1
|
Vaillant CL, Bruand M, Corre P. Can a Predetermined Grid and Multidisciplinary Consultation Improve the Description of Cleft lip with or Without Cleft Palate? Cleft Palate Craniofac J 2024; 61:1143-1148. [PMID: 36802821 DOI: 10.1177/10556656231156708] [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: 02/23/2023] Open
Abstract
OBJECTIVE Evaluate the two-dimensional (2D) ultrasound (US) grid and multidisciplinary consultation (maxillofacial surgeon-sonographer) during prenatal US imaging to improve the sensitivity of prenatal description for cleft lip (CL) with or without alveolar cleft (CLA) or +/- cleft palate (CLP). DESIGN Retrospective study of children with CL/P in a tertiary children's Hospital. SETTING Single-center cohort study conducted in a tertiary pediatric Hospital. PATIENTS/PARTICIPANTS Fifty-nine cases of prenatally diagnosed CL +/-CA or CP between January 2009 and December 2017 were analyzed. MAIN OUTCOME MEASURES The correlation was analyzed between prenatal US and postnatal data with regard to eight 2D US criteria (upper lip, alveolar ridge, median maxillary bud, homolateral nostril subsidence, deviated nasal septum, hard palate, tongue movement, nasal cushion flux) in order to propose them in a grid, as well as the presence of the maxillofacial surgeon during the US examination. RESULTS Among the 38 cases included, the results were considered satisfied for 87%. Sixty five percent of the US criteria were described when the final diagnosis was correct (5.2 criteria) versus (vs) 45% (3.6 criteria); [OR = 2.28; IC95% (1.10-4.75) P = .022 < 0.05]. This study also highlighted a more in-depth description when the maxillofacial surgeon was present with 68% of 2D US criteria fulfilled (5.4 criteria) vs 47.5% (3.8) when the sonographer was alone [OR = 2.32; IC95% (1.34-4.06) P < .001]. CONCLUSION This US grid with eight criteria has considerably contributed to a more precise prenatal description. In addition, the systematic multidisciplinary consultation seemed to optimize it and lead to better prenatal information on pathology and postnatal surgical techniques.
Collapse
Affiliation(s)
| | - Mariette Bruand
- Department of gynaecology obstetric, CHU Nantes, Nantes cedex, France
| | - Pierre Corre
- Department of stomatology, CHU Nantes, Nantes cedex, France
| |
Collapse
|
2
|
Baeza-Pagador A, Tejero-Martínez A, Salom-Alonso L, Camañes-Gonzalvo S, García-Sanz V, Paredes-Gallardo V. Diagnostic Methods for the Prenatal Detection of Cleft Lip and Palate: A Systematic Review. J Clin Med 2024; 13:2090. [PMID: 38610855 PMCID: PMC11012824 DOI: 10.3390/jcm13072090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. Methods: A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle-Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. Results: A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. Conclusions: The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.
Collapse
Affiliation(s)
- Ana Baeza-Pagador
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Ana Tejero-Martínez
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Lucas Salom-Alonso
- Department of Maxillofacial Surgery, La Fe Hospital, 46026 Valencia, Spain;
| | - Sara Camañes-Gonzalvo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Verónica García-Sanz
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| | - Vanessa Paredes-Gallardo
- Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (A.B.-P.); (A.T.-M.); (S.C.-G.); (V.G.-S.)
| |
Collapse
|
3
|
Zhai J, You S, Liang Z, Yu H, Zhu C, Han L. Diagnostic Potential of Complementation of MRI to Prenatal Ultrasound for Detecting Orofacial Clefts in High-Risk Fetuses: A Network Meta-Analysis. Cleft Palate Craniofac J 2024:10556656241231119. [PMID: 38490217 DOI: 10.1177/10556656241231119] [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: 03/17/2024] Open
Abstract
OBJECTIVE To compare the complementation of magnetic resonance imaging (MRI) to prenatal ultrasound (US) with prenatal US alone in detecting orofacial clefts in high-risk fetuses. DESIGN A network meta-analysis. SETTING Literature retrieval in PubMed, EMBASE, and Cochrane library, and meta-analysis based on STATA 14.0. PATIENTS Fetuses were at high-risk for orofacial clefts. INTERVENTIONS Prenatal US and the complementation of MRI to prenatal US. MAIN OUTCOME MEASURES The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and area under the curve (AUC). RESULTS Thirteen studies involving 776 patients were included. Direct meta-analysis showed that the complementation of MRI to prenatal US did not differ from prenatal US in detecting orofacial clefts if the type of orofacial clefts was not distinguished. Subgroup analysis showed that the specificity of prenatal US for the detection of isolated cleft palate (CP) was lower than that of the complementation of MRI to prenatal US. Furthermore, network meta-analysis consistently suggested a comparable diagnostic value between prenatal US and the complementation of MRI to prenatal US. Moreover, subgroup analysis showed that the specificity of prenatal US was significantly lower than that of complementation of MRI to prenatal US for the detection of isolated CP. CONCLUSIONS MRI is more accurate than ultrasound in detecting cleft palate. Therefore, MRI should be offered if there is a fetus with a possible or ultrasound diagnosis of cleft palate, especially if the evaluation of cleft palate is deemed unsatisfactory after careful evaluation of the images.
Collapse
Affiliation(s)
- Jing Zhai
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Shuyan You
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Zhonghua Liang
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Haihua Yu
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Chengfeng Zhu
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Lu Han
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| |
Collapse
|
4
|
Matthew J, Uus A, De Souza L, Wright R, Fukami-Gartner A, Priego G, Saija C, Deprez M, Collado AE, Hutter J, Story L, Malamateniou C, Rhode K, Hajnal J, Rutherford MA. Craniofacial phenotyping with fetal MRI: a feasibility study of 3D visualisation, segmentation, surface-rendered and physical models. BMC Med Imaging 2024; 24:52. [PMID: 38429666 PMCID: PMC10905839 DOI: 10.1186/s12880-024-01230-7] [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: 12/04/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
This study explores the potential of 3D Slice-to-Volume Registration (SVR) motion-corrected fetal MRI for craniofacial assessment, traditionally used only for fetal brain analysis. In addition, we present the first description of an automated pipeline based on 3D Attention UNet trained for 3D fetal MRI craniofacial segmentation, followed by surface refinement. Results of 3D printing of selected models are also presented.Qualitative analysis of multiplanar volumes, based on the SVR output and surface segmentations outputs, were assessed with computer and printed models, using standardised protocols that we developed for evaluating image quality and visibility of diagnostic craniofacial features. A test set of 25, postnatally confirmed, Trisomy 21 fetal cases (24-36 weeks gestational age), revealed that 3D reconstructed T2 SVR images provided 66-100% visibility of relevant craniofacial and head structures in the SVR output, and 20-100% and 60-90% anatomical visibility was seen for the baseline and refined 3D computer surface model outputs respectively. Furthermore, 12 of 25 cases, 48%, of refined surface models demonstrated good or excellent overall quality with a further 9 cases, 36%, demonstrating moderate quality to include facial, scalp and external ears. Additional 3D printing of 12 physical real-size models (20-36 weeks gestational age) revealed good/excellent overall quality in all cases and distinguishable features between healthy control cases and cases with confirmed anomalies, with only minor manual adjustments required before 3D printing.Despite varying image quality and data heterogeneity, 3D T2w SVR reconstructions and models provided sufficient resolution for the subjective characterisation of subtle craniofacial features. We also contributed a publicly accessible online 3D T2w MRI atlas of the fetal head, validated for accurate representation of normal fetal anatomy.Future research will focus on quantitative analysis, optimizing the pipeline, and exploring diagnostic, counselling, and educational applications in fetal craniofacial assessment.
Collapse
Affiliation(s)
- Jacqueline Matthew
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK.
- Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Alena Uus
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Leah De Souza
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Robert Wright
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Abi Fukami-Gartner
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Gema Priego
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Carlo Saija
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Maria Deprez
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Alexia Egloff Collado
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jana Hutter
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Lisa Story
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Jo Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Mary A Rutherford
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Vardhan H, Verma M. Prenatal management in clefts. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
|
6
|
Garel C, Vande Perre S, Guilbaud L, Soupre V, Blondiaux E, Ducou le Pointe H. Contribution of computed tomography and magnetic resonance imaging in the analysis of fetal craniofacial malformations. Pediatr Radiol 2021; 51:1917-1928. [PMID: 33852025 DOI: 10.1007/s00247-021-05033-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
A wide range of craniofacial malformations can be diagnosed in utero using ultrasonography. However, even with highly experienced sonographers and diagnostic physicians and optimal conditions of examination, some anatomical structures cannot be properly analyzed by this technique. The aim of this pictorial essay is to show the additional value of fetal magnetic resonance imaging and computed tomography in this setting and to illustrate the role of these modalities in facial clefts; craniosynostosis; ear, eye and nose abnormalities; otomandibular dysplasias; and facial cephaloceles.
Collapse
Affiliation(s)
- Catherine Garel
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Saskia Vande Perre
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - Lucie Guilbaud
- Service de Médecine Fœtale, Hôpital d´Enfants Armand-Trousseau APHP, Sorbonne Université, Paris, France
| | - Véronique Soupre
- Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker Enfants-Malades APHP, Paris, France
- Centre de référence Fentes et Malformations Faciales, APHP, Paris, France
| | - Eléonore Blondiaux
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - Hubert Ducou le Pointe
- Service de Radiologie, Hôpital d´Enfants Armand-Trousseau APHP, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| |
Collapse
|
7
|
Davidson JR, Uus A, Matthew J, Egloff AM, Deprez M, Yardley I, De Coppi P, David A, Carmichael J, Rutherford MA. Fetal body MRI and its application to fetal and neonatal treatment: an illustrative review. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:447-458. [PMID: 33721554 PMCID: PMC7614154 DOI: 10.1016/s2352-4642(20)30313-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
Collapse
Affiliation(s)
- Joseph R Davidson
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Alena Uus
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jacqueline Matthew
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia M Egloff
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Maria Deprez
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Iain Yardley
- Paediatric Surgery, Evelina London Children's Hospital, London, UK
| | - Paolo De Coppi
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK; Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anna David
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; Fetal Medicine Unit, University College London, London, UK
| | - Jim Carmichael
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Mary A Rutherford
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| |
Collapse
|
8
|
Sileo FG, Finarelli A, Contu G, Lugli L, Dipace V, Ballarini M, Guidi C, Facchinetti F, Bertucci E. Ultrasound screening for fetal anomalies in a single center: diagnostic performances twenty years after the Eurofetus Study. J Matern Fetal Neonatal Med 2021; 35:6312-6319. [PMID: 33910476 DOI: 10.1080/14767058.2021.1911994] [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: 10/21/2022]
Abstract
PURPOSE To establish the accuracy of ultrasound in detecting fetal anomalies looking at the concordance between prenatal and postnatal diagnosis. MATERIALS AND METHODS Retrospective analysis of concordance between prenatal and postnatal/autoptic diagnosis of fetuses with congenital abnormalities. Data are from a single center (Policlinico di Modena); all fetuses included were born between 2017 and 2018 and with a follow-up of at least 6 months. We included all deliveries (including perinatal deaths) and termination of pregnancy (TOP) for fetal indication. We calculated sensibility, sensitivity, Positive and Negative Likelihood Ratio, positive and negative predictive value of ultrasound. RESULTS During the study period 5920 deliveries, including perinatal deaths, and 28 TOP for fetal indication were registered at our center. The prevalence of congenital malformations was 2.6% (153/5920). At least one ultrasound was performed in our center in 1250 women delivering in our unit. All 28 TOP had the anomaly scan performed in our center. Among the total 1278 women scanned in our unit, there were 128 (10%) suspicious scans. In 5/128 (3.9%) cases we diagnosed a false alarm; in 8/128 (6.2%) cases an evolutive malformation with in-utero regression. The prenatal diagnosis was confirmed in 77 (60.2%) cases at birth and in 28/128 (21.9%) at postmortem analysis while there were 10/128 false positive (7.8%). Among the 153 congenital malformations diagnosed at birth, the anomaly scan was performed in our Prenatal Medicine Unit in 92 (60.1%) fetuses. Among these, there were 15 false negatives (9.8%) while in 77/92 (83.7%) the malformation at birth agreed with the sonographic diagnosis. Sensitivity and specificity of ultrasound were 87.5% (IC95 80.2-92.8%) and 99.1% (IC95 98.4-99.6%) respectively with a Positive Likelihood Ratio and Negative Likelihood Ratio of 101.3 (IC95 54.5-188.5) and 0.13 (IC95 0.08-0.2); Positive Predictive Value and Negative Predictive Value were 91.3% (IC95 85-95.1%) and 98.7(IC95 98-99.2%). CONCLUSION Anomaly scan in pregnancy allows the diagnosis of congenital malformations with a sensibility of 87.5% and specificity of 99.1%. The main limitations of this study are its retrospective design and that it was conducted in a single referral center.
Collapse
Affiliation(s)
- Filomena G Sileo
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Finarelli
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giannina Contu
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatology and Paediatric Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenza Dipace
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Ballarini
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Guidi
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
9
|
Oliver JD, Turner EC, Halpern LR, Jia S, Schneider P, D'Souza RN. Molecular Diagnostics and In Utero Therapeutics for Orofacial Clefts. J Dent Res 2020; 99:1221-1227. [PMID: 32609569 DOI: 10.1177/0022034520936245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Orofacial clefts and their management impose a substantial burden on patients, on their families, and on the health system. Under the current standard of care, affected patients are subjected to a lifelong journey of corrective surgeries and multidisciplinary management to replace bone and soft tissues, as well as restore esthetics and physiologic functions while restoring self-esteem and psychological health. Hence, a better understanding of the dynamic interplay of molecular signaling pathways at critical phases of palate development is necessary to pioneer novel prenatal interventions. Such pathways include transforming growth factor-β (Tgfβ), sonic hedgehog (Shh), wingless-integrated site (Wnt)/β-catenin, bone morphogenetic protein (Bmp), and fibroblast growth factor (Fgf) and its associated receptors, among others. Here, we summarize commonly used surgical methods used to correct cleft defects postnatally. We also review the advances made in prenatal diagnostics of clefts through imaging and genomics and the various in utero surgical corrections that have been attempted thus far. An overview of how key mediators of signaling that drive palatogenesis are emphasized in the context of the framework and rationale for the development and testing of therapeutics in animal model systems and in humans is provided. The pros and cons of in utero therapies that can potentially restore molecular homeostasis needed for the proper growth and fusion of palatal shelves are presented. The theme advanced throughout this review is the need to develop preclinical molecular therapies that could ultimately be translated into human trials that can correct orofacial clefts at earlier stages of development.
Collapse
Affiliation(s)
- J D Oliver
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA.,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - E C Turner
- University of Western Australia Dental School, Perth, Western Australia
| | - L R Halpern
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA
| | - S Jia
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA
| | - P Schneider
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - R N D'Souza
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA.,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA.,University of Utah, Departments of Neurobiology and Anatomy, Pathology, and Surgery, Salt Lake City, UT, USA
| |
Collapse
|