A case of agnathia-otocephaly complex assessed prenatally forex utero intrapartum treatment (EXIT) by three-dimensional ultrasonography

Prenatal Diagnosis of Isolated Agnathia-Otocephaly: A Case Report and Review of the Literature

Agnathia is a rare disease characterized by the absence of a mandible. Few cases of prenatally diagnosed isolated agnathia have been reported. We present a case report and review of the literature of prenatally diagnosed agnathia. A 38-year-old woman (gravida 0, para 0) was referred to our hospital at 28 weeks and 3 days of gestation for fetal evaluation because of polyhydramnios and suspected facial anomalies. Three-dimensional ultrasonography and MRI indicated agnathia. Premature rupture of the membranes occurred before the parents could reach a decision on the postnatal treatment. We performed emergency cesarean section on the second day of the 33rd week of gestation. The neonate was deemed nonresuscitable and he died of airway obstruction shortly after birth. Because agnathia is associated with very poor prognosis, accurate prenatal diagnosis and detailed counseling should be promptly provided before unexpected delivery to the parents for the determination of postnatal treatment.

Severe micrognathia with 21 trisomy assessed prenatally by performing three-dimensional computed tomography

Severe micrognathia can lead to death shortly after birth without a proper resuscitation. However, it is difficult to develop an effective resuscitation strategy without a prenatal diagnosis of the severity of micrognathia. In the present case, we used fetal three-dimensional computed tomography (3D-CT) to assess the severity of micrognathia. Its images clearly demonstrated bony framework of mandible and suggested that mandibular hypoplasia was too severe to allow for oral intubation. We therefore decided that the ex utero intrapartum treatment (EXIT) procedure would be more appropriate to establish the airway at birth. The prenatal 3D-CT is useful to evaluate the mandibular anatomy in utero if the severity of the micrognathia is not confirmed by the ultrasound or magnetic resonance imaging (MRI).

Prenatal diagnosis and molecular genetic studies on a new case of agnathia-otocephaly

Otocephaly is a severe and lethal malformation. We report a new case of a fetus with agnathia-otocephaly, presenting only the facial findings but with otherwise normal organs. The fetal karyotype was normal. We examined the fetal DNA for uniparental disomy of chromosomes 3 and 4, since the mother is a carrier of a t(3;4) chromosome, but did not identify any evidence. We were also unable to find mutations or possible associations with candidate otocephalic genes, including OTX2 and PGAP1. These findings suggest that the molecular etiology of agnathia-otocephaly is still unknown with a mutation yet to be identified in humans.