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Klippel-Feil anomaly-myopathy-facial dysmorphism syndrome(KFS4)

MedGen UID:
894399
Concept ID:
C4225285
Disease or Syndrome
Synonyms: Klippel-Feil syndrome 4, autosomal recessive, with myopathy and facial dysmorphism; Klippel-feil syndrome 4, autosomal recessive, with nemaline myopathy and facial dysmorphism
SNOMED CT: Klippel-Feil anomaly, myopathy, facial dysmorphism syndrome (1217225001)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): MYO18B (22q12.1)
 
Monarch Initiative: MONDO:0014689
OMIM®: 616549
Orphanet: ORPHA447974

Definition

Klippel-Feil syndrome-4 with nemaline myopathy and facial dysmorphism (KFS4) is an autosomal recessive disorder characterized mainly by severe hypotonia apparent from infancy. Klippel-Feil anomaly is primarily defined by fusion of the cervical spine, with associated low posterior hairline and limited neck mobility being observed in about half of patients (summary by Alazami et al., 2015). For a general description and a discussion of genetic heterogeneity of Klippel-Feil syndrome, see KFS1 (118100). [from OMIM]

Clinical features

From HPO
Acetabular dysplasia
MedGen UID:
233069
Concept ID:
C1328407
Anatomical Abnormality
A smaller than normal acetabulum that has insufficient femoral head coverage leading to abnormal hip joint contact pressures, instability and pain.
Cardiomyopathy
MedGen UID:
209232
Concept ID:
C0878544
Disease or Syndrome
A myocardial disorder in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease sufficient to cause the observed myocardial abnormality.
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
Low-set ears
MedGen UID:
65980
Concept ID:
C0239234
Congenital Abnormality
Upper insertion of the ear to the scalp below an imaginary horizontal line drawn between the inner canthi of the eye and extending posteriorly to the ear.
Motor delay
MedGen UID:
381392
Concept ID:
C1854301
Finding
A type of Developmental delay characterized by a delay in acquiring motor skills.
Klippel-Feil syndrome
MedGen UID:
9645
Concept ID:
C0022738
Disease or Syndrome
Klippel-Feil syndrome (KFS) is a congenital anomaly characterized by a defect in the formation or segmentation of the cervical vertebrae, resulting in a fused appearance. The clinical triad consists of short neck, low posterior hairline, and limited neck movement, although less than 50% of patients demonstrate all 3 clinical features (Tracy et al., 2004). Genetic Heterogeneity of Klippel-Feil Syndrome Additional forms of KFS include autosomal recessive KFS2 (214300), caused by mutation in the MEOX1 gene (600147) on chromosome 17q21, autosomal dominant KFS3 (613702), caused by mutation in the GDF3 gene (606522) on chromosome 12p13, and autosomal recessive KFS4 (616549), caused by mutation in the MYO18B gene (607295) on chromosome 22q12. See also MURCS association (601076), in which Klippel-Feil anomaly is associated with urogenital anomalies.
Micrognathia
MedGen UID:
44428
Concept ID:
C0025990
Congenital Abnormality
Developmental hypoplasia of the mandible.
Myopathy
MedGen UID:
10135
Concept ID:
C0026848
Disease or Syndrome
A disorder of muscle unrelated to impairment of innervation or neuromuscular junction.
Flexion contracture
MedGen UID:
83069
Concept ID:
C0333068
Anatomical Abnormality
A flexion contracture is a bent (flexed) joint that cannot be straightened actively or passively. It is thus a chronic loss of joint motion due to structural changes in muscle, tendons, ligaments, or skin that prevents normal movement of joints.
Thoracolumbar scoliosis
MedGen UID:
196671
Concept ID:
C0749379
Anatomical Abnormality
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Nemaline bodies
MedGen UID:
814369
Concept ID:
C3808039
Finding
Nemaline rods are abnormal bodies that can occur in skeletal muscle fibers. The rods can be observed on histological analysis of muscle biopsy tissue or upon electron microscopy, where they appear either as extensions of sarcomeric Z-lines, in random array without obvious attachment to Z-lines (often in areas devoid of sarcomeres) or in large clusters localized at the sarcolemma or intermyofibrillar spaces.
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.
Webbed neck
MedGen UID:
113154
Concept ID:
C0221217
Congenital Abnormality
Pterygium colli is a congenital skin fold that runs along the sides of the neck down to the shoulders. It involves an ectopic fibrotic facial band superficial to the trapezius muscle. Excess hair-bearing skin is also present and extends down the cervical region well beyond the normal hairline.
Bulbous nose
MedGen UID:
66013
Concept ID:
C0240543
Finding
Increased volume and globular shape of the anteroinferior aspect of the nose.
High palate
MedGen UID:
66814
Concept ID:
C0240635
Congenital Abnormality
Height of the palate more than 2 SD above the mean (objective) or palatal height at the level of the first permanent molar more than twice the height of the teeth (subjective).
Short neck
MedGen UID:
99267
Concept ID:
C0521525
Finding
Diminished length of the neck.
Underdeveloped nasal alae
MedGen UID:
322332
Concept ID:
C1834055
Congenital Abnormality
Thinned, deficient, or excessively arched ala nasi.
Narrow forehead
MedGen UID:
326956
Concept ID:
C1839758
Finding
Width of the forehead or distance between the frontotemporales is more than two standard deviations below the mean (objective); or apparently narrow intertemporal region (subjective).
Everted lower lip vermilion
MedGen UID:
344003
Concept ID:
C1853246
Finding
An abnormal configuration of the lower lip such that it is turned outward i.e., everted, with the Inner aspect of the lower lip vermilion (normally opposing the teeth) being visible in a frontal view.
Low posterior hairline
MedGen UID:
383755
Concept ID:
C1855728
Finding
Hair on the neck extends more inferiorly than usual.
Long philtrum
MedGen UID:
351278
Concept ID:
C1865014
Finding
Distance between nasal base and midline upper lip vermilion border more than 2 SD above the mean. Alternatively, an apparently increased distance between nasal base and midline upper lip vermilion border.
Thin upper lip vermilion
MedGen UID:
355352
Concept ID:
C1865017
Finding
Height of the vermilion of the upper lip in the midline more than 2 SD below the mean. Alternatively, an apparently reduced height of the vermilion of the upper lip in the frontal view (subjective).
Ptosis
MedGen UID:
2287
Concept ID:
C0005745
Disease or Syndrome
The upper eyelid margin is positioned 3 mm or more lower than usual and covers the superior portion of the iris (objective); or, the upper lid margin obscures at least part of the pupil (subjective).

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  

Professional guidelines

PubMed

Jae-Min Park A, Nelson SE, Mesfin A
JBJS Rev 2022 Feb 15;10(2) doi: 10.2106/JBJS.RVW.21.00166. PMID: 35171878
Litrenta J, Bi AS, Dryer JW
J Am Acad Orthop Surg 2021 Nov 15;29(22):951-960. doi: 10.5435/JAAOS-D-21-00190. PMID: 34288888
Tachdjian MO
Pediatr Clin North Am 1967 May;14(2):307-58. doi: 10.1016/s0031-3955(16)31980-0. PMID: 5337113

Recent clinical studies

Etiology

Jae-Min Park A, Nelson SE, Mesfin A
JBJS Rev 2022 Feb 15;10(2) doi: 10.2106/JBJS.RVW.21.00166. PMID: 35171878
Lee CY, Wu CL, Chang HK, Wu JC, Huang WC, Cheng H, Tu TH
Clin Neurol Neurosurg 2021 Oct;209:106934. Epub 2021 Sep 3 doi: 10.1016/j.clineuro.2021.106934. PMID: 34543827
Mancarella C, Delfini R, Landi A
Acta Neurochir Suppl 2019;125:89-95. doi: 10.1007/978-3-319-62515-7_13. PMID: 30610307
O'Donnel DP, Seupaul RA
Am J Emerg Med 2008 Feb;26(2):252.e1-2. doi: 10.1016/j.ajem.2007.04.017. PMID: 18272131
Smith BA, Griffin C
Ann Emerg Med 1992 Jul;21(7):876-9. doi: 10.1016/s0196-0644(05)81038-8. PMID: 1610048

Diagnosis

Jae-Min Park A, Nelson SE, Mesfin A
JBJS Rev 2022 Feb 15;10(2) doi: 10.2106/JBJS.RVW.21.00166. PMID: 35171878
Litrenta J, Bi AS, Dryer JW
J Am Acad Orthop Surg 2021 Nov 15;29(22):951-960. doi: 10.5435/JAAOS-D-21-00190. PMID: 34288888
Frikha R
Clin Dysmorphol 2020 Jan;29(1):35-37. doi: 10.1097/MCD.0000000000000301. PMID: 31577545
Mancarella C, Delfini R, Landi A
Acta Neurochir Suppl 2019;125:89-95. doi: 10.1007/978-3-319-62515-7_13. PMID: 30610307
McBride WZ
Am Fam Physician 1992 Feb;45(2):633-5. PMID: 1739048

Therapy

Zou Q, Wang L, Yang X, Song Y, Liu L, Wang L, Zhou Z, Hu B, Chen T, Liu H
BMC Musculoskelet Disord 2022 Feb 7;23(1):123. doi: 10.1186/s12891-022-05072-8. PMID: 35130887Free PMC Article
Čota S, Žagar I, Delimar V, Pap M, Perić D, Perić P
Rheumatol Int 2019 Sep;39(9):1655-1660. Epub 2019 Jun 18 doi: 10.1007/s00296-019-04346-0. PMID: 31214770
Park JH, Tai K, Sato Y, Nishiyama A, Shin JW
Pediatr Dent 2012 Mar-Apr;34(2):e35-9. PMID: 22583876
Harvey EJ, Bernstein M, Desy NM, Saran N, Ouellet JA
J Am Acad Orthop Surg 2012 Mar;20(3):177-86. doi: 10.5435/JAAOS-20-03-177. PMID: 22382290
Daniilidis J, Maganaris T, Dimitriadis A, Iliades T, Manolidis L
Laryngoscope 1978 Jul;88(7 Pt 1):1178-83. doi: 10.1002/lary.1978.88.7.1178. PMID: 672351

Prognosis

Courvoisier A
Orthop Traumatol Surg Res 2023 Feb;109(1S):103459. Epub 2022 Oct 24 doi: 10.1016/j.otsr.2022.103459. PMID: 36302448
Frikha R
Clin Dysmorphol 2020 Jan;29(1):35-37. doi: 10.1097/MCD.0000000000000301. PMID: 31577545
Čota S, Žagar I, Delimar V, Pap M, Perić D, Perić P
Rheumatol Int 2019 Sep;39(9):1655-1660. Epub 2019 Jun 18 doi: 10.1007/s00296-019-04346-0. PMID: 31214770
Tracy MR, Dormans JP, Kusumi K
Clin Orthop Relat Res 2004 Jul;(424):183-90. PMID: 15241163
McBride WZ
Am Fam Physician 1992 Feb;45(2):633-5. PMID: 1739048

Clinical prediction guides

Goel A, Vutha R, Shah A
Adv Tech Stand Neurosurg 2023;46:125-147. doi: 10.1007/978-3-031-28202-7_7. PMID: 37318573
Lee CY, Wu CL, Chang HK, Wu JC, Huang WC, Cheng H, Tu TH
Clin Neurol Neurosurg 2021 Oct;209:106934. Epub 2021 Sep 3 doi: 10.1016/j.clineuro.2021.106934. PMID: 34543827
Litrenta J, Bi AS, Dryer JW
J Am Acad Orthop Surg 2021 Nov 15;29(22):951-960. doi: 10.5435/JAAOS-D-21-00190. PMID: 34288888
Altuame FD, Haldeman-Englert C, Cupler E, Al Muhaizea MA, Al-Zaidan HI, Hashem M, Alkuraya FS
Am J Med Genet A 2021 Feb;185(2):370-376. Epub 2020 Nov 11 doi: 10.1002/ajmg.a.61957. PMID: 33179433
Čota S, Žagar I, Delimar V, Pap M, Perić D, Perić P
Rheumatol Int 2019 Sep;39(9):1655-1660. Epub 2019 Jun 18 doi: 10.1007/s00296-019-04346-0. PMID: 31214770

Recent systematic reviews

Nie JW, Sadeh M, Almadidy Z, Callahan N, Neckrysh S
Oper Neurosurg (Hagerstown) 2023 Aug 1;25(2):117-124. Epub 2023 May 22 doi: 10.1227/ons.0000000000000754. PMID: 37219571

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