The first arch syndrome.

Although disfiguring abnormalities of the face have been a problem to the plastic surgeon for many years and the accompanying embarrassment and morbidity have equally exercised the ingenuity of the psychiatrist, there is yet neither satisfactory treatment nor an adequate mask to shield the sufferer. Accordingly, the search for the cause and possible means of prevention has been intensively pursued for many years. From an examination of the clinical features, anatomy and embryology of the following anomalies of the head and neck, it is clear that all arise from abnormal development of the first visceral arch and should be regarded as comprising a 'first arch syndrome': (a) The Treacher Collins syndrome or mandibulofacial dysostosis; (b) Pierre Robin syndrome (hypoplasia of the mandible with glossoptosis); (c) mandibular dysostosis; (d) deformities of the external and middle ear; (e) congenital deafmutism; (f) cleft lip and cleft palate; (g) hypertelorism; (h) a recently described syndrome exhibiting congenital deafness and hypertelorism.