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X-linked Cleft Palate via the TBX22 Gene

Summary and Pricing

Test Method

Exome Sequencing with CNV Detection
Test Code Test Copy GenesTest CPT Code Gene CPT Codes Copy CPT Codes Base Price
TBX22 81479 81479,81479 $990
Test Code Test Copy Genes Test CPT Code Gene CPT Codes Copy CPT Code Base Price
12089TBX2281479 81479,81479 $990 Order Options and Pricing

An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.

Click here for costs to reflex to whole PGxome (if original test is on PGxome Sequencing platform).

Click here for costs to reflex to whole PGnome (if original test is on PGnome Sequencing platform).

Turnaround Time

3 weeks on average for standard orders or 2 weeks on average for STAT orders.

Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.

Targeted Testing

For ordering sequencing of targeted known variants, go to our Targeted Variants page.


Genetic Counselors


  • Stela Berisha, PhD, FACMG

Clinical Features and Genetics

Clinical Features

Pathogenic variants in the TBX22 gene are associated with X-linked cleft palate (CPX) and Abruzzo-Erickson syndrome. CPX is a non-syndromic (isolated) form of cleft palate. The palatal phenotype ranges from a high arched palate, bifid uvula or submucous cleft to complete cleft of the secondary palate (Baybrook et al. 2001. PubMed ID: 11559848; Marcano et al. 2004. PubMed ID: 14729838). Velopharyngeal insufficiency and ankyloglossia may accompany palatal anomalies or occur in isolation. Although CPX predominantly affects males, a proportion of carrier females present with ankyloglossia with or without cleft palate, bifid uvula or velopharyngeal insufficiency (Baybrook et al. 2001. PubMed ID: 11559848; Marcano et al. 2004. PubMed ID: 14729838).

At the other end of the spectrum is Abruzzo-Erickson syndrome, a rare syndromic form of cleft palate. To date, a single multigenerational family with this syndrome has been reported (Abruzzo and Erickson. 1977. PubMed ID: 839509; Pauws et al. 2013. PubMed ID: 22784330). The clinical features of Abruzzo-Erickson syndrome in this family include cleft palate, palatal rugosity, coloboma, malar hypoplasia, large ears, hearing impairment, hypospadias, radioulnar synostosis, wide-spaced second and third fingers, and short stature.


CPX and Abruzzo-Erickson syndrome are inherited in an X-linked dominant manner, although the phenotype displays incomplete dominance in females. The clinical phenotype in affected males is the result of complete loss of TBX22 protein function, whilst the clinical phenotype in females is a consequence of haploinsufficiency. Pathogenic frameshift, missense, nonsense, and splice site variants in TBX22 have been reported to cause CPX (Braybrook et al. 2002. PubMed ID: 12374769; Marcano et al. 2004. PubMed ID: 14729838; Pauws et al. 2013. PubMed ID: 22784330). Pathogenic missense variants causing CPX are localized to the highly conserved TBX22 DNA-binding T box domain and likely result in loss of function (Braybrook et al. 2002. PubMed ID: 12374769; Pauws et al. 2009. PubMed: 19648124). A single pathogenic TBX22 splice site variant has been reported to cause Abruzzo-Erickson syndrome (Abruzzo and Erickson. 1977. PubMed ID: 839509; Pauws et al. 2013. PubMed ID: 22784330).

TBX22 encodes the T-box 22 protein. This protein is a T-box-containing transcription factor that is primarily expressed in the palatal shelves and lingual frenulum during palatogenesis in the developing embryo (Braybrook et al. 2002. PubMed ID: 12374769). Studies of TBX22 null mice suggest that loss of TBX22 function results in a failure of palatal osteoblast differentiation and maturation, which reduces ossification and leads to craniofacial anomalies (Pauws et al. 2009. PubMed ID: 19648291).

Clinical Sensitivity - Sequencing with CNV PGxome

Up to 5% of unselected cases with non-syndromic cleft palate may be explained by pathogenic variants in the TBX22 gene (Marcano et al. 2004. PubMed ID: 14729838). The clinical sensitivity increases if individuals are selected based on a positive personal and family history of X-linked cleft palate and ankyloglossia (Braybrook et al. 2001. PubMed ID: 11559848).

Testing Strategy

This test provides full coverage of all coding exons of the TBX22 gene plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define full coverage as >20X NGS reads or Sanger sequencing. PGnome panels typically provide slightly increased coverage over the PGxome equivalent. PGnome sequencing panels have the added benefit of additional analysis and reporting of deep intronic regions (where applicable).

Dependent on the sequencing backbone selected for this testing, discounted reflex testing to any other similar backbone-based test is available (i.e., PGxome panel to whole PGxome; PGnome panel to whole PGnome).

Indications for Test

Candidates for testing include individuals with ankyloglossia, cleft palate with or without ankyloglossia or a family history consistent with a familial form of X-linked cleft palate. Individuals with a personal or family history consistent with X-linked Abruzzo-Erickson syndrome may also consider testing.


Official Gene Symbol OMIM ID
TBX22 300307
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT


Name Inheritance OMIM ID
Abruzzo-Erickson syndrome XL 302905
Cleft Palate X-Linked XL 303400


  • Abruzzo and Erickson. 1977. PubMed ID: 839509
  • Braybrook et al. 2001. PubMed ID: 11559848
  • Braybrook et al. 2002. PubMed ID: 12374769
  • Marçano et al. 2004. PubMed ID: 14729838
  • Pauws et al. 2009. PubMed ID: 19648291
  • Pauws et al. 2013. PubMed ID: 22784330


Ordering Options

We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.

myPrevent - Online Ordering

  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • PGnome sequencing panels can be ordered via the myPrevent portal only at this time.

Requisition Form

  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.

For Requisition Forms, visit our Forms page

If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.

Specimen Types

Specimen Requirements and Shipping Details

PGxome (Exome) Sequencing Panel

PGnome (Genome) Sequencing Panel

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Note: acceptable specimen types are whole blood and DNA from whole blood only.
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