Morphometric analysis of prenatally exposed children to anticonvulsant drugs

Abstract

OBJECTIVE: To evaluate the morphometric effect of prenatal exposure to phenytoin, phenobarbital and carbamazepine on the shape of the maxilla the posterior and overall cranial base. MATERIAL AND METHODS: Sample selection: This study is a retrospective analyses of lateral cephalograms of 67 (Phenobarbital =21, Phenytoin=21, Carbamazepine=25) children age 6 to 16 who had been exposed prenatally to one of these drugs and compared to a control group of 44 unexposed children of the same age. Cephalometric films were digitized and anatomical landmarks identified by a single investigator. Landmarks were chosen to outline the maxilla, the posterior and overall cranial base. Morphometric analysis including Procrustes superimposition was used to compare the exposed children to the control group. Principal components analysis (PCA) and MANOVA tests were performed to determine the differences between the two groups. RESULTS: The superimposed average showed a significant difference between the two groups. In the exposed group, the anterior cranial base was vertically shorter. Glabella was more inferior and anterior relative to nasion, and the nasal tip was more superior and posterior. Orbitale was more inferior and posterior, suggesting a more posterior articulation with maxilla. The posterior cranial base was vertically taller and sagittally shorter. Also in the exposed group, the maxilla was vertically shorter. CONCLUSION: These results demonstrate a shorter, retrusive maxilla that articulates more posteriorly with a shorter anterior cranial base, confirming the midface hypoplasia of traditional anticonvulsant facies.