✅Thalassemic or Chipmunk facies *Chipmunk facies also seen in parotid enlargement and Bullimia nervosa Due to excessive hemolysis, there is increased production of erythropoietin wch inturn causes extensive marrow expansion leading to frontal bossing, maxillary marrow hyperplasia..also there will be malocclusion of teeth and depressed nasal bridge.. THALASSEMIA * thalassa = sea ,emia= blood *Autosomal recessive *disease first described in people of Mediterranean ethnicity.. So beta thalassemia major or Cooleys anemia is also known as Mediterranean anemia. * alpha thalassemia Chromosome no 16p HbA1 & HbA2 genes * beta thalassemia Chromosome no 11 HbB gene *Investigation: - Peripheral smeae- microcytic hypochromic anemia wth target cells, basophilic stippling ,tear drop cells ,nucleated RBCs however retic count is low. - Hb electrophoresis and HPLC shows increased HbA2 - X Ray skull- hot cros bun configuration, wide diploic spaces, hair on end appearance *Treatment: -Regular blood transfusion -Iron chelators -Bone marrow transplant
Mumps enlargement should be near external acoustic meatus since parotid gland is located there ...not in front near the nose
