Rubinstein-Taybi syndrome: the changing face.

Rubinstein-Taybi syndrome is a rare multiple congenital anomaly (MCA) syndrome comprising mental and growth retardation, broad thumbs and big toes, and unusual face. The classical appearance is easy to recognize. It includes downslant of the palpebral fissures, epicanthal folds, ptosis, strabismus, highly arched palate, and apparently low-set angulated ears with thickened helices. The nose has a beaked appearance, broad fleshy bridge, deviated septum that is long, protruding below the level of the nasal alae with an associated short columella. Since the typical facial phenotype may not be obvious until late childhood, I have evaluated more than 40 cases of Rubinstein-Taybi syndrome, seen at varying ages from the newborn period through infancy, childhood, and adulthood, in order to learn more about the early facial appearance.