1
|
Zhong C, Xie Z, Dong H, Chen T, Zhang X, Ran S. Prenatal Diagnosis of Pierre Robin Sequence and Its Prognosis: A Retrospective Cohort Study. Am J Perinatol 2024; 41:e1639-e1646. [PMID: 37068514 DOI: 10.1055/s-0043-1768233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This study aimed to explore the efficiency of ultrasound (US) in prenatal diagnosis and prognosis of Pierre Robin sequence (PRS) of 18 cases. STUDY DESIGN A total of 79,305 women admitted for prenatal US examinations were recruited from January 2017 to December 2020. Eighteen cases of PRS fetuses were selected form the cohort and 40 cases of isolated micrognathia were recruited randomly as control group. All the clinical and imaging results were retrospectively reviewed. General condition, US measurements, and prognosis of fetuses were compared between groups. RESULTS Cleft palate, glossoptosis, and micrognathia were found in all 18 fetuses with PRS by prenatal US. Compared with the isolated micrognathia group, there were no significant differences in the PRS group in examination of maternal age, gestational weeks at assessment, and gender of fetuses, but significant lower measures in inferior facial angle, jaw index, and frontal nasal-mental angle (each p < 0.05). Twelve fetuses were defined to have other associated malformations. Ear malformations were the most common associated malformations with a prevalence of 44.4% (8/18). All of the18 cases were confirmed with PRS after delivery or autopsy. Two delivered infants were found bucking easily, one baby was spitting up frequently but growth showed normal. CONCLUSION Prenatal detection of PRS with US examination is highly efficient. Even with the triad of malformations, isolated PRS had good outcomes following initial stabilization and management in the neonatal period. Prenatal detection of Pierre Robin syndrome with targeted US examination is efficient in discerning characteristics of this rare syndrome. Even with the triad of malformations, isolated PRS had good outcomes following initial stabilization and management in the neonatal period. KEY POINTS · Prenatal diagnosis of fetal PRS is of great clinical importance.. · Micrognathia has been identified as the primary feature of PRS.. · Posterior displacement of the tongue may cause acute neonatal respiratory distress.. · Even with triad malformation, isolated PRS seemed to have good outcomes..
Collapse
Affiliation(s)
- ChunYan Zhong
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhaopeng Xie
- Department of Ultrasound, Chongqing Traditional Chinese Medicine Hospital, Chongqing, People's Republic of China
| | - Hongmei Dong
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ting Chen
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaohang Zhang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - SuZhen Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, People's Republic of China
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| |
Collapse
|
2
|
Wu S, Han J, Duan G, Xue J, Huang R, Wu L, Yan X, Pi H, Yang X. Prenatal Diagnosis of Fetal Micrognathia at 11-20 Weeks of Gestation: A Prospective Observation Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:491-499. [PMID: 38164991 DOI: 10.1002/jum.16379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To prospectively evaluate the prognosis of fetuses diagnosed with micrognathia using prenatal ultrasound screening. METHODS Between January 2019 and December 2022, a normal range of IFA to evaluate the facial profile in fetuses with micrognathia in a Chinese population between 11 and 20 gestational weeks was established, and the pregnancy outcomes of fetal micrognathia were described. The medical records of these pregnancies were collected, including family history, maternal demographics, sonographic findings, genetic testing results, and pregnancy outcomes. RESULTS Ultrasound identified 25 patients with fetal micrognathia, with a mean IFA value of 43.6°. All cases of isolated fetal micrognathia in the initial scans were non-isolated in the following scans. A total of 78.9% (15/19) cases had a genetic cause confirmed, including 12 with chromosomal abnormalities and 3 with monogenic disorders. Monogenic disorders were all known causes of micrognathia, including two cases of campomelic dysplasia affected by SOX9 mutations and one case of mandibulofacial dysostosis with an EFTUD2 mutation. In the end, 19 cases were terminated, 1 live birth was diagnosed as Pierre Robin syndrome, and 5 cases were lost to follow-up. CONCLUSION IFA is a useful indicator and three-dimensional ultrasound is a significant support technique for fetal micrognathia prenatal diagnosis. Repeat ultrasound monitoring and genetic testing are crucial, with CMA recommended and Whole exome sequencing performed when normal arrays are reported. Isolated fetal micrognathia may be an early manifestation of monogenic disorders.
Collapse
Affiliation(s)
- Siqi Wu
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Jin Han
- Department of Prenatal Diagnosis, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Guanhua Duan
- Department of Ultrasonics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Jiaxin Xue
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Ruchun Huang
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Liping Wu
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Xiuyan Yan
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Huichun Pi
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Xin Yang
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| |
Collapse
|
3
|
Liao M, Wang L, Shang N, Hu X, He B, Liu X, Xiang G, Zhong W. Ultrasound measurements of fetal facial profile markers and their associations with congenital malformations during early pregnancy. BMC Pregnancy Childbirth 2023; 23:772. [PMID: 37925422 PMCID: PMC10625258 DOI: 10.1186/s12884-023-06067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Fetal facial profile could be measured during the early pregnancy. Its abnormalities might be associated with certain congenital malformations. We aimed to study the associations between fetal facial profile measurements with crown-rump length and congenital malformations (cleft lip and palate, micrognathia, and open spina bifida) during early pregnancy. METHODS We performed a prospective cross-sectional study between June 2019 and April 2022. Pregnant women at a gestational age between 11-13+ 6 weeks were enrolled. Two sonographers performed fetal facial profile measurements independently. The associations between these measurements with crown-rump length and congenital malformations were evaluated. RESULTS There were 406 and 25 fetuses without or with congenital malformations, respectively. Two sonographers showed satisfactory inter- and intra-observer agreements and reproducibility. The maxillary gap was only observed in 7.6% of normal fetuses, whereas all cleft lip and palate fetuses had a maxillary gap ≥ 0.8 mm. The crown-rump length was negatively correlated with frontomaxillary facial angle, inferior facial angle, and profile line distance but positively correlated with maxilla-nasion-mandible angle, facial maxillary angle, frontal space distance, and palatine maxillary diameter. These measurements showed various significant changes with different congenital malformations. CONCLUSIONS Measurements of fetal facial profile in early pregnancy were feasible with satisfactory reproducibility. These measurements correlated with crown-rump length and showed significant differences with certain fetal congenital malformations.
Collapse
Affiliation(s)
- Minyan Liao
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Limin Wang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Ning Shang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China.
| | - Xueyi Hu
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Bingjia He
- Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Xiangjiao Liu
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Guanghua Xiang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Wei Zhong
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| |
Collapse
|
4
|
Ji C, Liu K, Yang X, Cao Y, Cao X, Pan Q, Yang Z, Sun L, Yin L, Deng X, Ni D. A novel artificial intelligence model for fetal facial profile marker measurement during the first trimester. BMC Pregnancy Childbirth 2023; 23:718. [PMID: 37817098 PMCID: PMC10563312 DOI: 10.1186/s12884-023-06046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND To study the validity of an artificial intelligence (AI) model for measuring fetal facial profile markers, and to evaluate the clinical value of the AI model for identifying fetal abnormalities during the first trimester. METHODS This retrospective study used two-dimensional mid-sagittal fetal profile images taken during singleton pregnancies at 11-13+ 6 weeks of gestation. We measured the facial profile markers, including inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial-maxillary angle (FMA), frontal space (FS) distance, and profile line (PL) distance using AI and manual measurements. Semantic segmentation and landmark localization were used to develop an AI model to measure the selected markers and evaluate the diagnostic value for fetal abnormalities. The consistency between AI and manual measurements was compared using intraclass correlation coefficients (ICC). The diagnostic value of facial markers measured using the AI model during fetal abnormality screening was evaluated using receiver operating characteristic (ROC) curves. RESULTS A total of 2372 normal fetuses and 37 with abnormalities were observed, including 18 with trisomy 21, 7 with trisomy 18, and 12 with CLP. Among them, 1872 normal fetuses were used for AI model training and validation, and the remaining 500 normal fetuses and all fetuses with abnormalities were used for clinical testing. The ICCs (95%CI) of the IFA, MNM angle, FMA, FS distance, and PL distance between the AI and manual measurement for the 500 normal fetuses were 0.812 (0.780-0.840), 0.760 (0.720-0.795), 0.766 (0.727-0.800), 0.807 (0.775-0.836), and 0.798 (0.764-0.828), respectively. IFA clinically significantly identified trisomy 21 and trisomy 18, with areas under the ROC curve (AUC) of 0.686 (95%CI, 0.585-0.788) and 0.729 (95%CI, 0.621-0.837), respectively. FMA effectively predicted trisomy 18, with an AUC of 0.904 (95%CI, 0.842-0.966). MNM angle and FS distance exhibited good predictive value in CLP, with AUCs of 0.738 (95%CI, 0.573-0.902) and 0.677 (95%CI, 0.494-0.859), respectively. CONCLUSIONS The consistency of fetal facial profile marker measurements between the AI and manual measurement was good during the first trimester. The AI model is a convenient and effective tool for the early screen for fetal trisomy 21, trisomy 18, and CLP, which can be generalized to first-trimester scanning (FTS).
Collapse
Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Kai Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
| | - Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
| | - Yan Cao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
- Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Xiaoju Cao
- Center for Reproduction and Genetics, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lingling Sun
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China.
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China.
| |
Collapse
|
5
|
Wiechers C, Poets C, Hoopmann M, Kagan KO. Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:299-306. [PMID: 34852370 DOI: 10.1055/a-1659-2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. METHODS This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. RESULTS 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. CONCLUSION PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.
Collapse
Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Poets
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
6
|
Bruce MK, Islam R, Anstadt EE, Kenkre TS, Pfaff MJ, Canavan T, Goldstein JA. Mandibular Measurements at the 20-Week Anatomy Ultrasound as a Prenatal Diagnostic Predictor of Pierre Robin Sequence. Cleft Palate Craniofac J 2023; 60:352-358. [PMID: 34860601 DOI: 10.1177/10556656211064771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and upper airway obstruction. Early recognition and appropriate perinatal management is crucial for optimizing outcomes. This study aimed to evaluate 20-week fetal ultrasounds to determine if specific mandibular measurements could predict PRS diagnosis and disease severity. METHODS A retrospective case-control study of 48 patients with PRS and gender-matched controls was performed. Medical records were reviewed for respiratory and surgical interventions. Three parameters to assess micrognathia were measured on mid-sagittal profile ultrasound images: frontal nasal-mental angle (FNMA), facial-maxillary angle (FMA), and alveolar overjet. Student's t-test and univariate logistic regression was performed. P ≤ 0.05 was considered statistically significant. RESULTS Patients with PRS demonstrated a significantly smaller mean FNMA compared to the control group, 129.3 ± 8.6° and 137.4 ± 3.2°, respectively (p < 0.0001), as well as significantly smaller mean FMA, 63.2 ± 9.2° and 74.8 ± 6.1°, respectively (p < 0.0001). The PRS group also demonstrated significantly larger mean alveolar overjet compared to the control group, 3.9 ± 1.4 mm and 2.1 ± 0.9 mm, respectively (p < 0.0001). The odds of respiratory intervention increased among cases when FMA was <68°. Additionally, there was a significant difference in median overjet between patients with PRS who did and did not require respiratory intervention. CONCLUSIONS Mandibular features on the 20-week ultrasound can be measured to predict diagnosis and severity of PRS. This is an important first step to prepare for potential respiratory intervention at delivery to minimize perinatal hypoxia. Alveolar overjet, previously not described in prenatal ultrasound literature, is measurable and has utility in prenatal screening for PRS, as do FMA and FNMA.
Collapse
Affiliation(s)
| | - Raeesa Islam
- 12317University of Pittsburgh School of Medicine
| | | | - Tanya S Kenkre
- Epidemiology Data Center, 171673University of Pittsburgh Graduate School of Public Health
| | | | | | | |
Collapse
|
7
|
Cang Z, Cui J, Pei J, Wang Z, Du Y, Mu S, Dou W, Fan X, Zhang X, Li Y. Prenatal diagnosis of micrognathia: a systematic review. Front Pediatr 2023; 11:1161421. [PMID: 37124181 PMCID: PMC10130438 DOI: 10.3389/fped.2023.1161421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose This systematic review aimed to analyze the characteristics of different diagnostic techniques for micrognathia, summarize the consistent diagnostic criteria of each technique, and provide a simple and convenient prenatal diagnosis strategy for micrognathia. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search was undertaken in three international databases (PubMed, Scopus, and Web of Science). The three reviewers assessed all papers and extracted the following variables: author's name and year of publication, country, study design, number of participants, gestational age, equipment for prenatal examination, biometric parameters related to micrognathia, main results. Results A total of 25 articles included in the analysis. Nineteen articles described cross-sectional studies (76 percent), 4 (16 percent) were case-control studies, and 2 (8 percent) were cohort studies. Fifteen studies (60 percent) had a prospective design, 9 (36 percent) had a retrospective design, and one (4 percent) had both prospective and retrospective design. Thirty-two percent of the studies (n = 8) were performed in USA, and the remaining studies were performed in China (n = 4), Israel (n = 3), Netherlands (n = 3), UK (n = 1), France (n = 1), Italy (n = 1), Belgium(n = 1), Germany (n = 1), Spain (n = 1), and Austria (n = 1). The prenatal diagnosis of micrognathia can be performed as early as possible in the first trimester, while the second and third trimester of pregnancy were the main prenatal diagnosis period. The articles that were included in the qualitative synthesis describe 30 biometric parameters related to the mandible. Conclusion Of the 30 biometric parameters related to the mandible, 15 can obtain the simple and convenient diagnostic criteria or warning value for micrognathia. Based on these diagnostic criteria or warning value, clinicians can quickly make a preliminary judgment on facial deformities, to carry out cytologic examination to further clarify the diagnosis of micrognathia.
Collapse
Affiliation(s)
- Zhengqiang Cang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jiangbo Cui
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jiaomiao Pei
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zheng Wang
- Department of Ultrasound Diagnosis, Qinhuang Hospital, Xi’an, China
| | - Yichen Du
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Siqi Mu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Wenjie Dou
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Correspondence: Xing Fan Xi Zhang Yang Li
| | - Xi Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Correspondence: Xing Fan Xi Zhang Yang Li
| | - Yang Li
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- Correspondence: Xing Fan Xi Zhang Yang Li
| |
Collapse
|
8
|
Zhou X, Ji C, Sun L, Yin L, Deng X, Pan Q, Zhang J, Yang Z, Zheng C, Ling C, Shi L, Wu Y. Clinical value of fetal facial profile markers during the first trimester. BMC Pregnancy Childbirth 2022; 22:738. [PMID: 36184592 PMCID: PMC9526988 DOI: 10.1186/s12884-022-05028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives To study the correlations between facial profile markers and crown-lump length (CRL) in a Chinese population, and to evaluate the clinical value of these markers for abnormal fetuses during the first trimester (11 to 13+6 gestational weeks). Methods The facial profile markers were as followings: inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA), frontal space (FS) distance and profile line (PL) distance. These markers were measured in facial mid-sagittal section through ViewPoint 6 software. The diagnostic value of these markers for abnormal fetuses was assessed by receiver operating characteristic (ROC) curves. Results According to the first-trimester scanning (FTS) and follow-up, 31 fetuses were enrolled in the abnormal group, including 14 cases of trisomy 21, 7 cases of trisomy 18, 10 cases with cleft lip and palate (CLP), and 1000 normal fetuses were selected. Among the normal fetuses, the IFA, FS distance and PL distance had negative correlations with CRL. The MNM angle and FMA had positive correlations with CRL. The mean IFA values for fetuses with trisomy 21 and trisomy 18 were 74.11° (standard deviation (SD) 7.48) and 69.88° (SD 7.08), respectively, which were significantly smaller than the normal fetuses (p = 0.013; p = 0.003). The mean MNM angle of fetuses with trisomy 18 and CLP were 6.98° (SD 2.61) and 9.41° (SD 2.57), respectively, which were significantly greater than the normal fetuses (p = 0.005; p < 0.001). The mean FMA values of trisomy 18 fetuses were 63.95° (SD 4.77), which was significantly smaller than the normal fetuses (p < 0.001). The mean FS distance of CLP fetuses was -0.22 mm (SD 1.38), which was significantly smaller than the normal fetuses (p < 0.001). The mean PL distance of trisomy 21, trisomy 18 and CLP fetuses were 2.89 mm (SD 0.41), 2.91 mm (SD 0.56) and 2.71 mm (SD 0.37), respectively. The difference with the normal fetuses had no statistical significance (p = 0.56; p = 0.607; p = 0.54). Conclusions Fetal facial profile markers had excellent correlations with CRL during the first trimester. IFA had certain clinical significance in detecting trisomy 21. FMA, IFA and MNM angle were reliable indicators for screening trisomy 18. The abnormal MNM angle and FS distance could be used as sensitive indicators for CLP. However, PL distance was not the best markers for trisomy 21, trisomy 18 and CLP. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05028-9.
Collapse
Affiliation(s)
- Xiaofeng Zhou
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
| | - Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Lingling Sun
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China.
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Chenhan Zheng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Chen Ling
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Liping Shi
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
| | - Yanqing Wu
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
| |
Collapse
|
9
|
Booncharoen P, Sawaddisan R, Suwanrath C, Geater A. Reference ranges of fetal mandible measurements: Inferior facial angle, jaw index, mandible width/maxilla width ratio and mandible length in Thai fetuses at 15 to 23 weeks of gestation. PLoS One 2022; 17:e0269095. [PMID: 35648768 PMCID: PMC9159587 DOI: 10.1371/journal.pone.0269095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives To determine the normal distribution of 1) inferior facial angles (IFA), 2) jaw index, 3) mandible width/maxilla width ratio (MD/MX ratio), and 4) mandible length (ML) in second trimester Thai fetuses. Methods A prospective study was performed between April 1 and October 31, 2020, at the Maternal-Fetal Medicine Unit of Songklanagarind Hospital. Transabdominal ultrasonography was performed on Thai singleton pregnant women at 150/7 to 236/7 weeks of gestation to measure IFA, jaw index, MD/MX ratio and ML. All women received standard antenatal care and were followed up until delivery. The exclusion criteria were multifetal gestation, congenital anomaly, chromosomal abnormality, fetal growth restriction, abnormal amniotic fluid volume, suspected abnormality of fetal mandible, maxilla or jaws based on the proposed criteria from previous studies and suspected neonatal structural or genetic abnormalities postnatally. Quantile regression was used to estimate changes in the median, 5th and 95th percentiles of each parameter across gestational ages and to generate formulas for predicting the 5th percentile value for each parameter. Results The results of 291 women were analyzed. Scatter plots and reference ranges of each parameter were generated. IFA, jaw index and ML values significantly increased, while the MD/MX ratio value significantly decreased, with increasing gestational age. The formulas calculated for predicting the 5th percentile value for each parameter were IFA = 55.12 + 0.045*(GA in days—136) jaw index = 37.272 + 0.01693*(GA in days—136) MD/MX ratio = exp(0.027–0.00110*(GA in days—136)) ML = 20.83 + 0.243*(GA in days—136). Conclusions The reference ranges and formulas to calculate the 5th percentile values of mandible parameters in Thai fetuses were developed. Trial registration This study has been reviewed and approved by the Thai Clinical Trials Registry with identification number TCTR20210602003.
Collapse
Affiliation(s)
- Pichaya Booncharoen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rapphon Sawaddisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- * E-mail:
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
10
|
Geerts L, Meyer R, Nolan H, Nel L, Nel DG, Brink L, Odendaal H. Reference standards for facial measurements in early third trimester South African fetuses, and the effect of maternal and fetal characteristics. J Matern Fetal Neonatal Med 2022; 35:8434-8442. [PMID: 35042446 DOI: 10.1080/14767058.2021.1977794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fetal alcohol spectrum disorder (FASD) is a major problem worldwide and dysmorphic facial features may be a prenatal biomarker for FASD. Deviations from normal facial development cannot be explored before establishing the normal variation in a specific population, since ethnic differences may exist.Objectives: Main objective: to establish reference standards for 23 facial measurements on 3D ultrasound volumes obtained between days 196 and 224 of gestation in healthy unexposed South African fetuses from an area with historically high alcohol consumption prevalence and a population group with no existing normative values. Secondary objective: to assess the confounding effect of maternal and fetal characteristics.Design: This study involves 97 women (including 43 smokers) who had been enrolled in the Safe Passage Study (SPS), a large prospective multinational cohort study assessing the effects of prenatal alcohol exposure. They had adequate 3 D ultrasound volumes of the fetal face acquired at 28+0-31+6 weeks in singleton pregnancies without comorbidities, congenital abnormalities or exposure to alcohol, marijuana, or methamphetamines from 4 weeks before conception.Participants, materials, setting, methods: The participants were recruited from two residential areas of low socioeconomic status in Cape Town. Meticulous information was collected on maternal and pregnancy characteristics, including alcohol use at different time points. Gestational age (GA) was based on ultrasound biometry before 24 weeks, and 3D ultrasound volumes were acquired trans-abdominally from a sagittal and axial plane of the fetal face. Volumes were independently assessed offline by two observers and the image with the best landmark definition was used for 23 facial measurements, representing features previously described in children with FASD. The relation to the exact GA was assessed by regression analysis, the expected mean value and standard error of the estimate (SEE) was determined to transform all raw measurements into z-scores, and the effect of possible confounders on z-scores was assessed by ANOVA.Results: Ten variables changed significantly with advancing GA (extraocular diameter, anteroposterior, medio-lateral and supero-inferior ocular diameter, ocular volume, interlens distance, prenasal thickness, nasal bone length, nose length and nose protrusion) and thirteen did not (interocular distance; interocular: extraocular diameter ratio, prenasal thickness: nasal bone length ratio, pronasal-subnasal distance, subnasal-mouth distance, philtrum length, upper vermillion thickness, nose-philtrum angle, maxillary angle, facial height, facial protrusion, frontomaxillary facial angle and maxilla-nasion-mandible angle). Reference values (expected mean and SEE) for the 23 measurements were established for each day.The z-scores of all facial measurements were not independently affected by maternal age, parity, gravidity, smoking or body mass index, but infant sex and birthweight z-score significantly influenced several z-scores (infant sex for extraocular, medio-lateral, and supero-inferior ocular diameter, ocular volume, prenasal thickness and nose protrusion; birthweight z-score for extraocular diameter, interocular and interlens distance, nose protrusion and maxillary angle).Limitations: GA was not always confirmed by first trimester ultrasound and some measurements could not be obtained in all cases due to suboptimal image quality. The cohort included few heavy smokers so an effect of heavy or continued smoking cannot be ruled out, and the effect of ethnicity was not assessed.Conclusions: These are the first local reference standards for fetal facial measurements and, to our knowledge, the first reference standards for the supero-inferior ocular diameter, face protrusion, upper vermillion thickness, maxillary angle, and nose-philtrum angle. They were broadly in keeping with published references, with small discrepancies explained by minor differences in technique. Even in this narrow GA window, the distribution of many variables changed over time and normal variation was significantly influenced by fetal sex and birthweight z-score. The possible confounding effect of these factors needs to be considered when assessing the impact of harmful exposures like alcohol on facial development.
Collapse
Affiliation(s)
- Lut Geerts
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Rosemary Meyer
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Heidi Nolan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Lynel Nel
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Daniel Gerhardus Nel
- Department of Statistics and Actuarial Science, Centre for Statistical Consultation, University of Stellenbosch, Parow, South Africa
| | - Lucy Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| | - Hein Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow, South Africa
| |
Collapse
|
11
|
Liu X, Sun W, Wang J, Chu G, He R, Zhang B, Zhao Y. Prenatal diagnosis of auriculocondylar syndrome with a novel missense variant of GNAI3: a case report. BMC Pregnancy Childbirth 2021; 21:780. [PMID: 34789173 PMCID: PMC8597305 DOI: 10.1186/s12884-021-04238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Auriculocondylar syndrome (ACS) is a rare disorder characterized by micrognathia, mandibular condyle hypoplasia, and auricular abnormalities. Only 6 pathogenic variants of GNAI3 have been identified associated with ACS so far. Here, we report a case of prenatal genetic diagnosis of ACS carrying a novel GNAI3 variant. CASE PRESENTATION A woman with 30 weeks of gestation was referred to genetic counseling for polyhydramnios and fetal craniofacial anomaly. Severe micrognathia and mandibular hypoplasia were identified on ultrasonography. The mandibular length was 2.4 cm, which was markedly smaller than the 95th percentile. The ears were low-set with no cleft or notching between the lobe and helix. The face was round with prominent cheeks. Whole-exome sequencing identified a novel de novo missense variant of c.140G > A in the GNAI3 gene. This mutation caused an amino acid substitution of p.Ser47Asn in the highly conserved G1 motif, which was predicted to impair the guanine nucleotide-binding function. All ACS cases with GNAI3 mutations were literature reviewed, revealing female-dominated severe cases and right-side-prone deformities. CONCLUSION Severe micrognathia and mandibular hypoplasia accompanied by polyhydramnios are prenatal indicators of ACS. We expanded the mutation spectrum of GNAI3 and summarized clinical features to promote awareness of ACS.
Collapse
Affiliation(s)
- Xiaoliang Liu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Ultrasonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoming Chu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rong He
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bijun Zhang
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanyan Zhao
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
12
|
Suwanrath C, Sawaddisan R, Booncharoen P. Reliability of measurements of facial profile parameters by operators with different levels of experience at 15 to 23 weeks of gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:315-321. [PMID: 33314194 DOI: 10.1002/jcu.22965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare the reliability of measurements of five fetal facial profile parameters by operators with different levels of experience, at 15 to 23 weeks of gestation in Thai fetuses. METHODS An observational study was conducted. The inferior facial angle, anteroposterior mandibular diameter, mandible width, maxilla width, and mandible length were measured in 123 normal fetuses, using 2D ultrasonography, by three operators with different levels of experience. Each participant was examined by two operators. Each operator performed three independent measurements for each parameter and was blinded to the results of the other. Reliability of measurement was evaluated using intraclass correlation coefficient. Bland-Altman analysis was used to evaluate agreement. RESULTS The ability to obtain a mandible length measurement was highest (100%) among the five parameters. Intraobserver variabilities of anteroposterior mandibular diameter, mandible width, maxilla width, and mandible length measurements were excellent for all operators (ICC 0.958-0.986), while those of inferior facial angle measurements were moderate to excellent (ICC 0.560-0.923), depending on the operators' experience. Interobserver variabilities varied between pairs of operators; only two parameters, anteroposterior mandibular diameter and mandible length, showed excellent interobserver variabilities (ICC >0.9), with good agreement. CONCLUSIONS The mandible length measurement was the best parameter in terms of feasibility and reliability.
Collapse
Affiliation(s)
- Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rapphon Sawaddisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pichaya Booncharoen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
13
|
Ji C, Jiang X, Yin L, Deng X, Yang Z, Pan Q, Zhang J, Liang Q. Ultrasonographic study of fetal facial profile markers during the first trimester. BMC Pregnancy Childbirth 2021; 21:324. [PMID: 33894762 PMCID: PMC8070329 DOI: 10.1186/s12884-021-03813-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/20/2021] [Indexed: 01/20/2023] Open
Abstract
Background To establish reference ranges of fetal facial profile markers and study their correlations with crown-rump length (CRL) during the first trimester (11 ~ 13+ 6 weeks’ gestation) in a Chinese population. Methods Ultrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal fetuses whose parents were both Chinese. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers. Results Three hundred and eighty fetuses were selected. The ICCs (95 % CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886 ~ 0.973), 0.804 (0.629 ~ 0.902), 0.834 (0.68 ~ 0.918) and 0.935 (0.868 ~ 0.969), respectively. The ICCs (95 % CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857 ~ 0.967), 0.809 (0.637 ~ 0.904), 0.786 (0.600 ~ 0.892) and 0.906 (0.813 ~ 0.954), respectively. The ICCs (95 % CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663 ~ 0.953), 0.829 (0.672 ~ 0.915), 0.77 (0.511 ~ 0.891) and 0.844 (0.68 ~ 0.925), respectively. The average ± SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL. Conclusions It was feasible to measure fetal facial markers during the first trimester. In Chinese population, the reference ranges of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively, and the measurements were found to correlate with CRL.
Collapse
Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Xiaoli Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China.
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| | - Qing Liang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, 215002, Suzhou, Jiangsu, China
| |
Collapse
|
14
|
Das P, Lacey M, Guillaume DJ. Modification of the Fetal Profile Line to Measure Reversal of Forehead Slope after Early Repair of Frontoethmoidal Encephalocele. J Neurol Surg B Skull Base 2020; 82:e300-e305. [PMID: 34306953 DOI: 10.1055/s-0039-3401998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022] Open
Abstract
Objective Congenital frontoethmoidal encephaloceles are associated with a shallow sloping forehead. We (1) sought to determine if early repair reverses abnormal forehead slope, and (2) assessed a modification of the fetal profile (FP) line to assess results. Design Study of two cases. Participants Newborns with frontoethmoidal encephaloceles repaired prior to the age of 4 months with cranial base bone grafting. Main Outcome Measures Forehead slope was assessed using a modification of the FP line, defined as the line that passes through the anterior border of the mandible and nasion, on pre and postoperative magnetic resonance imaging (MRI) in the midsagittal plane. A modified FP (mFP) line anterior to the forehead was " - ", while a posterior (normal) mFP line was " + ." The largest distance from the mFP line to the forehead was measured. Results Both infants underwent bifrontal craniotomy, excision of encephalocele, and repair of cribriform plate defect using full-thickness autologous parietal bone before the age of 4 months. Preoperatively, the mFP line was -20.6 mm in case 1, and -9.8 mm in case 2. In both cases, follow-up MRI showed excellent reversal of forehead slope and normal calvarium development. The mFP line improved to +7.4 (age = 16 months) in case 1, and +7.6 (age = 11 months) in case 2. The parietal bone donor site ossified completely within 3 months in both cases. Conclusion Early repair with bone grafting can promote normal frontal bone development and improve forehead slope. The mFP line is a useful method to measure degree of forehead slope.
Collapse
Affiliation(s)
- Paramita Das
- University of Chicago, School of Medicine, Chicago, Illinois, United States
| | - Martin Lacey
- Department of Plastic Surgery, Health Partners Specialty Center, St. Paul, Minnesota, United States
| | - Daniel J Guillaume
- Department of Neurological Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States
| |
Collapse
|