Skip Navigation
Genetics Home Reference: your guide to understanding genetic conditions     A service of the U.S. National Library of Medicine®

Nager syndrome

Reviewed July 2010

What is Nager syndrome?

Nager syndrome is a rare condition that mainly affects the development of the face, hands, and arms. The severity of this disorder varies among affected individuals.

Children with Nager syndrome are born with underdeveloped cheek bones (malar hypoplasia) and a very small lower jaw (micrognathia). They often have an opening in the roof of the mouth called a cleft palate. These abnormalities frequently cause feeding problems in infants with Nager syndrome. The airway is usually restricted due to the micrognathia, which can lead to life-threatening breathing problems.

People with Nager syndrome often have eyes that slant downward, absent eyelashes, and a notch in the lower eyelids called an eyelid coloboma. Many affected individuals have small or unusually formed ears, and about 60 percent have hearing loss caused by defects in the middle ear (conductive hearing loss). Nager syndrome does not affect a person's intelligence, although speech development may be delayed due to hearing impairment.

Individuals with Nager syndrome have bone abnormalities in their hands and arms. The most common abnormality is malformed or absent thumbs. Affected individuals may also have fingers that are unusually curved (clinodactyly) or fused together (syndactyly). Their forearms may be shortened due to the partial or complete absence of a bone called the radius. People with Nager syndrome sometimes have difficulty fully extending their elbows. This condition can also cause bone abnormalities in the legs and feet.

Less commonly, affected individuals have abnormalities of the heart, kidneys, genitalia, and urinary tract.

How common is Nager syndrome?

Nager syndrome is a rare condition, although its prevalence is unknown. More than 75 cases have been reported in the medical literature.

What genes are related to Nager syndrome?

The cause of Nager syndrome is unknown. Although the specific genes involved have not been identified, researchers believe that this condition is caused by changes in a particular region of chromosome 9 in some families.

Nager syndrome disrupts the development of structures called the first and second pharyngeal arches. The pharyngeal arches are five paired structures that form on each side of the head and neck during embryonic development. These structures develop into the bones, skin, nerves, and muscles of the head and neck. In particular, the first and second pharyngeal arches develop into the jaw, the nerves and muscles for chewing and facial expressions, the bones in the middle ear, and the outer ear. The cause of the abnormal development of the pharyngeal arches in Nager syndrome is unknown. It is also unclear why affected individuals have bone abnormalities in their arms and legs.

How do people inherit Nager syndrome?

Most cases of Nager syndrome are sporadic, which means that they occur in people with no history of the disorder in their family. Less commonly, this condition has been found to run in families. When the disorder is familial, it can have an autosomal dominant or an autosomal recessive pattern of inheritance.

Autosomal dominant inheritance means one copy of an altered gene in each cell is sufficient to cause the disorder, although no genes have been associated with Nager syndrome. In autosomal dominant Nager syndrome, an affected person usually inherits the condition from one affected parent.

Autosomal recessive inheritance means both copies of a gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of a mutated gene, but they typically do not show signs and symptoms of the condition. Nager syndrome is thought to have an autosomal recessive inheritance pattern when unaffected parents have more than one affected child.

The underlying genetic cause may differ among unrelated individuals with Nager syndrome, even among those with the same pattern of inheritance.

Where can I find information about diagnosis or management of Nager syndrome?

These resources address the diagnosis or management of Nager syndrome and may include treatment providers.

  • Foundation for Nager and Miller Syndromes (
  • Genetic Testing Registry: Nager syndrome (
  • University of California San Francisco Medical Center (

You might also find information on the diagnosis or management of Nager syndrome in Educational resources and Patient support.

General information about the diagnosis ( and management ( of genetic conditions is available in the Handbook. Read more about genetic testing (, particularly the difference between clinical tests and research tests (

To locate a healthcare provider, see How can I find a genetics professional in my area? ( in the Handbook.

Where can I find additional information about Nager syndrome?

You may find the following resources about Nager 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.

What other names do people use for Nager syndrome?

  • acrofacial dysostosis 1, Nager type
  • AFD1
  • NAFD
  • Nager acrofacial dysostosis
  • Nager acrofacial dysostosis syndrome
  • preaxial acrofacial dysostosis
  • preaxial mandibulofacial dysostosis

For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines ( and How are genetic conditions and genes named? ( in the Handbook.

What if I still have specific questions about Nager syndrome?

Ask the Genetic and Rare Diseases Information Center (

What glossary definitions help with understanding Nager syndrome?

autosomal ; autosomal dominant ; autosomal recessive ; cell ; chromosome ; cleft palate ; clinodactyly ; conductive hearing loss ; embryonic ; familial ; gene ; genitalia ; hypoplasia ; inheritance ; inheritance pattern ; lower jaw ; micrognathia ; palate ; pattern of inheritance ; prevalence ; recessive ; sporadic ; syndactyly ; syndrome

You may find definitions for these and many other terms in the Genetics Home Reference Glossary.


  • Couyoumjian CA, Treadwell MC, Barr M. Prenatal sonographic diagnosis of Nager acrofacial dysostosis with unilateral upper limb involvement. Prenat Diagn. 2008 Oct;28(10):964-6. doi: 10.1002/pd.2074. (
  • Halonen K, Hukki J, Arte S, Hurmerinta K. Craniofacial structures and dental development in three patients with Nager syndrome. J Craniofac Surg. 2006 Nov;17(6):1180-7. (
  • Herrmann BW, Karzon R, Molter DW. Otologic and audiologic features of Nager acrofacial dysostosis. Int J Pediatr Otorhinolaryngol. 2005 Aug;69(8):1053-9. Epub 2005 Mar 19. (
  • Ho AS, Aleshi P, Cohen SE, Koltai PJ, Cheng AG. Airway management in Nager Syndrome. Int J Pediatr Otorhinolaryngol. 2008 Dec;72(12):1885-8. doi: 10.1016/j.ijporl.2008.09.007. Epub 2008 Oct 22. (
  • Opitz C, Stoll C, Ring P. Nager syndrome. Problems and possibilities of therapy. J Orofac Orthop. 2000;61(4):226-36. Review. English, German. (


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? ( in the Handbook.

Reviewed: July 2010
Published: February 8, 2016