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Other names: ACS
Syndactyly in acrocephalosyndactyly (Apert)
SpecialtyMedical genetics

Acrocephalosyndactyly is a group of autosomal dominant congenital disorders characterized by craniofacial (craniosynostosis) and hand and foot (syndactyly) abnormalities.[1] When polydactyly is present, the classification is acrocephalopolysyndactyly.[2] Acrocephalosyndactyly is mainly diagnosed postnatally, although prenatal diagnosis is possible if the mutation is known to be within the family genome.[1] Treatment often involves surgery in early childhood to correct for craniosynostosis[3] and syndactyly.[4]

Signs and symptoms

Acrocephalosyndactyly presents in numerous different subtypes, however, considerable overlap in symptoms occurs. Generally, all forms of acrocephalosyndactyly are characterized by craniofacial, hand, and foot abnormalities, such as premature closure of the fibrous joints in between certain bones of the skull,[5][6] fusion of certain fingers or toes,[7] and/or more than the normal number of digits.[8] Some subtypes also involve structural heart deformations that are present at birth.[1]


Most forms of acrocephalosyndactyly or acrocephalopolysyndactyly are inherited in autosomal dominant pattern,[1] with the exclusion of Carpenter Syndrome which is inherited in autosomal recessive manner. De-novo mutations in different genes were reported to cause several types of acrocephalosyndactyly. Among known genetic changes, there are mutations in genes such as Fibroblast growth factor receptor (FGFR),[5][6][9][10] TWIST1,[11] and RAB23.[12] Genetically inherited acrocephalosyndactyly disorders all show high to complete penetrance with a variable expression.[1] Increased paternal age is considered a risk factor in some cases.[1]


Prenatal Diagnosis

Prenatal diagnosis is an option in some forms of acrocephalosyndactyly. A prenatal genetic diagnosis is only possible if the gene mutation responsible for the syndrome is known and the mutation causing the disease has been identified within the family genome. This can be done using amniocentesis or chorionic villus sampling, which test the embryonic stem cells in the amniotic fluid or placental cells, respectively.[13] There has been a case of a prenatal diagnosis of Apert syndrome using fetoscopy.[14] Alternatively, there has been interest in using non-invasive techniques like ultrasound to detect fetal skull abnormalities.[15]

Postnatal Diagnosis

Most diagnoses of acrocephalosyndactyly occur after birth by assessing the physical symptoms of the infant. This can be supported with radiographic evaluation, such as X-ray imaging, and molecular genetic testing, which looks for DNA mutations known to cause the disease.[16][17] Molecular genetic testing typically occurs in the FGFR, TWIST1, and RAB23 genes.


a) Apert Syndrome- craniofacial features includes midface hypoplasia, and osseous syndactyly in hands and feet b) Skull computer tomography with 3D model reconstruction -several sutures synostosis and midface hypoplasia shown in lateral

There is no consistent nomenclature or classification across the different syndromes under the umbrella of acrocephalosyndactyly and acrocephalopolysyndactyly. Although acrocephalosyndactyly has been reported as early as the 18th century,[18] the ACS and ACPS classifications only came in the latter 20th century. However, this classification may be outdated as it has been suggested that the distinction between acrocephalosyndactyly and acrocephalopolysyndactyly should be erased.[2]

Currently, Noack syndrome (ACPS type I) is now classified as Pfeiffer syndrome (ACS type V);[19] Goodman syndrome (ACPS type IV) is classified as a variation of Carpenter syndrome (ACPS type II);[8] and different researchers have combined Apert (ASC type I), Crouzon (ASC type II), and Pfeiffer (ASC type V) syndrome into Apert-Crouzon[20] and Crouzon-Pfeiffer[21] syndrome.

Acrocephalosyndactyly type IV was formerly called Mohr Syndrome, however, it was later classified under Orofaciodigital syndrome type II.[22] Pfeiffer syndrome was formerly type VI and Waardenburg type V, but this was changed sometime after 1966.[23]  

Acrocephalosyndactyly (ACS):

A related term, acrocephalopolysyndactyly (ACPS), refers to the inclusion of polydactyly to the presentation. It also has multiple types:



For subtypes with craniosynostosis, surgery is required to prevent premature fusion of cranial sutures, such as the coronal suture (brachycephaly).[3] Cranioplasty should be performed the first year of life to prevent disruptions in brain growth due to increased intracranial pressure. Additionally, surgery may be required to improve appearance, especially in unilateral coronal synostosis (anterior plagiocephaly). Midface surgery may also be required in childhood to detach the midface from the rest of the skull to correct respiratory and orthodontic problems.[32][33]


Syndactyly in certain subtypes is rarely severe enough to affect hand function, so treatment may not be needed.[32]

In more severe subtypes, as seen in Apert syndrome, surgical correction of syndactyly may be needed. Surgery is recommended to be performed as soon as possible, generally at 4 months of age. Treatment is dependent on the severity of syndactyly. The surgical treatment generally involves interdigital webspace release and thumb lengthening.[4]

See also


  1. 1.0 1.1 1.2 1.3 1.4 1.5 Bissonnette, Bruno; Luginbuehl, Igor; Marciniak, Bruno; Dalens, Bernard J. (2006), "Acrocephalosyndactyly Syndromes", Syndromes: Rapid Recognition and Perioperative Implications, New York, NY: The McGraw-Hill Companies, archived from the original on 23 July 2023
  2. 2.0 2.1 Cohen, M. Michael; Kreiborg, Sven (May 1995). "Hands and feet in the Apert syndrome". American Journal of Medical Genetics. 57 (1): 82–96. doi:10.1002/ajmg.1320570119. ISSN 0148-7299. PMID 7645606. Archived from the original on 23 October 2022. Retrieved 23 April 2023.
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  5. 5.0 5.1 Wilkie, Andrew O. M.; Slaney, Sarah F.; Oldridge, Michael; Poole, Michael D.; Ashworth, Geraldine J.; Hockley, Anthony D.; Hayward, Richard D.; David, David J.; Pulleyn, Louise J.; Rutland, Paul; Malcolm, Susan; Winter, Robin M.; Reardon, William (February 1995). "Apert syndrome results from localized mutations of FGFR2 and is allelic with Crouzon syndrome". Nature Genetics. 9 (2): 165–172. doi:10.1038/ng0295-165. ISSN 1546-1718. PMID 7719344. S2CID 12423131. Archived from the original on 23 October 2022. Retrieved 23 April 2023.
  6. 6.0 6.1 Carinci, Francesco; Pezzetti, Furio; Locci, Paola; Becchetti, Ennio; Carls, Friedrick; Avantaggiato, Anna; Becchetti, Alessio; Carinci, Paolo; Baroni, Tiziano; Bodo, Maria (May 2005). "Apert and Crouzon Syndromes: Clinical Findings, Genes and Extracellular Matrix". Journal of Craniofacial Surgery. 16 (3): 361–368. doi:10.1097/01.SCS.0000157078.53871.11. ISSN 1049-2275. PMID 15915098. S2CID 23327865. Archived from the original on 5 November 2022. Retrieved 23 April 2023.
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