Cerebro-costo-mandibular Syndrome (CCM Syndrome or CCMS)

Cerebro-costo-mandibular Syndrome General Facts:

• Also known as CCM syndrome, CCMS, or rib gap syndrome.
• Cerebrocostomandibular syndrome is very rare condition.
• The genetic mechanism is uncertain.

Clinical Features:

• 11 pairs of ribs are usually present. The ribs characteristically have abnormal costovertebral articulations & posterior ossification gaps which resemble fractures.
• The posterior ossification gaps will ossify later in life.
• Neonatal respiratory distress is common due to flail chest & airway abnormalities.

Clinical Problems (Listed):

• HEENT - cleft palate, conductive hearing loss, glossoptosis, high arched palate, micrognathia
• Cardiac - congenital heart disease
• Respiratory - respiratory distress, tracheal abnormalities
• Skeletal - elbow hypoplasia, kyphosis, rib dysplasia, scoliosis, slow postnatal growth, vertebral fusion
• Neurological - microcephaly
• Psychiatric - mental retardation (+)
• Genitourinary - ectopic kidney
• Skin - excessive skin

Differential Diagnosis:

• Multiple fractures

Prognosis:

• Approximately 35% of babies with CCMS will die within one year.
• Mortality rate of as high as 56% - especially from early respiratory problems.
• Cerebral involvement is mostly related to hypoxia, so early recognition & intervention is very important.
• Development progresses well once the initial respiratory problems are survived. [1]
• Longterm life expectancy is thus related to early interventions & managing major developmental anomalies.

Management:

• Includes intensive care for improving neonatal respiratory function
• Prevention of feeding difficulties.
• Operative interventions - musculoskeletal, palatal or hearing problems.

References:

• [1] - Van den Ende JJ, Schrander-Stumpel C, Rupprecht E, Meinecke P, Maroteaux P, de Die-Smulders C, et al. The cerebro-costo-mandibular syndrome: seven patients and review of the literature. Clin Dysmorphol 1998;7:87-95.
• Hosalkar HS, Shaw BA, Ceppi CL, Ng BC. The cerebro-costo-mandibular syndrome: 9-year follow-up of a case. J Postgrad Med 2000;46:268
• Cerebrocostomandibular Syndrome (http://www.rare-disorders.com/cerebrocostomandibular.html)

Tags: Cerebro-costo-mandibular Syndrome - Microcephaly - Rib Dysplasia
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