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Stickler syndrome is a group of hereditary conditions characterized by a distinctive facial appearance, eye abnormalities, hearing loss, and joint problems. These signs and symptoms vary widely among affected individuals.
A characteristic feature of Stickler syndrome is a somewhat flattened facial appearance. This is caused by underdeveloped bones in the middle of the face, including the cheekbones and the bridge of the nose. A particular group of physical features, called Pierre Robin sequence, is also common in people with Stickler syndrome. Robin sequence includes an opening in the roof of the mouth (a cleft palate), a tongue that is placed further back than normal (glossoptosis), and a small lower jaw (micrognathia). This combination of features can lead to feeding problems and difficulty breathing.
Many people with Stickler syndrome have severe nearsightedness (high myopia). In some cases, the clear gel that fills the eyeball (the vitreous) has an abnormal appearance, which is visible upon eye examination. Other eye problems are also common, including increased pressure within the eye (glaucoma), clouding of the lens of the eyes (cataracts), and tearing of the lining of the eye (retinal detachment). These eye abnormalities can cause impaired vision or blindness in some cases.
Another feature of Stickler syndrome is hearing loss. The degree of hearing loss varies among affected individuals and may become more severe over time.
Most people with Stickler syndrome have skeletal abnormalities that affect the joints. The joints of affected children and young adults may be loose and very flexible (hypermobile), though joints become less flexible with age. Arthritis often appears early in life and may cause joint pain or stiffness. Problems with the bones of the spine (vertebrae) may also occur, including abnormal curvature of the spine (scoliosis or kyphosis) and flattened vertebrae (platyspondyly). These spinal abnormalities may cause back pain.
Researchers have described several types of Stickler syndrome, which are distinguished by their genetic cause and their characteristic signs and symptoms. In particular, the eye abnormalities and severity of hearing loss differ among the types. Type I has the highest risk of retinal detachment. Type II also includes eye abnormalities, but type III does not (and is often called non-ocular Stickler syndrome). Types II and III are more likely than type I to have hearing loss. Types IV and V are very rare and have only been diagnosed in a few individuals.
A similar condition called Marshall syndrome is characterized by a distinctive facial appearance, eye abnormalities, hearing loss, and early-onset arthritis. Marshall syndrome can also include short stature, which is typically not seen in people with Stickler syndrome. Whether Marshall syndrome represents a variant of Stickler syndrome or a separate disorder is controversial.
Stickler syndrome affects an estimated 1 in 7,500 to 9,000 newborns.
Mutations in the COL2A1, COL11A1, COL11A2, COL9A1, and COL9A2 genes cause Stickler syndrome types I through V, respectively. Marshall syndrome, which may be a variant of Stickler syndrome, results from mutations in the COL11A1 gene.
The genes listed above are involved in the production of three types of collagen: type II, type IX, and type XI. Collagens are complex molecules that provide structure and strength to connective tissues that support the body's joints and organs. Type II, type IX, and type XI collagen are components of vitreous, cartilage, and other connective tissues.
Mutations in any one of these genes impair the production, processing, or assembly of type II, type IX, or type XI collagen. Defective collagen molecules or reduced amounts of collagen disrupt the development of connective tissues, leading to the characteristic features of Stickler syndrome.
Not all individuals with Stickler syndrome have mutations in one of the known genes. Researchers believe that mutations in other genes may also cause this condition, but those genes have not been identified.
Changes in these genes are associated with Stickler syndrome.
Types I, II, and III Stickler syndrome (caused by mutations in the COL2A1, COL11A1, and COL11A2 genes) are inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In some cases, an affected person inherits a gene mutation from one affected parent. Other cases may result from new mutations. These cases occur in people with no history of Stickler syndrome in their family.
Marshall syndrome also has an autosomal dominant pattern of inheritance.
Types IV and V Stickler syndrome (resulting from mutations in the COL9A1 or COL9A2 gene) are inherited in an autosomal recessive pattern. Autosomal recessive inheritance means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.
These resources address the diagnosis or management of Stickler syndrome and may include treatment providers.
You might also find information on the diagnosis or management of Stickler syndrome in Educational resources (http://www.ghr.nlm.nih.gov/condition/stickler-syndrome/show/Educational+resources) and Patient support (http://www.ghr.nlm.nih.gov/condition/stickler-syndrome/show/Patient+support).
General information about the diagnosis (http://ghr.nlm.nih.gov/handbook/consult/diagnosis) and management (http://ghr.nlm.nih.gov/handbook/consult/treatment) of genetic conditions is available in the Handbook. Read more about genetic testing (http://ghr.nlm.nih.gov/handbook/testing), particularly the difference between clinical tests and research tests (http://ghr.nlm.nih.gov/handbook/testing/researchtesting).
To locate a healthcare provider, see How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.
You may find the following resources about Stickler syndrome helpful. These materials are written for the general public.
You may also be interested in these resources, which are designed for healthcare professionals and researchers.
For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines (http://ghr.nlm.nih.gov/ConditionNameGuide) and How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.
Ask the Genetic and Rare Diseases Information Center (http://rarediseases.info.nih.gov/GARD/).
arthritis ; autosomal ; autosomal dominant ; autosomal recessive ; cartilage ; cell ; cleft palate ; collagen ; dysplasia ; gene ; glaucoma ; hereditary ; inheritance ; inherited ; joint ; lower jaw ; micrognathia ; mutation ; myopia ; nearsightedness ; palate ; pattern of inheritance ; recessive ; scoliosis ; short stature ; stature ; syndrome
You may find definitions for these and many other terms in the Genetics Home Reference Glossary (http://www.ghr.nlm.nih.gov/glossary).
The resources on this site should not be used as a substitute for professional medical care or advice. Users seeking information about a personal genetic disease, syndrome, or condition should consult with a qualified healthcare professional. See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.