Short Hard Palate in Newborn: Roentgen Sign of Mongolism

Abstract

The hard palate in mongolism is short (2). Studies with measurements, however, have been few and are limited to school-age and adult mongoloids (6, 7). To our knowledge, no series has been reported of short hard palate in the newborn. Because the diagnosis may yet be in need of confirmation at this age (5), we have examined lateral roentgenograms of the skull to determine length of the hard palate in the newborn period as a sign of mongolism. Materials and Methods Records of newborn infants from 1955 through 1967 were reviewed at the University of California Medical Center, San Francisco, and at the Children's Hospital Medical Center, Oakland. These revealed 10 patients with proved mongolism on whom lateral roentgenograms of the skull had been obtained with routine technic during the first month of life. On these roentgenograms the hard palate was readily observed. We have defined its length as extending from the anterior maxillary process to its posterior termination, both clearly defined endpoints (Fig. 1). The palates of 182 newborn controls of known weight were also measured. Roentgenograms on which easily defined palate length could not be measured (approximately 10 per cent of all patients) were discarded. To exclude geometric error from various distances between tube and film, no roentgenograms obtained with portable equipment were included. Results and Discussion The mean length of the hard palate of 182 newborn controls was 31 ± 3 mm (Table I). That of the 10 newborn mongoloids was considerably shorter: 25 ± 3 mm with p < 0.001. Five of the mongoloids were males and 5 were females. No difference in palate length was noted between the two sexes. The control subjects consisted of 106 males and 76 females, also without difference in palate length. The data were not biased by prematurity. Of the 182 controls, 155 (86 per cent) were born at term. The mean length of the hard palate in these was 31 mm. Among the controls were 27 (14 per cent) premature infants whose hard palates measured a mean length of 30 mm. The hard palates of 7 of these 27 (26 per cent), however, measured 28 mm or less. This measurement was within the mongoloid range, a shortening indeed expected from lack of growth. Nonetheless, the slightly lower values for premature births do not alter the control mean of 31 mm which was the same for both the term and the total control groups. About 20 per cent of mongoloids are born prematurely (5); the incidence in our review was the same, 2 of 10. The hard palate in the mongoloids born at term measured a mean length of 25 mm. In the 2 premature mongoloids, it measured 23 and 24 mm, respectively. The slightly lower values for the premature group do not alter the mongoloid mean of 25 mm, which was the same for both the term and the total mongoloid groups. Of the 8 full-term mongoloids, the length of the hard palate in 2 (25 per cent) was at the lower limit of the normal control range (28 mm for each).