> Competency 2: Identification of FASD and Diagnosis of FAS > 5a. Facial Anomalies
Competency 2: Identification of FASD and Diagnosis of FAS
FAS Diagnostic Criteria, Continued
Diagnostic References: Facial Anomalies
The facial anomalies that must be identified to confirm an FAS diagnosis, according
to the CDC2, are:
palpebral fissures (eye openings) (at or below 10th percentile )
philtrum (University of Washington Lip-Philtrum Guide rank 4 or 5)
- Thin vermillion border (top lip) (University of Washington Lip-Philtrum Guide rank
4 or 5)
Additional features that may be seen include epicanthal folds (skin of the upper
eyelid that covers the inner corner of the eye), low nasal bridge, and short nose.
In diagnosing FAS, it is important to consider racial and ethnic background.
Some features, such as epicanthal folds, may be seen in certain ethnic groups, such
The Lip-Philtrum Guide was developed by the Washington State FAS Diagnostic &
Prevention Network to guide medical professionals in diagnosing FAS. Because of
racial and ethnic differences, two guides were developed. One is for Caucasians
and one is for African-Americans. The Guide that best matches the phenotypic profile
of the patient's race should be used. The doctor uses the appropriate guide to rank
the smoothness of the philtrum and the thinness of the upper lip.
Palpebral fissure length, philtrum, and upper lip differ with race and age. Facial
anthropometric data are needed for the specific population, as
specificity of the assessment will be lowered without the use of
appropriate norms. It is also important to consider family traits. For example,
some families might have thin upper lips. In addition, a thin upper lip in one racial
group might be medium in another.