{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:42:17Z","timestamp":1760240537064,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T00:00:00Z","timestamp":1563235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Fetal alcohol spectrum disorder (FASD) is a developmental disorder with severe negative lifetime consequences for the affected person. Numerous diagnostic methods for facial assessment in FAS exist, but most of them are based on subjective evaluations. Our aim was therefore to find objective methods for the verification of FAS(D). Methods: 58 children (28 FAS; 30 controls) were examined prospectively. 3D facial scans were performed for each child and facial parameters at the mouth, nose and eye regions were measured and compared between the groups. Results: Significant differences could be found for the distance between right and left sulcus nasi at the transition point to the philtrum (p &lt; 0.001), for the inner canthal distance (p = 0.001) as well as for the right and left palpebral fissure length (p &lt; 0.001). No significant difference between the FAS and control children could be found for the measurements of mouth breadth (p = 0.267) and breadth between the left and right alares nasi (p = 0.260). Conclusions: Measurements of mouth breadth and nose breadth for the alares nasi are not suitable for FAS diagnosis. In contrast, digital contactless measurements of the distance between the right and left sulcus nasi at the transition point to the philtrum, as well as the inner canthal distance and palpebral fissure length of the left and right eyes, showed significant differences when comparing children with FAS to healthy controls. These measurements could thus be additional objective means for the verification of FAS.<\/jats:p>","DOI":"10.3390\/ijerph16142535","type":"journal-article","created":{"date-parts":[[2019,7,17]],"date-time":"2019-07-17T02:44:03Z","timestamp":1563331443000},"page":"2535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["3D-Analysis of Mouth, Nose and Eye Parameters in Children with Fetal Alcohol Syndrome (FAS)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8110-5829","authenticated-orcid":false,"given":"Moritz","family":"Blanck-Lubarsch","sequence":"first","affiliation":[{"name":"Department of Orthodontics, University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0129-1474","authenticated-orcid":false,"given":"Dieter","family":"Dirksen","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics and Biomaterials, University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhold","family":"Feldmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Sauerland","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University of M\u00fcnster, Schmeddingstra\u00dfe 56, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariane","family":"Hohoff","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, 48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.ejpn.2018.02.010","article-title":"Fetal alcohol spectrum disorders (FASD)\u2014What we know and what we should know\u2014The knowledge of German health professionals and parents","volume":"22","author":"Landgraf","year":"2018","journal-title":"Eur. J. Paediatr. Neurol. EJPN Off. J. Eur. Paediatr. Neurol. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1542\/peds.2014-2171","article-title":"Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure","volume":"135","author":"Chasnoff","year":"2015","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1001\/jama.2017.21896","article-title":"Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities","volume":"319","author":"May","year":"2018","journal-title":"JAMA"},{"key":"ref_4","first-page":"74","article-title":"A Long-Term Perspective of FAS","volume":"18","author":"Streissguth","year":"1994","journal-title":"Alcohol Health Res. World"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/pch\/7.3.139","article-title":"Fetal alcohol spectrum disorder\u2014New diagnostic initiatives","volume":"7","author":"Greenbaum","year":"2002","journal-title":"Paediatr. Child Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1001\/jamapediatrics.2017.0778","article-title":"Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age","volume":"171","author":"Muggli","year":"2017","journal-title":"JAMA Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jamapediatrics.2017.1919","article-title":"Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth: A Systematic Review and Meta-analysis","volume":"171","author":"Lange","year":"2017","journal-title":"JAMA Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1111\/add.14392","article-title":"Underestimation of alcohol consumption in cohort studies and implications for alcohol's contribution to the global burden of disease","volume":"113","author":"Stockwell","year":"2018","journal-title":"Addiction"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1016\/S2214-109X(18)30481-9","article-title":"Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: Prevalence and inequalities in 23 countries","volume":"7","author":"Ewerling","year":"2019","journal-title":"Lancet. Glob. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e290","DOI":"10.1016\/S2214-109X(17)30021-9","article-title":"Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis","volume":"5","author":"Popova","year":"2017","journal-title":"Lancet. Global Health"},{"key":"ref_11","unstructured":"Popova, S., Lange, S., Chudley, A.E., Reynolds, J.N., and Rehm, J. (2019, July 14). World Health Organization International Study on the Prevalence of Fetal Alcohol Spectrum Disorder (FASD). Available online: https:\/\/canfasd.ca\/wp-content\/uploads\/sites\/35\/2018\/05\/2018-Popova-WHO-FASD-Prevalance-Report.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1111\/acer.13032","article-title":"A Comparison Among 5 Methods for the Clinical Diagnosis of Fetal Alcohol Spectrum Disorders","volume":"40","author":"Coles","year":"2016","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_13","unstructured":"Astley, S.J. (2004). Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4- Digit Diagnostic Code., University of Washington Publication Services. [3rd ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/alcalc\/35.4.400","article-title":"Diagnosing the full spectrum of fetal alcohol-exposed individuals: introducing the 4-digit diagnostic code","volume":"35","author":"Astley","year":"2000","journal-title":"Alcohol Alcohol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/alcalc\/36.2.147","article-title":"Measuring the facial phenotype of individuals with prenatal alcohol exposure: Correlations with brain dysfunction","volume":"36","author":"Astley","year":"2001","journal-title":"Alcohol Alcohol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/alcalc\/agy088","article-title":"3D Analysis of Philtrum Depth in Children with Fetal Alcohol Syndrome","volume":"54","author":"Dirksen","year":"2019","journal-title":"Alcohol Alcohol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ejpn.2013.03.008","article-title":"Diagnosis of fetal alcohol syndrome (FAS): German guideline version 2013","volume":"17","author":"Landgraf","year":"2013","journal-title":"Eur. J. Paediatr. Neurol. EJPN Off. J. Eur. Paediatr. Neurol. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1515\/BMT.2007.048","article-title":"Modular optical topometric sensor for 3D acquisition of human body surfaces and long-term monitoring of variations","volume":"52","author":"Bischoff","year":"2007","journal-title":"Biomed. Technik. Biomed. Eng."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"De Berg, M., Cheong, O., Van Kreveld, M., and Overmars, M. (2008). Computational Geometry: Algorithms and Applications, Springer.","DOI":"10.1007\/978-3-540-77974-2"},{"key":"ref_20","first-page":"e231","article-title":"Canadian palpebral fissure length growth charts reflect a good fit for two school and FASD clinic-based U.S. populations","volume":"18","author":"Astley","year":"2011","journal-title":"J. Popul. Ther. Clin. Pharmacol."},{"key":"ref_21","first-page":"e67","article-title":"Normal distribution of palpebral fissure lengths in Canadian school age children","volume":"17","author":"Clarren","year":"2010","journal-title":"Can. J. Clin. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/02844319950159631","article-title":"Reference values of facial features in Scandinavian children measured with a range-camera technique","volume":"33","author":"Stromland","year":"1999","journal-title":"Scand. J. Plast. Reconstr. Surg. Hand. Surg."},{"key":"ref_23","first-page":"476","article-title":"Adolescent growth changes in soft tissue profile","volume":"107","author":"Wattel","year":"1995","journal-title":"Am. J. Orthod. Dentofac. Orthop Off. Publ. Am. Assoc. Orthod. Const. Soc. Am. Board Orthod."},{"key":"ref_24","first-page":"177","article-title":"Growth changes in the soft tissue facial profile","volume":"60","author":"Nanda","year":"1990","journal-title":"Angle Orthod."},{"key":"ref_25","first-page":"56","article-title":"Malocclusion Can Give Additional Hints for Diagnosis of Fetal Alcohol Spectrum Disorder","volume":"54","author":"Flieger","year":"2018","journal-title":"Alcohol Alcohol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S0022-3476(69)80206-4","article-title":"Normal inner canthal and outer orbital dimensions","volume":"74","author":"Laestadius","year":"1969","journal-title":"J. Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/ajhb.10182","article-title":"Role of depth in eye distance measurements: Comparison of single and stereo-photogrammetry","volume":"15","author":"Douglas","year":"2003","journal-title":"Am. J. Hum. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20162028","DOI":"10.1542\/peds.2016-2028","article-title":"Computer-Aided Recognition of Facial Attributes for Fetal Alcohol Spectrum Disorders","volume":"140","author":"Valentine","year":"2017","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e779","DOI":"10.1542\/peds.2012-1371","article-title":"Facial dysmorphism across the fetal alcohol spectrum","volume":"131","author":"Suttie","year":"2013","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1016\/j.jcms.2016.08.008","article-title":"Ev aluation of the accuracy of a mobile and a stationary system for three-dimensional facial scanning","volume":"44","author":"Modabber","year":"2016","journal-title":"J. Cranio-Maxillo-Facial Surg. Off. Publ. Eur. Assoc. Cranio-Maxillo-Facial Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/14\/2535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:06:02Z","timestamp":1760187962000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/14\/2535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,16]]},"references-count":30,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["ijerph16142535"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16142535","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2019,7,16]]}}}