The mother showed precocious cessation of menstruations (at 35 years of age). The patient was born by caesarean section, birth weight was 3150 gr, head circumference 38 cm. The baby presented respiratory distress, bilateral pes talo-valgus, feeding difficulties in the first months of life delayed developmental milestones, and frequent otitis. At 1 years 7 months of life, physical examination showed a female (Fig.1) in the 75 th percentile for height and in the 90 th percentile for weight (Italian growth charts). Frontal bossing, right eye microphthalmia with eyelid ptosis and strabismus were present. Palpebral fissures showed slight antimongoloid slant; eye movements were normal bilaterally. The face was asymmetric, with hemifacial microsomia, the chin was receding; mild malar hypoplasia, and the right ear set at a lower level than the left one were present. Ears presented bilaterally simple, with hypoplastic lobules, and were low set (Fig.2). Nasal root was flat and nasal pyramid was downturned. Malocclusion due to mandibular asymmetry, macrostomia, overjet and difficulties in chewing and swallowing were present. Teeth were small with some enamel dysplasias. The voice was na...