Laser light scan analysis of the "anticonvulsant face"

Abstract

Background: The "anticonvulsant face," with a short nose, broad nasal bridge, epicanthal folds, and wide mouth, was described in the 1970s in children who had been exposed during pregnancy to the anticonvulsant drugs phenytoin and phenobarbital. The laser light scan makes it possible to establish three-dimensional positions of physical features and to determine more objectively the changes in the size and shape of the affected soft tissues of the faces of children exposed to these anticonvulsant drugs during pregnancy.

Methods: Thirteen individuals, exposed throughout pregnancy to phenytoin as either monotherapy or polytherapy, were identified in a previous analysis as having significant changes in their craniofacial features based on measurements of cephalometric radiographs. Those changes were associated with midface hypoplasia and a short nose, features of the "anticonvulsant face." The soft tissues of their faces have been evaluated with laser light scans.

Results: The notable changes in soft tissues identified by laser light scans were a wide philtrum (cph-cph), narrow mouth (ch-ch), short nasal bridge (n-prn), shortened nose height (n-sn), and flattened orbits (orbital protrusion index).

Conclusion: This analysis of the facial features of phenytoin-exposed individuals, selected because of changes in their craniofacial bony structures, showed that there were several significant changes, two of which, widening of the philtrum and a small mouth, have not been described previously as part of this phenotype.

Keywords: anticonvulsants; laser light scanner; structured light scanner; the “anticonvulsant face”.

Figure 1

A view of part of the face of a participant, showing landmark placement with numbered dots. The numbers refer to landmarks listed in Table 1.This child has the anteverted nostrils, short nose and long upper lip of the “anticonvulsant face”.

Figure 2

Shows the abbreviations of the soft tissue landmarks, listed in Table 1, in a frontal photograph. This child had not been exposed during pregnancy to an anticonvulsant drug.