Sir.—Usowicz et al1 described three patients with fetal alcohol syndrome who had upper airway obstruction, presumably predisposed by midfacial (including maxillary) hypoplasia or micrognathia. Documentation of alveolar hypoventilation due to airway compromise by means of arterial blood gas analysis at rest or during sleep was not obtained. The clinical findings implicated choanal stenosis as the immediate cause of obstruction in one infant, obstructive lymphoid tissue in the second, and a laryngeal web in the third.
Readers of the above report should be reminded of another entity in which there is midfacial hypoplasia and which may be complicated by upper airway obstruction, namely, Down's syndrome. Rowland et al2 reported a case of cor pulmonale due to chronic upper airway obstruction in a 5-year-old child with Down's syndrome. Tonsillectomy and adenoidectomy relieved the hypoventilation, with subsequent resolution of pulmonary hypertension. Levine and Simpser3 described four infants with Down's