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Three-Dimensional Assessment of Facial Development in Children With Pierre Robin Sequence

Krimmel, Michael MD, DMD, PhD*; Kluba, Susanne MD, DMD*; Breidt, Martin MSc; Bacher, Margit DDS; Dietz, Klaus PhD§; Buelthoff, Heinrich PhD; Reinert, Siegmar MD, DMD, PhD*

Journal of Craniofacial Surgery: November 2009 - Volume 20 - Issue 6 - p 2055-2060
doi: 10.1097/SCS.0b013e3181be87db
Original Articles

Newborns with Pierre Robin sequence (PRS) have mandibular hypoplasia, glossoptosis, and possibly cleft palate. Their facial appearance is characteristic. The further facial development is controversial. The aim of this study was to analyze the facial development of children with PRS.

In a prospective, cross-sectional study, 344 healthy children and 37 children with PRS and cleft palate younger than 8 years were scanned three-dimensionally. Twenty-one standard anthropometric landmarks were identified, and the images were superimposed. Growth curves for normal facial development were calculated. The facial morphology of children with PRS was compared with that of healthy children.

The facial growth of children with PRS in the transversal and vertical direction was normal. In the sagittal direction, the mandibular deficit was confirmed. Except for the orbital landmarks and nasion, all landmarks of the midface demonstrated a significant sagittal deficit. This difference to healthy children remained constant for all ages.

Our study cannot support the theory of mandibular catch-up growth. The sagittal deficit of the midface could be observed in all ages. This indicates that children with PRS have a very early, severe, and persistent underdevelopment of this part of the face. We conclude that this disturbance must be addressed in early childhood with orthodontic and speech therapy.

From the *Department of Oral and Maxillofacial Surgery, University of Tübingen; †Max Planck Institute for Biological Cybernetics, Tübingen; and Departments of ‡Orthodontics and §Medical Biometry, University of Tübingen, Germany.

Received June 30, 2009.

Accepted for publication July 12, 2009.

Address correspondence and reprint requests to Michael Krimmel, MD, DMD, PhD, Klinik und Poliklinik für Mund-, Kiefer-, und Gesichtschirurgie, Osianderstr. 2-8, D-72076 Tübingen, Germany; E-mail:

© 2009 Mutaz B. Habal, MD