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Down Syndrome Abstract
of the Month: Oct 2002

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Age-related changes in anthropometric measurements in the craniofacial regions and in height in Down's syndrome

Farkas LG, Katic MJ, Forrest CR
J Craniofac Surg 2002 Sep;13(5):614-22

Center for Craniofacial Care and Research, The Hospital for Sick Children, and the Division of Plastic Surgery, University of Toronto, Ontario, Canada.

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This cross-sectional study analyzed age-related changes in normal and abnormal measurements of the head and face in three age categories in 115 Down's syndrome patients 1 to 36 years old. The frequency of normal measurements significantly surpassed that of abnormal ones in each category. Clinically, the key task was to ascertain differences between the youngest and oldest patients. In age group 1 (1 to 5 years), normal measurements in three of the six craniofacial regions were significantly more frequent than abnormal ones. In age group 2 (6 to 15 years) the percentage of normal measurements significantly increased, influenced by higher growth rates in the period of maturation, which coincided with this category. In age group 3 (16 to 36 years) the percentage of normal measurements significantly increased in the head and ear but decreased in the other regions, significantly in the orbits. The frequency of both optimal and severely abnormal measurements changed significantly from age group 1 to 3 in only five measurements each, with no consistency in the direction of results. Abnormal measurements qualified as stigmata and were recorded in 40% (10 of 25) in five regions: three in the face; two in each of the head, orbits, and ears; and one in the nose. Marked epicanthi covering the endocanthion decreased from 35.0% in age group 1 to 8.7% in group 3. In age group 1, the frequency of normal body height (20.7%) in both sexes was significantly less than subnormal (70.3%) but significantly decreased in age group 2. Mean height in group 3 was enough to rule out short stature as a stigmata of Down's syndrome. The study was limited by small numbers, particularly in the variations of normal and abnormal, but the trend toward normality after maturation suggests that reconstructive surgery should be delayed until this time.

My comments:

I'm not a fan of plastic surgery in children with DS. If the surgery is designed to increase function, such as repair of a cleft palate, that's one thing. But my personal opinion is that repair of the face of a child with DS just to make the child look more "normal" is undesirable. Having said that, the reason for my choosing this article as an Abstract of the Month is to show parents of young children with DS how they might expect the face to change as the child ages.

The authors looked at 25 different measurements of the face, divided into the five regions of head, face, orbits, nose, lip/mouth and ear. The number of abnormal measurements was higher in the age range of 1 to 5 years, and lowest in the 16 to 36 year range. It was also apparent that the face continued to "normalize" even after final height was reached. This result argues for waiting for plastic reconstructive surgery until after the face has fully matured.

I have to note that the best way to do this research would be to study a number of children with DS starting from birth and then make the measurements on these same children as they age, but I don't think that you can get a group of researchers to stick together for 20 years.

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